Answering Clinical Questions at the Point of Care 鄭如雅
Outline About UpToDate Evidence Grading How to search Q & A
About UpToDate You don’t need more information You need the right information
Synthesize current literature and best practices, then make specific clinical recommendations
Evidence is derived from a number of Sources Journals: 396 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
Quick Facts about UpToDate Topic reviews Patient information Drug Information Guideline Written by Physicians for Physicians
Quick Facts about UpToDate 3,600+ world-renowned physician authors (international) 7,100+ clinical topics in 13 specialties13 specialties 4,300+ unique drug entries in adult, pediatrics, international, and natural drugs (Lexi-Comp) 75,000+ pages of text 22,000+ graphics (figure, table, echocardiogram, histology, radiograph, movie…etc) 250,000+ references (Medline) Updated every 4 months
Evidence Grading
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 AHigh Quality Evidence Consistent evidence from randomized trials, or overwhelming evidence of some other form Grade BModerate Quality Evidence Evidence from randomized trials with important limitations, or very strong evidence of some other form Grade CLow Quality Evidence Evidence from observational studies, unsystematic clinical observations, or from randomized trials with serious flaws
How to search
Access to UpToDate No username and password required Unlimited and simultaneous access No remote access
To Access UpToDate Go to Just ‘Accept’ the license agreement and you are brought to the search page, ready for your use; within a few seconds
How to use UpToDate based on a Clinical Scenario How effective is long-term warfarin at preventing recurrent pulmonary embolism?
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?
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Q & A
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Drug Information - Lexi-Comp A Comprehensive Drug Database –Drug interactions –Pediatric drugs –Natural products –International drugs –Patient advisory leaflets
Guidelines ATS : American Thoracic Society ASN : The American Society of Nephrology The Endocrine Society ACR : American College of Rheumatology AGA : American Gastroenterological Association SGIM : Society of General Internal Medicine ACOG : The American College of Obstetricians and Gynecologists AAP : American Academy of Pediatrics American Academy of Nurse Practitioners
Specialties Cardiovascular Medicine Endocrinology & Diabetes Family Medicine Gastroenterology & Hepatology Hematology Infectious Diseases Internal Medicine Nephrology & Hypertension Obstetrics, Gynecology & Women’s Health Oncology Pediatrics Pulmonary Medicine, Critical Care Medicine & Sleep Medicine Rheumatology
In Development Neurology Allergy & Immunology Emergency Medicine Topics are still available in these fields