Knowledge Translation or KT can be used as

知識轉譯 Knowledge Translation (or KT) can be used as a noun or a verb: it describes either a structured process or the activity that results in scientifically researched evidence being used to improve the outcomes of professional practice. http: //en. wikipedia. org/wiki/Knowledge_translation 台北醫學大學市立萬芳醫院實證醫學中心

實證醫學之知識轉譯地圖 --from bench to bed (“B 2 B” : “ 5 S” , “ 7 A”) 注意到>接受>可行>有能力做>開始做>認同>養成習慣 Unsound Research Aware Accepted Applicable Acted on Agreed Adhered to Sound Research 7 A Systems Summaries Synopses 5 S Syntheses Studies 台北醫學大學Elsevier 市立萬芳醫院 Modify from “Straus et al. : Evidence-based medicine, Ltd. , 實證醫學中心

Evolving role of librarian • Hospital library – Clinical librarian • Academic library – Librarian in university 台北醫學大學市立萬芳醫院實證醫學中心

Clinical librarian Sargeant SJ, Harrison J. Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian. Health Info Libr J. 2004 Sep; 21(3): 173 -81. 台北醫學大學市立萬芳醫院實證醫學中心

Seven main core duties • attendance at ward rounds; • attendance at case conferences; • attendance at other clinical meetings (eg. informal discussions, case conferences; • clinical guideline development; • information searching; • information evaluation; • service promotion. Sargeant SJ, Harrison J. Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian. Health Info Libr J. 2004 Sep; 21(3): 173 -81. 台北醫學大學市立萬芳醫院實證醫學中心

Sargeant SJ, Harrison J. Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian. Health Info Libr J. 2004 Sep; 21(3): 173 -81. 台北醫學大學市立萬芳醫院實證醫學中心

What professional and personal qualities are required to become a Clinical Librarian? • the ability to build and maintain good professional relationships with the clinicians; • willingness to ask questions; • the ability to learn, understand take pleasure in learning; • a natural interest in clinical and scientific issues. Harrison J, Sargeant SJ. Clinical librarianship in the UK: temporary trend or permanent profession? Part II: present challenges and future opportunities. Health Info Libr J. 2004 Dec; 21(4): 220 -6. 台北醫學大學市立萬芳醫院實證醫學中心

Knowledge required for the role of Clinical Librarians was considered to be: • Some (unspecified) knowledge of anatomy and physiology; • origins and meanings of medical terms; • project management; • literature-searching experience; • knowledge of evidence-based practice; • research methods (both quantitative and qualitative); • epidemiology. . Harrison J, Sargeant SJ. Clinical librarianship in the UK: temporary trend or permanent profession? Part II: present challenges and future opportunities. Health Info Libr J. 2004 Dec; 21(4): 220 -6. 台北醫學大學市立萬芳醫院實證醫學中心

Working in the clinical setting? • all of the CLs reported working in ways that could be readily identified as traditional Librarians undertaking all of the following tasks: – – to assist in the development of clinical guidelines; researching previous and existing clinical guidelines; conducting intensive literature searches; creating a database of clinical questions to include examples of clinical questions for which high-grade evidence had been found; – to answer enquiries promptly within an appropriate time frame for the user; – user education and training. Harrison J, Sargeant SJ. Clinical librarianship in the UK: temporary trend or permanent profession? Part II: present challenges and future opportunities. Health Info Libr J. 2004 Dec; 21(4): 220 -6. 台北醫學大學市立萬芳醫院實證醫學中心

Linda Ward, A survey of UK clinical librarianship: February 2004, Health Information and Libraries Journal, 22, pp. 26– 34, 2005 台北醫學大學市立萬芳醫院實證醫學中心

marketing initiatives • Some generalized statements can be derived from data about marketing initiatives: • personal contacts work well, putting a name to a face; • being in the clinical setting, CLs can begin to understand the jargon used; • time is important, both in recognizing that health professionals have limited time (e. g. for drop-in sessions) and also managing the timing of marketing approaches. Linda Ward, A survey of UK clinical librarianship: February 2004, Health Information and Libraries Journal, 22, pp. 26– 34, 2005 台北醫學大學市立萬芳醫院實證醫學中心

Seven main core duties • attendance at ward rounds; • attendance at case conferences; • attendance at other clinical meetings (eg. informal discussions, case conferences; • clinical guideline development; • information searching; • information evaluation; • service promotion. Sargeant SJ, Harrison J. Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian. Health Info Libr J. 2004 Sep; 21(3): 173 -81. 台北醫學大學市立萬芳醫院實證醫學中心

大衛的證據車 Evidence Cart -CEBM - Centre for Evidence Based Medicine Dave Sackett 台北醫學大學市立萬芳醫院實證醫學中心

Seven main core duties • attendance at ward rounds; • attendance at case conferences; • attendance at other clinical meetings (eg. informal discussions, case conferences; • clinical guideline development; • information searching; • information evaluation; • service promotion. Sargeant SJ, Harrison J. Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian. Health Info Libr J. 2004 Sep; 21(3): 173 -81. 台北醫學大學市立萬芳醫院實證醫學中心

seven main core duties • attendance at ward rounds; • attendance at case conferences; • attendance at other clinical meetings (eg. informal discussions, case conferences; • clinical guideline development; • information searching; • information evaluation; • service promotion. Sargeant SJ, Harrison J. Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian. Health Info Libr J. 2004 Sep; 21(3): 173 -81. 台北醫學大學市立萬芳醫院實證醫學中心

Gap 1 實施實證醫學五大步驟 1. 整理出一個可以回答的問題 (Asking an answerable question) 2. 尋找文獻證據 (Tracking down the best evidence) 3. 嚴格評讀文獻 (Critical appraisal ) Gap 2 4. 應用於病人身上 (Integrating the appraisal with clinical expertise & patients’ preference) 5. 對過程進行稽核 (Auditing performance in step 1 -4) 台北醫學大學市立萬芳醫院實證醫學中心

品質鴻溝 2 Quality Gaps Gap 1: Knowledge gap 不知 Gap 2: Knowing-doing gap 知 EBM Step 1, 2, 3 行 EBM Step 4, 5 台北醫學大學市立萬芳醫院實證醫學中心

臨床診療指引（clinical practice guideline） • 「一種系統化製作的陳述，用來幫助臨床作者或是病患，在面臨特定的臨床狀況時，能做出合適的健康照護決策」 – Systemically defined statements to assist practitioner and patient decisions about appropriate health care of specific circumstances. -------Institutes of Medicine, 1990 台北醫學大學市立萬芳醫院實證醫學中心

"practice guideline"[Publication Type] OR "practice guidelines as topic"[Me. SH Terms] OR "practice guideline"[Text Word] 台北醫學大學市立萬芳醫院實證醫學中心

臨床指引的好處Benefits of guidelines 1. 增進品質並降低醫療錯誤 Improve quality and reduce rates of medical error 2. 組織大量的資料Organize massive amounts of data 3. 減少照護時的變數Reduce variations in care 4. 排除浪費Eliminate waste 5. 改善對慢性病的處理 Improve management of chronic disease * What about “patient outcome”? IOM, 1990 台北醫學大學市立萬芳醫院實證醫學中心

臨床診療指引—知識轉譯的橋樑 CPG – the bridge between bench and bed 知識轉譯：一種將”科學研究證據”用以改善”專業執行成果”的活動或固定流程 Knowledge Translation (or KT)(知識轉譯) describes either a structured process or the activity that results in scientifically researched evidence being used to improve the outcomes of professional practice. http: //en. wikipedia. org/wiki/Knowledge_translation 台北醫學大學市立萬芳醫院實證醫學中心

The "5 S" levels of organisation of evidence from healthcare research 精要: 結合於臨床系統結論摘要綜述研究文獻 Brian Haynes, R Evid Based Med 2006; 11: 162 -164 Haynes RB. Of studies, syntheses, synopses, summaries, and systems: the "5 S" evolution of information services for evidence-based healthcare decisions. Evid Based Med. 2006 Dec; 11(6): 162 -4. Copyright © 2006 BMJ Publishing Group Ltd. 台北醫學大學市立萬芳醫院實證醫學中心

http: //www. nhi. gov. tw/webdata/Attach. Files/Attach_613_1_CPG. pdf 台北醫學大學市立萬芳醫院實證醫學中心

Keeping up with the Joneses! Bench Marks from our neighbourhood －example of CPG development 台北醫學大學市立萬芳醫院實證醫學中心

G-I-N 2007 • • 70 organizations from 36 countries 400+ participants 6 plenary sessions Parallel session up to 7 tracks progressing at the same time. 台北醫學大學市立萬芳醫院實證醫學中心

Seven main core duties • attendance at ward rounds; • attendance at case conferences; • attendance at other clinical meetings (eg. informal discussions, case conferences; • clinical guideline development; • information searching; • information evaluation; • service promotion. Sargeant SJ, Harrison J. Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian. Health Info Libr J. 2004 Sep; 21(3): 173 -81. 台北醫學大學市立萬芳醫院實證醫學中心

2 nd step After the discussion Homework: Cubby Review the case on the website Review previous established flow charts 台北醫學大學市立萬芳醫院實證醫學中心 Discuss with the clinician

Clinical bottom line • Pulmonary and peripheral artery catheters need not be routinely replaced more often than every 5– 7 days • Other short-term CVCs and arterial catheters need not be routinely replaced • Safdar N, Kluger DM, Maki DG. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies. Medicine (Baltimore). 2002 Nov; 81(6): 466 -79. 台北醫學大學市立萬芳醫院實證醫學中心

reference • Safdar N, Kluger DM, Maki DG. A review of risk factors for catheter-related bloodstream infection caused by percutaneously inserted, noncuffed central venous catheters: implications for preventive strategies. Medicine (Baltimore). 2002 Nov; 81(6): 466 -79. • Single citation matcher (Pub. Med) 台北醫學大學市立萬芳醫院實證醫學中心

“Doer” or “User” • Doer – Clinical trial (重業) – Systematic review (輕業) – Guideline development • ? % of us are “Users” only. U D 台北醫學大學市立萬芳醫院實證醫學中心

When systematic reviews are not availability clinicians need efficient strategies for identifying relevant research • EBM • Steps ．Answerable Question ．Search ．Appraise • Apply • Time ： 6 minutes • Systematic Review • Steps ． Answerable Question ．Search ++++ ．Appraise × 2 ．Synthesize • Apply • Time ： 6 months 摘錄自Paul Glasziou ‘s lecture, 2006 台北醫學大學市立萬芳醫院實證醫學中心

文獻搜尋 • 一級文獻(primary literature ) • 原始研究(original research ) • 臨床發現(clinical findings) • 二級文獻(secondary literature) – 系統性回顧(systematic reviews) – 統合分析(meta-analyses) – 文獻回顧(reviews of individual articles) • 先找二級文獻再找原著台北醫學大學市立萬芳醫院實證醫學中心

Seven main core duties • attendance at ward rounds; • attendance at case conferences; • attendance at other clinical meetings (eg. informal discussions, case conferences; • clinical guideline development; • information searching; • information evaluation; • service promotion. Sargeant SJ, Harrison J. Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian. Health Info Libr J. 2004 Sep; 21(3): 173 -81. 台北醫學大學市立萬芳醫院實證醫學中心

Six factors influence the uptake of innovations 在設計「基於實證醫學的專業執行」之學習環境時，創新的擴散六要項：（1）相對優勢（relative benefit）（2）複雜性（complexity）（3）可試驗性（trial ability）（4）可觀察性（observability）（5）相容性（compatibility）（6）再發明（reinvention） Rogers EM. Diffusion of Innovations. 5 th ed. New York: Free Press; 2003. 台北醫學大學市立萬芳醫院實證醫學中心

Seven main core duties • attendance at ward rounds; • attendance at case conferences; • attendance at other clinical meetings (eg. informal discussions, case conferences; • clinical guideline development; • information searching; • information evaluation; • service promotion. Sargeant SJ, Harrison J. Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian. Health Info Libr J. 2004 Sep; 21(3): 173 -81. 台北醫學大學市立萬芳醫院實證醫學中心