臨床問題的最佳解答 UpToDate Introductions… 陳玉嬋製作

UpToDate 的任務 確認並建立臨床醫學上的重要問題 Primary Care –家庭醫學, 婦產科, 兒科等 包含13種專科(2008年) 徵募該領域的專家回答問題 隨時更新最新的醫療數據及治療方式 能迅速簡易地找到資料 利用圖表,解決臨床許多觀念難以用文字敘述清楚表達

UpToDate: 內容廣泛度 與 即時性 廣泛度 -250,000筆來自medline的參考書目 即時性 各醫學領域近3000位專家撰寫評論文獻 7,100種主題 超過75,000頁的全文 100,000篇以上的摘要 22,000張以上圖片 -250,000筆來自medline的參考書目 藥物資料庫 病患衛教 即時性 每4個月更新內容

調查顯示：使用過UpToDate的醫師 認為UpToDate能在30秒內快速回答他們3/4的問題 因此能使醫師…. ‧提供較好的治療方式 ‧更佳的治療決策 ‧更精確的診斷病情

UpToDate的檢索方法 至圖書館首頁http://www.cych.org.tw/cych/lib1/index.asp →點選資料庫 →至資料庫名稱 →進入UptoDate 鎖院內IP, 請輸入各人帳號密碼或用遠端桌面進入

選擇Accept進入

鍵入keyword→按GO 範例: beta blockers Search on beta blockers 鍵入keyword→按GO 範例: beta blockers

檢索結果有7項符合,點選其中最符合的一項,此處選擇Beta blockers 5 search terms match “beta blockers” 檢索結果有7項符合,點選其中最符合的一項,此處選擇Beta blockers

共有242篇文章符合,可選擇Narrow Search Result縮小檢索範圍 250 titles match “Beta Blockers” You can now quickly narrow your search by clicking on the “Narrow Search Results” button 共有242篇文章符合,可選擇Narrow Search Result縮小檢索範圍

鍵入另一個keyword, 範例:depression You can narrow your search by putting in a secondary search term, such as “depression” 鍵入另一個keyword, 範例:depression

選擇最適合的主題, 此處選擇Depression Choose topic most relevant to the search, here “Major side effects of beta blockers” is the most relevant 選擇最適合的主題, 此處選擇Depression

Click on the name of the author to show his or her affiliation. Each topic review will also show you when it was last updated. On the left had side of each topic review is an outline. This is a good way to navigate through the topic review. 結果縮減為10篇Beta blockers與Depression相關性的文章,此處選擇Most Relevant Topics中的 Major side effects of beta blockers

左側為文章大綱,右側為文章內容 每篇文章起始註明資料更新時間 Using the outline, you can quickly locate the answer. We clicked on adverse non-cardiac affects due to beta blockers and then clicked on the section depression, fatigue and sexual dysfunction. Which will take you to the answer to your question. “The best available data on this issue come from a systematic review of randomized trials, which found no increased risk of depression with beta blocker therapy, and only small increases in fatigue and sexual dysfunction [29].” 左側為文章大綱,右側為文章內容 每篇文章起始註明資料更新時間

點選左側大綱 Adverse Effects Unrelated to Beta Blockade Clicking on reference number 29, will take you to the Medline abstract supporting that recommendation. 利用左側大綱, 可以快速連結至相關內容 點選左側大綱 Adverse Effects Unrelated to Beta Blockade

點選Drug interactions內的(show table) By clicking on the highlighted drug name, this will bring you to the integrated Lexi-Comp drug database. Another way to access the drug database is to put the name of the drug in the search field. 點選Drug interactions內的(show table) 或左側大綱的GRAPHICS 的TABLES 可連結至 Integrated Lexi-Comp 藥品資料庫

UpToDate includes over 10,000 graphics and photos UpToDate includes over 10,000 graphics and photos. Simply click under the graphics heading in the table of contents. The graphics can be easily exported into Power Point by right clicking on the graphic and saving it to your computer. .UpTodate包含了10,000張以上的圖表,按右鍵即可列印或儲存

點選reference有highlight的部分可看摘要 選擇左側outline的Reference, 可直接連結至參考文獻部分 點選reference有highlight的部分可看摘要

上方黑色區域可選擇New Search檢索新的主題 At the top right of the topic review you can choose to either print a topic and/or email the topic to a colleague. In the top navigation bar is a link to the table of contents… 文章右上角可選擇列印或寄到信箱 上方黑色區域可選擇New Search檢索新的主題 或進入Tables of Contents

List of Authors – 3000位醫學專家名單 .The table of contents includes: The “What’s New” section which points out highlights of what’s been added to the latest release. Patient Information can be printed and given to patients (in development) List of Authors – shows 3,000 contributing authors. Clicking on the specialty will show you the authors in that specialty Table of Contents除了包含各項醫學主題外,還包含了: What’s New:包含各醫學專科的最新發展 Patient Information:病患衛教 List of Authors – 3000位醫學專家名單

欲檢索病患衛教,請至New Search, 鍵入patient information

共有287篇關於Patint information之文章, 可直接點選進入閱覽,或利用Narrow Search Result縮小範圍

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