資料庫檢索簡介及操 作 北醫附醫實證醫學中心蔡龍文

Clinical Epidemiology - 臨床流行病學

以流行病學及統計學的方法，從龐大 的醫學資料中過濾出值得信賴的部份， 嚴格評讀、綜合分析、將所能獲得的最 佳文獻、證據 (Evidence) ，與醫護人員 的經驗 (Experience) ，及病人期望 (Expectation) 的結合，以應用於臨床工 作中。

Triple “E” of EBM Evidence Experience Expectation Decision Analysis

Textbooks and the Internet Finding Answers to More General Questions: Textbooks and the Internet Finding Answers to More General Questions: Textbooks and the Internet

Search

Search evidence

Steps Problem 1: You are trying to find a known Problem 1: You are trying to find a known paper paper 眾裡尋她 眾裡尋她 Problem 2: You want to answer a specific Problem 2: You want to answer a specific question question 直指核心 直指核心 Problem 3: You want to get general Problem 3: You want to get general information quickly about a information quickly about a well defined topic well defined topic 綜覽主題 綜覽主題 Problem 4: Your search gives irrelevant articles Problem 4: Your search gives irrelevant articles 去蕪存菁 去蕪存菁

Steps Problem 5: The search gives no articles, or too few Problem 5: The search gives no articles, or too few 絕處逢生 絕處逢生 Problem 6: You don ‘ t know where to start searching Problem 6: You don ‘ t know where to start searching 無從下手 無從下手 Problem 7: Limiting a set loses important articles but does not exclude Problem 7: Limiting a set loses important articles but does not exclude those of low methodological those of low methodological quality quality 點石成金 點石成金 Problem 8: Medline hasn't helped Problem 8: Medline hasn't helped 另謀蹊徑 另謀蹊徑

Up to 63% of all available RCTs may be missed by a search strategy limited to MEDLINE Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. A comparison of results of meta analyses of randomized control trials and recommendations of clinical experts: Treatment for myocardial infarction. JAMA. 1992;268: Beyand Medline……

證據金字塔

Classification of evidence --US Agency for Health Care Policy and Research Classification (AHCPR, 1992) Evidence level Description Ia:evidence from meta-analysis of randomised controlled trials Ib:evidence from at least one randomised controlled trial IIa:evidence from at least one controlled study without randomisation IIb:evidence from at least one other type of quasi-experimental study III:evidence from non-experimental descriptive studies, such as comparative studies, correlation studies and case-control studies IV:evidence from expert committee reports or opinions and/or clinical experience of respected authorities

實證醫學中心 敬請指教 !