[Random thoughts (ÀÓ»óÁø·áÁöħ)]
ÀÓ»óÁø·áÁöħÀ» ¸¸µå´Â °úÁ¤Àº ±¹°¡¿Í ±â°ü¿¡ µû¶ó Å©°Ô ´Ù¸£´Ù. ¿ì¸®´Â Çѱ¹½ÇÁ¤¿¡ ¸Â´Â ¿ì¸®ÀÇ Áø·áÁöħ °³¹ß¹ýÀ» ¹ßÀü½ÃÄÑ¾ß ÇÑ´Ù. ¿Ü±¹ÀÇ °æÇè¿¡¼ ¹è¿ï Á¡Àº ¹è¿ì°í ¹ö¸± Á¡Àº ¹ö·Á¾ß ÇÑ´Ù. ¸ÕÀú ¾ç ±Ø´Ü¿¡ ÀÖ´Â ¿µ±¹°ú ¹Ì±¹À» ºñ±³Çغ¸ÀÚ.
¿µ±¹Àº ¹Ì±¹°ú ´Ù¸£´Ù. ±¹°¡ÁÖµµ ÀÇ·á½Ã½ºÅÛÀÎ ¿µ±¹¿¡¼´Â ÇàÁ¤°ø¹«¿øÀÇ ¿ªÇÒÀÌ Áß¿äÇÏ´Ù. Áø·áÁöħÀÇ °³¹ßµµ SIGNÀ̳ª NICE¿Í °°Àº ±¹°¡±â°ü¿¡¼ ÁÖµµÇÏ°í ÀÖ´Ù. ƯÁ¤ ºÐ¾ß Àü¹® Àǻ簡 ¾Æ´Ñ °ø¹«¿ø Áß½ÉÀ¸·Î ÁöħÀÌ ¸¸µé¾îÁö´Ùº¸´Ï Àü¹®°¡ÀÇ Àǰߺ¸´Ù´Â ¹ßÇ¥µÈ ¹®ÇåÀ» ü°èÀûÀÎ ¹æ¹ý·Ð(¿¹, GRADE, Cochrane, EBM)À¸·Î ºÐ¼®ÇÏ¿© ±â°èÀûÀ¸·Î Áø·áÁöħÀ» ¸¸µé°í ÀÖ´Ù. Àü¹®°¡ÀÇ ÀÇ°ßÀÌ µé¾î°¥ ¿©Áö°¡ Á¼´Ù. ¹®ÇåÀ¸·Î Á¤¸®µÇÁö ¸øÇÑ »õ·Î¿î Áø´Ü/Ä¡·á¹ýÀÌ Áø·áÁöħ¿¡ ¾ð±ÞµÇ±â ¾î·Æ´Ù. ¿µ±¹ÀÇ Áø·áÁöħÀº Æò±Õ ¼öÁØÀÇ ÀǷḦ ÁöÇâÇÏ°í ÀÖ´Ù. ÀåÁ¡Àº ½Î´Ù´Â °ÍÀÌ´Ù.
¹Ì±¹Àº ¿µ±¹°ú ´Ù¸£´Ù. ¹Î°£ ÀÇ·á½Ã½ºÅÛÀÎ ¹Ì±¹¿¡¼´Â Àǻ簡 Áß½ÉÀÌ´Ù. Áø·áÁöħÀÇ °³¹ßµµ NCCN°ú °°Àº ÀÇ·áÀÎ Áß½ÉÀÇ ±â°ü¿¡¼ ÁÖµµÇÏ°í ÀÖ´Ù. »õ·Î¿î Áø´Ü/Ä¡·á¹ýÀÌ Ã¤ÅõDZ⠾î·Æ´Ù´Â ´ÜÁ¡ÀÌ ÀÖ´Â EBM¿¡ º°·Î ÀÇÁ¸ÇÏÁö ¾Ê´Â´Ù. ÷´ÜÀǷḦ ÁöÇâÇÏ¸é¼ Àü¹®°¡ÀÇ ÀÇ°ßÀÌ °ÇÏ°Ô ¹Ý¿µµÈ ½Ç¿ëÀû Áø·áÁöħÀ» ¸¸µé°í ÀÖ´Ù. ¹®Çå±Ù°Å°¡ ´Ù¼Ò ºÎÁ·ÇÏ´õ¶óµµ Àü¹®°¡µéÀÇ consensus°¡ ÀÖ´Â »õ·Î¿î Áø´Ü/Ä¡·á¹ýÀº °·ÂÈ÷ ¹Ð°í ÀÖ´Ù. ¹Ì±¹ÀÇ Áø·áÁöħÀº ÷´ÜÀǷḦ ÁöÇâÇÏ°í ÀÖ´Ù. ´ÜÁ¡Àº ºñ½Î´Ù´Â °ÍÀÌ´Ù.
¿ì¸®´Â ¾î¶² Àü·«À» ÃëÇØ¾ß ÇÒ °ÍÀΰ¡?
[°¢±¹ÀÇ ÇöȲ]
1. ¹Ì±¹: US Department of Health & Human Services »êÇÏ AHRQ (Agency for Healthcare and Research and Quality)¿¡¼ Áø·áÁöħ º¸±Þ ¹× È®»êÀ» À§ÇÏ¿© National Guideline Clearinghouse¶ó´Â website¸¦ ¿î¿ëÇÏ°í ÀÖÀ½
2. ¿µ±¹: DH (Department of Health) »êÇÏ NICE (National Institute for Health and Clinical Excellence)¿¡¼ °³¹ßÇÏ¿© º¸±Þ. Royal College of PhysiciansÀÇ NCGC (National Clinical Guideline Centre)¿¡¼ Áø·áÁöħ °³¹ß¿¡ °ü¿©ÇÔ.
3. Scotland: SIGN (Scottish Intercollegiate Guidelines Network)¿¡¼ °³¹ßÇÏ¿© º¸±Þ.
¼ö¿ë°³¹ß°ú de novo °³¹ß
2011³â 8¿ù 29ÀÏ GIN 2011¿¡¼ 'Guidance in the abscence of evidence: what can - and cannot - be done?'À̶ó´Â Á¦¸ñÀÇ plenary sessionÀÌ ÀÖ¾ú´Ù. È£ÁÖ Bond ´ëÇÐÀÇ Paul Glasziou°¡ 'When are randomized trials not needed?'¶ó´Â Á¦¸ñÀÇ ¹ßÇ¥¸¦ ÇÏ¿´´Ù. ±× °á·ÐÀº ÀÌ·¸´Ù.
1. RCTs are necessary for small effects.
2. RCTs are unnecessary to demonstrate dramatic effects of treatment.
3. Is the observed effect greater than plausible biases?
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