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
Synthesize current literature and best
practices, then make specific clinical
recommendations
UpToDate enables
• Access the most current information within your
specialty
• Recognize the clinical manifestations of a wide variety of
disorders and describe current options for diagnosis,
management and therapy, including the efficacy, doses,
and interactions of individual drugs
• Identify optimal screening and prevention strategies
Quick Facts about UpToDate
• Topic reviews
• Patient information
• Drug Information
• Guideline
Written by Physicians for Physicians
Quick Facts about UpToDate
• 3,300+ world-renowned physician authors
(international)
• 7,000+ clinical topics in 13 specialties
• 4,100+ unique drug entries in adult, pediatrics,
international, and natural drugs (Lexi-Comp)
• 70,000+ pages of text
• 21,000+ graphics
• 230,000+ references (Medline)
• Updated every 4 months
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
How to search
• New search
– search  display result  output
• Others
– Evidence grading
• SUMMARY AND RECOMMENDATIONS
– Drug interaction
– Calculator
– Movies
To Access UpToDate
• Please go to library homepage
• 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
• A 60-year-old man comes in for a routine exam and
mentions that two months earlier he lost vision in his
right eye for 10 minutes.
• Send him for carotid duplex and find a 60 percent right
carotid stenosis.
• Given that the TIA occurred more than two months ago.
• Is he an appropriate candidate for carotid
endarterectomy ?
How to use UpToDate based on a
Clinical Scenario
• A patient for whom you have prescribed atorvastatin
comes in saying he has been reading that atorvastatin
can cause muscle pain and that taking coenzyme Q10
supplements may be helpful in preventing this.
• Is there any evidence to support taking coQ10?
Q&A
Citing an UpToDate topic review
• 篇名：Carotid endarterectomy in symptomatic patients.
• 作者：James P Greelish, MD
• Greelish, JP. Carotid endarterectomy in symptomatic
patients. In: UpToDate, Rose, BD (Ed), UpToDate,
Waltham, MA, 2007.
Thank you for your attention
Specialties
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Cardiovascular Medicine
Endocrinology
Family Medicine
Gastroenterology & Hepatology
Hematology
Infectious Diseases
Internal Medicine
Nephrology
Obstetrics & Gynecology
Oncology
Pediatrics
Pulmonary Medicine and Critical Care Medicine
Rheumatology