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Pawin NumthavajPawin NumthavajSection for Clinical Epidemiology and Biostatistics,Section for Clinical Epidemiology and Biostatistics,

Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityFaculty of Medicine Ramathibodi Hospital, Mahidol Universitypawin.num@mahidol.ac.thpawin.num@mahidol.ac.th

•• To answer patient’s questionsTo answer patient’s questions•• To answer ourselves/our To answer ourselves/our

colleaguescolleagues•• To gather information for a topic To gather information for a topic

reviewreview•• To produce extensive searching To produce extensive searching

before conducting another before conducting another research or systematic reviewresearch or systematic review

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How should I apply the results to patient care?

What are the results?

How valid is the evidence?

Find the best evidence

Define a structured question

Identify your problem

•• Background questionBackground question–– What is this disease?What is this disease?–– What are possible What are possible

therapeutic options?therapeutic options?•• Foreground questionForeground question

–– Is surgery better than Is surgery better than medication?medication?

–– What is the most What is the most accurate diagnostic accurate diagnostic investigation?investigation?

ForegroundForeground

BackgroundBackground

Experience with conditionExperience with condition

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•• DiagnosisDiagnosis•• PrognosisPrognosis•• TherapeuticTherapeutic•• PreventionPrevention•• HarmHarm

•• Forming Clinical Question (PICO)Forming Clinical Question (PICO)–– PatientPatient–– InterventionIntervention–– ComparisonComparison–– OutcomeOutcome–– (Time limit)(Time limit)

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•• Describe the patient/problem that you came into Describe the patient/problem that you came into contact with and are relevant to your practicecontact with and are relevant to your practice

•• Drug therapies, surgical treatment, counseling or Drug therapies, surgical treatment, counseling or factors that are differentfactors that are different

•• May also be diagnostic testsMay also be diagnostic tests

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•• Standard therapyStandard therapy•• May also be no intervention / placebo / May also be no intervention / placebo /

alternative treatment / exposure / another alternative treatment / exposure / another diagnostic testdiagnostic test

•• Outcome which is relevant to your Outcome which is relevant to your patient/problempatient/problem

•• May need to consider what exactly is important to May need to consider what exactly is important to you and your patient (Patientyou and your patient (Patient--oriented outcomes)oriented outcomes)

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Patient ProfilePatient Profile ¼Ù�»�ǪҠÍÒÂØ ¼Ù�»�ǪҠÍÒÂØ 40 40 »� ¾¹Ñ¡§Ò¹ºÃÔÉÑ·»� ¾¹Ñ¡§Ò¹ºÃÔÉÑ·Chief Complaint Chief Complaint ˹�ÒàºÕÂÇÁÒ Ë¹�ÒàºÕÂÇÁÒ 1 1 ÇѹÇѹPatient ProfilePatient Profile1 1 Çѹ¡�͹˹�ÒÁÒþÇѹ¡�͹˹�ÒÁÒþ. . µ×¹¢Ö¹Áҵ͹á»Ã§¿�¹ÊѧࡵÇ�ÒÁÕ¹ÒäËŵ׹¢Ö¹Áҵ͹á»Ã§¿�¹ÊѧࡵÇ�ÒÁÕ¹ÒäËŨҡÁØÁ»Ò¡ �Ò¹¢ÇÒµÅÍ´ ÃÙ�ÊÖ¡ãºË¹�Ò«Õ¡¢ÇÒäÁ�à·�ҡѺ¢�Ò§«�Ò ¨Ò¡ÁØÁ»Ò¡ �Ò¹¢ÇÒµÅÍ´ ÃÙ�ÊÖ¡ãºË¹�Ò«Õ¡¢ÇÒäÁ�à·�ҡѺ¢�Ò§«�Ò ÃÙ�ÊÖ¡ÁÕËÙ¢ÇҤѹ áÅÐÁÕ¼×¹¢Ö¹ �Ç áµ�äÁ�·ÃÒºÇ�Òà»�¹Áҵѧáµ�ÃÙ�ÊÖ¡ÁÕËÙ¢ÇҤѹ áÅÐÁÕ¼×¹¢Ö¹ �Ç áµ�äÁ�·ÃÒºÇ�Òà»�¹Áҵѧáµ�àÁ×Íã´àÁ×Íã´¡�͹˹�Ò¹ÕÍÒ¡Òû¡µÔ Õ ª�ǧ¹ÕäÁ�ä �ÁÕÍÒ¡ÒÃËÇÑ´ÁÒ¡�͹¡�͹˹�Ò¹ÕÍÒ¡Òû¡µÔ Õ ª�ǧ¹ÕäÁ�ä �ÁÕÍÒ¡ÒÃËÇÑ´ÁÒ¡�͹

Physical ExaminationPhysical ExaminationEarsEars RtRt: Multi stages vesicles at : Multi stages vesicles at

EAC, erythematous skin, dry EAC, erythematous skin, dry scales, cannot see TMscales, cannot see TMLt: NormalLt: Normal

RtRt Facial palsy, LMN, HouseFacial palsy, LMN, House--BrackmannBrackmann grade VI (Total grade VI (Total paralysis)paralysis)

Other cranial nerve exams and Other cranial nerve exams and neuroneuro exams are grossly intact, exams are grossly intact, other ENT exams normalother ENT exams normal

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•• Your Diagnosis: Herpes Zoster Your Diagnosis: Herpes Zoster OticusOticus (Ramsay Hunt (Ramsay Hunt Syndrome)Syndrome)

•• You want to know You want to know whether you should prescribe whether you should prescribe acyclovir, an antiviral agent, to this patientacyclovir, an antiviral agent, to this patient

P:P: In patient with a diagnosis of Herpes Zoster In patient with a diagnosis of Herpes Zoster OticusOticus

I:I: AcyclovirAcyclovirC:C: No treatment with acyclovirNo treatment with acyclovirO:O: Facial palsy recovery rateFacial palsy recovery rate

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•• 6868--yearyear--old woman with well controlled DM came to old woman with well controlled DM came to you to ask what she recently see an article about you to ask what she recently see an article about influenza vaccination. She ask for your advice.influenza vaccination. She ask for your advice.

•• PP•• II•• CC•• OO

•• 6868--yearyear--old woman with well controlled DM came to old woman with well controlled DM came to you to ask what she recently see an article about you to ask what she recently see an article about influenza vaccination. She ask for your advice.influenza vaccination. She ask for your advice.

•• PP Elderly woman with DiabetesElderly woman with Diabetes•• II Influenza vaccinationInfluenza vaccination•• CC No treatmentNo treatment•• OO Prevention of influenza (Incidence of influenza)Prevention of influenza (Incidence of influenza)

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•• 5050--yearyear--old man presented with chronic old man presented with chronic constipation. He has family history of CA Colon. He constipation. He has family history of CA Colon. He ask you for accuracy of screening CT scan.ask you for accuracy of screening CT scan.

•• PP•• II•• CC•• OO

•• 5050--yearyear--old man presented with chronic old man presented with chronic constipation. He has family history of CA Colon. He constipation. He has family history of CA Colon. He ask you for accuracy of screening CT scan.ask you for accuracy of screening CT scan.

•• PP Patient with chronic constipation, family Patient with chronic constipation, family HxHx of of CA ColonCA Colon

•• II Screening CT Screening CT ColonographyColonography•• CC EndoscopyEndoscopy•• OO Diagnosis of CA ColonDiagnosis of CA Colon

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•• ˹ѧÊ×Í˹ѧÊ×Í•• ¶ÒÁÍÒ¨ÒÃÂ� ¶ÒÁà¾×͹ ¶ÒÁÃØ�¹¾Õ¶ÒÁÍÒ¨ÒÃÂ� ¶ÒÁà¾×͹ ¶ÒÁÃØ�¹¾Õ•• °Ò¹¢�ÍÁÙÅ °Ò¹¢�ÍÁÙÅ EBM EBM àª�¹àª�¹ UpToDateUpToDate•• Google?Google?•• Google ScholarGoogle Scholar•• PubMedPubMed•• OvidOvid•• SCOPUSSCOPUS

Systems Synopses

Summaries Studies

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•• Regularly updated evidenceRegularly updated evidence•• Sometimes with guidance/recommendationsSometimes with guidance/recommendations

•• PIER: PIER: http://pier.acponline.org/index.htmlhttp://pier.acponline.org/index.html•• UpToDateUpToDate: : http://www.uptodate.com/ (Ramahttp://www.uptodate.com/ (Rama: :

library.ra.mahidol.ac.th/library.ra.mahidol.ac.th/utdutd/)/)

•• BMJ Clinical Evidence: BMJ Clinical Evidence: http://www.clinicalevidence.comhttp://www.clinicalevidence.com

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•• PrePre--appraised journals and databasesappraised journals and databases

•• ACP Journal club: ACP Journal club: http://www.acpjc.comhttp://www.acpjc.com•• InfoPOEMsInfoPOEMs: : http://www.infopoems.comhttp://www.infopoems.com•• EBM Journal (by BMJ): EBM Journal (by BMJ): http://ebm.bmj.com/http://ebm.bmj.com/

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•• Systematic reviews that are well conductedSystematic reviews that are well conducted

•• The Cochrane The Cochrane LLibrary: ibrary: http://www.cochrane.org/http://www.cochrane.org/

•• thecochranelibrary.comthecochranelibrary.com•• cochrane.orgcochrane.org

•• The The CCochrane Collaboration ochrane Collaboration founded with respected to founded with respected to Archie Cochrane (Archie Cochrane (19091909--19881988))

•• Database of Systematic Database of Systematic ReviewReview

Professor Archibald Leman Cochrane, CBE

FRCP FFCM, (1909 - 1988)

From “Cardiff University Library, Cochrane Archive, University Hospital Llandough”.

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•• Original primary studiesOriginal primary studies–– Randomized/Nonrandomized Controlled TrialsRandomized/Nonrandomized Controlled Trials–– Cohort studiesCohort studies–– CaseCase--control studiescontrol studies–– Cross sectional studiesCross sectional studies–– Case reportsCase reports

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Search Engine Database(s)PubMed MEDLINE

Ovid MEDLINE, EMBASE, …Scopus SCOPUS

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Search EngineSearch EngineSearch EngineSearch Engine ÃдѺ¤ÇÒÁ§�ÒÂÃдѺ¤ÇÒÁ§�ÒÂÃдѺ¤ÇÒÁ§�ÒÂÃдѺ¤ÇÒÁ§�Ò ¢�Í´Õ¢�Í´Õ¢�Í´Õ¢�Í´Õ----¢�ÍàÊÕÂÍ×¹¢�ÍàÊÕÂÍ×¹¢�ÍàÊÕÂÍ×¹¢�ÍàÊÕÂÍ×¹

Googlehttp://www.google.com

¢ÂÐàÂÍÐ

Google Scholarhttp://scholar.google.com

°Ò¹¢�ÍÁÙÅẺ»�´ äÁ�ÃÙ�Ç�Ò¨Ðà¨ÍÍÐäú�ҧ㹹ѹ

PubMedhttp://www.pubmed.gov

ÍÒ¨ËÅØ´ Journal á»Å¡æ

Scopushttp://www.scopus.com

ãª�ÂÒ¡ ÁÕ°Ò¹¢�ÍÁÙÅãË­� áµ�¤�¹ä �ÅÐàÍÕ´ àÊÕÂà§Ô¹

Ovidhttp://gateway.ovid.com

ãª�ÂÒ¡ °Ò¹¢�ÍÁÙÅËÅÒ°ҹµÒÁáµ�ÊÁѤà ¤�¹ä �ÅÐàÍÕ´ àÊÕÂà§Ô¹

•• Free search engineFree search engine•• Comprises of MEDLINE databaseComprises of MEDLINE database•• Maintain by US National Library of Medicine, Maintain by US National Library of Medicine,

National Institutes of HealthNational Institutes of Health•• First released in First released in 19961996•• Accessed from “http://www.pubmed.gov”Accessed from “http://www.pubmed.gov”

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•• 1946 1946 to present materialto present material•• 55,,600 600 journals in journals in 39 39 languageslanguages•• 22,,000000--44,,000 000 references added each dayreferences added each day•• Biomedicine and healthBiomedicine and health

•• ID (PubMed ID)ID (PubMed ID)•• AuthorAuthor•• TitleTitle•• AbstractAbstract•• Publication TypePublication Type•• Publication Date, TimePublication Date, Time•• Publication JournalPublication Journal•• “Keyword”“Keyword”

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•• Å�Í仵ÒÁ Å�Í仵ÒÁ QuestionQuestion•• ãÊ�Íѹ·ÕÊҤѭ µÒÁÅÒ ÑºãÊ�Íѹ·ÕÊҤѭ µÒÁÅÒ Ñº

P:P: In patient with a diagnosis of Herpes Zoster In patient with a diagnosis of Herpes Zoster OticusOticus

I:I: AcyclovirAcyclovirC:C: No treatment with acyclovirNo treatment with acyclovirO:O: Facial palsy recovery rateFacial palsy recovery rate

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•• Herpes Zoster Herpes Zoster OticusOticus–– Ramsay Hunt SyndromeRamsay Hunt Syndrome

•• AcyclovirAcyclovir

•• PubMed (MEDLINE database)PubMed (MEDLINE database)

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•• Publication TypesPublication Types

Study Type Notes

Observational Studies Cross-sectional, cohort, case-control, case series, case studyà»�¹¡ÒÃÈÖ¡ÉÒ·Õ¼Ù�ÇÔ¨ÑÂäÁ�ÊѧãË� Intervention

Clinical Trials Randomized controlled trialsNonrandomized controlled trials

Systemic Review & Meta analysis

#1 of evidenceÃǺÃÇÁ¡ÒÃÈÖ¡ÉÒµ�Ò§æ ÍÂ�Ò§¤Ãº¶�ǹ áÅÐà»�¹Ãкºáººá¼¹

(Traditional) Review For background questionsà¢Õ¹àËÁ×͹˹ѧÊ×Í ÍÒ¨äÁ�à»�¹áººá¼¹

Letter ¨´ËÁÒ¶֧ Editor

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•• àÂÍÐÁÒ¡ Í�Ò¹äÁ�äËÇàÂÍÐÁÒ¡ Í�Ò¹äÁ�äËÇ–– µ�ͧ µ�ͧ limitlimit

•• äÁ�à¨ÍàÅÂäÁ�à¨ÍàÅ–– ¾ÔÁ¾�¼Ô´¾ÔÁ¾�¼Ô´??–– µÑ§¤Ò¶ÒÁ¶Ù¡ËÃ×ÍÂѧµÑ§¤Ò¶ÒÁ¶Ù¡ËÃ×ÍÂѧ??

•• ãª� ãª� KeywordKeyword

–– Å´ Å´ Search TermSearch Term

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•• áµ�Åаҹ¢�ÍÁÙÅ ¨ÐÁÕ°Ò¹¤ÒÈѾ·� áµ�Åаҹ¢�ÍÁÙÅ ¨ÐÁÕ°Ò¹¤ÒÈѾ·� keyword keyword ÍÂÙ�ÍÂÙ�•• Paper Paper áµ�ÅÐÍѹ㹰ҹ¢�ÍÁÙÅ ¨ÐÁÕ¡ÒÃŧáµ�ÅÐÍѹ㹰ҹ¢�ÍÁÙÅ ¨ÐÁÕ¡ÒÃŧ keyword keyword ¢Í§ ¢Í§

paper paper ¹Ñ¹æ áÁ�äÁ�ä �ÁդҹѹÍÂÙ�ã¹ ¹Ñ¹æ áÁ�äÁ�ä �ÁդҹѹÍÂÙ�ã¹ paper paper àÅ¡µÒÁàÅ¡µÒÁ•• àÃÒ Ö§ä �¼ÅÅѾ �ÁÒ¡¡Ç�Ò µÃ§¡Ç�ÒàÃÒ Ö§ä �¼ÅÅѾ �ÁÒ¡¡Ç�Ò µÃ§¡Ç�Ò•• MEDLINE: MESH TermsMEDLINE: MESH Terms

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•• Use MESH termsUse MESH terms•• Use search operators “AND” “OR” “NOT” and ()Use search operators “AND” “OR” “NOT” and ()•• Use limits to filter unwanted resultsUse limits to filter unwanted results•• Create a ‘My NCBI’ account (free) for saving your Create a ‘My NCBI’ account (free) for saving your

collection of articles for later usecollection of articles for later use–– CollectionCollection–– Saved searchSaved search

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1.1. MESHMESH2.2. Search OperatorsSearch Operators3.3. LimitsLimits4.4. ClipboardClipboard5.5. Save searchesSave searches6.6. Advanced searchAdvanced search7.7. Citation matcherCitation matcher8.8. Clinical QueriesClinical Queries9.9. Retrieval of full text paperRetrieval of full text paper

•• Medical Subject HeadingMedical Subject Heading•• “Tag” of subject in database“Tag” of subject in database

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•• Truncated search term (wildcards)Truncated search term (wildcards)–– fflavor* = flavorlavor* = flavoringing + flavor+ flavoreded + flavor+ flavorss–– synerchisynerchi* = synerchi* = synerchiaeae + synerchi+ synerchiaa

•• Combining search terms Combining search terms (Always Capitalized (Always Capitalized (Always Capitalized (Always Capitalized (Always Capitalized (Always Capitalized (Always Capitalized (Always Capitalized Booleans!)Booleans!)Booleans!)Booleans!)Booleans!)Booleans!)Booleans!)Booleans!)–– ANDAND–– OROR–– NOTNOT–– ( )( )

•• Filter unwanted resultsFilter unwanted results–– Age: infants, adults, …Age: infants, adults, …–– Article types: original studies, RCTs, MetaArticle types: original studies, RCTs, Meta--analysis, …analysis, …–– Article languageArticle language–– Done on humanDone on human–– Recently publishedRecently published

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•• Stored items for later reviewStored items for later review•• Max Max 500 500 itemsitems•• 8 8 hours before deletedhours before deleted•• Send to ‘collection’ instead if you want to Send to ‘collection’ instead if you want to

permanently storedpermanently stored•• (Need (Need My NCBI accountMy NCBI account))

•• Save for later updatesSave for later updates•• Useful when you’re doing systematic reviewUseful when you’re doing systematic review•• Can also automatically eCan also automatically e--mail updatesmail updates

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•• Search in command lineSearch in command line--basedbased•• Use # for referring to previous searchesUse # for referring to previous searches•• Operators: AND, OR, NOT, and ()Operators: AND, OR, NOT, and ()

•• Locate an article when you know the author Locate an article when you know the author name / title / journal name / name / title / journal name / volvol / pages/ pages

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•• Answer clinical questionsAnswer clinical questions–– EtiologyEtiology–– DiagnosisDiagnosis–– TherapyTherapy–– PrognosisPrognosis–– Clinical Prediction GuidesClinical Prediction Guides

•• Search filterSearch filter

Category Optimized ForSensitive/

SpecificPubMed Equivalent

therapy

sensitive/broad 99%/70%

((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical

trials[MeSH Terms] OR clinical trial[Publication Type] OR

random*[Title/Abstract] OR random allocation[MeSH Terms] OR

therapeutic use[MeSH Subheading])

specific/narrow 93%/97%

(randomized controlled trial[Publication Type] OR

(randomized[Title/Abstract] AND controlled[Title/Abstract] AND

trial[Title/Abstract]))

diagnosissensitive/broad 98%/74%

(sensitiv*[Title/Abstract] OR sensitivity and specificity[MeSH

Terms] OR diagnos*[Title/Abstract] OR diagnosis[MeSH:noexp] OR

diagnostic * [MeSH:noexp] OR diagnosis,differential[MeSH:noexp]

OR diagnosis[Subheading:noexp])

specific/narrow 64%/98% (specificity[Title/Abstract])

etiology

sensitive/broad 93%/63%

(risk*[Title/Abstract] OR risk*[MeSH:noexp] OR risk

*[MeSH:noexp] OR cohort studies[MeSH Terms] OR group*[Text

Word])

specific/narrow 51%/95%

((relative[Title/Abstract] AND risk*[Title/Abstract]) OR (relative

risk[Text Word]) OR risks[Text Word] OR cohort

studies[MeSH:noexp] OR (cohort[Title/Abstract] AND

stud*[Title/Abstract]))

prognosis

sensitive/broad 90%/80%

(incidence[MeSH:noexp] OR mortality[MeSH Terms] OR follow up

studies[MeSH:noexp] OR prognos*[Text Word] OR predict*[Text

Word] OR course*[Text Word])

(prognos*[Title/Abstract] OR (first[Title/Abstract] AND

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Patient ProfilePatient Profile Ë­Ô§ä·ÂâÊ´ ÍÒÂØ Ë­Ô§ä·ÂâÊ´ ÍÒÂØ 30 30 »�»�Chief Complaint Chief Complaint ¤Ñ´á¹�¹¨ÁÙ¡ ¹ÒÁÙ¡äËÅŧ¤Í ¤Ñ´á¹�¹¨ÁÙ¡ ¹ÒÁÙ¡äËÅŧ¤Í 3 3 ÇѹÇѹPatient ProfilePatient Profile3 3 Çѹ¡�͹˹�ÒÁÒ Ã¾Çѹ¡�͹˹�ÒÁÒ Ã¾. . ÁÕä¢� ÍÒ¡ÒäѴá¹�¹¨ÁÙ¡ �Ò¹«�Ò ¹ÒÁÙ¡ÁÕä¢� ÍÒ¡ÒäѴá¹�¹¨ÁÙ¡ �Ò¹«�Ò ¹ÒÁÙ¡¢�¹ÊÕàËÅ×ͧ»ÃÔÁÒ³ÁÒ¡ ºÒ§¤ÃѧÁÕ¹ÒÁÙ¡äËÅŧ¤ÍáÅÐÁÕÍÒ¡ÒÃäÍ¢�¹ÊÕàËÅ×ͧ»ÃÔÁÒ³ÁÒ¡ ºÒ§¤ÃѧÁÕ¹ÒÁÙ¡äËÅŧ¤ÍáÅÐÁÕÍÒ¡ÒÃäÍÃ�ÇÁ �ÇÂÃ�ÇÁ �ÇÂ

Physical ExaminationPhysical ExaminationNose: Nose: congested Lt nasal congested Lt nasal turbinatesturbinates with purulent with purulent

dischargedischargeOral cavity:Oral cavity: Postnasal drip LtPostnasal drip LtSinus tender Lt sideSinus tender Lt side

Diagnosis: Diagnosis: Acute sinusitisAcute sinusitis·�ҹʧÊÑÂÇ�Ò ¡ÒÃãË� ·�ҹʧÊÑÂÇ�Ò ¡ÒÃãË� intranasal steroid intranasal steroid ÁÕ»ÃÐ⪹�㹡ÒúÃÃà·ÒÁÕ»ÃÐ⪹�㹡ÒúÃÃà·ÒÍÒ¡ÒÃËÃ×ÍäÁ�ÍÒ¡ÒÃËÃ×ÍäÁ�

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•• PP•• II•• CC•• OO

•• P:P: Adult presented with acute sinusitisAdult presented with acute sinusitis•• I:I: Intranasal steroidIntranasal steroid•• C:C: No treatmentNo treatment•• O:O: Sinonasal symptomSinonasal symptom

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•• Í�Ò¹·Ø¡ Í�Ò¹·Ø¡ Paper Paper áÅ�ÇÁҹѧ¾Ô¨ÒóÒáÅ�ÇÁҹѧ¾Ô¨Òóҕ• àÅ×͡੾ÒкҧàÅ×͡੾Òкҧ Paper Paper ¨Ò¡ ¨Ò¡ Title & AbstractTitle & Abstract

–– Answer my questionAnswer my question–– Higher level of evidenceHigher level of evidence–– Publish in credible journalPublish in credible journal–– Publish not long agoPublish not long ago

BMJ 2001;323:334.1

Systematic Review & MetaSystematic Review & Meta--analysisanalysis

Randomized Controlled TrialsRandomized Controlled Trials

NonNon--randomisedrandomised intervention studiesintervention studies

Observational studiesObservational studies

NonNon--experimental studiesexperimental studies

Expert opinionExpert opinion

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•• Top wellTop well--known general known general journalsjournals–– NEJM (New England NEJM (New England

Journal of Medicine)Journal of Medicine)–– JAMA (Journal of JAMA (Journal of

American Medical American Medical Association)Association)

–– BMJ (British Medical BMJ (British Medical Journal)Journal)

–– The LancetThe Lancet–– Annals of Internal Annals of Internal

MedicineMedicine

•• Impact factorImpact factor–– ISI Web of ScienceISI Web of Science–– http://library.ra.mahidol.ac.th/http://library.ra.mahidol.ac.th/

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•• ¨Ò¹Ç¹ ¨Ò¹Ç¹ Citation Citation ·Ñ§ËÁ´ã¹»�¹Õ·ÕÁÕµ�Í ·Ñ§ËÁ´ã¹»�¹Õ·ÕÁÕµ�Í Journal Journal ã¹ ã¹ 2 2 »�·Õ»�·Õ¼�Ò¹ÁÒ¼�Ò¹ÁÒ Į Į ¨Ò¹Ç¹ ¨Ò¹Ç¹ Articles Articles ·Ñ§ËÁ´·ÕµÕ¾ÔÁ¾�ã¹ ·Ñ§ËÁ´·ÕµÕ¾ÔÁ¾�ã¹ 2 2 »�·Õ¼�Ò¹ÁÒ»�·Õ¼�Ò¹ÁÒ

•• ÂÔ§ÁÒ¡ ËÁÒ¶֧ ÁÕ¤¹Í�Ò§ ÂÔ§ÁÒ¡ ËÁÒ¶֧ ÁÕ¤¹Í�Ò§ Paper Paper ¨Ò¡ã¹ ¨Ò¡ã¹ Journal Journal ¹Ñ¹æ ¹Ñ¹æ àÂÍÐ áÊ´§Ç�Òà»�¹ àÂÍÐ áÊ´§Ç�Òà»�¹ Journal Journal ·ÕÁÕ¤¹Í�Ò¹àÂÍзÕÁÕ¤¹Í�Ò¹àÂÍÐ

•• áÅÐáÅÐÍÒ¨ÍÒ¨ËÁÒ¶֧à»�¹ ËÁÒ¶֧à»�¹ Journal Journal ·ÕÁդسÀÒ¾ Õ¡Ç�Ò·ÕÁդسÀÒ¾ Õ¡Ç�Ò

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•• Ë�ͧÊÁØ´Ë�ͧÊÁØ´•• ÅÔ§¤�ã¹°Ò¹¢�ÍÁÙÅâ´ÂµÃ§ÅÔ§¤�ã¹°Ò¹¢�ÍÁÙÅâ´ÂµÃ§: PubMed : PubMed ¡´ ¡´ LinkOutLinkOut �Ò¹Å�Ò§�Ò¹Å�Ò§

•• ¡ÒõÒÁ ¡ÒõÒÁ Full Paper Full Paper ¨Ò¡ÍÔ¹à·ÍÃ�๵¹Í¡ÁËԴŨҡÍÔ¹à·ÍÃ�๵¹Í¡ÁËÔ´Å–– EjournalEjournal Proxy: Proxy: http://ejournal.mahidol.ac.thhttp://ejournal.mahidol.ac.th

¤Ù�Á×Í ¤Ù�Á×Í http://www.li.mahidol.ac.th/ehttp://www.li.mahidol.ac.th/e--resource/pdf/ejournal.pdfresource/pdf/ejournal.pdf

–– MahidolMahidol VPN: VPN: http://vpn.mahidol.ac.thhttp://vpn.mahidol.ac.th¤Ù�Á×Í ¤Ù�Á×Í http://www.muit.mahidol.ac.th/pdf/remote_access/VPN.pdfhttp://www.muit.mahidol.ac.th/pdf/remote_access/VPN.pdf

•• ÍÂ�ÒÅ×ÁÍÂ�ÒÅ×Á ¶�ÒËÒäÁ�à¨ÍÅͧ¶ÒÁºÃóÒÃÑ¡É�ä �¶�ÒËÒäÁ�à¨ÍÅͧ¶ÒÁºÃóÒÃÑ¡É�ä �

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