Up To Date Cochrane Library Pub Med Medline
資料庫的選擇 Up. To. Date Cochrane Library Pub. Med, Medline
前景問題的呈現 • • Patient and/or problem: 病人和/或問題 Intervention/or exposure:介入或暴露 Comparison (if relevant):比較 (不一定有) Outcomes:臨床結果 (盡量數據化)
PICO P: 吞嚥困難病患需長期管灌飲食 I: 胃造廔管管灌飲食 C: 鼻胃管管灌飲食 P: 產生併發症之機率 背景知識 (可利用Google, textbook, uptodate, guideline): Percutaneous Endoscopic Gastristrostomy (PEG)
布林邏輯 (boolean searching) • AND • OR • NOT A B
找出所有替代字眼 • beta-blocker = beta blocker = β-blocker • Hypertension ~ Blood pressure ~ antihypertensive ~ • Stroke = cerebrovascular accident = cerebrovascular event 善用OR
注意字尾變化 • Diabetes/Diabetic • Hypertersion/Hypertensive • Hemorrhage/Hemorrhagic • Antidepressant/Antidepressants 利用星號, 如Diabet* 注意複數
證據強度的決定 Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Level 治療型文章 1 • 分析隨機臨床對照試驗之系統性回顧 (Systematic review of randomized controlled trials) • 單人交叉臨床試驗 (n-of-1 trials) 2 • 設計良好,結果精確之隨機臨床對照試驗 (Randomized controlled trials) • 有巨大成效之觀察性研究 (Oservational study) 3 • 追蹤性世代研究(Cohort/follow-up study) 4 • 系列病例報告(Case Series Study) • 病例對照研究 (case control study) • 回顧性對照研究 (historically controlled study) 5 • 理論性文章 (Mechanism-based reasoning) * 等級可依據研究品質加以升級或降級 Adapted from Center for Evidenced-Based Medicine. http: //www. cebm. net
Results • Cochrane Database Syst Rev. 2012 (Systematic Review + meta-analysis of RCTs, 比較中風病人): – PEG 比起NG在各種併發症產生機率較少. 且營 養供給也較佳 • Cochrane Database Syst Rev. 2012 (Systematic Review + meta-analysis of RCTs, 比較吞嚥困難患者 ): – PEG 比起NG介入失敗率較低,同時也較為安全 及有效率,在死亡率及肺炎罹患率則兩者無差 別
背景知識 (二) • 了解同義詞: – 外側上髁炎: lateral epicondylitis/epicondylosis, tennis elbow, common extensor tendinitis/tendinosis of elbow – 富含血小板血漿注射: (autologous) platelet-rich plasma injection, PRP injection – 自體血液注射: autologous blood injection (ABI), autologous whole blood injection
背景知識 (二) • 了解同義詞: – 外側上髁炎: lateral epicondylitis/epicondylosis, tennis elbow, common extensor tendinitis/tendinosis of elbow – 富含血小板血漿注射: (autologous) platelet-rich plasma injection, PRP injection – 自體血液注射: autologous blood injection, autologous whole blood injection, ABI
Think about keywords ! • plantar fasciitis: "plantar fasci*" or "plantar heel*" or "plantar foot" or "heel pain" or "painful heel*" or "hindfoot pain" or "painful hindfoot“ • angiotensin II receptor blocker: = (angiotensin) +/- (II or 2) +/- (type 1) + receptor + (blocker or antagonist or blockade or inhibitor) +/- "s" = ARBs = AT 1 -receptor + (blocker or antagonist or blockade or inhibitor) +/- "s" = Sartan +/- "s"
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