临床问题OVIDMEDLINE文献检索主要步骤.PPT

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 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 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