Internet Internet Access to Evidence-Based Information Access to Evidence-Based Information 實實實實實實實實 實實實實實實實實 TEBMA TEBMA (Taiwan Evidence Based Medicine (Taiwan Evidence Based Medicine Association) Association)
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InternetInternet Access to Evidence-Based InformationAccess to Evidence-Based Information
實證文獻搜尋簡介實證文獻搜尋簡介TEBMATEBMA
(Taiwan Evidence Based Medicine Association)(Taiwan Evidence Based Medicine Association)
2009 NCKUFM-YCY
*"Kill as Few Patients as Possible"*"Kill as Few Patients as Possible" - Oscar London - Oscar London
0
500000
1000000
1500000
2000000
2500000
Trials MEDLINE BioMedical
Med
ical
Art
icle
s p
er Y
ear
5,000?per day
1,400 per day95 per
day
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資訊爆炸資訊爆炸如何避免迷失在濃密的資訊叢林如何避免迷失在濃密的資訊叢林如何迅速獲得目前最佳證據資訊如何迅速獲得目前最佳證據資訊如何優游於浩瀚無疆的資訊大海如何優游於浩瀚無疆的資訊大海如何在有限時間有限預算下進行如何在有限時間有限預算下進行
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266,000,000 Evidence based
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如何檢視實證資源如何檢視實證資源be be up to dateup to date ( (< 1 year old< 1 year old))state state how it searcheshow it searches for evidence for evidencestate state how it appraiseshow it appraises evidence evidencestate state what the evidence iswhat the evidence is and and
provide a provide a referencereference state the state the level of evidencelevel of evidence
in support of its in support of its recommendationsrecommendations
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Oxford Center for EOxford Center for EBM:BM:Levels of Evidence (Therapy)Levels of Evidence (Therapy)
LevelLevel TherapyTherapy
1a1a 系統性回顧 系統性回顧 Systematic review Systematic review (( 分析數個隨機臨床對照試驗分析數個隨機臨床對照試驗 , , 其結果均類似其結果均類似 ))
1b1b 設計良好設計良好 , , 結果精確 之隨機臨床對照試驗 結果精確 之隨機臨床對照試驗
1c1c All or noneAll or none
2a2a 系統性回顧 系統性回顧 (( 分析數個世代研究分析數個世代研究 , , 其結果均類似其結果均類似 ))
2b2b 世代研究 世代研究 Cohort study; Cohort study; 設計粗糙之隨機臨床對照試驗設計粗糙之隨機臨床對照試驗2c2c 生態研究生態研究 Ecological studies, outcome researchEcological studies, outcome research
3a3a 系統性回顧 系統性回顧 (( 分析數個病例分析數個病例 -- 對照研究對照研究 , , 其結果均類似其結果均類似 ))
3b3b 病例 病例 - - 對照研究 對照研究 Case-control studyCase-control study
44 某家醫院的十年經驗某家醫院的十年經驗 ; ; 設計不良之世代研究 及病例 設計不良之世代研究 及病例 - - 對照研究 對照研究
55 未經考證之專家個人意見未經考證之專家個人意見 , , 基礎研究基礎研究 , , 細胞實驗細胞實驗 , , 生理實驗生理實驗 , , 動物實驗動物實驗……的的結果 結果
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Centre For Evidence-Based Medicine Levels of Evidence http://www.cebm.net/?o=11167Not all evidence is equal: hierarchy of evidenceNot all evidence is equal: hierarchy of evidence
Oxford Centre for Evidence-based Medicine - Levels of Evidence (March 2009)
Level Therapy / Prevention, Aetiology / Harm Prognosis Diagnosis Differential diagnosis /
symptom prevalence studyEconomic 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"
終身學習終身學習
備用學習備用學習 Just in Case Just in Case
learninglearning
即時學習即時學習Just in Time Just in Time
LearningLearning
Be Expertise in your field Be Expertise in your field
PushPush PullPull
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Coping with the overload: Coping with the overload:
1 .Read an evidence-based abstraction journal(and cancel other journals)
2. Keep a logbook of yourown clinical questions
3. Run a case-discussion journal club with your practice
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How can I have best evidence find me? How can I have best evidence find me?
““Push Push && Prompt Prompt”” ResourcesResources
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http://medlineplus.gov
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MedlinePlus Health News (HealthDay stories and press announcements)
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MedlinePlus E-mail Announcement ListsMedlinePlus E-mail Announcement Lists Subscribe to these general MedlinePlus listservs that cover all health Subscribe to these general MedlinePlus listservs that cover all health
topics:topics: MEDLINEPLUS-NEW MEDLINEPLUS-NEW (Weekly) (Weekly)
- includes all new resources, health topics, and announcements.- includes all new resources, health topics, and announcements. MEDLINEPLUS-NIHMEDLINEPLUS-NIH (Weekly) (Weekly)
- includes only new and updated consumer health information from the - includes only new and updated consumer health information from the National Institutes of Health, plus announcements and newNational Institutes of Health, plus announcements and new health health topics.topics.
MEDLINEPLUS-NWS MEDLINEPLUS-NWS (Daily) (Daily)- includes all news headlines published on MEDLINEplus.- includes all news headlines published on MEDLINEplus.
Specialty Topics Specialty Topics (weekly) :(weekly) : ChildrenChildren DiabetesDiabetes Environmental HealthEnvironmental Health Men's HealthMen's Health Mental HealthMental Health Nutrition & Healthy EatingNutrition & Healthy Eating Senior's HealthSenior's Health Women's HealthWomen's Health
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路透社消息路透社消息
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Nutrition News from Medline plusNutrition News from Medline plus Health Tip: Making Better Choices for Fast Food (06/08/2009, HealthDay) (06/08/2009, HealthDay) Healthy Diet May Boost Men's Fertility (06/08/2009, Reuters Health) (06/08/2009, Reuters Health) Want to Stop Cancer? You Can, Experts Say (06/03/2009, HealthDay) (06/03/2009, HealthDay) Summer Fruits and Veggies (06/01/2009, Centers for Disease Control and Prevention) (06/01/2009, Centers for Disease Control and Prevention) Americans Score Low on Healthy Lifestyle (05/27/2009, HealthDay) (05/27/2009, HealthDay) Too Much Cola Can Cause Muscle Problems (05/27/2009, HealthDay) (05/27/2009, HealthDay) Skip the Burgers and Throw Some Veggies on the Grill (05/22/2009, HealthDay) (05/22/2009, HealthDay) Coffee in Pregnancy May up Cleft Lip Risk Slightly (05/06/2009, Reuters Health) (05/06/2009, Reuters Health) More Educated Choose Healthier Foods, But Pay More (05/01/2009, HealthDay) (05/01/2009, HealthDay) Healthy Items on Menu Make Unhealthy Picks Easier (04/30/2009, Reuters Health) (04/30/2009, Reuters Health) Plant-Based Flavonoid May Cut Ovarian Cancer Risk (04/22/2009, Reuters Health) (04/22/2009, Reuters Health) Soy May Not Lead to Denser Breasts (04/22/2009, HealthDay) (04/22/2009, HealthDay) Fructose-Sweetened Drinks Up Metabolic Syndrome Risk (04/20/2009, HealthDay) (04/20/2009, HealthDay) U.S. Nutritionists Urge New, Not-As-Sweet Drinks (04/20/2009, Reuters Health) (04/20/2009, Reuters Health) Broccoli May Ward Off Serious Stomach Ailments (04/06/2009, HealthDay) (04/06/2009, HealthDay) Antioxidant-Rich Foods Lose Nutritional Luster Over Time (04/02/2009, HealthDay) (04/02/2009, HealthDay) Fast-Food Diners Don't Check Calorie Content (03/26/2009, Reuters Health) (03/26/2009, Reuters Health) Urine Test May ID Unhealthy Diets (03/26/2009, HealthDay) (03/26/2009, HealthDay) Too Much Red Meat May Shorten Life Span (03/23/2009, HealthDay) (03/23/2009, HealthDay) Also see MedlinePlus Also see MedlinePlus Nutrition
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吃太多紅肉可能會早死吃太多紅肉可能會早死
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訂閱訂閱 ADA newslettersADA newsletters ( ( 每週四每週四 ))
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Where can I find current best evidence?Where can I find current best evidence?
““PullPull” Resources” Resources(ie, information sources that allow you to (ie, information sources that allow you to findfind current best current best
evidence)evidence)
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Original articles
Systematic ReviewCochrane reviews
Evidence based journals EBM, EBN, EBMH, ACP J club
Computerized Decision Computerized Decision Support System (CDSS)Support System (CDSS) 電腦化的決策支持系統電腦化的決策支持系統
““ 5S 5S ”” Information ResourcesInformation Resources
BMJUpdates+PubMed Clinical Queries
Evidence based textbooksEvidence based textbooksUpToDate, DynaMed, ACP PIERBMJ Clinical Evidence
研究Studies
統整Syntheses
精要Synopses
綜結Summaries
系統系統SystemsSystems
Haynes, R. (2006, November). 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-A9.
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System
Summaries
Synopses
Synthesis
StudiesSystemsSystems
Computerized Decision Computerized Decision Support System (CDSS)Support System (CDSS)
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Summaries Summaries –– examples of evidence-based textbooksexamples of evidence-based textbooks
Evidence-Based specialty texts (eg Evidence-Based specialty texts (eg BMJ series))
System
Summaries
Synopses
Synthesis
Studies
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Summaries Summaries –– examples of evidence-based textbooksexamples of evidence-based textbooks
UpToDate (UpToDate (www.uptodate.com) ) Clinical Evidence Clinical Evidence
((www.clinicalevidence.com or OVID) or OVID) Physician Information and Evidence Resource (Physician Information and Evidence Resource (
pier.acponline.org or Stat!Ref: or Stat!Ref: www.statref.com) ) Evidence-Based specialty texts (eg Evidence-Based specialty texts (eg BMJ series)) Evidence-Based On-Call Evidence-Based On-Call
((www.eboncall.org) )
System
Summaries
Synopses
Synthesis
Studies
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www.uptodate.com
2009
UpToDate 之使用① 檢索可以一個或多個關鍵字、詞句或問題。Ex: treatment of raynaud’s disease in womenpatient info raynaud’s disease— 特別檢索病患資訊② 瀏覽檢索結果。③ 利用 Outline 快速瀏覽， Summary and
Recommendations 提供摘要與建議，閱讀實證等級。④ 檢索歷史回顧。
UpToDate 之使用① 檢索可以一個或多個關鍵字、詞句或問題。Ex: treatment of raynaud’s disease in womenpatient info raynaud’s disease— 特別檢索病患資訊② 瀏覽檢索結果。③ 利用 Outline 快速瀏覽， Summary and
Recommendations 提供摘要與建議，閱讀實證等級。④ 檢索歷史回顧。
26
UpToDate
26http://www.uptodate.com/home/index.html
2009
DynaMed
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DynaMed 匯總了近 2,000 個醫學臨床課題①主題檢索。②A-Z 瀏覽。③全文檢索。④學科瀏覽。⑤檢索結果資訊包含：病況描述( 涵蓋 ICD-9/10 codes), 造成原因及危險因子 (Causes & Risk Factors), 併發症及相關表徵 (Complications & Associated Conditions), 病況歷史(History), 身體狀態 (physical), 診斷(Diagnosis), 預後 (Prognosis), 治療(Treatment), 防治及篩選 (Prevention & Screening), 參考文獻 (包括評論(Reviews)及指南 (Guidelines)), 病患資料 (Patient Information) 等。
DynaMed 匯總了近 2,000 個醫學臨床課題①主題檢索。②A-Z 瀏覽。③全文檢索。④學科瀏覽。⑤檢索結果資訊包含：病況描述( 涵蓋 ICD-9/10 codes), 造成原因及危險因子 (Causes & Risk Factors), 併發症及相關表徵 (Complications & Associated Conditions), 病況歷史(History), 身體狀態 (physical), 診斷(Diagnosis), 預後 (Prognosis), 治療(Treatment), 防治及篩選 (Prevention & Screening), 參考文獻 (包括評論(Reviews)及指南 (Guidelines)), 病患資料 (Patient Information) 等。
http://www.ebscohost.com/dynamed/
2009
DynaMed
28
DynaMedLevel 1 (likely reliable) evidence最有效之報告（以病患導向為主的結論），例：以 RCT 為主之實驗結果（有效追蹤達 80% 以上）、來自世代研究初期（ inception cohort studies ）的預後資訊（ prognostic information ）、系統性文獻回顧所得之結果。Level 2 (mid-level) evidence 以病患導向為主的結論而產生的報告，且以科學化的檢視為方法，但是還未到 level 1 的標準。例如有效追蹤低於 80%的 RCT 、非隨機對照實驗的研究方式、缺乏足夠參考標準的診斷研究。 Level 2 並不代表可靠的證據等級。例如荷爾蒙補充療法在大多數的世代研究中都顯示可以降低心血管疾病的發生，但在許多的屬於 LEVEL 1 等級的 RCT 實驗中，此一療法不但無法預防心血管疾病，甚至有還可能會增加心血管疾病的風險。Level 3 (lacking direct) evidence 非科學化的分析研究且不是以病患為導向的結論報告，例如：病例報告、專家意見、及缺乏科學根據的推論
DynaMedLevel 1 (likely reliable) evidence最有效之報告（以病患導向為主的結論），例：以 RCT 為主之實驗結果（有效追蹤達 80% 以上）、來自世代研究初期（ inception cohort studies ）的預後資訊（ prognostic information ）、系統性文獻回顧所得之結果。Level 2 (mid-level) evidence 以病患導向為主的結論而產生的報告，且以科學化的檢視為方法，但是還未到 level 1 的標準。例如有效追蹤低於 80%的 RCT 、非隨機對照實驗的研究方式、缺乏足夠參考標準的診斷研究。 Level 2 並不代表可靠的證據等級。例如荷爾蒙補充療法在大多數的世代研究中都顯示可以降低心血管疾病的發生，但在許多的屬於 LEVEL 1 等級的 RCT 實驗中，此一療法不但無法預防心血管疾病，甚至有還可能會增加心血管疾病的風險。Level 3 (lacking direct) evidence 非科學化的分析研究且不是以病患為導向的結論報告，例如：病例報告、專家意見、及缺乏科學根據的推論
2009
Clinical Evidence
29
Clinical Evidence 選取基礎醫療常見的 臨 床 問 題 ， 收 集 來 自 Cochrane Library、 MEDLINE、 EMBASE 和實證醫學期刊研究的報告結果，提供系 統 性 文 獻 評 論 (Systematic Reviews) 、隨機取樣的臨床對照試驗 (RCTs) 及觀察研究 (Observational Studies) 證據。Clinical Evidence 之使用①使用 Sections 按主題瀏覽； Full Review List 依據 A-Z 選單瀏覽；站內檢索 Search this Site 。②Conditions 以症狀瀏覽。③瀏覽檢索結果內容：Interventions 提供不同療法之利弊比較； About this condition 提供症狀 / 疾病之定義、傳播、風險因子、預後、治療目的、結果、方法；Updates 資訊、 Guidelines、 Reference 。
Clinical Evidence 選取基礎醫療常見的 臨 床 問 題 ， 收 集 來 自 Cochrane Library、 MEDLINE、 EMBASE 和實證醫學期刊研究的報告結果，提供系 統 性 文 獻 評 論 (Systematic Reviews) 、隨機取樣的臨床對照試驗 (RCTs) 及觀察研究 (Observational Studies) 證據。Clinical Evidence 之使用①使用 Sections 按主題瀏覽； Full Review List 依據 A-Z 選單瀏覽；站內檢索 Search this Site 。②Conditions 以症狀瀏覽。③瀏覽檢索結果內容：Interventions 提供不同療法之利弊比較； About this condition 提供症狀 / 疾病之定義、傳播、風險因子、預後、治療目的、結果、方法；Updates 資訊、 Guidelines、 Reference 。http://clinicalevidence.bmj.com/ceweb/index.jsp
Free on-line access for physicians in the UK or in developing countries.
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SynopsesSynopses - - examplesexamplesSystem
Summaries
Synopses
Synthesis
Studies
2009
EBM Solution, ACP Journal Club
31
ACP Journal Club ：提供臨床實證醫學文獻資訊 ①Advanced Search②Filter by text type 依據內文類型篩選③檢索包含英文字字尾變化④Search Sets 依據類別分類檢索⑤瀏覽 EBM Solution 資源
ACP Journal Club ：提供臨床實證醫學文獻資訊 ①Advanced Search②Filter by text type 依據內文類型篩選③檢索包含英文字字尾變化④Search Sets 依據類別分類檢索⑤瀏覽 EBM Solution 資源
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Critically appraised Critically appraised ResourcesResources
Critically Appraised Papers (CAPs) Critically Appraised Papers (CAPs) Critically Appraised Topics (CATs)Critically Appraised Topics (CATs)
University of Rochester Medical Center (CATs) (CATs) University of Michigan Paediatrics (CATs) University of Michigan Paediatrics (CATs) University of Washington (CATs) University of Washington (CATs) BestBETs (CATs) (Best Evidence Topics)BestBETs (CATs) (Best Evidence Topics)
Patient-Oriented Evidence that Matters (POEM)Patient-Oriented Evidence that Matters (POEM) The Journal of Family PracticeThe Journal of Family Practice, which reviews 7-10 , which reviews 7-10
articles from the primary care literature each month articles from the primary care literature each month as part of POEMs as part of POEMs
PedsCCM Evidence-Based Journal Club, which PedsCCM Evidence-Based Journal Club, which reviews clinical trials relevant to paediatric care. reviews clinical trials relevant to paediatric care.
Evidence-Based on Call Evidence-Based on Call
System
Summaries
Synopses
Synthesis
Studies
2009 33
Bandolier Knowledge Library 提供實證醫學資料包括：治療主題相關之系統性評論，診斷證據，健康經濟或流行病學等，資訊類型包含： Systematic reviews, meta-analyses, randomised trials, and from high quality observational studies.①關鍵字檢索②A-Z 瀏覽
Bandolier Knowledge Library 提供實證醫學資料包括：治療主題相關之系統性評論，診斷證據，健康經濟或流行病學等，資訊類型包含： Systematic reviews, meta-analyses, randomised trials, and from high quality observational studies.①關鍵字檢索②A-Z 瀏覽
http://www.medicine.ox.ac.uk/bandolier/knowledge.html
Bandolier
http://www.medicine.ox.ac.uk/bandolier/
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2009
Essential Evidence Plus (Formerly InfoPOEMs)
35
Essential Evidence Plus 包含 EBM Guidelines、 Daily POEMs、 Cochrane Abstracts 、Selected Practice Guidelines 、 Decision Support Calculators 、 H&P Calculators 、 Diagnostic Test Calculators 、 Derm Expert 、 E/M Coding 、 ICD-9 Lookup Tool 。①檢索②依據主題分類瀏覽檢索結果。③依據檢索結果類型瀏覽檢索結果，亦提供依據資源分類瀏覽檢索結果。④檢索結果提示證據等級。
Essential Evidence Plus 包含 EBM Guidelines、 Daily POEMs、 Cochrane Abstracts 、Selected Practice Guidelines 、 Decision Support Calculators 、 H&P Calculators 、 Diagnostic Test Calculators 、 Derm Expert 、 E/M Coding 、 ICD-9 Lookup Tool 。①檢索②依據主題分類瀏覽檢索結果。③依據檢索結果類型瀏覽檢索結果，亦提供依據資源分類瀏覽檢索結果。④檢索結果提示證據等級。http://www.essentialevidenceplus.com/
2009 NCKUFM-YCY
SynthesesSyntheses:: ExamplesExamples
http://www.cochrane.org/reviews/http://www.cochrane.org/reviews/
PubMedPubMed Clinical Queries Clinical Queries ““Systemic ReviewsSystemic Reviews” ” or or OvidOvid Clinical Queries Clinical Queries ““ReviewReview” search strategy” search strategy
System
Summaries
Synopses
Synthesis
Studies
2009 NCKUFM-YCY
鍵入搜尋主題或關鍵字
2009 NCKUFM-YCY
Systematic Reviews Systematic Reviews 檢索策略檢索策略•Systematic[sb]Systematic[sb] 等於等於
2009 NCKUFM-YCY
StudiesStudies
Clinical Queries
(look for these when you can’t find the information (look for these when you can’t find the information you need in a system, synopsis, or synthesis)you need in a system, synopsis, or synthesis)
System
Summaries
Synopses
Synthesis
Studies
2009 NCKUFM-YCY
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
http://www.pubmed.com
http://www.pubmed.gov
http://www.pubmed.net
http://www.pubmed.org
2009 NCKUFM-YCY
鍵入搜尋主題或關鍵字
2009 NCKUFM-YCY
Clinical QueriesClinical Queries Methodology FiltersMethodology Filters
2009 NCKUFM-YCY
PubMedPubMed——檢索詞彙修正參考檢索詞彙修正參考
43
Select MeSH
MeSH Database
Search Keyword
Send toSearch Box with AND/OR/NOT
Search other MeSH and repeat
Search PubMed
LinkPubMed Major Topic
2009 NCKUFM-YCY
PubMedPubMed——檢索詞彙修正參考檢索詞彙修正參考
44
Browse Details
Check Translations for Searched MeSH
Display Citations
Browse Article's related MeSH
2009 NCKUFM-YCY
PubMedPubMed——篩選資料篩選資料
45
類別
Limits加入限制性條件
出版時間
文章類型
欄位檢索
2009 NCKUFM-YCY
PubMedPubMed——篩選資料篩選資料
46
Register Personal Account
Click
Choose Filter
Add Filter Function to Personal Environment
Results Filter by Setting
2009 NCKUFM-YCY
實用技巧實用技巧 -- 布林邏輯與運算元布林邏輯與運算元
運算元運算元 OVIDOVID 範例範例
OROR (pregnancy or birth).ti.(pregnancy or birth).ti.1 or 2 or 3 or 51 or 2 or 3 or 5 ＝＝ or/1,2,3,5or/1,2,3,5 ＝＝ or/1-3,5or/1-3,5
ANDAND (pregnancy and birth).ti.(pregnancy and birth).ti.1 and 2 and 3 and 51 and 2 and 3 and 5 ＝＝ and/1,2,3,5and/1,2,3,5 ＝＝ and/1-3,5and/1-3,5
NotNot排除排除
(education not patient education).ti.(education not patient education).ti.safety not patient safety.ti. safety.mp not patient safety.ti⇒safety not patient safety.ti. safety.mp not patient safety.ti⇒safety not patient safety safety.mp not patient safety.mp⇒safety not patient safety safety.mp not patient safety.mp⇒1 not 21 not 2
AdjNAdjN指定距離指定距離
physician adj5 relationshipphysician adj5 relationship(information adj3 retrieval).tw.(information adj3 retrieval).tw.
FreqFreq關鍵字出現關鍵字出現頻率頻率
blood pressure.ab./freq=10 blood pressure.ab./freq=10 (information adj3 retrieval).tw./freq=5(information adj3 retrieval).tw./freq=5一次僅指定一個欄位；且組合型欄位如一次僅指定一個欄位；且組合型欄位如 SOSO無法使用無法使用 Freq.Freq.
成功大學圖書館醫學院分館， 2008-07-09(三 ) 「實證醫學 / 護理在 Medline 」教育訓練會，飛資得資訊股份有限公司李紹迪小姐主講。
萬用字元符號於每個資料庫定義不同，需針對個別資料庫設定而使用萬用字元符號於每個資料庫定義不同，需針對個別資料庫設定而使用
2009 NCKUFM-YCY
實用技巧實用技巧 -- 切截字與萬用字元切截字與萬用字元
2009 NCKUFM-YCY
EB Shopping MallEB Shopping Mall: : ex.1ex.1 Systems, linked summaries, synopses, studiesSystems, linked summaries, synopses, studies
summaries
Ovid has the best collection of Ovid has the best collection of evidence-based information, especially in its evidence-based information, especially in its Evidence-Based Medicine Reviews collection.Evidence-Based Medicine Reviews collection.
synopses
synthesis
studies
System
Summaries
Synopses
Synthesis
Studies
2009 NCKUFM-YCY
EB Shopping MallEB Shopping Mall: : ex. 2ex. 2Systems, linked summaries, synopses, studiesSystems, linked summaries, synopses, studies
1.1. ClinicClinic2.2. Books Books 3.3. Journals Journals 4.4. Drugs Drugs 5.5. News News 6.6. Current Practice Current Practice 7.7. Patient Handouts Patient Handouts 8.8. Student UnionStudent Union9.9. MDC MobileMDC Mobile
System
Summaries
Synopses
Synthesis
Studies
2009
Clin-eguide
51
Clin-eguide前身為 Skolar MD ClinicalResource@Ovid ，包含豐富臨床資源、實證醫學與藥學的整合系統，核心資源包括： Clin-eguide Evidence-Based Medicine、 EBM Articles 、 National Guideline Clearinghouse 、 Aulstraliz/New Zealand Guideline 、 Ebook ex: 5-Minute Consult Datebase 、 Books@OVID 、Medline 、 Nurisng Advisor 、 Journal@OVID 、 Drug Facts & Comparisons 等藥典資源。① 自然語言檢索② 整合多資源檢索③ 依照需求資源個別檢索④ 藥物資訊快速查詢⑤ 其他工具：快速診斷、 ICD 9 、醫學公式速查工具
Clin-eguide前身為 Skolar MD ClinicalResource@Ovid ，包含豐富臨床資源、實證醫學與藥學的整合系統，核心資源包括： Clin-eguide Evidence-Based Medicine、 EBM Articles 、 National Guideline Clearinghouse 、 Aulstraliz/New Zealand Guideline 、 Ebook ex: 5-Minute Consult Datebase 、 Books@OVID 、Medline 、 Nurisng Advisor 、 Journal@OVID 、 Drug Facts & Comparisons 等藥典資源。① 自然語言檢索② 整合多資源檢索③ 依照需求資源個別檢索④ 藥物資訊快速查詢⑤ 其他工具：快速診斷、 ICD 9 、醫學公式速查工具
2009
US National Guidelines Clearinghouse (NGC)
52http://www.ngc.gov/
The National Guideline Clearinghouse 為美國 Evidence-Based Clinical Practice Guidelines 資料庫，包含 Structured Abstracts ，連結 Full-Text Guidelines ，並提供Guideline 比較工具。檢索方式包括：①主題檢索： Detailed Search, Frequent Searches of Frequently Requested Topics②瀏覽 By Disease/Condition, Treatment/Intervention, Measures, etc.③Guideline 比較
The National Guideline Clearinghouse 為美國 Evidence-Based Clinical Practice Guidelines 資料庫，包含 Structured Abstracts ，連結 Full-Text Guidelines ，並提供Guideline 比較工具。檢索方式包括：①主題檢索： Detailed Search, Frequent Searches of Frequently Requested Topics②瀏覽 By Disease/Condition, Treatment/Intervention, Measures, etc.③Guideline 比較
2009
CMA Infobase: Clinical Practice Guidelines(CPG)
53
http://www.cma.ca/index.cfm/ci_id/54316/la_id/1.htm
CMA Infobase 為加拿大 Evidence-Based Clinical Practice Guidelines 資料庫。檢索方式包括：①關鍵字檢索②Advanced Search 利用 Limits 篩選資料，例如： Specialty、 Domain如 Diagnosis、 Treatment 、 Target Gender
CMA Infobase 為加拿大 Evidence-Based Clinical Practice Guidelines 資料庫。檢索方式包括：①關鍵字檢索②Advanced Search 利用 Limits 篩選資料，例如： Specialty、 Domain如 Diagnosis、 Treatment 、 Target Gender
2009
UK National Library of Health (NLH)
54http://www.library.nhs.uk/default.aspx
2009 NCKUFM-YCY
PushPush
PullPull
PromptPrompt…..some labs and eMRs with a credible …..some labs and eMRs with a credible evidence-based pedigree evidence-based pedigree
Summary: Summary: Access to Evidence-Based InformationAccess to Evidence-Based Information
System
Summaries
Synopses
Synthesis
Studies
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