7/14/2015

Thng tin thuc

PGS. TS. Nguyn Ngc Khi
BM. Dc lm sng, Khoa Dc
H Y Dc TP. H Ch Minh

Mc tiu

1. Trnh by c ngha ca vic cung cp thng tin thuc

2. Phn loi c cc cp thng tin
3. Trnh by c cc ngun thng tin cp 3 chnh
4. p dng c cch tm thng tin thuc

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Ni dung

1.

ngha ca vic cung cp thng tin thuc

2.

Phn loi thng tin thuc

3.

Cc ngun thng tin thuc

4.

Chin lc tm thng tin thuc

5.

Cc k nng thng tin thuc

ngha ca thng tin thuc

H tr cho cng tc lm sng
Tr li cc cu hi lin quan n:

Hng dn s dng thuc

Xy dng phc

Hot ng ca Hi ng thuc v iu tr

Chnh sch s dng thuc

La chn dng thuc s dng ph hp

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ngha ca thng tin thuc

Xut bn (tp ch, thng tin trn website)
Gio dc / ging dy

Hc vin cc ngnh y dc

Ngi tiu dng / bnh nhn

Tham gia vo kim sot cc hot ng iu tr

nh gi iu tr

Thng tin cho y, bc s

Phn loi thng tin thuc

Theo ni dung:
1.

Danh php & xc nh

2.

Cch s dng trong iu tr

3.

Tc dng khng mong mun

4.

Thng mi & Kinh t

5.

Quy ch

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Phn loi thng tin thuc

Danh php & xc nh

Tn ca mt loi thuc

Tn ng ngha v m ca mt loi thuc

Thnh phn ha hc v tnh cht vt l

Cc thuc c cu trc ha hc /tc ng tng t

Phn loi thng tin thuc

Cch s dng trong iu tr

Cc khuyn co iu tr ca thuc

C ch tc ng

Liu lng khuyn co v ng s dng

Hp thu, phn phi, chuyn ha v thi tr (ADME)

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Phn loi thng tin thuc

Tc dng khng mong mun

Tc dng ph

Tng tc:

Thuc / thuc
Thuc / Thc phm
Thuc / Dc liu

Kh nng gy c

Chng ch nh

Kh nng gy qui thai

9

Phn loi thng tin thuc

Thng mi & Kinh t

Gi thuc

Doanh s thuc

Cc cng ty phn phi thuc

Cc nh sn xut

Cc hiu thuc

Cc loi thuc c ghi nhiu nht

10

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Phn loi thng tin thuc

Quy ch

Qu trnh ph duyt thuc

Cc nc chp thun s dng

Hn ch / cm vic s dng

11

Phn loi thng tin thuc

Theo tnh cht:

C bn (background)

Vn ni cm

(foreground)

12

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Phn loi thng tin thuc

C bn (background)

Cu hi trong phm vi rng

Cu tr li l kin thc tng qut

C th c gii quyt tt vi cc ngun ti liu cp

ba

Vd: A l thuc c lu hnh M hay khng?

C ch tc ng ca thuc l g?
Chng ch nh ca thuc A?
13

Phn loi thng tin thuc

Vn ni cm (foreground)

Cu hi trong phm vi hp

Cu tr li i hi kim tra mc chng c mi hoc

cc vn cn mu thun

C th c gii quyt tt vi cc ngun ti liu cp

mt v cp hai

Vd: Hiu qu ca thuc mi so vi cc thuc c?

Vic s dng off-label ca mt thuc?
14

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Cc ngun thng tin thuc

Tp ch

Sch

u im?

Nhc im?

tin cy?

Internet

15

Cc ngun thng tin thuc

Ngun thng tin

Cp 1 (Primary Resource)

Cp 2 (Secondary Resource)

Cp 3 (Tertiary Resource)

16

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Cc ngun thng tin thuc

Ngun thng tin cp 1 (Primary Resource)

Cc tp ch khoa hc

Cung cp cc nghin cu c bn hoc bo co

V d: Th nghim lm sng, bo co hng lot ca/ 1 ca

Ph hp tr li v cc vn ni cm

Phm vi hp

Tt d liu mi hoc cng b mi

17

Cc ngun thng tin thuc

Ngun thng tin cp 1 (Primary Resource)

18

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Cc ngun thng tin thuc

Ngun thng tin cp 1 (Primary Resource)
u im:

Hu ht l cc bng chng hin ti

Cung cp d liu v loi thuc mi

Tng c nhn c th nh gi tnh gi tr ca nghin cu

19

Cc ngun thng tin thuc

Ngun thng tin cp 1 (Primary Resource)
Nhc im:

Phm vi gii hn

D liu t hay gy cn tranh lun

Nghin cu u c nhng hn ch

Qu phc tp cho bnh nhn

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Cc ngun thng tin thuc

Ngun thng tin cp 2 (Secondary Resource)

http://www.ncbi.nlm.nih.gov/pubmed/

http://www.cochrane.org/

http://www.tripdatabase.com/

21

Cc ngun thng tin thuc

Ngun thng tin cp 2 (Secondary Resource)

Tm kim vi t kha abiraterone

ngy 29-6-2011 cho 110 kt qu
ngy 15-9-2014 cho 592 kt qu
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Cc ngun thng tin thuc

Ngun thng tin cp 2 (Secondary Resource)

Th mc c s d liu cung cp tm tt
hoc ton vn cc nghin cu

Ph hp tr li v cc vn ni cm

23

Cc ngun thng tin thuc

Ngun thng tin cp 2 (Secondary Resource)
u im:

C th tm kim tm thng tin v mt vn c th c h

thng

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12

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Cc ngun thng tin thuc

Ngun thng tin cp 2 (Secondary Resource)
Nhc im:

Thng i hi chuyn mn nhiu hn s dng ngun

ti liu ny

Chn lc ti liu tham kho

Theo di ngun ti liu trc khi tm kim cu tr li

Qu phc tp cho bnh nhn

25

Cc ngun thng tin thuc

Ngun thng tin cp 3 (Tertiary Resource)

http://www.uptodate.com/index

http://www.lexi.com/

Sch tham kho

http://www.micromedex.com/

26

13

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Cc ngun thng tin thuc

Ngun thng tin cp 3 (Tertiary Resource)
Sch chuyn kho, sch tham kho, cc chuyn lun
online

Tp hp kin thc trong lnh vc ny

Ph hp tr li v cc vn c bn

Phm vi rng
27

Cc ngun thng tin thuc

Ngun thng tin cp 3 (Tertiary Resource)
u im:

Cung cp thng tin ton din

Thng tin phn nh quan im ca nhiu chuyn gia

trong lnh vc

Nhanh chng, d s dng cho bnh nhn

28

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Cc ngun thng tin thuc

Ngun thng tin cp 3 (Tertiary Resource)
Nhc im:

Thng thng thng tin chm t nht 2 nm do phi qua

khu bin tp v xut bn

Ph thuc nhiu vo cch gii thch ca tc gi **

** Dc s c th khc phc iu ny bng cch

tham kho t nht hai ngun thng tin cp 3
29

Cc ngun thng tin thuc

Primary
Resources

JAPhA
JAMA
Pharmacotherapy
New England Journal of Medicine
Annals of Internal Medicine
AJHP

Secondary
Resources

PubMed/Ovid MEDLINE
Cochrane Database of Systematic Reviews
DARE
TRIP
National Guideline Clearinghouse

Tertiary
Resources

Access Pharmacy
UpToDate
Drug Facts and Comparisons
Epocrates
Lexi-Comp
Micromedex
Clinical Pharmacology
30

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Cc ngun thng tin thuc

Ngun thng tin cp mt
(cc bi bo nghin cu, bo co)
Cp nht

Ngun thng tin cp hai

(danh mc, tm tt)

Ngun thng tin cp ba

(sch, chuyn lun)

D c, tip cn
tr v thng tin
31

Chin lc tm thng tin thuc

Cch tip cn / tr li mt cu hi
Bc I. c im ca ngi yu cu
Bc II. Thng tin c bn (tn, tui)
Bc III. Xc nh v phn loi cu hi chnh

Bc IV. Pht trin chin lc v tin hnh tm kim

Bc V. Thc hin nh gi, phn tch v tng hp
Bc VI. Xy dng v cung cp cu tr li
Bc VII. Tin hnh theo di v lu ti liu
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Chin lc tm thng tin thuc

Chin lc tm kim
Chin lc tt nht l thng xuyn tham kho cc ngun ti liu
theo th t sau

Ngun thng tin cp 3 (Tertiary Resource)

Ngun thng tin cp 2 (Secondary Resource)

Ngun thng tin cp 1 (Primary Resource)

33

Chin lc tm thng tin thuc

Chin lc tm kim
Ngun thng tin cp 3

Tr li cho mt cu hi l kin thc c bn

Vn c nghin cu rng ri v kt lun

Nhiu chuyn gia ng vi cu tr li

34

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Chin lc tm thng tin thuc

Danh php & xc nh
Ngun thng tin cp 3

Merck Index

Martindale: the complete drug reference

Dc th

35

Chin lc tm thng tin thuc

Cch s dng trong iu tr
Ngun thng tin cp 3 (theo nhm)

AHFS Drug Information

Drug Facts and Comparisons

Martindale

Dc th

36

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Chin lc tm thng tin thuc

Cch s dng trong iu tr
Ngun thng tin cp 3 (theo bnh)

Harrisons Principles of Internal Medicine

Applied Therapeutics: The Clinical use of Drugs

(Mary Anne Koda-Kimble)

Goldman's Cecil Medicine

37

Chin lc tm thng tin thuc

Cch s dng trong iu tr
Ngun thng tin cp 3 (dc l)

Goodman & Gilman's

the

Pharmacological Basis of Therapeutics

38

19

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Chin lc tm thng tin thuc

Tc dng khng mong mun
Ngun thng tin cp 3 (tc dng ph)

Meyler's Side Effects of Drugs

AHFS Drug Information

Drug Facts and Comparisons

Dc th

39

Chin lc tm thng tin thuc

Tc dng khng mong mun
Ngun thng tin cp 3 (tng tc)

Drug Interactions: Analysis and

Management (Philip D. Hansten & John R. Horn)

Drug Facts and Comparisons

Stockleys Drug Interactions

Tng tc thuc v ch khi ch nh

40

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Chin lc tm thng tin thuc

Tc dng khng mong mun
Ngun thng tin cp 3 (gy qui thai)

Drugs in Pregnancy and Lactation.

(Gerald Briggs)

Prescribing in pregnancy

41

Chin lc tm thng tin thuc

S dng thuc cho tr em
Pediatric & Neonatal Dosage Handbook
944 chuyn lun v thuc
> 130 cng thc pha ch dng ngay

Tn gi, cc thuc c th nhm ln (tn, hnh dng)

iu tr: c ch, dc lc hc, dc ng hc, liu cho tr,
liu ti a, hiu chnh (suy thn), theo di trong tr liu
Cc dng ch phm, liu ca mt n v (M)
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Chin lc tm thng tin thuc

S dng thuc cho tr em
The Harriet Lane Handbook
(The Johns Hopkins University)
Chm sc tr trong cp cu
Xp theo tng nhm bnh: tim mch, gim au, da liu, huyt
hc, nhim trng, thn-tit niu, thn kinh, dinh dng, ung th,
chm sc gim nh
Trong mi phn, cc bc cn nh gi, iu tr c th c km
phc iu tr
43

Chin lc tm thng tin thuc

Dc ng hc
Applied Clinical Pharmacokinetics
Phn 1: Khi nim c bn, cch tnh ton,
liu s dng i tng c bit (suy thn,
suy gan, thm phn, suy tim, bo ph) v cc tng tc thuc
Cc phn sau: sp xp theo tng nhm thuc nh khng sinh, tim
mch, thuc chng ng kinh, c ch min dch
Trong mi phn nu r v liu iu tr/ gy c, cc thng s dc
ng c th ca thuc, vic xc nh liu (liu u, duy tr)
trong iu tr, mt s v d bi tp

44

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Chin lc tm thng tin thuc

Dc ng hc
Basic Clinical Pharmacokinetics
Phn 1: Khi nim c bn, nguyn tc v
dc ng hc, sinh kh dng, th tch phn b,
tc thi tr, T1/2.
Phn 2: ng dng dc ng hc trong lm sng bao gm cc
chuyn lun sp xp theo tng nhm v thuc c th.

45

Chin lc tm thng tin thuc

Dc ng hc
Applied Biopharmaceutics & Pharmacokinetics
Dc ng hc mt ngn, nhiu ngn;
dng tim truyn, tim bolus, dng ung.
S hp thu, phn ha, chuyn ha, thi tr ca thuc; dc l di
truyn; cc dng bo ch mi (phng thch ti ch, cc dng
phng thch c kim sot).
Tng ng sinh hc v sinh kh dng ca thuc.
Cc ng dng ca dc ng hc trn lm sng v hiu chnh liu
cho ngi suy gan, thn
46

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Chin lc tm thng tin thuc

Dc l
Goodman & Gilman's the Pharmacological Basis
of Therapeutics
Chng m u: thng tin chung s pht trin thuc, dc ng
hc, dc lc hc, c tnh v ng c thuc, dc l di truyn.
Cc chng k tip trnh by tng nhm thuc theo tc dng
dc l trn thn kinh, tim mch, qu trnh vim, iu ha min
dch, huyt hc, hormon, tiu ha, nhim trng v ung th.
Sch kinh in: nguyn tc v dc l hc + ng dng lm sng
47

Chin lc tm thng tin thuc

Dc l
Basic and Clinical Pharmacology
Chng m u: thng tin chung v receptor,
dc ng hc v dc lc hc, pht trin v qun l thuc.

Cc chng k tip trnh by tng nhm thuc theo tc dng

dc l trn thn kinh t ng, tim mch thn, c trn, thn
kinh trung ng, mu, qua 1trnh vim, ni tit v ung th
Nguyn tc v dc l hc + ng dng lm sng: la chn thuc,
theo di tc dng, cc ca lm sng minh ha.
48

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Chin lc tm thng tin thuc

Dc l
Rang & Dale's Pharmacology
Phn 1: cc khi nim, c ch tc ng ca thuc,

cc

tnh cht v hp thu, phn b, chuyn ha, thi tr ca thuc v

dc l di truyn.
Phn 2: Cc cht trung gian ha hc
Cc phn cn li ln lt m t chi tit cc tc ng (xp theo h c
quan, thn linh trung ng hay nhim trng, ung th).
C bn, khng qu phc tp
49

Chin lc tm thng tin thuc

S dng thuc khi c thai / cho con b
Drugs in Pregnancy and Lactation
Trong tng chuyn lun, mi thuc s c ghi nhn
v khuyn co cho cc i tng c bit ny,
cc bng chng nguy hi cng c cp, gip cho cc nh
lm sng c th tra cu thuc trc khi quyt nh
S dng tra cu thuc

50

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Chin lc tm thng tin thuc

S dng thuc khi c thai / cho con b
Drugs During Pregnancy and Lactation
Thng tin chung bao gm: s pht trin bo thai,
dc ng hc khi c thai, ng hc ca thuc qua bo thai,
phn loi thuc trong thai k.
Cc chng tip theo cp tng nhm thuc trong iu tr nh
nhm gim au, khng vim, chng d ng, thuc iu tr hen
suyn v tr ho, thuc chng nn, thuc tc ng trn tiu ha
v lipid huyt, nhim trng, tim mch
Chn la thuc khi iu tr

51

Chin lc tm thng tin thuc

nh gi iu tr / la chn thuc
Applied Therapeutics: The Clinical Use of Drugs
Chm sc c bn: nh gi tr liu, xt nghim,
sc phn v, d ng thuc, iu tr ng c, nn, au, khi phu
thut, ri lon dch v cht in gii, chng nga, thiu mu.
Cc chng tip theo cp vic iu tr tng nhm iu tr: tim
mch, h hp, tiu ha, thn, ghp tng, dinh dng, da liu,
S dng cc ca lm sng c th tip cn tng vn

52

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Chin lc tm thng tin thuc

nh gi iu tr / la chn thuc
Goldman's Cecil Medicine
Vn chung: au, s thay i trong c th
(thn nhit, thn kinh, nhn khoa, h hp, sinh dc), di truyn,
dinh dng
i vi tng nhm bnh, vic thm khm, xt nghim cho tng h
c quan pht hin cc bt thng, trong mi bnh cc phn
sinh l bnh, chn on phn bit v iu tr.

53

Chin lc tm thng tin thuc

nh gi iu tr / la chn thuc
The Merck Manual
Ngun ti liu ny cung cp tm tt bnh hc,
triu chng, chn on v iu tr.

Cho php truy cp min ph trc tuyn ti a ch:

http://www.merckmanuals.com/home/index.html

54

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Chin lc tm thng tin thuc

nh gi iu tr / la chn thuc
Pharmacotherapy: A Pathophysiologic Approach
Tp trung vo iu tr bnh.
Thng tin c cung cp v cc ri lon bao gm dch t hc,
nguyn nhn, sinh l bnh, iu tr v nh gi kt qu iu tr.
Cc bng so snh cc thuc v liu, c ch tc ng, tc dng
ph, chng ch nh, mc chng c
S tm tt phc iu tr
Tm tt cc khi nim quan trng (key concepts)

55

Chin lc tm thng tin thuc

nh gi iu tr / la chn thuc
Pharmacotherapy Principles and Practice
Tng t nh quyn Pharmacotherapy:
A Pathophysiologic Approach.

Phn chung: ngi gi, tr em, chm sc gim nh.

Bnh: cc phn dch t hc, nguyn nhn, sinh l bnh, iu tr v
nh gi kt qu iu tr c trnh by tm tt.
Km thm Pharmacotherapy Principles and Practice Study Guide
tng ca lm sng km cc cu hi v tr li
56

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Chin lc tm thng tin thuc

c cht hc
Casarett & Doull's Toxicology
Nu cc vn chung ca c cht hc.
Phn i cng
c tnh hng c quan (mu, min dich, gan, thn)
c tnh khng hng c quan (kh nng sinh ung th, di truyn,
trn s pht trin)
Cc ngun c cht (thuc tr su, kim loi, dung mi, cht phng
x, thc vt).

57

Chin lc tm thng tin thuc

c cht hc
Clinical Toxicology
Phn chung ca c cht hc.
X tr ng c trong tng trng hp c th t vic trnh by

c ch dc l, sinh l bnh ca tng trng hp ng c,

biu hin lm sng, chn on phn bit, iu tr

58

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Chin lc tm thng tin thuc

tr li mt cu hi
Ngun thng tin cp 2 v cp 1

Vn mi

Khng c s ng thun gia cc chuyn gia

C bng chng mu thun nhau

59

Chin lc tm thng tin thuc

V d 1: BN nam 44 tui, cao huyt p c ghi toa
thuc c ch ACE Ho khan

Cu hi: Ho l mt tc dng ph ca cc thuc c ch

ACE?

Loi cu hi:

Ngun ti liu:

Cc khi nim tm kim:

60

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Chin lc tm thng tin thuc

Thuc c ch men chuyn angiotensin

C ch tc ng

Angiotensin-Converting Enzyme Inhibitors (ACEIs)

Ho

Gin mch
Bt hot

Mch mu
T bo c trn

Thn

Mch mu

Gim gi
Na v H2O
Gin mch

61

Stan Bardal et al, Applied Pharmacology, Saunders, 2010

Chin lc tm thng tin thuc

V d 2: BN nam 64 tui, ri lon lipid huyt ang
s dng vin Ti Khuyn co?

Cu hi: Tc dng ca Ti trong vic lm h lipid huyt

Loi cu hi:

Ngun ti liu:

Cc khi nim tm kim:

62

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Chin lc tm thng tin thuc

T kha (keywords):

Thut ton Boolean:

Cc cng c trn PubMed: MeSH

63

Chin lc tm thng tin thuc

TQ
h thng

tin cy tng dn

RCT
NC on h
NC bnh - chng
Bo co tng ca, hng lot ca
kin chuyn gia, th nghim trn th
64

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Chin lc tm thng tin thuc

Loi v mc chng c
Loi

ngha

Chng c mnh, c t nht mt bi tng quan c h thng

ca nhiu th nghim i chng ngu nhin (RCT) c

thit k tt.
II

Chng c mnh, c t nht mt th nghim ngu nhin c

i chng (RCT) ph hp

III

Chng c trung bnh, t nhiu th nghim c thit k tt

nhng khng ngu nhin, ch c mt nhm, nghin cu
on h, bo co hng lot ca, hoc nghin cu bt cp.

IV

Chng c trung bnh, t cc cng trnh nghin cu khng

thc nghim c thit k nghin cu tt.

kin chuyn gia, hi ng.

65

Chin lc tm thng tin thuc

Nghin cu bnh chng (case-control study)
Phi nhim
(+)

Hin ti

Phi nhim
(-)

Bnh (+)

Phi nhim
(+)

Phi nhim
(-)

Dn s

Chng Bnh thng

Thi gian (nm)

Vd: acetaldehyd v K phi

66

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Chin lc tm thng tin thuc

Nghin cu on h (Cohort Studies)
Hin ti

Dn s

Hu qu
(-)

Hu qu
(+)

Phi nhim
(+)

Hu qu
(-)

Mu
B. thng
Phi nhim
(-)

Hu qu
(+)

Thi gian (nm)

Vd: The Nurses Health Study (NHS):

1200 n y t KS sd aspirin v bnh tim mch

67

Chin lc tm thng tin thuc

Nghin cu ngu nhin c i chng (RCT)
Ngu nhin: Tt c cc i tng nghin cu c c hi nh
nhau 'phn cng' vo mt trong hai nhm can thip hoc i
chng
Can thip

Theo di

Chia
ngu nhin

i chng

So snh KQ
68

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Chin lc tm thng tin thuc

Nghin cu ngu nhin c i chng (RCT)
Th nghim

i tng

S phn cng nhm

Bit

Khng m

Khng bit

M n

hay

M i

M ba

X
69

Cc k nng thng tin thuc

nh gi cc thng tin / thu thp d liu cn thit
Xy dng cu hi / bc tip cn thch hp
Tip cn c h thng tm thng tin cn thit
nh gi thng tin quan trng (gi tr / ng dng)
Xy dng, sp xp v tm tt tr li cho vn
Giao tip r rng (ni /vit)
D on nhu cu thng tin khc

70

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