Transcript UpToDate Presentaion

Answering Clinical Questions at the Point of Care
鄭如雅
[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
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)
Synthesize current literature and best
practices, then make specific clinical
recommendations
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
Quick Facts about UpToDate
• Topic reviews
• Patient information
• Drug Information
• Guideline
Written by Physicians for Physicians
Drug Information - Lexi-Comp
• A Comprehensive Drug Database
– Drug interactions
– Pediatric drugs
– Natural products
– International drugs
– Patient advisory leaflets
Guidelines
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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
Quick Facts about UpToDate
• 3,663 world-renowned physician authors (international)
• 7,309 clinical topics in 13 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)
Specialties
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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
In Development
• Neurology
• Allergy & Immunology
• Emergency Medicine
Topics are still available in these fields
Evidence Grading
Evidence Grading – UTD GRADE
RECOMMENDATION GRADES
Grade 1
Grade 2
Strong Recommendation
“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
High Quality Evidence
Consistent evidence from randomized trials, or
overwhelming evidence of some other form
Grade B
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
Grade C
How to search
Access to UpToDate
• No username and password required
• Unlimited and simultaneous access
• No remote access
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
How to use UpToDate based on a
Clinical Scenario
• How effective is long-term warfarin at preventing
recurrent pulmonary embolism?
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?
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
Q&A
Thank you for your attention