醫學院大學部講義

簡史

學科主題:臨床及基礎醫學、護理、牙醫、獸醫及醫療相關如醫技、職治、物治 及生命科學如生物學、環境科學等。
資料類型 :  索摘資料庫,收錄資料類型有journals. monographs of congresses and symposia (1976-1981)
收錄年代 : 1949-Present
收錄期刊數 :5200多種(含括37種語言),其中47%的出版品來自美國,將近90%出版品是以英文寫成，79%有作者寫的英文摘要
2002年起將Healthstar、Aidsline、BioethicsLin的資料併入

資料來源： http://www.nlm.nih.gov/pubs/factsheets/medline.html

生物醫學相關資料庫：

BIOSIS Previews：

• 收錄Biological abstracts(1969至今)、Biological abstracts/PRM(1980年至今)的會議、評論、書刊、書之章節、專論等資料，及BioResearch Index(1969-1979)的期刊文獻
• 範圍：傳統的生物學如分子生物學、植物學、生態環境學、醫學、藥理學、獸醫學、動物學，跨領域主題有農業、生物化學、生物醫藥、生物科技、實驗、臨床醫學及獸醫學、遺傳學、營養學及公共衛生
• 約有67%為Medline與EMBASE兩資料庫未收錄

資料來源:蔡明月、尤慧敏，台灣地區生命科學研究者發表期刊論文之生產力研究.國家圖書館館刊，第二期，92 ，p.4.

嚴謹定義的醫學標題( Medical Subject Heading 簡稱為 MeSH)

MeSH 的15 大類

層次分明的樹狀架構( Tree Structure)

Broader Terms vs. Narrow Terms

每一標題下可其依類，再下分為不同的副標題(Subheading)，計有86個副標題
 

換語詞索引( Permuted Index)

在不確定有那些標題可以使用時，可以利用替換語詞索引檔引介出可用的語詞

各種查詢的介面:

Unique Identifier . Record Owner.Authors . Authors Full Name.Title.Original Title. Institution. Comments.Gene Symbol.General Note.Grant Number.CAS Registry/EC Number.nstitution. Source . Publishing Model.Abbreviated Source.NLM Journal Code.Journal Subset. Local Message.Country of Publication .MeSH Subject Headings.Abstract .Registry Numbers .ISSN .Publication Type .Language .Entry Date.Update date

查詢的步驟:
  題目：想查有關壓力造成頭痛的文章，特別希望針對兒童學齡及青少年。最好是1990年後的文獻。

基本的畫面如下：

1.Chang database：可以同時檢索Econlit及PsycInfo或同一個檢索詞在Medline檢索後直接切換到Econlit或PsycInfo進行檢索 2.目前檢索的資料庫名稱及資料庫蒐錄年代 3.Basic Search：自然語言的檢索方式，檢索結果會以相關度高低列出 4. Find citation：當不確定書目資料的正確性或手中書目資料量不足時要確定書目時使用，例如只知道title為Developing unbiased diagnostic and treatment guidelines in psychiatry，不知道出於那一本期刊的那一卷期，可利用此種功能查詢 5.Search Tools：提供標題比對、內容註、樹狀架構、複分標題等檢索功能 6.Search Fields：提供卷、期、頁數等更多的檢索欄位 7.Advanced Ovid Search：提供map term to subject heading的檢索 8.Multi-Field Search：條列及下拉選項式提供不同欄位檢索 9.以點選方式選擇要進行keyword、author 、title、journal檢索 10鍵入檢索詞 11.檢索詞要比對subject heading 12.對於所鍵入的檢索詞要進一步限制檢索的結果

檢索詞彙：壓力(stress)、頭痛(headache)

縮小範圍詞彙：年齡層：學齡前、青少年

 年代：屬於1990年代之後發表的文章

  選定標題後，系統會引導你進入副標題(Sub-heading)的選擇。

除非你的主題只有單一觀念或是非常肯定某一些副標題與查詢相關，亦即你要縮小查詢的目標，你可以複選相關的 sub-headings。
  例如：你只對某病症的治療有興趣，可以選擇下列副標題是與廣義的治療(therapy) 有關 diet therapy(et)、 drug therapy(dt)、 nursing(nu)、prevention & control (pc)、
rehabilitation (rh)、radiotherapy (rt) surgery (su)、 transplantation (tr)

 
  針對每一策略逐條完成，查詢的結果展現在主要畫面。因為選擇詞彙不同，結果會不同
 

下一步可決定是否需要修飾查詢結果

限制功能能快速縮小搜尋的結果，除了常用的限制檢索欄 (Year、 Review article、 English）外，還有特定的出版品(publication type)以符合所需，如dissertation、tutorial 或 clinical trial等。Medline 還可以提供不同的限制條件。
 
 
 
  最後瀏覽文獻
 

條列式的呈現

 完整的單筆書目

檢索功能

and : A and B,檢索出來的資料要同時有A與B兩個主題

or : A or B,檢索出來的資料要有A或B主題

not : A not B,檢索出來的資料有A但不可談論到B主題

$：用在字尾，後面不加數字表示不限定字尾有幾個字母。如rat會收ration、rats、ratify,字尾單複數。

#：用在單複數變化,如wom#n,可檢索出有women.woman的字
 

呈現.列印及存檔都要先到citation manager做設定

列印 : 選定好要列印主題後,利用browser做列印

E-Mail:勾選好要E-Mail回去的資料,到citation manager選擇email

儲存： 勾選所要儲存的資料後,到citation manager點選save

檢索策略的儲存

需先在系統建立一個帳號，之後才能進行儲存

同時檢索Medline、Econlit、Healthstar

1、任選這三個資料庫中的一個進入

2、點選Chang Database

3、勾選要查詢的資料庫

4、將上一檢索詞再到其它資料庫進行檢索或清空或回到原先檢索的資料庫

5、顯示各個資料庫筆數

keep up with the world most progressive biomedical fields  

因為Medline 的更新很快，除了要對各學科的概念清楚外，對於日益增加的標題或是new terms與現有辭庫中的關連性，更會需要仰賴完整的索引建。故對於初學者有下列建議：
 

盡量利用標題比對，選擇適用的標題

一開始查詢不要先作太多限制( go straight)

仔細瀏覽所查結果中的標題它提供該文獻的重點(*)處，由此判斷查詢的方向是否穩合所需

做好修改(modification)的心理準備

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1. Leptin是由脂肪細胞所分泌的一種荷爾蒙。1996年Considine RV等人發現在人類肥胖者Leptin濃度較一般人高，且Leptin的量會與體內脂肪量成正相關。

A.   請查出近二年內在medline中發表關於leptin 與肥胖的研究，特別侷限於對青少年齡層方面的討論。

B.2002年有幾篇Salbe AD.等人所寫與青少年有關的文章，請提供文章出處(含期刊刊名，卷號、期號等)

2. 醫學上有愈來愈多的醫療嘗試用傳統中醫治療

從本資料庫中可否查詢到使用針灸治療在一般生理或是心理產生的壓力上？【提示：針灸 Acupuncture ；壓力 Stress】

3.自1992年美國小兒科學會(AAP)建議應該讓小寶貝們仰睡，盡量避免俯睡以避免產生嬰兒瘁死症(SID)。從許多數據顯示，的確有減少案例的趨勢。

A.請問再1999年後有多少討論預防SID的review 文獻？

B.又從查詢的過程中，你可知道SID的全名是什麼？【提示：建議選用合適的副標題】

4.狂熱的電腦族要注意了！長期過度敲打鍵盤的動作，可能為你帶來了電腦族的病變叫「重複使力傷害：Repetitive Strain Injury，RSI」。若一旦受到嚴重的傷害，雙手將無法靈活運用。

近年間有文獻探討過電腦造成這種病變？【你可知道Cumulative Trauma Disorders 與 Repetitive Strain Injury的關聯？】

5.近年來許多大型醫院增設正子放射斷層攝影儀器(Positron Emission Tomography 簡稱 PET Scan) 作為癌症的偵測或是診斷腦部病變等。其實PET Scan 是利用體內對於葡萄糖代謝的生化現象來推斷，對於腫瘤診斷上的確是一種新途徑。

請問在資料庫中探討關於利用PET Scan的技術對於卵巢瘤(ovarian cancer)的診斷文獻？比較一下利用副標題diagnosis的差異？【提示：注意 PET Scan 對應的醫學標題】

6.請找出文獻證明餵母乳有助於預防嬰兒過敏

7.Irritable bowel disorder is a digestive problem that causes abdominal pain, bloating, gas, diarrhea, and constipation--or some combination of these symptoms. One of the causes may be the patient may lack of a special kind of enzyme, which cause the similar bowel irritable symptoms, usually your doctor will perform a test for your breath.Please provide any relevant articles and cite the most current one.

8. A child may compulsively check all the doors and windows of his home or keep washing his hands to make sure they are clean. Obessive-Compulsive Disorder usually begins in adolescence or young adulthood and is seen in as many as 1 in 200 children and adolescents. Except helping those patients with drug or psychotherapy , the family support and education are also central to the success of treatment. From Medline please look for articles concerning the family treatment to OCD, and the articles I need must include patients who is under 18.

9.My roommate will grind and clench his teeth during his sleep, that noises is really bothering me.I heard that kind of grinding may damage to the teeth or jaw and cause a temporomandibular disorders.I am interesting to look for English review type of articles that published after year 2000.

10. There is a lot of people suffer from the sinusitis, that patient may have facial pain or pressure, nasal obstruction, thick nasal discharge, post-nasal drainage. They may also have headache, bad breath, and fatigue. An endoscope is a special fiber optic instrument for the examination of the interior of a canal.So first find out how many articles talk about endoscopy to treat sinusitis between 2003-4.Secondly, are there research teams that were conducted the above study in Taiwan. Please cite that reference.

11. If you notice periods of depression that seem to accompany seasonal changes during the year, you may suffer from seasonal affective disorder. Light therapy is now considered the first-line treatment intervention, and if properly dosed can produce relief within days. Anti-depression drugs may also help, and if necessary can be used in conjunction with light. Take a look in Medline see how many review articles discussed the light treatment to the searsonal depression in year 2003?

12.Will wearing of tight underpants and trousers risk of our men dyspermia？ Quite an interesting topic.Let’s see if there is any study about men’s clothes will affect their infertility. How many articles do you get? Please cite the most current article.

13.Nighttime bed-wetting is normal and very common among preschoolers. It affects about 40 percent of 3-year-olds.Most of the causes might be the bladder is not yet developed.And another reason may be a sign of stress to cause the problem.Physical condition is not my interest.Please look for any discussion concerning the disorder from a psychological point of view.Provide the most recent publication.

14. Many people consider snoring a minor annoyance, but it can signal a potentially serious condition called sleep apnea, temporary interruptions in breathing during sleep. These interruptions in breathing can occur as often as 20 to 30 times per hour. A research report speculated there is a genetic marker called apolipoprotein E that makes someone susceptible to developing sleep-disordered breathing.First please pull out any relevant reference for me. Secondly, look for that one article was published in a journal calls “The Journal of the American Medical Association” in June 2001. Please tell me which institute was conducting this research.

15. Rheumatoid arthritis involves inflammation in the lining of the joints and/or other internal organs. RA typically affects many different joints. It is typically chronic, which means it lasts a long time, and can be a disease of flare-ups. It was thought for many years that if you had arthritis you should not exercise because it would damage your joints. Now, however, research has shown that exercise is an essential tool in managing your arthritis.Please find out articles that prove the points. By the way, I need only review articles concerning studies about middle age (from45-64 years old)

16.“Gout” (痛風) is caused by excessive blood levels of uric acid, a waste product formed from the breakdown of purines (普林)。Treatment involved severe dietary restrictions. Today, medications such as allopurinol抑制尿酸劑 (Zyloprim, Aloprim) is much more effective in controlling gout than dietary changes”

A. 請利用medline 找出有關痛風的藥物治療，特別是針對上述所提及的藥物。限制條件是2000年(含)以後的English review article.

B.請直接利用MESH subject heading 查詢 gout suppressants，

(1) 詳讀其scope

(2)展開樹狀架構分別用focus及explore 對gout suppressants進行檢索，比較檢索所得結果，利用布林邏輯對檢索結果進行說明.

C.   痛風的發生，便是因為普林的代謝出現異常，使得尿酸無法正常排出。痛風者酌量減少含普林食物的攝取，例如少吃內臟類、豆類、胚芽、魚肉。請從痛風食療法的觀點查看有多少文章提及普林？

17.甲狀腺疾病是常見的內分泌腺疾病，它位於於頸部喉結下方如蝴蝶狀的腺體。當甲狀腺分泌過多時會造成甲狀腺機能亢進 hyperthyroidism。典型的症狀為心跳快、焦慮、易緊張、體重下降。一般治療方式為服用抗甲狀腺藥物antithyroid drugs、服用放射性碘(radioactive iodine) 或是採用手術切除thyroid gland.

A.   請查閱病人服用抗甲狀腺藥物的回顧文獻

B.     請特別提供一篇發表在 New England Journal of Medicine 2001的一篇review article