1. Answering Clinical Questions at the Point of Care Cecilia Chang cchang@uptodate.com Tel : 04-22930887 Mobile : 0930380588

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

3. 3 瞎子摸象的故事 ----- 訊息全方位對病患的重要性

4. Bud Rose with Taiwan Team 4

5. 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

6. Evidence is derived from a number of sources……………… including but not limited  Journals: 440+ 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

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

12. Quick Facts about UpToDate  4,400+ world-renowned physician authors (international)  8,000+ clinical topic in 16 specialties  4,600+ unique drug entries in adult, pediatrics, international and natural drugs (Lexi-Comp)  21,000+ graphics  385,000+ references (Medline)  Updated every 4 months (March, July, November) 12

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

14. Specialties in Development  Dermatology  Psychiatry  Surgery 14

15. 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

16. 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. How to Search  New Search  Search  display results  topic review  output  Others  Evidence grading  Grading Tutorial  RECOMMENDATIONS  Calculators  Drug Interactions  ECG test  Movies 17

18. 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 drug 18

19. 19 Feedback

20. - 歡迎並感謝給予任何意見 -Email 內容直接至美國主編群，並由主編群直接回覆

21. 21 About UpToDate You don’t need more information You need the right information

22. 22 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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25. Q & A 25

26. 26 Thank you for your attention !!