The Cochrane Library 027731 5800 Standard EBMSteps in

The Cochrane Library 講師: 王韻婷 碩睿資訊有限公司 (02)7731 -5800

實證醫學五步驟 “Standard EBM”Steps in EBM process (5 As) • 提出問題(Ask: PICO) – Formulate an answerable question • 搜尋證據(Acquire) – Track down the best evidence • 嚴格評讀(Appraisal: VIP) – Critically appraise the evidence • 恰當運用(Apply: 3 E) – Integrate with clinical expertise and patient values • 衡量結果(Audit) – Monitoring your performance

文獻搜尋優先順序(STRATEGY: top down)

為什麼需要The Cochrane Library?

The Cochrane Library 實證醫學資料庫， 包括六個文獻庫 • Cochrane Database of Systematic Reviews (Cochrane Reviews) Impact Factor 2010= 6. 186 (10/151 Medicine, General & Internal) • 針對特定的疾病或其他健康照顧方面的問題給予系統評論定義，並裁定這項 治療方法是否有效 • Database of Abstracts of Reviews of Effects (Other Reviews) • 收錄經過嚴格審核標準的系統評論摘要資料庫 • Cochrane Central Register of Controlled Trials (Clinical Trials) • 全世界收錄最多且最大的隨機臨床實驗資料庫 • Cochrane Methodology Register (Methods Studies) • 蒐集已出版的且針對產生對照實驗的方法使用的書目資訊 • Health Technology Assessment Database (Technology Assessments) • 提供健康醫療技術之評估，目的在於改善健康照顧的品質及成本效益 • NHS Economic Evaluation Database (Economic Evaluations) • 收錄治療方式的比較、成本和治療效果等相關資料 • About The Cochrane Collaboration (Cochrane Groups)

Cochrane Library主頁面 3 2 1 5 4

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Other Reviews

Method Studies

Technology Assessment

Economic Evalution

Case Study

Question? 提出問題 Does corticosteroid treatment in patients with septic shock improve mortality?

Question? 提出問題 Does corticosteroid treatment in patients with septic shock improve mortality?

PICO n� 病患或族群（Patient or Population） ØPatient with septic shock n� 介入或臨床指標 (Intervention or Indicator） ØCorticosteroid n� 比較標的（Comparator） ØNo corticosteroid n� 結果（Outcome） ØMortality

Key wards Septic shock AND corticosteroid AND mortality

Cochrane library n Topic: Corticosteroids for treating severe sepsis and septic shock [review article] Djillali Annane, Eric Bellissant, Pierre Edouard Bollaert, Josef Briegel, Didier Keh, Yizhak Kupfer January 2009 n�Septic shock is the most severe form of infection. It may also interfere with the production of corticosteroids, a a key hormone for host defence against infection). This review showed that overall corticosteroids did not impact on mortality. n�However, the trials conducted after 1992 showed long that course (≥ 5 days) of low dose of corticosteroids improved survival in septic shock without causing harm. Trials performed before 1992 showed no benefit from short course of high dose corticosteroids.

Primary database-- Pub. Med

蔓越莓預防泌尿道感染是否有用? >Cranberry or Cranberries? >prevent or prevented or prevention… prevent*

預防兒童肥胖的介入方法 • Child or children? • Prevent? preventing? Prevention? . . . • Obesity