诊断性问题的循证实践.pptVIP

首先检索经过评估或筛选的循证医学信息资源(二次文献数据库)BestEvidence(Evidence-basedMedicineandACPJournalClub)CochraneLibrary：Cochrane系统评价数据库(CochraneDatabaseofSystematicReviews，CDSR)UpToDateSumSearch再考虑检索未经评估或筛选的信息资源(原始文献数据库)01PubMedEMBASECBM02根据构成临床问题四要素（PICO），本病例检索可选择检索词包括：patentarterialduct，diagnostictest，clinicalexamination，sensitivity，specificity，preterm。检索词采用检索词patentarterialduct，sensitivity，preterm制定检索策略[patentarterialduct]AND[sensitivity]AND[preterm]，并根据检索数据库相应调整。检索策略二、确定检索词和检索策略首先检索二次文献数据库BestEvidence和CDSR，未检出相关文献。1再检索PubMed从“ClinicalQueries”进入检索口“SearchbyClinicalStudyCategory”，输入“[patentarterialduct]AND[sensitivity]AND[preterm]”，在“Category”下选择“diagnosis”，在“Scope”下选择“broad，sensitivesearch”.2三、检索相关数据库检出58篇相关文献，仔细阅读题目和摘要，发现4篇文献与本病例相关，结合病案具体情况，选择“DavisP，Turner-GomesS，CunninghamK,etalPrecisionandaccuracyofclinicalandradiologicalsignsinprematureinfantsatriskofpatentductusarteriosus．ArchPediatrAdolesc1995；149(10):1136-1141．”一文回答提出的临床问题(以下简称Davisstudy)ArchPediatrAdolescMed.1995Oct;149(10):1136-41.Precisionandaccuracyofclinicalandradiologicalsignsinprematureinfantsatriskofpatentductusarteriosus.DavisP,Turner-GomesS,CunninghamK,WayC,RobertsR,SchmidtB.Source:DepartmentofPediatrics,McMasterUniversity,Hamilton,Ontario.AbstractOBJECTIVE:Todeterminetheprecision(interobserveragreement)andaccuracy(agreementwithcriterionstandard)ofclinicalandradiologicalsignsinprematureinfantsatriskofpatentductusarteriosus(PDA)withleft-to-rightshunting.DESIGN:MaskedcomparisonofclinicalandradiologicalexaminationwithDopplerflowechocardiography(criterionstandard).SETTING:Neonatalintensivecareunit.PATIENTS:Onehundredinfantswithbirthweightslessthan1750gwerestudiedoncebetweendays3and7oflife.Athirdofthecohortwasintubatedatthetimeofstudy.INTERVENTION:Fiveindependentobserversnotedthepresenceorabsenceofaninc