The Cochrane Library

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The Cochrane Library. 碩睿資訊有限公司 http://www.sris.com.tw. Professor Archibald Leman Cochrane, CBE FRCP FFCM, (1909 - 1988). Archie Cochrane 是當時英國內科醫師及著名的流行病學專家,他對於流行病學發展的偉大貢獻,以致 Cochrane Collaboration 以他的名字命名以表達對他的敬意 - PowerPoint PPT Presentation

Text of The Cochrane Library

  • The Cochrane Libraryhttp://www.sris.com.tw

  • Professor Archibald Leman Cochrane, CBE FRCP FFCM, (1909 - 1988) Archie Cochrane Cochrane Collaboration 1972- Effectiveness and Efficiency: Random Reflections on Health Services Randomised Controlled Trials, RCTs

    CBE )FRCP FFCM

  • 1972corticosteroid 1989 1991 30% 50%The Cochrane Collaboration Logo

  • (STRATEGY: top down)

  • The Cochrane Library Cochrane Database of Systematic Reviews (Cochrane Reviews) Impact Factor 2010= 6.186 (10/151 Medicine, General & Internal)Database of Abstracts of Reviews of Effects (Other Reviews)Cochrane Central Register of Controlled Trials (Clinical Trials)Cochrane Methodology Register (Methods Studies) Health Technology Assessment Database (Technology Assessments) NHS Economic Evaluation Database (Economic Evaluations)

  • Standard EBMSteps in EBM process (5 As)(Ask: PICO)Formulate an answerable question(Acquire) Track down the best evidence(Appraisal: VIP)Critically appraise the evidence(Apply: 3E) Integrate with clinical expertise and patient values(Audit) Monitoring your performance

  • (Ask: PICO)Patient or Problem( )Intervention or Indicator() Comparator() Outcome ()

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  • Cochrane Library

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  • Does corticosteroid treatment in patients with septic shock improve mortality?Question?

  • Patient or PopulationPatient with septic shock (Intervention or IndicatorCorticosteroid ComparatorNo corticosteroid OutcomeMortalityPICO

  • Septic shock ANDcorticosteroid ANDmortalityKey wards

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  • Topic: Corticosteroids for treating severe sepsis and septic shock [review article] Djillali Annane, Eric Bellissant, Pierre Edouard Bollaert, Josef Briegel, Didier Keh, Yizhak Kupfer January 2009Septic shock is the most severe form of infection. It may also interfere with the production of corticosteroids, a a key hormone for host defence against infection). This review showed that overall corticosteroids did not impact on mortality. However, the trials conducted after 1992 showed that long course ( 5 days) of low dose of corticosteroids improved survival in septic shock without causing harm. Trials performed before 1992 showed no benefit from short course of high dose corticosteroids.Cochrane library

  • spesisseptic shock(corticotropin stimulation test)(a daily dose of 200 to 300 mg of hydrocortisone (or equivalent) at least 5 days)

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  • MeSH Search

  • MeSH SearchNational Library of MedicineNLM1954Subject Heading Authority List1960Index MedicusMedical Subject HeadingsM e S HM e S HNLMNLMMEDLINE/PubMED

  • MeSH SearchMedical Subject HeadingsM e S HSee:

  • Case Study

  • 6-8?

    6-8??

  • Question?

    Patient or PopulationAnesthesia, Spinal (Intervention or IndicatorBed Rest ComparatorNo Bed Rest OutcomeHeadache

  • Key Words Anesthesia, Spinal ANDbed rest ANDheadache

  • Topic: Posture and fluids for preventing post-dural puncture headache[review article] Cathie LM Sudlow,Charles P Warlow 21 JAN 2009To assess the effects on post dural puncture headache of a period of bed rest versus early mobilisation, of different positions during a period of bed rest, and of administering supplementary fluids after the procedure. There is no good evidence from randomised trials to suggest that routine bed rest after dural puncture is beneficial. The role of fluid supplementation in the prevention of post-dural puncture headache remains uncertain.

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    ************PICOpatient,intervention,comparison,outcomesVIPvalidity,impact,practical in practice3Eevidence,expertise,expectation***********************(National Health Research Institutes, Taiwan)2008The Cochrane LibraryWiley-Blackwell

    *******************Anesthesia, Conduction [+4] Anesthesia, Epidural [+1] Anesthesia, Local Anesthesia, Spinal Nerve Block [+1]

    Anesthesia, Dental [+1] Anesthesia, General [+3] Anesthesia, Intratracheal Anesthesia, Intravenous Anesthesia, Obstetrical*****