如何运用实证医学资料库快速回答临床问题课件.pptVIP

如何運用實證醫學資料庫快速回答臨床問題 Quickly Effectively 臨床人員的處境: Solution 時間有限、情況緊急: Quickly 醫療資訊太多: Effectively 醫學進步太快: Current 病人的期望: Best 缺乏Time勝於缺乏Skill在搜尋與評讀上 理想的解決方案 以最好的實證資訊，快速答覆所有的問題 把尋找證據、嚴格評讀的重擔交給研究者與作者 臨床人員在使用實證資源時 快速（最好當下即可取得與應用） 確實能夠提供答案 今日節目表 認識證據等級 搜尋實證障礙 實證資源類型 PICO、關鍵字與MeSH Term 資訊檢索概念 Summaries Databases PubMed Database 動動腦時間 認識證據等級 表濃縮自: Oxford Centre for EBM Levels of Evidence /index.aspx?o=1047 證據力強 設計嚴謹 偏差少 證據力弱 設計薄弱 偏差多 並非所有臨床問題都可找到最高等級文獻，但應盡可能使用等級高的證據來源 Level Therapy/Prevention, Aetiology/Harm 1a Systematic review of RCTs + Meta-Analysis 1b Randomized controlled trial (RCT) 1c ‘All-or-none’ 2a Systematic review of cohort studies 2b Cohort study or poor RCT 2c ‘Outcomes’ research 3a Systematic review of case-control studies 3b Case-control study 4 Case series 5 Expert opinion without explicit critical appraisal, or based on physiology, bench research or first principles Level Therapy/Prevention, Aetiology/Harm 1a Systematic review of RCTs + Meta-Analysis 1b Randomized controlled trial (RCT) 1c ‘All-or-none’ 2a Systematic review of cohort studies 2b Cohort study or poor RCT 2c ‘Outcomes’ research ; Ecological studies 3a Systematic review of case-control studies 3b Case-control study 4 Case series 5 Expert opinion without explicit critical appraisal, or based on physiology, bench research or first principles 搜尋實證障礙 不知道怎麼定義關鍵字 PICO, plus 同義字, MeSH Terms 資源太多，不知道從何下手 Filtered Resources FIRST, plus Unfiltered Resources 不熟悉搜尋方式 只找到/看到片面現象(B)，而非貼近事實(A) (Information bias) 5S EBM Resources (非關證據強弱!) Model from: Haynes, R. B. (2006). Of studies, syntheses, synopses, summaries, and systems: the 5S evolution of information services for evidence-based health care decisions. ACP Journal Club, 145(3), A8. 整合證據提供特定臨床問題之概述與建議 ACP PIER BMJ Clinical Evidence DynaMed FirstConsult UpToDate 對單篇研究或回顧性文獻作摘要與評述 ACP Journal Club, Evidence-Based Medicine (PubMed, Ovid Medline) 特定臨床問題的系統性評論文獻 Cochrane Database of Systematic Reviews Database of Abstracts of Reviews of Effects