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Department of Child and Adolescent Health and Development Identifying topics on TB treatment for literature review In collaboration with International Child Health Review Collaboration (ICHRC) Meeting of the Childhood TB Subgroup Paris, 1 November 2006 Shamim Qazi WHO, Geneva
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Department of Child and Adolescent Health and Development Why do we need the evidence base? Evidence often not easily accessible Helpful in the acceptance of guidelines in countries Helpful in medical education and other pre-service training Defines need for further research
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Department of Child and Adolescent Health and Development 7 alternatives to evidence- based medicine Eminence Vehemence Eloquence Providence Diffidence Nervousness Confidence…. based medicine BMJ 319: 1618 (1999)
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Department of Child and Adolescent Health and Development Why PubMed? Provides free access to Medline 16 million citations 4800 journals 30-40 languages OLDMEDLINE for pre-1966 citations. Provides a Clinical Queries search filters page Uses keywords or Medical Subject Headings (MeSH) A spell checker
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Department of Child and Adolescent Health and Development Why PubMed? Provides articles not yet indexed in Medline (in press) Defined sensitivity and specificity Can save and re-run searches using the “My NCBI” function Combining filters with limits as well if needed Request email updates as new trials/reviews are published
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Department of Child and Adolescent Health and Development Why Clinical queries? provides specialized PubMed searches for clinicians easier to find articles that report applied clinical research. defined sensitivity and specificity methodology validated by hand searching Haynes et al; http://www.nlm.nih.gov/pubs/techbull/jf04/cq_info.html ……again can save results and search strategies Easy and quick!
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Department of Child and Adolescent Health and Development
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Department of Child and Adolescent Health and Development
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Department of Child and Adolescent Health and Development Clinical Queries using Research Methodology Filters Category Optimized ForBroad/ Narrow therapy sensitive/broad99%/70% specific/narrow93%/97% diagnosis sensitive/broad98%/74% specific/narrow 64%/98% etiology sensitive/broad93%/63% specific/narrow51%/95% prognosis sensitive/broad90%/80% specific/narrow52%/94% clinical prediction guides sensitive/broad96%/79% specific/narrow54%/99%
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Department of Child and Adolescent Health and Development
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Department of Child and Adolescent Health and Development
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Department of Child and Adolescent Health and Development
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Department of Child and Adolescent Health and Development
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Department of Child and Adolescent Health and Development
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Department of Child and Adolescent Health and Development
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Department of Child and Adolescent Health and Development ICHRC web site www.ichrc.org
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Department of Child and Adolescent Health and Development Reviewer's Tool kit
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Department of Child and Adolescent Health and Development Cough or difficult Breathing
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Department of Child and Adolescent Health and Development ARI Questions addressed In children aged 2-59 months with pneumonia, which clinical signs best predict hypoxemia? What are the common causes of childhood pneumonia in developing countries? Should zinc be used in the prevention and management of acute respiratory infections? What is the most appropriate empirical therapy for very severe pneumonia in children older than 2 months? What are the clinical risk factors for death in children with pneumonia? Is 3 days of amoxicillin as effective as 5 days or more in the treatment of non-severe pneumonia in children? What are appropriate empiric antibiotics for empyema? What is the role of subcutaneous adrenaline in the management of acute asthma? When are oral steroids indicated in acute asthma?
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Department of Child and Adolescent Health and Development Possible Paediatric TB Areas for review Epidemiology Diagnosis Treatment Contact tracing and management Programme monitoring and evaluation Health staff and family roles and responsibilities BCG immunization
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