Uchapupu-inobva mushonga. Center nokuti Uchapupu-Based Medicine. Principles emishonga umboo anotsanangura

EBM inomiririra Zvakanyanya Kunaka Panguva Yepamuviri kusangana nharo sayenzi kunotoda ruzivo murwere zvinodiwa. Zviri kushandiswa hwakadzama uye pfungwa yakanaka kubudirira ano vari nedanho zvisarudzo pakurapa varwere. Inoshandisa chete nharo idzo zvinobviswa enderana wongororo. mushonga umboo-kwakavakirwa rinoshanda tsvakurudzo akaora, kufungisisa zvinodiwa nomurwere. Mhedzisiro Uchapupu ndivo rakavimbika uye rakarurama nechirwere nemiedzo uye inspections, kukosha Zvaifungidzirwa kuita, kushanda zvakanaka uye kuchengeteka mishonga, vapore uye ekudzivirira.

Nyaya

Muna 1940, yokutanga randomized (kurongwa kuparadzira) inodzidza kushandiswa mari "streptomycin yakawanikwa" pakurapa tibhii rakaitwa. Muna 1962, kuti US Committee, iro kudzora kunaka Pharmaceuticals nezvokudya vave chinotaurwa mitemo zvainanga kuongorora marudzi itsva zvinodhaka. Makore Mapfumbamwe pashure Anodzidza ichi Archi Kokran mooted pamusoro kushaya uchapupu nesayenzi. Makore matatu gare gare takazoziva kupokana dzidziso uye tsika. Mukupera 80 - mangwanani 90 afunge chakatorwa kuti kudiwa hurongwa wongororo munzvimbo yokuora mirayiridzo. Kokutanga rokuti "uchapupu-kwakavakirwa mushonga" akanga aronga muna 1988 ne epidemiologists uye vanachiremba vakanga vasina aishanda Canadian McMaster University. Archi Kokran akapa rondedzero sei kupa kutsvakurudza kuti unyanzvi. Uyezve, vakabatsira kuti migumisiro avo yokuona nayo hurukuro uye ongororo yakarurama. Cochran nevamwe vake, avo vari British Medical Research Council, vadyi kuedza chaizvo kuti pave ano mushonga umboo anotsanangura. Ndiye muna 1979 vakauya yokuti sayenzi hakuna kukwana dzinonetsa zvakabuda randomized pehurumende miedzo. Cochran rakaumbwa wokutanga Center kuti Evidence-Based Medicine, iyo inonzi vanomutevera. Akatanga kushanda Oxford makore 10 apfuura. Kune Parizvino 15 nzvimbo dzakadaro pose. Vanotungamira basa remarudzi boka nevatsvakurudzi.

nzendo

Kune shanu kwevari mushonga umboo nezveBhaibheri:

1. Bvunza mubvunzo kuti pane mukana kuwana mhinduro.
2. Find yakanaka ongororo.
3. Ongorora achitsoropodza humboo.
4. Funga uchapupu kwakavakirwa kunotoda unyanzvi uye murwere zvido.
5. Kuongorora kuti noitika kushandiswa kutsigira ruzivo.

Principles emishonga umboo anotsanangura. Kuwana yakanakisisa uchapupu

Nyanzvi tsvaka uchapupu, pana Keywords: Murwere, kupindira, kuenzanisa, zvaitika. Chokutanga, unofanira vaita hurongwa nezvaro uye randomized aidzora miedzo nokuti zvimwe zvakavimbika. Kana uchapupu havasi varumbidzwa kutanga kutsvaka uchapupu yakaderera chechetere. Izvi zvinosanganisira kudzidza Boka, "nyaya kuzvidzora" uye vamwe.

Critical kupima uchapupu

With kupima ichi, unogona kusarudza kuti zvakavimbika uchapupu yakawanikwa uye migumisiro pakudzidza. Kuongorora rakavimbika randomly kuparadzirwa kudzorwa zvidzidzo, unofanira kupindura mibvunzo inotevera:

1. Ko randomization wevarwere akanga akatakurwa achiburitswa kunze?
2. Ko varwere vose kutora chikamu kudzidza akaipedza?
3. Zvange kuongorora dzevarwere vari mumapoka yavakanga randomized?
4. Aiva pakurapa "mapofu" kuti vaongorori uye varwere?
5. Ita zvakafanana kuchengetwa mapoka asati kutanga kudzidza?
6. Ko chete kurapwa rakaiswa, asi mutyairi?

Kana Qualitative tsvakurudzo anogona mberi kuti kunyatsoongorora zvabuda.

Kuongororwa nemaitiro

kupima Izvi pamwe mibvunzo inotevera:

1. Ko ndiri kuitei?
2. Nokuti zvinoitwa, chii migumisiro dzakarongwa kugamuchira?
3. Ndezvipi inopikira ose efficacy uye kuchengeteka basa iri?
4. Pane, nzira kukodzera chinhu kunyange nani kuita izvi?

mikana yekudzidza

Kuti vatsvake nharo uye kutsoropodza kuongorora zviri chemhando yepamusoro, varapi vainawo anodiwa unyanzvi uye nguva. Uyezve, anogona kushandisa magazini mabhuku masayendisiti pasi uye zvimwe. Zvinobatsira kureva pfupiso zvokurapa umboo anotsanangura, rakanyorwa nedzimwe nyanzvi. Izvi zvingava Cochrane Database, bhuku M. Enkin, mamwe mabhuku munharaunda iyi. Tinewo kutokurudzira makagadzirira akagadzirwa protocols, izvo vakagadzirira pahwaro mushonga umboo anotsanangura.

Periodic ongororo mabhuku

Kwakajairika uchenjeri anoti chakakomba sayenzi uchapupu chete chiduku chikamu zvoutano kupindira. Zviri pamusoro 15%. Zuva nezuva, vashandi zvokurapa munyika chinodiwa kuti tiwane dzinokosha itsva uchapupu zvakakodzera kuti kunyatsoshanda uye kurapwa wevarwere. Kuti aite izvi, vanachiremba vanofanira kuwana ruzivo dzakananga ichi profile. Zvinokurudzirwa kushandisa zvokurapa mabhuku, izvo pari kwazvo. uwandu Its muna 1970 yakapetwa kaviri. Uyezve, zviri kuwedzera zuva nezuva. Gore negore, nyaya bhodhi rakabudiswa anenge 6000 nyaya munzvimbo dzakadai Gynecology uye Obstetrics. Kuti kuenzaniswa padanho ruzivo dzazvino, chiremba kunodiwa kuverenga 20 nyaya rimwe zuva. Mumwe mubvunzo ndewekuti pane nguva ino, mushandi weutano? It anofanira kufungawo chokwadi kuti vazhinji nyaya havana kusangana kunyange shoma mitemo yepamusoro.

kwakakodzera oparesheni

Part zivo yezvokurapa rinozivikanwa yakakanganiswa kana zvisingachashandi pashure pemakore mashanu pashure mudzidzi kudzidza sangano chepamusoro yedzidzo. Chokwadi, zviri haizivikanwi tsoziva zvikuru. Books pamusoro mushonga kunogona kufananidzwa nomusango, sezvo kunowedzera nokukurumidza kwazvo, ipapo vazhinji "miti akafa", "madandaude" uye "nyoka" vari, asi kumwe ose pfuma yakavanzwa.

Basic mashoko

mushonga umboo-kwakavakirwa chinhu nzira sarudzo. Panyaya iyi, varapi anoshandisa zvakanaka nharo dziripo, uye nyanzvi ruzivo. Mutongo chinobviswa murwere, kufungisisa ayo zvarwo. Zuva nezuva, vashandi vanoshanda mune zvokurapa zvinoda siyana zvinyorwa kuwana mhinduro nekorasi mibvunzo. Somuenzaniso, vadzidzi kudzidza munharaunda iyi vanoda ruzivo inokosha, kubatanidza zvinokonzera chirwere chacho pathogenesis, zvakasikwa zviri nezvimwe zvakawanda. Basic Data ndezvaJehovha sayenzi siyana. Izvi, zvikurukuru, physiology, pathogenesis, anatomi, etiology. Basic mashoko ari vanganzi kugadzikana, zviri handbooks, mabhuku, uye zvimwe zvayo mishonga. Zvisinei, vanachiremba vakawanda vanoda kupindura mibvunzo chokuita kutarisirwa murwere wake kurapwa zvakananga. Heino mimwe mienzaniso nyaya iyo chokuita nechirwere kana ezvinhu, asi regai kureva zvakananga kuna zvekuchipatara tsika:

• Izvo zvinoreva ...?
• Chii otitis nhau?
• Chii tusingaoneki vakabatsira otitis vezvenhau?

Mhinduro dzemibvunzo iyi mhando anogona kuwanikwa mumabhuku, mabhuku uye kumwewo.

Information pamusoro kurapa varwere

Kunze inokosha ruzivo, chiremba anoda mashoko zvakananga kushanda kuti kurapa murwere, zvokuongorora nzira, kurapwa uye fungidziro. Rinotaura nyaya mushonga umboo nemabhuku akadai. Mashoko anokosha pano vari "nechirwere, kurapwa, fungidziro." Kuti tiwane migumisiro yakanakisisa uye yakanaka mhinduro zvakafanira kuzoumba mubvunzo nomazvo.

zvekuchipatara muenzaniso

Unogona kuona mabiko "diethylstilbestrol" mushonga kudzivirira kupfupfudzika vakadzi. Chikonzero kushandiswa chokushandisa ichi anoita kakawanda akatevedzana akazvitakura. Panyaya iyi, basa inonzi estrogen ari zvinodhaka kudzivirira pamuviri anonzi musoro. Varwere kutora mushonga uyu, pamuviri, zvikurukuru vakachengetedzwa. Mumakore 50 kuti somugumisiro matanhatu dzisiri randomized zveBhaibheri anotsigirwa nokuderedza uwandu pamuviri panguva yaitonga mushonga "diethylstilbestrol." Uyewo zvakanga aiitisa zvidzidzo mashanu, umo varwere vakanga vakakamurwa kuva mapoka maviri asingashumbi zvakabudiswa. Wokutanga akatora zvinodhaka "diethylstilbestrol", wechipiri - a kurapa kunonyaradza pfungwa. Maererano migumisiro Kuedza vakadzi vachishandisa nzira iyi, kupfupfudzika kwakaitika muna 7% nyaya. Kugumiswa pamuviri yechipiri boka rakanga 5%. Nokuda zvawanikwa aya vakawana hwakajeka hwokuti mushonga isinakukodzera. Asi, pasinei ichi, kushandiswa kwayo kuchiri kuitika. 1970 asati, vakanga vachibatwa nemamiriyoni evakadzi. Uchapupu-inobva mushonga zvinoda kwete chete yaidiwa zvokuverenga pane imwe nguva. Sezvineiwo kushandura uye nevamwe 'tsika dzako dzinobva mashoko matsva. mushonga umboo-inobva kunopa prerequisites kuti chinangwa tinyatsonzwisisa kubudirira zvokurapa kupindira, uyewo nemigumisiro yayo chikumbiro mune yokuora tsika. Chokwadi, hazvisi nyore, nokuti vari kutsvaka uchapupu, uye kwekuda kwavo uye pakatanga kuchinja, anogona kuwanikwa zvipingamupinyi kuti kuitika munyika izvi.

paumbwe pfungwa

Uchapupu-inobva mushonga wose munyika iri kuwedzera kuva geometrical kunoita. Kutanga '90s, nguva yaro inotungamirwa, uye nhasi nhamba mabhuku, forum uye nzvimbo iyi zvinofungidzirwa mu vevane gumi, uye uwandu mabhuku - nemazana. Muna 1997, 12 nzvimbo dzakadaro vakagamuchira dzorubatsiro kwemakore 5 kubva US Agency mutemo, sainzi uye utano. Masangano aya dzakatangwa panguva achitungamirira mumayunivhesiti nokutsvakurudza masangano akasiyana anoti. Vakawedzera uwandu nzvimbo zvikuru unyanzvi nyaya dzakadai vana uye utano hwepfungwa, rwekutanga uye nedzimwe nzvimbo. General nezvavo kuti kushandisa nheyo huripo ose Hazvizivikanwi kusarudza kubva kuruzhinji hunhu chirongwa uye anopera kugadzwa nomunhu kurapwa. MuRussia, ivo establishments dzakakurumbira dziri muSt Petersburg uye Moscow. Pakati pamusoro kunetsa uye kiriniki umboo anotsanangura mushonga, Kazan. Institution nyanzvi nechirwere, neurology, Pediatrics uye urology, andrology uye Gynecology, gastroenterology uye zvirwere pfava.

Nham

mushonga umboo-inobva ndiye Russian Federation ari kukura nokukurumidza. In Russia ipapo Interregional munharaunda mafurati. Chakasimudzira akagamuchira kunyoresa muna 2003. Society wemishonga umboo anotsanangura chokuzvidira asiri mubereko nokuwadzana. It anoshanda pasi Charter. The mabasa chikuru mafurati:

1. Kudzidzisa basa chokuita methodological nezvinetso epidemiological uye kurapwa zvidzidzo systematics ruzivo mumunda zvinyorwa sayenzi kunyatsoongorora Statistical date kuongorora.
2. The mbirikira pamusoro migumisiro dzinokosha yesayenzi kuedza.
3. The Sumo mberi okurapa.
4. Kuongorora unhu nemabhuku kwesayenzi, protocols varwere uye nevamwe.
5. Sotsioepidemiologicheskie uye anorapa achishandisa mitemo tsvakurudzo.

Misimboti nhengo mafurati:

- kufambiswa tsvakurudzo anotsanangura mashoko pamusoro wezvokurapa kupindira uye nzira nokuda kuzviwanira mashoko akadai;

- kurega kuzivisa mabasa mashoko, ayo asina nesayenzi nekusimba;

- kuzivisa aivapo vaite zvido.

Vashandi vari sangano ndivo vanachiremba vanorambira zvinotaurwa izvi nekuita navo uchidzidzira. To musi, muUnited 17 nharaunda uye vanopfuura 300 nhengo. Musoro Regional mahofisi dzine vanonyatsokwanisa mishonga uye zvoutano.

Center nokuti Uchapupu-Based Medicine (Education, 14, St. Petersburg)

It anoshanda Zvivako pamwe sere mangwanani kusvikira nomwe usiku uye ane chete goho, izvo inowira weSvondo. The Northwest Center kuti Medicine Evidence-Based anogovera siyana mabasa nokuda kwevanhu. Munowanepi zano uye kurapwa kubva vanachiremba ezvitanda specialization, kupfuura rabhoritari Diagnostics, colposcopy, Ultrasound, masaja kosi. Uchapupu-Based Medicine Center zvakare anoita zuva richiona nezvezvabuda ECG + BP. tsvimbo All kushanda tsika vari vanachiremba zvikuru vanokwanisa. Northwest Center nokuti Medicine Evidence-Based unyanzvi mune zvirwere zvakadai:

- osteochondrosis, kuwedzerwa vertebral Cervicalgia, discogenic radiculitis uye lumbodynia;

- compression neuropathy, ischemic, inova chiratidzo chiveve muna nemimwe;

- deforming osteoarthrosis mumatanho dzakasiyana (sezvo kurapa akashandisa medikametoznye blockade akashandisa hyaluronic acid);

- pathological kusagadzikana pakati nemarunda nemarunda (tendovaginitah, enthesopathies nevamwe);

- zvokurwara rwakashodoka capsules, "kunoita" achangopfuura.

A yechipiri anozivikanwa masangano St. Petersburg

Center nokuti Uchapupu-Based Medicine (Lenin 88) anomhanya kubva sere mangwanani kusvikira masere usiku. Kutangwa riri mune chivako chokugara pasi rokutanga. Modern zvokushandisa, mukuru pamwero basa, yepamusoro nzira nechirwere - ichi hachisi mazita rakakwana zvakanakira kuti Muzinda Uchapupu-Based Medicine. Reviews wevarwere zhinji anoratidza kuti pano mushanyi mumwe achapiwa kunonyanyisa kutarisirwa. Kuonga dzakaratidzwa kuti unhu mabasa. Unogona kutsvaka rubatsiro nyanzvi zvakadai gayinakorojisiti uye gastroenterologist, chiremba wetsinga uye internist, cardiologist uye ophthalmologist, endocrinologist, chiremba wezvedundira, uye zvichingodaro. The kiriniki inopa uchapupu-kwakavakirwa mushonga uye Diagnostics vari yezvirwere, vakabata Ultrasound, echocardiography, kalposkopii, masaja, electrocardiography. Chiremba mukuru tsika akagadza oncologist Beynusov Dmitriy Sergeevich. pakuongororwa anogona kuwanikwa nokudana kana kugamuchira kwavari tsamba. Kuwedzera zvipatara, basa vanachiremba rinoshanda kune guta kuchipatara. Medical kubvunza kunodyira 1200 rubles.