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Internet Access to Evidence-Based Information 實證文獻搜尋簡介

Internet Access to Evidence-Based Information 實證文獻搜尋簡介. TEBMA (Taiwan Evidence Based Medicine Association). *"Kill as Few Patients as Possible" - Oscar London. 5,000? per day. 1,400 per day. 95 per day. 資訊爆炸. 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. 266,000,000

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Internet Access to Evidence-Based Information 實證文獻搜尋簡介

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  1. InternetAccess to Evidence-Based Information實證文獻搜尋簡介 TEBMA (Taiwan Evidence Based Medicine Association)

  2. *"Kill as Few Patients as Possible"- Oscar London 5,000? per day 1,400 per day 95 per day NCKUFM-YCY

  3. 資訊爆炸 • 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 NCKUFM-YCY

  4. 266,000,000 Evidence based NCKUFM-YCY

  5. 如何檢視實證資源 • be up to date (< 1 year old) • state how it searches for evidence • state how it appraises evidence • state what the evidence is and provide a reference • state the level of evidencein support of its recommendations NCKUFM-YCY

  6. Oxford Center for EBM:Levels of Evidence (Therapy) NCKUFM-YCY

  7. Oxford Centre for Evidence-based Medicine - Levels of Evidence (March 2009) Centre For Evidence-Based Medicine Levels of Evidence http://www.cebm.net/?o=1116 7 Not all evidence is equal: hierarchy of evidence NCKUFM-YCY

  8. 即時學習 Just in Time Learning 終身學習 Push Pull 備用學習Just in Case learning Be Expertise in your field

  9. 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 NCKUFM-YCY

  10. How can I have best evidence find me? “Push & Prompt” Resources NCKUFM-YCY

  11. http://medlineplus.gov NCKUFM-YCY

  12.     MedlinePlus Health News (HealthDay stories and press announcements) NCKUFM-YCY

  13. MedlinePlus E-mail Announcement Lists • Subscribe to these general MedlinePlus listservs that cover all health topics: • MEDLINEPLUS-NEW (Weekly)- includes all new resources, health topics, and announcements. • MEDLINEPLUS-NIH (Weekly)- includes only new and updated consumer health information from the National Institutes of Health, plus announcements and new health topics. • MEDLINEPLUS-NWS (Daily)- includes all news headlines published on MEDLINEplus. • Specialty Topics (weekly) : • Children • Diabetes • Environmental Health • Men's Health • Mental Health • Nutrition & Healthy Eating • Senior's Health • Women's Health NCKUFM-YCY

  14. 路透社消息 NCKUFM-YCY

  15. Nutrition News from Medline plus • Health Tip: Making Better Choices for Fast Food (06/08/2009, HealthDay) • Healthy Diet May Boost Men's Fertility (06/08/2009, Reuters Health) • Want to Stop Cancer? You Can, Experts Say (06/03/2009, HealthDay) • Summer Fruits and Veggies (06/01/2009, Centers for Disease Control and Prevention) • Americans Score Low on Healthy Lifestyle (05/27/2009, HealthDay) • Too Much Cola Can Cause Muscle Problems (05/27/2009, HealthDay) • Skip the Burgers and Throw Some Veggies on the Grill (05/22/2009, HealthDay) • Coffee in Pregnancy May up Cleft Lip Risk Slightly (05/06/2009, Reuters Health) • More Educated Choose Healthier Foods, But Pay More (05/01/2009, HealthDay) • Healthy Items on Menu Make Unhealthy Picks Easier (04/30/2009, Reuters Health) • Plant-Based Flavonoid May Cut Ovarian Cancer Risk (04/22/2009, Reuters Health) • Soy May Not Lead to Denser Breasts (04/22/2009, HealthDay) • Fructose-Sweetened Drinks Up Metabolic Syndrome Risk (04/20/2009, HealthDay) • U.S. Nutritionists Urge New, Not-As-Sweet Drinks (04/20/2009, Reuters Health) • Broccoli May Ward Off Serious Stomach Ailments (04/06/2009, HealthDay) • Antioxidant-Rich Foods Lose Nutritional Luster Over Time (04/02/2009, HealthDay) • Fast-Food Diners Don't Check Calorie Content (03/26/2009, Reuters Health) • Urine Test May ID Unhealthy Diets (03/26/2009, HealthDay) • Too Much Red Meat May Shorten Life Span (03/23/2009, HealthDay) • Also see MedlinePlus Nutrition NCKUFM-YCY

  16. 吃太多紅肉可能會早死 NCKUFM-YCY

  17. NCKUFM-YCY

  18. NCKUFM-YCY

  19. 訂閱ADA newsletters (每週四) NCKUFM-YCY

  20. Where can I find current best evidence? “Pull” Resources(ie, information sources that allow you to find current best evidence) NCKUFM-YCY

  21. “ 5S ”Information Resources Computerized Decision Support System (CDSS)電腦化的決策支持系統 系統 Systems Evidence based textbooks 綜結 Summaries UpToDate, DynaMed, ACP PIER BMJ Clinical Evidence Evidence based journals EBM, EBN, EBMH, ACP J club 精要 Synopses 統整 Syntheses Systematic Review Cochrane reviews BMJUpdates+ PubMed Clinical Queries 研究 Studies Original articles 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. NCKUFM-YCY

  22. System Summaries Synopses Synthesis Studies Systems Computerized Decision Support System (CDSS) NCKUFM-YCY 原始研究 Studies

  23. System Summaries Synopses Synthesis Studies Summaries –examples of evidence-based textbooks • Evidence-Based specialty texts (eg BMJ series) NCKUFM-YCY

  24. System Summaries Synopses Synthesis Studies Summaries –examples of evidence-based textbooks • UpToDate (www.uptodate.com) • Clinical Evidence (www.clinicalevidence.com or OVID) • Physician Information and Evidence Resource (pier.acponline.org or Stat!Ref: www.statref.com) • Evidence-Based specialty texts (eg BMJ series) • Evidence-Based On-Call (www.eboncall.org) NCKUFM-YCY

  25. www.uptodate.com NCKUFM-YCY

  26. UpToDate 26    UpToDate之使用 檢索可以一個或多個關鍵字、詞句或問題。 Ex: treatment of raynaud’s disease in women patient info raynaud’s disease—特別檢索病患資訊 瀏覽檢索結果。 利用Outline快速瀏覽，Summary and Recommendations提供摘要與建議，閱讀實證等級。 檢索歷史回顧。  26 http://www.uptodate.com/home/index.html

  27. DynaMed     DynaMed 匯總了近2,000個醫學臨床課題 主題檢索。 A-Z瀏覽。 全文檢索。 學科瀏覽。 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。  27 http://www.ebscohost.com/dynamed/

  28. DynaMed DynaMed Level 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 28

  29. Clinical Evidence   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 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。 Conditions以症狀瀏覽。 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。  Free on-line access for physicians in the UK or in developing countries. 29 http://clinicalevidence.bmj.com/ceweb/index.jsp

  30. System Summaries Synopses Synthesis Studies Synopses - examples NCKUFM-YCY

  31. EBM Solution, ACP Journal Club   ACP Journal Club：提供臨床實證醫學文獻資訊 Advanced Search Filter by text type 依據內文類型篩選 檢索包含英文字字尾變化 Search Sets依據類別分類檢索 瀏覽EBM Solution資源    31

  32. System Summaries Synopses Synthesis Studies Critically appraised Resources • Critically Appraised Papers (CAPs) • Critically Appraised Topics (CATs) • University of Rochester Medical Center (CATs) • University of Michigan Paediatrics (CATs) • University of Washington (CATs) • BestBETs (CATs) (Best Evidence Topics) • Patient-Oriented Evidence that Matters (POEM) • The Journal of Family Practice, which reviews 7-10 articles from the primary care literature each month as part of POEMs • PedsCCM Evidence-Based Journal Club, which reviews clinical trials relevant to paediatric care. • Evidence-Based on Call NCKUFM-YCY

  33. Bandolier  http://www.medicine.ox.ac.uk/bandolier/ 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. 關鍵字檢索 A-Z 瀏覽  33 http://www.medicine.ox.ac.uk/bandolier/knowledge.html

  34. NCKUFM-YCY

  35. Essential Evidence Plus (Formerly InfoPOEMs)    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。 檢索 依據主題分類瀏覽檢索結果。 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。 檢索結果提示證據等級。  35 http://www.essentialevidenceplus.com/

  36. System Summaries Synopses Synthesis Studies Syntheses:Examples • http://www.cochrane.org/reviews/ • PubMed Clinical Queries “Systemic Reviews” or Ovid Clinical Queries “Review” search strategy NCKUFM-YCY

  37. 鍵入搜尋主題或關鍵字 NCKUFM-YCY

  38. Systematic Reviews 檢索策略 • Systematic[sb]等於 NCKUFM-YCY

  39. System Summaries Synopses Synthesis Studies Studies (look for these when you can’t find the information you need in a system, synopsis, or synthesis)  Clinical Queries NCKUFM-YCY

  40. http://www.pubmed.com http://www.pubmed.gov http://www.pubmed.net http://www.pubmed.org http://www.ncbi.nlm.nih.gov/entrez/query.fcgi NCKUFM-YCY

  41. 鍵入搜尋主題或關鍵字 NCKUFM-YCY

  42. Clinical QueriesMethodology Filters NCKUFM-YCY

  43. PubMed—檢索詞彙修正參考 Search Keyword Search PubMed Send to Search Box with AND/OR/NOT Select MeSH  MeSH Database Search other MeSH and repeat  Link PubMed Major Topic 43 NCKUFM-YCY

  44. PubMed—檢索詞彙修正參考 Browse Details Check Translations for Searched MeSH Display Citations Browse Article's related MeSH 44 NCKUFM-YCY

  45. PubMed—篩選資料 Limits加入限制性條件 出版時間 類別  文章 類型  欄位 檢索 45 NCKUFM-YCY

  46. PubMed—篩選資料 Register Personal Account  Click Results Filter by Setting  Choose Filter Add Filter Function to Personal Environment 46 NCKUFM-YCY

  47. 實用技巧-布林邏輯與運算元 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 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。 NCKUFM-YCY

  48. 實用技巧-切截字與萬用字元 NCKUFM-YCY

  49. System Summaries Synopses Synthesis Studies EB Shopping Mall: ex.1Systems, linked summaries, synopses, studies Ovid has the best collection of evidence-based information, especially in its Evidence-Based Medicine Reviews collection. summaries studies synopses synthesis NCKUFM-YCY

  50. System Summaries Synopses Synthesis Studies EB Shopping Mall: ex. 2Systems, linked summaries, synopses, studies • Clinic • Books • Journals • Drugs • News • Current Practice • Patient Handouts • Student Union • MDC Mobile NCKUFM-YCY

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