Transcript UpToDate

Answering Clinical Questions at the
Point of Care
Cecilia Chang
[email protected]
Tel : 04-22930887
Mobile : 0930380588
Outline
 About UpToDate
 Evidence Grading
 How to Search
 Q&A
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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
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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
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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
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Quick Facts about UpToDate
 Topic reviews
 Patient Information
 Drug Information
Written by Physicians for Physicians
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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)
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Specialties
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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
Specialties in Development
 Dermatology
 Psychiatry
 Surgery
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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
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Evidence Grading
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
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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
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
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How to Search
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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
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Thinking about….
 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?
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About UpToDate
You don’t need more information
You need the right information
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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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Q&A
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Thank you for your attention !!
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