Answering Clinical Questions at the Point of Care Cecilia Chang Tel : Mobile :

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

3 瞎子摸象的故事 訊息全方位對病患的重要性

Bud Rose with Taiwan Team 4

UpToDate  UpToDate is a Clinical decision support system that helps clinicians throughout the world provide the best patient care  We use the best available current evidence to answer clinical questions, quickly and easily at the point of care  This saves clinicians time, improves patient outcomes and lowers health care costs 5

Evidence is derived from a number of sources……………… including but not limited  Journals: 460+ peer reviewed journals  Databases:  MEDLINE, The Cochrane Database, Clinical Evidence and ACP Journal Club  Guidelines  Clinical trials  FDA, CDC, NIH  Proceedings  Clinical experiences and observations 6

The editorial process 7 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.....

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Quick Facts about UpToDate  Topic reviews  Patient Information  Drug Information 11 Written by Physicians for Physicians

Quick Facts about UpToDate  4,800+ world-renowned physician authors (international)  9,000+ clinical topic in 17 specialties  5,000+ unique drug entries in adult, pediatrics, international and natural drugs (Lexi-Comp)  23,000+ graphics  328,000+ references (Medline)  Updated every 4 months (March, July, November) 12

Specialties  Adult and Pediatric Emergency Medicine  Adult Primary Care & Internal Medicine  Allergy and Immunology  Cardiovascular Medicine  Endocrinology & Diabetes  Family Medicine  Gastroenterology & Hepatology  Hospital Medicine {NEW}  Hematology  Infectious Diseases  Nephrology & Hypertension  Neurology  Obstetrics, Gynecology & Women’s Health  Oncology  Pediatrics  Pulmonary, Critical Care & Sleep Medicine  Rheumatology 13

Specialties in Development  Dermatology  Psychiatry  Surgery 14

Evidence Grading  In 2001, we began a collaboration with Gordon Guyatt, a world leader in EBM, and his colleagues in the international GRADE collaborative to implement a grading system for recommendations  UpToDate grades specific treatment and screening recommendations 15

Evidence Grading 16 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

17 Synthesizes the medical literature, incorporates the latest evidence, and provides specific recommendations for patient care 將醫學的文獻組織合併成為最終的實證, 並提供 明確的臨床經驗治療建議在病患處置照護上

How to Search 18

使用時登入 個人成功入口帳密 使用時登入 個人成功入口帳密 醫圖簡訊介紹 IE, FireFox, Netscape 設定校外連線方式 校外連線設定教學檔 醫圖簡訊介紹 IE, FireFox, Netscape 設定校外連線方式 校外連線設定教學檔

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How to use UpToDate based on a Clinical scenario A 37 year-old woman,G1P1,and she just had normal spontaneous delivery at GA 39+2 wks 2 days ago.During her regular prenatal care,the laboratory data including urinary analysis were all within normal limit. She is breastfeeding now. As consistent hypertension with blood pressures of / mmHg was noted during the first 48 hours postpartum,you would like to prescribe an antihypertensive medication, which one should use prescribe? -Sample from: Dr. Liang- 21

How to use UpToDate based on a Clinical scenario Trial Key word : Postpartum hypertension 22

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

24 UpToDate - Key Development Purpose Save your Cost !! Save your Time !! Answer Clinical Question !! 使得醫療專家可以在搜尋與判讀的過程中節省時間, 將主 要的心力集中在研讀更重要的治療主題資訊上

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Q & A 27

28 Thank you for your attention !!