Ávinningur af auknu aðgengi að upplýsingum

Sigurður Helgason

Ritstjóri klínískra leiðbeininga

Landlæknisembættinu

Upplýsingaflóð alla að drepa !!

- óljós spurning eða illa fram sett

- óljós hugmynd um hvar á að leita

- leitaraðferð ómarkviss

Fáum oft ónothæfar upplýsingar og eyðum miklum tíma

Misvísandi niðurstöður !!

Hver er sannleikurinn?

Greinar Leiðbeiningar

Endurmenntun

Sérfræðiálit Textabækur

Gagnreynd læknisfræði

-ofnotað sem orðatiltæki en vannotað í vinnu !!!!!

- litið á sem leið til að brúa bilið milli rannsókna og daglegrar vinnu.

-áherslan er á að besta vísindaleg þekking nýtist við m.a. klíníska ákvörðunartöku.

Að byggja á bestu upplýsingum

Getur leitt til:Gagnsærri ákvörðunartökuAukinnar ábyrgðar

rökstuðningur fyrir ákvörðunum verður aðgengilegur

Mats á óvissu ljóst er hve sönnun er mikil / eða lítil

Notkun vísindaniðurstaðna á kostnað reynslu og hyggjuvits

Nám - framhaldsmenntun

-hvernig við öðlumst þekkingu er jafn mikilvægt og vitneskjan sem við búum yfir. mikilvægara er að leggja áherslu á hvernig

við öflum þekkingar og förum með hana en skapa þekkingarílát sem gubba út upplýsingum eftir óskum

Kennsla með þetta í huga þarf að stóraukast á öllum stigum í námi heilbrigðisstétta

Vinna =HeimildaleitElta uppi gögnMat á gögnum (Appraisal)Heimfæra upp á vandamálið

Notagildi upplýsinga =

Relevance x Validity

VinnaVinna

Benjamin Rush 1797. Blóðtaka.

-óhemju upprifinn af árangri af blóðtöku. -fór sem eldur um sinu -mjög ótæpileg notkun á blóðtöku.

George Washington dó úr hálsbólgu eftir að tappað var af honum um 2 lítrum.

Mótbárur

-oft byggðar á misskilningi – Það þarf að sníða vísindalega þekkingu að

hverjum einstaklingi og það gerir sá læknir best sem til hans þekkir - eins og að troða ferköntuðum kubb í kringlótt gat!!

Við eigum ekki að vera svo barnaleg að halda að Evidence sé alltaf á hreinu. Það má ekki gera of mikið úr gagnreyndri

læknisfræði – við verðum að viðurkenna annmarka.

Hlutur stjórnenda

Það er langt í frá nóg að dreifa EBM efni – yfirvöld / stofnanir þurfa að skapa rétta umhverfið til að

þetta gangi upp. – með því hagnast heilbrigðiskerfið og sérlega sjúklingar.

Aðeins um þriðjungur af því sem við praktiserum er byggt á bestu upplýsingum

Bisbjerg audit. Ugeskr Læger 2000;162:4382

EBI

Forsendur betri heilsu í gegnum EBI:

Stjórnendur verða að að geta greint á milli góðra og lélegra upplýsinga

Breytt þekking þarf að leiða til breytinga í framkvæmd heilbrigðisþjónustu

Breytt þjónusta þarf að leiða til betri útkomu fyrir skjólstæðinga okkar

EBI

Upplýsingatækni sem stoð til betri heilsu þarf að búa yfir a.m.k þrem eiginleikum:Aðgengilegt – þægilegt

Réttur tími og staður

AðgreiningarhæfniGóðar og réttar upplýsingar eru aðgreindar frá

villandi eða ónauðsynlegum upplýsingum

SamtvinnunUpplýsingar frá mörgum stöðum

Economic? and influenza (33)

Zanamivir or oseltamivir (50)

Economic? and (zanamivir or oseltamivir) (1)

Economic analysis of influenza vaccination and antiviral treatment for healthy working adults; Patrick Y Lee; Annals of Internal Medicine Philadelphia; Aug 20,2002;Vol. 137, Iss. 4; pg. 225, 7 pgs

WWW.HVAR.IS

Proquest

Medline 1966-okt 2002

Influenza (27731)Economic? and influenza (196)Zanamivir or oseltamivir (352)Economic? and (zanamivir or oseltamivir) (7)

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Lee PY. Matchar DB. Clements DA. Huber J. Hamilton JD. Peterson ED. Economic analysis of influenza vaccination and antiviral treatment for healthy working adults. [summary for patients in .]. [Journal Article] Annals of Internal Medicine. 137(4):225-31, 2002 Aug 20.

Burls A. Clark W. Stewart T. Preston C. Bryan S. Jefferson T. Fry-Smith A. Zanamivir for the treatment of influenza in adults: a systematic review and economic evaluation. [Review] [89 refs] [Journal Article. Review. Review Literature] Health Technology Assessment (Winchester, England). 6(9):1-87, 2002.

Cram P. Blitz SG. Monto A. Fendrick AM. Influenza. Cost of illness and considerations in the economic evaluation of new and emerging therapies. [Journal Article] Pharmacoeconomics. 19(3):223-30, 2001.

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van Loon FP. Voordouw AC. Simonian S. Koopmans PP. [Critical review of anti-influenza drugs]. [Review] [22 refs] [Dutch] [Journal Article. Review. Review, Tutorial] Nederlands Tijdschrift voor Geneeskunde. 144(4):165-7, 2000 Jan 22.

Demicheli V. Jefferson T. Rivetti D. Deeks J. Prevention and early treatment of influenza in healthy adults. [Review] [37 refs] [Journal Article. Review. Review, Tutorial] Vaccine. 18(11-12):957-1030, 2000 Jan 6.

EBM ovid

Influenza (1256)Economic? and influenza (12) (neðan)Zanamivir or oseltamivir (57)Economic? and (zanamivir or oseltamivir) (1) (neðan) EBM Reviews - ACP Journal Club Influenza vaccination of healthy adults was effective during the 1998 to 1999 flu season but not the 1997 to

1998 season [Therapeutics] ACP Journal Club. v134(3):90, May/June, 2001. EBM Reviews - ACP Journal Club Vaccination against influenza had both health and economic benefits for healthy, working adults

[Therapeutics] ACP Journal Club. v124:52, Mar-April, 1996. EBM Reviews - Database of Abstracts of Reviews of Effectiveness Center for Reviews and Dissemination Reviewers. The efficacy of influenza

vaccine in elderly persons: a meta-analysis and review of the literature. [Prevention] Database of Abstracts of Reviews of Effectiveness. Issue 4, December 2002

EBM Reviews - Database of Abstracts of Reviews of Effectiveness Center for Reviews and Dissemination Reviewers. Oseltamivir for the treatment of suspected influenza: a clinical and economic assessment. [Miscellaneous] Database of Abstracts of Reviews of Effectiveness. Issue 4, December 2002

EBM Reviews - Cochrane Controlled Trials Register Bridges CB, Thompson WW, Meltzer MI, Reeve GR, Talamonti WJ, Cox NJ, Lilac HA, Hall H, Klimov A, Fukuda K Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial. [see comments]. [Clinical Trial. Journal Article. Randomized Controlled Trial] JAMA. 284(13):1655-63, 2000 Oct 4

EBM Reviews - Cochrane Controlled Trials Register Nexoe, J., Kragstrup, J., and Ronne, T. [The impact of postal invitations and user fee on influenza vaccination among the elderly. A randomized controlled trial in general practice] [CLINICAL TRIAL. JOURNAL ARTICLE. RANDOMIZED CONTROLLED TRIAL] Ugeskrift for Laeger. 159(27):4270-3, 1997

EBM Reviews - Cochrane Controlled Trials Register Nichol KL, Lind A, Margolis KL, Murdoch M, McFadden R, Hauge M, Magnan S, Drake M The effectiveness of vaccination against influenza in healthy, working adults. [see comments]. [Clinical Trial. Journal Article. Randomized Controlled Trial] New England Journal of Medicine. 333(14):889-93, 1995 Oct 5.

EBM Reviews - Database of Abstracts of Reviews of Effectiveness Center for Reviews and Dissemination Reviewers. Oseltamivir for the treatment of suspected influenza: a clinical and economic assessment. [Miscellaneous] Database of Abstracts of Reviews of Effectiveness. Issue 4, December 2002. ( COMMENT Husereau D R, Brady B, McGeer A. )

http://agatha.york.ac.uk/welcome.htm

HTA - Guidelines

HTA - Guidelines

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Economic? and influenza (9) (neðan)

Zanamivir or oseltamivir (12) (næsta)

Economic? and (zanamivir or oseltamivir) (0) Cost-effectiveness of influenza vaccine in The Netherlands. Reinders A, Postma M J,

Govaert T M, Sprenger M J. Nederlands Tijdschrift voor Geneeskunde 1997; 141(2): 93-97 A pharmacoeconomic model for the treatment of influenza.

Mauskopf J A, Cates S C, Griffin A D. Pharmacoeconomics 1999; 16(Suppl 1): 73-84. Pharmacoeconomic model to evaluate new influenza treatments.

Armstrong E P, Abarca J. Hospital Formulary 2000; 35(2): 169-181. Cost-benefit evaluation of routine influenza immunization in subjects 65-74 years of

age - primary research (project). UK NHS National Coordinating Centre for Health Technology Assessment (NCCHTA).

The cost effectiveness of zanamivir and oseltamivir for influenza treatment. Armstrong E P, Khan Z M, Perry A S, Perri L R. Formulary 2000; 35(12): 979-989.

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An assessment of oseltamivir for the treatment of suspected influenza. Husereau DR, Brady B, McGeer A. Canadian Coordinating Office for Health Technology Assessment (CCOHTA) 2002 (Technology Overview Issue 7): 12.

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Cost effectiveness of zanamivir for the treatment of influenza in a high risk population in Australia. Mauskopf J A, Cates S C, Griffin A D, Neighbors D M, Lamb S C, Rutherford C. Pharmacoeconomics 2000; 17(6): 611-620.

Economic evaluation of zanamivir (relenza) for the treatment of influenza. Brady B, McAuley L, Shukla V K. Canadian Coordinating Office for Health Technology Assessment (CCOHTA) 2001 (Technology Report Issue 13): 63.

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Cost-effectiveness analysis of inhaled zanamivir in the treatment of influenza A and B in high-risk patients. Griffin A D, Perry A S, Fleming D M. Pharmacoeconomics 2001; 19(3): 293-301.

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