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

2. How is UpToDate different from other resources I use? UpToDate is unlike any other clinical resource: More comprehensive = over 60,000 pages of original, peer- reviewed text. Unique format and search capability = access answers to clinical questions in seconds. Continually updated by a staff of physician editors in conjunction with nearly 3,000 authors = entire content is always current. The expert faculty synthesizes and summarizes the latest evidence = provides specific, practical recommendations for diagnosis and treatment. Combines the broad coverage of adult primary care with the in-depth information written by, and for, sub-specialists. You get the equivalent of a full library for internists, all in one service.

3. Specialist Level UpToDate covers 13 completed medical specialties and subspecialties written at the specialist level. UpToDate is complete in the following 13 specialties: Adult Primary Care & Internal Medicine Cardiovascular Medicine Endocrinology & Diabetes Family Practice Gastroenterology & Hepatology Hematology Infectious Diseases Nephrology & Hypertension Obstetrics & Gynecology Oncology Pediatrics Pulmonary & Critical Care Medicine Rheumatology

4. In Development Allergy & Immunology Neurology Topics are still available in these fields

5. How often is the service updated? UpToDate is updated daily in our offices. For enterprise or site subscribers, a new updated version is released once every 4 months on-line.

6. How does UpToDate stay current? The creation of new and updated topic reviews is a rigorous and ongoing process. Here’s a look at how the process works: Our physician editors begin the update process by reading and reviewing, in aggregate, an average of 330 journals every month. These journals include those in their own area of expertise, in related fields in internal medicine, basic science and general medical journals. By keeping current on all the reported research, the UpToDate editors ensure that you get the full picture of the current thinking on a particular condition. Having surveyed the newly published research, the UpToDate editors determine, with the help of editorial boards, professional societies, and colleagues, what new information to include in the program for the next release. The guiding principle is whether the material under consideration is well supported by data and would be useful in a clinical setting. If a medical finding is deemed important, it is then added to the relevant topic review(s) after approval by an internal peer review and by the authors.

7. Lexi-Comp (2004 released) A Comprehensive Drug Database –Drug interactions –Pediatric drugs –Natural products –International drugs –Patient advisory leaflets

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

9. To Access UpToDate Go to library homepage (a user name and password is not needed) Just ‘Accept’ the license agreement and you are brought to the Search page, ready for your use; within a few seconds

10. How to use UpToDate based on a Clinical Scenario You have a patient who becomes depressed while taking a beta blocker. The question from your patient or yourself may be: “What is the likelihood that the beta blocker is contributing to his depression?”

11. 在 Enter search term 處將檢索字彙輸入

12. 輸入 “ beta blocker”, 點選 “Go” ( 這裡可以輸入病名, 藥名等等 )

13. 檢索結果與 “beta blocker” 有關的有 7 個, 點選最相關的一個 “Beta blockers”

14. 在 “Beta Blocker” 之下共有 228 個 titles. 若您覺得數量太多, 可以用左上角之 “Narrow Search Results” 的功能鍵, 將檢索結果再精確化

15. 點選 “Narrow Search Results” 之後, 出現 “Enter a secondary search term”, 輸入 “depress” 或點選右邊的 “Side effects”

16. 點選 “ Depression”

17. 檢索結果會依據相關性 (relevant) 高低做一排序, 並會註明那一個相關性最高 點選相關性最高的 : “Major side effects on beta blockers”

18. 點選作者, 會出現作者的基本資料 每一篇文章都會註明什麼時候被撰寫更新的 在左手邊則為文章的大綱, 可以依據您的需求直接點選閱讀, 可以在這裡直接找到您的問題答案

20. 點選 [34], 為第 34 筆參考書目, 會顯示出這筆參考書目的書目資料加上摘要

21. 點選藥名

22. 點選藥名, 會另開一個視窗, 開啟藥學資料庫 Lexi-Comp.藥學資料庫 Lexi-Comp 提供另外一個方式去檢索藥學相關資料.

23. 點選 “Graphics” 下的選項, 會另開一視窗

24. 在 UpToDate 中包含了超過 10,000 個圖表. 可以直接利用滑鼠右鍵來做圖檔的輸出

25. 在文章的右上方, 提供 print 或 email

26. 在檢索主頁, 也可以選擇 “Table of Contents”, 除了 13 大主題外, 還特別列出 : What’s New Patient Information List of Authors

27. 每次更新的版本, 在 What’s new 中, 一定都會標示出 13 大主題

28. 以 “What’s new in Family Medicine” 為例, 從左手邊的大網, 可以看到在 family medicine 中有多少的新發展

29. Patient information 則提供最新發展狀況的衛教資料

30. 點選 Patient information 下的任何一個主題, 都可以閱讀到對疾病的說明和治療

31. 所提供的資訊, 為很好的衛教資料.

32. 我們也提供線上求助指引和使用導覽, 請多加利用 “Help” 功能鍵

33. 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

34. Thank you for your attention