Answering Clinical Questions at the Point of Care


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  • Introductions…
  • Answering Clinical Questions at the Point of Care

    1. 1. Answering Clinical Questions at the Point of Care 鄭 如 雅 [email_address]
    2. 2. Outline <ul><li>About UpToDate </li></ul><ul><li>14.1 News </li></ul><ul><li>How to search </li></ul><ul><li>Q & A </li></ul>
    3. 3. About UpToDate You don’t need more information You need the right information
    4. 4. Quick Facts about UpToDate <ul><li>Topic reviews </li></ul><ul><li>Patient information </li></ul><ul><li>Drug Information </li></ul><ul><li>Guideline </li></ul><ul><li>Written by Physicians for Physicians </li></ul>
    5. 5. Quick Facts about UpToDate <ul><li>3,000+ world-renowned physician authors (international) </li></ul><ul><li>7,000+ clinical topics in 13 specialties </li></ul><ul><li>3,800+ unique drug entries in adult, pediatrics, international, and natural drugs (Lexi-Comp) </li></ul><ul><li>70,000+ pages of text </li></ul><ul><li>19,000+ graphics </li></ul><ul><li>250,000+ references (Medline) </li></ul><ul><li>360+ journals reviewed </li></ul><ul><li>Updated every 4 months </li></ul><ul><li>185 new topics added for 14.2 </li></ul>
    6. 6. 14.1 News
    7. 7. 14.1 News <ul><li>Evidence Grading (UTD-GRADE) </li></ul>Evidence from observational studies, unsystematic clinical observations, or from randomized trials with serious flaws Low Quality Evidence Grade C Evidence from randomized trials with important limitations, or very strong evidence of some other form Moderate Quality Evidence Grade B Consistent evidence from randomized trials, or overwhelming evidence of some other form High Quality Evidence Grade A EVIDENCE GRADES “ We suggest…” Benefits and risks closely balanced and/or uncertain Weaker Recommendation Grade 2 “ We recommend…” Benefits clearly outweigh the risks and burdens (or vice versa) for most, if not all, patients Strong Recommendation Grade 1 RECOMMENDATION GRADES
    8. 8. How to search
    9. 9. How to search <ul><li>New search </li></ul><ul><ul><li>search  display result  output </li></ul></ul><ul><li>Others </li></ul><ul><ul><li>Evidence grading </li></ul></ul><ul><ul><ul><li>SUMMARY AND RECOMMENDATION </li></ul></ul></ul><ul><ul><li>Drug interaction </li></ul></ul><ul><ul><li>Calculator </li></ul></ul><ul><ul><li>Movies </li></ul></ul>
    10. 10. To Access UpToDate <ul><li>Go to library homepage : </li></ul><ul><li>Just ‘Accept’ the license agreement and you are brought to the search page, ready for your use; within a few seconds </li></ul>
    11. 11. How to use UpToDate based on a Clinical Scenario <ul><li>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. </li></ul><ul><li>Send him for carotid duplex and find a 60 percent right carotid stenosis. </li></ul><ul><li>Given that the TIA occurred more than two months ago. </li></ul><ul><li>Is he an appropriate candidate for carotid endarterectomy ? </li></ul>
    12. 12. How to use UpToDate based on a Clinical Scenario <ul><li>A 28 year-old woman comes in with her 4 th vaginal yeast infection this year. </li></ul><ul><li>Because of the recurrent infections, a culture is taken which indicates Candida glabrata. </li></ul><ul><li>How should this type of yeast infection be treated ? </li></ul>
    13. 13. How to use UpToDate based on a Clinical Scenario <ul><li>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. </li></ul><ul><li>Is there any evidence to support taking coQ10? </li></ul>
    14. 14. Q & A
    15. 15. Citing an UpToDate topic review <ul><li>篇名: Carotid endarterectomy in symptomatic patients. </li></ul><ul><li>作者: James P Greelish, MD </li></ul><ul><li>Greelish, JP. Carotid endarterectomy in symptomatic patients. In: UpToDate, Rose, BD (Ed), UpToDate, Waltham, MA, 2006. </li></ul>
    16. 16. Thank you for your attention
    17. 17. Specialties <ul><li>Cardiovascular Medicine </li></ul><ul><li>Endocrinology </li></ul><ul><li>Family Medicine </li></ul><ul><li>Gastroenterology & Hepatology </li></ul><ul><li>Hematology </li></ul><ul><li>Infectious Diseases </li></ul><ul><li>Internal Medicine </li></ul><ul><li>Nephrology </li></ul><ul><li>Obstetrics & Gynecology </li></ul><ul><li>Oncology </li></ul><ul><li>Pediatrics </li></ul><ul><li>Pulmonary Medicine </li></ul><ul><li>Rheumatology </li></ul>