ovid medline. 收錄年代: 1946~current 收錄主題範圍...
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OVID MEDLINEOVID MEDLINE
OVID MEDLINEOVID MEDLINE
收錄年代: 1946~Current收錄主題範圍
收錄內容:文獻之書目資料、摘要
基礎醫學 臨床醫學 生物科學
解剖學 醫務管理學 化學與藥物
心理學 社會醫學 生物農業與營養
醫材設備 醫事技術 醫事資訊
MeSH 醫學標題MeSH 醫學標題Title FRAX or fiction: determining optimal screening strategies for
treatment of osteoporosis in residents in long-term care facilities.
主標題: Osteoporosis Diphosphonates Cross-Sectional Studies
副標題:
Osteoporosis
Diagnosis
Drug therapy
Epidemiology
文獻的重點為討論 osteoporosis 的流行病學研究,但文中有討論到治療及藥物治療而且是以 Diphosphonates 為主要治療用藥
什麼是 MeSH ?什麼是 MeSH ?運動、遊戲、娛樂圈、音樂 ..... 什麼都有
– NLM 在分析生物醫學方面之期刊文獻、圖書、視聽資料、電子資源等資源的主題時,為了將同一概念用固定的詞彙表達,於是建立一套醫學標題詞( MeSH ),以達到控制詞彙的目的。 –索引專家們更在眾多標題詞中建立主題關係連結,
可利用樹狀結構圖呈現出詞彙間語義或從屬上的關係。
以固定的詞彙表達以固定的詞彙表達1. 彙整同義詞至同一標題詞 (MeSH)
標題詞(MeSH)
彙整的同義詞
2. 彙整相同主題的文章至同一標題詞 (MeSH)
標題詞(MeSH)
樹狀結構樹狀結構
The “6S” levels of organization of evidence from health care researchThe “6S” levels of organization of evidence from health care research
Computerized decision support
Evidence-based clinical practice guidelinesEvidence based textbook
ACP Journal Club 、 DARE
Systematic reviews
Original journal articles
Computer
Summaries
Synopses of Syntheses
Syntheses
Studies
Synopses of studiesACP Journal Club
by R Brain Haynes, 2009by R Brain Haynes, 2009
二次研究證據 ( 已經整理的文獻 ) 1. System 系統 2. Summaries
(1) Best Practice-Clinical Evidence (2) UpToDate (3) ACP Pier & ACP Medicine (4) DynaMed (5) Medscape-eMedicine (free)
3. Synopses of Syntheses (1) ACP Journal Club (2) Evidence-based Medicine (3) Evidence-based Nursing (4) Database of Abstracts of Reviewsof Effects (DARE)
4. Syntheses 統整( Systematic reviews )
(1) The Cochrane Library - CDSR & Other Reviews ( 中文版摘要 free)
(2) ACPJC PLUS (3) Medline 之 systematic review
5.Synopses of Syntheses
原始研究證據 ( 未經整理的文獻 ) 6. Studies ( Original journals articles )
(1) The Cochrane Library- Clinical trials (2) PubMed -Clinical Queries 之 Clinical study search (free) (3) Medline ( 善用 more limit 之功能 )
搜尋流程 (
自二次研究證據找
起 )
臨床決策模型臨床決策模型
J Am Med Inform Assoc. 1997 Jul-Aug;4(4):266-78. Elson RB, Faughnan JG, Connelly DP
實證醫學三大要素實證醫學三大要素
Evidence
Experience
Expectation
EBM
May using Aspirin prevent colorectal cancer ?
臨床問題臨床問題
OVID MEDLINE 文獻檢索主要步驟OVID MEDLINE 文獻檢索主要步驟
檢索自然語言、關鍵字
MeSH
條件限制 Clinical Queries
Publication Type
輸出書目資料管理
全文、內容
檢 索檢 索
原始關鍵字 Primary Term 或 MeSH
Term 同義字 1 同義字 2
P ( or or ) and
I ( aspirin oracetylsalicylic
acidor ) and
C ( or or ) and
O ( Colorectal Cancer orColorectal Neoplasm
or )
BASIC SearshBASIC Searsh
Advanced Search(MeSH)Advanced Search(MeSH)
選擇主標題
選擇副標題( 找尋以 prevention 為主要研究方向的文獻 )
條 件 限 制
Clinical Queries( 找回 reviews 的文獻 )Clinical Queries( 找回 reviews 的文獻 )
以語彙控制為工具針對臨床行為做分類, senstivity 為最嚴格、 best balance 次之, specificity 為較鬆散的條件
Sample 年齡 期刊收錄主題
出版語系
文獻研究方法
Publication types & subject subsets(systematic revews 、 mata-analysis 、 RCTs)Publication types & subject subsets(systematic revews 、 mata-analysis 、 RCTs)
Meta analysis 4 篇Systematic Review 14 篇RCTs 35 篇
輸 出
全文輸出
輸出勾選文獻的書目資料
實施實證醫學五大步驟實施實證醫學五大步驟整理出一個可以回答的問題
asking an answerable question尋找文獻證據
tracking down the best evidence嚴格評讀文獻
critical appraisal應用於病人身上
integrating the appraisal with clinical expertise and patients preference
對過程進行稽核auditing performance in step 1-4
臨床問題從哪裡來?臨床問題從哪裡來?臨床發現 ( clinical findings )病因 ( etiology )疾病的臨床表徵 ( clinical menifestations of
diseases )鑑別診斷與診斷檢查 ( DDx & diagnostic test )治療 ( therapy)預後 ( prognosis )預防措施 ( prevention )(生病)的經驗與意義 ( experience & meaning )自我學習發展的過程 ( self-improvement )
臨床問題的種類臨床問題的種類Therapy/Prevention :治療 / 預防的問題
研究治療或預防方法的有效性例如:服用“阿斯匹林”是否可以預防中風?
Diagnosis :診斷問題研究檢查方法或臨床表徵對疾病診斷的有效性
例如: McBurney’s sign 診斷急性盲腸炎的敏感度及特異度為何?
Harm/Etiology :危害 / 病因問題研究暴露的危害或疾病的原因
例如:停經婦女使用荷爾蒙治療是否會增加乳癌的機會?Prognosis :預後
建立疾病預後的預測模式例如:利用 Ranson’s criteria 預測急性胰臟炎死亡率為何?例如 : In healthy women who have recently had a miscarriage( 流產 ), what is the usual grieving( 悲傷 ) process and are any factors associated with longer than normal grieving?
Level
Therapy/Prevention, Aetiology/Harm
Prognosis Diagnosis Differential diagnosis/symptom prevalence study
Economic and decision analyses
1a SR (with homogeneity*) of RCTs
SR (with homogeneity*) of inception cohort studies; CDR† validated in different populations
SR (with homogeneity*) of Level 1 diagnostic studies; CDR† with 1b studies from different clinical centres
SR (with homogeneity*) of prospective cohort studies
SR (with homogeneity*) of Level 1 economic studies
1b Individual RCT (with narrow Confidence Interval‡)
Individual inception cohort study with > 80% follow-up; CDR† validated in a single population
Validating** cohort study with good††† reference standards; or CDR† tested within one clinical centre
Prospective cohort study with good follow-up****
Analysis based on clinically sensible costs or alternatives; systematic review(s) of the evidence; and including multi-way sensitivity analyses
1c All or none§ All or none case-series Absolute SpPins and SnNouts††
All or none case-series Absolute better-value or worse-value analyses ††††
2a SR (with homogeneity*) of cohort studies
SR (with homogeneity*) of either retrospective cohort studies or untreated control groups in RCTs
SR (with homogeneity*) of Level >2 diagnostic studies
SR (with homogeneity*) of 2b and better studies
SR (with homogeneity*) of Level >2 economic studies
2b Individual cohort study (including low quality RCT; e.g., <80% follow-up)
Retrospective cohort study or follow-up of untreated control patients in an RCT; Derivation of CDR† or validated on split-sample§§§ only
Exploratory** cohort study with good†††reference standards; CDR† after derivation, or validated only on split-sample§§§ or databases
Retrospective cohort study, or poor follow-up
Analysis based on clinically sensible costs or alternatives; limited review(s) of the evidence, or single studies; and including multi-way sensitivity analyses
2c "Outcomes" Research; Ecological studies
"Outcomes" Research Ecological studies Audit or outcomes research
3a SR (with homogeneity*) of case-control studies
SR (with homogeneity*) of 3b and better studies
SR (with homogeneity*) of 3b and better studies
SR (with homogeneity*) of 3b and better studies
3b Individual Case-Control Study
Non-consecutive study; or without consistently applied reference standards
Non-consecutive cohort study, or very limited population
Analysis based on limited alternatives or costs, poor quality estimates of data, but including sensitivity analyses incorporating clinically sensible variations.
4 Case-series (and poor quality cohort and case-control studies§§)
Case-series (and poor quality prognostic cohort studies***)
Case-control study, poor or non-independent reference standard
Case-series or superseded reference standards
Analysis with no sensitivity analysis
5 Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles"
Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles"
Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles"
Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles"
Expert opinion without explicit critical appraisal, or based on economic theory or "first principles"
Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001)Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001)
http://www.cebm.net/index.aspx?o=5653 10 June 2010
New
研究設計分類 ( A taxonomy of clinical research)
by David A Grimes, Kenneth F Schulz,2002
研究設計分類 ( A taxonomy of clinical research)
by David A Grimes, Kenneth F Schulz,2002
Did investigatorAssign exposures?
Observational studyExperimental study
Comparison group?Random allocation?
RandomizedControlled trial
Non-Randomized
Controlled trial
Analyticalstudy
Descriptivestudy
Direction ?
Cohortstudy
Case-controlstudy
Cross-sectional
study
Yes
Yes Yes
No
NoNo
Exposure Outcome
Exposure Outcome
Exposure and Outcome at same time
•Generating evidence from research
•Synthesising the evidence
•Creating evidence based clinical policies
•Applying the policies Brian Haynes, Andrew Haines. Education and debate: Getting research findings into practice: Barriers and bridges to evidence based clinical practice. BMJ 1998;317:273-276.
Steps to the solution as proposed
文獻結果文獻結果
Meta analysis1. Aspirin for the chemoprevention of colorectal adenomas: meta-analysis of the randomized trials.
Systematic ReviewSystematic Review
1. Aspirin for the prevention of colorectal cancer. [Review]
Randomized Controlled Trial Randomized Controlled Trial
1. Prevention by daily soluble aspirin of colorectal adenoma recurrence: 4-year results of the APACC randomised trial.
Thank You!Thank You!