Ubungqina-based amayeza. Centre for Ubungqina-Based Medicine. Principles of amayeza olusekelwe kubungqina

EBM imele kangangoko uhlanganiso iimpikiswano ezenzululwazi kunye namava onyango kunye neemfuno yesigulana. It is a ukusetyenziswa eneenkcukacha kunye ubengo kwimpumelelo best mihla kwinkqubo yokwenza izigqibo unyango lwezigulane. Isebenzisa kuphela ezo iingxoxo zona zivela wokujongwa kwakhona kweenkqubo. iyeza Ubungqina-based yi ngokwezonyango uphando efanelekileyo, kuthathelwa ingqalelo iimfuno yesigulana. Le ngenxa yobungqina na ukuthembeka kunye nokuchaneka iimvavanyo isifo kunye nokuhlolwa, ukubaluleka komsebenzi iingqikelelo, ukusebenza kunye nokhuseleko unyango, kwisimo kunye nothintelo.

Indaba

Ngowe-1940, i-kokuhlola (distribution random) yokuqala lifunda ukusetyenziswa kwemali "streptomycin" kwi unyango lwesifo sephepha sele yenziwe. Ngowe-1962, iKomiti US, leyo ukulawula umgangatho imithi kunye iimveliso zokutya ziye zaziswa imithetho ejoliswe ngokuphonononga iindidi ezintsha zamachiza. iminyaka elithoba emva koku sezifo Archi Kokran owaqala ngalo yokungabikho kobungqina yenzululwazi. Kwiminyaka emithathu kamva siye safumanisa ukungangqinelani phakathi ithiyori practice. Ngasekupheleni-80 - ekuqaleni 90 kaThixo ingqalelo ingqalelo imfuneko yokuba wokujongwa kwakhona kweenkqubo imfundo clinical. Ngokuba lixesha lokuqala elithi "iyeza kubungqina-based" yaphakanyiswa ngo-1988 ngu epidemiologists baseklinikhi abasebenze kwi Canadian McMaster University. Archi Kokran wanikela inkcazelo yendlela phambi uphando ukuya kwiingcali. Ngaphezu koko, ukuba negalelo yokuba iziphumo zabo kwingongoma yeengxoxo kunye uhlalutyo oluchanekileyo. Cochran noogxa bakhe, bonke abakulo British Medical Research Council, iinzame ezibambeneyo benze iinzame ezinkulu uphuhliso iyeza olusekelwe kubungqina mihla. Yaba nguye owathi ngo-1979 weza ingcamango yokuba inzululwazi ayikho ezifunyanisiweyo ngokwaneleyo ezibalulekileyo amalingo alawulwayo angathathi cala. Cochran yasekwa iZiko kuqala Ubungqina-Based Medicine, ekuthiwa emva kwakhe. Yena waqala ukusebenza ngo-Oxford kwiminyaka eli-10 eyadlulayo. Kukho Okwangoku-15 amaziko anjalo ehlabathini lonke. Ukuqondisa umsebenzi iqela lelizwe abaphandi.

izigaba

Kukho imigangatho emihlanu amayeza olusekelwe kubungqina:

1. Buza umbuzo ukuba apho kukho kungenzeka ukufumana impendulo.
2. Fumana yokuqinisekisa ilungileyo.
3. Phonononga ngokunzulu idatha.
4. Qwalasela ubuchule ubungqina esekelwe lwezonyango kunye nomdla yesigulana.
5. Vavanya ukusetyenziswa kobugcisa axhasayo indlela kunokwenzeka.

Principles of amayeza olusekelwe kubungqina obubambekayo. Ukufumana i balawo

Iingcali khangela ubungqina, ngokusekelwe amagama: nomonde, ungenelelo, uthelekiso, iziphumo. Okokuqala, kufuneka uqhubeke ku wokujongwa kwakhona kweenkqubo kwaye lunomkhethe izilingo ezilawulwa ngenxa yokuba inokuthenjwa. Ukuba nobungqina Kucetyiswa ukuba uqale ukufuna ubungqina kwinqanaba elisezantsi. Ezi ziquka iqela lokufunda, "kwimeko-control" kunye nabanye.

uvavanyo Critical kobungqina

Nesisicatshulwa, uyakwazi ukubona indlela ethembekileyo ubungqina eyafunyanwayo kunye ne ziphumo zeso sifundo. Ukujonga ukuthembeka lezifundo ezilawulwa ngokungakhethiyo zisasazwe, kufuneka uphendule le mibuzo ilandelayo:

1. Ngaba engakhethiyo lwezigulane kuthwalelwa phandle?
2. Ngaba zonke izigulane ezithatha inxaxheba kuphononongo lufezeke?
3. Ngaba kukho uhlalutyo lwezigulana kumaqela ukuba zona lunomkhethe?
4. Ngaba unyango "iimfama" ukuba abaphandi kunye nezigulane?
5. Yenza ukufana waphawula kumaqela phambi kokuqalisa kwesi sifundo?
6. Ngaba impatho efanayo busetyenzisiwe, ngaphandle ekuza kulingwa?

Kwimeko uphando qualitative nga phambili kwi ukuvavanywa kweziphumo.

analysis kwezenzo

Olu vavanyo sikhatshwa le mibuzo ilandelayo:

1. I ntoni mna?
2. Kuba yintoni sokuba kwenziwe oko, yintoni iziphumo zicwangciselwe ukufumana?
3. Zeziphi ziziqinisekiso ukusebenza kunye nokhuseleko lo msebenzi?
4. Ingaba kukho indlela engcono, ezifaneleke ngakumbi ukuphumeza le njongo?

amathuba okufunda

Ukukhangela ukuba iingxoxo kunye uhlalutyo ebaluleke kakhulu umgangatho ophezulu, nonoklinikhi kufuneka ukuba nezakhono eziyimfuneko kunye nexesha. Ukongezelela, anokuyisebenzisa iimagazini iincwadi zezifundo kunye nezinye zenzululwazi. Kuluncedo ukuba libhekisela isishwankathelo iyeza olusekelwe kubungqina, oluqulunqwe zezinye iingcali. Oku kuba uvimba Cochrane, incwadi M. Enkin, nolunye uncwadi kule ndawo. Siyaleza kwakhona imithetho elandelwayo esele zenziwe, ezo zilungiselelwe ngokusekelwe iyeza olusekelwe kubungqina obubambekayo.

ngokutsha Periodic iincwadi

ukuhlakanipha uthi ubungqina esinzulu yenzululwazi yinxalenye encinane kuphela kongenelelo zokhathalelo lwempilo. Kumalunga-15%. Yonke imihla, abasebenzi amayeza kwihlabathi kufuneka ukuba ufumane ubungqina ebalulekileyo ezintsha ukwenzela ukusebenza kwaye unyango olufanelekileyo zezigulane. Ukuze wenze oku, oogqirha kufuneka ukufumana ulwazi oluthile kule nkangeleko. Kucetyiswa ukuba basebenzise uncwadi zonyango, nto leyo okwangoku kakhulu kunene. iye kabini imali yayo ngo-1970. Ngaphezu koko, ubukhula yonke imihla. Nyaka ngamnye, ibhodi lomhleli elalipapashwe malunga 6000 amanqaku kwiindawo ezifana izifo nococeko kunye nokubeleka. Ukuze ukutshatisa izinga lolwazi bamaxesha mihla, ugqirha kufuneka ukuba ukufunda amanqaku-20 ngosuku. Omnye umbuzo kukuba ingaba kukho ngeli xesha, umsebenzi wezempilo? Kufuneka athathe ingqalelo into yokuba uninzi amanqaku musa ukuhlangabezana nokuba nemigangatho isezantsi esemgangathweni.

nokusebenza ngendlela efanelekileyo

Inxalenye ulwazi lwezonyango ibonwa eziphosakeleyo okanye lixesha emva kweminyaka emihlanu emva kokuba umfundi ephumelele ukusuka kwiziko lemfundo ephakamileyo. Liyinyaniso elokuba, ayaziwa ncam kangakanani. Iincwadi emithi ezinokufaniswa kwihlathi, njengoko kwandisa ngokukhawuleza kakhulu, kukho "imithi abafileyo" abaninzi, 'izigcawu "kunye" iinyoka ", kodwa kwindawo ethile bonke ubuncwane obufihliweyo.

ulwazi basic

iyeza Ubungqina-based yindlela ekuthatheni izigqibo ezizizo. Kulo mzekelo, nonoklinikhi isebenzisa iimpikiswano ilungileyo ezikhoyo, kunye namava obungcali. Le kuthathwe isigqibo kunye isigulane, kuthathelwa ingqalelo izinto zawo. Yonke imihla, abasebenzi abasebenza kwezonyango ifuna iintlobo ezahlukeneyo zemithombo ukufumana iimpendulo kwimibuzo okuqhubekayo. Umzekelo, abafundi befunda kule ndawo ufuna ingcaciso esisiseko, ekwenzeni izizathu sifo kunye Pathogenesis kwayo, iimpawu zendalo kunye nezinye iinkcukacha. data esisiseko bangamalungu Sciences ezahlukeneyo. Oku, ingakumbi, amalungu, Pathogenesis, anatomy, umyalezo. ulwazi Basic xa ikuthelekiswa kuzinza, nto kwiincwadana, iincwadi, kunye nezinye izinto zonyango ngokubanzi. Noko ke, oogqirha abaninzi kufuneka baphendule imibuzo enxulumene ngqo kukunyamekela yomguli kunye nonyango lwakhe. Nantsi eminye imizekelo imiba enxulumene isifo okanye imeko, kodwa musa ngokukodwa ukwenza clinical:

• Yeyiphi kuthetha ...?
• Yintoni otitis eendaba?
• Yintoni Cya negalelo eendaba otitis?

Iimpendulo kwimibuzo yolu hlobo zifumaneka iincwadi zezifundo, iincwadi reference kunye neminye imithombo.

Ulwazi malunga nolawulo abagulayo

Ngaphandle ulwazi olusisiseko, ugqirha kufuneka iinkcukacha ezibalulekileyo ngqo kulawulo umguli, iindlela isifo, unyango kunye abane. Ukwachaphazela nemiba amayeza olusekelwe kubungqina ezinjalo. Amagama angundoqo apha "uxilongo, unyango, abantu abane." Ukuze ufumane iziphumo ezingcono kunye impendulo engcono kuyimfuneko ukuqulunqa imibuzo ngokuchanekileyo.

Umzekelo clinical

Uyakwazi ukubona lolwamkelo esikolweni "diethylstilbestrol" iziyobisi ukuthintela kwesisu kwabasetyhini. Isizathu ukusetyenziswa kwale sixhobo wenza uphazamiseko rhoqo yokukhulelwa. Kulo mba, indima estrogen ichiza ukuthintela kwezisu kugqalwa ubhalo. Izigulane ezithatha le amayeza, ukukhulelwa, ubukhulu becala igcinwe. Xa iminyaka engama-50 ngenxa zophando non-kokuhlola ezintandathu ziye yaqinisekiswa ngokunciphisa inani kwezisu ngexesha kulawulo iziyobisi "diethylstilbestrol." Kwakhona ukuba baqhube izifundo ezihlanu, ngexesha apho izigulane bohlulwa babe ngamaqela amabini isampuli ejikelezayo. Waza owokuqala wazeka ichiza "diethylstilbestrol", owesibini - i-placebo. Ngokutsho iziphumo ulingelo abafazi usebenzisa esi sixhobo, ukuphuphuma kwenzeka ngo-7% yamatyala. Ukupheliswa ukukhulelwa kwiqela yesibini 5%. Ngenxa ezi ziphumo zifunyenwe ubungqina obucacileyo bokuba ichiza ayiloncedo. Kodwa ke, nangona oku, ukusetyenziswa kwayo usaqhubeka. Ngaphambi 1970, baye baphathwa yezigidi ngabafazi. Ubungqina-based amayeza ifuna nje kuphela izinto zokufunda ezifunekayo ngexesha elithile. Ngokuphawulekayo ukutshintsha izenzo zakho kunye nabanye 'ngokusekelwe kulwazi olutsha. iyeza Ubungqina-based inika ezona zinto zifuneka kuqala ukuze uvavanyo Injongo ukusebenza zokungenelela zonyango, kwakunye neziphumo isicelo yayo practice clinical. Kakade ke, oko kungelula, ngenxa yokuba ekufuneni ukuba ubungqina, kwaye usasazo kunye nokwaziswa utshintsho, inokufumaneka zithintelo kwenzeka okoko le nkqubo.

ukuyilwa izimvo

iyeza Ubungqina-based ukuba wonke umntu ehlabathini iyakhula a zejometri ukuqhubela phambili. Ukuqala kunye '90, ixesha nokubunjwa kwayo, yaye namhlanje inani leencwadi, iiforam kunye namaziko kule ndawo kulinganiselwa ngamashumi, kwaye inani iimpapasho - ngamakhulu. Ngowe-1997, 12 amaziko anjalo bafumene izibonelelo iminyaka emi-5 ukusuka Arhente US nkqubo, inzululwazi kunye nempilo. Le mibutho zasekwa kwiiyunivesithi eziphambili kunye namaziko ophando kumazwe ahlukeneyo. Ukwanda inani lamaziko imiba ezizodwa kakhulu ezifana zabantwana kunye nempilo yengqondo, zoncedo lokuqala kunye nakwezinye iindawo. reference jikelele kuzo ukusebenzisa umgaqo ubungqina kuwo onke amazinga kwezigqibo ukusuka uhlobo lwasesidlangalaleni nkqubo kunye nesiphelo kunye nokuqeshwa unyango ngamnye. ERashiya, izithuba edumileyo ibekwe eSt Petersburg eMoscow. Kwakhona phakathi inkxalabo phezulu namayeza kwikliniki olusekelwe kubungqina, Nizhnevartovsk. Iziko ezikhethekileyo uxilongo, yeenkqubo zengqondo, wezifo kunye nomchamo, Andrology izifo nococeko, Move kunye nezifo ENT.

HOA

iyeza Ubungqina-ezisekelwe kwiziphumo Russian Federation nalo olukhula ngokukhawuleza. In Russia kukho Condominiums zoluntu nqila. Kuye ufumene ubhaliso ngo-2003. Society of amayeza olusekelwe kubungqina umbutho ongenzi nzuzo ngokuzithandela. Esebenza phantsi kwale Tshatha. Eyona engundoqo Imisebenzi ye Condominiums:

1. Ukufundisa umsebenzi enxulumene iingxaki methodological izifundo nyhikityha kunye lwezonyango systematics ulwazi entsimini iimpapasho inzululwazi kunye novavanyo analysis data manani.
2. Amehlo abantu iziphumo imifuniselo yezenzululwazi ezisisiseko.
3. Ukuqaliswa inkqubela yezonyango.
4. Uviwo lwe umgangatho iimpapasho zobunzululwazi, iiprotokoli kwizigulane kunye nabanye.
5. Sotsioepidemiologicheskie kunye nophando biomedical.

Imithetho-siseko ye-amalungu Condominiums:

- nokusasazwa kolwazi lophando-based malunga ungenelelo lonyango kunye iinketho yokuqala ekufunyanweni kolunye data ezinjalo;

- eyekela isibhengezo iinkcukacha zomsebenzi, leyo ayikhange angqiniweyo ngokwezenzululwazi;

- isibhengezo ukungangqinelani iimfuno ezikhoyo.

Abasebenzi yombutho oogqirha abo ngqo le migaqo nangoko baze baqalise ukulusebenzisa practice. Ukuza kuthi ga ngoku, kule mimandla United 17 kunye namalungu angekho ngaphezulu kwe-300. INtloko ofisi zesithili unyango lwempilo abaneziqinisekiso kakhulu.

Center for Medicine Ubungqina-Based (Education, 14, eSt Petersburg)

Isebenza iziko kunye yesibhozo kusasa kwada ezisixhenxe ebusuku kwaye imveliso enye, oluba ngeCawa. I Northwest Centre for Medicine Ubungqina-Based inika uluhlu olubanzi lweenkonzo zoluntu. Apho unokufumana iingcebiso kunye nonyango koogqirha obungcali emxinwa, kwathi uxilongo elebhu, Colposcopy, ultrasound, ikhondo umyalezo. Ubungqina-Based Medicine Iziko lwenza ujongo lwamihla le ECG + uxinzelelo lwegazi. Bonke abasebenzi abasebenza kwiziko oogqirha abafanelekayo kakhulu. Ntshona Centre for Medicine Ubungqina-Based ligxininisa izifo ezifana:

- osteochondrosis, okuphinde vertebral Cervicalgia, radiculitis discogenic kunye lumbodynia;

- ucinezelo neuropathy, kobuchopho, nto leyo iliphawu antsi kwi iminwe;

- deforming osteoarthrosis kumanqanaba ahlukeneyo (njenge unyango kusetyenziswa medikametoznye kwafa isicelo hyaluronic acid);

- nokuphazamiseka yezifo le imisipha kunye nemisipha (tendovaginitah, enthesopathies kunye nabanye);

- ngezifo iipilisi ngokudibeneyo, "loza" phezu izithende.

A amaziko ezaziwayo-kakuhle yesibini ka St. Petersburg

Centre for Ubungqina-Based Medicine (uLenin 88) kuqhuba ukususela yesibhozo kusasa kwada ezisibhozo ebusuku. Ukusekwa imi kwisakhiwo zokuhlala kumgangatho wokuqala. izixhobo Modern, inqanaba eliphezulu lenkonzo, iindlela phambili kwesifo - oku uluhlu olupheleleyo yeenzuzo ukuba Centre for Ubungqina-Based Medicine. Izimvo izigulane ezininzi ibonisa ukuba apha undwendwe nganye iya kunikwa ingqalelo eliphezulu. Umbulelo wabonakaliswa umgangatho weenkonzo. Unga ufune uncedo leengcali efana ugqirha kunye gastroenterologist, emine kunye internist, cardiologist wamehlo, endocrinologist, womchamo, njalo njalo. Ikliniki inika iyeza olusekelwe kubungqina kunye uxilongo e-lab, ebambe ultrasound, echocardiography, kalposkopii, massage, electrocardiography. Ugqirha oyintloko yeziko elimisiweyo somdlavuza Beynusov Dmitriy Sergeevich. iziphumo zovavanyo zingafumaneka ngokuthi okanye ezifumene ngeposi. Ukongeza kwiziko lonyango, umsebenzi eengcali kuyasebenza kwakhona esibhedlele wesixeko. thethwano Medical ixabisa 1200 engange.