MAKING EVIDENCE ACCESSIBLE IN REMOTE AREAS OF BRAZIL Prof. Dr. Álvaro Nagib Atallah Director  Brazilian Cochrane Centre Ch...
BRAZIL  <ul><li>300.000 MDs </li></ul><ul><li>2,5 Millions of Health Professionals </li></ul><ul><li>184.000.000 Inhabitan...
Tarsila do Amaral - Abapuru
Van Gogh – Sunflowers
BRAZILIAN COCHRANE CENTRE
BRAZILIAN   COCHRANE CENTRE   <ul><li>11 YEARS </li></ul><ul><li>METHODS AND COCHRANE EVIDENCES TEACHING AND DISSEMINATION...
COCHRANE CENTRE   UNIVESIDADE FEDERAL    DE SÃO PAULO - UNIFESP <ul><li>FEATURES  </li></ul><ul><li>GRADUATION  </li></ul>...
http://www.centrocochranedobrasil.org.br/pgmit/linhas.htm MASTER DEGREE / PHD
http://www.centrocochranedobrasil.org.br/pgmit/linhas.htm MASTER DEGREE / PHD <ul><li>RESEARCH AREAS </li></ul><ul><li>Met...
http://www.centrocochranedobrasil.org.br/pgmit/linhas.htm <ul><li>RESEARCH AREAS </li></ul><ul><li>Efficiency  of diagnost...
MASTER DEGREE  EFECTIVENESS EFICIENCY SAFETY - EVIDENCE BASED HEALTH EVALUATION INSIDE BRAZILIAN MINISTRY OF HEALTH http:/...
MASTER DEGREE  EFECTIVENESS EFFICIENCY SAFETY - EVIDENCE BASED HEALTH EVALUATION INSIDE BRAZILIAN MINISTRY OF HEALTH http:...
POS-GRADUATED HEALTH PROFESSIONALS 1998 À 2007 124 PGS  30 PHD  94 MASTER DEGREE
DISTRIBUITION OF POSTGRADUATE  ACCORDING TO BRAZILIAN REGIONS 19 1 73 5 9 3 1 NORTH NORTHEAST CENTER SOUTH SOUTHEAST
REGULAR MEDICAL GRADUATION COURSE <ul><li>REGULAR COURSE </li></ul><ul><li>EVIDENCE BASED EMERGENCY MEDICINE  - PROBLEM BA...
MAPPING EVIDENCE BASED MEDICINE TEACHING AS PART CURRICULUM OF MEDICAL SCHOOLS IN BRAZIL – MD THESIS 3 3 1 3 1 6 3 3 Twent...
ONLINE COURSE SYSTEMATIC REVIEWS   Number of Accesses   90.240
ONLINE COURSE SYSTEMATIC REVIEWS http://www.virtual.epm.br/cursos/metanalise/
COCHRANE LIBRARY FOR FREE 1998 – PAHOS / CAPES   http://cochrane.bvsalud.org/portal/php/index.php?lang=pt
<ul><li>1,000,000 ACCESS PER YEAR  CENTRAL SOUTH AMERICA ABOUT 600,000 FROM BRAZIL </li></ul>
APM ON TV ~      1000 Shows
PRIME TIME  OPEN CHANNEL  NATIONAL BROADCAST TELEVISION PROGRAM  EVIDENCE BASED  MEDICINE APM ON  TV
<ul><li>Format Talk Show: </li></ul><ul><li>Features </li></ul><ul><li>Continous Medical Education </li></ul><ul><li>Invit...
<ul><li>EBM Training  MD Interviewer </li></ul><ul><li>References written on video  </li></ul><ul><li>Prohibition of comme...
<ul><li>Foto do pantanal  </li></ul>
Evaluation of the Audience <ul><ul><li>95% rank excellent or good  </li></ul></ul><ul><ul><li>n = 2005 doctors </li></ul><...
1995 - 2005
APM ON TV EVIDENCE BASED MEDICINE <ul><li>TRANSMISSION </li></ul><ul><li>SATURDAY  and SUNDAY 21h to 22h </li></ul><ul><li...
APM ON TV EVIDENCE BASED MEDICINE <ul><li>TRANSMISSION </li></ul><ul><li>SATURDAY  and SUNDAY 21h às 22h </li></ul><ul><li...
EVIDENCE BASED MEDICINE  TV SHOW  <ul><li>CONTINUOUS MEDICAL EDUCATION AT HOME </li></ul><ul><li>(Programs  can be purchas...
APM SCIENTIFIC  Videotec  50 Cities
Distribuition Centers of DVD’s
HISTORY OF THE PROGRAM <ul><li>BRAZILIAN COCHRANE CENTRE/ ASSOCIAÇÃO PAULISTA DE MEDICINA </li></ul><ul><li>1995- 2005 </l...
THE PROGRAM <ul><li>EACH THEME:  </li></ul><ul><li>PRESENTED FOR  25min; </li></ul><ul><li>COMMENTED FOR  20 min BY A SPEC...
VÍDEO
THEMES  <ul><li>ANESTESIOLOGY </li></ul><ul><li>SURGERY </li></ul><ul><li>CLINICAL MEDICINE </li></ul><ul><li>GINECOLOGY  ...
THE LANCET – Vol..352 . August 8, 1998
DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH 2006-2008   SÍRIO LIBANÊS HOSPITAL BRAZILIAN COCHRANE CENTRE NATIONAL HEALTH ...
DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH   <ul><li>TWO TECHNOLOGIES : </li></ul><ul><li>MULTIPOINT VIDEOCONFERENCING S...
DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH 2006   <ul><li>5 Brazilian cities: </li></ul><ul><li>(Belém, Manaus, Natal, F...
DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH 2007 http://www.hospitalsiriolibanes.org.br/iep/ensino/telemedicina_educacao....
EVIDENCE-BASED HEALTH CARE ANVISA’S NATIONAL NETWORKS OF 90 REGIONAL HOSPITALS  USE OF MEDICATION NETWORK EVIDENCE-BASED H...
 
 
 
 
 
 
 
 
DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH <ul><li>VIDEOCOFERENCE- VC </li></ul><ul><li>VIDEOSTREAMING - VS </li></ul>
DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH <ul><li>Beginning 02/08/2007 to 31/07/2008 </li></ul><ul><li>50 Tutors – 1 Tu...
DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH <ul><li>37 classes emphasizing Systematic Reviews – Cochrane Library – Clinic...
DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH
MAP WITH DISTRIBUTION OF 90 HOSPITALS PER BRAZLIAN REGION NORTH NORTHEST CENTER SOUTHEAST SOUTH 9 30 8 25 18
DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH NATIONAL REACH 1900 PARTICIPANTS 23 STATES 12  INSTITUTIONS VC 78 INSTITUTION...
DISTRIBUTION OF STUDENTS PER STATE
1401 PARTICIPANTS FEMALE MALE
1401 PARTICIPANTS PROFESSION NURSES 454 PHARMACYSTS 283 DOCTORS 207 PHYSICAL THERAPITS 59 SOCIAL WORKER 33 NUTRICIONISTS 3...
FREQUENCY OF PARTICIPANTS  IN CLASS DATE FREQUENCY 2/8/07 93% 9/8/07 86% 16/8/07 87% 23/8/07 87% 30/8/07 86% 6/9/07 88% 13...
RESULTS OF POLL 18/10/2007 LIVE <ul><li>352 PARTICIPANTS </li></ul><ul><li>32 INSTITUTIONS </li></ul><ul><li>(58 POINTS TO...
excellent good regular bad
Excellent good regular bad
Excellent Good Regular
Excellent Good Regular
 
 
 
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Making evidence accessible in remote areas of Brazil

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Alvaro Atallah speaking at plenary session 4 at the XV Cochrane Colloquium in Sao Paulo, Brasil

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Making evidence accessible in remote areas of Brazil

  1. 1. MAKING EVIDENCE ACCESSIBLE IN REMOTE AREAS OF BRAZIL Prof. Dr. Álvaro Nagib Atallah Director Brazilian Cochrane Centre Chief Professor Emmergency and Evidence Based Medicine UNIFESP/EPM.
  2. 2. BRAZIL <ul><li>300.000 MDs </li></ul><ul><li>2,5 Millions of Health Professionals </li></ul><ul><li>184.000.000 Inhabitants </li></ul>
  3. 3. Tarsila do Amaral - Abapuru
  4. 4. Van Gogh – Sunflowers
  5. 5. BRAZILIAN COCHRANE CENTRE
  6. 6. BRAZILIAN COCHRANE CENTRE <ul><li>11 YEARS </li></ul><ul><li>METHODS AND COCHRANE EVIDENCES TEACHING AND DISSEMINATION </li></ul>
  7. 7. COCHRANE CENTRE UNIVESIDADE FEDERAL DE SÃO PAULO - UNIFESP <ul><li>FEATURES </li></ul><ul><li>GRADUATION </li></ul><ul><li>POS-GRADUATION </li></ul><ul><li>AND RESIDENCE PROGRAMS CLINICAL RESEARCH METHODOLOGY AND EBM </li></ul>            
  8. 8. http://www.centrocochranedobrasil.org.br/pgmit/linhas.htm MASTER DEGREE / PHD
  9. 9. http://www.centrocochranedobrasil.org.br/pgmit/linhas.htm MASTER DEGREE / PHD <ul><li>RESEARCH AREAS </li></ul><ul><li>Methodology for systematic review in health therapy; </li></ul><ul><li>Prevention and treatment of hypertensive disorders in pregnancy </li></ul><ul><li>EBM implementation methodology; </li></ul>
  10. 10. http://www.centrocochranedobrasil.org.br/pgmit/linhas.htm <ul><li>RESEARCH AREAS </li></ul><ul><li>Efficiency of diagnostics tests </li></ul><ul><li>and therapeutics; </li></ul><ul><li>Sleep disorders; </li></ul><ul><li>RCTS; </li></ul><ul><li> </li></ul>MASTER DEGREE / PHD
  11. 11. MASTER DEGREE EFECTIVENESS EFICIENCY SAFETY - EVIDENCE BASED HEALTH EVALUATION INSIDE BRAZILIAN MINISTRY OF HEALTH http://www.centrocochranedobrasil.org.br/mestradoProfissional/
  12. 12. MASTER DEGREE EFECTIVENESS EFFICIENCY SAFETY - EVIDENCE BASED HEALTH EVALUATION INSIDE BRAZILIAN MINISTRY OF HEALTH http://www.centrocochranedobrasil.org.br/mestradoProfissional/
  13. 13. POS-GRADUATED HEALTH PROFESSIONALS 1998 À 2007 124 PGS 30 PHD 94 MASTER DEGREE
  14. 14. DISTRIBUITION OF POSTGRADUATE ACCORDING TO BRAZILIAN REGIONS 19 1 73 5 9 3 1 NORTH NORTHEAST CENTER SOUTH SOUTHEAST
  15. 15. REGULAR MEDICAL GRADUATION COURSE <ul><li>REGULAR COURSE </li></ul><ul><li>EVIDENCE BASED EMERGENCY MEDICINE - PROBLEM BASED LEARNING STRATEGY </li></ul>
  16. 16. MAPPING EVIDENCE BASED MEDICINE TEACHING AS PART CURRICULUM OF MEDICAL SCHOOLS IN BRAZIL – MD THESIS 3 3 1 3 1 6 3 3 Twenty Tree Medical SCHOOLS NORTH CENTER SOUTH SOUTHEAST NORTHEAST
  17. 17. ONLINE COURSE SYSTEMATIC REVIEWS Number of Accesses 90.240
  18. 18. ONLINE COURSE SYSTEMATIC REVIEWS http://www.virtual.epm.br/cursos/metanalise/
  19. 19. COCHRANE LIBRARY FOR FREE 1998 – PAHOS / CAPES http://cochrane.bvsalud.org/portal/php/index.php?lang=pt
  20. 20. <ul><li>1,000,000 ACCESS PER YEAR CENTRAL SOUTH AMERICA ABOUT 600,000 FROM BRAZIL </li></ul>
  21. 21. APM ON TV ~  1000 Shows
  22. 22. PRIME TIME OPEN CHANNEL NATIONAL BROADCAST TELEVISION PROGRAM EVIDENCE BASED MEDICINE APM ON TV
  23. 23. <ul><li>Format Talk Show: </li></ul><ul><li>Features </li></ul><ul><li>Continous Medical Education </li></ul><ul><li>Invited participants Opinion Leader Faculties </li></ul><ul><li>Agreement : express evidence based statements </li></ul>
  24. 24. <ul><li>EBM Training MD Interviewer </li></ul><ul><li>References written on video </li></ul><ul><li>Prohibition of commercials about Tobacco, Drugs, Health Care Companies during the show </li></ul>
  25. 25. <ul><li>Foto do pantanal </li></ul>
  26. 26. Evaluation of the Audience <ul><ul><li>95% rank excellent or good </li></ul></ul><ul><ul><li>n = 2005 doctors </li></ul></ul>
  27. 27. 1995 - 2005
  28. 28. APM ON TV EVIDENCE BASED MEDICINE <ul><li>TRANSMISSION </li></ul><ul><li>SATURDAY and SUNDAY 21h to 22h </li></ul><ul><li>REDE MULHER DE TELEVISÃO </li></ul><ul><li>REDE VIDA </li></ul><ul><li>TV ASSEMBLÉIA </li></ul>
  29. 29. APM ON TV EVIDENCE BASED MEDICINE <ul><li>TRANSMISSION </li></ul><ul><li>SATURDAY and SUNDAY 21h às 22h </li></ul><ul><li>Canal 42 UHF </li></ul><ul><li>NET </li></ul><ul><li>TVA </li></ul><ul><li>Parabolic (Brazil e Mercosul) </li></ul><ul><li>12 millions antennas </li></ul>
  30. 30. EVIDENCE BASED MEDICINE TV SHOW <ul><li>CONTINUOUS MEDICAL EDUCATION AT HOME </li></ul><ul><li>(Programs can be purchased or rented at – Videoteca APM) </li></ul><ul><li>http://www.apm.org.br </li></ul>
  31. 31. APM SCIENTIFIC Videotec 50 Cities
  32. 32. Distribuition Centers of DVD’s
  33. 33. HISTORY OF THE PROGRAM <ul><li>BRAZILIAN COCHRANE CENTRE/ ASSOCIAÇÃO PAULISTA DE MEDICINA </li></ul><ul><li>1995- 2005 </li></ul><ul><li>1000 PROGRAMS TRANSMITED AND RECORDED </li></ul><ul><li>86 CHIEF PROFESSORS </li></ul><ul><li>1 a 2.000.000 MILLIONS SPECTATORS </li></ul><ul><li>79% BRAZILIAN DOCTORS AND PART OF PARAGUAY AND BOLIVIA WITH ACCESS TO PROGRAM </li></ul>
  34. 34. THE PROGRAM <ul><li>EACH THEME: </li></ul><ul><li>PRESENTED FOR 25min; </li></ul><ul><li>COMMENTED FOR 20 min BY A SPECIALIST </li></ul><ul><li>ANSWERS QUESTIONS FOR 15 min </li></ul>
  35. 35. VÍDEO
  36. 36. THEMES <ul><li>ANESTESIOLOGY </li></ul><ul><li>SURGERY </li></ul><ul><li>CLINICAL MEDICINE </li></ul><ul><li>GINECOLOGY AND OBSTETRICS </li></ul><ul><li>NEUROLOGY </li></ul><ul><li>EVIDENCE BASED MEDICINE </li></ul><ul><li>PEDIATRIC </li></ul><ul><li>PSICHIATRY </li></ul><ul><li>GENERAL THEMES </li></ul><ul><li>INSTITUCIONALS </li></ul>
  37. 37. THE LANCET – Vol..352 . August 8, 1998
  38. 38. DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH 2006-2008 SÍRIO LIBANÊS HOSPITAL BRAZILIAN COCHRANE CENTRE NATIONAL HEALTH SURVEILLANCE AGENCY - ANVISA
  39. 39. DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH <ul><li>TWO TECHNOLOGIES : </li></ul><ul><li>MULTIPOINT VIDEOCONFERENCING SYSTEM </li></ul><ul><li>INTERNET ACCESS </li></ul>
  40. 40. DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH 2006 <ul><li>5 Brazilian cities: </li></ul><ul><li>(Belém, Manaus, Natal, Fortaleza and Cuiabá) </li></ul><ul><li>180 ANVISA health Professionals in activity </li></ul>
  41. 41. DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH 2007 http://www.hospitalsiriolibanes.org.br/iep/ensino/telemedicina_educacao.asp
  42. 42. EVIDENCE-BASED HEALTH CARE ANVISA’S NATIONAL NETWORKS OF 90 REGIONAL HOSPITALS USE OF MEDICATION NETWORK EVIDENCE-BASED HEALTH CARE COURSE IN 2007:
  43. 51. DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH <ul><li>VIDEOCOFERENCE- VC </li></ul><ul><li>VIDEOSTREAMING - VS </li></ul>
  44. 52. DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH <ul><li>Beginning 02/08/2007 to 31/07/2008 </li></ul><ul><li>50 Tutors – 1 Tutor per 40 Participants </li></ul><ul><li>1900 Health Professionals </li></ul><ul><li>90 Hospitals of ANVISA`s sentinel network for the rational use of medications </li></ul>
  45. 53. DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH <ul><li>37 classes emphasizing Systematic Reviews – Cochrane Library – Clinical Research Methodology and Critical Appraisal - HTA </li></ul><ul><li>2 hours each </li></ul><ul><li>20 minutes questions per video- </li></ul><ul><li>conference </li></ul><ul><li>Weekly forum with 50 tutors </li></ul><ul><li>Exam at the end of each module </li></ul>
  46. 54. DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH
  47. 55. MAP WITH DISTRIBUTION OF 90 HOSPITALS PER BRAZLIAN REGION NORTH NORTHEST CENTER SOUTHEAST SOUTH 9 30 8 25 18
  48. 56. DISTANCE EDUCATION FOR EVIDENCE-BASED HEALTH NATIONAL REACH 1900 PARTICIPANTS 23 STATES 12 INSTITUTIONS VC 78 INSTITUTIONS WWW 148 HOURS
  49. 57. DISTRIBUTION OF STUDENTS PER STATE
  50. 58. 1401 PARTICIPANTS FEMALE MALE
  51. 59. 1401 PARTICIPANTS PROFESSION NURSES 454 PHARMACYSTS 283 DOCTORS 207 PHYSICAL THERAPITS 59 SOCIAL WORKER 33 NUTRICIONISTS 30 BIOLOGIST, BIOMEDIC, PHONOAUDIOLOGISTO, ADMINISTRATOR, ENGINEER 159 NO INFORMATION 176
  52. 60. FREQUENCY OF PARTICIPANTS IN CLASS DATE FREQUENCY 2/8/07 93% 9/8/07 86% 16/8/07 87% 23/8/07 87% 30/8/07 86% 6/9/07 88% 13/9/07 84% 20/9/07 82% 27/9/07 87% 4/10/07 81% 11/10/07 76%
  53. 61. RESULTS OF POLL 18/10/2007 LIVE <ul><li>352 PARTICIPANTS </li></ul><ul><li>32 INSTITUTIONS </li></ul><ul><li>(58 POINTS TOTAL) </li></ul>
  54. 62. excellent good regular bad
  55. 63. Excellent good regular bad
  56. 64. Excellent Good Regular
  57. 65. Excellent Good Regular

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