%0期刊文章%@ 1438-8871 %I JMIR出版物%V 20%卡塔尔世界杯8强波胆分析 N 2% P e34% T知识如何在医生的虚拟社区中构建和交换:在线思维定性研究%A Wieringa,Sietse %A Engebretsen,Eivind %A Heggen,Kristin %A Greenhalgh,Trisha %+循证健康护理计划，牛津大学继续教育系，Rewley House 1，惠灵顿广场，牛津，OX1 2JA，英国，44 7549911036，sietse.wieringa@kellogg.ox.ac.uk %K知识管理%K转化医学研究%K指南作为主题%K循证医学%K循证实践%D 2018 %7 02.02.2018 %9原始论文%J J医学互联网Res %G英文%X背景:作为对循证实践目前面临的批评的回应，卫生保健研究人员和指南制定者已经开始呼吁在指南制作中评估和包括不同种类的知识(随机对照试验[rct]除外)，以便更好地与临床实践中使用的非正式知识联系起来。在一项民族志研究中，Gabbay和Le May表明，临床医生在日常实践中不会明确或有意识地使用指南。相反，他们使用思维方式:由许多来源形成的集体共享的、大多数是隐性的知识，包括积累的个人经验、教育(正式和非正式)、指导，以及同事之间分享的关于病人的叙述。在这项关于非正式知识的研究中，我们认为临床医生的虚拟网络代表了更广泛的医学界的思维方式，是知识的持有者，也是知识的催化剂。目的:本研究的目的是探讨临床医生社区中的非正式知识及其创造如何与指南制定中产生的更结构化的知识相比较。方法:本研究包括对英国、荷兰和挪威三个大型虚拟网络上的医生帖子进行定性研究，以他汀类药物为主题进行案例研究，涵盖1400多个帖子。参考合作知识构建理论和实践社区对数据进行专题分析。 Results: The dataset showed very few postings referring to, or seeking to adhere to, explicit guidance and recommendations. Participants presented many instances of individual case narratives that highlighted quantitative test results and clinical examination findings. There was an emphasis on outliers and the material, regulatory, and practical constraints on knowledge use by clinicians. Participants conveyed not-so-explicit knowledge as tacit and practical knowledge and used a prevailing style of pragmatic reasoning focusing on what was likely to work in a particular case. Throughout the discussions, a collective conceptualization of statins was generated and reinforced in many contexts through stories, jokes, and imagery. Conclusions: Informal knowledge and knowing in clinical communities entail an inherently collective dynamic practice that includes explicit and nonexplicit components. It can be characterized as knowledge-in-context in practice, with a strong focus on casuistry. Validity of knowledge appears not to be based on criteria of consensus, coherence, or correspondence but on a more polyphonic understanding of truth. We contend that our findings give enough ground for further research on how exploring mindlines of clinicians online could help improve guideline development processes. %M 29396385 %R 10.2196/jmir.8325 %U //www.mybigtv.com/2018/2/e34/ %U https://doi.org/10.2196/jmir.8325 %U http://www.ncbi.nlm.nih.gov/pubmed/29396385