answering clinical questions at the point of care answering clinical questions at the point of care

Answering Clinical Questions at the Point of Care

鄭 如 雅ccheng@uptodate.com

Outline

• About UpToDate

• Evidence Grading

• How to search

• Q & A

About UpToDate

You don’t need more informationYou 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 1Strong Recommendation Benefits clearly outweigh the risks and

burdens (or vice versa) for most, if not all, patients “ We recommend…”

Grade 2Weaker Recommendation Benefits and risks closely balanced and/or

uncertain “ We suggest…”

EVIDENCE GRADES

Grade A High Quality EvidenceConsistent 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

Grade C Low Quality EvidenceEvidence from observational studies, unsystematic clinical observations, or from randomized trials with serious flaws

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• Cardiovascular Medicine• Endocrinology• Family Medicine• Gastroenterology & Hepatology• Hematology• Infectious Diseases• Internal Medicine• Nephrology• Obstetrics & Gynecology• Oncology• Pediatrics• Pulmonary Medicine and Critical Care Medicine• Rheumatology