Answering Clinical Questions at the Point of Care

Presentation on theme: "Answering Clinical Questions at the Point of Care"— Presentation transcript:

1 Answering Clinical Questions at the Point of Care
鄭如雅

2 Outline About UpToDate Evidence Grading How to Search Q & A

3 You don’t need more information You need the right information
About UpToDate You don’t need more information You need the right information

4 Synthesizes the medical literature, incorporates the latest evidence, and provides specific recommendations for patient care Our authors write original content for UTD. In creating topics, they review all of the available information. 我們的作者會 review 所有相關的資訊 They include background information, relevant new studies, and practical recommendations for patient care. 包括背景資料, 新的研究 和 實用的醫囑 When they incorporate new studies in topics, they place the information in the context of existing knowledge 當有新的研究寫入文章時, 作者會將相關資訊一同寫入 So that you understand how this applies to your patients 如此一來使用者可以了解如何應用在病人身上 You are accessing the best information to confirm a diagnosis, formulate a treatment plan, review drug information, and stay current 我們所提供的資料可以讓您確認診斷, 規劃治療的計劃, 查看藥物資訊 和 持續更新

5 Evidence is derived from a number of Sources
Journals: 430+ peer reviewed journals Databases: MEDLINE, The Cochrane Database, Clinical Evidence and ACP Journal Club Guidelines Clinical trials FDA, CDC, NIH Proceedings Clinical experience and observations Including but not limited

6 Read ..... Analyze ..... Summarize .....
The editorial process Leading and Evidence Based Literature and Resources UpToDate Topic Review Read Analyze Summarize ..... ..... Synthesize ..... ..... Expert Comments ..... ..... Expert Opinion ..... ..... Recommendations ..... ..... Grade the Evidence ..... ..... Editorial Peer Review .....

7 Quick Facts about UpToDate
Topic reviews Patient Information Drug Information Written by Physicians for Physicians

8 Quick Facts about UpToDate
4,055 world-renowned physician authors (international) 7,775 clinical topics in 15 specialties 4,619 unique drug entries in adult, pediatrics, international, and natural drugs (Lexi-Comp) 24,637 graphics 262,209 references (Medline) Updated every 4 months (March, July, November) 4055 authors 34 deputy editors 280 section editors 300 peer reviewers

9 Specialties Adult and Pediatric Emergency Medicine
{ new specialty - November 2009} Adult Primary Care & Internal Medicine Cardiovascular Medicine Endocrinology & Diabetes Family Medicine Gastroenterology & Hepatology Hematology Infectious Diseases Nephrology & Hypertension Neurology { new specialty - March 2009} Obstetrics , Gynecology & Women’s Health Oncology Pediatrics Pulmonary, Critical Care & Sleep Medicine Rheumatology

10 In Development Allergy and Immunology Dermatology Psychiatry Surgery

11 Evidence Grading 證據等級的說明

12 Evidence Grading – UTD GRADE
RECOMMENDATION GRADES Grade 1 Strong Recommendation Benefits clearly outweigh the risks and burdens (or vice versa) for most, if not all, patients “We recommend…” Grade 2 Weaker Recommendation Benefits and risks closely balanced and/or uncertain “We suggest…” EVIDENCE GRADES Grade A High Quality Evidence Consistent evidence from randomized trials, or overwhelming evidence of some other form Grade B Moderate Quality Evidence Evidence from randomized trials with important limitations, or very strong evidence of some other form Grade C Low Quality Evidence Evidence from observational studies, unsystematic clinical observations, or from randomized trials with serious flaws 證據等級是用 UTD Grade 用數字和英文做表 數字代表醫囑的強度 英文代表證據的品質 在文中會出現的組合是 1A, 1B, 1C, 2A, 2B, 2C 也不用特別記憶, 在文章中會有超連結連至證據等級說明的視窗

13 How to Search

14 How to Search New Search search  display result  output Others
Evidence grading RECOMMENDATIONS Calculators Drug interactions ECG Test Movies 所謂的 google style 輸入關鍵字, 可以輸入病名, 藥名, 症狀, 可以輸入一個關鍵字或多個關鍵字 病名可以縮寫, 全稱, 會做spelling check 藥名可以輸入, 學名, brand name, 但無法做 spelling check 症狀也會做 spelling check 其他的功能 證據等級會放在 Recommendations的段落裡, 而Recommendations不是每一篇都有, 若有的話會放在Reference參考書目的上一個 藥物交互作用, 可用 (1)aspirin, (2)grape seed, (3)irresa 做示範, 一次輸一種藥名 ECG 自我測試, 若要示範ECG test,直接輸入 ECG test, 第二, 三, 四篇結果才是 ECG test Calculator 試算表, 目前有81種, 要查的話, 要先輸入 Calculator 就會列出所有的試算表 Movies 影像檔, 可用 cadiomegaly 心室肥大做示範, 輸入後選一篇就有 Movies, 列在graphic之下

15 To Access UpToDate Please go to library homepage
Just “Accept” the license agreement and you are brought to the search page, ready for your use; within a few seconds 請從圖書館的網頁進入

16 How to use UpToDate based on a Clinical Scenario
A 50 year old woman is obese (BMI=32) and has hypertension. She has not achieved weight loss despite counseling for diet and lifestyle changes. What is the best medication for pharmacologic management of her obesity Keyword : obesity drugs

17 How to use UpToDate based on a Clinical Scenario
A 58 year-old postmenopausal woman is experiencing stress urinary incontinence that is interfering with her quality of life. She is not having hot flashes, but she has heard that estrogen therapy is very effective for urinary incontinence. What advice do you give her? Keyword : estrogen for urinary incontinence in postmenopausal women 這題可留著自我練習

18 Q & A

19 Thank you for your attention