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eqimTa informaciuli moTxovnilebebis
dakmayofilebis mcdeloba
Richard Smith,britanuli samedicino Jurnalis
redaqtoriwww.bmj.com/talks
gansaxilveli sakiTxebis nusxa
• ra viciT eqimTa informaciuli moTxovnilebebis Sesaxeb?
• rogor vakmayofilebT Cven am moTxovnilebebs?
• rogor SeiZleba informaciis miwodebis gaumjobeseba?
gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Covell,
1985• sul Sinagan medicinaSi momuSave 47 eqimi,
12 zogadi praqtikis da 35 eqim-specialisti; • TiToeulma maTganma naxevari dRis
ganmavlobaSi gasinja 1-dan 16 avadmyofamde;• konsultaciebis Catarebamde eqimebma
upasuxes daxuruli saxis kiTxvars (A closed questionnaire);
• yoveli konsultaciis Semdeg eqimTan tardeboda interviu im kiTxvebis gamosavlenad, romelic wamoiWra avadmyofis gasinjvisas da romelzedac eqims pasuxi ar moepoveboda.
gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Covell,
1985• eqimebma dasawyisSi ganacxades, rom maT
damatebiTi informacia sWirdebodaT daaxloebiT erTxel kviraSi;
• sinamdvileSi ki 269 kiTxva wamoiWra 409 avadmyofis vizitis dros – daaxloebiT 2 kiTxva 3 avadmyofze; kiTxvebi exeboda:
• specifikuri daavadebebis mkurnalobas – 1/3• diagnozs – 1/4• medikamentebs - 14%
gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Covell,
1985• samedicino saxis informacia - faqti,
romelic rogorc wesi, sadavo ar aris. magaliTad, "ra gverdiTi movlenebia dakavSirebuli bromokriptinis gamoyenebasTan?" – 40%;
• samedicino sakiTxi, romelic rogorc wesi, iwvevs azrTa sxvadasxvaobas. magaliTad, "rogor vumkurnaloT labiluri hipertenziis mqone avadmyofs?" - 45%;
• arasamedicino saxis informacia ("rogor ganvaxorcieloT avadmyofis movla binaze?") – daaxloebiT 15-16%.
gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Covell,
1985
mravali kiTxva Tavisi xasiaTiT iyo ara zogadi, aramed konkretuli.
ara "ra SemTxvevebSia saWiro plazmaSi prokainamidis donis gansazRvra?", aramed "saWiroa Tu ara am konkretul avadmyofSi plazmaSi prokainamidis donis gansazRvra?"
informaciis wyaro eqimTa gancxadebiTa da dakvirvebis mixedviT
informaciis wyaro eqimTa gancxadebiT
dakvirvebis mixedviT
beWdviTi gamocemebi 62 27specialuri an zogadi saxis saxelmZRvaneloebi
25 3
farmacevtuli saxelmZRvaneloebi 14 9samedicino Jurnalebi 18 7medikamentebis Semqmneli kompaniebis mier mowodebuli informacia
1 1
sakuTari Canawerebi 4 7
adamianebi 33 53eqim-specialistebi 18 24zogadi praqtikis eqimebi 1 1sakuTari ofisis TanamSromeli (eqimi)
3 4
farmacevti 6 3sxva 5 21
gamokvleva eqimTa informaciuli moTxovnilebebis
Sesaxeb: Osheroff et al, 1991• pitsburgSi universitetTan arsebuli zogadi
medicinis klinikaSi momuSave 24 eqimi da studenti.
• damkvirvebeli iyo anTropologi. anTropologis mier gakeTebuli Canawerebis safuZvelze zogadi medicinis specialistebma gamoavlines kiTxvebi, romlebic wamoiWra avadmyofTa gasinjvisa da mkurnalobis dros.
• dakvirvebis 17 saaTis ganmavlobaSi stacionarsa da ambulatoriaSi daaxloebiT 90 avadmyofis gamo wamoiWra 519 kiTxva.
gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb: Osheroff et al,
1991
• 454 iyo "mkacrad klinikuri" saxis SekiTxva – saSualod 5 TiToeul avadmyofze;
• 75% exeboda daavadebaTa diagnostikas;
• 60% - specifikur avadmyofebs; • 25% - mkurnalobas;• 16% - medikamentebis
gamoyenebas.
gamokvleva eqimTa informaciuli moTxovnilebebis Sesaxeb:
Forsythe et al, 1992• wina dakvirvebis msgavsi, mxolod 35 saaTis
ganmavlobaSi;• mravali informaciuli saWiroeba ar vlindeba
kiTxvebis saxiT, ufro metic, zogjer saerTod ar xdeba maTi verbalizacia;
• informaciis moZiebasTan dakavSirebuli mesijebis interpretacia xSirad SesaZlebelia mxolod konkretuli situaciis gaTvaliswinebiT;
• eqimebsa da studentebs zogjer sWirdebaT specifikur klinikur informaciaze meti. saqme exeba mxardaWeras, maTi saqmianobis warmarTvasa da dasturs am saqmianobisaTvis.
ramdeni kiTxva wamoiWreba eqimisa da avadmyofis
urTierTobisas? gamo kvl eva
gamokvl evi s Cat ar ebi s adgi l i
gamokvl evi s subieqt i
meTodi
kiTxvebi s saS. r aodenoba er T konsul t aci aze
Covell et al 1985
eqimTa ofi sebi
47 eqimi i nt er viu vi z i t i s
Semdeg
0.66
Timpka et al 1990
j anmr Tel obi s 4 cent r i SveciaSi
12 zogadi pr aqt i ki s eqimi
konsul t aci ebi s videogadaReba
1.85
Osheroff et al 1991
univer si t et Tan ar sebul i zogadi samedi cino kl i ni ka (st aci onar i+ambul at .)
24 eqimi da st udent i
anTr opol ogiur i dakvi r veba
5.77
Ely et al 1992
eqimTa ofi sebi 34 oj axi s
eqimi
dakvi r veba konsul t aci i s dr os
0.07
Gorman et al 1994
eqimTa ofi sebi
49 oj axi s eqimi
i nt er viu vi z i t i s Semdeg
0.57
Guise et al 1994
ambul at or i a Sidsi s avadmyof TaTvi s
7 eqimi - speci al i st i
avad. i st or i aSi gakeT. Canawer ebi s ganxi l va
2.22
eqimTa informaciuli moTxovnilebebis Sesaxeb Catarebuli gamokvlevebidan
gamomdinare daskvnebi• damatebiTi informaciis saWiroeba
warmoiqmneba regularulad roca eqimebi naxuloben avadmyofebs;
• kiTxvebis umravlesoba exeba mkurnalobis sakiTxebs, kerZod medikamentebs;
• kiTxvebi xSirad rTuli da mravalwaxnagovania;• eqimTa moTxovnilebani mxolod informaciiT ar
Semoifargleba. eqimebi eZeben fsiqologiur mxardaWerasa da TanagrZnobas, maT sWirdebaT rCeva, dasturi ama Tu im moqmedebisaTvis, am moqmedebebis gansja-garCeva da azrTa gaziareba.
eqimTa informaciuli moTxovnilebebis Sesaxeb Catarebuli gamokvlevebidan
gamomdinare daskvnebi
• konsultaciebis dros wamoWrili kiTxvebis umravlesoba rCeba upasuxod;
• rogorc Cans, eqimebi yvelaze metad cdiloben TavianT kiTxvebze pasuxi miiRon kolegebisagan;
• kiTxvebis umravlesobas moepoveba pasuxi, magram maTi moZieba did TanxebTan da drois danakargebTanaa dakavSirebuli;
• rogorc Cans, eqimebi waleka informaciis nakadma.
arsebuli problemebi
• gTxovT, ifiqroT yvela im informaciaze, risi gacnobac dagexmarebaT Tqveni movaleobebis ukeTesad SesrulebaSi.
• am informaciis ramdeni procentis wakiTxvas axerxebT?
arsebuli problemebi
gTxovT, ifiqroT im samedicino informaciaze, romelsac Tqven RebulobT da ecadeT es informacia erTi sityviT daaxasiaToT.
41 eqimis mier maTTvis miwodebuli samedicino informaciis
dasaxasiaTeblad gamoyenebuli sityvebi
• SeuZlebeli SeuZlebeli SeuZlebeli SeuZlebeli SeuZlebeli SeuZlebeli
• wamlekavi wamlekavi wamlekavi wamlekavi wamlekavi wamlekavi
• rTuli rTuli rTuli rTuli• SiSis momgvreli SiSis
momgvreli SiSis momgvreli • momabezrebeli• maxrCobela• depresiis gamowvevi• sasowarkveTilebis
gamomwvevi• SemaSfoTebeli• damakmayofilebeli
• usazRvro• damxmare• gamomfitavi• imedgacruebis gamomwvevi• drois didi danakargebiT
mimdinare• Semzaravi• saSineli• brZolasTan asocirebuli• damafrTxobeli• ararealuri• stresis gamomwvevi• gamowveva gamowveva
gamowveva• amaRelvebeli• sasicocxlo mniSvnelobis
mqone
informaciuli paradoqsi
“informaciam eqimebi waleka, magram amasTanave isini ver pouloben sasurvel informacias saWiroebis SemTxvevaSi."
Muir Gray
informaciuli paradoqsi
"wyali, yvelgan wyali da erTi wveTic ara wyurvilis mosaklavad"
antikuri xanis mezRvauris leqsidan
Sexeduleba informaciaze poetis
Tvalsazrisisad aris sibrZne
codnaSi gacvlili?
da TviT codna informaciaSi Cakarguli?
• T S Eliot
gasul kviras ra dro dauTmeT literaturis kiTxvas Tqveni pacientebis
daavadebebTan dakavSirebiT?
kar ier i s et api kiTxvaze saSual od daxar j ul i dr o (wuTebSi )
% vinc ganacxada, r om ar af er i waukiTxavs gasul kvi r as
st udent ebi 90 0
House officers* 0 75
Registrars** 60 40
konsul t ant ebi , r oml ebmac daamTavr es inst i t ut i 1975 wl i s Semdeg
45 30
konsul t ant ebi , r oml ebmac daamTavr es inst i t ut i 1975 wl amde
30 40
bristolSi zogadi praqtikis eqimebis mier samedicino
literaturis kiTxvaze daxarjuli dro
moqmedeba wuTebi
bibl ioTekaSi kiTxva 35
bibl ioTekaSi misvl a da wamosvl a
70
rogoria CamorCena literaturis kiTxvaSi?
• Jurnalebis raodenoba 10 000• axali statiebis raodenoba
yovelkvireulad 40 000• erTi statiis wasakiTxad
saWiro dro 30 wuTi• Tu eqimi mTel dros
kiTxvaSi atarebs, maSin 6 kviris Semdeg ramdeniT CamorCeba igi?
mTeli erTi saukuniT
informaciis sargeblianoba
Sesaferisoba x marTebuloba x urTierTmoqmedeba
sargeblianoba= _____________________________________________informaciis posapoveblad gaweuli
Sroma
informaciis sxvadasxva wyaros sargeblianoba
i nf or maci i s wyar o
Sesaf er i soba
mar Te bul oba
ur Tier T zegavl ena (ur Tier T moqmedeba)
inf or maci i s mosapovebl ad gaweul i Sr oma
sar gebliano ba
saJur nal o st at iebi
dabal i maRal i ar avi Tar i maRal i dabal i
saxel mZRvane l oebi
saSual o saSual o ar avi Tar i saSual o saSual o
kol egebi maRal i saSual o maRal i dabal i maRal i
samedicino JurnalebTan dakavSirebuli problemebi
• am JurnalebSi mocemuli informacia ar akmayofilebs mkiTxvelTa moTxovnilebebs;
• Zalian bevria;• bevri sisulele iwereba;• maTi kiTxva Zalian mZime Sromaa;• araa Sesaferisi;• Zalian mosawyenia;• Zalian Zviria;
samedicino JurnalebTan dakavSirebuli problemebi
• arafer mniSvnelovans ar sZenen mkiTxvels;
• nebismieri saqme gadahyavT nel ritmSi;
• adgili aqvs mikerZoebas;• mravali maTgani mtruladaa
ganwyobili axali azris mimarT;• Zalian cudi Sesaxedavia;• Zalian pompezuria;• orientirebulia istebliSmentze;
samedicino JurnalebTan dakavSirebuli problemebi
• ver swvdeba ganviTarebad samyaros;
• ver umklavdeba siyalbes;• uamravi ganmeorebaa;• ZiriTadad orientirebulia
avtorze da ara mkiTxvelze;• maT aravin ar kiTxulobs.
"klinikuri mtkicebuleba"
• is Seicavs efeqturi jandacvisaTvis saWiro saukeTeso informacias;
• cvlilebebis Setana xdeba yovel 6 TveSi;
• me-3-14 gamocemebze xeli miuwvdeba aSS-Si 500 000 eqims;
• britaneTis erovnuli jandacvis sistemam (NHS) SeiZina 40 000 egzemplari.
"klinikuri mtkicebulebis" damaxasiaTebeli Tvisebebi• "Cven gawvdiT faqtebs, Tqven da Tqvenma
avadmyofebma ki unda miiRoT gadawyvetileba";
• saWirboroto sakiTxebisa Tu kiTxvebis wamoyeneba xdeba TviT eqimebisa da avadmyofebis mier;
• WeSmariti, faqtebze dafuZnebuli meTodologia;
• avlens xarvezebs, faqtebis deficits; • gvawvdis faqtebs ama Tu im Carevis
sargeblisa da zianis Sesaxeb;• arsebobs internetis versia.
panacea, romelic gadagvarCens
• Zalian rTul kiTxvebze pasuxis gacemis unari;
• dakavSirebuli sarwmuno informaciis monacemTa did bazasTan;
• eleqtruli, portatuli, swrafi da advilad gamosayenebeli;
• eqimebisaTvis daxmarebis gawevis SesaZlebloba maTi grZnobebis Seuracxyofis gareSe;
panacea, romelic gadagvarCens
• dakavSirebuli avadmyofis samedicino monacemTa bazasTan;
• daxmareba rogorc avadmyofebisaTvis, aseve eqimTaTvis;
• rogorc fsiqologiuri mxardaWeris, aseve moqmedebebze dasturis micemis SesaZlebloba.
daskvnebi• mravali kiTxva wamoiWreba eqimebis mier
konsultaciebis Catarebisas; • kiTxvaTa umravlesoba rCeba upasuxod;• Cven eqimebs kargad ver vawvdiT saWiro
informacias;• informaciam eqimebi waleka, magram
amasTanave isini ver pouloben sasurvel informacias saWiroebis SemTxvevaSi;
• axali teqnologiebi gvaZlevs SesaZleblobas, rom informacia eqimebs gacilebiT ukeTesad mivawodoT;
• es procesi ar iqneba advili da dakavSirebuli iqneba did TanxebTan da drois danaxarjebTan, aseve igi moiTxovs Cveni azrovnebis Secvlas;
leqciis Sefaseba
Tqveni Sefasebebi Zalian mniSvnelovania superkursis Semdgomi ganviTarebisaTvis. gTxovT SeavsoT leqciis bolo gverdze (review) moyvanili forma da daaWiroT submit button-s. Tu inglisuri ena giqmniT problemas, gamoagzavneT Tqveni komentarebi Semdeg misamarTze: [email protected].