Systematic Reviews/Evidence-Based Medicine

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1 EMBASE 를활용한 EBM 정보검색가이드 엘스비어한국지사김혜령과장 customer consultant, Life Science solution

2 Preparing a Systematic Review Cochrane Handbook outlines: SRs 연구일반적인 8 단계 ❶ 리뷰진행할의학적질문정의및연구를위한기준검토 ❷ 의학적질문리뷰를위한연구계획수립 ( 검색전략 ) 을위한검색 ❸ 연구를위한데이터수집 ( 문헌검색 ) 4. 포함된연구에서편중위험평가 5. 데이터분석과메타분석진행 6.

2 2 Preparing a Systematic Review Cochrane Handbook outlines: SRs 연구일반적인 8 단계 ❶ 리뷰진행할의학적질문정의및연구를위한기준검토 ❷ 의학적질문리뷰를위한연구계획수립 ( 검색전략 ) 을위한검색 ❸ 연구를위한데이터수집 ( 문헌검색 ) 4. 포함된연구에서편중위험평가 5. 데이터분석과메타분석진행 6. 리포팅편중 (biases) 지정 7. " 연구결과의요약 " 테이블과결과제시 8. 결과해석및결론 High-Quality Systematic Review The Cochrane Collaboration 은예방, 치료및재활의효과를시험뿐만아니라의료시스템의개입에대해무작위대조연구의체계적검토를진행하는 31,000 이상의의료전문가그룹입니다. Cochrane Reviews 는국제적으로근거중심보건의료에서가장신뢰도높은표준으로인정받고있습니다. The Cochrane Handbook 에서는포괄적인 systematic review 를위해 MEDLINE 과 EMBASE 모두검색할것을권장합니다.

3 3 What is EMBASE? 세계적인전문학술지에게재된광범위하고신뢰할수있는바이오, 질병및약물, 관련문헌정보수록, 임상진행상황모니터링, 부작용, 독성등약물안정성, 치료법등에대한정보제공 1947~ 현재까지 international biomedical 문헌정보제공 (1947~1973 년 Embase Classic 별도 ) EMBASE(1947 년 - 현재 ) 와 MEDLINE(1966 년 - 현재 ) 의자료가통합된 Database 8,500 가지이상의저널타이틀과 EMBASE 만의 2,800 여종저널추가제공 (+5.9m 레코드 ) 출간물, peer-reviewed literature, 출간예정인아티클, 회의초록 Life Science 분야의 Thesaurus Emtree ( 질병, 약물, 메디컬장비등 ) 를통한강력한 통합검색 Drugs, Disease, Medical device 부제목 / 검색필터기능 Evidence based medicine (EBM) 정보및 Systematic review 를위한신뢰도높은자료 검색제공

4 색인 4 Embase helps search best evidence for SRs 종합적이고신뢰도높은컨텐츠 / 브라우징용어집 종합적이고신뢰할만한컨텐츠제공최신의문헌의빠른업데이트 주제어에대한정확한이해및정의 / 동의어확장 빠르고쉽게검색어선택및동의어조합 정확한검색결과제공 편리한검색툴 결과관리기능 다양한검색툴과옵션을활용해검색전략설계 Easy & Fast Try & Error 결과 / 문헌관리효율성향상기능 결과여러형태로저장 / 반출관리기능

5 EMBASE에서, 1. PICO 연구주제선정 1-1. 리뷰진행할의학적질문정의 1-2. 연구를위한기준검토

6 6 PICO Framework 검색질문검토 / 전략수립하기 PICO 는문헌검색에서특정의학적인문제에대해더많은사례 ( 증거 ) 를기반으로판단할수있도록사례 ( 증거 ) 문헌을수집하는검색전략입니다. P = Patient AND I = Intervention AND C = Comparison/control AND O = Outcome 문제에대해 4 가지요소의조합결과 The PICO Framework (Sackett et al, 1997)

7 7 PICO Question 설계예시 Question Type Patient or Problem Intervention Comparison Outcome Treatment (Therapy) 치료 환자의질병 (disease) 이나상태 (condition) (e.g., diabetes mellitus, constipation or meningitis) 치료방법 (e.g., drug, surgery or lifestyle modification) 대체치료방법혹은 placebo ( 표준치료 ) 예 ) 사망 (mortality) 생산성 (productivity), 통증 (pain), 장애 (disability) 혹은고용 (employment) Prevention 예방 환자위험요인또는전반적인건강상태 예방법 (e.g., drug or lifestyle modification) May not be applicable 예 ) 병상태 (morbidity), 사망 (mortality), 통증 (pain), 장애 (disability) Diagnosis 진단 대상질환또는상태진단검사나절차 문제에대한현재의기준 / 표준시험 검사유용성의측정 (e.g., sensitivity, specificity or odds ratio) Prognosis (natural history) 예후 예후 (Prognosis) 임상문제의심각도 (severity) 및지속시간 (duration) Usually time, sometimes expressed as watchful waiting Usually not applicable. watchful waiting 의경우표준치료식별 예 : 생존율, 사망률이나질병의진행속도 Etiology 환자위험요인, or harm 현재질병상태, (causation) 전반적인건강상태위험요인 위험인자의강도 ( 도즈 ) 의 indication과 May not be 노출기간을포함하여 applicable 인자개입 예 ) 질병발병율, 질병의진행속도, 혹은사망율 Adapted from

8 8 진단 (Diagnosis) PICO 검색예 Question components P Patient or Population Describe the most important characteristics of the patient (e.g.-age, disease/condition, gender) Your question Asthma diagnosis I- Intervention Prognostic factor, Exposure Describe the main intervention (e.g.-drug or other treatment, diagnostic/screening test) thorax radiography C-Comparison (if appropriate) Describe the main alternative being considered (e.g. placebo, standard therapy, no treatment, the gold standard) O-Outcome Describe what you re trying to accomplish, measure improve, affect. (e.g.- reduced mortality or morbidity, improved memory, accurate and timely diagnosis) The well-built clinical question: What is the added value of chest radiography in diagnosis of asthma?

9 9 치료 (Therapy) PICO 검색예 Question components P Patient or Population Describe the most important characteristics of the patient (e.g.-age, disease/condition, gender) I- Intervention Prognostic factor, Exposure Describe the main intervention (e.g.-drug or other treatment, diagnostic/screening test) C-Comparison (if appropriate) Describe the main alternative being considered (e.g. placebo, standard therapy, no treatment, the gold standard) O-Outcome Describe what you re trying to accomplish, measure improve, affect. (e.g.- reduced mortality or morbidity, improved memory, accurate and timely diagnosis) Your question Pregnant women AND diabetes Insulin pump therapy Conventional insulin therapy Improved management of glucose levels Successful pregnancy effectiveness, outcome The well-built clinical question: Are insulin pumps more effective than conventional therapies in managing diabetes in pregnant women?

10 EMBASE 에서, 2. 의학적질문리뷰를위한연구계획수립 2-1. Quick Search 검색

11 11 빠른검색 (Quick Search) 선행연구에대한개요빠른검색 특정 Cochrane review or systematic review 에서연구전략참고 인용수확인인용이많이된자료검토

12 12 선행연구참고 검색된선행 Cochrane review or systematic review 에서검색전략을참고합니다. 검색전략에서 적용을위해연관성을평가합니다. 필요하면, 검색식을해석참고합니다. 사용된색인용어 (indexed terms), 자유어 (free-text terms) 를참고합니다. 주제어변경등

13 EMBASE 에서, 3. 검색전략수립 ( 검색용어정의 ) 및검색식조합

14 검색어찾기 : 우선어 / 동의어 in Emtree Record 14

다양한검색연산자 - Search tips 15 불리언연산자 Boolean operators AND depression AND tricyclic 단어나구를모두레코드에있는경우 OR elderly OR aged 적어도하나의단어나문장은레코드에있는경우 NOT

Proximity operators NEAR/n NEXT/n drug* NEAR/2 adverse adverse NEXT/2 reaction* 순서에상관없이, n 개의단어내에있어야합니다 동일한순서로 n 개의단어내에있어야합니다 근접및불리언연산자를결합하여복잡한단일검색

15 다양한검색연산자 - Search tips 15 불리언연산자 Boolean operators AND depression AND tricyclic 단어나구를모두레코드에있는경우 OR elderly OR aged 적어도하나의단어나문장은레코드에있는경우 NOT depression NOT tricyclic NOT 뒤에단어나구문은제외 복잡한단일검색에서괄호를사용하고여러연산자를결합하여사용 (aged OR elderly OR geriatic) AND (depression OR insomnia) Note: 괄호사용 인접검색 Proximity operators NEAR/n NEXT/n drug* NEAR/2 adverse adverse NEXT/2 reaction* 순서에상관없이, n 개의단어내에있어야합니다 동일한순서로 n 개의단어내에있어야합니다 근접및불리언연산자를결합하여복잡한단일검색 ( 괄호사용 ) 'clinical' NEXT/2 ('trial*' OR 'application*') ('adverse' OR 'side' OR 'undesirable') NEXT/2 (effect* OR 'event*' OR 'reaction*' OR 'outcome*') Note: 괄호사용

16 16 다양한검색연산자 - Search tips 구문검색 (Phrase search) 'heart attack' "heart attack" heart-attack 구문에서단어를따옴표또는하이픈으로연결하지않으면, Emtree term 혹은자유어 ( free text) 로인식하여각단어를 AND 로검색진행예 ) heart attack 'heart'/exp OR heart AND attack. 예 ) 'heart attack' AND (clinical NEXT/2 (trial OR study)) 절단자 Truncation/Wildcards * 하나이상의문자를대체? 단일문자절단 sul*ur 'heart attack*' sulf?nyl catheter? 결과 : sulfur, sulphur 결과 heart attack, heart attacks 결과 'sulfonyl' and 'sulfinyl 와같은단어포함결과 'catheters 검색 'catheter' or 'catheterization 검색안됨 Note: * 로절단하기전에적어도세개의문자를입력 Wildcard + field 조합 : 예 ) sul*ur:ti:ab? + field 조합은지원하지않음 ( 예 : sulf?nyl:ab:ti) 구문내에서절단문자 ( 와일드카드 ) 를사용 : heart infarct* or "metabol* disorder*" Wildcard * 2 단어미만이문자로사용할수없음 : 예 ) "m* disorder" or "metabol* d*"

17 17 검색범위지정 검색예 )

18 18 Embase 검색범위 ( 검색용어의범위 ) Embase 검색옵션 Map to preferred term in Emtree Search also as free text in all fields Explode using narrower Emtree terms Search as broadly as possible Limit to terms indexed in article as major focus 설명 우선어와동의어를입력시자동으로인식되어우선어동의어동시검색예 ): myocardial infarction, heart attack 은 heart infarction 로매핑검색 검색범위를지정하지않을경우자유어로 all fields 로검색이진행됨 검색어가모든필드에서자유어 (free text search) 로검색되어짐 title, abstract, Key words, idex terms, 소속등. Emtree 하위용어까지확장검색 최대한넓게검색 / 위모든조건들모두포함하며검색어를 AND 연산자로분리하여검색, 검색어들간에 OR 검색실행예 ) heart attack -> 'heart'/exp OR heart AND attack 논문중에서가장중요한 main topic 을 Indexer 가부여이옵션을선택하면용어색인이있지만아이클에서주요주제어로간주되지않는모든기록은제외되며, 이옵션을해제하면, 검색은아티클내에서주요주제어가아닐지라도검색어로색인된레코드가검색이됩니다.

19 19 Advanced Search 검색가이드 진단 (Diagnosis) PICO 검색예 Question components Your question P Patient or Population Describe the most important characteristics of the patient (e.g.-age, disease/condition, gender) I- Intervention Prognostic factor, Exposure Describe the main intervention (e.g.-drug or other treatment, diagnostic/screening test) Asthma diagnosis thorax radiography C-Comparison (if appropriate) Describe the main alternative being considered (e.g. placebo, standard therapy, no treatment, the gold standard) O-Outcome Describe what you re trying to accomplish, measure improve, affect. (e.g.- reduced mortality or morbidity, improved memory, accurate and timely diagnosis) The well-built clinical question: What is the added value of chest radiography in diagnosis of asthma?

20 ❶ 검색어입력하기 20 asthma thorax radiography

21 ❷ 동의어검색하기 21

22 ❸ 우선어 / 동의어등용어검색조합 OR, AND 사용 22

23 23 ❹ 검색결과다운로드 / 반출하기 Endnote 등으로다운로드

24 ❺ 검색식저장및반출 24

25 25 ❻ 저장쿼리관리 (saved search) 저장된검색, Rerun 재검색 최신업데이트정보관리 / alert 등록최신업데이트자동수신

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Systematic Reviews/Evidence-Based Medicine

Systematic Reviews/Evidence-Based Medicine EMBASE 기본검색가이드 엘스비어한국지사김혜령과장 customer consultant, Life Science solution 2 EMBASE 소개 세계적인전문학술지에게재된광범위하고신뢰할수있는바이오, 질병및약물, 관련문헌정보수록, 임상진행상황모니터링, 부작용, 독성등약물안정성, 치료법등에대한정보제공 1947~ 현재까지 international biomedical