Transcript “主题=厄贝沙坦” AND

循证医学证据检索
Searching for Best Evidence
韦焘
昆明医学院图书馆
Library of Kunming Medical University
2015/4/13
Outline
1.Introduction to EBM
2.Category & Pyramid of Evidence
3.Sources of Evidence
4.Searching for Evidence
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1. Introduction to Evidence-Based Medicine
1.1 Definition
1.2 Three key points of EBM
1.3 Basic steps to practice EBM
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1.1 What is EBM?
The conscientious, explicit and judicious use of
current best evidence in making decisions about the
care of individual patients based on doctors’ clinical
expertise, patients’ values and expectations.
3 Key Points：
– evidence
– doctor
– patient
Dr. Sackett
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1.1.1 Evidence
• validity
• importance
• applicability
1.1.1.1 Validity
1) RANDOMIZED?
2) METHODOLOGY?
3) RESULTS?
1.1.1.2 Importance
1) TREATMENT EFFECT?
2) PRECISION?
1.1.1.3 Applicability
1) STUDY OBJECTS VS PATIENT
2) TREATMENT FEASIBLE?
3) BENEFIT & HARM
4) PATIENT’S VALUES & PREFERENCES
1.1.2 Doctor
• Expertise
• Experience
1.1.3 Patient
• Value
• Expectation
1.2 Origin & Development of EBM
• Spectrum of Disease
• Cost of Researches
• Effectiveness and
Efficiency – Random
Reflections on Health
Services
• Resources: RCT, SR,
MA …
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Dr. Archie Cochrane
British physician and epidemiologist
1.3 Steps for Evidence-based practice
(1) Ask
Questions
(5) Assess
effectiveness,
efficiency of
EBM process
(2) Acquire
the evidence
5A’s
(4) Apply
the evidence
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(3) Appraise
the evidence
1.3.1 Step 1
Ask questions
1) Causes, Diagnosis, Treatment, Prevention, Prognosis…
2) PICO
Population/patient
Intervention/issue of interest
Comparison intervention/comparison group
Outcome
3) Example: Liver Cancer
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1.3.2 Step 2
Acquire the evidence
Databases:
1 Clinical Queries, PubMed
2 Cochrane Library
3 SinoMed
4 CNKI
5 VIP
6 WANFANG
…
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1.3.2.1 PubMed Clinical Queries
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1.3.2.2 Homepage of Cochrane Library
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1.3.3 Step 3
Appraise the evidence
Category of Evidence
e.g., systematic review, meta analysis,
randomized controlled trials…
Pyramid of Evidence
e.g., SR is a priority…
NNT (Number needed to treat)
NNH (Number needed to harm)
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1.3.4 Step 4
Apply the evidence
Develop a relevant program to use the evidence.
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1.3.5 Step 5
Assess effectiveness, efficiency of EBM process
What were implemented well?
What could be implemented better next time?
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2. Category & Pyramid of Evidence
• What kinds of evidence are there in EBM?
• What is the pyramid of evidence?
• 8 major categories
• 5 major levels
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2.1 Category of Evidence(1)
2.1.1 Systematic Review
also Cochrane review, a literature review focused
on a single question that tries to identify, appraise,
select and synthesize all high quality research
evidence relevant to that question.
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2.1 Category of Evidence(2)
2.1.2 Meta Analysis
uses statistical techniques for combining results
from different studies to obtain a quantitative
estimate of the overall effect of a particular
intervention or variable on a defined outcome,
producing a stronger conclusion than any
individual study.
(http://medicaldictionary.thefreedictionary.com/meta-analysis)
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2.1 Category of Evidence(3)
2.1.3 Clinical Practice Guideline (CPG)
A Clinical Practice Guideline is a
systematically developed statement/document
to assist practitioner and patient make
decisions about appropriate health care for
specific clinical circumstances.
(http://www.cvh.on.ca/pro/cpg.php)
2.1 Category of Evidence(4)
2.1.4 Health Technology Assessment (HTA)
HTA is an innovative program that determines
if health services used are safe and effective.
(http://www.hta.hca.wa.gov/)
2.1 Category of Evidence(5)
• 2.1.3 Randomized Controlled Trial
A study in which patients are randomly assigned to
the treatment or control group and are followed
prospectively.
(www.orthobullets.com/basic-science/9080/clinicaltrials)
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2.1 Category of Evidence(6)
• Cohort Study
A Cohort Study is a study in which patients who
presently have a certain condition and/or receive a
particular treatment are followed over time and
compared with another group who are not affected by
the condition under investigation.
(http://library.downstate.edu/EBM2/2400.htm)
2.1 Category of Evidence(7)
• Case-Control Study
Case control studies are studies
in which patients who already
have a certain condition are
compared with people who do
not.
2.1 Category of Evidence(8)
• Case Series and Case Report
Case series and case reports consist either of
collections of reports on the treatment of
individual patients, or of reports on a single
patient.
(http://library.downstate.edu/EBM2/2600.htm)
2.2 Pyramid of Evidence(1)
• Consideration
– Which kind of evidence have you got?
– How do you know it is good or not? To
what extent?
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2.2 Pyramid of Evidence(2)
Ⅰ
SR, MA, CPG, HTA
Ⅱ
Randomized Controlled Trial
Ⅲ
Cohort Study
Ⅳ
Case-Control Study
Ⅴ
Case Report, Case Series, and Personal Opinion
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3.Sources of Evidence
1) Information in Chinese
2) Information in English
3) Information in Other Languages
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3.1Information in Chinese
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2)
1)3)
Wanfang
SinoMed
4)CNKI
VIP
3.2 Information in English
1)
2)PubMed
COCHRANE
Clinical
LIBRARY
Queries
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4.Searching for Evidence
• Case Study
– There is a patient with hypertension, who has
been taking Irbesartan and Amlodipine for
more than two years.
• Question
– He would like to know if the side effects of the
two drugs are serious.
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4.1 Searching Strategy
• Searching words:
– Irbesartan 厄贝沙坦
– Amlodipine 氨氯地平
– High blood pressure / hypertension 高血压/高血压病
• Sources of evidence
– 中文数据库：CBM, CNKI, etc.
– English databases: PubMed, Cochrane Library,
etc.
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4.2.1 Searching Steps (CBM)
基本检索
厄贝沙坦
厄贝沙坦主题检索
AND 高血压 AND 多中心研究
记录数：0
系统评价 AND 厄贝沙坦
更多限定
记录数：1
记录总数：7 Meta分析
记录数：0
记录数：1055
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4.2.2 Searching Steps (CNKI)
“主题=厄贝沙坦” AND
“主题=厄贝沙坦”
AND“主题=系统评价”
“主题=Meta”
“主题=厄贝沙坦” AND “主题=系统回顾”
6篇关于Meta分析的文章
厄贝沙坦氢氯噻嗪治疗老年原
发性高血压的汇总分析
厄贝沙坦治疗轻、中度高血压
的疗效和安全性Meta分析
4.2.3 Searching Steps (PubMed)
Irbesartan
PubMed Clinical Queries
Systematic Reviews: 32
Clinical Queries
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4.2.4 Searching Steps (Cochrane Library)
The Cochrane Library
Cochrane Review (1)
Title, Abstract or Keywords = irbesartan
Title of Review
Wrap-up
1. Definition of EBM
2. Three key points of EBM
3. Five steps to practice EBM
4. Categories of evidence
5. Pyramid of evidence
6. Sources of evidence
7. Ways to search for evidence
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Thanks a lot.
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