By Miss Joey Moon (何宗慧) TEL: 02-87860601#803 E-mail: jher@ebsco.com

大綱 何為Dynamed Dynamed 內容 - 資料來源 - 內容架構 Dynamed編輯群 七大步驟與證據等級 Dynamed特色 與其他實證資料庫比較 結論

DynaMed 是什麼… DynaMed is a clinical reference tool designed for use by physicians and other health care professionals at the point-of-care. (重點、快速、正確) DynaMed is proven to answer most clinical questions in primary care. 1 1 (Ann Fam Med 2005;3:507) DynaMed is a clinical reference tool created by physicians for physicians and other health care professionals for use primarily at the point-of-care. With clinically-organized summaries for nearly 3,000 topics, DynaMed is the only evidence-based reference shown to answer most clinical questions during practice.

DynaMed內容-資訊來源 審視逾500種的頂尖醫學期刊 、重要醫學二次文獻、 實證醫學文獻資源、藥物資訊資源、臨床診療指引 BMC Clinical Pharmacology Cochrane Database of Systematic Reviews Annals of Family Medicine American Family Physician http://www.dynamicmedical.com/sources.php

提供3,000個臨床的主題性標題 同時可查詢的正在開發中的標題（in process） Offer clinically-organized summaries for nearly 3,000 topics DynaMed Topics範例 一般與異常的疾病或是症狀（Chest Pain） 特定議題（例:Avian Influenza, SARS, H1N1） 正在發展的最新研究或範疇（例: 阿斯匹靈可降低心臟病及女性癌症罹患率） 使用DynaMed的醫生或是專業人員的建議 同時可查詢的正在開發中的標題（in process） 新標題可能來自於DynaMed內部討團隊討論、讀者建議或是 其他可能的優秀作者。 http://www.dynamicmedical.com/organization.php

內容結構基於容易使用、臨床實際應用所開發 Content is organized in an easy-to-use, clinically-practical format. General Information (including ICD-9 & ICD-10 codes) 概述 Causes & Risk Factors 致病因素及危險因子 Complications & Associated Conditions 併發症與相關症狀 History 病史 Physical 理學資訊 Diagnosis 診斷 Prognosis 預後 Treatment 治療 Prevention & Screening 預防與篩選 References (including reviews & guidelines) 參考文獻 Patient Information 給予病患的相關資訊 Acknowledgement http://www.dynamicmedical.com/organization.php

Evidence-Based Information 真正符合實證基礎的資訊 Evidence-Based Information 實證基礎七大步驟的創設團隊 Brian Alper：DynaMed創立者與總編輯 David Tovey：BMJ Knowledge Editor主編、Clinical Evidence主編 Jon Brassey：TRIP Database 編輯 Bruce Arroll：奧克蘭大學 醫療照護與業務系 系主任 透明 Transparent 持續 Consistent 完整 Complete http://www.dynamicmedical.com/content.php

7 Steps of Evidence-Based Information 1. 以系統性方法鑑別所有的實證案例並分類 Step 1: Systematic identification of evidence 2. 以系統性方法從鑑定過的實證案例選擇出各類別最佳實證案例 Step 2: Systematic selection of the best available evidence from that identified 3. 以系統性方法同時以最嚴謹的態度評價所選出的最佳實證案例 Step 3: Systematic evaluation of the selected evidence (critical appraisal) 4. 對於選出的實證案例提出準確的結論與品質鑑定 Step 4: Accurate summarization of the evidence and its quality 5. 基於這些所選擇的實證案例結論作出總結 Step 5: Making conclusions dependent on the evidence 6. 結合各個類別的實證總結成為一個完整的最後結論 Step 6: Synthesizing multiple bits of evidence for overall conclusions 7. 當有更好的實證案例出現時立即修正最後結論 Step 7: Changing the conclusions when new evidence alters the best available evidence

Patient-oriented outcomes 提供以病患為導向的資訊 Patient-oriented outcomes 提供容易判讀的實證等級-美國家庭醫學分類 Level of Evidence: Level 1 (likely reliable) Evidence: randomized trials with at least 80% follow up, inception cohort studies for prognostic information, systematic review of Level 1 evidence reports. Level 2 (mid-level) Evidence: randomized trials with less than 80% follow up, non-randomized comparison studies, and diagnostic studies without adequate reference standards. Level 3 (lacking direct) Evidence: case series, case reports, expert opinion and conclusions extrapolated indirectly form scientific studies. 提供容易判讀的建議等級 Recommendations: Grade A recommendation (consistent high-quality evidence) Grade B recommendation (inconsistent or limited evidence) Grade C recommendation (lacking direct evidence) http://www.dynamicmedical.com/levels.php

Dynamed 特色: 每日更新 Really Up to Date

Dynamed 特色: 清楚指示證據等級與來源出處 Level of Evidence labels Reference Source

Reference Source:連結至Pubmed或全文電子期刊

Dynamed 特色:與Dynamed編輯群交流

增強搜尋功能，降低查詢時間 結合Search 與 Browse 功能，只需一個按鍵即可檢索主題與全文。 自動完成功能，關鍵字詞輸入後檢索欄位即會顯示最接近字與加快檢索速度。

根據使用者的建議，更新介面，使查詢更有效率 快速連結 Rx、Tx、Dx Rx : Dosage and Administration for Drugs 用藥資訊 Tx : Treatment 治療 Dx : Diagnosis 診斷

5S EBM Resources (非關證據強弱! 1.systems 連結個別病歷的臨床知識與支援決策系統 整合證據提供特定臨床問題之概述與建議 ACP PIER BMJ Clinical Evidence DynaMed MDconsult UpToDate 2.summaries 對單篇研究或回顧性文獻作摘要與評述 ACP Journal Club, Evidence-Based Medicine (PubMed, Ovid Medline) 3.synopses 特定臨床問題的系統性評論文獻 Cochrane Database of Systematic Reviews Database of Abstracts of Reviews of Effects (PubMed, Ovid Medline): Systematic Reviews 4.syntheses 原始文獻 (PubMed, Ovid Medline, CINAHL, EMBASE Cochrane CENTRAL, Google Scholar CEPS中文電子期刊, 中文期刊篇目索引) 5.studies Model from: Haynes, R. B. (2006). Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based health care decisions. ACP Journal Club, 145(3), A8.

多元化的使用方式 透過個人電腦經由網際網路使用（院內與院外連線） 透過PDA手機，同時支援： Palm OS, Windows Mobile, Blackberry i-Phone , i Pod Touch http://www.dynamicmedical.com/technical.php

實際線上操作

Dynamed使用路徑 一

DynaMed主畫面 3,000+ topic by alphabetical

輸入關鍵字

瀏覽主題

選取所欲瀏覽之主題

提供關於主題之12個結構項目

1. 概述

2. 致病因素及危險因子

參考文獻之連結

參考文獻

3. 併發症與併發症狀

4. 疾病的歷史資訊

5. 理學資訊

6. 診斷

DynaMed連結EBSCOhost資料庫之全文

顯示全文

7. 預診

8. 治療

建議等級

9. 預防與檢驗

證據等級

10. 參考文獻 Including reviews and guidelines

顯示Guideline之全文連結

開啟Guideline之全文連結

11. 給予病患的相關資訊

13. 意見交換

Thanks for your attention!!! 報告人：何宗慧 TEL: 02-87860601#803 E-mail: jher@ebsco.com