??? [e-mail]

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????????

• ??? yslin2_at_ym.edu.tw
• Head, Collection Circulation Dept.University
  Library
• National Yang Ming Univ.

??99?5?31?
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? ?

• ??????
• -- ?????????????????
• ??????????
• -- ??????,??????
• ????????
• ??????
• Guideline,HTA,Cochrane , EMBASE
• CEPS, ??????????

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Soft drink
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Oxford Center for Evidence-based Medicine Levels
of Evidence (May 2001)
Level Therapy
1a ????? Systematic review, ???? Meta analysis (????????????, ??????)
1b ????, ???? ????????? (Randomized Controlled Trial ,RCT)
1c All or none
2a ????? (????????, ??????)
2b ???? Cohort study ?????????????
2c "Outcomes" Research Ecological studies
3a ????? (??????-????, ??????)
3b ?? - ???? Case-control study
4 ????????? ????????? ??? - ????
5 ???????????, ????, ????, ????, ???????
5
?????????????????????

• Address a focused clinical question
• Comprehensive literature search
  
• Explicit selection criteria
  
• Thorough assessment of the quality
• Objective and reproducible data abstraction
• Examine for any variations in treatment effects
• ??????????????????, ??????? (Meta-analysis)
• ????????????????, ??MEDLINE?1966??????????????????
  ??, ?????, ??????????????????????????????,
  ?????????????????????????, ???????????????????????
  ?? ???? database ????
• JAMA 1992 268 240-248

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??????

• ???????????
• ?????? Meta Analysis, review, Randomized
  Controlled Trial.
• ????
• ????????????????????????

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?????EBM ??

• ???-????
• ??????
• ?????????????
• ??????
• ???
• ???
• ????

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Do Something Is Better Than Do Nothing?

• ????????
• ????????????, ????????(Portal-Systemic Shunting)?
  
• ?????????,
• ???????????????
• ????????
• ????????

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????HTA

• ?????
• ????????????????????
• Team-young vs just come back from Harvard at that
  time

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Search strategy

• Guideline, HTA websites search
• OVID search (publication typeRCT Review
• - Effectiveness
• - Alzheimer Diseases
• - Cholinesterase inhibitors
• - Donepezil
• - Galantamine
• - Rivastigmine
• - Economic studies
• Cochrane Library
• EMBase
• Miss papers

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????????????? ???

• ?????????????????
• ????????????????
• ????????????????????,?????????,???????
• ???????????(20-55?)
• ???????????????????,
• ???????????
• ???????????????????
• (??????625-1400???),?????????????????
• ?????????gt2??????????,???????????????????

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?????????????????????

• ?????????????????????(RHC), ????? ??RHC ?
  ???RHC?? ???????????? (Confounded by indication)
• ??????????, ??????????????????????????????????????
  ?????????????????????, ????????????, ????????
• ??????????????????????? ?????????????????????,
  ??????????????????
• JAMA 2001286309-14

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??????????,???????????????

• ?????????(gt 50)
• ????????
• ?III??IV????
• ??????????????
• ??????????/???????????(stress tests)
• ????????????????
• ????????,????PTCA?????????
• ???????? ??????????

Kirklin JW, Akins CW, Blackstone EH et al.
Guidelines and indications for coronary artery
bypass graft surgery a report of the American
College of Cardiology/American Heart Association
Task Force on Assessment of Diagnostic and
Therapeutic Cardiovascular Procedures
(Subcommittee on Coronary Artery Bypass Graft
Surgery). J Am Coll Cardiol 1991 17543 89.
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Who Are at a Significant Risk in Developing
Hemolytic Anemia?

• Those who were treated by ribavirin dosage?1.0
  g/day
• The risk of anemia related to ribavirin treatment
  were significantly higher among Asian studies,
  which may be due to differences in
• Criteria for study entry,
• Ribavirin dosage titration strategy,
• Ethnic vulnerability.
• Or
• Just BY CHANCE ??

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Risk of Ribavirin-induced Hemolytic Anemia in
Enrolled Studies
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5S Levels
Systems
Evidence-based textbooks UpToDate, Clinical
Evidence
Prefiltered
Summaries
Evidence-based journal abstracts ACP Journal
Club.
Synopses
Systematic Reviews The Cochrane Library
Syntheses
Studies
Original journal article PubMed
Unfiltered
Modified from R Brain Haynes et al. ACP Journal
Club Nov/Dec 2006 Vol 145 Number 34A8-A9.
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?????????

• Guidelines
• Health Technology Assessment (HTA)
• UpToDate
• Clinical Evidence
• The Cochrane Library
• PubMed
• Ovid Medline

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?????????

• OVID Medline ????
• -- ???? vs. ???? (MeSH)
• -- Explode Focus
• -- Mapping
• -- ????? (adj, adv, near)
• -- ??
• -- ???? (search feedback)
• - ???????????????????
• - Major MeSH ? Pubmed related ??

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?????

• ?????? MeSH ??
• ?????????Subject Headings,????????????
• ????????Subject Headings ????????????????????Subje
  ct Headings???
• Neoplasms

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?????

• ??????
• ????
• ??????(title)???(abstract)??????(registry number
  word)?mesh??, ??????????????????????
• Tumor,Cancer,Carcinoma,Neoplasms

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Mapping Display
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????

• ?????
• ADJ????????,?????????????,?????????????,?????????
  ?
• NEAR/XX??????????????,??????????????????
• ??Truncation
• ??(STEMMING)?? renal tubul,?? renal tubules,
  renal tubular????
• in OVID Medline
• in Pubmed

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??

• ??hypothermia????comatose cardiac
  arrest??,????standard normothermic????????????????
  ?

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????therapy

• P cardiac arrest
• I hypothermia
• C standard normothermic management
• O more favorable neurological outcome,
  reduction in mortality

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UpToDate
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Clinical Evidence
???BMJ Group?Cochrane Lubrary???
?????????
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Clinical Evidence
????????
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The Cochrane Library
????
????
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The Cochrane Library
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The Cochrane Library
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The Cochrane Library
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The Cochrane Library
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The Cochrane Library
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PubMed
? ??Clinical Queries
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PubMed
v
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PubMed
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Ovid Medline
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Ovid Medline
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The necessary of surgery for asymptomatic
intestinal malrotation

• ??????????
• ???? X??????????
• ??????,???????
• ???????????????
• ????? PICO
• - Population
• - Intervention
• - Comparison
• - Outcome

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Foreword

• ????????????????,???????????????????????????,?????
  ,?????????????,????????????????,??????????????????
  ?,?????????,?????????????,????????????,???????????
  ?????????????(?????,????????????????????)?????????
  ???????,???????????

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?,??????????????complete review,??????????????????
,?????????,?????????????,?,????PubMed???,?????????
???????
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Pubmed ?? history
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????????796???,????,????????,?????????????????????
,??????,????Annals of Thoracic Surgery????????????
??,???PubMed?????Related articles? !
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?,??????,????105?,???????????????????????,????????
????????????????????????,?????????????????????????
?????????,?????????????,?????????????,????????????
????????,??????????
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?????

• ?????????PubMed?Ovid?paper,???????????????,???????
  ???????????????paper,????????????????paper?,?????,
  ??????Google???,??,???????????????????????????,???
  ?????????????????????????,????????Paper???,???????
  ??????????????,???????????????????,??????????????,
  ??????????????

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QA?