Answering Clinical Questions at the Point of Care

1. Answering Clinical Questions at the Point of Care 王信傑Ricky Wang rwang@uptodate.com Tel : +886-2-82854526 Mobile : +886-958931227

2. Outline • About UpToDate • Evidence Grading • How to Search • New Function • Q&A

3. 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

4. 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

5. Quick Facts about UpToDate • Topic reviews • Patient Information • Drug Information • systemic, topical, inhalation, nasal, ophthalmic Written by Physicians for Physicians

6. Quick Facts about UpToDate • 4,800+ world-renowned physician authors (international) • 9,500+ clinical topic in 19 specialties • 5,100+ 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)

7. Specialties • Adult and Pediatric Emergency Medicine {November 2009} • Adult Primary Care & Internal Medicine • Allergy and Immunology {March 2010} • Cardiovascular Medicine • Endocrinology & Diabetes • Family Medicine • Gastroenterology & Hepatology • Geriatric Specialty {July 2011} • Hematology • Hospital Medicine {November 2010} • Infectious Diseases • Nephrology & Hypertension • Neurology {March 2009} • Obstetrics, Gynecology & Women’s Health • Oncology • Pediatrics • Pulmonary, Critical Care & Sleep Medicine • Rheumatology • Surgery

8. Specialties in Development • Dermatology • Psychiatry

9. 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

10. 何謂實證醫學 • 以流行病學和統計學的方法，從龐大的醫學資料中嚴格評讀、綜合分析並找出值得信賴的部分，並將所能獲得的最佳文獻證據，應用於臨床工作中，使病人獲得最佳的照顧。

11. 何謂實證護理 • 傳統的臨床實務中，護理人員通常憑藉教課書及職場的學姐、專家的教導，以經驗解決臨床問題；隨著畢業時間的增加，新知識累積愈少，導致知識落差。所以，傳統解決問題的方法已不符合目前詭變的醫療環境。       實證護理（Evidence-based Nursing），依據國際護理榮譽學會的定義，涵概現有之最佳證據及護理實務經驗，並重視個人、家庭及社區之價值與偏好的護理照護。Ingersoll對實證護理的定義：針對一個病人或一群病人，能誠實、詳盡與明斷的運用「有理論為起源、研究為基礎的資訊」於臨床護理決策，並考慮到個案的需求與喜好。換言之實證護理就是護理人員必需具備「定義臨床問題」、「搜尋科學研究證據」、「評讀」、以及「將所得的證據應用病人臨床照護」之能力。      實證照護（Evidence-based health care）主要是引用最佳的證據，作為臨床照護決策依據。實證醫學（Evidence-based Medicine）重視病患治療效果，偏重隨機試驗之量性研究，實證護理重視病患的感受、態度，最佳研究證據來源，不單是量性研究文章，更包涵質性研究的文獻。透過實證護理，希望護理人員能不斷更新知識，學習以實證的方式做出以病人為中心的臨床決策。

13. How to Search • New Search • Search  display results  topic review  output • Others • Evidence grading • RECOMMENDATIONS • 125 Calculators • Drug Interactions • ECG test • Movies  no need install software

14. How to use UpToDate based on a Clinical scenario • A 50 year old woman is obese (BMI=32) and has hypertension. She has not achieved weight loss despite counseling for diet and lifestyle changes. What is the best medication for pharmacologic management of her obesity. • Keyword: • Obesity drug

15. How to use UpToDate based on a Clinical scenario • A65 year old man comes to see you with moderately symptomatic heart failure. He has a remote history of a large anterior wall MI and an echocardiogram shows an ejection fraction of 30%. His LDL cholesterol is 150 mg/dL, currently untreated. Should he be started on a statin ? • Keyword : • Statins in HF

16. How to use UpToDate based on a Clinical scenario • Will grapefruit juice interact with Cisapride ?

17. How to use UpToDate based on a Clinical scenario • How effective is long-term warfarin at preventing recurrent pulmonary embolism?

18. New Function • New graphics search feature • Over 23,000+ graphics • Pictures, tables, figures, graphs, algorithms and movies

19. Q&A