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OVID MEDLINE 報告人：林芳輝
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The “6S” levels of organization of evidence from health care research
by R Brain Haynes, 2009 Computerized decision support Evidence-based clinical practice guidelines Evidence based textbook ACP Journal Club、DARE Systematic reviews Original journal articles Computer Summaries Synopses of Syntheses Syntheses ACP Journal Club Synopses of studies Studies
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MEDLINE 收錄年代：1946~Current 收錄主題範圍 收錄內容：文獻之書目資料、摘要 基礎醫學 臨床醫學 生物科學 解剖學
醫務管理學 化學與藥物 心理學 社會醫學 生物農業與營養 醫材設備 醫事技術 醫事資訊
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MeSH 醫學標題 Title FRAX or fiction: determining optimal screening strategies for treatment of osteoporosis in residents in long-term care facilities. 主標題：Osteoprosis Diphosphonates Cross-Sectional Studies 副標題： Diagnosis Osteoprosis Drug therapy Epidemiology 文獻的重點為討論osteoprosis的流行病學研究，但文中有討論到治療及藥物治療 而且是以Diphosphonates為主要治療用藥
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什麼是MeSH？ 運動、遊戲、娛樂圈、音樂.....什麼都有
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NLM在分析生物醫學方面之期刊文獻、圖書、視聽資料、電子資源等資源的主題時，為了將同一概念用固定的詞彙表達，於是建立一套醫學標題詞（MeSH），以達到控制詞彙的目的。
索引專家們更在眾多標題詞中建立主題關係連結，可利用樹狀結構圖呈現出詞彙間語義或從屬上的關係。
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NLM在分析生物醫學方面之期刊文獻、圖書、視聽資料、電子資源等資源的主題時，為了將同一概念用固定的詞彙表達，於是建立一套醫學標題詞（MeSH），以達到控制詞彙的目的。
索引專家們更在眾多標題詞中建立主題關係連結，可利用樹狀結構圖呈現出詞彙間語義或從屬上的關係。
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1. 彙整相同主題的文章至同一標題詞(MeSH)
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以固定的詞彙表達 2. 彙整同義詞至同一標題詞(MeSH) 標題詞(MeSH) 彙整的同義詞
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樹狀結構
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研究設計分類 ( A taxonomy of clinical research) by David A Grimes, Kenneth F Schulz,2002
Did investigator Assign exposures? Observational study Experimental study Comparison group? Random allocation? Randomized Controlled trial Non-Randomized Analytical study Descriptive Direction？ Cohort Case-control Cross- sectional Yes No Exposure Outcome Exposure Outcome Exposure and Outcome at same time
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臨床問題的種類 Therapy/Prevention：治療/預防的問題 研究治療或預防方法的有效性 例如：服用“阿斯匹林”是否可以預防中風？
Diagnosis：診斷問題 研究檢查方法或臨床表徵對疾病診斷的有效性 例如：McBurney’s sign 診斷急性盲腸炎的敏感度及特異度為何？ Harm/Etiology：危害/病因問題 研究暴露的危害或疾病的原因 例如：停經婦女使用荷爾蒙治療是否會增加乳癌的機會？ Prognosis：預後 建立疾病預後的預測模式 例如：利用Ranson’s criteria 預測急性胰臟炎死亡率為何？ 例如: In healthy women who have recently had a miscarriage(流 產), what is the usual grieving(悲傷) process and are any factors associated with longer than normal grieving?
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Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001)
Therapy/Prevention, Aetiology/Harm Prognosis Diagnosis Differential diagnosis/symptom prevalence study Economic and decision analyses 1a SR (with homogeneity*) of RCTs SR (with homogeneity*) of inception cohort studies; CDR† validated in different populations SR (with homogeneity*) of Level 1 diagnostic studies; CDR† with 1b studies from different clinical centres SR (with homogeneity*) of prospective cohort studies SR (with homogeneity*) of Level 1 economic studies 1b Individual RCT (with narrow Confidence Interval‡) Individual inception cohort study with > 80% follow-up; CDR† validated in a single population Validating** cohort study with good††† reference standards; or CDR† tested within one clinical centre Prospective cohort study with good follow-up**** Analysis based on clinically sensible costs or alternatives; systematic review(s) of the evidence; and including multi-way sensitivity analyses 1c All or none§ All or none case-series Absolute SpPins and SnNouts†† Absolute better-value or worse-value analyses †††† 2a SR (with homogeneity*) of cohort studies SR (with homogeneity*) of either retrospective cohort studies or untreated control groups in RCTs SR (with homogeneity*) of Level >2 diagnostic studies SR (with homogeneity*) of 2b and better studies SR (with homogeneity*) of Level >2 economic studies 2b Individual cohort study (including low quality RCT; e.g., <80% follow-up) Retrospective cohort study or follow-up of untreated control patients in an RCT; Derivation of CDR† or validated on split-sample§§§ only Exploratory** cohort study with good†††reference standards; CDR† after derivation, or validated only on split-sample§§§ or databases Retrospective cohort study, or poor follow-up Analysis based on clinically sensible costs or alternatives; limited review(s) of the evidence, or single studies; and including multi-way sensitivity analyses 2c "Outcomes" Research; Ecological studies "Outcomes" Research Ecological studies Audit or outcomes research 3a SR (with homogeneity*) of case-control studies SR (with homogeneity*) of 3b and better studies 3b Individual Case-Control Study Non-consecutive study; or without consistently applied reference standards Non-consecutive cohort study, or very limited population Analysis based on limited alternatives or costs, poor quality estimates of data, but including sensitivity analyses incorporating clinically sensible variations. 4 Case-series (and poor quality cohort and case-control studies§§) Case-series (and poor quality prognostic cohort studies***) Case-control study, poor or non-independent reference standard Case-series or superseded reference standards Analysis with no sensitivity analysis 5 Expert opinion without explicit critical appraisal, or based on physiology, bench research or "first principles" Expert opinion without explicit critical appraisal, or based on economic theory or "first principles" All or none study(本來的疾病個案都會死亡，只要有新治療能讓一個人存活，就代表是有效的治療。)
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臨床問題 Which therapy have more benefit for Atopic Dermatitis either Tacrolimus or Corticosteroids.
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原始關鍵字Primary Term 或MeSH Term
同義字1 同義字2 P ( Atopic Dermatitis with children or eczema atopic eczema infantile ) and I Tacrolimus fk 506 Protopic C Corticosteroids adrenal cortex hormones corticoids O quality of life
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檢索 條件限制 輸出 MEDLINE 文獻檢索主要步驟 關鍵字 MeSH Clinical Queries Publication Type
全文、內容 輸出 書目資料管理
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檢 索
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文獻查詢 (選擇適合的查詢模組） 如果您需要在很短的時間得到答案 →Basic Search
如果您想查特定一篇文獻，且知道該文獻部分出版資訊 →Find Citation 如果您熟悉專業標題詞彙，欲利用特定工具協助查詢 →Search Tools 如果您想針對文獻的某特定欄位查詢資料 →Search Fields 如果您需要完整而精確的檢索策略查詢 →Advanced Ovid Search 如果您想要一次查詢多個特定欄位資料 →Multi-Field Search
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關鍵字搜尋
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主要比對title、author、journal name、abstract四個地方
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Find Citation 例如：以文獻標題、作者及出版年做條件進行檢索 找出特定一篇文獻
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Search Tools Map Term：主題比對；等同於Advanced Ovid Search之Map Term to Subject Heading。 Tree：顯示以樹狀構造排列之主題表；標準控制詞彙以具階級架構的樹狀圖排列，使用者可以了解輸入之關鍵字或片語可對應的主題所在位置以及了解相關父階層或子階層的主題。 Permuted Index：替代索引；藉由輸入單一關鍵字顯示所有包含此關鍵字的主題、Related terms和Used-for terms等。 Scope Note：名詞解釋；提供該標準主題詞彙的參考資料。 Explode：延展主題查詢；延展搜尋結果，包含該主題以及子階層之主題。 Subheadings：指定MeSH的副標題查詢；查詢並顯示標準主題詞彙的副標題，副標題詞幫助者找尋描述某一標題詞特定觀點資料。
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Search Fields 以機構名稱為例
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醫學標題檢索
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交集一個以上的醫學標題
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多媒體檢索一
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多媒體檢索二
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條 件 限 制
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年齡群組
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文獻類型
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輸 出
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全文輸出
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書目資料輸出 輸出勾選文獻的書目資料
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My Workspace
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申請個人帳號 帳號登入
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個人資料夾 資料夾表列 所在資料夾名稱及描述 所在資料夾文獻表列
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增加一個 主項目 例如： intertrochanteric fracture
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新增一個子項目 例如：在femur neck fracture增加一個mortality的子項目
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提供子項目名稱
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手動增加一筆文獻紀錄 例如：在femur neck fracture \ mortality下手動增加一筆文獻紀錄
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上傳文章
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上傳檔案 例如：上傳圖檔到femur neck fracture 此項目下
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附加檔案
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標註說明 開啟圖檔 說明項
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帶入檢索結果至my workspace 全部選取匯入 挑選特定文獻做匯入
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選擇欲匯入的項目
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將書目資料匯出至書目管理軟體 可以在my workspace中管理全文
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Thank You!
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