The Cochrane Library http www sris com tw

The Cochrane Library 碩睿資訊有限公司 http: //www. sris. com. tw

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文獻搜尋優先順序(STRATEGY: top down)

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

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

Cochrane Library主頁面 3 1 2 5 4

3. 點選主頁面的Access內Log In via Online Library。

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關鍵字 Septic shock AND corticosteroid AND mortality

Advance search

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.

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Me. SH search

Me. SH Search 醫學標題表（Medical Subject Headings；簡稱M e S H）輸入一般用的詞

Me. SH Search 醫學標題表（Medical Subject Headings；簡稱M e S H）不用的詞 See: 用的詞

Case Study

Question? 提出問題 n 病患或族群（Patient or Population） ØAnesthesia, Spinal n 介入或臨床指標 (Intervention or Indicator） ØBed Rest n 比較標的（Comparator） ØNo Bed Rest n 結果（Outcome） ØHeadache

Key Words關鍵字 Anesthesia, Spinal AND bed rest AND headache

Cochrane library n Topic: Posture and fluids for preventing post-dural puncture headache[review article] Cathie LM Sudlow, Charles P Warlow 21 JAN 2009 n�To assess the effects on post dural puncture headac period of bed rest versus early mobilisation, of different positions during a period of bed rest, and of administering supplementary fluids after the procedure. n� There is no good evidence from randomised trials to suggest that routine bed rest after dural puncture is beneficial. The role of fluid supplementation in the prevention of post-dural puncture headache remains uncertain.