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?

raze metyveleben eqimTa informaciul moTxovnilebebze

Catarebuli gamokvlevebi?

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.

rogor vakmayofilebT Cven eqimTa informaciul

moTxovnilebebs?

arsebuli problemebi

• gTxovT, ifiqroT yvela im informaciaze, risi gacnobac dagexmarebaT Tqveni movaleobebis ukeTesad SesrulebaSi.

• am informaciis ramdeni procentis wakiTxvas axerxebT?

9%

40% 40%

10%1%

waki Txul i s mocul oba

eqim

Ta r

aod.

pr

ocen

tebS

i

Tavs gr ZnobT damnaSaved i mi s gamo, r om cot as

ki Txul obT?

di ax

ar a

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.

rogor gavaumjobesoT eqimebisaTvis

informaciis miwodebis procesi?

sistemebi

sinTezi

sinopsi

gamokvlevebi

"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: malkhaz_j@hotmail.com.