中山醫學大學附設醫院圖書室 參考諮詢分機: 34901-34903
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實證醫學評論文獻及資料庫簡介. 中山醫學大學附設醫院圖書室 參考諮詢分機: 34901-34903. Evidence-Based Medicine(EBM). 定義: 將好的醫療證據實地應用於個案病例上,並針對整個過程加以評估 步驟: 1. QUESTION 確定一個需要執行實證醫學的問題 2.SEARCH 尋找最佳的臨床文獻資源證據 3.APPRAISE 評價證據的真實性、可靠性、臨床 價值及適用性 4.PRACTICE 在臨床上實施具有效益的證據結果 5.AUDIT 對所做的整個工作流程進行評估. - PowerPoint PPT PresentationTRANSCRIPT
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34901-34903
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Evidence-Based Medicine(EBM) 1. QUESTION 2.SEARCH 3.APPRAISE 4.PRACTICE 5.AUDIT
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Where is the Evidence?Cohort StudyMulti-center StudyClinical Research and/or Studies in Medline:Clinical TrialsClinical Trials Phase IClinical Trials Phase IIClinical Trials Phase IIIClinical Trials Phase IVRandomized Controlled Trials
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Animal researchIn vitro(Test tube) researchCase ReportsIdeas, Editorials, OpinionsCase Control StudiesCohort studiesRandomized Controlled Double Blind Studies Meta - analysisRandomized Controlled Studies
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- 1 randomized controlled trials 2systematic review
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Grade of recommendation
Level of evidence
Interventions
A
1a
Systematic review of randomized controlled trials
1b
Individual randomized controlled trial
B
2a
Systematic review of cohort studies
2b
Individual cohort study
3a
Systematic review of case-control studies
3b
Individual case-control study
C
4
Case series
D
5
Expert opinion without explicit critical appraisal or based on physiology or bench research
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Sheet1
LevelTherapy
1aSystematic review()
1b
1cAll or none
2aSystematic review()
2bCohort study
2c"Outcome" Research; Ecological studies
3aSystematic review(-)
3b- Case-control syudy
4-
5
Sheet2
Sheet3
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(Case Reports )
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-Case Reports(halothane)?
Recurrent hepatitis attributable to halothane sensitization in an anesthetist. N Engl J Med 1969; 280:515-522.
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,(Case Series, Case Analysis )(10)p
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-Case Series laryngeal cancer19817199161061556%615179246271182425824503582%73%73%67%64%54%35100%91%95%85%88%82%72%61%3594%93%86%71%52%42%25%0%10,, 1994; 295: 376-383
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(Case-control study)
Retrospective, ,
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- Case-control study
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(Cohort study)
ProspectiveretrospectiveBoth are longitudinal!
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- Cohort study
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(Intervention study)
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(Clinical Trial)
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(Clinical Trial)Inclusion criteria ()Exclusion criteria () randomized assignSingle blind () Double blind () Triple blind ( )
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- Randomized Controlled Clinical Trial()()
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(Meta-Analysis):
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-1(all studies)?() (P)
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-2(cohort studies)
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-3(randomized trials)()
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-4 (case-control studies)
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-5 (Meta-analysis)()()()
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CoChrane Collaboration1972Archie Cochrane(Randomized controlled trials;RCT)1992Archie Cochrane1993Cochrane Collaboration http://www.cochrane.org
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Archie CochraneIt 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.
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THE COCHRANECOLLABORATION
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Cochrane Organization- Collaborative Review Groups Methods Groups Field/Networks Consumer Network Centers Steering Group
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EBM- ReviewArticle Review-Database of Abstract of Review Effectiveness
Topic Review-Cochrance Database of Systematic Review
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What is Article Review????
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Article ReviewBest Evidence
ObjectiveDesignSettingPatientsInterventionMain OutcomeMain ResultsConclusion
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Article Review ProcessMonthly Reviewof Top ClinicalJournalsQualityScreeningArticle Review :Enhanced Abstract
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Core Journals for Article ReviewAmerican Journal of MedicineAnnals of Internal MedicineArchives of Internal MedicineJournal of Internal MedicineNew England Journal of MedicineDiabetes CareCirculation, JAMA, Lancet
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Outline of a Article ReviewAbstract:QuestionDesignSettingPatientsInterventionMain Outcome MeasureMain ResultsConclusions
Commentary:
Reference
Footnotes
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What is Systematic Reviews????Topic Review?(CDSR)
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Topic ReviewRCTCochrnae Database of Systematic Reviews(CDSR)
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Systematic Review ProcessComprehensiveTopic SearchQualityScreeningMeta AnalysisTopic Review
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Review Groups HIV/AIDSHypertensionIncontinence Infectious diseasesInflammatory bowel diseaseInjuriesLung cancerMenstrual disorders and subfertilityMetabolic and endocrine disordersMovement disordersMultiple sclerosisMuskuloskeletal Musculoskeletal injuriesNeonatalNeuromuscular diseaseOral healthPain, palliative and supportive carePeripheral vascular diseasesPregnancy and childbirthProstatic diseases and urologic cancersRenalSchizophrenia
200450Review Groups
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Cochrane LibraryUpToDateClinical EvidencePubMed-Clinical QueriesMedline-Publication Types
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Cochrane Library Cochrane Reviews Cochrane Database of Systematic Reviews DARE Database of Abstracts of Reviews of Effects CENTRAL Cochrane Central Register of Controlled Trials Methodology Reviews CMR--The Cochrane Methodology Register HTA The Health Technology Assessment Database NHS EED The NHS Economic Evaluation Database About Topics
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Cochrane Reviews-- Cochrane Database of Systematic Reviews Systematic Reviews of Topic Areas CDSR 49 RCT
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DAREDatabase of Abstracts of Review of Effects -4100-Nathonal Health Service Centre for Reviews and Dissemination (NHS CRD)- Systematic reviews- CDSR.
CENTRALCochrane Central Register of Controlled Trials - 40 / - Cochrane - MedlineCinahl -
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Cochrane Database of Methodology Reviews (Methodology Reviews)- - - .- Cochrane Methodology Register (CMR) - - - - MEDLINE - systematic review
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Health Technology AssessmentDatabase (HTA) - ()NHS Economic Evaluation Database (NHS EED) - - -
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AboutThe Cochrane Collaboration and the Cochrane Collaborative Review Groups - /Topics - Cochrane review groups
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Search
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Search The cochrane library:
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EX: Cochrane Reviews
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Search The cochrane libraryTopies-- Groups
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Search The cochrane libraryTopies
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Search The cochrane library:
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Search The cochrane library
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Search The cochrane library
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Search The cochrane libraryAdvanced Search
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Search The cochrane libraryMeSH Search/
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Search The cochrane libraryMeSH Search
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Search The cochrane libraryMeSH Search
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Results
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Results- The cochrane library
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Results- The cochrane libraryReviews / Protocols
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Results- The cochrane library
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Results- The cochrane library A full Review A Protocol (Review) /(Review) (Review/Protocal)
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Results- The cochrane libraryExporting Citations
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Results- The cochrane libraryExporting Citations
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Results- The cochrane librarySave SearchEdit Search
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Registration
Search History
Saved Searches
Alert
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Registration
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Registration
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Registration
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Registration-Log inPersonal Navigation Bar
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Registration-Cochrane Library
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Search History
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Search History
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Save Search
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Save SearchSave Search
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Saved Searches
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Saved Searches / Alert AlertAlert
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UPToDate
American Academy of Family PhysiciansTopic Review6,0003000
narrow search
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Clinical Evidence
Topic Review
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PubMed-Clinical Queries
Haynes RB(Therapy)(Diagnosis)(Etiology)(Prognosis)(sensitivity)(specificity)
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Medline-Publication Types LimitPublication types hierarchy systematic reviewrandomized controlled trials(RCT)controlled trialsMedlineLimitpublication typesmeta-analysisrandomized controlled trials(Ctrl+Enter)
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Publication Types
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National Guideline Clearinghouse (NGC)PDA
http://www.guideline.gov
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1994OxfordRAM and HJM1995
http://www.jr2.ox.ac.uk/bandolier/ Bandolier
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