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[循证临床实践。第二部分——检索证据数据库]

[Evidence-based clinical practice. Part II--Searching evidence databases].

作者信息

Bernardo Wanderley Marques, Nobre Moacyr Roberto Cuce, Jatene Fábio Biscegli

机构信息

Associação Médica Brasileira, São Paulo, SP.

出版信息

Rev Assoc Med Bras (1992). 2004 Jan-Mar;50(1):104-8. doi: 10.1590/s0104-42302004000100045.

Abstract

The inadequacy of most of traditional sources for medical information, like textbook and review article, do not sustained the clinical decision based on the best evidence current available, exposing the patient to a unnecessary risk. Although not integrated around clinical problem areas in the convenient way of textbooks, current best evidence from specific studies of clinical problems can be found in an increasing number of Internet and electronic databases. The sources that have already undergone rigorous critical appraisal are classified as secondary information sources, others that provide access to original article or abstract, as primary information source, where the quality assessment of the article rely on the clinician oneself . The most useful primary information source are SciELO, the online collection of Brazilian scientific journals, and Medline, the most comprehensive database of the USA National Library of Medicine, where the search may start with use of keywords, that were obtained at the structured answer construction (P.I.C.O.), with the addition of boolean operators "AND", "OR", "NOT". Between the secondary information sources, some of them provide critically appraised articles, like ACP Journal Club, Evidence Based Medicine and InfoPOEMs, others provide evidences organized as online texts, such as "Clinical Evidence" and "UpToDate", and finally, Cochrane Library are composed by systematic reviews of randomized controlled trials. To get studies that could answer the clinical question is part of a mindful practice, that is, becoming quicker and quicker and dynamic with the use of PDAs, Palmtops and Notebooks.

摘要

大多数传统医学信息来源,如教科书和综述文章,并不足以支持基于当前可得最佳证据的临床决策,从而使患者面临不必要的风险。尽管不像教科书那样以方便的方式围绕临床问题领域进行整合,但越来越多的互联网和电子数据库中可以找到来自临床问题具体研究的当前最佳证据。已经经过严格批判性评价的来源被归类为二级信息来源,其他提供原始文章或摘要访问的来源则为一级信息来源,文章的质量评估依赖于临床医生自己。最有用的一级信息来源是SciELO(巴西科学期刊在线合集)和Medline(美国国立医学图书馆最全面的数据库),在这些数据库中搜索可以从使用在结构化答案构建(P.I.C.O.)中获得的关键词开始,并添加布尔运算符“AND”“OR”“NOT”。在二级信息来源中,有些提供经过批判性评价的文章,如《美国内科医师学会杂志俱乐部》《循证医学》和《信息诗》,其他的则提供整理成在线文本的证据,如《临床证据》和《UpToDate》,最后,Cochrane图书馆由随机对照试验的系统评价组成。获取能够回答临床问题的研究是审慎实践的一部分,也就是说,要越来越熟练且灵活地使用个人数字助理、掌上电脑和笔记本电脑。

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