Ávinningur af auknu aðgengi að upplýsingum

1. Ávinningur af auknu aðgengi að upplýsingum Sigurður Helgason Ritstjóri klínískra leiðbeininga Landlæknisembættinu

2. 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

3. Misvísandi niðurstöður !! Leiðbeiningar Greinar Endurmenntun Sérfræðiálit Textabækur Hver er sannleikurinn?

4. 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.

5. Að byggja á bestu upplýsingum • Getur leitt til: • Gagnsærri ákvörðunartöku • Aukinnar ábyrgðar • rökstuðningur fyrir ákvörðunum verður aðgengilegur • Mats á óvissu • ljóst er hve sönnun er mikil / eða lítil • Notkun vísindaniðurstaðna á kostnað reynslu og hyggjuvits

6. 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

7. Vinna= • Heimildaleit • Elta uppi gögn • Mat á gögnum (Appraisal) • Heimfæra upp á vandamálið Notagildi upplýsinga Relevance x Validity = Vinna

8. -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. Benjamin Rush 1797. Blóðtaka.

9. 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.

10. 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

11. 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

12. EBI • Upplýsingatækni sem stoð til betri heilsu þarf að búa yfir a.m.k þrem eiginleikum: • Aðgengilegt – þægilegt • Réttur tími og staður • Aðgreiningarhæfni • Góðar og réttar upplýsingar eru aðgreindar frá villandi eða ónauðsynlegum upplýsingum • Samtvinnun • Upplýsingar frá mörgum stöðum

14. Proquest 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 MedicinePhiladelphia; Aug 20,2002;Vol. 137, Iss. 4; pg. 225, 7 pgs • WWW.HVAR.IS

16. Medline 1966-okt 2002 Influenza (27731) Economic? and influenza (196) Zanamivir or oseltamivir (352) Economic? and (zanamivir or oseltamivir) (7) • Anonymous. Summaries for patients. Influenza vaccination or antiviral treatment for healthy working adults: an economic analysis. [original report in .]. [Journal Article. Patient Education Handout] Annals of Internal Medicine. 137(4):I22, 2002 Aug 20. • 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. • Calza L. Briganti E. Manfredi R. Chiodo F. [Influenza]. [Review] [48 refs] [Italian] [Historical Article. Journal Article. Review. Review, Tutorial] Recenti Progressi in Medicina. 91(12):657-66, 2000 Dec. • 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.

17. EBM ovid Influenza (1256) Economic? and influenza (12) (neðan) Zanamivir or oseltamivir (57) Economic? and (zanamivir or oseltamivir) (1) (neðan) • EBM Reviews - ACP Journal ClubInfluenza 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 ClubVaccination 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. )

18. HTA - Guidelines http://agatha.york.ac.uk/welcome.htm

19. HTA - Guidelines Influenza (129) 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 voorGeneeskunde 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).

20. 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. • Oseltamivir for the treatment of suspected influenza: a clinical and economic assessment. Husereau D R, Brady B, McGeer A. Ottawa, ON, Canada: Canadian Coordinating Office for Health Technology Assessment 2001: i-89. • 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. • Zanamivir for the treatment of influenza in adults: a systematic review and economic evaluation. Burls A, Clark W, Stewart T, Preston C, Bryan S, Jefferson T, Fry-Smith A. UK NHS National Coordinating Centre for Health Technology Assessment (NCCHTA) 2002: 87. • 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. • Guidance on the use of zanamivir (Relenza) in the treatment ofinfluenza. National Institute for Clinical Excellence. National Institute for Clinical Excellence (NICE) 2000 (Technology Appraisal Guidance - No.15): 12. • Treating influenza by medication - zanamivir - early assessment briefs (ALERT). Swedish Council on Technology Assessment in Health Care. Swedish Council on Technology Assessment in Health Care (SBU) 2000. • 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. • Evidence-based drug reviews: Zanamivir. No noticeable progress against influenza.. . Canadian Family Physician 2000; 46: 2003-2008. • Do neuraminidase inhibitors prevent influenza?. Husereau D R. Canadian Coordinating Office for Health Technology Assessment (CCOHTA) 2001 (Issues in Emerging Health Technologies Issue 27): 4.