1. Presented By: Andy Chuang Elsevier Taiwan LLC Date: Aug 21, 2007

2. FIRSTConsult FIRSTConsult Overview Differential Diagnosis Medical Topics Procedures Patient Education Full Text Search Feature Work with MD Consult FIRSTConsult Handheld Benefits of FIRSTConsult

3. Systematically Review SUMSearch (http://sumsearch.uthscsa.edu/)http://sumsearch.uthscsa.edu/ TRIP (www.tripdatabase.com)www.tripdatabase.com Entrez PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi)http://www.ncbi.nlm.nih.gov/entrez/query.fcgi Cochrane Database of Systematic reviews National Guidelines Clearinghouse (www.guidelines.gov)www.guidelines.gov

4. FIRSTConsult: editorial workflow for Medical Topics 10. Content Editors and Drugs Editors (PharmD’s) undertake final check prior to publication to live site 1. Medical Topic – including drug doses, risks & benefits - written by professional medical writer 3. Topic Editor (Attending Physician in US) edits Medical Topic to ensure clinical relevance and accuracy, and answers queries 4. Content Editors & Drugs Editors (PharmD’s) check Topic Ed work 2A. Content Editors check style, consistency, omissions 2B Drugs Editors (PharmD’s) check doses provided by med writer and write all other drugs info by customizing data in FC drugs dbase 9. Evidence-Based Medicine Editors (MD’s) insert evidence references and links to guidelines 8. Generalist Editor (e.g. internist or family physician) review Medical Topic to ensure relevance to target audience 6. Specialty Editor (e.g. cardiologist or hematologist) reviews Medical Topic for clinical accuracy & currency, and writes Clinical Pearls etc. 5. CAM Editor (complementary/alternative medicine) review (optional) 7. Content Editors & Drugs Editors (PharmD’s) check Specialty Editor’s work Pink box = medical writer (work for hire) Blue box = in-house check Green box = external review by Ed Board member

5. Evidence-Based Medicine Evidence-based medicine (EBM) has been defined as 'the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients' (Sackett DL, Rosenberg WMC, Gray JAM, et al. BMJ 1996;312:71-2). Look for the icon in the text Evidence is summarized by our team of experts, principally from three critically evaluated, very highly regarded sources: Cochrane Systematic Reviews Clinical Evidence The National Guideline Clearinghouse™ Within the Medical Topics, the best available evidence and guidelines are integrated into the content. You can find evidence and guidelines in the following sections: Diagnosis - for diagnostic guidelines Treatment - for guidelines relating to management; and summaries of evidence from primary research articles and systematic reviews relevant to your treatment plan Prevention - for evidence and guidelines relating to prevention

6. Level of Evidence Resource from: http://www.mdconsult.com/php/about/82479328-4/pm_FC_EBM.html

7. What is FIRSTConsult? FIRSTConsult is a revolutionary web and PDA-based clinical information system that provides continuously-updated, evidence-based guidance on the latest in patient evaluation, diagnosis, and management — all written and designed for rapid access at the point of care! FIRSTConsult offers: Covering Specialty: 23 Medical Topic: 684 Patient Education: 360 Procedure: 70 DDX: 320 Diagnosis: 1800

8. Synthesized …are synthesized under the supervision of expert faculty… Cochrane Database National Guidelines Clearinghouse Clinical Evidence (ACP/BMJ) MD Consult Consensus Statements Reference Texts and Peer- Reviewed Articles Editorial Advisory Board Leaders and well-known authors in IM, FP, Peds Ob-gyn, emergency and specialty medicine. Clinical Reviewers Practicing clinicians and regional experts. Medical Writers Assist in categorizing information and creating a consistency of style from diverse sources Sources of Evidence… …delivered via web/PDA

9. Evidence-Based Medicine Look for the icon in the text Evidence is summarized by our team of experts, principally from three critically evaluated, very highly regarded sources: Cochrane Systematic Reviews Clinical Evidence The National Guideline Clearinghouse™ Once summarized, Evidence is only then included if clinically actionable All evidence is based on a rating system published by the AAFP Evidence and guidelines are regularly updated

10. Evidence Glossary Includes definitions for: Case-control study Clinical cohort study Cross-sectional study Meta-analysis Randomized controlled trial Retrospective study Systematic review Uncontrolled study

11. Differential Diagnosis Based on the patient’s chief complaint Start by choosing from over 320 signs & symptoms Search options include: Enter chief complaint in search box Scroll the list to find the complaint Click on A-Z to jump to the chief complaint

12. Differential Diagnosis Work from the chief complaint to the diagnostic tables Over 1,800 possible diagnoses available Sorted by age and prevalence Emergency conditions are marked in red *

13. Differential Diagnosis Clinical Benchmarks provided for each diagnosis Click on diagnosis to view

14. Differential Diagnosis To compare multiple disorders, select the check boxes and click ‘Compare’

15. Differential Diagnosis Show all of the characteristics for this diagnose.

16. Medical Topics 684 medical topics Browse by alphabetical on A- Z or search in the up blank field

17. Medical Topics Use left site navigation to access in-depth information 3-9 subcategories in each menu Content is updated weekly

18. Medical Topics Background Menu includes: Cardinal features Causes Epidemiology Codes Diagnosis Menu includes: Clinical presentation Differential diagnosis Clinical pearls Consider consult Workup Diagnostic decision Questions to ask Examination Tests Treatment Menu includes: Immediate action Therapeutic options Summary of therapies Medications and other therapies [EBM] Summary of evidence Clinical pearls Follow-up Outcomes Menu includes: Prognosis Clinical complications Consider consult Prevention Menu includes: Primary prevention Modifiable risk factors Secondary prevention Screening Guidelines Resources Menu includes: References Guidelines Associations Patient and caregiver information Related topics Contributors

19. Procedures Systematic guidance on surgical and diagnostic procedures commonly performed 70 available Video clips or animations included with each file

20. Full Text Search Feature Full Text Search function will take your keywords and present ranked, targeted results, from all of the FIRSTConsult content. Enter search term(s) in the Full Text Search box on the left-hand panel Search terms can contain Boolean terms, such as AND, OR, NOT. Header describes the details of the current search Results include an ordered list of search hits, the most relevant appearing first and also provide Recommended Results

21. Work with MD Consult An automatic MD Consult search will be generated using the term you have linked from when you click this icon Totally integrated to MD Consult

22. Thank You!