Answering Clinical Questions at the
Point of Care
Cecilia Chang
cchang@uptodate.com
Tel : 04-22930887
Mobile : 0930380588
Outline
 About UpToDate
 Evidence Grading
 How to Search
 Q&A
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瞎子摸象的故事----訊息全方位對病患的重要性
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Bud Rose with Taiwan Team
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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: 440+ 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
 4,400+ world-renowned physician authors
(international)
 8,000+ clinical topic in 16 specialties
 4,600+ unique drug entries in adult, pediatrics,
international and natural drugs (Lexi-Comp)
 21,000+ graphics
 385,000+ 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 {NEW}
Cardiovascular Medicine
Endocrinology & Diabetes
Family Medicine
Gastroenterology & Hepatology
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
How to Search
 New Search
 Search  display results  topic review  output
 Others
 Evidence grading
 Grading Tutorial
 RECOMMENDATIONS
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Calculators
Drug Interactions
ECG test
Movies
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
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What’s New
Calculators
Patient Information
此為主畫面
除此以外另有三個頁面可以選點
-Patient Info
-What’s New
-Calculators
關鍵字可以是
-病名, 藥名, 症狀
-大小寫皆可
-可同時輸入二個字以上
-接受布林邏輯裡的 and 以及 or
-系統亦提供拼錯檢查
-單複數不會影響檢索結果
我們以acute otitis Media 來做查詢
當我們把關鍵字鍵入後
系統會跳出相關的詞以供選擇
輸入完畢直接選點 Go
此為檢索結果
另外有三個選項可以改變檢索結果的順序
-Prioritize adult topics
-Prioritize pediatric topics
-Prioritize patient topics
建議：
-This topic last update 這篇文章被更新的日期
-Introduction 這個議題的簡介
-Recommendations 提供及時的答案
Drug information : 藥物資訊由
Lexi-Comp 提供，若想要得到更
詳細的資料， 可以點選具有超
連結的藥名
此為另開一視窗
以供瀏覽
-Reference 參考書目
圖表部份
點選後則另開啟一個視窗以供瀏覽
- Export TO PowerPoint 直接將圖表轉入 PowerPoint
- Print
- Email
- 亦可滑鼠移到圖片上方, 按滑鼠右鍵, 選擇”複製”
Output
Print, Email, Save
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-Print
若要列印請選擇此功能
可以完整的列出整篇文章
包括圖表在內 (若文章有附)
-Email
可以 email 文章內容
不包括圖表在內
-Print
若要列印請選擇此功能
可以完整的列出整篇文章
包括圖表在內 (若文章有附)
-Email
可以 email 文章內容
不包括圖表在內
cc
ccheng@uptodate.com
ccheng@uptodate.com
-星號欄位必填
-Your name 為寄件人的名字
-Your e-mail 為寄件人的帳號
-E-mail address of recipient
為收件人的帳號
-填寫完畢後，點選 Send
Patient Information
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What’s New
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提供各科別的新訊
為重點式的說明
Calculators
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輸入身高和體重
切換成我們常用的單
位 (公分和公斤)
輸入完畢後
BMI值就呈現出來
Evidence Grading
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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
會放在特定的段落 :
Recommendations
-點選 Evidence Grading 的超連結
-會有說明的視窗出現
Others:
Drug Interactions
ECG
Movies
Feedback
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-提供二種以上的藥物執行藥物交互作用
-目前以美國藥品為主
-來源 : Lexi-Comp
-一次輸入一種藥名
-可輸入多種藥品
-以以下藥品為例
aspirin
grapefruit Juice
norvasc
amoxicillin
-輸入完畢
-Analyze
-Risk rating 藥物交互作用的說明
-點選超連結有藥物交互作結果的說明
若想知道單一藥品已知藥物交互作用的種類
輸入藥名後
再直接點選藥名即會出現
ECG test
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-關鍵字 : ecg test (ekg test)
-檢索結果第一至第三個為 ECG test
分為初級 Basic，中級 Intermediate，高級 Advanced
Movies in Graphics
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-會依據文章內容所提及部份輔以圖表做說明
-圖表的大標題為 : Graphics
-之下再細分屬性，例如 echocardiograms, table, figure
-Movies 為影像檔
-播放的軟體為：Apple Quick Time
此軟體為免費下載
-系統會先偵測電腦有無安裝 Apple Quick Time
有 : 會出現以下畫面
無 : 會出現請至網頁下載並安裝 Apple Quick Time 提示畫面
-右邊
為左邊心臟的定格，再加上文字說明
-左邊
為影像檔 ，會跳動並自動重複播放
Feedback
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-歡迎並感謝給予任何意見
-Email內容直接至美國主編群，並由主編群直接回覆
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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