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Bölüm Aşı Karşıtlığı 3 Doğru Yanlış Demeden, Aşı Karşıtlarının Belirttikleri Ve Kanıta Dayalı Tıp * M

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Bölüm Aşı Karşıtlığı 3 Doğru Yanlış Demeden, Aşı Karşıtlarının Belirttikleri Ve Kanıta Dayalı Tıp * M Türk Dünyası Uygulama ve Araştırma Merkezi İnfeksiyon Dergisi No. 2018/1 Bölüm Aşı Karşıtlığı 3 Doğru yanlış demeden, Aşı karşıtlarının belirttikleri ve Kanıta Dayalı Tıp * M. Arif AKŞİT** *Bir genç hakkında konuştuğun hususları kapsayan bir yazıdır. ***Uzman Dr. Çocuk Sağlığı ve Hastalıkları, Neonatoloji/Yenidoğan ve Pediatrik Genetik, Acıbadem Hastanesi, Eskişehir Aşı ve aşılama konusunda özellikle basında çıkan haberler, kişilerin görüşleri, bir hekim ve kızamık, polio, difteri ve boğmacadan ölen hastaları olan ve bunların bir aşı ile önlenebileceği algısı ile kahrolan bir doktor olarak, aşı karşıtlarının gerekçelerini öğrenmek gerektiği görüşündeyim. Bu gerekçeleri olduğu gibi ele alıp, bunun gerçeklik durumuna bakılmasının daha doğru olacağı inancındayım. Dolayısıyla bu belirtilenleri aktararak, kanıt durumu ile karşılaştırmaktayım. Bu çalışma Ünitenin temel yaklaşımıdır. Aşı karşıtlarının görüşü ile bilimsel gerçeklere bakılmıştır. Etik kurulların kuruluşundan bu yana, emekli olana kadar, etik kurullarda 22 yıldan daha uzun bir süre, başkanlık yapmış, (Pamukkale ve Osmangazi Üniversitesi) bir öğretim üyesi olarak ileri sürülenler bilimsel açıdan, Kanıta Dayalı Tıp Kavramında incelenmiştir, doğru veya yanlış değil, verinin değeri incelenmeye çalışılmıştır. izin belirttikleriniz, toplumda ne kadar yansımaktadır? Bazen bir konuşma tam ters neticeler doğurmaktadır. Politikacıların bazı sözlerinin algısı tam ters olduğu gibi, bilim adamı olarak televizyona çıkan hocaların sonuçta tam ters yorumlara neden olacak boyutta girdiği izlemektedir. Ülkemizde zakkum olayı yaşanmış ve bunun bir anlamı olmadığı ötesinde, zakkumdan S çay yapılıp iyileşenler bilinmediği gibi, ölenler gözlenmiştir, kanserli oldukları için, bir olay olarak nitelendirilmemiştir. Tedavi olduklarını beyan edenlerin tam tıbbi tedavi görenlerdir. Bu Ünitede Web taraması ile karşı görüşler temelinde belirtilenler ile bunların bilimsel kanıtlarına bakılmıştır. Toplumda sanal algıların olması patolojik olarak irdelenmemelidir. Sayfa. 69 Türk Dünyası Uygulama ve Araştırma Merkezi İnfeksiyon Dergisi No. 2018/1 Dolayısıyla doğru veya yanlış tanımlama ve yargılama yerine, verilerin analizini yapmak daha gerekçi olarak görülmüştür. Belirtilenler, olayın boyutu ve sonuçları, gerekli bilgi sorgulaması ile birebir birlikte sunulması amaçlanmıştır. Belirtilenler olduğu gibi yayına konulmuştur, kısıntılar minimaldir. Özet Yargılamadan, Aşı karşıtlarının belirttikleri ve Kanıta Dayalı Tıp Amaç: Aşılama karşıtı olanların gerekçelerine bakarak, bunun kanıta dayalı tıp kavramında irdelenmesi amaçlanmaktadır. Dayanaklar/Kaynaklar: İnternet dayalı olarak aşı karşıtlarının görüşleri toparlanmış ve bunu Tıp Literatürü yerine web kaynaklı, özellikle Wikipedia’dan alınan bilgiler ile değerlendirilmiştir. Genel Yaklaşım; Bir görüş ele alınmalı, onun dayanakları da ele alınarak, bunun bilimsel açıdan Kanıta Dayalı Tıp yaklaşımı içinde irdelenmesi yapılmıştır. Yaklaşım: Aşının yapılma amacı bir hastalığın kökünün kazınmasıdır. Bu açıdan hastalık olup olmadığı değil, birey ve toplumun o mikroptan kurtulmasıdır. Sonuç: Aşılama oranının azalması ile oluşan salgınlar nedeniyle aşılama zorunlu olarak uygulandığı görülmektedir. Birçok tanımlanan yan etkilerin, toplumda görülme oranına göre, aşı yapılanlarda daha az rastlanıldığı da bir bulgudur. Otizm konusundaki yayının bir aldatmaca olduğu anlaşılmış ve yayını yapan doktorun meslek ile ilişkisi kesilmiştir. Bu yayına bağlı aşılamada olan aksaklıklar ile salgınlar oluşmuştur. Bir bireyin bedensel gücünü kuvvetli olması hastalanmayı önlemez, sadece hafif geçirmesine neden olur ve toplumda bir bulaştırıcı ve kaynak olacaktır. Disneyland boyutunda görüldüğü gibi, aşısız olanlar Amerika’da 27 Eyalette ve Filipin’ler de bulaştırmışlardır. Anahtar Kelimeler: Aşı karşıtlığı ve Kanıta Dayalı Tıp Outline Without any judging, anti-vaccination indications and the Evidence Based Medicine AIM: The oppositions grounding, reasoning to vaccination, discussed according to evidence based medicine perspective. Grounding Aspects: Web/Google search, and Wikipedia notifications are the main source of information, since, not to be taken from medical ones, for more acceptable evaluation. Introduction: A thought must be taken in notice, thus, consider its foundations and logics, and evaluated under the Evidence Based Medical Aspects. Notions: The reasoning of vaccination is for eradication of the disease. To be get rid of personal infected, and the community, especially for contagious and epidemic risk at the diseases. Conclusion: The reduction of vaccination ratio leads epidemics, on contagious diseases. The protecting the diseases by vaccination, urges to vaccination is obligatory. The indicated complications are mostly more reduced at the vaccinated ones, opposite as indicated. Especially autism suggestion, the article at Lancet, compilated is dishonest, thus, the physician is now dismissed form medial staff, causes vaccination refuses and epidemics are encountered. Healthy person is also infected and be a source of a microorganism, like Disneyland event, thus, cause of epidemics, noticed at 27 States and even Filipins. Key Words: Vaccine contrary, Evidence Based Medicine Giriş Bir insana elma desem, neyi algılayacaktır. Manisa elması mı, sarı, golden elması gibi tanımlarken, bu konun uzmanı olanlar ise starkspur golden, pinova, campbell, erovan gibi adlar belirtilmektedir. Elma türleri, üreten ile tüketen farklı yorumlamaktadır. Bu durum Sayfa. 70 Türk Dünyası Uygulama ve Araştırma Merkezi İnfeksiyon Dergisi No. 2018/1 sağlık sektöründe de ilaçların reklam yapılması yerine, doğrudan tanıtımcılar tarafından bilgi sunulmaktadır. Reklam yasak kapsamındadır. Aşı konusunda da toplumsal algı ile bilimsel yaklaşım bütünleşmese bile, toplumun belirttiklerine bakılmalı, onlar kanıta göre irdelenmelidir. Doğru veya yanlış demek, doğrudan yargı ve itici olmakta, sonuçta anlaşım zeminini kaldırmaktadır. Öncelikle bilimsel kanıt ve kanıta dayalı tıp kavramından söz edilecektir. İrdeleme boyutunun temel alınan dayanan özellikler sunulacaktır. Yorum Verilerin gerçekçi, güvenilir olup olmadığı konusu öncelikle değerlendirilmelidir. Kanıta Dayalı Tıp Bir kanıtın geçerliliği önemlidir. Dünya mı, Güneşin etrafında dönmekte, Güneş mi? Her gün görünüme göre Güneşin Dünya etrafında döndüğü kesindir ama bilim tam tersini söylemektedir. Bunun gibi söylenen, algı ile olanlar ile gerçeklik, doğruluk ancak bilim ile oluşabilir. Hekimliğin etik ilkelerde temeli zararımızın dokunmamasıdır. Bu açıdan yarar için zarar örtülemez. KANITA DAYALI TIP Kaynağı: Ergör, G. Kanıta Dayalı Tıp Nedir? Ergör G. Kanıta dayalı tıp, Modern Tıp Seminerleri Dizisi, Sayı: 27, Güneş Kitapevi Yayınları, Ankara, 2003, sayfa 1–6. Kanıt Düzeylerine Göre Yapılan Gruplandırma KANIT DÜZEYLERİ VE ÖNEM DERECELERİ 1: Sistematik derleme, randomize klinik çalışmalar KANIT PİRAMİDİ 2 a: Sistematik derlemeler, Kohort Meta analiz 2 b: Kohort çalışmalar, izlemde kalan %80 olan randomize Randomize kontrollü çalışmalar klinik çalışmalar Kohort 3 a: Sistemik derleme, olgu kontrol çalışmalar Olgu-kontrol çalışmaları 3 b: Olgu kontrol çalışmalar Olgu serisi 4: Olgu serileri, kontrolsüz Kohort veya randomize klinik Olgu sunumu çalışmalar Uzman görüşü, Editör makalesi 5: Uzman görüşü, eleştirel değer biçmeye dayalı olmayan Hayvan deneyleri çalışmalar İn vitro çalışmalar Kanıtlara Göre Uygulamalar a) Hak edişe göre yaklaşım/adalet • YAP (A) 1++ Bireysel yanılgı az 1+ Yanlı olma riski az 1- Yüksek yanlı olma durumu • YAPILMALI (B) 2++ Yanlılık riski düşük, kontrol çalışması var 2+ Karışıklık yapacak yanlılık riski az 2- Yanlılık riski yüksek • OLGUYA GÖRE (C) 3. Vaka serileri, analitik olmayan çalışmalar • UZMAN GÖRÜŞÜ-ARAŞTIRMA (D) 4. Konsey Kararları, ortak değerlendirme ile alınan kararlar Deneysel çalışmalar (Etik Kurul kararları gereklidir) b) Zarar Vermeme • Sakıncalı, Zararlı, Kontra-Endikasyon • UYARILAR: Dikkat edilecekler ve yapılacaklar Sayfa. 71 Türk Dünyası Uygulama ve Araştırma Merkezi İnfeksiyon Dergisi No. 2018/1 • YAN ETKİLER: Temel etki yerine destekleyici • ADVERS ETKİ, Ters etkiler • KOMPLİKASYON: İstenmeyen ama beklenen etki c) İnsancıl Kullanım Ruhsat Dışı Kullanım veya Yarar olasılığı olan ilaç ve yaklaşımlar d) Plasebo Yalancı ilaç veya yaklaşım yapmak (etkilerin gerçek boyutunu anlayabilmek için kontrol gönüllüler, kontrol olduğunu bilmeden uygulanmaktadır) Bir çalışmanın Uygun Kanıtlı olup olmadığının sorgulanması KANITA DAYALI TIP UYGULAMASINDAKİ 5 ADIM 6. ADIM: Problemi uygun bir SORU haline dönüştürmek 7. ADIM: Yanıtlamak için LİTERATÜR taraması 8. ADIM: Makalelerin ELEŞTİRİSEL değer biçme (critical appraisal) 9. ADIM: KARAR verme (eldeki kanıt, hekimin deneyimi, hastanın seçimi) 10. ADIM: Karar ve tüm sürecin DEĞERLENDİRİLMESİ Yorum Kanıtların gerçek olup olmadığı ötesinde, bunun karar olarak net ortaya konulması gerekir. Ülkemizde zakkum ile kanser tedavisi gündemde iken, bunun bilimsel kanıtlanması gerekir diyen Farmakoloji Profesörüne, doktor cevaben benim iyileşen hastaların var demiştir. Önce zakkum maddesi araştırmaları belirtilmiş, a) zakkumdan 3 adet kanser ilacı oluşturulmuş ama doğal bitki ile ilintili değil denildi, cevap olarak işte varmış diye cevap alındı, b) Toksik nedeniyle ölenlerin olduğu vurgulanınca, benim yaptığım usulde yok cevabına karşın, sizin yaptığınız incelendi, çok sulandırılmış olduğundan az zehirli olmakta olduğu vurgulandı, d) olgularım var denilince vakalar incelenmeli denildi ve gururla işte olgular dedi. Tümü Hacettepe Onkoloji Hastaları olduğunu vurguladı. Hacettepe
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