Introdue EBM resources

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  • Introdue EBM resources

    1. 1. 實證資源介紹 2008/09/20 基隆長庚.實證中心 楊宗翰
    2. 2. 實證資源 <ul><li>實證基本概念(步驟,計算,應用) </li></ul><ul><li>臨床研究結果 </li></ul><ul><ul><li>Primary databases </li></ul></ul><ul><ul><ul><li>PubMed / Medline </li></ul></ul></ul><ul><ul><li>Secondary databases - EBM reviews </li></ul></ul><ul><ul><ul><li>Topic reviews (summaries) </li></ul></ul></ul><ul><ul><ul><li>Article reviews (synopses) </li></ul></ul></ul><ul><ul><ul><li>Critical Appraisal Topics (CATs) </li></ul></ul></ul>
    3. 3. 實證基本概念 <ul><li>English </li></ul><ul><ul><li>http://www.cebm.net/ </li></ul></ul><ul><ul><li>http://www.cebm.utoronto.ca/ </li></ul></ul><ul><ul><li>http://www.hsl.unc.edu/Services/Tutorials/EBM/ </li></ul></ul><ul><ul><li>http://www.mclibrary.duke.edu/subject/ebm </li></ul></ul><ul><li>中文 </li></ul><ul><ul><li>http://www.tebma.org.tw/ </li></ul></ul>
    4. 4. Differences b/w Databases <ul><li>Contents </li></ul><ul><li>How to search? </li></ul><ul><li>Results of search? </li></ul>
    5. 5. http://www.hubmed.org/
    6. 7. EBMR – the new 101
    7. 8. http://skyscraperpage.com/ 1993 1997 2004
    8. 9. 492 m 448 m 508 m 2008 2004
    9. 10. 2009 508 m 807.7 m 688 m
    10. 11. 江山代有人材出 各領風騷數 年 百
    11. 12. 臨床研究結果 <ul><li>一 </li></ul>
    12. 13. The “5S” levels of organization of evidence from health care research – by R Brain Haynes, 2006 Systems Summaries Synopses Syntheses Studies Original journals articles 原始研究文獻 Pre-filtered Secondary Computerized decision support 實證臨床資訊決策系統 Evidence based textbooks 針對某臨床主題統整各類證據以形成之概述 Evidence based journal abstracts 對單篇研究及 SR 做摘要性評估之文章 Systematic reviews 系統性評論 Primary
    13. 14. Evidence-based resources simplified !? Can Fam Physician. 2008 Feb;54(2):241-3. http://www.library.utoronto.ca/mtsinai/EBM.PDF
    14. 17. Appraise <ul><li>Appraised by yourself … </li></ul><ul><ul><li>Time consuming </li></ul></ul><ul><ul><li>Original articles </li></ul></ul><ul><li>Appraised by authorized specialists </li></ul><ul><ul><li>Systems, Synopses, Synthesis </li></ul></ul><ul><ul><li>Review articles (narrative, systematic, EBM review) </li></ul></ul><ul><ul><ul><li>topic or article review </li></ul></ul></ul>Dave Sackett
    15. 18. CAT EBM Review ACP Journal Club EBM BMJ Primary DB
    16. 19. 臨床研究結果 <ul><ul><li>Primary databases </li></ul></ul><ul><ul><ul><li>PubMed / Medline; EMBASE; CINAHL </li></ul></ul></ul><ul><ul><ul><ul><li>PubMed clones … (hubmed, clustermed) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>CENTRAL ( Cochrane Central Register of Controlled Trials ) </li></ul></ul></ul></ul><ul><ul><ul><li>Google Scholar, WoS, Scopus </li></ul></ul></ul><ul><ul><li>Secondary databases - Reviews </li></ul></ul><ul><ul><ul><li>Topic reviews (summaries) </li></ul></ul></ul><ul><ul><ul><li>Article reviews (synopses) </li></ul></ul></ul><ul><ul><ul><li>Critical Appraisal Topics (CATs) </li></ul></ul></ul>
    17. 20. Cochrane Central Register of Controlled Trials (CENTRAL) <ul><li>Published articles taken from bibliographic databases (notably MEDLINE and EMBASE ), and other published and unpublished sources . </li></ul><ul><li>500,000 records, About 3/5 of the records in CENTRAL are taken from MEDLINE. </li></ul>
    18. 21. Secondary DBs <ul><li>Review Primary Data sources </li></ul>Expert Opinion
    19. 22. Database Critical Appraisal ( Content ) <ul><li>Type of articles (topic/article review or CAT/POEM) </li></ul><ul><ul><li>POEM™ = Patient-Oriented Evidence that Matters™ </li></ul></ul><ul><li>Review & Update Interval </li></ul><ul><ul><li>Immediately & Regularly </li></ul></ul><ul><ul><li>Daily > Weekly > Monthly > Quarter > … </li></ul></ul><ul><li>Review Process </li></ul><ul><ul><li>Reviewers </li></ul></ul><ul><ul><li>Systematic identification / selection / evaluation </li></ul></ul><ul><li>Methods of Review Synthesis </li></ul><ul><ul><li>Accurate summarization of the evidence and its quality </li></ul></ul><ul><ul><li>Making conclusions dependent on the evidence </li></ul></ul><ul><ul><li>Synthesizing multiple bits of evidence for overall conclusions </li></ul></ul>DISCERN Tools: http://www.discern.org.uk/discern_instrument.php
    20. 23. Secondary DBs <ul><li>Narrative reviews </li></ul><ul><li>Topic reviews (summaries) </li></ul><ul><li>Article reviews (synopses) </li></ul><ul><li>Critical Appraisal Topics (CATs/POEMs) </li></ul>
    21. 24. $, Narrative Review, Uptodate 每季更新 7,400 topics
    22. 25. $, Narrative Review, Harrison’s 2008
    23. 26. Narrative Review, Merck Manual http://www.merck.com/pubs/ 2006
    24. 27. Secondary DBs <ul><li>Narrative reviews </li></ul><ul><li>Topic reviews (summaries) </li></ul><ul><li>Article reviews (synopses) </li></ul><ul><li>Critical Appraisal Topics (CATs) </li></ul>
    25. 28. $, Topic review, Dynamed 每日更新 > 3,000 topics
    26. 29. Clinical Knowledge Summaries http://www.cks.library.nhs.uk/
    27. 30. Taiwan, Province of China
    28. 31. $, Topic review, First Consult 每週更新 ? topics
    29. 32. Topic review, Bandolier monthly issue, but no update
    30. 34. Secondary DBs <ul><li>Narrative reviews </li></ul><ul><li>Topic reviews (summaries) </li></ul><ul><li>Article reviews (synopses) </li></ul><ul><li>Critical Appraisal Topics (CATs) </li></ul>
    31. 35. $, Article review
    32. 39. Article review, DARE Database of Abstracts of Reviews of Effects The Centre for Reviews and Dissemination http://www.york.ac.uk/inst/crd/
    33. 41. Secondary DBs <ul><li>Narrative reviews </li></ul><ul><li>Topic reviews (summaries) </li></ul><ul><li>Article reviews (synopses) </li></ul><ul><li>Critical Appraisal Topics (CATs) </li></ul>
    34. 42. CAT, Best Bets
    35. 43. http://www.eboncall.org/
    36. 45. http://www.ebm.twbbs.org/search http://dr3939.twbbs.org/2008/09/ebm-search.html
    37. 46. $, Meta Search <ul><li>First Consult / MD Consult @ Elsevier </li></ul><ul><ul><li>Books, EBMR, Medline … </li></ul></ul><ul><ul><li>Update weekly, Topics ?. </li></ul></ul><ul><li>Clin-eguide @ OVID </li></ul><ul><ul><li>Books, Drugs, Guidelines, EBMR, Medline … </li></ul></ul><ul><ul><li>Update ?, Topics ?. </li></ul></ul><ul><li>Essential Evidence Plus @ Wiley InterScience </li></ul><ul><ul><li>POEMs, Guidelines, … </li></ul></ul><ul><ul><li>Update daily to quarterly, Topics ?. </li></ul></ul>
    38. 47. Taiwan, Province of China
    39. 50. Summary
    40. 51. 資料庫的使用 <ul><li>一 </li></ul>
    41. 52. CAT EBM Review ACP Journal Club EBM BMJ Primary DB
    42. 53. Sequence Primary (Original) < Secondary (Review) Quantity < Quality ___
    43. 54. Clin-eguide MD Consult SUM search Meta Medline EMBASE PubMed CENTRAL Primary DB Uptodate Merck Manual Review DB Dynamed First Consult [email_address] Bandolier EBMR Topic Review ACP JC EBM DARE EBMR Article Review InfoPOEMs CAT search CAT $ Free
    44. 55. 2009 508 m 807.7 m 688 m
    45. 56. Database Critical Appraisal ( Content ) <ul><li>Type of articles (topic/article review or CAT/POEM) </li></ul><ul><ul><li>POEM™ = Patient-Oriented Evidence that Matters™ </li></ul></ul><ul><li>Review & Update Interval </li></ul><ul><ul><li>Immediately & Regularly </li></ul></ul><ul><ul><li>Daily > Weekly > Monthly > Quarter > … </li></ul></ul><ul><li>Review Process </li></ul><ul><ul><li>Reviewers </li></ul></ul><ul><ul><li>Systematic identification / selection / evaluation </li></ul></ul><ul><li>Methods of Review Synthesis </li></ul><ul><ul><li>Accurate summarization of the evidence and its quality </li></ul></ul><ul><ul><li>Making conclusions dependent on the evidence </li></ul></ul><ul><ul><li>Synthesizing multiple bits of evidence for overall conclusions </li></ul></ul>DISCERN Tools: http://www.discern.org.uk/discern_instrument.php
    46. 57. Not included <ul><li>Guidelines </li></ul><ul><li>Cochrane Library </li></ul><ul><ul><li>CENTRAL, DARE </li></ul></ul><ul><ul><li>CDSR (Systematic Review) </li></ul></ul>

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