Ubufakazi ezisekelwe imithi. Centre for Medicine Olusekelwe Ebufakazini. Izimiso emithi ubufakazi-based

EBM limelela elilungile ukuhlanganiswa agumenti isayensi kanye nesipiliyoni emitholampilo abanezidingo lesiguli. Ukusetshenziswa enemininingwane futhi okunengqondo impumelelo umhlabeleli zanamuhla inqubo izinqumo ekwelapheni iziguli. Isebenzisa kuphela labo agumenti okuyinto zihlobene Izibuyekezo ehlelekile. imithi Ubufakazi yematheksthi emtholampilo ucwaningo olufanele, ikhumbula izithakazelo isiguli. Umphumela ubufakazi kukhona nokwethenjelwa ukunemba uphethwe ukuhlolwa kanye ukuhlolwa, ukubaluleka izibikezelo ukusebenza, ukusebenza kahle kanye nokuphepha yokwelapha, ukuvuselelwa kanye nokuvinjelwa.

Indaba

Ngo-1940, i-olwenziwa (ukusatshalaliswa okungahleliwe) kuqala study ukusetshenziswa kwezimali "streptomycin" ekwelapheni isifo sofuba ziye kwenziwe. Ngo-1962, iKomiti US, okuyinto ukulawula izinga kwemikhiqizo yasekhemisi kanye nemikhiqizo ukudla ziye wethula imithetho okuhloswe ngaso ukuhlola izinhlobo ezintsha izidakamizwa. yiminyaka emakhulu asithoba ngemva kwalokhu Uchwepheshe wezifo eziwumshayabhuqe Archi Kokran mooted ngokuntuleka ubufakazi besayensi. Ngemva kweminyaka emithathu thina wathola phakathi kwe theory kanye umkhuba. Ngasekupheleni kwawo-80 sika - zakuqala 90 sika kwagxilwa isidingo Izibuyekezo ehlelekile imfundo emitholampilo. Ngokokuqala ngqá igama elithi "imithi ubufakazi-based" kwahlongozwa ngo-1988 ngu-epidemiologists futhi odokotela abaye basebenza ngesikhathi Canadian McMaster University. Archi Kokran wanikeza incazelo kanjani ukwethula ucwaningo Ochwepheshe. Ngaphezu kwalokho, kwaba nomthelela yokuthi imiphumela yawo kwakuyilawa umbandela wokuthola ingxoxo kanye nokuhlaziywa olunembile. Cochran nozakwabo, abangamalungu e-British Medical Research Council, imizamo ngokuhlanganyela baye benza imizamo emikhulu ukuze ukuthuthukiswa wokuphila emkhakheni wamuva wezokwelapha okuncike ebufakazini. Nguye 1979 weza umqondo wokuthi isayensi akusiyo okutholakele ngokwanele abagxeka olwenziwa nokulingwa elawulwa. Cochran yasungulwa Centre lokuqala Medicine Olusekelwe Ebufakazini, okuyinto ezibizwa ngegama lakhe. Waqala ukusebenza e Oxford engu-10 edlule. Kukhona okwamanje 15 izikhungo ezifana emhlabeni wonke. Liqondisa umsebenzi iqembu lomhlaba wonke abacwaningi.

izigaba

Zikhona amazinga ezinhlanu imithi ubufakazi-based:

1. Buza umbuzo lapho kukhona kungenzeka ukuba uthole impendulo.
2. Thola yokuqinisekisa engcono.
3. Aphinde acubungule ngokuhlolisisa idatha.
4. Cabangela ubufakazi based ubuchwepheshe emitholampilo izithakazelo lesiguli.
5. Hlaziya indlela ukusetshenziswa kobuchwepheshe asekelayo ingenzeka.

Izimiso emithi ubufakazi-based. Ukuthola ubufakazi engcono

Ochwepheshe ufune ubufakazi, ngokusekelwe angukhiye: nesineke, kokungenela, ukuqhathanisa, imiPhumela yokuFunda kumiphumela yokuhlaziya. Okokuqala, udinga uqhubekele Izibuyekezo ehlelekile futhi olwenziwa nokulingwa elawulwa ngoba kukhona eziqinile. Uma ubufakazi kungukuthi Kunconywa ukuba aqale ukufuna ubufakazi ezingeni leliphasi. Lezi zihlanganisa welicembu cwaningo, "ukulawula-case" nabanye.

ukuhlolwa ezibucayi kobufakazi

Nge loluhlolo, ungakwazi ukunquma indlela enokwethenjelwa ubufakazi owayetholakala imiphumela yocwaningo. Ukuze uhlole ukuthembeka nemiyalezo basakaza izifundo elawulwa, kufanele yini le mibuzo elandelayo:

1. Ingabe eqenjini ngokwethuba iziguli kwenziwa?
2. Ingabe zonke iziguli ukuthatha ukuhlanganyela esifundweni kuqedwe?
3. Ingabe kukhona ekuhlaziyweni iziguli amaqembu ababeya olwenziwa?
4. Ingabe ukwelapha "abayizimpumputhe" ivulela abacwaningi kanye iziguli?
5. Ingabe ukufana ebonwe amaqembu ngaphambi kokuqala ucwaningo?
6. Ingabe ukwelashwa okufanayo lasetshenziswa, ngaphandle umshayeli?

Endabeni ucwaningo qualitative uqhubeke kokuhlaziywa kwemiphumela.

ukuhlaziya imikhuba

Lokhu kuhlola ephelezelwa imibuzo elandelayo:

1. Yini engiyenzayo?
2. Ukuze ukuthi yenzeni, futhi kube namiphi imiphumela ihlelelwe ukuthola?
3. Yiziphi iziqinisekiso of nephephe yalo msebenzi?
4. Ingabe kukhona okungcono ngisho, indlela elungile ngaphezulu ukuze kufinyelelwe lo mgomo?

amathuba okufunda

Ukucinga izimpikiswano kuhlatiya kukhona eliphezulu kakhulu, odokotela kufanele anobungcweti nesikhathi. Ngaphezu kwalokho, ungasebenzisa omagazini yezincwadi kuncike nezinye ngokwesayensi. Kuyasiza ubheke isifinyezo imithi ubufakazi-based, ihlanganiswe ezinye Ochwepheshe. Lokhu kungaba semininingwane Cochrane, incwadi M. Enkin, nezinye izincwadi kule ndawo. Siphinde ukutusa Izivumelwano ngomumo eyenziwe, okuyinto uzilungiselele ngesisekelo imithi okuncike ebufakazini.

Ukubuyekeza Periodic kwezincwadi

ukuhlakanipha okungokwesiko uthi ubufakazi sina yesayensi kuphela ingxenye encane ukunakekelwa kwezempilo ukungenelela. Kumayelana 15%. Nsuku zonke, abasebenzi imithi emhlabeni edingekayo ukuze sithole ubufakazi obusha abalulekile adingekayo ukuze ukusebenza kahle kanye nokuphatha kahle iziguli. Ukuze wenze lokhu, odokotela badinga ukuthola ulwazi oluthile kule iphrofayli. Kunconywa ukusebenzisa izincwadi zezokwelapha ezisekelwe ekwazisweni, okumanje kakhulu. Inani lalo e-1970 liye laphindeka kabili. Ngaphezu kwalokho, i-WSF nsuku zonke. Minyaka yonke, ibhodi yomhleli wephephandaba elithile eyanyatheliswa izihloko mayelana 6000 ezindaweni ezifana zabesifazane kanye zokubelethisa. Ukuze ukufanisa ezingeni lolwazi ezikhathini zanamuhla, udokotela liyadingeka ukufunda 20 izihloko ngosuku. Omunye umbuzo ingabe kukhona ngalesi sikhathi, umsebenzi wezempilo? Idinga acabangele yokuthi abaningi izihloko angahlangabezani ngisho linanincane lemacophelo izinga.

ukusebenza kahle

Ingxenye yolwazi lwezokwelapha saziwa eyiphutha noma akudala emva kweminyaka emihlanu ngemva umfundi iziqu esikhungweni semfundo ephakeme. Yiqiniso, ayaziwa kahle kangakanani. Izincwadi ku imithi ongaqhathaniswa ehlathini, njengoba kwandisa ngokushesha kakhulu, kunezindlela eziningi "nemithi efile", "izicabucabu" futhi "izinyoka", kodwa endaweni ethile yonke ingcebo efihliweyo.

ulwazi oluyisisekelo

imithi Ubufakazi ezisekelwe yindlela ekutsatseni tincumo. Kulokhu, odokotela isebenzisa agumenti engcono ukuthi ziyatholakala, futhi isipiliyoni lochwepheshe. Isinqumo esithathwa isiguli, ikhumbula izithakazelo zayo. nsuku zonke, abasebenzi abasebenza emkhakheni wezokwelapha adinga izinhlobo ezahlukene imithombo ukuthola izimpendulo zemibuzo ezilokhu zivela. Ngokwesibonelo, abenza izifundo kule ndawo kudingeka ulwazi oluyisisekelo, lokuhlanganisa izimbangela zesifo kanye pathogenesis yayo, izici zemvelo kanye neminye imininingwane. idatha Basic basonta wesayensi ezahlukene. Lokhu, ikakhulukazi, izitho zomzimba, pathogenesis, anatomy, omsakazo. Imininingwane Basic uzinzile elithe, kuba wabahlinzeki, izincwadi, kanye nezinye izindlela zokuphakelwa jikelele wezokwelapha. Nokho, odokotela abaningi okudingeka uyiphendule imibuzo kuhlobane ngokuqondile ukunakekelwa isiguli kanye nokwelashwa kwakhe. Nazi ezinye izibonelo nezindaba ezihlobene sifo noma isimo, kodwa musa ubheke ngokuqondile umkhuba emtholampilo:

• Okuchaza ...?
• Kuyini otitis abezindaba?
• Yini nezilwanyana ezincane nomthelela abezindaba otitis?

Izimpendulo zemibuzo yalolu hlobo ingatholakala izincwadi, izincwadi kanye nezinye imithombo.

Imininingwane kubaphathi abagulayo

Ngaphandle ulwazi oluyisisekelo, udokotela udinga ulwazi lokufaneleka ngqo ekuphathweni isiguli, izindlela ukuxilongwa, ukwelashwa kanye Izibikezelo. Ikhuluma izindaba imithi yilobo bufakazi-based. Amagama ayisihluthulelo lapha "sitholakele, ukwelashwa, onalesi sifo." Ukuze uthole imiphumela emihle kakhulu futhi indlela engcono kakhulu ongasabela kuyadingeka ukusungula umbuzo ngendlela efanele.

Ngokwesibonelo emitholampilo

Ungabona reception "diethylstilbestrol" izidakamizwa ukuvimbela izisu kwabesifazane. Isizathu ukusetshenziswa kwaleli thuluzi wenza ngesiphazamiso njalo yokukhulelwa. Kule ndaba, indima estrogen izidakamizwa ukuvimbela kwesisu kubhekwa okunengqondo. Iziguli kokuthatha lesi imithi, ukukhulelwa, ikakhulukazi balondolozwa. Ngo-50 ngenxa izifundo ze-non-olwenziwa eziyisithupha eye yaqinisekiswa ukunciphisa isibalo izisu phakathi nesimiso sokuqondisa izidakamizwa "diethylstilbestrol." Futhi-ke izifundo emihlanu, phakathi kwesikhathi lapho iziguli ayehlukaniswe amaqembu amabili by amasampuli okungahleliwe. Owokuqala wathatha lesi sidakamizwa "diethylstilbestrol", owesibili - placebo. Ngokusho imiphumela isilingo abesifazane uyalisebenzisa yini leli thuluzi, izisu kwenzeka ngo-7% amacala. Ukukhipha izisu eqenjini yesibili kwakunguDodayi 5%. Ngenxa le miphumela zazitholakala ubufakazi obucacile bokuthi izidakamizwa akusizi. Kodwa, naphezu kwalokhu, ukusetshenziswa kwalo usaqhubeka. Ngaphambi 1970, babephathwa yizigidi abesifazane. Ubufakazi ezisekelwe imithi akudingi nje kuphela edingekayo Ukufundwa izinto ngesikhathi esithile. Kuyaphawuleka ukushintsha imikhuba yakho wakhe newalabanye esekelwe ulwazi olusha. imithi Ubufakazi ezisekelwe inikeza izimfanelo i ukuhlolwa Inhloso imphumelelo yekungenelela wezokwelapha, kanye imiphumela isebenza umkhuba emtholampilo. Yiqiniso, akulula, ngoba ukufuna ubufakazi, futhi ukusatshalaliswa yabo kanye nokwethulwa izinguquko, kungenziwa izithiyo ezenzeka kuyo yonke inqubo ezitholakele.

kumiswa imibono

imithi Ubufakazi ezisekelwe kuwo wonke umuntu emhlabeni yokuzenzela, umkhuba oqhubekayo wokubuka yejeyomethri. Kusukela '90s, kwenkathi lasungulwa, futhi namuhla nenani lezincwadi, izinkundla kanye nezikhungo kulendawo kulinganiselwa ku amashumi, futhi nenombolo izincwadi - ngamakhulu. Ngo-1997, abangu-12 izikhungo ezifana baye abathole isibonelelo iminyaka 5 kusukela US Agency inqubomgomo, isayensi kanye nezempilo. Lezi zinhlangano Kwamiswa emanyuvesi ehola kanye nezikhungo zocwaningo ezifundeni ezehlukene. Isibalo sezikhungo izikhungo nezindaba ezikhethekile kakhulu ezifana zezingane nempilo yengqondo, usizo lokuqala kanye nezinye izindawo. inkomba Jikelele kubo ukuba asebenzise isimiso kobufakazi kuwo wonke amazinga ekuthathweni kwezinqumo kusukela imvelo umphakathi zohlelo ziphethe ukuqokwa ukwelashwa ngabanye. ERussia, izikhungo edume kunazo akhiwe Petersburg naseMoscow. Futhi phakathi ukukhathazeka phezulu futhi imithi emtholampilo ubufakazi-based, Nizhnevartovsk. Yezefundo ezikhethekile uphethwe, Neurology, Pediatrics futhi Urology, andrology ukusebenza kwayo nezifo zabesifazane, Gastroenterology nezifo ENT.

HOA

imithi Ubufakazi olusekelwe phezu kwemiphumela yiyona Russian Federation nayo ithuthuka ngokushesha. ERussia kukhona Interregional condominiums umphakathi. Ithole yokubhalisa ngo-2003. Umphakathi wezokwelapha ubufakazi-based kuyinto yokuzithandela engenzi-nzuzo inhlangano. Isebenza ngaphansi kwalesi siVumelwano. Imisebenzi esemqoka condos:

1. umsebenzi elihlobene ne-izinkinga methodological izifundo epidemiological futhi emtholampilo systematics Imininingwane emkhakheni izincwadi isayensi kanye nokuhlola kwezibalo ukuhlaziywa idatha Ukufundisa.
2. I emphakathini imiphumela ucwaningo lwesayensi eziyisisekelo.
3. Ukwethulwa kwentuthuko zokwelapha.
4. Ukuhlola izinga izincwadi zesayensi, yezifiso iziguli kanye nabanye.
5. Sotsioepidemiologicheskie nocwaningo bezokwelapha.

Izimiso amalungu condos:

- ukusakazwa kokwaziswa esekelwe kucwaningo ngokungenela yezokwelapha futhi ongakhetha for yokufuna idatha efana;

- kokugwema isimemezelo Imininingwane ukusebenza, okuyinto engakaze ngokwesayensi kungase kutholakale;

- ukumenyezelwa ukungqubuzana izithakazelo ekhona.

Abasebenzi lenhlangano kukhona odokotela abanamathela migomo kanye eyisebenzisa practice. Kuze kube manje, ezindaweni United 17 namalungu angaphezu kuka-300. INhloko amahhovisi ezifunda kukhona ukunakekelwa ngezokwelashwa kanye impilo abaqeqeshiwe.

Centre for Olusekelwe Ebufakazini Medicine (Ezemfundo, 14, eSt Petersburg)

Isebenza luhlobo nge eziyisishiyagalombili ekuseni kuze eziyisikhombisa ebusuku futhi okukhipha olulodwa, olungena ngeSonto. I-Northwest Centre for Medicine Olusekelwe Ebufakazini inikeza uhlu olubanzi amasevisi emphakathini. Lapho ungathola iseluleko kanye nokwelashwa kusuka odokotela of lunye ewumngcingo, kudlule ukuhlola laboratory, colposcopy, imisindo ephansi, ukubhucungwa Yiqiniso. Olusekelwe Ebufakazini Medicine Centre futhi wenza kukulandzelela kwemalanga onkhe ECG + wegazi. Bonke abasebenzi abasebenza isikhungo kukhona ngodokotela abaqeqeshiwe. Northwest Centre for Medicine Olusekelwe Ebufakazini ngokukhethekile izifo ezifana:

- osteochondrosis, ukugebenga esebenzisa isihluku vertebral Cervicalgia, radiculitis discogenic futhi lumbodynia;

- kokucindezelwa peripheral, ischemic, okuyinto kuwuphawu ndikindiki iminwe;

- deforming osteoarthrosis emazingeni ahlukahlukeneko (njengendlela yokwelapha esetshenziswa medikametoznye ukuvinjelwa isicelo asidi i-hyaluronic);

- iziyaluyalu sokugembula we imisipha kanye nemisipha (tendovaginitah, enthesopathies nabanye);

- zokugula amaphilisi ngokuhlanganyela, "iqhubezela" on the izithende.

A izikhungo yesibili owaziwa Petersburg

Centre for Medicine Olusekelwe Ebufakazini (Lenin 88) esiqala eziyisishiyagalombili ekuseni kuze iri lobunane ebusuku. Ukusungulwa iseningizimu isakhiwo yokuhlala esitezi sokuqala. imishini yesimanje, nasezingeni eliphezulu of service, izindlela ezithuthukile ukuxilongwa - lokhu akulona uhlu oluphelele izinzuzo ukuthi Centre for Medicine Olusekelwe Ebufakazini. Izibuyekezo iziguli eziningi zibonisa ukuthi lapha isivakashi ngasinye uyonakwa esiphezulu. Kwabongwa ikhwalithi yamasevisi. Ungakwazi ukucela usizo lochwepheshe ezifana udokotela wezifo zabesifazane kanye gastroenterologist, isazi sezinzwa futhi wemithi yangaphakathi, wenhliziyo kanye ophthalmologist, endocrinology, Urologist, nokunye. Umtholampilo unikeza nemithi ubufakazi-based nokuhlola in the lab, ubambe ultrasound, echocardiography, kalposkopii, massage, electrocardiography. Udokotela induna isikhungo esimisiwe oncologist Beynusov Dmitriy Sergeevich. Imiphumela yokuhlolwa zingatholakala ngokubiza noma ethola kubo eposini. Ngaphezu isikhungo sezokwelapha, umsebenzi Ochwepheshe kuyasebenza futhi nakubafazi esibhedlela edolobheni. kokubonisana Medical kubiza ruble 1200.