20090324 MD Consult Talk

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  • 20090324 MD Consult Talk

    1. 1. MD Consult 2009 Mar. 24 楊宗翰
    2. 2. Contents <ul><li>MD 的需求 </li></ul><ul><li>MD Consult 的特性 </li></ul><ul><li>範例 </li></ul>
    3. 3. Roles of a doctor (MD) Clinician Educator Researcher
    4. 4. As a clinician <ul><li>臨床工作.解決患者的問題 </li></ul><ul><ul><li>診斷、預後、 病因、 治療 </li></ul></ul><ul><li>實證醫學 </li></ul><ul><ul><li>The application of the best available evidence (current best evidence) to patient care . </li></ul></ul><ul><li>資料品質 = Best </li></ul><ul><li>定期更新 = Current </li></ul><ul><li>簡單易用 = Application </li></ul>
    5. 5. As a researcher <ul><li>研究工作.探索世界 </li></ul><ul><li>登上一流的雜誌 </li></ul><ul><ul><li>創新、改變世界 </li></ul></ul><ul><ul><li>最新、最流行 </li></ul></ul><ul><li>定期更新 = Current </li></ul><ul><li>資料內容 = Complete </li></ul>
    6. 6. As a educator <ul><li>教育醫學生、年輕醫生 </li></ul><ul><ul><li>學習 解決臨床問題 的能力 ( 邏輯 ) </li></ul></ul><ul><li>最 正確 、最 重要 ( 且 完整 ) 的 觀念 </li></ul><ul><ul><li>過去 </li></ul></ul><ul><ul><li>現在 </li></ul></ul><ul><ul><li>未來 </li></ul></ul><ul><li>資料內容 = Stable & Mostly Correct ( Complete … ) </li></ul><ul><li>定期更新 = Current ( Relatively ) </li></ul>
    7. 8. <ul><li>台灣醫師的平均壽命比平常人少 10 歲以上,只有 62 到 63 歲( 95 年國人男性平均壽命約 74 歲,女性約 81 歲。) </li></ul>http://www.businessweekly.com.tw/webarticle.php?id=29335 語出:孫安迪醫師
    8. 9. Information … Time …
    9. 10. <ul><li>doctor </li></ul><ul><li>: </li></ul><ul><li>v </li></ul><ul><li>information </li></ul>
    10. 11. Solution - Database
    11. 13. One
    12. 14. Solutions Clinician = 優 Educator = 穩 Researcher = 新
    13. 15.
    14. 16. Contents <ul><li>MD 的需求 </li></ul><ul><li>MD Consult 的特性 </li></ul><ul><li>範例 </li></ul>
    15. 17. Database <ul><li>Contents – 資料庫的命脈 </li></ul><ul><li>How to search? </li></ul><ul><ul><li>keyword vs. indexed terms (MeSH) </li></ul></ul><ul><li>Results of search? </li></ul><ul><ul><li>who ranks first </li></ul></ul>
    16. 18. Contents 穩 新 優 需求 Reviews (books, narrative reviews) Primary databases (citations) EBM resources (EBM article/case/topic review) Contents
    17. 19. Patient education ( 10,000+) , Drugs, Images (50,000+) , News, CME, PDA … … Books (51) , Clinics (36) 穩 Core Journals (53) & MEDLINE 新 First Consult EBM Journals (6) Guidelines 優
    18. 20. 整合多元資源 智慧型查詢 內容導覽 熱門話題 醫學新知
    19. 21. 十大主題 <ul><li>First Consult (Topics, DDx, Procedures) 診療指南( Guidelines )、實證期刊( Journals – EBxx ) </li></ul><ul><li>醫學用書( Books )、臨床期刊 (The Clinics) </li></ul><ul><li>醫學期刊( Journals ) </li></ul><ul><li>病患須知( Patient Education ) </li></ul><ul><li>藥物資訊( Drugs )、圖片( Image )、持續醫學教育( CME ) </li></ul><ul><li>新聞( News ) </li></ul><ul><ul><li>本周醫藥新知( This Week in Medicine ) </li></ul></ul><ul><ul><li>當週期刊( In This Week’s Journals ) </li></ul></ul>
    20. 22. 優 - First Consult <ul><li>Medical Topics, Differential Diagnosis, and Procedures </li></ul>
    21. 23. 優 - 診療指南 Guidelines <ul><li>超過 1,000 份同儕評鑑臨床診療指南 </li></ul><ul><li>按照主題名稱、專科、機構別分類,並依更新時間排列 </li></ul>
    22. 24. 優 - 實證期刊( EBxx ) <ul><li>Evidence-based Cardiovascular Medicine Full text available from April 1997 - June 2006 </li></ul><ul><li>Evidence-based Health Policy & Management Full text available from March 1997 - December 1998 </li></ul><ul><li>Evidence-based Healthcare and Public Health Full text available from October 2004 - December 2005 </li></ul><ul><li>Evidence-based Healthcare: A Scientific Approach to Health Policy Full text available from March 1999 - August 2004 </li></ul><ul><li>Evidence-based Obstetrics & Gynecology Full text available from March 1999 - September 2006 </li></ul><ul><li>Evidence-based Oncology Full text available from March 2000 - December 2002 </li></ul>
    23. 25. 穩 - 參考書籍 <ul><li>29 個專科, 51 本參考書籍,其中包括多本經典教科書如: </li></ul><ul><li>Robbins and Cotran 2005 7e </li></ul><ul><li>Cecil Textbook of Medicine 2007 23/e </li></ul><ul><li>Braunwald's Heart Disease 2007 8/e </li></ul><ul><li>Brenner & Rector‘s The Kidney 2007 8/e </li></ul><ul><li>Sleisenger & Fordtran's Gastrointestinal and Liver Disease 2006 8/e </li></ul><ul><li>Kelley's Textbook of Rheumatology 2008 8/e </li></ul><ul><li>Campbell-Walsh Urology 2007 9/e </li></ul>
    24. 26. 穩 - The Clinics <ul><li>36 本 最具權威的北美臨床雜誌 </li></ul><ul><li>每篇全文均包括書目資料及目錄 </li></ul><ul><li>簡單而靈活的搜尋選項,包括 </li></ul><ul><ul><li>專科 、 受試者年齡 等選項 </li></ul></ul><ul><ul><li>依全文、相關性或出版日期排序 </li></ul></ul>
    25. 27. 新 - Journals 包括 Medline 檢索 全文包括 53 本核心期刊,及其他 Science Direct 內的期刊
    26. 28. 藥物資訊 <ul><li>Clinical Pharmacology 所提供的藥物資訊 </li></ul><ul><ul><li>包括藥物圖片及說明 </li></ul></ul><ul><li>FDA 第一手訊息 , 包含: </li></ul><ul><ul><li>剛核准上市的新藥 </li></ul></ul><ul><ul><li>安全性通告 </li></ul></ul><ul><ul><li>新核准的指示 </li></ul></ul><ul><ul><li>Off-Label Use… </li></ul></ul><ul><li>資料 每日 更新 </li></ul><ul><li>通過以下四大類別搜尋指定藥物: </li></ul><ul><ul><li>商品名 + 適應症 </li></ul></ul><ul><ul><li>商品名 </li></ul></ul><ul><ul><li>適應症 </li></ul></ul><ul><ul><li>禁忌 </li></ul></ul>
    27. 29. 圖片 <ul><li>超過 50,000 張圖片 </li></ul><ul><li>可供 查詢 及 比對 </li></ul><ul><li>來源:資料庫中的 Books </li></ul>
    28. 30. 病患須知 ( Patient Education ) <ul><li>超過 10,000 篇文章 </li></ul><ul><li>可依需求修訂 </li></ul><ul><li>內容淺顯易懂 – 只要具備美國 6 至 8 級閱讀水平 </li></ul><ul><li>平均篇幅 1~2 頁 </li></ul><ul><li>超過 100 篇綜合版病患須知 </li></ul><ul><li>部分衛教資訊附有圖片 </li></ul>
    29. 31. 新聞報導 <ul><li>獲取美國醫學界的最新發展 </li></ul><ul><li>涵蓋兩方面: </li></ul><ul><ul><li>本週醫藥新知 </li></ul></ul><ul><ul><li>當週期刊 </li></ul></ul>
    30. 32. 訂閱電子報 POCKET Consult
    31. 33. Search & Result <ul><li>Keywords & Indexed Terms (MeSH) </li></ul><ul><li>同義字 及 檢索建議 搜尋 </li></ul><ul><li>檢索策略 轉譯 </li></ul><ul><li>搜尋精化 :進一步 分類 快速篩選 </li></ul><ul><li>建議結果 :以最 簡潔 的結果呈現 </li></ul>
    32. 34. 同義字 & 轉譯 <ul><li>能讓使用者找到一開始沒有考慮到的詞彙以增加搜尋內容的 廣度 </li></ul><ul><li>大部分的關鍵字詞在 MD Consult 中都解會被正確解讀並進一步查詢相關字彙 </li></ul><ul><ul><li>Coumadin vs. Warfarin </li></ul></ul><ul><ul><li>“ DVT” or “ D eep V ein T hrombosis” </li></ul></ul><ul><li>標點符號的轉譯:“ bell’s palsy” vs. “bells palsy” </li></ul><ul><li>特定轉譯: ICD-9: 88.72 (echocardiography) </li></ul>
    33. 36. 檢索策略轉譯 <ul><li>“(“heart attack” or “myocardial infarct” or “cardiac infarction” or “infarction of heart” or “myocardial infarction”)” AND cancer </li></ul>heart attack cancer Search heart AND (attack cancer) (heart attack) AND cancer
    34. 37. <ul><li>Keywords </li></ul><ul><li>vs. Indexed Terms (MeSH) </li></ul>
    35. 38. Advanced Searching (MeSH) gout vs. gout[sh]
    36. 39. gout[sh] gout
    37. 41. Article Type <ul><li>Reviews — those found in the Clinics of North America or classified as Reviews in MEDLINE </li></ul><ul><li>Opinions — Searches for articles that have been classified in MEDLINE as Comments or Editorials . </li></ul><ul><li>Cochrane — those found in The Cochrane Database of Systematic Reviews ( CDSR ) </li></ul><ul><li>Trials — Narrows you search to articles containing information about Clinical Trials, Randomized Control Trials, and similar articles . </li></ul>
    38. 42. 搜尋精化 <ul><li>將搜尋結果做進一步的精確分類 </li></ul>
    39. 43. 檢索建議 <ul><li>跟著檢索結果提供  ”建議結果” </li></ul><ul><li>商品名稱,書籍及期刊名稱 </li></ul><ul><li>作者姓名 、重要新聞 , 以及其他適當的內容 </li></ul>
    40. 44. 建議結果 <ul><li>針對在診斷或疾病方面較為常用的字彙提供建議結果 </li></ul><ul><ul><li>acne, </li></ul></ul><ul><ul><li>asthma </li></ul></ul><ul><ul><li>COPD </li></ul></ul><ul><ul><li>diarrhea </li></ul></ul><ul><ul><li>hepatitis </li></ul></ul><ul><ul><li>lupus </li></ul></ul><ul><ul><li>obesity </li></ul></ul><ul><li>~200 個 Recommended Results </li></ul><ul><ul><li>提供最常被搜尋的內容 </li></ul></ul><ul><ul><li>占 5% - 8% of all searches </li></ul></ul><ul><li>包含最新、最相關以及最有用的臨床資訊的內容 </li></ul>
    41. 47. Contents <ul><li>MD 的需求 </li></ul><ul><li>MD Consult 的特性 </li></ul><ul><li>範例 </li></ul><ul><ul><li>藥物資訊 - COX2 - etoricoxib </li></ul></ul><ul><ul><li>蛀牙 (dental caries) vs xylitol </li></ul></ul><ul><ul><li>益生菌 (probiotic) </li></ul></ul>
    42. 48. Drug Info COX2 - etoricoxib
    43. 49. MD Consult
    44. 50. MD Consult
    45. 51. 蛀牙 (dental caries)
    46. 52. Case – Researcher ( 新 / 全 )
    47. 53. Case – Educator ( 穩 ) 1/2 3 2007 2008 2008 2006 2007 2007 1/2
    48. 56. Result <ul><li>Book </li></ul><ul><li>Nelson Textbook of Pediatrics, 2007 18e . </li></ul><ul><ul><li>possible sources of evidences 2004-2006 </li></ul></ul><ul><li>Review </li></ul><ul><li>Dental caries. Lancet 369:51-9 2007 </li></ul><ul><li>Infect Dis Clin North Am 2007 ; 21(2): 471-502 </li></ul><ul><ul><li>possible sources of evidences 2006-2007 </li></ul></ul><ul><li>Patient Education </li></ul><ul><li>Early childhood caries, </li></ul><ul><li>Dental cavities, Radiography, Dental </li></ul>
    49. 58. Rampant caries (early childhood caries) in 3 yr old child
    50. 59. Basic Dental Anatomy
    51. 60. Diagnosis (iceberg metaphor)
    52. 61. Caries Process
    53. 63. Clinical Presentations
    54. 64. Clinical Implications
    55. 65. Clinical Implications
    56. 66. Patient Education
    57. 67. Case - Clinician <ul><li>張小妹,六歲,喜歡吃糖但卻滿口蛀口。 </li></ul>
    58. 68. Ask <ul><li>P: children/adults (with dental caries) </li></ul><ul><li>I: chewing gum with xylitol </li></ul><ul><li>C: chewing gum without xylitol </li></ul><ul><li>O: incidence of dental decay </li></ul><ul><li>Type of Question: therapy </li></ul><ul><li>Keyword: </li></ul><ul><ul><li>Dental caries </li></ul></ul><ul><ul><li>xylitol </li></ul></ul>
    59. 69. Acquire / Search 2007
    60. 70. Search - xylitol dental caries 2009
    61. 71. Acquire / Search 2009 xylitol dental caries xylitol 2007 2009
    62. 72. Advanced Search - Article Type <ul><li>Cochrane — thoes found in The Cochrane Database of Systematic Reviews ( CDSR ) </li></ul><ul><li>Trials — Narrows you search to articles containing information about Clinical Trials, Randomized Control Trials, and similar articles . </li></ul>
    63. 73. 2005 2005 2004 2007 2008
    64. 74. 益生菌 (Probiotic)
    65. 75. LOE: Level of Evidence (Oxford) 前瞻性 世代研究 前瞻性起始 世代研究 由連續或隨機取樣組成的 橫斷面研究 隨機對照 試驗 II 第 II 級 證據的 系統回顧 (systematic review) I 病因 預後 診斷 治療 等級
    66. 76. LOE (GRADE) <ul><li>評分方式:結合 研究方法 , 研究品質 , 一致性 , 相關性 </li></ul><ul><li>高( high ) = further research is very unlikely to change our confidence in the estimate of effect </li></ul><ul><li>中( moderate ) = further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate </li></ul><ul><li>低( low ) = further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate </li></ul><ul><li>極低( very low ) = any estimate of effect is very uncertain </li></ul>The GRADE Working Group - http://www.gradeworkinggroup.org/
    67. 78. Apply ?
    68. 79. Summary <ul><li>醫師 (MD) 的需求 </li></ul><ul><ul><li>優、新、穩 </li></ul></ul><ul><ul><li>快 </li></ul></ul><ul><li>MD Consult 的特性 </li></ul><ul><ul><li>內容 (original, EBM review, review) </li></ul></ul><ul><ul><li>檢索及結果呈現方式 </li></ul></ul><ul><li>範例 </li></ul><ul><ul><li>藥物資訊 - COX2 - etoricoxib </li></ul></ul><ul><ul><li>蛀牙 (dental caries) vs xylitol </li></ul></ul><ul><ul><li>益生菌 (probiotic) – LOE (GRADE) </li></ul></ul>
    69. 80. MD Consult Clinician = 優 Educator = 穩 Researcher = 新
    70. 81. One
    71. 82. Time … Information …
    72. 83. Patient education ( 10,000+) , Drugs, Images (50,000+) , News, CME, PDA … … Books (51) , Clinics (36) 穩 Core Journals (53) & MEDLINE 新 First Consult EBM Journals (6) Guidelines 優

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