WFU

2023/11/05

[亞大實證AI] 情緒分析


Part 1: 
Paul Ekman 於 1972年提出的基本情感
喜悅(Joy)
憂傷(Sadness)
憤怒(Anger)
恐懼(Fear)
驚訝(Surprise)
厭惡(Disgust)




Part 2:
分析大堂課情境中「黃醫師」的情緒狀態。要思考「prompt」怎麼寫、怎麼輸出…

###
「333,二樓門診治療室,333,二樓門診治療室…」 在一個平凡的下午,眾多病人在院內等待看診,醫療團隊在各自的崗位上工作時,突然間,一個警報聲響起,院內緊急急救小組隨即馬上啟動。 緊急的CPR流程在第一時間就展開,相關小組成員很快到達了現場,現場的 leader 王醫師很熟練的下著指令:壓胸、Ambu給氣、準備給予 bosmin 1 amp。門診醫師黃醫師被通知,也趕緊過來現場,目前在急救病人平常是黃醫師在追蹤的,這次因為病人的血色素只有 5.5 ,所以他讓病人來治療室輸血。 輸血的流程才在準備時,病人開始覺得胸口緊緊的不舒服,過了十分鐘後,意識開始不清楚,很快的人就叫不醒。治療室的護理師發現異況後隨即量病人的脈搏,但量不到,便緊急通知總機廣播333。 黃醫師到急救現場時,詢問現場是否有皮質類固醇的針劑藥物,黃醫師表示若現場有相關藥物的針劑,馬上給病人打一劑類固醇。緊救現場的leader王醫師雖然自己心中沒有很贊同緊救當下給予類固醇,因為目前使用類固醇在心跳停止 (cardiac arrest) 時並沒有共識,便問黃醫師為何想用此藥物。 黃醫師表示,雖然類固醇對預後似乎有爭議,但有些報告有做出急救後恢復自發性循環 (return of spontaneous circulation, ROSC) 的比率比較高,即使可能只有一點點幫助,他還是想試看看。
###

2023/11/04

[亞大實證AI] CEBM Q2-Q5 原始內文 與 題目拆解

主題拆解示範 prompt for Q2 part 1

這是 CEBM checklist for SR Q2 的內容
我想要拆解 Q2 為更細項的小題目,目標是 3~7 題。拆解的小題目要符合原始 Q2 的內容/評估順序/原則。
###
CEBM for SR: Q2
Is it unlikely that important, relevant studies were missed?

What is best? 
The starting point for a comprehensive search for all relevant studies is the major bibliographic databases (eg Medline, Cochrane, EMBASE, etc) but should also include a search of reference lists from relevant studies and contact with experts, particularly to inquire about unpublished studies. The search should not be limited to English language only. The search strategy should include both MESH terms and text words.

Where do I find the information?
The Methods section should describe the search strategy, including the terms used, in some detail. The Results section will outline the number of titles and abstracts reviewed, the number of fulltext studies retrieved, and the number of studies excluded together with the reasons for exclusion. This information may be presented in a figure or flow chart.

In this paper:
[ ] Yes
[ ] No
[ ] Unclear

Comment: ###


主題拆解示範 prompt for Q2 part 2

請將這些拆解的內容與目標,寫成適合用來評讀文獻的 prompt。各小題要各自評估(回答Yes/No/Unclear),回答時要引用原始文獻字句,最後總結要對原始問題做最後評估。最後的輸出要用 table。

請將此 prompt 輸出於 code block 內


CEBM checklist for SR: Q2

CEBM for SR: Q2
Is it unlikely that important, relevant studies were missed?

What is best? 
The starting point for a comprehensive search for all relevant studies is the major bibliographic databases (eg Medline, Cochrane, EMBASE, etc) but should also include a search of reference lists from relevant studies and contact with experts, particularly to inquire about unpublished studies. The search should not be limited to English language only. The search strategy should include both MESH terms and text words.

Where do I find the information?
The Methods section should describe the search strategy, including the terms used, in some detail. The Results section will outline the number of titles and abstracts reviewed, the number of fulltext studies retrieved, and the number of studies excluded together with the reasons for exclusion. This information may be presented in a figure or flow chart.

In this paper:
[ ] Yes
[ ] No
[ ] Unclear

Comment: 


CEBM checklist for SR: Q3

CEBM for SR: Q3  
Were the criteria used to select articles for inclusion appropriate?

What is best?  
The inclusion or exclusion of studies in a systematic review should be clearly defined a priori. The eligibility criteria should specify the patients, interventions or exposures, and outcomes of interest. In many cases, the type of study design will also be a key component of the eligibility criteria.

Where do I find the information?  
The Methods section should describe in detail the inclusion and exclusion criteria, which typically includes the study design.

In this paper:  
[ ] Yes  
[ ] No  
[ ] Unclear  

Comment:


CEBM checklist for SR: Q4

CEBM for SR: Q4  
Were the included studies sufficiently valid for the type of question asked?

What is best?  
The article should describe how the quality of each study was assessed using predetermined quality criteria appropriate to the type of clinical question (e.g., randomization, blinding, and completeness of follow-up).

Where do I find the information?  
The Methods section should describe the assessment of quality and the criteria used. The Results section should provide information on the quality of the individual studies.

In this paper:  
[ ] Yes  
[ ] No  
[ ] Unclear  

Comment:


CEBM checklist for SR: Q5

CEBM for SR: Q5
Were the results similar from study to study?

What is best?  
Ideally, the results of the different studies should be similar or homogeneous. If heterogeneity exists the authors may estimate whether the differences are significant (chi-square test). Possible reasons for the heterogeneity should be explored.

Where do I find the information?  
The Results section should state whether the results are heterogeneous and discuss possible reasons. The forest plot should show the results of the chi-square test for heterogeneity and discuss reasons for heterogeneity, if present.

In this paper:  
[ ] Yes  
[ ] No  
[ ] Unclear  

Comment:


[亞大實證AI] PubMed 標題篩選 PICO

PubMed 標題篩選 PICO 示範

我的PICO:「P: CPR case / I: steroid / O: ROSC rate」
以下是 pubmed 搜尋的文章標題列表,請判斷這些標題和「我的PICO」兩者的相似度,相似度請用1~10分來評估。
結果輸出請用表格,表格欄位: 標題 | 符合P | 符合I | 符合O | 相似度分數 | PMID連結。符合的項目請輸出「●」,不符合請空白。PMID欄位請呈現 {PMID}(https://pubmed.ncbi.nlm.nih.gov/{PMID})

###
1: Ge L, Li Y, Zhou J, Zhao X, Chen X, Wang W, Li Z, Ge P, Cui L. Effect of
different treatment protocols on in vitro fertilisation/intracytoplasmic sperm
injection (IVF/ICSI) outcomes in adenomyosis women: a systematic review and
meta-analysis. BMJ Open. 2024 Jul 18;14(7):e077025. doi:
10.1136/bmjopen-2023-077025. PMID: 39025820; PMCID: PMC11261672.

2: Zhou FW, Liu C, Li DZ, Zhang Y, Zhou FC. Efficacy and safety of
corticosteroid therapy in patients with cardiac arrest: A meta-analysis of
randomized controlled trials. Am J Emerg Med. 2024 Jan;75:111-118. doi:
10.1016/j.ajem.2023.10.031. Epub 2023 Oct 30. PMID: 37939521.

3: Kong SY, Jung E, Hwang SS, Ro YS, Shin SD, Cha KC, Hwang SO. Circulating
Vitamin D Level and Risk of Sudden Cardiac Death and Cardiovascular Mortality: A
Dose-Response Meta-Analysis of Prospective Studies. J Korean Med Sci. 2023 Aug
21;38(33):e260. doi: 10.3346/jkms.2023.38.e260. PMID: 37605499; PMCID:
PMC10442497.

4: Hameed I, Malik S, Nusrat K, Siddiqui OM, Khan MO, Mahmood S, Memon A, Usman
MS, Siddiqi TJ. Effect of vitamin D on postoperative atrial fibrillation in
patients who underwent coronary artery bypass grafting: A systematic review and
meta-analysis. J Cardiol. 2023 Sep;82(3):220-224. doi:
10.1016/j.jjcc.2023.05.007. Epub 2023 May 24. PMID: 37236436.

5: Glujovsky D, Lattes K, Miguens M, Pesce R, Ciapponi A. Personalized embryo
transfer guided by endometrial receptivity analysis: a systematic review with
meta-analysis. Hum Reprod. 2023 Jul 5;38(7):1305-1317. doi:
10.1093/humrep/dead098. PMID: 37203432.

6: Yan W, Dong W, Song X, Zhou W, Chen Z. Therapeutic effects of vasopressin on
cardiac arrest: a systematic review and meta-analysis. BMJ Open. 2023 Apr
17;13(4):e065061. doi: 10.1136/bmjopen-2022-065061. PMID: 37068900; PMCID:
PMC10111914.

7: Jiang Y, Wang L, Shen H, Wang B, Wu J, Hu K, Wang Y, Ma B, Zhang X. The
effect of progesterone supplementation for luteal phase support in natural cycle
frozen embryo transfer: a systematic review and meta-analysis based on
randomized controlled trials. Fertil Steril. 2023 Apr;119(4):597-605. doi:
10.1016/j.fertnstert.2022.12.035. Epub 2022 Dec 24. PMID: 36574915.

8: Elbadawi A, Tan BE, Assaf Y, Elzeneini M, Baig B, Hamed M, Elgendy IY, Mamas
M. Meta-Analysis of Efficacy of Vasopressin During Cardiopulmonary
Resuscitation. Am J Cardiol. 2022 Oct 15;181:122-129. doi:
10.1016/j.amjcard.2022.06.042. Epub 2022 Aug 5. PMID: 35934565.

9: Abdelazeem B, Awad AK, Manasrah N, Elbadawy MA, Ahmad S, Savarapu P, Abbas
KS, Kunadi A. The Effect of Vasopressin and Methylprednisolone on Return of
Spontaneous Circulation in Patients with In-Hospital Cardiac Arrest: A
Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J
Cardiovasc Drugs. 2022 Sep;22(5):523-533. doi: 10.1007/s40256-022-00522-z. Epub
2022 Mar 22. PMID: 35314927.

10: Holmberg MJ, Granfeldt A, Mentzelopoulos SD, Andersen LW. Vasopressin and
glucocorticoids for in-hospital cardiac arrest: A systematic review and meta-
analysis of individual participant data. Resuscitation. 2022 Feb;171:48-56. doi:
10.1016/j.resuscitation.2021.12.030. Epub 2022 Jan 3. Erratum in: Resuscitation.
2023 Sep;190:109929. doi: 10.1016/j.resuscitation.2023.109929. PMID: 34990764.

11: Sahebnasagh A, Nejad PS, Salehi-Abargouei A, Dehghani MH, Saghafi F. A
characterization of cortisol level and adrenal reservation in human
cardiopulmonary arrest: systematic review and meta-analysis. Syst Rev. 2021 Oct
8;10(1):266. doi: 10.1186/s13643-021-01820-4. PMID: 34625103; PMCID: PMC8499554.

12: Mizrachi Y, Horowitz E, Ganer Herman H, Farhi J, Raziel A, Weissman A.
Should women receive luteal support following natural cycle frozen embryo
transfer? A systematic review and meta-analysis. Hum Reprod Update. 2021 Jun
22;27(4):643-650. doi: 10.1093/humupd/dmab011. PMID: 33829269.

13: Shah K, Mitra AR. Use of Corticosteroids in Cardiac Arrest-A Systematic
Review and Meta-Analysis. Crit Care Med. 2021 Jun 1;49(6):e642-e650. doi:
10.1097/CCM.0000000000004941. PMID: 33729721.

14: Glujovsky D, Pesce R, Sueldo C, Quinteiro Retamar AM, Hart RJ, Ciapponi A.
Endometrial preparation for women undergoing embryo transfer with frozen embryos
or embryos derived from donor oocytes. Cochrane Database Syst Rev. 2020 Oct
28;10(10):CD006359. doi: 10.1002/14651858.CD006359.pub3. PMID: 33112418; PMCID:
PMC8094620.

15: Cozzolino M, Busnelli A, Pellegrini L, Riviello E, Vitagliano A. How vitamin
D level influences in vitro fertilization outcomes: results of a systematic
review and meta-analysis. Fertil Steril. 2020 Nov;114(5):1014-1025. doi:
10.1016/j.fertnstert.2020.05.040. Epub 2020 Oct 1. PMID: 33012554.

16: Liu B, Zhang Q, Li C. Steroid use after cardiac arrest is associated with
favourable outcomes: a systematic review and meta-analysis. J Int Med Res. 2020
May;48(5):300060520921670. doi: 10.1177/0300060520921670. PMID: 32400236; PMCID:
PMC7223213.
###

[亞大實證AI] 情境文字

提取問題

以下是臨床情境。
請寫出三個背景問題(background question)
及三個前景問題(foreground question)
###
{Scene}
###


大堂課情境

「333,二樓門診治療室,333,二樓門診治療室…」
    
在一個平凡的下午,眾多病人在院內等待看診,醫療團隊在各自的崗位上工作時,突然間,一個警報聲響起,院內緊急急救小組隨即馬上啟動。
緊急的CPR流程在第一時間就展開,相關小組成員很快到達了現場,現場的 leader 王醫師很熟練的下著指令:壓胸、Ambu給氣、準備給予 bosmin 1 amp。門診醫師黃醫師被通知,也趕緊過來現場,目前在急救病人平常是黃醫師在追蹤的,這次因為病人的血色素只有 5.5 ,所以他讓病人來治療室輸血。

輸血的流程才在準備時,病人開始覺得胸口緊緊的不舒服,過了十分鐘後,意識開始不清楚,很快的人就叫不醒。治療室的護理師發現異況後隨即量病人的脈搏,但量不到,便緊急通知總機廣播333。

黃醫師到急救現場時,詢問現場是否有皮質類固醇的針劑藥物,黃醫師表示若現場有相關藥物的針劑,馬上給病人打一劑類固醇。緊救現場的leader王醫師雖然自己心中沒有很贊同緊救當下給予類固醇,因為目前使用類固醇在心跳停止 (cardiac arrest) 時並沒有共識,便問黃醫師為何想用此藥物。

黃醫師表示,雖然類固醇對預後似乎有爭議,但有些報告有做出急救後恢復自發性循環 (return of spontaneous circulation, ROSC) 的比率比較高,即使可能只有一點點幫助,他還是想試看看。

正在學實證的你,你的意見如何呢?


小組情境(1) - UTI版本1

彭醫師是脊椎外科醫師,他最近接手了一位名叫王小姐的病人,王小姐為了腰痛所苦已久,在做過詳細檢查後,與醫療團隊討論,準備要住院手術。
    
王小姐日前住院後,彭醫師的團隊也為王小進行了手術。手術很成功、術後四小時王小姐人就很清醒了。

然而,在術後的隔天早上,王小姐開始感到不舒服,她覺得下腹一直會有異物感,因此提出了想要拔掉尿管的需求。彭醫師心中擔心腰椎手術後對膀胱功能的影響仍未知,以往他的習慣是術後第二天才會移除病人的尿管,目前才術後第一天時王小姐就提出想拔尿管的要求,他在想有沒有兩全其美的辦法。

彭醫師告訴病房的吳護理師,請她幫王小姐做「尿管訓練」,彭醫師想知道王小姐的膀胱是否會有「感覺」,有想尿的感覺他才會讓王小姐提早一天拔尿管。

今天因為病房白班護理師臨時有人新冠肺炎確診,病房目前正缺人手。在支援的人力尚未到達以前,吳護理師現在要顧12個病人,聽到彭醫師說要做「尿管訓練」,心中有點不高興。吳護理師之前聽學姊說,做「尿管訓練」會增加泌尿道感染的風險,但她不知道這是不是真的。
正在學實證的你,你能解決吳護理師的疑問嗎?


小組情境(2) - UTI版本2

陳醫師是內科醫師,他最近接手了一位75歲的李伯伯。李伯伯因為社區性肺炎而需要住院治療,他已經在病房住了十天。剛住院時因為解尿解不出來,李伯伯就被放置了尿管,但剛住院的這幾天精神體力一直沒有恢復,尿管就一直被放著。
    
陳醫師發現李伯伯用了抗生素一週後,精神比較好了,也開始下床走路。陳醫師考慮要拔除他的導尿管,因為陳醫師怕使用導尿管容易導致泌尿道感染,但他希望先評估李伯伯的膀胱是否能正常排尿,才決定是否要拔除導尿管。

陳醫師告訴林護理師,請她幫李先生做「膀胱訓練」,測試他的膀胱是否有正常的感覺和控制能力。護理長在旁邊聽到了,便和陳醫師討論,雖然目前院內對於移除尿管沒有一套標準流程,但直接拔尿管而不做膀胱訓練也是另一種選擇,問陳醫師是否有考慮直接移除尿管呢?陳醫師聽了心中並不高興,為什麼要來質疑我的處置……

正在學實證的你,你能解決雙方認知上的落差嗎?


小組情境(3) - SSI版本1

西邊某間醫院的手術室,目前是使用 povidone-iodine 做為術前及術中皮膚消毒的方式,但近期因為 Surgical Site Infections (SSI) 監測指標超過閥值而被醫品部指示,要提出檢討方案。
    
在經過幾次開會討論後,手術室仍然都沒有提出很好的對策,有的主管認為要更改皮膚的消毒方式,有的主管認為是手術房動線的問題,每個人發表的意見都不一致,因此目前仍處於仍在收集各方意見後,擇期再開始討論。

你是此手術室的護理組長,此時你被交派一項任務,任務的內容是去收集 chlorhexidine 的製品中的各種不同濃度(0.5%, 2.0%, 4.0%等),和 povidone-iodine 相比預防 SSI 的成效如何?更進一步,能否估算減少 SSI 比率可帶來的可能成本效益?

你被交派這個任務後,感到很頭大,不知道要怎麼開始找資料,於是報名了參加實證中心所舉辦的工作坊課程……


小組情境(4) - SSI版本4

南邊某間醫院手術室,目前是術前及術中皮膚消毒的方式有兩種方式可以選擇:0.5% chlorhexidine 及 povidone-iodine 消毒夜,手術時要選擇哪一種消毒方式是看執行手術的醫師的喜好,目前院方並沒有強制規定標準流程。
    
一天,王小姐住院要準備開脊椎手術,術前她就表示她自己對 povidone-iodine 會過敏,因此詢問是否有其它的消毒方式。主刀的彭醫師向王小姐說明,會採用另一種 chlorhexidine 的皮膚消毒方式。王小姐隨即再詢問,她自己在網路上有看到使用越高濃度的 chlorhexidine ,預防術後感染的效果越好,因為自己是開脊椎的刀,若有傷口感染怕會影響到神經系統,因此她想問說是否能使用較高濃度的 chlorhexidine 來消毒。

彭醫師向王小姐說明,目前院內只有單一種濃度的 chlorhexidine ,並沒有其它選擇。彭醫師在聽完病人的疑問後,心中有兩個疑問,(1) chlorhexidine 及 povidone-iodine 相比,哪一個 SSI 發生率較低; (2) 越高濃度的 chlorhexidine 真的效果越好嗎?其成本效益划算嗎?會不會有更多的副作用呢?

正在學實證的你,你能解決彭醫師的疑問嗎?