第2講-循證醫(yī)學的證據(jù)來源和檢索課件1

循證醫(yī)學研究證據(jù)的

來源與檢索張嘯飛浙醫(yī)二院臨床流行病和生物統(tǒng)計中心xfzhang63@163.com精品課件循證醫(yī)學研究證據(jù)的

來源與檢索精品課件復習：什么是循證醫(yī)學？Evidence-basedMedicine？2022/12/222精品課件復習：什么是循證醫(yī)學？Evidence-basedMeEvidence-basedmedicine(EBM)Evidence-basedmedicine(EBM)isthenamegiventothe‘theconscientious,judiciousandexplicituseofcurrentbestevidenceinmakingdecisionsaboutthecareoftheindividualpatient’(Sackettetal.BMJ1996).精品課件Evidence-basedmedicine(EBM)EEBM，循證醫(yī)學（EvidencebasedMedicine）：是臨床醫(yī)生經過認真盡責地、正確判斷地且很明確地做出決定：將最佳證據(jù)應用于臨床實踐診治病人以便于取得最佳診療效果。

2022/12/224精品課件EBM，循證醫(yī)學（EvidencebasedMediciEBMThethinkingbehindevidence-basedmedicineisverysoundlybasedonClinicalEpidemiology;andthepracticewillbefamiliartothoseofyouwhohaveexperienceofproblem-basedlearning.精品課件EBMThethinkingbehindevidencEBMThephilosophyofevidence-basedmedicineisnotnew.Whatisnewistheenormousandgrowingcapacitytoaccessknowledgeinanefficientmanner.Evidence-basedmedicineexploitstheinformationexplosionthatmightotherwiseoverwhelmus.Theskillsbeingtoasktherightquestions,lookforanswers,andinterpretandapplythoseanswersforthebesthealthoutcomes.精品課件EBMThephilosophyofevidence-EBMEvidence-basedmedicineisatoolwithmanyapplications:tocomplementclinicalexpertiseinprovidingbestcareforpatients;tomakebest,rational,useoflimitedresources;asanaidtocontinuingeducationandprofessionaldevelopment.精品課件EBMEvidence-basedmedicineisEBM精品課件EBM精品課件

四大因素的有機結合2022/12/229臨床流行病學方法學基礎最佳研究成果素質良好醫(yī)師患者的參與循證醫(yī)學精品課件四大因素的有機結合2022/12/209臨床流行病學方

STEPSINEBM

Evidence-basedMedicinestartswithawell-definedclinicalproblemandthenseeksbestevidencetosolvethisproblemfortheindividualpatient’ssituation.Therearefourmainsteps:精品課件

STEPSINEBM

Evidence-basedMSTEPSINEBMFramingClinicalQuestions.SearchingforEvidence.AppraisingtheEvidence.ApplyingtheEvidence.精品課件STEPSINEBMFramingClinicalQ復習：怎么構架問題？或者都有哪些問題需要來回答的？2022/12/2212精品課件復習：怎么構架問題？或者都有哪些問題需要來回答的？2022Step1-FramingClinicalQuestions詢證醫(yī)學的第一步是問正確的臨床問題：這些有關患者保健問題都是醫(yī)生每天所要面對的。如何解釋這些臨床結果?哪些診斷試驗有助于診斷和管理病人?哪些治療將會帶來最大的“風險與獲益”比?預后是怎樣的?精品課件Step1-FramingClinicalQuesStep1-FramingClinicalQuestionsEightcentraltasksofclinicalworkthatgenerateclinicalquestions:臨床結果（Clinicalfindings）:怎樣恰當?shù)夭杉∈?，并根?jù)病史和身體檢查來解釋臨床結果。（howtoproperlygatherandinterpretfindingsfromthehistoryandphysicalexamination.）病因學（Etiology）:怎樣來識別或鑒定病因（howtoidentifycausesfordisease(includingitsiatrogenicforms，醫(yī)源性的)）？精品課件Step1-FramingClinicalQuesEightcentraltasksofclinicalworkthatgenerateclinicalquestions:Differentialdiagnosis（鑒別診斷）:whenconsideringthepossiblecausesofapatient’sclinicalproblem,howtorankthembylikelihood,seriousnessandtreatability.Diagnostictest（診斷檢查）:howtoselectandinterpretdiagnostictests,inordertoconfirmorexcludeadiagnosis,basedonconsideringtheirprecision,accuracy,acceptability,expense,safetyetc.精品課件EightcentraltasksofclinicaEightcentraltasksofclinicalworkthatgenerateclinicalquestions:Prognosis（預后）:howtoestimatethepatient’slikelyclinicalcourseovertimeandanticipatelikelycomplicationsofthedisease.Therapy（治療）:howtoselecttreatmentstoofferthepatientsthatdomoregoodthanharmandthatareworththeeffortsandcostsofusingthem.精品課件EightcentraltasksofclinicaEightcentraltasksofclinicalworkthatgenerateclinicalquestions:7.Prevention（預防）:howtoreducethechanceofdiseasebyidentifyingandmodifyingriskfactorsandhowtodiagnosediseaseearlybyscreening.8.Self-improvement（自我完善）:howtokeepup-to-date,improveyouclinicalskillsandrunabetter,moreefficientclinicalpractice.精品課件EightcentraltasksofclinicaStep2-SearchingforEvidence

Havingframedyourquestion,thenextstepistoidentifysourcesofinformation.Thesemightinclude:TextbooksJournalsandNewsletters.Forexample:AmericanCollegeofPhysiciansJournalClubEvidence-basedMedicine

Scientificreports/Governmentreports.Forexample:NationalHealthandMedicalResearchCouncilHealthAdvisoryCommittee

精品課件Step2-SearchingforEvidencStep2-SearchingforEvidenceGuidelines.Forexample:TheUnitedStatesPreventiveServicesTaskForce-GuidetoClinicalPreventiveServices

EMJAClinicalGuidelines

Databases.Forexample:CochraneLibraryBestEvidenceBibliographicdatabases.Forexample:MedlineEMBASEOtherinternetsources.Forexample:DARE精品課件Step2-SearchingforEvidenc2022/12/2220精品課件2022/12/2020精品課件2022/12/22精品課件2022/12/20精品課件2022/12/2222精品課件2022/12/2022精品課件2022/12/2223精品課件2022/12/2023精品課件2022/12/2224精品課件2022/12/2024精品課件2022/12/2225精品課件2022/12/2025精品課件2022/12/2226精品課件2022/12/2026精品課件循證醫(yī)學實踐的步驟

檢索相關文獻根據(jù)提出的臨床問題，確定“檢索詞”利用各種權威的檢索系統(tǒng)檢索相關文獻。從檢索結果中找出與問題關系密切的資料，作為分析評價之用。文獻檢索只是循證醫(yī)學實踐中的一個環(huán)節(jié)。2022/12/2227精品課件循證醫(yī)學實踐的步驟檢索相關文獻2022/12/202

尋找外部證據(jù)的途徑

教科書與專著：從教科書與專著循證是傳統(tǒng)的方法，但不是最佳的方法。因為許多臨床的問題，難以從教科書中找到令人滿意的解答。各個層次的教科書一般來說已經成熟的理論多體現(xiàn)在教科書，專著也多是每數(shù)年再版一次，除成熟的理論外，多有作者比較成熟的經驗和觀點。對于全科醫(yī)生和低年資的?？漆t(yī)生，教科書和專著往往是循證的重要途徑。即使是高年資的專科醫(yī)生，也常常需要瀏覽教科書和專著，以較全面地了解本學科的總體發(fā)展。對于特殊臨床問題的循證，往往需要從后面幾個角度去尋找外部的證據(jù)。

2022/12/2228精品課件尋找外部證據(jù)的途徑教科書與專醫(yī)學期刊是循證醫(yī)學最重要的源泉國內外際上有數(shù)以萬計的醫(yī)學期刊。循證醫(yī)學，需要學會快速地檢索和獲取醫(yī)學期刊文獻。通過互聯(lián)網(wǎng)絡檢索是最快獲取資料的方法之一，有許多檢索方法和網(wǎng)址，其中較常用的之一是美國國家生物學技術信息中心的PubMed網(wǎng)頁從互聯(lián)網(wǎng)絡上所能獲得的文獻的原文是很有限的，圖書館中的期刊是循證醫(yī)學的源泉。在獲得所需要的文章以后，還要運用臨床流行病學的方法判斷該研究的可靠性和有效性。

2022/12/2229精品課件醫(yī)學期刊是循證醫(yī)學最重要的源泉國內外際上有數(shù)以萬計的醫(yī)學期刊一次文獻：專著，期刊論文，科技報告，學位論文。

二次文獻：索引，文摘，目錄，相應的數(shù)據(jù)庫。

三次文獻：綜述，評述，進展，現(xiàn)狀，發(fā)展趨勢等期刊文獻和百科全書，年鑒，手冊等參考工具書。

零次文獻：實驗數(shù)據(jù)，觀測記錄，調查材料。2022/12/2230精品課件一次文獻：專著，期刊論文，科技報告，學位論文。

2022/2022/12/2231精品課件2022/12/2031精品課件2022/12/2232精品課件2022/12/2032精品課件PubMed：美國國立醫(yī)學圖書館創(chuàng)建，收集全球70多個國家和地區(qū)3900余種雜志，Evidence-BasedMedicine是主題詞（MeSHTerm）

http://ncbi.nlm.nih.gve/PubMed

CochraneLibrary：每年四期，中文生物醫(yī)學文獻數(shù)據(jù)庫（CBM）：中國醫(yī)學科學院醫(yī)學信息研究所研制2022/12/2233精品課件PubMed：美國國立醫(yī)學圖書館創(chuàng)建，收集全球70多個國家和SearchforPrimarySources

Usemethodologicalfilterstotargettherighttypeofstudy.Forinstance,PubMEDfiltersfor:therapydiagnosisprognosisaetiology2022/12/2234精品課件SearchforPrimarySources

Use查找二級資源Guidelines:UKNationalLibraryforHealth,NICE,SIGN;USNationalGuidelinesClearinghouse;CanadianMedicalAssociation;NewZealandGuidelinesGroup.

CATs:CATCrawler

Evidence-BasedSummaries:

Bandolier,ClinicalEvidence

StructuredAbstracts:EBMOnline,ACPJournalClub

SystematicReviews:CochraneLibrary

Tosearchseveralofthedatabasessimultaneouslyyoucanuse:

2022/12/2235精品課件查找二級資源Guidelines:UKNational

證據(jù)的檢索EBM數(shù)據(jù)庫綜合性數(shù)據(jù)庫EBM期刊臨床實踐指南衛(wèi)生技術評估2022/12/2236精品課件證據(jù)的檢索EBM數(shù)據(jù)庫2022/12/Cochrane圖書館Cochrane圖書館的資料也是循證醫(yī)學的一個重要的組成部分。Cochrane醫(yī)生生前極力倡導，各專業(yè)應在世界范圍內收隨機臨床試驗的研究，進行Meta分析，向世界各國醫(yī)生提供臨床決策的最佳證據(jù)。Cochrane圖書館，以出版光碟的形式向全世界傳播治療學方面的，以Meta分析為主的系統(tǒng)評價形式的研究論文。Cochrane圖書館的內容無疑是非常重要的循證醫(yī)學方面的來源，因為它為治療學所提供的決策依據(jù)具有較高的可靠性。2022/12/2237精品課件Cochrane圖書館Cochrane圖書館的資料也是循證醫(yī)1.CochraneLibrary

據(jù)庫CochraneLibrary

是獲取循證醫(yī)學證據(jù)的主要來源，由Cochrane協(xié)作網(wǎng)創(chuàng)建。電子出版物，每年四期，可免費獲取文摘。主要有三個子庫2022/12/2238精品課件1.CochraneLibrary

CochraneLibrary的子庫

(1)TheCochraneDatabaseofSystematicReviews

考科蘭協(xié)作網(wǎng)系統(tǒng)評價數(shù)據(jù)庫

該庫收錄由Cochrane協(xié)作網(wǎng)50余個系統(tǒng)綜述專業(yè)組在統(tǒng)一工作手冊指導下完成的系統(tǒng)綜述，包括系統(tǒng)綜述全文(Review)和研究方案(Protocol)，并隨著讀者的建議和評論以及新的臨床試驗的出現(xiàn)不斷補充和更新。2022/12/2239精品課件CochraneLibrary的子庫

CochraneLibrary的子庫(2)TheDatabaseofAbstractsofReviewsofEffectiveness

效果評價文摘數(shù)據(jù)庫

該庫包括非Cochrane協(xié)作網(wǎng)成員發(fā)表的普通系統(tǒng)評價的摘要和目錄，是對Cochrane系統(tǒng)評價的補充，由英國約克大學的國家衛(wèi)生服務部評價和傳播中心提供。DARE的特點是其系統(tǒng)評價的摘要包括了作者對系統(tǒng)評價質量的評估。與CDSR不同的是它只收集了評論性摘要、題目及出處，而沒有全文，并且不一定符合Cochrane系統(tǒng)評價的要求。2022/12/2240精品課件CochraneLibrary的子庫(

CochraneLibrary的子庫(3)TheCochraneCENTRALRegisterofControlledTrials

考科蘭臨床對照試驗注冊中心

資料來源于協(xié)作網(wǎng)各系統(tǒng)評價小組和其它組織的專業(yè)臨床試驗資料庫以及在MEDLINE上被檢索出的隨機對照試驗（RCT）和臨床對照試驗（CCT）。還包括了全世界Cochrane協(xié)作網(wǎng)成員從有關醫(yī)學雜志會議論文集和其他來源中收集到的CCT報告。2022/12/2241精品課件CochraneLibrary的子庫(

CochraneLibrary的檢索2022/12/2242數(shù)據(jù)庫列表檢索方式精品課件CochraneLibrary的檢索2

CochraneLibrary的檢索2022/12/2243簡單檢索高級檢索主題詞檢索精品課件CochraneLibrary的檢索2

CochraneLibrary高級檢索界面2022/12/22442.選擇欲檢字段1.輸入檢索詞4.點此進行檢索3.選擇欲檢索數(shù)據(jù)庫例1：急性心肌梗死的溶栓治療精品課件CochraneLibrary高級檢

檢索結果2022/12/2245獲取摘要精品課件檢索結果2022/12/2045獲取摘要

文摘格式2022/12/2246免費摘要，授權用戶可查看全文。精品課件文摘格式2022/12/2046免費摘要2022/12/2247

CochraneLibraryMeSH檢索界面選擇副主題詞執(zhí)行檢索例2：人類病毒性肝炎的藥物治療精品課件2022/12/2047Cochrane

檢索結果2022/12/2248獲取摘要精品課件檢索結果2022/12/2048獲取摘要2022/12/2249精品課件2022/12/2049精品課件2.綜合性數(shù)據(jù)庫(1)Ovid數(shù)據(jù)庫()由4個子庫組成CCRCT即考科蘭臨床對照試驗注冊中心；ACPJournalClub由兩本期刊組成，它按照循證醫(yī)學文獻要求的標準，從100多種生物醫(yī)學期刊中選擇和提煉相關文獻，并對該文獻臨床應用價值進行評論。CDSR即考科蘭協(xié)作網(wǎng)系統(tǒng)評價數(shù)據(jù)庫DARE即效果評價文摘數(shù)據(jù)庫。2022/12/2250精品課件2.綜合性數(shù)據(jù)庫(1)Ovid數(shù)據(jù)庫

選擇數(shù)據(jù)庫2022/12/2251循證醫(yī)學數(shù)據(jù)庫列表選擇AllEBMReviews，即同時檢索四個子庫精品課件選擇數(shù)據(jù)庫2022/12/2051循證醫(yī)

關鍵詞檢索2022/12/22521.輸入檢索式3.點擊search4.顯示詳細檢索結果2.限定檢索例3：缺鐵性貧血的治療精品課件關鍵詞檢索2022/12/20521.輸

檢索結果2022/12/2253顯示結果精品課件檢索結果2022/12/2053顯示結果

獲取全文2022/12/2254獲取全文精品課件獲取全文2022/12/2054獲取全文

全文2022/12/2255精品課件全文2022/12/2055精品課件2.綜合性數(shù)據(jù)庫(2)PubMed數(shù)據(jù)庫方法一：字段限定例：irondeficiencyanaemiaANDsystematic[sb]2022/12/2256精品課件2.綜合性數(shù)據(jù)庫(2)PubMed數(shù)2022/12/2257字段限定精品課件2022/12/2057字段限定精品課件方法二：ClinicalQueries2022/12/2258精品課件方法二：ClinicalQueries2022/12/20方法三：Limits的文獻類型中有Meta－分析、實踐指南和隨機對照試驗。2022/12/2259精品課件方法三：Limits的文獻類型中有Meta－分析、實踐指南和3.EBM期刊Bandolier

月刊由英國OxfordHSR&DDirectorate于1994年創(chuàng)辦，網(wǎng)絡版始于1995年，可免費獲取全文。提供兩種檢索方式：

●SubjectIndex：瀏覽學科專題目錄，逐層點擊，直至所需文獻。

●Search：輸入檢索詞，可檢索到Bandolier的所有文獻，并以星級表示檢出文獻的相關度。2022/12/2260精品課件3.EBM期刊Bandolier2022/1

主題索引2022/12/2261主題索引輸詞檢索精品課件主題索引2022/12/2061主題索引

輸詞檢索2022/12/2262檢索有關高血壓治療的文獻精品課件輸詞檢索2022/12/2062檢索有關高2022/12/2263檢出文獻的相關度精品課件2022/12/2063檢出文獻的相關度精品課件2022/12/2264全文精品課件2022/12/2064全文精品課件3.EBM期刊(2)ACPJournalClub

雙月刊由美國內科醫(yī)師協(xié)會和美國內科協(xié)會聯(lián)合主辦

2022/12/2265精品課件3.EBM期刊(2)ACPJournal2022/12/2266過刊精品課件2022/12/2066過刊精品課件3.EBM期刊(3)Evidence-basedMedicine

雙月刊由英國醫(yī)學雜志和美國內科醫(yī)師協(xié)會聯(lián)合主辦。

2022/12/2267精品課件3.EBM期刊(3)Evidence-ba2022/12/2268檢索方法精品課件2022/12/2068檢索方法精品課件3.EBM期刊(4)《循證醫(yī)學》

雙月刊

由廣東省循證醫(yī)學科研中心、廣東省人

民醫(yī)院和中山大學附屬第三醫(yī)院主辦。重點是腫瘤學領域的循證醫(yī)學實踐。

2022/12/2269精品課件3.EBM期刊(4)《循證醫(yī)學》2022/2022/12/2270精品課件2022/12/2070精品課件4.臨床實踐指南(1)NationalGuidelineClearinghouse(NGC)

NGC是由AgencyforHealthcareResearch&Quality、AmericanMedicalAssociation

和AmericanAssociationofHealthPlans主辦的循證醫(yī)學臨床實踐指南數(shù)據(jù)庫。提供全文。有檢索、瀏覽和比較等功能。/

2022/12/2271精品課件4.臨床實踐指南(1)NationSearch（檢索）

可進行BasicSearch或DetailedSearch方式檢索，其檢索規(guī)則與PubMed相似，支持布爾邏輯組配AND、OR、NOT，短語加“”號，截詞符用“*”號。Browse（瀏覽）

分為多個欄目，可通過瀏覽目錄，層層點擊直至所需指南。主要有Disease／condition、Treatment/Intervention、Measures/Tools、Organization等欄目。2022/12/2272精品課件Search（檢索）

可進行BasicSearch或DCompareguidelines（比較）AddtomyCollection：將選中的指南加入指南集合中。CompareSelectedGuidelines：對選中的指南進行比較。ViewGuidelinesCollection：瀏覽當前指南集合RemoveSelectedGuidelinesfromCollection：選中欲去除指南前的方框，去除選中指南RemoveAllGuidelinesinCollection：去除指南集合中所有指南。2022/12/2273精品課件Compareguidelines（比較）2022/122022/12/2274選擇要比較的指南,并加入集合中。精品課件2022/12/2074選擇要比較的指南,并加入集合中。精品2022/12/2275選擇指南,進行比較。要比較的精品課件2022/12/2075選擇指南,進行比較。要比較的精品課件

指南比較結果2022/12/2276精品課件指南比較結果2022/12/2076精品4.臨床實踐指南(2)CMAInfobase：ClinicalPracticeGuidelineshttp://www.cma.ca/cpgs/

加拿大臨床實踐指南數(shù)據(jù)庫于1995年由加拿大國家、州或地區(qū)醫(yī)學衛(wèi)生組織，專業(yè)協(xié)會，政府機構和專家小組共同主辦并認可。它提供多種檢索途徑：KeywordSearch：輸入關鍵詞或短語進行檢索，也可選擇BasicSearch或AdvancedSearch方式檢索：2022/12/2277精品課件4.臨床實踐指南(2)CMAInBrowseBydevelopers：從創(chuàng)建guideline的機構名著手進行檢索。Recentadditions：最近新增加的guideline.NewsCurrenthealthtopic：從最新衛(wèi)生專題著手檢索。Inthenews：新聞。ResourcesFordevelopers：機構的信息。OtherCPGdatabases：其他國家則臨床實踐指南數(shù)據(jù)庫。FAQs：常見問題解答。

2022/12/2278http://www.cma.ca/cpgs/精品課件Browse2022/12/2078http://www.c2022/12/2279精品課件2022/12/2079精品課件5.衛(wèi)生技術評估(1)INAHTA國際衛(wèi)生技術評估網(wǎng)(TheInternationalNetworkofAgenciesforHealthTechnologyAssessment)成立于1993年，秘書處在瑞典。

(2)ISTAHC國際衛(wèi)生技術評估會成立于1985年，秘書處設在加拿大。

2022/12/2280精品課件5.衛(wèi)生技術評估(1)INAHTA

檢索實例1一名內科醫(yī)生在臨床實踐中提出問題：是否能夠將溶栓聯(lián)合冠狀動脈介入治療急性心肌梗塞，目前有無充分的相關證據(jù)？2022/12/2281精品課件檢索實例1一名內科醫(yī)生在臨該醫(yī)生檢索文獻的目的并非廣泛收集信息，進行科學研究，而是希望能夠獲取解決臨床問題的最佳證據(jù)，因此屬于循證醫(yī)學實踐范疇。從查全率和查準率的角度看，查準更為重要，因此，在檢索時應首先查看是否有相關的高質量的臨床實踐指南、系統(tǒng)評價和Meta分析。若無，再查看其他等級證據(jù)，如單個樣本量足夠的隨機對照實驗、設對照組但未用隨機方法分組的研究等。2022/12/2282精品課件該醫(yī)生檢索文獻的目的并非廣泛收集信息，進行科學研究，而是希望選詞急性心肌梗塞（Acutemyocardialinfarction）血栓溶解療法（Thrombolytictherapy）急診冠狀動脈介入治療（Primarycoronaryintervention）經皮經腔冠狀動脈血管成形術（Percutaneouscoronarytransluminalangioplasty）2022/12/2283精品課件選詞2022/12/2083精品課件數(shù)據(jù)庫的選擇NationalGuidelineClearinghouse/PubMed2022/12/2284精品課件數(shù)據(jù)庫的選擇2022/12/2084精品課件2022/12/22851.將檢索詞輸入相應位置，點擊Search進行檢索。精品課件2022/12/20851.將檢索詞輸入相應位置，點擊Sea2022/12/22863.點擊指南標題即可看到全文。精品課件2022/12/20863.點擊指南標題即可看到全文。精品課SearchPubMed2022/12/2287精品課件SearchPubMed2022/12/2087精品課件2022/12/22881.在檢索框中輸入Acutemyocardialinfarction，點擊GO，即可得到檢索結果。2.然后，再返回此界面分別在檢索框中輸入Thrombolytictherapy；Primarycoronaryintervention；Percutaneouscoronarytransluminalangioplasty，進行檢索。精品課件2022/12/20881.在檢索框中輸入Acutemyo2022/12/22893.點擊History，查看檢索史，以便進行邏輯組配檢索。4.將檢索序號進行邏輯組配后，點擊Go。精品課件2022/12/20893.點擊History，查看檢索史，例二2022/12/2290精品課件例二2022/12/2090精品課件尋找證據(jù)應用PICO來構成研究問題例如，英國一個對戒煙感興趣的全科保健醫(yī)生，他想要在自己對青少年醫(yī)療實踐中，阻止吸煙。為了勸服同行們，他想要看看目前有那些證據(jù)，尤其是在一些簡潔干預技術的效果方面上的證據(jù)。2022/12/2291精品課件尋找證據(jù)應用PICO來構成研究問題2022/12/2091精2022/12/2292精品課件2022/12/2092精品課件2022/12/2293精品課件2022/12/2093精品課件問題簡潔干預（Briefintervention）手段能被看做是青少年(Teenagers)有效戒煙（Smokingcessation)的一種技術手段嗎？2022/12/2294精品課件問題簡潔干預（Briefintervention）手段能被Howtocombinesearchterms

OR–combineterms(words)whereyouwanteitheroranyofthemtoappearinanarticle.e.g.,TeenagersorAdolescents2022/12/2295精品課件Howtocombinesearchterms

2HowtocombinesearchtermsAnd-combineterms(words)whereyouwantbothorallofthemtoappearinanarticle.e.g.,TeenagersandSmoking2022/12/2296精品課件HowtocombinesearchtermsAndHowtocombinesearchtermsForspellingvariationsuse*E.g.adolescen*willsearchforadolescentoradolescentsoradolescence2022/12/2297精品課件HowtocombinesearchtermsFor構建你的檢索策略PIOTeenage*orAdolescen*orYoungpeopleBriefintervention*orBriefadviceorBriefconsel*SmokingcessationorStop*smokingorQuitsmokingP檢索結果的數(shù)據(jù)庫SetofresultsforPI檢索結果的數(shù)據(jù)庫Set

ofresultsforIO檢索結果的數(shù)據(jù)庫Set

ofresultsforO2022/12/2298andand精品課件構建你的檢索策略PIOTeenage*Briefinter利用PubMed文獻數(shù)據(jù)庫2022/12/2299精品課件利用PubMed文獻數(shù)據(jù)庫2022/12/2099精品課件2022/12/22100精品課件2022/12/20100精品課件2022/12/22101精品課件2022/12/20101精品課件2022/12/22102精品課件2022/12/20102精品課件2022/12/22103精品課件2022/12/20103精品課件2022/12/22104精品課件2022/12/20104精品課件2022/12/22105精品課件2022/12/20105精品課件2022/12/22106精品課件2022/12/20106精品課件2022/12/22107精品課件2022/12/20107精品課件2022/12/22108精品課件2022/12/20108精品課件2022/12/22109精品課件2022/12/20109精品課件2022/12/22110精品課件2022/12/20110精品課件2022/12/22111精品課件2022/12/20111精品課件2022/12/22112精品課件2022/12/20112精品課件2022/12/22113精品課件2022/12/20113精品課件2022/12/22114精品課件2022/12/20114精品課件2022/12/22115精品課件2022/12/20115精品課件2022/12/22116精品課件2022/12/20116精品課件2022/12/22117精品課件2022/12/20117精品課件2022/12/22118精品課件2022/12/20118精品課件2022/12/22119精品課件2022/12/20119精品課件2022/12/22120精品課件2022/12/20120精品課件2022/12/22121精品課件2022/12/20121精品課件Cochranereview示例2022/12/22122精品課件Cochranereview示例2022/12/2012Selectiveserotoninreuptakeinhibitors(SSRIs)forstrokerecovery:aCochranereviewClinical精品課件SelectiveserotoninreuptakeiClinicalquestionDoselectiveserotoninreuptakeinhibitors(SSRIs)prescribedduringthefirstyearafterstrokeimproverecoveryattheendoftreatmentandtheendoffollow-up?Source:MeadGE,HsiehCF,LeeR,KutlubaevMA,ClaxtonA,HankeyGJ,HackettML.Selectiveserotoninreuptakeinhibitors(SSRIs)forstrokerecovery.

CochraneDatabaseofSystematicReviews2012,Issue11.Art.No.:CD009286.DOI:10.1002/14651858.CD009286.pub2.精品課件ClinicalquestionDoselectiveContext精品課件Strokeisthemajorcauseofadultdisability.Selectiveserotoninreuptakeinhibitors(SSRIs)havebeenusedformanyyearstomanagedepression,includinginpeoplewhohavehadastroke.Recently,smalltrialshavedemonstratedthatSSRIsmightimproverecoveryafterstroke,eveninpeoplewhoarenotdepressed.Context精品課件StrokeisthemajorMethodsTheregistersoftheCochraneStrokeandDepressionAnxietyandNeurosisGroupsweresearched,alongwiththeCochraneCentralRegisterofControlledTrials,MEDLINE,EMBASE,CINAHL,AMED,PsycINFOandPsychBITE.Trialregistriesandpharmaceuticalwebsiteswereexamined,referencelistswerecheckedandcitationtrackingwasdoneofincludedstudies.Meta-analysesusedtherandomeffectsmodels,withriskratios(RR)fordichotomousdataandstandardisedmeandifferences(SMD)forordinalandcontinuousdata.TheCochraneRiskofBiastoolwasapplied,withsensitivityanalysesconductedthatrestrictedeachmeta-analysistotrialsatlowriskofbiasforeachqualitycriterion.精品課件MethodsTheregistersoftheCoPICO(S)toassesseligiblestudiesParticipants:

Peoplewhohadhadastroke(notatransientischaemicattack,TIA)intheprevious12months.

Intervention:Selectiveserotoninreuptakeinhibitor(SSRI)ofanytypeandduration,usedforanyindication.Comparison:PlaceboorusualcarewithouttheSSRI.Outcomes:Primaryoutcomes:dependenceanddisability.Secondaryoutcomes:neurologicalimpairmentsoverall,cognition,motorfunction,depression,anxiety,qualityoflife,death,adverseevents,prematuretrialwithdrawal,fatigueandhealthcarecosts.Studies:Randomisedtrials.精品課件PICO(S)toassesseligiblestuDescriptionofeligiblestudies52studies(4059participants)wereincludedinthemeta-analyses,withmostrecruitedpeoplehavinghadanischaemicstroke.ThemostcommonSSRIwasfluoxetine,whichwasusedin28trials.TrialswerefromUSA,Europe,AustraliaandChina.Meanageofparticipantsineachtrialrangedfrom55to77years.Moststudiesexcludedpeoplewhocouldnotconsentforthemselves(e.g.duetoaphasiaorconfusion).精品課件DescriptionofeligiblestudieResults–primaryoutcomesOnetrial(112participants)provideddataondependencyattheendoftreatment,RR:0.81(95%CI0.68to0.97).22trials(1343participants)couldbecombinedinthemeta-analysisofdisabilityscoreattheendoftreatment,SMD:0.91(95%CI0.60to1.22);butwithhighheterogeneity(I2=87%).Only7trialsprovideddataonfollow-upaftertheendoftreatment.精品課件Results–primaryoutcomesOneResults–disabilityatendoftreatment精品課件Results–disabilityatendofSecondaryoutcomesatendoftreatmentOutcomeTrials(participants)Effectsize(95%CI)Heterogeneity(I2)Neurologicalscore29(n=2011)SMD-1.00(-1.26,-0.75)86%Depression(dichotomous)8(n=771)RR0.43(0.24,0.77)77%Depression(continuous)39(n=2728)SMD-1.91(-2.34,-1.48)95%Anxiety8(n=413)SMD-0.77(-1.52,-0.02)92%Cognition7(n=425)SMD0.32(-0.23,0.86)86%Motordeficits2(n=145)SMD-0.33(-1.22,0.56)n/aDeath46(n=3344)RR0.76(0.34,1.70)0%Leavingtrialearly49(n=3851)RR1.02(0.86,1.21)31%Seizures7(n=444)RR2.67(0.61,11.63)0%GIsideeffects14(n=902)RR1.90(0.94,3.85)31%Bleeding2(n=249)RR1.63(0.20,13.05)0%精品課件SecondaryoutcomesatendoftFollow-upaftertheendoftreatment精品課件OutcomeTrials(participants)Effectsize(95%CI)Disability2(n=155)SMD1.78(-1.01,4.57)Neurologicaldeficit4(n=275)SMD-0.63(-1.30,0.04)Depression(continuous)4(n=275)SMD-1.10(-2.16,0.04)Depression(dichotomous)1(n=99)RR0.77(0.35,1.76)Cognition1(n=99)SMD0.02(-0.37,0.42)Death3(n=257)RR0.08(0.00,1.41)Follow-upaftertheendoftreSensitivityanalysesfordisabilityatendoftreatment,restrictedtotrialsatlowriskofbiasQualitycriterionSMD(95%CI)fordisabilityAlltrials(i.e.noqualitycriteriaapplied)0.91(0.60,1.22)Randomisation0.32(0.06,0.58)Allocationconcealed0.70(-0.73,2.13)Patient/personnelblind0.29(0.04,0.53)Outcomeassessorblind0.78(0.04,1.52)Incompleteoutcomedata0.77(0.22,1.33)Selectivereporting0.11(-0.26,0.47)精品課件SensitivityanalysesfordisabConclusionsforpracticeAttheendoftreatment,SSRIsreduceddependency,disability,neurologicaldeficit,depression,andanxiety;butwithsubstantialstatisticalheterogeneityandmultiplesourcesofbias.Therearenodataonfatigueorcosts.Thereareinsufficientdatatodrawconclusionsaboutlong-termoutcome.Nevertheless,SSRIsareapromisinginterventiontofacilitatestrokerecovery.精品課件ConclusionsforpracticeAttheFutureresearch Further,large-scalerandomisedtrialsareneededfindoutwhetherfluoxetineimprovesstrokerecovery. ThreesuchtrialsareFOCUS(.uk)intheUKAFFINITY()inAustraliaEFFECTS(www.effects.se)inSweden精品課件Futureresearch Further,largeUsefullinksCochraneJournalClubdiscussionpointsSelectiveserotoninreuptakeinhibitors(SSRIs)forstrokerecovery精品課件UsefullinksCochraneJournalC薈萃分析（Metaanalysis)2022/12/22137精品課件薈萃分析（Metaanalysis)2022/12/20Meta-AnalysisMeta-Analysis的基本原理在meta-analysis中的每個研究都被看做是一個體層面，并應用統(tǒng)計方法把所有層結合起來并且獲得總的估計效果量。

但不要忘記這樣估計的可信性和有用性是與每個研究相關的。

精品課件Meta-AnalysisMeta-Analysis的基本原進行Meta-Analysis的步驟我們應該怎樣編碼數(shù)據(jù)和萃取數(shù)據(jù)？

不同研究中對干預、暴露及結果的表述是足夠相似的可以合并嗎？

我們怎樣來評價每個研究的質量？

識別出作用大?。↖dentifyingtheeffectsize(ES)）合并研究

展示結果

解釋異質性

精品課件進行Meta-Analysis的步驟我們應該怎樣編碼數(shù)據(jù)和萃NEWCASTLE-OTTAWAQUALITYASSESSMENTSCALE CASECONTROLSTUDIES

Note:AstudycanbeawardedamaximumofonestarforeachnumbereditemwithintheSelectionandExposurecategories.AmaximumoftwostarscanbegivenforComparability.

Selection1)Isthecasedefinitionadequate?a)yes,withindependentvalidationˉb)yes,egrecordlinkageorbasedonselfreportsc)nodescription2)Representativenessofthecasesa)consecutiveorobviouslyrepresentativeseriesofcasesˉb)potentialforselectionbiasesornotstated3)SelectionofControlsa)communitycontrolsˉb)hospitalcontrolsc)nodescription4)DefinitionofControlsa)nohistoryofdisease(endpoint)ˉb)nodescriptionofsourceComparability1)Comparabilityofcasesandcontrolsonthebasisofthedesignoranalysisa)studycontrolsfor_______________(Selectthemostimportantfactor.)ˉb)studycontrolsforanyadditionalfactorˉ(Thiscriteriacouldbemodifiedtoindicatespecificcontrolforasecondimportantfactor.)

Exposure1)Ascertainmentofexposurea)securerecord(egsurgicalrecords)ˉb)structuredinterviewwhereblindtocase/controlstatusˉc)interviewnotblindedtocase/controlstatusd)writtenselfreportormedicalrecordonlye)nodescription2)Samemethodofascertainmentforcasesandcontrolsa)yesˉb)no3)Non-Responseratea)samerateforbothgroupsˉb)nonrespondentsdescribedc)ratedifferentandnodesignation精品課件NEWCASTLE-OTTAWAQUALITYASSNEWCASTLE-OTTAWAQUALITYASSESSMENTSCALE COHORTSTUDIES

Note:AstudycanbeawardedamaximumofonestarforeachnumbereditemwithintheSelectionandOutcomecategories.AmaximumoftwostarscanbegivenforComparability

Selection1)Representativenessoftheexposedcohorta)trulyrepresentativeoftheaverage_______________(describe)inthecommunityˉ

b)somewhatrepresentativeoftheaverage______________inthecommunityˉc)selectedgroupofusersegnurses,volunteersd)nodescriptionofthederivationofthecohort2)Selectionofthenonexposedcohorta)drawnfromthesamecommunityastheexposedcohortˉb)drawnfromadifferentsourcec)nodescriptionofthederivationofthenonexposedcohort 3)Ascertainmentofexposurea)securerecord(egsurgicalrecords)ˉb)structuredinterviewˉc)writtenselfreportd)nodescription4)Demonstrationthatoutcomeofinterestwasnotpresentatstartofstudya)yesˉb)noComparability1)Comparabilityofcohortsonthebasisofthedesignoranalysisa)studycontrolsfor_____________(selectthemostimportantfactor)ˉb)studycontrolsforanyadditionalfactorˉ(Thiscriteriacouldbemodifiedtoindicatespecificcontrolforasecondimportantfactor.) Outcome1)Assessmentofoutcome

a)independentblindassessmentˉ

b)recordlinkageˉc)selfreport d)nodescription2)Wasfollow-uplongenoughforoutcomestooccura)yes(selectanadequatefollowupperiodforoutcomeofinterest)ˉb)no3)Adequacyoffollowupofcohortsa)completefollowup-allsubjectsaccountedforˉ

b)subjectslosttofollowupunlikelytointroducebias-smallnumberlost->____%(selectanadequate%)followup,ordescriptionprovidedofthoselost)ˉc)followuprate<____%(selectanadequate%)andnodescriptionofthoselostd)nostatement精品課件NEWCASTLE-OTTAWAQUALITYASS精品課件精品課件進行Meta-Analysis的步驟精品課件進行Meta-Analysis的步驟精品課件2022/12/22144精品課件2022/12/20144精品課件2022/12/22145精品課件2022/12/20145精品課件2022/12/22146精品課件2022/12/20146精品課件2022/12/22147精品課件2022/12/20147精品課件2022/12/22148精品課件2022/12/20148精品課件2022/12/22149精品課件2022/12/20149精品課件2022/12/22150精品課件2022/12/20150精品課件2022/12/22151精品課件2022/12/20151精品課件2022/12/22152精品課件2022/12/20152精品課件2022/12/22153精品課件2022/12/20153精品課件2022/1