1. Y HOÏC CHÖÙNG CÔÙ
NG
BS HOAØNG LEÂ PHUÙC
NG
BEÄNH VIEÄN NHI ÑOÀNG 1
NH NG

2. Rule 31 –
Review the World Literature
Fortnightly*
*quot;Kill as Few Patients as Possiblequot; - Oscar London
5,000?
2500000 per day
Medical Articles per Year
2000000
1500000
1,400
1000000
55 per per day
500000 day
0
Trials MEDLINE BioMedical
27Kg of Guidelines

3. Indexing bias…MEDLINE
Ongoing
Ongoing
All
RCTs
Unpublished
Unpublished
Completed
Completed
Abstracts,
Abstracts,
theses, etc
theses, etc Non-MEDLINE
Non-MEDLINE
Published
Published journals
journals
(c. 12 000)
(c. 12 000)
1966
1966
Journals
Journals RCTs not
RCTs not
MEDLINE identified by
identified by
MEDLINE
journals
journals
MEDLINE
MEDLINE
(c. 3 700)
(c. 3 700)
1966
1966 RCTs
RCTs
identified by
identified by
MEDLINE
MEDLINE

4. KHAÙI NIEÄM Y HOÏC CHÖÙNG CÔÙ
NG
Moät phöông phaùp ñieàu trò ñöôïc chöùng minh coù
ng
hieäu quaû - Thöïc haønh chuaån: 8 - 13 naêm
nh
(Phillips,1998)
70% caùc phöông phaùp ñieàu trò: chöa ñuû chöùng côù
ng
chöùng minh toát hôn khoâng ñieàu trò
ng
(Chalmers,1993)
Treân 12 trieäu CTNC / Medline:
nghieân cöùu ñuùng + khoâng ñuùng phöông phaùp
ng ng

5. …reduced osmolarity ORS with WHO standard ORS
in children with acute diarrhoea
unscheduled IV
41 studies fluid infusions,
stool volume,
(-)6 / RCTs(-) vomiting,
(-)9 / intervention >< reduced osmolarity ORS hyponatraemia
(-)6 / control group did not use (WHO) std. ORS
20 remaining RCTs
(-)2 / not in children;
(-)2 / no relevant outcomes reported;
2 excluded (Mexico 1988, Mexico 1990b,
Mexico 1990a).
13 remaining RCTs
(Panama 1982, USA 1982).
14 studies met the inclusion criteria.

6. Feed thickener for newborn infants
with gastro-oesophageal reflux
MEDLINE from 1966 to March 2004,
the Cochrane Central Register of Controlled
Trials (CENTRAL, The Cochrane Library, Issue
2, 2004).
CINAHL from 1982 to December 2001,
Conference and symposia proceedings published
in Pediatric Research 1990 to 1994.
Conference proceedings for the ESPGAN and
NASPGAN from 1994 to December 2001
There is no evidence from RCTs to support or
refute the efficacy of feedthickeners
in newborn infants with GOR

7. KHAÙI NIEÄM Y HOÏC CHÖÙNG CÔÙ
NG
Thu heïp khoaûng caùch:
ng ch
nghieân cöùu - thöïc haønh ?
nh
Caäp nhaät caùc thaønh quaû cuûa caùc nghieân cöùu coù
nh
giaù trò vaøo thöïc teá ?
Y HOÏC CHÖÙNG CÔÙ
NG

8. KHAÙI NIEÄM Y HOÏC CHÖÙNG CÔÙ
NG
YHCC laø vieäc söû duïng caån thaän, roû raøng, ñuùng ñaén
ng ng ng
caùc chöùng côù toát nhaát hieän coù ñeå ñöa ra quyeát ñònh
ng
chaêm soùc beänh nhaân cuï theå.
nh

9. KHAÙI NIEÄM Y HOÏC CHÖÙNG CÔÙ
NG
Thöïc haønh döïa treân YHCC laø tích hôïp
nh
söï thaønh thaïo laâm saøng
nh ng
vôùi
chöùng côù laâm saøng beân ngoaøi toát nhaát saün coù
ng ng
töø caùc nghieân cöùu heä thoáng
ng
vaø
cô ñòa, söï mong ñôïi cuûa beänh nhaân
nh

10. KHAÙI NIEÄM Y HOÏC CHÖÙNG CÔÙ
NG
Söï thaønh thaïo laâm saøng
nh ng
– Kyõ naêng & söùc phaùn ñoaùn laâm saøng
– Kinh nghieäm thöïc haønh laâm saøng

11. KHAÙI NIEÄM Y HOÏC CHÖÙNG CÔÙ
NG
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 tieân
löôïng, hieäu quaû vaø an toaøn cuûa phöông phaùp ñieàu
trò, phuïc hoài vaø döï phoøng.
– Thay theá caùc phöông phaùp chaån ñoaùn, ñieàu trò cuõ
baèng phöông phaùp khaùc maïnh, chính xaùc, hieäu
quaû vaø an toaøn hôn

12. THÖÏC HAØNH YHCC
NH
Ñaët caâu hoûi veà thoâng tin caàn truy caäp
Truy caäp thoâng tin coù giaù trò chöùng côù
Ñaùnh giaù ñoä maïnh chöùng côù cuûa thoâng tin coù ñöôïc
Aùp duïng vaøo thöïc teá laâm saøng
Löôïng giaù hieäu quaû vieäc aùp duïng

13. Unsound
Research 1
Aware Accepted Applicable Able Acted on AgreedAdhered to
Sound
Research
3
4
Systems
(bottomline± ref)
Synopses
(user summary of research)
2
Systematic Reviews and CATs
(search; appraisal; synthesis)
© Elsevier Ltd 2005. Straus et al.: Evidence-based medicine

14. WAYS TO INCORPORATE
EVIDENCE INTO PRACTICES
Doing
Using
Replicating

15. TRUY CAÄP THOÂNG TIN
Y HOÏC CHÖÙNG CÔÙ
NG

17. GIÔÙI HAÏN THOÂNG TIN
Usefulness = Relevance * Validity / Effort

18. CAÙC BÖÔÙC TRUY CAÄP THOÂNG TIN
Y HOÏC CHÖÙNG CÔÙ CÔ BAÛN
1. Laøm roõ caâu hoûi laâm saøng vaø tìm caùc töø khoùa
theo 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 tin
4. Thöïc hieän tìm kieám caùc töø khoùa ñaõ coù ñöôïc töø
böôùc 1
5. Giôùi haïn keát quaû coù ñöôïc töø böôùc 4 baèng caùch
keát hôïp vôùi böôùc 2.

19. Phöông phaùp PICO
Patient or population Moâ taû beänh nhaân (tuoåi, giôùi, chuûng
(Beänh nhaân / Daân soá) toäc, tieàn söû,...)
Intervention/ exposure Vieäc xaûy ra hay ñaõ ñöôïc laøm : ñieàu
(Can thieäp / Tieáp xuùc) trò, xeùt nghieäm chaån ñoaùn, phôi
nhieãm (VD: huùt thuoác laù thuï ñoäng)
Comparison So saùnh vôùi gì ? Khoâng so saùnh,
(So saùnh) placebo, loaïi can thieäp khaùc
Outcomes Hieäu quaû cuûa can thieäp laø gì? Phaûi
(Keát quaû, thöôøng laø ñaëc hieäu ( töû vong, tyû leä nhaäp vieän...)
laâm saøng)
Böôùc 1

20. In patients undergoing hip replacement,
to what extent is the risk of post-operative infection
reduced by antimicrobial prophylaxis?
patients undergoing hip
Population
replacement
Intervention
FACETS
antimicrobial prophylaxis
Comparison
placebo
Outcome post-operative infection
Böôùc 1

21. Hip replacement, Hip joint, hip prothesis,
patients
Total-hip replacement, total-joint replace..
undergoing hip
Hip surgery, hip operation, acetabulum
replacement
hip arthroplasty,… OF SYNONYMS AND
DRAW UP A LIST
FACETS ABBREVIATIONS AND SPELLING
Anti-infective agents, infection control,
antimicrobial VARIANTS WHICH MAY BE USED BY
antibiotics, antibiotic prophylaxis,
prophylaxis antimicrobial, anti-microbial, ultraclean,
hypersterile
AUTHORS
Bacterial infections, postopertavie
post-operative
complications, surgical wound infections,
infection
prothesis-related infections, sepsis
Böôùc 1

22. Hip replacement, Hip joint, hip prothesis,
patients
Total-hip replacement, total-joint replace..
undergoing hip
Hip surgery, hip operation, acetabulum
replacement
hip arthroplasty,…
DRAW UP A LIST OF SYNONYMS AND
ABBREVIATIONS AND SPELLING
Anti-infective agents, infection control,
antimicrobial antibiotics, antibiotic prophylaxis,
VARIANTS WHICH MAY BE USED BY
prophylaxis antimicrobial, anti-microbial, ultraclean,
FACETS hypersterile AUTHORS
Bacterial infections, postopertavie
post-operative
complications, surgical wound infections,
infection
prothesis-related infections, sepsis
Böôùc 1

23. Hip replacement, Hip joint, hip prothesis,
patients
Total-hip replacement, total-joint replace..
undergoing hip
Hip surgery, hip operation, acetabulum
replacement
hip arthroplasty,…
Anti-infective agents, infection control,
antimicrobial antibiotics, antibiotic prophylaxis,
prophylaxis antimicrobial, OF SYNONYMS AND ABBREVIATIONS
DRAW UP A LIST
anti-microbial, ultraclean,
hypersterile VARIANTS WHICH MAY BE USED BY
AND SPELLING
Bacterial infections, postopertavie
post-operative AUTHORS
FACETS complications, surgical wound infections,
infection
prothesis-related infections, sepsis
Böôùc 1

24. Hip replacement, Hip joint, hip prothesis,
patients
Total-hip replacement, total-joint replace..
undergoing hip
Hip surgery, hip operation, acetabulum
replacement
hip arthroplasty,…
Anti-infective agents, infection control,
antimicrobial antibiotics, antibiotic prophylaxis,
prophylaxis antimicrobial, anti-microbial, ultraclean,
hypersterile
BacterialUP A LIST OF SYNONYMS AND ABBREVIATIONS
DRAW infections, postopertavie
post-operative
complications, surgical wound infections,
infection
prothesis-related infections, USED BY AUTHORS
AND SPELLING VARIANTS WHICH MAY BE sepsis
Böôùc 1

25. Hip replacement, Hip joint, hip prothesis,
patients
Total-hip replacement, total-joint replace..
undergoing hip
Hip surgery, hip operation, acetabulum
replacement
hip arthroplasty,…
Anti-infective agents, infection control,
antimicrobial antibiotics, antibiotic prophylaxis,
prophylaxis antimicrobial, anti-microbial, ultraclean,
hypersterile
Bacterial infections, postopertavie
post-operative
complications, surgical wound infections,
infection
prothesis-related infections, sepsis
Böôùc 1

26. CAÙC BÖÔÙC TRUY CAÄP THOÂNG TIN
Y HOÏC CHÖÙNG CÔÙ CÔ BAÛN
1. Laøm roõ caâu hoûi laâm saøng vaø tìm caùc töø khoùa
theo phöông phaùp PICO
2. Phaân loaïi vaán ñeà thaønh Ñieàu trò, Chaån
nh
ñoaùn, Tieân löôïng, Nguy cô,...
ng
3. Choïn nguoàn döõ lieäu ñeå tìm kieám thoâng tin
4. Thöïc hieän tìm kieám caùc töø khoùa ñaõ coù ñöôïc töø
böôùc 1
5. Giôùi haïn keát quaû coù ñöôïc töø böôùc 4 baèng caùch
keát hôïp vôùi böôùc 2.

28. ÑOÄ MAÏNH CUÛA CHÖÙNG CÔÙ
NH NG
Loaïi I : töø CT ñaùnh giaù heä thoáng
nh ng
Loaïi II : töø ít nhaát 1 CT NC coù ñoái chöùng ngaãu nhieân
ng
Loaïi III : töø caùc NC thöïc nghieäm, khoâng ñoái chöùng
ng
Loaïi IV : töø caùc NC khoâng thöïc nghieäm
Loaïi V : töø quan ñieåm caù nhaân, ca LS

29. ÑOÄ MAÏNH CAÙC THIEÁT KEÁ NGHIEÂN CÖÙU
CHO CAÙC LOAÏI CAÂU HOÛI LAÂM SAØNG
Clinical Prospective, blind comparison
Examination to gold standard
Diagnostic Prospective, blind comparison
Testing to gold standard
Prognosis Cohort study > Case Control > Case Series
Therapy
Therapy Randomized control trial (RCT)
Randomized control trial
Etiology / Harm Cohort study > Case Control > Case Series
Prevention RCT > Cohort study > Case Control >Case
Series
Böôùc 2

30. ÑOÄ MAÏNH CAÙC THIEÁT KEÁ NGHIEÂN CÖÙU
CHO CAÙC LOAÏI CAÂU HOÛI LAÂM SAØNG
Caùc toång quan heä thoáng coù theå traû lôøi cho moïi
loaïi caâu hoûi laâm saøng vôùi ñoä tin caäy cao nhaát
neáu thöïc hieän ñuùng phöông phaùp
Böôùc 2

31. CAÙC BÖÔÙC TRUY CAÄP THOÂNG TIN
Y HOÏC CHÖÙNG CÔÙ CÔ BAÛN
1. Laøm roõ caâu hoûi laâm saøng vaø tìm caùc töø khoùa
theo 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 tin
4. Thöïc hieän tìm kieám caùc töø khoùa ñaõ coù ñöôïc töø
böôùc 1
5. Giôùi haïn keát quaû coù ñöôïc töø böôùc 4 baèng caùch
keát hôïp vôùi böôùc 2.

32. PHAÂN LOAÏI DÖÕ LIEÄU
NGUYEÂN PHAÙT
ÑAÕ ÑÖÔÏC ÑAÙNH GIAÙ
NH
– GIAÙ TRÒ TÖØNG NGHIEÂN CÖÙU
NG
– TOÅNG QUAN HEÄ THOÁNG
NG NG
– GUIDELINES
– KINH ÑIEÅN

33. DÖÕ LIEÄU NGUYEÂN PHAÙT
MEDLINE (MEDlars onLINE)
EMBASE
CINAHL (Cumulative Index to Nursing and
Allied Health Literature)
LILACS (Latin American and Caribbean
Health Sciences)
PsycInfo

34. DÖÕ LIEÄU NGUYEÂN PHAÙT
MEDLINE
NATIONAL LIBRARY OF MEDICINE: 1879
1960, MEDLARS (Medical Literature Analysis and Retrieval
(
System)
TOÅ CHÖÙC DÖÔÙI DAÏNG INDEX (Medical Subject Headings)
NG
12 TRIEÄU RECORDS
4600 TÔØ BAÙO
CAÄP NHAÄT MOÃI TUAÀN
86 % TÖØ TIEÁNG ANH / ABSTRACTS
NG
76% COÙ ABSTRACT

35. DÖÕ LIEÄU NGUYEÂN PHAÙT
MEDLINE
TRUY XUAÁT DÖÕ LIEÄU TUØY THUOÄC TOÅ CHÖÙC SÔÛ HÖÕU DÖÕ LIEÄU
– MIEÃN PHÍ & TRAÛ TIEÀN

36. DÖÕ LIEÄU NGUYEÂN PHAÙT
JOURNAL
Abridged Index Medicus (AIM) Journal Titles
University of Texas Health Science Center at
San Antonio
Evaluating Web-sites
– The URL: .ORG; .GOV & .DOH; .EDU & .AC
– Health Information Quality Assessment Tool,
– Health On the Net Foundation:

37. DÖÕ LIEÄU THÖÙ PHAÙT
CAT (Critical Appraised Topics)
– Moät hình thöùc bình baùo
– Ñaùnh giaù giaù trò cuûa 1 baøi baùo theo tieâu
nh
chuaån ñaõ ñöa ra.
– Nhoùm chuyeân vieân cuûa moät trung taâm
– FORM

38. DÖÕ LIEÄU THÖÙ PHAÙT
Critical Appraised Topics

40. DATA REVIEW
SAMPLE
DÖÕ LIEÄU THÖÙ PHAÙT

41. DÖÕ LIEÄU THÖÙ PHAÙT
Toång quan heä thoáng
ng ng
– Toång quan TAÁT CAÛ taøi lieäu COÙ LIEÂN QUAN
ng
theo moät khuoân maãu ñònh saün
– Ñaùnh giaù giaù trò cuûa moät vaán ñeà
nh
– Nhoùm chuyeân vieân

42. …reduced osmolarity ORS with WHO standard ORS
in children with acute diarrhoea
unscheduled IV
41 studies fluid infusions,
stool volume,
(-)6 / RCTs(-) vomiting,
(-)9 / intervention >< reduced osmolarity ORS hyponatraemia
(-)6 / control group did not use (WHO) std. ORS
20 remaining RCTs
(-)2 / not in children;
(-)2 / no relevant outcomes reported;
2 excluded (Mexico 1988, Mexico 1990b,
Mexico 1990a).
13 remaining RCTs
(Panama 1982, USA 1982).
14 studies met the inclusion criteria.

43. Meta-analysis

44. SYSTEMATIC REVIEW
DÖÕ LIEÄU THÖÙ PHAÙT

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

46. DÖÕ LIEÄU THÖÙ PHAÙT
GUIDELINES

47. Treating giant cell arteritis:
A consistent level 1 studies
Grades of B consistent level 2 or 3 studies or extrapolations from level 1 studies
C Give4 steroids (A) immediately (D) at
level studies or extrapolations from level 2 or 3 studies
Recommendation
D dosesevidence or troublingly inconsistent or inconclusive studies of any level
level 5 of at least 20 mg (C) daily (A).

48. SAÙCH GIAÙO KHOA
CH
CD ROM
ONLINE
– MD CONSULT
– OVID
– STATREF
– Uptodate

49. TEXTBOOKS
GUIDELINES / EBM
COCHRANE LIBRARY
DARE, HTA
CAT

50. CAÙC BÖÔÙC TRUY CAÄP THOÂNG TIN
Y HOÏC CHÖÙNG CÔÙ CÔ BAÛN
1. Laøm roõ caâu hoûi laâm saøng vaø tìm caùc töø khoùa
theo 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 tin
4. Thöïc hieän tìm kieám caùc töø khoùa ñaõ coù ñöôïc
töø böôùc 1
5. Giôùi haïn keát quaû coù ñöôïc töø böôùc 4 baèng caùch
keát hôïp vôùi böôùc 2.

52. GIÔÙI HAÏN THOÂNG TIN
No. relevant items found
Sensitivity =
No. relevant items in existence
No. relevant items found
Precision =
Total no. items found
Böôùc 5

53. TIEÂU CHUAÅN VAØNG
NG
Anne McKibbon at McMaster University
10 TAÏP CHÍ NOÅI TIEÁNG 1983-1991
NG
Handsearching

54. Table for Clinical Queries using Research Methodology Filters
Optimized Sensitivity/
Category PubMed equivalent³
for Specificity²
quot;randomized controlled trialquot; [PTYP] | quot;drug therapyquot; [SH]
sensitivity 99%/74%
Therapy | quot;therapeutic usequot; [SH:NOEXP] | quot;random*quot; [WORD]
specificity 57%/97% (double [WORD] & blind* [WORD]) | placebo [WORD]
quot;sensitivity and specificityquot; [MESH] | quot;sensitivityquot; [WORD]
sensitivity 92%/73% | (quot;diagnosisquot; [SH] | quot;diagnostic usequot; [SH] | quot;specificityquot;
Diagnosis [WORD]
quot;sensitivity and specificityquot; [MESH] | ( quot;predictivequot;
specificity 55%/98%
[WORD] & quot;value*quot; [WORD] )
quot;cohort studiesquot; [MESH] | quot;riskquot; [MESH] | (quot;oddsquot;
sensitivity 82%/70% [WORD] & quot;ratio*quot; [WORD]) | (quot;relativequot; [WORD] & quot;riskquot;
Etiology [WORD]) | (quot;casequot; [WORD] & quot;control*quot; [WORD])
quot;case-control studiesquot; [MH:NOEXP] | quot;cohort studiesquot;
specificity 40%/98%
[MH:NOEXP]
quot;incidencequot; [MESH] | quot;mortalityquot; [MESH] | quot;follow-up
sensitivity 92%/73% studiesquot; [MESH] | quot;mortalityquot; [SH] | prognos* [WORD] |
Prognosis predict* [WORD] | course [WORD]
specificity 49%/97% prognosis [MH:NOEXP] | quot;survival analysisquot; [MH:NOEXP]

56. MEDLINEPRO.COM

57. Xin caùm ôn söï theo doõi cuûa
Toaøn Theå Hoäi Tröôøng ng