‐Minds事業のあゆみと診療GL作成の最新情報- 医学文献評価選定部会

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1 第 9 回 EBM 研究フォーラム 診療ガイドラインを明日につなげる ~ 現場のニーズに応える Minds を目指して ~ 医学文献評価選定部会 国際医療福祉大学塩谷病院 森實敏夫

2 概要 Minds と医学文献評価選定部会の活動 Minds アブストラクトの現況 今後の展開

3 Minds のミッション 日本国民が健康でよい人生をおくることができる 有益性対害 負担 費用のエビデンスに基づいた医療の普及 =EBM の普及 エビデンスに関する情報を医療従事者および国民に提供する 診療ガイドライン コクランレビュー Minds アブストラクト

4 Minds = ウェブ上に展開する日本語による総合的臨床医学情報データベース 診療ガイドライン : 日本で作成されたもの Minds アブストラクト : 個別論文の日本語化した構造化抄録 コクランレビュー : 日本語化 トピックス :CPG 発行以後の新知見の紹介 CPG レビュー : 海外の診療ガイドラインとの比較など 横断的検索

5 Minds アブストラクトの企図 臨床的意義の高い質の高い論文を選定する ランダム化比較試験またはメタアナリシス / システマティック レビュー 疾患を限定 ( 診療ガイドラインに対応 ) 日本語化された構造化抄録として批判的吟味に必要な情報を含んで提供する 疾患レビュアー ( その分野のエキスパート ) のコメントを付ける

6 方法論 EBM 実践のための医学文献評価選定マニュアル PubMed 検索 臨床的意義 relevance: 得られるもの benefit と失うもの dwonsides とそれぞれの大きさのバランス 妥当性 validity 信頼性 reliability

7 Minds アブストラクトの構成ランダム化比較試験

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9 The EU-EBM project A course for post-graduate education which is clinically integrated and allows maximum flexibility for teachers and learners. After completion of the course, participants should be able 1. to generate structured questions arising from problems in their own clinical practice in PICO (population, intervention, comparator and outcome) format. 2. to search for relevant literature, aiming for and identifying systematic reviews wherever possible. 3. to assess the quality (validity) of systematic reviews and the primary research included within them 4. to assess the applicability and generalisability of the research findings to their own clinical practice. 5. to demonstrate their understanding of strategies to effectively implement new research findings into clinical practice, including knowledge of barriers that often block such implementation in clinical practice. BMC Medical Education 2007, 7:46

10 A clinically integrated course for the Aim teachers of EBM To provide guidance on practical and effective methods to teach clinically integrated evidence based medicine (EBM) in various clinical settings. Target participants Senior health professionals in a clinical setting with responsibility for teaching and training. BMC Medical Education 2009, 9:59

11 Learning objectives Upon completion of the course participants should be confidently able to identify and use learning opportunities in a clinical setting to provide on-the-job training to trainees by - exposing knowledge gaps in the trainees that leads to construction of structured question - seeking information from trainees on how they will track the best evidence to answer the question - developing confidence in number crunching to interpret the results - effectively using various clinical opportunities to teach critical appraisal of literature - demonstrating how clinical judgement is used to determine the extent to which research evidence can be applied for individual patient care - enabling trainees to present and discuss in formal clinical meetings by applying the steps of EBM

12 認知領域 Cognitive Domain ( Bloom s Revised Taxonomy ) 1. 創造 Creation ( 合成 Synthesis) 知識 Knowledge 2. 評価 Evaluation 3. 分析 Analysis 4. 応用 Application 5. 理解 Comprehension 6. 知識 Knowledge Minds アブストラクトの作成に必要なコンピテンシー

13 EBM 学習コース の目的 このコースで学習し 総括的評価を受けると 何ができるようになるかを明確にする 何ができるようになるか = アウトカム コンピテンシー エキスパートの意見 患者 管理者の意見 何ができるようになるべきか 何ができるようになってほしいのか 何ができるようになりたいのか = ニーズのアセスメント 医療従事者の意見

14 アンケート調査 ( 例 ) 患者の臨床上の問題を明確にするためには どのような EBM の知識 スキルが必要か? 臨床症状の出現頻度 ( 陽性率 ) の知識 診察所見の出現頻度 ( 陽性率 ) の知識 臨床検査の感度 特異度の知識 症状 診察所見 検査結果から疾患確率を導き出すことができる 検査法の診断能の評価ができる 感度 特異度を説明できる 尤度比を説明できる ROC 解析を説明できる

15 アウトカム EBM learning course 1. 臨床の現場で EBM を実践することにより より適切な医療を提供できる 2. 臨床の現場で EBM 実践の教育 指導をすることによって 医療機関の医療の質を向上できる 3. 臨床の現場で有用性を認められる Minds アブストラクトの作成ができる

16 Minds アブストラクトの作成に必要なコ ンピテンシー 臨床の現場で有用性を認められる Minds アブストラクトの作成ができる クリニカルクエスチョンの作成ができる 文献検索ができる 臨床的意義の判定ができる 論文の批判的吟味ができる 論文の重要な情報を抽出できる 構造化抄録を執筆できる CLRCEW Clinical Question -Literature Search Relevance - Critical Appraisal Extracting Major Information - Writing

17 ユニット 1 1-1a. 担当する患者の臨床上の問題を明確にすることができる 診断 実施すべき検査法の適切な選択 介入 適切な介入の選択 管理 適切な管理の決定 1-1b. 適切なクリニカルクエスチョンの作成ができる

18 ユニット 2 1-2a. 質の高い二次情報の検索ができる Minds コクランライブラリ- その他 1-2b. PubMed 検索ができる 検索式の作成 検索結果の利用

19 今後の目標 EBM 学習コース に対するニーズ調査を行い それに基づいて カリキュラム コンテンツを作成する 出来るだけ多数の参加者をえて Minds アブストラクト作成者を養成する Minds アブストラクトをより多く作成する 臨床現場での活用促進を図る 有益性対害 負担 費用のエビデンスに基づいた医療の普及 =EBM の普及に貢献する

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