【階層】又是一個讓我陷入瘋狂的關鍵字。我又會不自覺將之複雜化，複雜化之後又順帶想將之系統化。因為建置系統的素材有點煩瑣，所以今天先獻上系統模式的相關概念。
階層模式
如果依照檢索目標與檢索複雜程度將文獻檢索策略進行運用難易程度分級，則我初步將之分類成三個模式:簡易、中間、複雜。
Ø 簡易模式，顧名思義為簡單、快速且容易操作。運用的檢索技巧有關鍵字、布林邏輯以及限制檢索範圍。關鍵字主要選用核心詞彙；限定範圍可選擇將關鍵字限定在標題或標題/摘要進行檢索。
Ø 中間模式，為簡易模式進階，但尚未達到複雜模式的統稱。主要差異為關鍵字方面會再額外使用次要詞彙以及擴大布林邏輯(OR)的運用，並額外使用Mesh terms來增加主題涵蓋的廣度，且運用布林邏輯(NOT)及限定檢索條件來限縮主題範圍。限定檢索條件可選擇文章出版類型、出版時間、物種、語言、主題、年紀或性別。
Ø 複雜模式，為可完整涵蓋所有可能主題的檢索方式。主要的差異為擴大檢索範圍的技巧使用:廣泛性相關詞彙的使用、Mesh terms的進階運用、切截運用與相近運算元的使用。
模式
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適用情境
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檢索策略運用
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簡易
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只想快速找到幾篇與主題非常相關的文章。
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[關鍵字(核心詞彙)] + [布林邏輯(AND)] + [限定檢索範圍(Title) (Title/Abstract)]
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中間
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想大略了解相關主題的潛在文章。
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[關鍵字(核心詞彙) (次要詞彙)]
+ [布林邏輯(AND) (OR) (NOT)] +
[限定檢索範圍(Title/Abstract) (Mesh terms)]
+ [限定檢索條件(article type) (publication dates) (Species)
(Languages) (Subjects) (Ages)
(Sex)]
|
複雜
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想全面且完整地檢視所有相關主題的潛在文章。
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[關鍵字(核心詞彙) (次要詞彙) (相關詞彙)] +
[布林邏輯(AND) (OR)
(NOT)] + [限定檢索範圍(Title/Abstract) (Mesh terms) (Majr) (Mesh:NoExp) (Mesh)(Majr:NoExp)]
+ [限定檢索條件(article
type) (publication dates) (Species) (Languages) (Subjects) (Ages) (Sex)] + [切截運用(*) (#) ($)] + [相近運算元(adj)(near)]
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檢索素材
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主題
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詞彙
|
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共同決策
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核心
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關鍵字
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shared
decision making, shared decision, sharing decision, 共同決策
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Mesh terms
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decision
making
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次要
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關鍵字
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communication,
negotiation, patient participation, patient involvement, consumer
participation,
consumer
involvement溝通 個案參與
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Mesh
terms
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patient
participation, communication
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相關
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關鍵字
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informed decision, informed choice,
decision aid, decision support, patient education, choice behavior
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Mesh
terms
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decision support techniques, decision
support systems, choice behavior, patient education as topic
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臨床試驗
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核心
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關鍵字
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clinical trial
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Mesh
terms
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Clinical
Trials as Topic
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次要
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關鍵字
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randomized controlled trial, controlled
clinical trial
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Mesh
terms
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controlled clinical trials as topic,
Randomized Controlled Trials as Topic
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相關
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關鍵字
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double blind, controlled before, before
and after, intervention, pretest, pre test, posttest, post test, prepost, pre
post, interrupted time, time serie, placebo
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Mesh
terms
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Evaluation Studies as Topic, intervention
studies, random allocation, program evaluation, Placebos
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[出版類型
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Clinical Trial, Controlled Clinical Trial,
Randomized Controlled Trial
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排除條件
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[出版類型]:
Review, Editorial, Meta-analysis, Comment, Validation Studies
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限定條件
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[出刊時間]:5年內
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模式應用
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模式
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實際應用
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結果
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簡易
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※共同決策(核心詞彙)[Title] AND臨床試驗(核心詞彙) [Publication
type]
(shared decision making[Title]) AND (Clinical
Trial[ptyp])
|
83筆
|
|
※與上述差異在於共同決策的核心詞彙改限定在 [Title/Abstract]
(shared decision making[Title/Abstract])
AND (Clinical Trial[ptyp])
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203筆
|
|
中間
|
※共同決策(核心詞彙 OR 次要詞彙)[Title/Abstract] AND臨床試驗 [publication type] OR [Mesh
terms] NOT排除文章類型[review/ guideline/ Editorial/ Meta-analysis/ Comment/ Validation
Studies] AND 限制年代[近5年內]
(shared decision making[Title/Abstract]
OR patient participation[Title/Abstract] OR patient
involvement[Title/Abstract]) AND (Clinical Trial[ptyp] OR Controlled Clinical
Trial[ptyp] OR Randomized Controlled Trial[ptyp] OR "Clinical Trials as
Topic"[mesh:noexp] OR "controlled clinical trials as
topic"[mesh:noexp] OR "randomized controlled trials as
topic"[mesh:noexp]) NOT (Review[ptyp] OR Editorial[ptyp] OR
Meta-analysis[ptyp] OR Comment[ptyp] OR Validation Studies[ptyp] OR "Guidelines
as Topic"[mesh:noexp]) AND ("2011/07/25"[PDat] :
"2016/07/22"[PDat])
|
198筆
|
|
※與上述差異在於增加臨床試驗核心詞彙與次要詞彙的使用。
(shared decision making[Title/Abstract]
OR patient participation[Title/Abstract] OR patient
involvement[Title/Abstract]) AND (clinical trial[Title/Abstract] OR
controlled clinical trial[Title/Abstract] OR randomized controlled
trial[Title/Abstract] OR Clinical Trial[ptyp] OR Controlled Clinical
Trial[ptyp] OR Randomized Controlled Trial[ptyp] OR "Clinical Trials as
Topic"[mesh:noexp] OR "controlled clinical trials as
topic"[mesh:noexp] OR "randomized controlled trials as
topic"[mesh:noexp]) NOT (Review[ptyp] OR Editorial[ptyp] OR
Meta-analysis[ptyp] OR Comment[ptyp] OR Validation Studies[ptyp] OR
"Guidelines as Topic"[mesh:noexp]) AND ("2011/07/25"[PDat]
: "2016/07/22"[PDat])
|
264筆
|
|
※與上述差異在於增加共同決策相關詞彙的使用及切截運用。
((shared
decision*[tiab] or sharing decision*[tiab] or informed decision*[tiab] or
informed choice*[tiab] or decision aid*[tiab]) or ((share*[ti] or
informed*[ti]) and (decision*[ti] or deciding*[ti] or choice*[ti])))AND
(clinical trial[Title/Abstract] OR controlled clinical trial[Title/Abstract]
OR randomized controlled trial[Title/Abstract] OR Clinical Trial[ptyp] OR
Controlled Clinical Trial[ptyp] OR Randomized Controlled Trial[ptyp] OR
"Clinical Trials as Topic"[mesh:noexp] OR "controlled clinical
trials as topic"[mesh:noexp] OR "randomized controlled trials as
topic"[mesh:noexp]) NOT (Review[ptyp] OR Editorial[ptyp] OR
Meta-analysis[ptyp] OR Comment[ptyp] OR Validation Studies[ptyp] OR
"Guidelines as Topic"[mesh:noexp]) AND
("2011/07/25"[PDat] : "2016/07/22"[PDat])
|
473筆
|
|
複雜
|
(shared decision*[tiab] OR sharing
decision*[tiab] OR informed decision*[tiab] OR informed choice*[tiab] OR
decision aid*[tiab] OR ((share*[ti] OR sharing*[ti] OR informed*[ti]) AND
(decision*[ti] OR deciding*[ti] OR choice*[ti])) OR decision making[mh:noexp]
or decision support techniques[mh:noexp] OR decision support systems,
clinical[mh] OR choice behaviour[mh:noexp] OR decision making*[tiab] OR
decision support*[tiab] OR choice behavior*[tiab] OR ((decision*[ti] OR
choice*[ti]) AND (making*[ti] OR support*[ti] OR behaviour*[ti])) OR patient
participation[mh] OR patient participation*[tiab] OR consumer
participation*[tiab] OR patient involvement*[tiab] OR consumer
involvement*[tiab] OR ((patient*[ti] OR consumer*[ti]) AND (involvement*[ti]
OR involving*[ti] OR participation*[ti] OR participating*[ti]))) AND (clinical
trial[Title/Abstract] OR controlled clinical trial[Title/Abstract] OR randomized
controlled trial[Title/Abstract] OR Clinical Trial[ptyp] OR Controlled
Clinical Trial[ptyp] OR Randomized Controlled Trial[ptyp] OR "Clinical
Trials as Topic"[mesh:noexp] OR "controlled clinical trials as
topic"[mesh:noexp] OR "randomized controlled trials as
topic"[mesh:noexp]) NOT (Review[ptyp] OR Editorial[ptyp] OR
Meta-analysis[ptyp] OR Comment[ptyp] OR Validation Studies[ptyp] OR
"Guidelines as Topic"[mesh:noexp]) AND
("2011/07/25"[PDat] : "2016/07/22"[PDat])
|
3815筆
|
|
※與上述差異在於增加臨床試驗相關詞彙的使用及切截運用。
(shared decision*[tiab] OR sharing
decision*[tiab] OR informed decision*[tiab] OR informed choice*[tiab] OR
decision aid*[tiab] OR ((share*[ti] OR sharing*[ti] OR informed*[ti]) AND (decision*[ti]
OR deciding*[ti] OR choice*[ti])) OR decision making[mh:noexp] or decision
support techniques[mh:noexp] OR decision support systems, clinical[mh] OR
choice behaviour[mh:noexp] OR decision making*[tiab] OR decision
support*[tiab] OR choice behavior*[tiab] OR ((decision*[ti] OR choice*[ti]) AND
(making*[ti] OR support*[ti] OR behaviour*[ti])) OR patient participation[mh]
OR patient participation*[tiab] OR consumer participation*[tiab] OR patient
involvement*[tiab] OR consumer involvement*[tiab] OR ((patient*[ti] OR
consumer*[ti]) AND (involvement*[ti] OR involving*[ti] OR participation*[ti] OR
participating*[ti])))AND (clinical trial[pt:noexp] OR randomized controlled
trial[pt] OR controlled clinical trial[pt] OR evaluation studies[pt] OR
comparative study[pt] OR Evaluation Studies as Topic[mh:noexp] OR program
evaluation[mh:noexp] OR random allocation[mh] OR random*[tiab] OR double
blind*[tiab] OR controlled trial*[tiab] OR clinical trial*[tiab] OR
pretest*[tiab] OR pre test*[tiab] OR posttest*[tiab] OR post test*[tiab] OR
prepost*[tiab] OR pre post*[tiab] OR controlled before*[tiab] OR "before
and after"[tiab] OR interrupted time*[tiab] OR time serie*[tiab] OR
intervention*[tiab]) NOT (Review[ptyp] OR Editorial[ptyp] OR
Meta-analysis[ptyp] OR Comment[ptyp] OR Validation Studies[ptyp] OR
"Guidelines as Topic"[mesh:noexp]) AND
("2011/07/25"[PDat] : "2016/07/22"[PDat])
|
15524筆
|
由複雜模式的檢索結果可推測，增加詞彙的使用量以及切截技巧的運用可以明顯增加回收筆數。但我們需考量的是，回收筆數是否越多越好?因為回收筆數越多，我們需要投入人工篩檢的時間也會越多，而此時間的投入是否值得?還是我們還有其它策略可以用來減少不必要的資料，進而增加精確率呢?這個問題很值得繼續深入思考!!
複雜檢索模式系統
為了增加檢索精確率以及維持一定量的回收率，我將複雜檢索模式再細分成三個階層:核心概念、次要概念與相關概念。
因此，此複雜檢索模式的初步架構如下:
然而，我們該如何將相關概念正確地進行階層分類呢?這讓我意識到:如果要正確分類必須先掌握共同決策模式的運作系統。
以下是我簡略建構的共同決策運作系統(仍待修訂):
在正式進行共同決策前，需考量患者的決策需求、患者及醫療人員的溝通態度、患者的健康識能以及對於決策主題的相關知識。
當患者相關知識不足時，則需事先提供決策協助，如:衛教(衛教素材、人員諮商)。衛教內容應呈現治療觀點、告知有利及有風險的訊息。
溝通中，醫療人員與患者必須提出自己的意見與想法，並澄清不明瞭的訊息。
溝通後，醫療人員與病患取得一定的決策共識。
Still 繼續思考....
