Ebm Ph2c

Y HOÏÏC CHC CHÖÙÖÙNG CÔNG CÔÙÙBS HOABS HOAØØNG LEÂ PHUNG LEÂ PHUÙÙCCBEBEÄÄNH VIENH VIEÄÄN NHI N NHI ÑÑOOÀÀNG 1NG 1

0

500000

1000000

1500000

2000000

2500000

Trials MEDLINE BioMedical

Med

ical

Art

icle

s pe

r Yea

r

*"Kill as Few Patients as Possible" - Oscar London

Rule 31 Rule 31 ––Review the World Literature Review the World Literature Fortnightly*Fortnightly*

5,000?per day

1,400 per day55 per

day

27Kg of Guidelines

Indexing bias…MEDLINE

AllRCTs

AllRCTs

OngoingOngoing

CompletedCompleted

RCTs notidentified byMEDLINE

RCTs notidentified byMEDLINE

RCTsidentified byMEDLINE

RCTsidentified byMEDLINE

UnpublishedUnpublished

PublishedPublished

Abstracts,theses, etcAbstracts,theses, etc

JournalsJournals

MEDLINEjournals(c. 3 700)

1966

MEDLINEjournals(c. 3 700)

1966

Non-MEDLINEjournals

(c. 12 000)1966

Non-MEDLINEjournals

(c. 12 000)1966

MoMoäätt phphööôngông phaphaùùpp ññieieààuu tròtrò ñöñöôôïïcc chchöùöùngng minh minh cocoùùhiehieääuu quaquaûû -- ThThöïöïcc hahaøønhnh chuachuaåånn: 8 : 8 -- 13 13 naêmnaêm(Phillips,1998)(Phillips,1998)

70% 70% cacaùùcc phphööôngông phaphaùùpp ññieieààuu tròtrò: : chchööaa ññuuûû chchöùöùngng côcôùùchchöùöùngng minh minh totoáátt hônhôn khoângkhoâng ññieieààuu tròtrò(Chalmers,1993)(Chalmers,1993)

TreânTreân 12 12 trietrieääuu CTNC / Medline: CTNC / Medline: nghieânnghieân ccöùöùuu ññuuùùngng + + khoângkhoâng ññuuùùngng phphööôngông phaphaùùpp

KHAKHAÙÙI NIEI NIEÄÄM Y HOM Y HOÏÏC CHC CHÖÙÖÙNG CÔNG CÔÙÙ

……reduced reduced osmolarityosmolarity ORS with WHO standard ORS ORS with WHO standard ORS in children with acute in children with acute diarrhoeadiarrhoea

((--)6 / )6 / RCTsRCTs((--))((--)9 / intervention >< reduced )9 / intervention >< reduced osmolarityosmolarity ORSORS((--)6 / control group did not use (WHO) std. ORS)6 / control group did not use (WHO) std. ORS

((--)2 / not in children;)2 / not in children;((--)2 / no relevant outcomes reported;)2 / no relevant outcomes reported;2 excluded (2 excluded (Mexico 1988Mexico 1988, , Mexico 1990bMexico 1990b, , Mexico 1990aMexico 1990a).).

41 studies41 studies

20 remaining 20 remaining RCTsRCTs


14 studies met the inclusion criteria.14 studies met the inclusion criteria.

((Panama 1982Panama 1982, , USA 1982USA 1982).).

unscheduled IV fluid infusions, stool volume,

vomiting, hyponatraemia

Feed thickener for newborn infants Feed thickener for newborn infants with gastrowith gastro--oesophagealoesophageal refluxreflux

MEDLINE from 1966 to March 2004, MEDLINE from 1966 to March 2004, the Cochrane Central Register of Controlled the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue Trials (CENTRAL, The Cochrane Library, Issue 2, 2004).2, 2004).CINAHL from 1982 to December 2001, CINAHL from 1982 to December 2001, Conference and symposia proceedings published Conference and symposia proceedings published in Pediatric Research 1990 to 1994. in Pediatric Research 1990 to 1994. Conference proceedings for the ESPGAN and Conference proceedings for the ESPGAN and NASPGAN from 1994 to December 2001 NASPGAN from 1994 to December 2001

There is no evidence from RCTs to support or refute the efficacy of feedthickenersin newborn infants with GOR

Thu Thu heheïïpp khoakhoaûûngng cacaùùchch: : nghieânnghieân ccöùöùuu -- ththöïöïcc hahaøønhnh ??CaCaääpp nhanhaäätt cacaùùcc thathaøønhnh quaquaûû cucuûûaa cacaùùcc nghieânnghieân ccöùöùuu cocoùùgiagiaùù tròtrò vavaøøoo ththöïöïcc teteáá ??

Y HOY HOÏÏC CHC CHÖÙÖÙNG CÔNG CÔÙÙ



YHCC YHCC lalaøø vievieääcc ssöûöû duduïïngng cacaåånn thathaäänn, , roroûû raraøøngng, , ññuuùùngng ññaaéénncacaùùcc chchöùöùngng côcôùù totoáátt nhanhaáátt hiehieäänn cocoùù ññeeåå ñöñöaa rara quyequyeáátt ññònhònhchaêmchaêm sosoùùcc bebeäänhnh nhaânnhaân cucuïï thetheåå. .


ThThöïöïcc hahaøønhnh ddöïöïaa treântreân YHCC YHCC lalaøø ttííchch hôhôïïppssöïöï thathaøønhnh thathaïïoo laâmlaâm sasaøøngngvôvôùùiichchöùöùngng côcôùù laâmlaâm sasaøøngng beânbeân ngoangoaøøii totoáátt nhanhaáátt sasaüünn cocoùùttöøöø cacaùùcc nghieânnghieân ccöùöùuu heheää thothoáángngvavaøøcôcô ññòaòa, , ssöïöï mongmong ññôôïïii cucuûûaa bebeäänhnh nhaânnhaân


SSöïöï thathaøønhnh thathaïïoo laâmlaâm sasaøøngng– Kyõ naêng & söùc phaùn ñoaùn laâm saøng– Kinh nghieäm thöïc haønh laâm saøng


Chöùng côù laâm saøng beân ngoaøi– Nghieân cöùu laâm saøng thích hôïp– Nghieân cöùu laáy beänh nhaân laøm trung taâm veà caùc

lónh vöïc: tính ñuùng vaø chính xaùc cuûa xeùt nghieäm(daáu hieäu laâm saøng), ñoä maïnh cuûa caùc yeáu toá tieânlöôïng, hieäu quaû vaø an toaøn cuûa phöông phaùp ñieàutrò, phuïc hoài vaø döï phoøng.

– Thay theá caùc phöông phaùp chaån ñoaùn, ñieàu trò cuõbaèng phöông phaùp khaùc maïnh, chính xaùc, hieäuquaû vaø an toaøn hôn

THTHÖÏÖÏC HAC HAØØNH YHCCNH YHCC

Ñaët caâu hoûi veà thoâng tin caàn truy caäpTruy caäp thoâng tin coù giaù trò chöùng côùÑaùnh giaù ñoä maïnh chöùng côù cuûa thoâng tin coù ñöôïcAùp duïng vaøo thöïc teá laâm saøngLöôïng giaù hieäu quaû vieäc aùp duïng

Aware Accepted Applicable Able Acted on AgreedAdhered to

Systems(bottomline± ref)

Synopses(user summary of research)

Systematic Reviews and CATs(search; appraisal; synthesis)

UnsoundResearch

SoundResearch

3

1

2

4

© Elsevier Ltd 2005. Straus et al.: Evidence-based medicine

WAYS TO INCORPORATE EVIDENCE INTO PRACTICES

DoingDoingUsingUsing

ReplicatingReplicating

TRUY CATRUY CAÄÄP THOÂNG TIN P THOÂNG TIN Y HOY HOÏÏC CHC CHÖÙÖÙNG CÔNG CÔÙÙ

GIÔGIÔÙÙI HAI HAÏÏN THOÂNG TINN THOÂNG TIN

Usefulness = Relevance * Validity / Effort

CAÙC BÖÔÙC TRUY CAÄP THOÂNG TIN Y HOÏC CHÖÙNG CÔÙ CÔ BAÛN

1. Laøm roõ caâu hoûi laâm saøng vaø tìm caùc töø khoùatheo phöông phaùp PICO

2. Phaân loaïi vaán ñeà thaønh Ñieàu trò, Chaån ñoaùn, Tieân löôïng, Nguy cô,...

3. Choïn nguoàn döõ lieäu ñeå tìm kieám thoâng tin4. Thöïc hieän tìm kieám caùc töø khoùa ñaõ coù ñöôïc töø

böôùc 15. Giôùi haïn keát quaû coù ñöôïc töø böôùc 4 baèng caùch

keát hôïp vôùi böôùc 2.

PhPhööôngông phaphaùùpp PICOPICO

Patient or population(Beänh nhaân / Daân soá)

Moâ taû beänh nhaân (tuoåi, giôùi, chuûngtoäc, tieàn söû,...)

Intervention/ exposure (Can thieäp / Tieáp xuùc)

Vieäc xaûy ra hay ñaõ ñöôïc laøm : ñieàutrò, xeùt nghieäm chaån ñoaùn, phôinhieãm (VD: huùt thuoác laù thuï ñoäng)

Comparison(So saùnh)

So saùnh vôùi gì ? Khoâng so saùnh, placebo, loaïi can thieäp khaùc

Outcomes (Keát quaû, thöôøng laølaâm saøng)

Hieäu quaû cuûa can thieäp laø gì? Phaûiñaëc hieäu ( töû vong, tyû leä nhaäp vieän...)

BBööôôùùcc 11

In patients undergoing hip replacement, In patients undergoing hip replacement, to what extent is the risk of postto what extent is the risk of post--operative infection operative infection reduced by antimicrobial prophylaxis?reduced by antimicrobial prophylaxis?

PopulationPopulation patients undergoing hip patients undergoing hip replacement replacement

InterventionIntervention antimicrobial prophylaxis antimicrobial prophylaxis

ComparisonComparison placeboplacebo

OutcomeOutcome postpost--operative infection operative infection

BBööôôùùcc 11

FACETS

patients patients undergoing hip undergoing hip replacementreplacement

Hip replacement, Hip joint, hip Hip replacement, Hip joint, hip prothesisprothesis, , TotalTotal--hip replacement, totalhip replacement, total--joint replace..joint replace..Hip surgery, hip operation, Hip surgery, hip operation, acetabulumacetabulumhip hip arthroplastyarthroplasty,,……

antimicrobial antimicrobial prophylaxisprophylaxis

AntiAnti--infective agents, infection control, infective agents, infection control, antibiotics, antibiotic prophylaxis, antibiotics, antibiotic prophylaxis, antimicrobial, antiantimicrobial, anti--microbial, microbial, ultracleanultraclean, , hypersterilehypersterile

postpost--operative operative infection infection

Bacterial infections, Bacterial infections, postopertaviepostopertaviecomplications, surgical wound infections, complications, surgical wound infections, prothesisprothesis--related infections, sepsisrelated infections, sepsis

DRAW UP A LIST OF SYNONYMS AND ABBREVIATIONS AND SPELLING

VARIANTS WHICH MAY BE USED BY AUTHORS

FACETS

BBööôôùùcc 11







DRAW UP A LIST OF SYNONYMS AND ABBREVIATIONS AND SPELLING

VARIANTS WHICH MAY BE USED BY AUTHORSFACETS

BBööôôùùcc 11







DRAW UP A LIST OF SYNONYMS AND ABBREVIATIONS

AND SPELLING VARIANTS WHICH MAY BE USED BY

AUTHORSFACETS

BBööôôùùcc 11







DRAW UP A LIST OF SYNONYMS AND ABBREVIATIONS

AND SPELLING VARIANTS WHICH MAY BE USED BY AUTHORS

BBööôôùùcc 11







BBööôôùùcc 11



2.2. PhaânPhaân loaloaïïii vavaáánn ññeeàà thathaøønhnh ÑÑieieààuu tròtrò, , ChaChaåånnññoaoaùùnn, , TieânTieân llööôôïïngng, , NguyNguy côcô,...,...

3. Choïn nguoàn döõ lieäu ñeå tìm kieám thoâng tin4. Thöïc hieän tìm kieám caùc töø khoùa ñaõ coù ñöôïc töø



ÑÑOOÄÄ MAMAÏÏNH CUNH CUÛÛA CHA CHÖÙÖÙNG CÔNG CÔÙÙ

LoaLoaïïii II : : ttöøöø CT CT ññaaùùnhnh giagiaùù heheää thothoáángngLoaLoaïïii IIII : : ttöøöø íítt nhanhaáátt 1 CT NC 1 CT NC cocoùù ññooááii chchöùöùngng ngaãungaãu nhieânnhieânLoaLoaïïii IIIIII : : ttöøöø cacaùùcc NC NC ththöïöïcc nghienghieäämm, , khoângkhoâng ññooááii chchöùöùngngLoaLoaïïii IVIV : : ttöøöø cacaùùcc NC NC khoângkhoâng ththöïöïcc nghienghieäämmLoaLoaïïii VV : : ttöøöø quanquan ññieieååmm cacaùù nhaânnhaân, ca LS, ca LS

ÑOÄ MAÏNH CAÙC THIEÁT KEÁ NGHIEÂN CÖÙU CHO CAÙC LOAÏI CAÂU HOÛI LAÂM SAØNG

ClinicalExamination

Prospective, blind comparison to gold standard

DiagnosticTesting

Prospective, blind comparison to gold standard

Prognosis Cohort study > Case Control > Case SeriesTherapy Randomized control trial (RCT)Etiology / Harm Cohort study > Case Control > Case Series

Prevention RCT > Cohort study > Case Control >Case Series

BBööôôùùcc 22

TherapyTherapy Randomized control trial (RCT)Randomized control trial (RCT)

Caùc toång quan heä thoáng coù theå traû lôøi cho moïiloaïi caâu hoûi laâm saøng vôùi ñoä tin caäy cao nhaátneáu thöïc hieän ñuùng phöông phaùp

ÑOÄ MAÏNH CAÙC THIEÁT KEÁ NGHIEÂN CÖÙU CHO CAÙC LOAÏI CAÂU HOÛI LAÂM SAØNG

BBööôôùùcc 22




3.3. ChoChoïïnn nguonguoàànn ddööõõ lielieääuu ññeeåå ttììmm kiekieáámm thoângthoâng tintin4. Thöïc hieän tìm kieám caùc töø khoùa ñaõ coù ñöôïc töø



PHAÂN LOAPHAÂN LOAÏÏI DI DÖÖÕ LIEÕ LIEÄÄUU

NGUYEÂN PHANGUYEÂN PHAÙÙTTÑÑAÕ AÕ ÑÖÑÖÔÔÏÏC C ÑÑAAÙÙNH GIANH GIAÙÙ–– GIAGIAÙÙ TRÒ TTRÒ TÖØÖØNG NGHIEÂN CNG NGHIEÂN CÖÙÖÙU U –– TOTOÅÅNG QUAN HENG QUAN HEÄÄ THOTHOÁÁNGNG

–– GUIDELINES GUIDELINES

–– KINH KINH ÑÑIEIEÅÅNN

DDÖÖÕ LIEÕ LIEÄÄU NGUYEÂN PHAU NGUYEÂN PHAÙÙTT

MEDLINE (MEDLINE (MEDlarsMEDlars onLINEonLINE))EMBASEEMBASECINAHL CINAHL (Cumulative Index to Nursing and Allied Health Literature)LILACS LILACS (Latin American and Caribbean Health Sciences) PsycInfo


NATIONAL LIBRARY OF MEDICINE: 18791960, MEDLARS (1960, MEDLARS (Medical Literature Analysis and Retrieval System)TOTOÅÅ CHCHÖÙÖÙC DC DÖÖÔÔÙÙI DAI DAÏÏNG INDEX (NG INDEX (Medical Subject HeadingsMedical Subject Headings))

12 TRIE12 TRIEÄÄU RECORDSU RECORDS

4600 TÔ4600 TÔØØ BABAÙÙOO

CACAÄÄP NHAP NHAÄÄT MOÃI TUAT MOÃI TUAÀÀNN

86 % T86 % TÖØÖØ TIETIEÁÁNG ANH / ABSTRACTSNG ANH / ABSTRACTS

76% CO76% COÙÙ ABSTRACTABSTRACT

MEDLINE

TRUY XUATRUY XUAÁÁT DT DÖÖÕ LIEÕ LIEÄÄU TUU TUØØY THUOY THUOÄÄC TOC TOÅÅ CHCHÖÙÖÙC SÔC SÔÛÛ HHÖÖÕU DÕU DÖÖÕ LIEÕ LIEÄÄUU–– MIEÃN PHMIEÃN PHÍÍ & TRA& TRAÛÛ TIETIEÀÀNN

MEDLINE


JOURNALJOURNAL

Abridged Index Abridged Index MedicusMedicus (AIM) Journal Titles (AIM) Journal Titles University of Texas Health Science Center at University of Texas Health Science Center at San Antonio San Antonio Evaluating WebEvaluating Web--sitessites–– The URL: .ORG; .GOV & .DOH; .EDU & .ACThe URL: .ORG; .GOV & .DOH; .EDU & .AC–– Health Information Quality Assessment Tool, Health Information Quality Assessment Tool, –– Health On the Net Foundation:Health On the Net Foundation:


DDÖÖÕ LIEÕ LIEÄÄU THU THÖÙÖÙ PHAPHAÙÙTT

CATCAT (Critical Appraised Topics)(Critical Appraised Topics)–– MoMoäätt hhììnhnh ththöùöùcc bbììnhnh babaùùoo–– ÑÑaaùùnhnh giagiaùù giagiaùù tròtrò cucuûûaa 1 1 babaøøii babaùùoo theotheo tieâutieâu

chuachuaåånn ññaõaõ ñöñöaa rara..–– NhoNhoùùmm chuyeânchuyeân vieânvieân cucuûûaa momoäätt trungtrung taâmtaâm–– FORMFORM


Critical Appraised TopicsCritical Appraised Topics

http://www.urmc.rochester.edu/medicine/res/CATS/ped.html

http://pedsccm.wustl.edu/PedsCCM_Home_page.html

DATA REVIEWDATA REVIEW

SAMPLE


DDÖÖÕ LIEÕ LIEÄÄU THU THÖÙÖÙ PHAPHAÙÙTTToToåångng quanquan heheää thothoáángng–– ToToåångng quanquan TATAÁÁT CAT CAÛÛ tataøøii lielieääuu COCOÙÙ LIEÂN QUAN LIEÂN QUAN

theotheo momoäätt khuoânkhuoân maãumaãu ññònhònh sasaüünn–– ÑÑaaùùnhnh giagiaùù giagiaùù tròtrò cucuûûaa momoäätt vavaáánn ññeeàà–– NhoNhoùùmm chuyeânchuyeân vieânvieân

……reduced reduced osmolarityosmolarity ORS with WHO standard ORS ORS with WHO standard ORS in children with acute in children with acute diarrhoeadiarrhoea

((--)6 / )6 / RCTsRCTs((--))((--)9 / intervention >< reduced )9 / intervention >< reduced osmolarityosmolarity ORSORS((--)6 / control group did not use (WHO) std. ORS)6 / control group did not use (WHO) std. ORS

((--)2 / not in children;)2 / not in children;((--)2 / no relevant outcomes reported;)2 / no relevant outcomes reported;2 excluded (2 excluded (Mexico 1988Mexico 1988, , Mexico 1990bMexico 1990b, , Mexico 1990aMexico 1990a).).

41 studies41 studies



14 studies met the inclusion criteria.14 studies met the inclusion criteria.

((Panama 1982Panama 1982, , USA 1982USA 1982).).

unscheduled IV fluid infusions, stool volume,

vomiting, hyponatraemia

Meta-analysis


SYSTEMATIC REVIEWSYSTEMATIC REVIEW

The Cochrane Database of The Cochrane Database of Systematic ReviewsSystematic Reviews (3559) (3559) Database of Abstracts of Reviews of EffectsDatabase of Abstracts of Reviews of Effects(4795) (4795) The Cochrane Central Register of The Cochrane Central Register of Controlled Trials (CENTRAL)Controlled Trials (CENTRAL) (415918) (415918)

GUIDELINES GUIDELINES DDÖÖÕ LIEÕ LIEÄÄU THU THÖÙÖÙ PHAPHAÙÙTT

http://www.cdc.gov/

Grades of Recommendation

A consistent level 1 studies

B consistent level 2 or 3 studies or extrapolations from level 1 studies

C level 4 studies or extrapolations from level 2 or 3 studies

D level 5 evidence or troublingly inconsistent or inconclusive studies of any level

Treating giant cell arteritis: Give steroids (A) immediately (D) at doses of at least 20 mg (C) daily (A).

SASAÙÙCH GIACH GIAÙÙO KHOAO KHOA

CD ROMCD ROM

ONLINEONLINE–– MD CONSULTMD CONSULT

–– OVIDOVID

–– STATREFSTATREF

–– UptodateUptodate

TEXTBOOKS

GUIDELINES / EBM

COCHRANE LIBRARY

DARE, HTA

CAT




3. Choïn nguoàn döõ lieäu ñeå tìm kieám thoâng tin4.4. ThThöïöïcc hiehieäänn ttììmm kiekieáámm cacaùùcc ttöøöø khokhoùùaa ññaõaõ cocoùù ñöñöôôïïcc

ttöøöø bbööôôùùcc 115. Giôùi haïn keát quaû coù ñöôïc töø böôùc 4 baèng caùch


GIÔGIÔÙÙI HAI HAÏÏN THOÂNG TINN THOÂNG TIN

Sensitivity =No. relevant items in existence

No. relevant items found

Precision = No. relevant items found

Total no. items found

BBööôôùùcc 55

TIEÂU CHUATIEÂU CHUAÅÅN VAN VAØØNGNG

Anne Anne McKibbonMcKibbon at McMaster Universityat McMaster University10 TA10 TAÏÏP CHP CHÍÍ NONOÅÅI TIEI TIEÁÁNG 1983NG 1983--1991 1991 HandsearchingHandsearching

CategoryCategory Optimized Optimized forfor

Sensitivity/Sensitivity/SpecificitySpecificity²² PubMedPubMed equivalentequivalent³³

sensitivity 99%/74% "randomized controlled trial" [PTYP] | "drug therapy" [SH] | "therapeutic use" [SH:NOEXP] | "random*" [WORD]

specificity 57%/97% (double [WORD] & blind* [WORD]) | placebo [WORD]

sensitivity 92%/73%"sensitivity and specificity" [MESH] | "sensitivity" [WORD] | ("diagnosis" [SH] | "diagnostic use" [SH] | "specificity" [WORD]

specificity 55%/98% "sensitivity and specificity" [MESH] | ( "predictive" [WORD] & "value*" [WORD] )

sensitivity 82%/70%"cohort studies" [MESH] | "risk" [MESH] | ("odds" [WORD] & "ratio*" [WORD]) | ("relative" [WORD] & "risk" [WORD]) | ("case" [WORD] & "control*" [WORD])

specificity 40%/98% "case-control studies" [MH:NOEXP] | "cohort studies" [MH:NOEXP]

sensitivity 92%/73%"incidence" [MESH] | "mortality" [MESH] | "follow-up studies" [MESH] | "mortality" [SH] | prognos* [WORD] | predict* [WORD] | course [WORD]

specificity 49%/97% prognosis [MH:NOEXP] | "survival analysis" [MH:NOEXP]

PrognosisPrognosis

EtiologyEtiology

DiagnosisDiagnosis

TherapyTherapy

Table for Clinical Queries using Research Methodology Filters

MEDLINEPRO.COMMEDLINEPRO.COM

XinXin cacaùùmm ônôn ssöïöï theotheo doõidoõi cucuûûaaToaToaøønn TheTheåå HoHoääii TrTrööôôøøngng

Ebm Ph2c

Health & Medicine

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