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Bgn Ilmu Penyakit Syaraf Fakultas Kedokteran Universitas Andalas
Pendahuluan
Dokter dalam pekerjaannya se-hari2 dihadapkan pd perubahan yg cepat dalam perkembangan informasi terutama yg relevan dgn masaalah medis (evidence based) dan informasi tersebut sangat bermanfaat untuk meningkatkan kualitas perawatan pasien.
Dokter memerlukan informasi yg terbaru dan juga memerlukan keterampilan baru (learn new skills) Undergraduate medical education, have to master: * current information * techniques * prepare for life long learning
Research evidence
Definisi:
Proses penelitian dan penggunaan informasi yg disajikan dalam literatur untuk memperbaiki perawatan pasien.
Prosesnya melibatkan:
* Dokter terlatih (mengubah kekurangan pengetahuan (knowledge deficit) ---- > menjadi pertanyaan klinik yg spesifik. * Meneliti (meng-evaluasi) bahan kepustaka an yg berhubungan dengan pertanyaan klinis,
EBM adalah pendekatan terhadap keputusan klinik atau problem solving <------- dengan menggunakan sumber informasi Future of medicine ---- > patient care should be Evidenced Based. Practising EBM require skills (efficient and effective literature searching), critical appraisal and the application of this finding to the clinical problem.
To formulate questions that are both patientbased and learner-centered (difficult). Well constructed clinical questions helps to direct the search for evidence and for precise answers.
4. outcomes
EBM
Telah memperlihatkan pergeseran dalam
pengambilan keputusan medis Secara dramatis telah memperbaiki kualitas dan mampu meningkatkan perawatan pasien.
For example;
Patients with acute otitis media does antibiotica therapy lead to faster resolution of symptoms compared with no intervention ?. Mr X, aged 31 years, with chronic low back pain, ask to be referred to a chiropractor
Students must be aware of the hierarchy of evidence that forms an important principle in EBM.
Critically appraising the evidence. Once the best evidence has been found, next step is to appraise it critically for its validity and usefulness. Mastery a fundamental knowledge of research methodology (basis for critical appraisal of the literature) Software to help construct critical apprasial is available at the website (CAT maker at the Center of EBM).
Mastery a fundamental knowledge of research methodology (basis for critical appraisal of the literature)
Contoh: Seorang pasien wanita 46 thn dgn kolitis ulseratif selama 17 thn, mengenai kolon secara ekstensive dgn gejala yg cukup hebat. Saat ini kolitisnya kambuh, ia tdk mau dioperasi tetapi sadar akan resiko kanker yg ia dengar dan baca dari newsletter. Suaminya tlh meyakinkannya akan resiko yg akan terjadi.
P = 46 yr old women I = Long standing ulcerative colitis, now in remision C = Patients without P = 46 ys old women with long standing ulcerative colitis, now in remision. I = Mesalamine
ulcerative colitis
O = Prevention / control of colon cancer
C = Standard therapy.
O = Prevention of relaps