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醫師們是如何使用醫學資料庫
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醫師們是如何使用醫學資料庫

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Patient Safety – 醫學研究、文獻出版與醫療資訊的有效應用研討會.使用者分享 - 善用醫學資料庫,加速醫學研究發展

Patient Safety – 醫學研究、文獻出版與醫療資訊的有效應用研討會.使用者分享 - 善用醫學資料庫,加速醫學研究發展
2008, Jun. 26(50 分鐘)

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醫師們是如何使用醫學資料庫 Presentation Transcript

  • 1. 使用者分享 善用醫學資料庫,加速醫學研究發展 2008 Jun. 26 基隆長庚.楊宗翰醫師 實證醫學中心
  • 2. Contents
    • 醫師的需求
    • 資料庫的特性
    • 範例
  • 3. Roles of a doctor Clinician Educator Researcher
  • 4. As a clinician
    • 臨床工作.解決患者的問題
      • 診斷、預後、 病因、 治療(預防)
    • 實證醫學
      • The application of the best available evidence (current best evidence) to patient care .
  • 5. As a clinician - best solution
    • 資料品質 = Best
    • 定期更新 = Current
    • 簡單易用 = Application
  • 6. As a researcher
    • 研究工作.探索世界
    • 登上一流的雜誌
      • 創新、改變世界
      • 最新、最流行
  • 7. As a researcher - best solution
    • 定期更新 = Current
    • 資料內容 = Complete
  • 8. As a educator
    • 教育醫學生、年輕醫生
      • 學習 解決臨床問題 的能力 ( 邏輯 )
    • 最 正確 、最 重要 ( 且 完整 ) 的 觀念
      • 過去
      • 現在
      • 未來
  • 9. As a educator - best solution
    • 資料內容 = Stable & Mostly Correct ( Complete … )
    • 定期更新 = Current ( Relatively )
  • 10. Burning candle at both ends exhausted doctors …
  • 11.
    • 台灣醫師的平均壽命比平常人少 10 歲以上,只有 62 到 63 歲( 95 年國人男性平均壽命約 74 歲,女性約 81 歲。)
    http://www.businessweekly.com.tw/webarticle.php?id=29335 語出:孫安迪醫師
  • 12. Information … Time …
  • 13. Man buried in books …
  • 14.
    • doctor
    • :
    • v
    • information
  • 15. solution
    • human
      • librarians
    • electronic
      • computers – databases
  • 16. Solutions Clinician = 優 Educator = 穩 Researcher = 新
  • 17. 快
  • 18. Contents
    • 醫師的需求
    • 資料庫的特性
    • 範例
  • 19.
    • Medline vs. 非 Medline
    資料庫的選擇
  • 20. 資料庫的選擇 OVID vs. 非 OVID
  • 21. One
  • 22. Which & Why?
    • Contents
    • How to search?
      • keyword vs. indexed terms (MeSH)
    • Results of search?
      • who ranks first
  • 23. Contents 穩 新 優 Reviews (books, narrative reviews) Primary databases (citations) EBM resources (EBM article/case/topic review) Contents
  • 24. Contents Nursing Advisor ICD9, DDx, Drugs, … … Books Books 穩 MEDLINE CINAHL MEDLINE CINAHL 新 EBMR Clin-eguide Guidelines (US, AU, NZ) EBMR 優 Clin-eguide OVID SP
  • 25. Clin-eguide 整合多 元資源 Warfarin 藥物資訊快速查詢 快速診斷 /ICD 9/ 醫學公式 快速查詢小工具 自然語言輸入查詢
  • 26. OvidSP
  • 27. Contents Books (Reviews) Books Reviews Educator MEDLINE CINAHL MEDLINE CINAHL Researcher EBMR Clin-eguide Guidelines (US, AU, NZ) Nursing Advisor ICD9, DDx, Drugs EBMR Clinician Clin-eguide OVID SP
  • 28. Search & Result 關聯度 rank Multiple DBs Single DB Result 同義辭庫 + 自然語言 Keyword Keyword + MeSH Search Clin-eguide OVID SP
  • 29. 自然語言
    • Clin-eguide / OvidSP Basic Search 分析句子並找出要查詢的關鍵字
      • treatment for childhood obesity
      • treatment / childhood / obesity
    • 系統會分析哪些是名詞、片語或形容詞,進而了解整個查詢的架構,進而可以將上一步驟中所得到的字詞混合組成一個完整的檢索概念
  • 30. 同義辭庫
    • UMLS Meta-thesaurus 、醫學辭典與專業詞典、醫學縮寫、藥典與疾病名稱、和美國及英國標準英文辭典,找出同義詞執行查詢,也包括:
      • 單複數及詞性的變化
      • 一般俗稱或常用的稱呼,公認或常用的縮寫
      • 因語系不同產生之異體字,譬如美式英文與英式英文
  • 31. 同義辭庫 + 自然語言
    • treatment for childhood obesity
    輸入辭彙 相關辭彙 treatment therapy, palliative, relieve, ameliorate, alleviate, therapeutic, treatments, relief, therapies, therapeutics, amelioration, relieving, alleviated, alleviation, alleviating, ameliorates, relieves, alleviates, reliefs, management, intervention, cure, treated childhood child, children, kids, kid, childhoods, child hood, child youth obesity obesity, adiposes, adiposis, adiposities, adiposity, obesities, overweight, overweights, obesity unspecified
  • 32. Results 星等數 = 主題相關度 ※ 五顆星表示相關度最高。
  • 33. Results
  • 34. Ranking ( 關聯度 ) …
    • Count 在每個段落中出現的次數
        • How many search concepts appear in the passage
    • Frequency 在每個段落中出現的頻率
        • How often concepts occur in the passage
    • Importance 關鍵字在資料庫中的重要性
        • How rare the terms are in the database
    • Cohesion 關鍵字彼此之間的距離遠近
        • Whether or not terms within phrases occur closely together
    • Vocabulary Level 與輸入的關鍵字相符程度
        • How closely a passage's language matches your word choices rather than variants and synonyms
    • 根據以上五條件決定星等,並以 5 顆星表示相關度最高。
  • 35. Results - EBMR Article 同時您也可以按各自需求決定檢索結果的排列順序: Ranking: 按結果相關度高低排列 Year of Publication :按年代排列
  • 36. Results - Medline MEDLINE 還提供診斷相關篩選條件,以及全文的篩選選項等。 例如我們要篩選與診斷相關,且有全文可參考的檢索結果,則請點選: Diagnosis / Full Text
  • 37. Results – Medline + Clinical Query
  • 38. Contents
    • 醫師的需求
    • 資料庫的特性
    • 範例 – 蛀牙 / dental caries
  • 39. Case – Educator ( 穩 ) 1/2 1/2 3
  • 40. Result
    • Book
    • Oxford Textbook of Medicine - 2003
      • possible sources of evidences 2000-2002
    • Review
    • Dental caries. Lancet 369:51-9 2007
      • possible sources of evidences 2006-2007
  • 41. Diagnosis (iceberg metaphor)
  • 42. Caries Process
  • 43.  
  • 44. Case – Researcher ( 新 / 全 )
    • keywords
      • truncation ($/*; Salmonell* or child$)
    • indexed terms
      • MeSH (Medline/Pubmed)
      • CINAHL Index Terms (CINAHL)
      • EMTAGs (EMBASE)
    • automatic term mapping (ATM)
  • 45. MeSH ...
    • Most human beings on the planet who are not librarians don't know anything about how to search with MeSH.
      • John Sack, the director of HighWire Press.
    NEJM 2005;354:1:4-7
  • 46. Keywords or Index Terms
    • Definition
      • Neoplasms
        • cancer, carcinoma, tumor
    • Relevance (focus/explode)
  • 47.  
  • 48. OvidSP
  • 49. Questions - Cancer
    • Include Related Terms ( 同義辭庫 + 自然語言 ) cancer (no related terms - related terms )
    • Keyword cancer - cancer$ ( truncation )
    • MeSH (focus - explode ) *Neoplasms/ - exp Neoplasms/
    • Pubmed (ATM, automatic term mapping)
  • 50. Current: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1950 to Present
  • 51.  
  • 52. Is the more the better?
    • Quality --- Quantity
  • 53. Case - Clinician
    • 張小妹,六歲,喜歡吃糖但卻滿口蛀口。
  • 54. Ask
    • P: children/adults (with dental caries)
    • I: chewing gum with xylitol
    • C: chewing gum without xylitol
    • O: incidence of dental decay
    • Type of Question: therapy
    • Keyword:
      • Dental caries
      • xylitol
  • 55.  
  • 56.  
  • 57. Therapy Therapy
  • 58.  
  • 59.  
  • 60. Apply ?
  • 61. Summary
    • 醫師的需求
      • 優、新、穩
    • 資料庫的特性
      • 內容 (original, EBM review, review)
      • 檢索及結果呈現方式
    • 範例
  • 62. Solutions Clinician = 優 Educator = 穩 Researcher = 新
  • 63. Contents Books (Reviews) Books Reviews Educator MEDLINE CINAHL MEDLINE CINAHL Researcher EBMR Clin-eguide Guidelines (US, AU, NZ) Nursing Advisor ICD9, DDx, Drugs EBMR Clinician Clin-eguide OVID SP
  • 64. Search & Result Multiple DBs Single DB Result 關聯度 Rank Q N Q & N 同義辭庫 + 自然語言 Keyword Keyword + MeSH Search Clin-eguide OVID SP
  • 65. Keywords or Index Terms (N/Q)
    • Keywords with truncation
    • OR
    • Index Terms (MeSH)
    • 完全包含 Include Related Terms ( 同義辭庫 )
    • 但略少於 Pubmed (ATM)
  • 66. Time … Information …
  • 67. One
  • 68.  
  • 69. Summary OVID SP ~ Clin-eguide Books (Reviews) +/- EBMR Educator OVID SP > Clin-eguide (MEDLINE, CINAHL) Researcher Clin-eguide > OVID SP EBMR, Clin-eguide Guidelines (US, AU, NZ) ICD9, DDx, Drugs Clinician Recommendations
  • 70. The End.
  • 71.