EVIDENCE-BASED MEDICINE AND HEALTH TECHNOLOGY ASSESSMENT IN THE SCHOOL OF PUBLIC HEALTH

What has been done in 2000

What has been done in 2001

Articles on EBM

Why we start speaking about EBM? (from Russian Family Physician, article is in Russian)

Year 2000

EBM on the Second Summer School

During the Second Summer School around 9 hours of lectures and discussions were devoted to explanations of the basics of EBM and HTA. Principal lecturers were Kjell Asplud (SBU), Sviatoslav Plavinski (MAPS) and Andrej Biskoup (Oblast Cardiological Clinics). Some of their lectures could be found here (all lectures are in Russian or with Russian translation)

S.Plavinski lecture N1 (1 856 Kb) - 35 minutes and N2 (2 086 Kb) - 39 minutes

A.Biskoup lecture (2 040 Kb) - 38 minutes

K.Asplund lecture (1 076 Kb) - 20 minutes (translated by A.Biskoup)

Recording has been made with help of digital recorder and to preserve quality of recording (or better, not deteriorate it further) lectures are placed in the format of this recorder. To listen to them you should obtain copy of the free VoiceIt Player from producer Web-site (http://www.voiceit.com) Size of player - less than 315 Kb.

First course

On January 26 – February 4, 2000 at MAPS first crash courses for faculty on the Evidence-Based Medicine were organized together with SBU (Sweden). The course consisted of two parts first of which was dedicated to the general concept of evidence-based medicine, its links with clinical epidemiology and biostatistics. The second part was taught by prof. E.Johnsson of SBU and consisted of the introduction to the Health Technology Assessment and workshop on articles assessment.

The first part was based on the course taught by the Department of Teaching Skills of MAPS “Informational Competence in the Professional Activity of the Medical Personnell” and aimed at the doctorant students at MAPS. This part of course included:

Unfortunately some important things has been left out of the course, notably

Some of these themes are covered in the aforementioned course, some of them are left for the deep courses in EBM and statistics that will be held at PHS starting from the autumn 2000.

Second part consisted of deep introduction to the Health Technology Assessment followed by a one day critical literature appraisal in the groups. The literature was dedicated to the question of low back pain.

Fig. Prof. Egon Johnsson delivering lecture on the introduction to the EBM

Last day included general discussion of HTA and possible ways of its development at the School of Public Health

Training

During the spring 2000 two trainees from Russia - Andrej Biskoup and Veronika Kolesnik were accepted as trainees at SBU. They were trained in the HTA approaches and systematic review compilation. Details of their experience could be found in the SBU publication "Medical Science and Practice" N2, 2000. (Available from SBU site). Unfortunately, both has decided not take part in the active work on development of HTA at MAPS and as a result their contribution to future development (after the year 2000) has been limited.

During summer time 2000 administration of MAPS has decided to create department that will be responsible for the HTA studies and training. In August regulations stating position of this department at MAPS has been created and in September Scientific Council of MAPS acceded to form this division.

Also in August first systematic review prepared by former SBU trainees has been published in international press: Kolesnik V., Biskop A. Long-term inhibition of platelet aggregation. Lancet 2000, Aug 26;356(9231):768 . During summer time two issues of Russian Family Physician journal dedicated to the questions of Public Health has been published. One of those contained articles by A.Biskoup and S.Plavinski about Health Technology Assessment and Introduction to Evidence-Based Medicine. In the same time at MAPS work has continued on creation of the Information Center for the School of Public Health which should work in close relations with Department of HTA.

In December curriculum for HTA/EBM training has been finalized but due to increased volume of training at MAPS deep course was decided to be conducted at a later time. In the same period, according to the agreement with Nordic School of Public Health it was decided that courses in EBM in framework of BRIMHealth project will be conducted in November 2001 at MAPS. In December, 2000 several seminars on EBM has been organized for young physicians at MAPS.

Year 2001

In 2001 development of HTA/EBM in the School has been was centered mostly on getting recognition for this field and providing training and information on this respect. The lectures and training seminars on use of EBM in clinical medicine and HTA in policy making were:

Report of S.Plavinski "Analytical Hierarchy Process Incorporating Evidence-Based Effect Measures " has been accepted as oral presentation at the 17th Annual ISTAHC Conference, but due to lack of financing has not been presented there.

Apart from that material for EBM implementation and critical appraisal of literature has been presented on courses organized by the Department of Teaching Skills in February and December 2001 (in Russian) and on course for General Practitioners in November 2001.

For the next year course on EBM and HTA has been included in the official (approved by Ministry of Health of Russian Federation) plan of courses at MAPS (Department of Teaching Skills).

Also in framework of EBM/HTA development staff of the Department of HTA at MAPS has started the work on full-scale systematic review and meta-analysis that could be used for training purposes. The theme for this meta-analysis has been selected "Whether hypolipidemic therapy prolong life?". After the search, abstracts of 336 original articles published during the last 26 years in 120 journals, has been analyzed and 78 large studies has been identified which used for treatment different methods from statins to diet. As major outcome measure total mortality has been selected. Analysis was limited to published articles only. The summary analysis used fixed-effect model, statistical analysis performed with help of SAS software (ver. 6.12).This meta-analysis includes also estimation of cost of treatment in Russian and how much each additional life-year will cost for Russian citizen (out-of pocket money)

Two books in Russian - "Introduction to Clinical Decision Analysis" and "Short handbook of meta-analysis" has been published in December 2001.

In September 2001 new acting head for the Department for HTA at MAPS has been appointed (Dr.T.Dubikaitis, MD, MPH). Several candidates for the Department staff are under consideration (including V.Savinova - trained in 2001 in Sweden in general epidemiology). Also general agreement with SBU director, E.Jonsson has been reached that T.Dubikaitis will be trained in SBU next winter (2002).
Department of HTA has been responsible for organization of the BRIMHealth course on EBM and HTA at MAPS in November, 2001. During 2001 much efforts has been put into securing access to EBM resources for trainees at the School of Public Health and MAPS. The information center (set up in 2000 with help of OSI funds) was provided with paid subscription for Cochrane library, International Journal of Medical Practice (Russian-language variant of ACP Journal Club). The subscription for the next year (2001) was also paid. Also means from HTA/EBM grant has been used for purchasing special subscription to the E-library and EBSCO. Also search for free Internet resources has been undertaken (and students are provided with bookmarks to corresponding sites, i.e ACP Journal Club, BMJ, NEJM, JAMA, etc.)
At present information center provides access to:

EBSCO full-text database, including

  1. Business Source Premier
  2. MasterFILE Premier
  3. Newspaper Source
  4. Clinical Reference Systems
  5. Health Source: Consumer Edition
  6. USP DI Volume II, Advice for the Patient
  7. Business Wire News
  8. Academic Search Premier
  9. Health Source: Nursing/Academic Edition

E-library

Full-text database of journals from 31 publishing house (1384 journals total, 45593 issues)

Cochrane Library 2001

International Journal of Medical Practice 1996-2000

Russian Medline 1988-2000

MEDLINE (PubMed, with training)

Free Journals on Internet (and limited access journals):

BMJ, Lancet, NEJM, JAMA, AJPH, ACP Journal Club


In Summer 2001 access to the Internet was dramatically improved (from copper phone cable to ISDN line). As the result download speed increased to 7-8 kB/sec and made on-line work in center comfortable. Starting from the fall 2001 Information Center provides free on-line access to the resources for MAPS faculty and School students. In cases help or training is needed specially trained librarians are working there.
Collaboration with other Russian EBM centers. EBM in Russia is not well developed yet. At present centers exist in St.Petersburg and Moscow. Attempts to organize EBM center are also undertaken in Tcheljabinsk. During 2001 contacts with center in Moscow has been strengthened. Director of the Moscow Center for Evidence-Based Practice has been invited to the HTA/EBM course in St.Petersburg. She has meeting with acting director of the Department of HTA/EBM at MAPS. Oral agreement on coordination of activity has been reached. Also agreement on coordinating activity and on use of St.Petersburg experience has been reached with administration of the Association of University Programs, which coordinates activity of Center for Evidence-Based Practice in Moscow. Staff of the Department of HTA/EBM at MAPS actively participated in development of distance learning materials. Financing of the Department activity (including financing of HTA/EBM course, purchasing subscription to electronic media, books publishing) has been mostly through SEEC grant, purchases of some equipment have been performed with STAKES financial support.

First Deep course

The course has been organized in November under common umbrella of St.Petersburg School of Public Health and Nordic School of Public Health (BRIMHealth project). It was course on evidence-based medicine and health technology assessment. The course was provided in English for students from Norway, Finland, Lithuania, Latvia, Estonia and Russia. Lecturers for the course were from St.Petersburg, Moscow, Sweden, Finland. The course has been supported by SEEC, OSI, STAKES. It is important to note that during those courses not only students were trained, but also faculty of the School as well as opportunities for the preparation of a new themes has been used.

Materials for preparation to the course in English are available here and in Russian here

 

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