1. Answering Clinical Questions at the Point of Care 鄭如雅 ccheng@uptodate.com

2. Outline About UpToDate Evidence Grading How to search Q & A

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

4. UpToDate can SAVE you time Doctors do not have enough time to search for all answers Doctors are overloaded by the huge volume of (new) information (every day 800 new publications in Medline)

5. Synthesize current literature and best practices, then make specific clinical recommendations

6. Evidence is derived from a number of Sources Journals: 377 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

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

8. Drug Information - Lexi-Comp A Comprehensive Drug Database –Drug interactions –Pediatric drugs –Natural products –International drugs –Patient advisory leaflets

9. 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

10. Quick Facts about UpToDate 3,663 world-renowned physician authors (international) 7,309 clinical topics in 13 specialties13 specialties 4,327 unique drug entries in adult, pediatrics, international, and natural drugs (Lexi-Comp) 75,832 pages of text 23,220 graphics (figure, table, echocardiogram, histology, radiograph, movie…etc) 254,555 references (Medline) Updated every 4 months (March, July, November)

11. Specialties Adult Primary Care & Internal Medicine Cardiovascular Medicine Endocrinology & Diabetes Family Medicine Gastroenterology & Hepatology Hematology Infectious Diseases Nephrology & Hypertension Obstetrics, Gynecology & Women’s Health Oncology Pediatrics Pulmonary Medicine, Critical Care Medicine & Sleep Medicine Rheumatology

12. In Development Neurology Allergy & Immunology Emergency Medicine Topics are still available in these fields

13. Evidence Grading

14. 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

15. How to search

16. Access to UpToDate No username and password required Unlimited and simultaneous access No remote access

17. To Access UpToDate Go to http://www.uptodate.com/online Just ‘Accept’ the license agreement and you are brought to the search page, ready for your use; within a few seconds

18. How to use UpToDate based on a Clinical Scenario How effective is long-term warfarin at preventing recurrent pulmonary embolism?

19. 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?

20. The Net Result of Using UpToDate: 96-99% said UpToDate makes them more comfortable with their decisions 97-100% said it helps them provide the best care for their patients 88-99% said it makes them a better doctor >95% said it faster or much faster than other means of finding information and, as a result, UpToDate save time

21. Q & A

22. Thank you for your attention