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

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

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 3

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 4

The editorial process 5 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.....

Quick Facts about UpToDate  Topic reviews  Patient Information  Drug Information 6 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) 7

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 8

Specialties in Development  Dermatology  Psychiatry  Surgery 9

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 10

Evidence Grading 11 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

12 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 13

How to use UpToDate based on a Clinical scenario Case practice: What are the treatment options for a 69 year-old woman with inadequately controlled diabetes (A1C 8.1 percent)despite lifestyle intervention and metformin therapy? Key word: Type 2 DM management 14

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 Is the diagnosis accurate? If accurate, does the patient need treatment?  If treatment is instituted, what is the best initial drug and optimal dose?  What are the next best choices if disease recurs or if the patient is unresponsive?  At what point is the patient considered to have resistant disease? What are the best therapeutic options then? Thinking about…. 16

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

18 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

Q & A 19

20 Thank you for your attention !!