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實證期刊（ EBxx ） Evidence-based Cardiovascular Medicine Full text available from April 1997 - June 2006 Evidence-based Health Policy & Management Full text available from March 1997 - December 1998 Evidence-based Healthcare and Public Health Full text available from October 2004 - December 2005 Evidence-based Healthcare: A Scientific Approach to Health Policy Full text available from March 1999 - August 2004 Evidence-based Obstetrics & Gynecology Full text available from March 1999 - September 2006 Evidence-based Oncology Full text available from March 2000 - December 2002
Searching Tips for Journals and The Clinics Search FieldsExample Abstractcarpal tunnel [ab],[mdcab],[abstract] Article Titlecarpal tunnel [ti],[titl],[mdcti],[title] Author(s)Last name in first text box. First initial in next text box. Middle initial in the third box. Author AffiliationOregon Health Sciences University [mdcad],[authoraffiliation] Chemical Compound NamePeptide Fragments[mdcrn] LanguageEnglish [mdcla],[language] Major MeSHEndolymphatic Duct [majr],[meshmajor] MeSHdrug therapy [sh],[mesh] NLM Citation ID16442896 [nlmid], [mdcui] Publication Date01 JUL 1998 [pd], Jul 1998 [pd], 1998[pd] Publication TitleNew England Journal of Medicine [jn],[ta],[jour],pubtitle,[mdcpub_title] Publication Title, AbbreviatedN Engl J Med [mdccite] Publication TypeJournal Article [pt],[pubtype],[ptyp],[mdcpt] Source Database (Medline)MI [mdcsource] Year Book Articlesmdcyb[metasource]
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線上診療系統 & 實證醫學資料庫 內容包括 Medical Topics 、 Differential Diagnosis 、 Procedures 持續更新內容 可下載至 PDA Level of Evidence (Level A, B, C, and uncategorized) 標準來源 AAFP ( American Academy of Family Physicians ) US Agency for Healthcare Policy and Research Classification
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First Consult Editorial Board #1 Fred Ferri Chairs the Executive Committee. Associate Director of the Brown University Medical School and Faculty Director & Coordinator of the 'Business of Medicine' course. He is a world-expert in the field of Internal Medicine & has authored over 20 major publications, including Ferri's Clinical Advisor Joseph Scherger Professor of Clinical Family & Preventive Medicine at the University of California, San Diego School of Medicine (UCSD). His main focus is on the redesign of office practice using the tools of information technology and quality improvement. He has received numerous awards, including Outstanding Clinical Instructor in the School of Medicine at the University of California, Davis, in 1984, 1989, and 1990. Stephen Sisson Associate Professor at John Hopkins University School of Medicine and is a leading expert in internal medicine. Editor of the John Hopkins Internal Medicine Board Review Book and the John Hopkins Internet Learning Center. He has been presented with the Society of General Internal Medicine Innovations in Education Award in 2005 and the American College of Physicians Conley Award in Education in 2006. Steven Opal Professor of Medicine of the Infectious Disease Division of Brown Medical School. He has previously served as a US Army Major for 9 years, receiving the Army Commendation Medal in 1985. He is considered a world-expert in the study of infectious diseases, and has received, amongst numerous honors, the Brown Medical School Infectious Disease Fellowship Teacher of the Year award in 2003. He was also included in the Best Doctors in America selection for 2003-4, and has served on the editorial boards of a variety of books and journals. Sara McIntire Professor of Pediatrics at the University of Pittsburgh School of Medicine. She has been presented with the Alpha Omega Alpha Society Award, the Merck Scholar Award, the Janet Glasgow Award & the Academy of Master Educators Award. She has authored several notable publications and has been a regular speaker at several area institutions since 1990, speaking on a wide variety of pediatric topics.
First Consult Editorial Board #2 Tracey Arnell Assistant Professor of Surgery at the New York Presbyterian Hospital. Editorial Board of Contemporary Surgery and a Fellow of the American College of Surgeons. She is a leading expert in the field of gastrointestinal and colorectal surgery. Kathleen O'Hanlon Professor of Family and Community Health at the Joan C. Edwards Marshall University School of Medicine. Chief Editor of First Consult's procedures content. A lifelong member of the AOA Honorary Society. Her professional interests lie chiefly in procedural medicine, comprehensive patient care & teaching. David Fairchild Chief Medical Officer and Chief of the Division of General Medicine at Tufts-New England Medical Center. Associate Professor of Medicine at Tufts University School of Medicine. He has been practicing internal medicine for 20 years. In addition to his clinical and administrative duties, he is a health services researcher with an interest in quality improvement in ambulatory care settings. Barbara Blok Assistant Professor of the Division of Emergency Medicine at the University of Colorado Health Science Center. She is one of the leaders of the Wilderness Medicine Course for the University of Colorado. She has previously worked as the Associate Residency Director at the Johns Hopkins Department of Emergency Medicine, where she established her passion for resident education, emergency ultrasound training and residency administration. During her time at Johns Hopkins she was also presented with the Outstanding Contribution to Teaching and Education Award in 2005. Andrew Hull Associate Professor of Reproductive Medicine at the University of California, San Diego and Director of the UCSD Fetal Diagnosis and Treatment Center. He is a Fellow of the Royal College of Obstetricians & Gynaecologists and a leading expert in the field. He has presented his work at over 40 national and international meetings, and has been honoured with several notable awards, including the Young MRCOG Award and the Ortho Award for Outstanding Research by a Resident in Obstetrics & Gynecology.
First Consult FAQ Q. Where does the First Consult content come from? A. First Consult content is completely original and is created using its unique collaborative authoring process. collaborative authoring process Information is based on multiple sources including, but not limited to, respected textbooks, peer- reviewed articles, evidence databases, drug alerts, practice guidelines, and position papers reviewed and edited by opinion leaders in clinical practice. Our prestigious Editorial Board are all nationally recognized leaders in primary care and specialty medicine.Editorial Board Q. What evidence sources does First Consult use? A. Evidence is summarized, where possible, from systematic reviews of primary research. The main source of these is from the Cochrane Collaboration. Where a Cochrane Review or another good-quality systematic review cannot be identified, other well-regarded sources of aggregated evidence are used to identify relevant research. Otherwise, individual research papers may be identified. Evidence-based guidelines are identified by use of the National Guideline Clearinghouse or directly from the Web site of relevant learned societies, professional associations, and government organizations. Q. Does First Consult grade its evidence? A. Yes, First Consult evaluates all evidence based on a rating system derived from those produced by the American Academy of Family Physicians and the US Agency for Healthcare Policy and Research Classification. Q. How are the diagnostic tables ordered in the Differential Diagnoses section? A. Potential diagnoses for a chief complaint are displayed by age groups, and within each age group they are ordered by prevalence from most common to least common. Items displayed with an asterisk (*) should be ruled out immediately. Ordering of diagnoses is regularly reviewed by the Differential Diagnoses Editorial Board members.
Evaluation of Evidence In this rating system, in order to indicate the strength of the supporting evidence, each summary evidence statement is accorded one of three levels, or uncategorized: Level A Cochrane Reviews of randomized controlled trials (RCTs) where adequate data are found for analysis Other good quality systematic reviews or meta-analyses of RCTs where adequate data are found for analysis Good-quality RCTs Level B Other RCTs not included in Level A Other systematic reviews or meta-analyses not included in Level A Rarely, good-quality nonrandomized clinical trials, and very occasionally other types of study such as case-control studies, clinical cohort studies, cross-sectional studies, retrospective studies, or uncontrolled studies Level C Evidence-based consensus statements and expert guidelines Uncategorized Where a Cochrane Review or other systematic review or meta-analysis reviews a clinical problem but finds no adequate trials upon which to base a conclusion.
1.Formulate an answerable question. (PICO) 由個案的臨床資料形成可回答的臨床問題 2.Track down the best evidence. (Search database) 尋找最佳的實證﹝各種文獻及資料庫，包括發表及未發表資料﹞ 3.Critically appraise the evidence for validity, impact, and applicability. (VIP) 評估各種醫學報告的可信度、臨床重要性，以及可應用性 clinical expertisepatient values 4.Integrate with our clinical expertise and patient values. 整合並應用於實際患者的治療決策﹝臨床應用﹞ 5.Evaluate our effectiveness and efficacy. 效果評估 實證醫學的五大進行步驟 Five Steps to Practice EBM
Case PICO 對於 慢性蕁麻疹 (chronic urticaria) ， Zytec 與 Allegra 的那一種治療效果比較好呢？ P Chronic Urticaria I Zytec (Cetirizine, 驅特異膜衣錠 ) C Allegra (Fexofenadine, 艾來錠 ) O Which one is better?
52:cetirizine45:fexofenadine symptom free27(51.9%)2(4.4%) partial improvement19(36.5%)19(42.2%) no improvement6(11.5%)24(53.3%)
Lifestyle Level of Evidence
Case PICO 慢性蕁麻疹 (chronic urticaria) ， Zytec 與 Allegra 的那一種效果比較好呢？ P Chronic Urticaria I Zytec (Cetirizine, 驅特異膜衣錠 ) C Allegra (Fexofenadine, 艾來錠 ) O Zytec is better !
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