1. Answering Clinical Questions at the Point of Care
Introductions…
鄭 如 雅

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

3. You don’t need more information You need the right information
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 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. Evidence Grading 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 A
High Quality Evidence
Consistent 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 Evidence
Evidence from observational studies, unsystematic clinical observations, or from randomized trials with serious flaws

10. How to search

11. How to search 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. 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?

15. Q & A

16. 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.

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 and Critical Care Medicine
Rheumatology