MDConsult & FirstConsult Presented By: 莊俊彥 Andy Chuang

Who is Elsevier? Academic Press Butterworth-Heinemann Morgan Kaufmann Mosby Saunders Churchill Livingstone Science Direct (SDOL) MD Consult The Lancet Cell Scopus

E – Product Family MD Consult / First Consult - Core Service Nursing Consult Nursing Skills Physical Examinations DVDs (Seidel, Javis) Nursing Skills DVDs Medical Surgical Procedure DVDs Medical Assistants DVDs Journals Consult eClips Consult Procedures Consult Imaging Consult Clinical Pharmacology Nursing Index

What is MD Consult? (51) Leading medical reference BOOKS & (31) YEAR BOOK Evidence based answers for the point of care – FIRST CONSULT (87) Full-text JOURNALS and CLINICS with MEDLINE Nearly (10,000) customizable PATIENT EDUCATION DRUGS provided by Gold Standard The latest medical NEWS Over (1,000) peer-reviewed practice GUIDELINES Over (50,000) IMAGES that can be downloaded or printed POCKET Consult – free for your PDA

整合多元資源 智慧型查詢 熱門話題醫學新知 智慧型 查詢 十大主題 熱門話題 醫學新知

Books 可針對整個書庫中的書籍 進行搜尋 ( 針對內文 ) 提供索引及目次，方便您 的點閱及搜尋 可儲存最近的搜尋記錄及 搜尋結果 ( 個人化功能 ) * 需先註冊個人帳密功能

51 Reference Books

Journals / Clinics Elservier 所出版的 Journal 和 Clinics 均提供全文內容 包含超過 30,000 篇文章 提供 HTML / PDF 兩種格式 同時搜尋 Medline 資料庫 Journal: Back to 1996 Clinics: Back to 2002

實證期刊（ EBxx ） Evidence-based Cardiovascular Medicine Full text available from April June 2006 Evidence-based Health Policy & Management Full text available from March December 1998 Evidence-based Healthcare and Public Health Full text available from October December 2005 Evidence-based Healthcare: A Scientific Approach to Health Policy Full text available from March August 2004 Evidence-based Obstetrics & Gynecology Full text available from March September 2006 Evidence-based Oncology Full text available from March December 2002

Searching Tips for Journals and The Clinics Search FieldsExample Abstractcarpal tunnel [ab],[mdcab],[abstract] Article Titlecarpal tunnel [ti],[titl],[mdcti],[title] Author(s)Last name in first text box. First initial in next text box. Middle initial in the third box. Author AffiliationOregon Health Sciences University [mdcad],[authoraffiliation] Chemical Compound NamePeptide Fragments[mdcrn] LanguageEnglish [mdcla],[language] Major MeSHEndolymphatic Duct [majr],[meshmajor] MeSHdrug therapy [sh],[mesh] NLM Citation ID [nlmid], [mdcui] Publication Date01 JUL 1998 [pd], Jul 1998 [pd], 1998[pd] Publication TitleNew England Journal of Medicine [jn],[ta],[jour],pubtitle,[mdcpub_title] Publication Title, AbbreviatedN Engl J Med [mdccite] Publication TypeJournal Article [pt],[pubtype],[ptyp],[mdcpt] Source Database (Medline)MI [mdcsource] Year Book Articlesmdcyb[metasource]

Search Journals/MEDLINE Tips 1. Use our new Citation Search to search by Term, Journal, Date, Volume Number, Issue Number, and/or First Page Number. 2. Use Journals Search to search by Term, Author, Journal, Date or Date Range, Article Type, and/or Age of Study Subjects.

gout[sh] gout Example: Searching “gout” with MeSH term

Article Type Reviews — those found in the Clinics of North America or classified as Reviews in MEDLINE Opinions — Searches for articles that have been classified in MEDLINE as Comments or Editorials. Cochrane — those found in The Cochrane Database of Systematic Reviews (CDSR) Trials — Narrows you search to articles containing information about Clinical Trials, Randomized Control Trials, and similar articles.

Patient Education 超過 10,000 篇衛教 可供印列及修訂 每篇長度為 1 ~ 2 頁 允許加註訊息給病患 Comprehensive Version for Health Professionals

Drugs 提供藥物商品的圖片 藥物衛教手冊 藥物資訊包含： 藥物分類、別名、學名 副作用 交互作用 藥物動力學、機轉 分子結構 … 等相關藥物 資訊 24 小時隨時更新

Drug Look-Up ( 藥物搜尋 ) 可用四大類別搜尋藥物： 商品名 + 適應症 商品名 適應症 禁忌 FDA 第一手訊息, 包含： 剛核准上市的新藥 安全性通告 新核准的指示 Off-Label Use…

Guidelines 超過 1,000 份同儕評鑑 臨床診療指南 (Peer- Review Articles) 按照 3 種方式分類 : 專題的字母順序 專科別 授權機構 每篇全文文章均包括 書目資料及目錄

Medical Images ( 圖片 ) 超過 50,000 張圖片 可供查詢 及 圖片比對 來源：資料庫中的 Books

News 每日更新 提供最新醫學發展新知 當週新聞 先賭為快 ~ 預覽未出版之重要期刊摘要 RSS Feed for News

News Customization 提供自訂有興趣的科別 * 需先註冊個人帳密功能

Newsletter

Global Search ( 整合搜尋 ) 同時檢索整個資料 庫內容 提供下拉式選單進 行快速檢索

Recommended Results ( 建議結果 ) Recommended Results 是根據過去 點閱記錄而整理出來 的結果

Top Search Results ( 檢索結果 ) 檢索結果會顯示出 每一主題當中的前 三筆資料 顯示檢索結果筆數

Refine Your Search ( 精確檢索 ) 畫面右方提供建議的 精確檢索

線上診療系統 & 實證醫學資料庫 內容包括 Medical Topics 、 Differential Diagnosis 、 Procedures 持續更新內容 可下載至 PDA Level of Evidence (Level A, B, C, and uncategorized) 標準來源 AAFP ( American Academy of Family Physicians ) US Agency for Healthcare Policy and Research Classification

First Consult Collaborative Authoring Process

瀏覽 Medical Topics

Differential Diagnosis

First Consult Editorial Board #1 Fred Ferri Chairs the Executive Committee. Associate Director of the Brown University Medical School and Faculty Director & Coordinator of the 'Business of Medicine' course. He is a world-expert in the field of Internal Medicine & has authored over 20 major publications, including Ferri's Clinical Advisor Joseph Scherger Professor of Clinical Family & Preventive Medicine at the University of California, San Diego School of Medicine (UCSD). His main focus is on the redesign of office practice using the tools of information technology and quality improvement. He has received numerous awards, including Outstanding Clinical Instructor in the School of Medicine at the University of California, Davis, in 1984, 1989, and Stephen Sisson Associate Professor at John Hopkins University School of Medicine and is a leading expert in internal medicine. Editor of the John Hopkins Internal Medicine Board Review Book and the John Hopkins Internet Learning Center. He has been presented with the Society of General Internal Medicine Innovations in Education Award in 2005 and the American College of Physicians Conley Award in Education in Steven Opal Professor of Medicine of the Infectious Disease Division of Brown Medical School. He has previously served as a US Army Major for 9 years, receiving the Army Commendation Medal in He is considered a world-expert in the study of infectious diseases, and has received, amongst numerous honors, the Brown Medical School Infectious Disease Fellowship Teacher of the Year award in He was also included in the Best Doctors in America selection for , and has served on the editorial boards of a variety of books and journals. Sara McIntire Professor of Pediatrics at the University of Pittsburgh School of Medicine. She has been presented with the Alpha Omega Alpha Society Award, the Merck Scholar Award, the Janet Glasgow Award & the Academy of Master Educators Award. She has authored several notable publications and has been a regular speaker at several area institutions since 1990, speaking on a wide variety of pediatric topics.

First Consult Editorial Board #2 Tracey Arnell Assistant Professor of Surgery at the New York Presbyterian Hospital. Editorial Board of Contemporary Surgery and a Fellow of the American College of Surgeons. She is a leading expert in the field of gastrointestinal and colorectal surgery. Kathleen O'Hanlon Professor of Family and Community Health at the Joan C. Edwards Marshall University School of Medicine. Chief Editor of First Consult's procedures content. A lifelong member of the AOA Honorary Society. Her professional interests lie chiefly in procedural medicine, comprehensive patient care & teaching. David Fairchild Chief Medical Officer and Chief of the Division of General Medicine at Tufts-New England Medical Center. Associate Professor of Medicine at Tufts University School of Medicine. He has been practicing internal medicine for 20 years. In addition to his clinical and administrative duties, he is a health services researcher with an interest in quality improvement in ambulatory care settings. Barbara Blok Assistant Professor of the Division of Emergency Medicine at the University of Colorado Health Science Center. She is one of the leaders of the Wilderness Medicine Course for the University of Colorado. She has previously worked as the Associate Residency Director at the Johns Hopkins Department of Emergency Medicine, where she established her passion for resident education, emergency ultrasound training and residency administration. During her time at Johns Hopkins she was also presented with the Outstanding Contribution to Teaching and Education Award in Andrew Hull Associate Professor of Reproductive Medicine at the University of California, San Diego and Director of the UCSD Fetal Diagnosis and Treatment Center. He is a Fellow of the Royal College of Obstetricians & Gynaecologists and a leading expert in the field. He has presented his work at over 40 national and international meetings, and has been honoured with several notable awards, including the Young MRCOG Award and the Ortho Award for Outstanding Research by a Resident in Obstetrics & Gynecology.

First Consult FAQ Q. Where does the First Consult content come from? A. First Consult content is completely original and is created using its unique collaborative authoring process. collaborative authoring process Information is based on multiple sources including, but not limited to, respected textbooks, peer- reviewed articles, evidence databases, drug alerts, practice guidelines, and position papers reviewed and edited by opinion leaders in clinical practice. Our prestigious Editorial Board are all nationally recognized leaders in primary care and specialty medicine.Editorial Board Q. What evidence sources does First Consult use? A. Evidence is summarized, where possible, from systematic reviews of primary research. The main source of these is from the Cochrane Collaboration. Where a Cochrane Review or another good-quality systematic review cannot be identified, other well-regarded sources of aggregated evidence are used to identify relevant research. Otherwise, individual research papers may be identified. Evidence-based guidelines are identified by use of the National Guideline Clearinghouse or directly from the Web site of relevant learned societies, professional associations, and government organizations. Q. Does First Consult grade its evidence? A. Yes, First Consult evaluates all evidence based on a rating system derived from those produced by the American Academy of Family Physicians and the US Agency for Healthcare Policy and Research Classification. Q. How are the diagnostic tables ordered in the Differential Diagnoses section? A. Potential diagnoses for a chief complaint are displayed by age groups, and within each age group they are ordered by prevalence from most common to least common. Items displayed with an asterisk (*) should be ruled out immediately. Ordering of diagnoses is regularly reviewed by the Differential Diagnoses Editorial Board members.

Evaluation of Evidence In this rating system, in order to indicate the strength of the supporting evidence, each summary evidence statement is accorded one of three levels, or uncategorized: Level A Cochrane Reviews of randomized controlled trials (RCTs) where adequate data are found for analysis Other good quality systematic reviews or meta-analyses of RCTs where adequate data are found for analysis Good-quality RCTs Level B Other RCTs not included in Level A Other systematic reviews or meta-analyses not included in Level A Rarely, good-quality nonrandomized clinical trials, and very occasionally other types of study such as case-control studies, clinical cohort studies, cross-sectional studies, retrospective studies, or uncontrolled studies Level C Evidence-based consensus statements and expert guidelines Uncategorized Where a Cochrane Review or other systematic review or meta-analysis reviews a clinical problem but finds no adequate trials upon which to base a conclusion.

Case Study

1.Formulate an answerable question. (PICO) 由個案的臨床資料形成可回答的臨床問題 2.Track down the best evidence. (Search database) 尋找最佳的實證﹝各種文獻及資料庫，包括發表及未發表資料﹞ 3.Critically appraise the evidence for validity, impact, and applicability. (VIP) 評估各種醫學報告的可信度、臨床重要性，以及可應用性 clinical expertisepatient values 4.Integrate with our clinical expertise and patient values. 整合並應用於實際患者的治療決策﹝臨床應用﹞ 5.Evaluate our effectiveness and efficacy. 效果評估 實證醫學的五大進行步驟 Five Steps to Practice EBM

Case PICO 對於 慢性蕁麻疹 (chronic urticaria) ， Zytec 與 Allegra 的那一種治療效果比較好呢？ P Chronic Urticaria I Zytec (Cetirizine, 驅特異膜衣錠 ) C Allegra (Fexofenadine, 艾來錠 ) O Which one is better?

Acquire / Search Chronic Urticaria Cetirizine Fexofenadine

Search Resules Summary

1 Journals 2

Books

Medical Topic

52:cetirizine45:fexofenadine symptom free27(51.9%)2(4.4%) partial improvement19(36.5%)19(42.2%) no improvement6(11.5%)24(53.3%)

Lifestyle Level of Evidence

Case PICO 慢性蕁麻疹 (chronic urticaria) ， Zytec 與 Allegra 的那一種效果比較好呢？ P Chronic Urticaria I Zytec (Cetirizine, 驅特異膜衣錠 ) C Allegra (Fexofenadine, 艾來錠 ) O Zytec is better !

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