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亞東醫院 【OVID 實証醫學資源 】. 飛資得資訊有限公司 95.12.28. 說明會內容. 實証醫學五步驟 透視 OVID Medline 實証醫學文獻及資源. 實証醫學五步驟. 實証醫學五步驟. Cochrane Organization. Collaborative Review Groups 協會評論小組 Methods Groups 實行方法小組 Field/Networks 領域小組 Consumer Network 消費者網路 Centers 中心 Steering Group 指導委員會. EBM TEAM. - PowerPoint PPT Presentation
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亞東醫院【 OVID 實証醫學資源】
飛資得資訊有限公司95.12.28
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說明會內容
實証醫學五步驟 透視 OVID Medline
實証醫學文獻及資源
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TM 實証醫學五步驟
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實証醫學五步驟
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Cochrane Organization Collaborative Review Groups
協會評論小組 Methods Groups
實行方法小組 Field/Networks 領域小組 Consumer Network 消費者網路 Centers 中心 Steering Group 指導委員會
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EBM TEAM
QUESTION : Clinical Profession
SEARCH : Librarian Medical Informaticus
APPRAISE : Public Health (Epidemiology) Medical Informaticus
PRACTICE : Clinical Profession
AUDIT : Clinical Profession Public Health : (Management)
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THE COCHRANECOLLABORATION
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Archie Cochrane
“It is “It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted
periodically, of all relevant randomised controlled trials.”
surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant
randomised controlled trials.”
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Cochrane Centres
South African
Australasian
Chinese
Brazilian
Nordic
German
San Antonio
ItalianIberoamerican
French
Dutch
UK
Canadian
New England
San Francisco
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TM Evidence-Based Medicine
Review
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TMEBMR
EBM Review-ACP Journal Club
EBM Review-Cochrane Database of Systemic Review(CDSR)
EBM Review-Database of Abstracts of Reviews Effectiveness(DARE)
EBM Review -The Cochrane Central Register of Controlled Trials
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TM 資料庫內容屬性Review
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Article Review– -ACP Journal Club– -Database of Abstract of Review
Effectiveness
Topic Review-Cochrance Database of Systematic Review
-Cochrane of Clinicaled Trials of Register
(-Database of Abstract of Review Effectiveness)
EBM- Review
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TM What is article What is article
review?review?
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Article ReviewArticle Review
ACP Journal Club– ACP Journal Club– Evidence Based Medicine(ACP , BMJ)– － 1999
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Article ReviewArticle Review
收錄臨床醫學雜誌中每月重要的期刊論文。
針對同一個主題選出最好的文獻 Best Evidence
最符合該主題的文獻
ObjectiveDesignSettingPatientsInterventionMain OutcomeMain ResultsConclusion
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Article Review ProcessArticle Review ProcessMonthly ReviewMonthly Reviewof Top Clinicalof Top Clinical
JournalsJournals
QualityQualityScreeningScreening
Article Review :Article Review :Enhanced AbstractEnhanced Abstract
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Core Journals for Article Review
American Journal of Medicine Annals of Internal Medicine Archives of Internal Medicine Journal of Internal Medicine New England Journal of Medicine Diabetes Care Circulation, Jama, Lancet
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Outline of a Article ReviewOutline of a Article Review
Abstract:– Question– Design– Setting– Patients– Intervention– Main Outcome
Measure– Main Results– Conclusions
Commentary:
Reference
Footnotes
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What is topic What is topic revew?revew?
Systematic reviewSystematic review
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領域 A 領域 B 領域 C
Topic1 Topic2 Topic3 ……Topic1 Topic2 Topic3 ……Topic1 Topic2 Topic3 ……
……
RCT RCTRCT RCT RCT RCT RCT RCTRCT RCTRCT RCTRCT RCTRCT RCT
……
Quality??Quality??
Validity??Validity??
Reliability??Reliability??
Effectiveness of treatment or prevention??Effectiveness of treatment or prevention??
MR MR MR MR MR MR MR MR MR MR MR MRMR MR MR MRMR MR
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CDSR
Reference
Articles
收 集 以 RCT 為研究方法的臨床實驗報告文獻。
智慧文獻篩選 Cochrnae Database of Systematic Reviews
(CDSR)
Topic ReviewTopic Review
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Systematic Review Systematic Review ProcessProcess
ComprehensiveComprehensiveTopic SearchTopic Search
QualityQualityScreeningScreening
Meta AnalysisMeta AnalysisTopic ReviewTopic Review
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Review Groups
HIV/AIDS Hypertension Incontinence Infectious diseases Inflammatory bowel disease Injuries Lung cancer Menstrual disorders and
subfertility Metabolic and endocrine
disorders Movement disorders Multiple sclerosis
Muskuloskeletal Musculoskeletal injuries Neonatal Neuromuscular disease Oral health Pain, palliative and
supportive care Peripheral vascular diseases Pregnancy and childbirth Prostatic diseases and
urologic cancers Renal Schizophrenia
目前共有 50 個 Review Groups
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CDSR CCTR
What’s relationship between CDSR and CCTR?
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領域 A 領域 B 領域 C
Topic1 Topic2 Topic3 ……Topic1 Topic2 Topic3 ……Topic1 Topic2 Topic3 ……
……
RCT RCTRCT RCT RCT RCT RCT RCTRCT RCTRCT RCTRCT RCTRCT RCT
……MR MR MR MR MR MR MR MR MR MR MR MRMR MR MR MRMR MR
Controlled Trials Register
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What is CCTR?
資料來源： Medline,EMBASE, 其他電子資料庫
CCTR 包含超過 300,000 有關Randomized Controlled trials 隨機臨床試驗或 controlled clinical trials 控制臨床實驗
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CCTR
提供更多的 clinical information 客觀的 RCT: 未被 CDSR 收錄的
Randomized Controlled Trials 的資料同樣可以為實証研究者做為參考資料
在 EBMR 中的 CCTR 是唯一參考型書目資料
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TM 透視 OVID Medline
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透視 OVID Medline
檢索特性– 醫學標題– 精選文獻– 欄位多樣 ( 重 ) 化
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定義：提供一完整的檢索，用意在以一控制字彚表MeSH ，給每一篇文獻適當的標題，提供讀者得以依循進而檢索的功效。– 標題檢索：
醫學標題檢索為常用到的檢索，是 OVID Medline 最重要的功能。
運用：即使用不同的作者，用不同的用詞表示同一個疾病名稱，如 Breast cancer, Breast carcinoma, Breast tumor, Breast neoplasm, Breast oncology…… 時，讀者只要鍵入 breast neoplasm or breast tumor 均可以找到全部的乳癌的資料。
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TM( 醫學標題 )
醫學標題分類：醫學標題主要分成四種型式，讀者可以依據檢索的需求，來決定用哪一個 TERM ：
主要標題：– 呈現方式： *breast cancer– 顯示該篇文獻主要討論主題 breast neoplasm
次要標題：– 呈現方式： breast cancer– 顯示該篇文獻主要重點主題非 breast neoplasm
副標題– 呈現方式： *breast neoplasm/Drug therapy, – 顯示所有文獻主要在討論 breast neoplasm 的藥物治
療 條件依循值
– 呈現方式： infant , adult , animal, male, female
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MeSH Tree sturcture
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主要標題
次要標題
條件依循值
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MeSH subheading
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實例分享 :西醫 ( 資料庫之系統運用 )
精選所有的文獻
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多樣 ( 重 ) 性的欄位
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多樣 ( 重 ) 性的欄位
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TMMedline
Input– 檢索方法一– 檢索方法二– 檢索方法三– 擇其中最適合您所要的檢索方法
Output– View– Select– Print– Email– Save
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TM INPUT
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作者查尋
篇名查尋
關鍵字查尋
檢索方法一 from title
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TM 篇名查尋
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篇名查尋
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進階的文獻篩選
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篇名查尋
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值得思索的問題
1.NLM 評定為 RCT 文獻 ?
2. 文章題目 (title) 出現 RCT 文獻 ?
3. 以上二者何者才為可以找到真正的 RCT檢索技巧呢
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檢索方法二 -from MeSH
運用醫學標題
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直接按 continue , 選擇所有的副標題
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TM 運用醫學標題
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直接按 continue , 選擇所有的副標題
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TM 運用布林邏輯
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進階的文獻篩選
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篩選文章的格式
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篇名查尋
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運用布林邏輯
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檢索方法三 -MeSH (Exp, Focus)
運用醫學標題
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延展搜尋範圍(board term)
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直接按 continue , 選擇所有的副標題
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延展搜尋範圍(board term)
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直接按 continue , 選擇所有的副標題
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運用布林邏輯
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篇名查尋
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運用布林邏輯
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TM Output
View-Select-Print-Email-Save
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TMView
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尋找相關主題文獻
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Select- 選擇所要的文獻
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TMPrint
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TMEmail
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TMSave
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與書目管理軟體結合與書目管理軟體結合
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TM 實証醫學文獻等級及搜尋資源
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Oxford Center for Evidence-based Medicine Levels of Evidence
Level Therapy
1a 系統性回顧 Systematic review, 綜合分析 Meta analysis
( 分析數個隨機臨床對照試驗 , 其結果均類似 )
1b 設計良好 , 結果精確 之隨機臨床對照試驗 Randomized Controlled Trial
1c All or none
2a 系統性回顧 ( 分析數個世代研究 , 其結果均類似 )
2b 世代研究 Cohort study; 設計粗糙之隨機臨床對照試驗2c "Outcomes" Research; Ecological studies
3a 系統性回顧 ( 分析數個病例 -對照研究 , 其結果均類似 )
3b 病例 - 對照研究 Case-control study
4 某家醫院的十年經驗 ; 設計不良之世代研究 及病例 - 對照研究 5 未經考證之專家個人意見 , 基礎研究 , 細胞實驗 , 生理實驗 , 動
物實驗…的結果
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Cochrane Database of Systematic Reviews. 3:CD006150, 2006
SEARCH STRATEGY: We searched Medline (January 1980-December 2004), EMBASE (January 1985-December 2004) and The Cochrane Library (Issue 4, 2004) without language restrictions to identify randomised controlled trials that compared adjunctive corticosteroids to control in HIV-infected patients with PCP. We further reviewed the reference lists from previously published overviews, we searched UptoDate version 2005 and Clinical Evidence Concise (Issue 12, 2004), contacted experts of the field, and searched reference lists of identified publications for citations of additional relevant articles.
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