1. Answering Clinical Questions at the Point of Care 鄭如雅 ccheng@uptodate.com

2. Outline About UpToDate Evidence Grading How to search Q & A

3. About UpToDate You don’t need more information You need the right information

4. Synthesize current literature and best practices, then make specific clinical recommendations

5. 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

6. Quick Facts about UpToDate Topic reviews Patient information Drug Information Guideline Written by Physicians for Physicians

7. Quick Facts about UpToDate 3,300+ world-renowned physician authors (international) 7,000+ clinical topics in 13 specialties13 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

8. Evidence Grading

9. UTD-GRADE RECOMMENDATION GRADES Grade 1 Strong Recommendation Benefits clearly outweigh the risks and burdens (or vice versa) for most, if not all, patients “We recommend…” Grade 2 Weaker Recommendation Benefits and risks closely balanced and/or uncertain “We suggest…” EVIDENCE GRADES Grade AHigh Quality Evidence Consistent evidence from randomized trials, or overwhelming evidence of some other form Grade BModerate Quality Evidence Evidence from randomized trials with important limitations, or very strong evidence of some other form Grade CLow Quality Evidence Evidence from observational studies, unsystematic clinical observations, or from randomized trials with serious flaws

10. How to search

11. New search –search  display result  output Others –Evidence grading SUMMARY AND RECOMMENDATIONS –Drug interaction –Calculator –Movies

12. 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

13. 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 ?

14. Q & A

15. 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.

16. 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?

17. Thank you for your attention

18. Specialties Cardiovascular Medicine Endocrinology Family Medicine Gastroenterology & Hepatology Hematology Infectious Diseases Internal Medicine Nephrology Obstetrics & Gynecology Oncology Pediatrics Pulmonary Medicine Rheumatology