Transcript Answering Clinical Questions at the Point of Care Cecilia Chang

Answering Clinical Questions at the
Point of Care
Cecilia Chang
[email protected]
Outline
• About UpToDate
• Evidence Grading
• How to Search
• Q&A
About UpToDate
You don’t need more information
You need the right information
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
The editorial process
Leading and Evidence Based Literature and Resources
Read ..... Analyze ..... Summarize .....
..... Synthesize .....
..... Expert Comments .....
..... Expert Opinion .....
..... Recommendations .....
..... Grade the Evidence .....
..... Editorial Peer Review .....
UpToDate Topic Review
Quick Facts about UpToDate
• Topic reviews
• Patient Information
• Drug Information
Written by Physicians for Physicians
Quick Facts about UpToDate
 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
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
In Development
• Dermatology
• Psychiatry
• Surgery
Evidence Grading
Evidence Grading – UTD GRADE
RECOMMENDATION GRADES
Strong Recommendation
Grade 1
Grade 2
“We recommend…”
Weaker Recommendation
“We suggest…”
Benefits clearly outweigh the risks and
burdens (or vice versa) for most, if not
all, patients
Benefits and risks closely balanced
and/or uncertain
EVIDENCE GRADES
Grade A
Grade B
Grade C
High Quality Evidence
Consistent evidence from randomized
trials, or overwhelming evidence of
some other form
Moderate Quality Evidence
Evidence from randomized trials with
important limitations, or very strong
evidence of some other form
Low Quality Evidence
Evidence from observational studies,
unsystematic clinical observations, or
from randomized trials with serious
flaws
How to Search
How to Search
• New Search
– search  display result  output
• Others
– Evidence grading
• RECOMMENDATIONS
– Calculators
– Drug interactions
– ECG Test
– Movies
How to use UpToDate based on a Clinical Scenario
• Question:
You are seeing a 9 month old girl with a history of fever
>39ºC (102.2°F) for two days. She has no underlying
medical problems and no exposure to ill contacts.
However, she only received immunizations at two and
four months of age. On physical examination, she is well
appearing and has no source of fever. Should you
perform any laboratory tests?
• Key words: Febrile infant
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