Answering Clinical Questions at the Point of Care

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Answering Clinical Questions at the Point of Care
???ccheng_at_uptodate.com
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Outline

• About UpToDate
• Evidence Grading
• How to search
• Q A

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About UpToDate

• You dont need more information
• You need the right information

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

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Quick Facts about UpToDate

• Topic reviews
• Patient information
• Drug Information
• Guideline
• Written by Physicians for Physicians

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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

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Evidence Grading
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Evidence Grading

• UTD-GRADE

RECOMMENDATION GRADES RECOMMENDATION GRADES RECOMMENDATION GRADES
Grade 1 Strong Recommendation Benefits clearly outweigh the risks and burdens (or vice versa) for most, if not all, patients
Grade 1 We recommend Benefits clearly outweigh the risks and burdens (or vice versa) for most, if not all, patients
Grade 2 Weaker Recommendation Benefits and risks closely balanced and/or uncertain
Grade 2 We suggest Benefits and risks closely balanced and/or uncertain
EVIDENCE GRADES EVIDENCE GRADES 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
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How to search
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How to search

• New search
• search ? display result ? output
• Others
• Evidence grading
• SUMMARY AND RECOMMENDATIONS
• Drug interaction
• Calculator
• Movies

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To Access UpToDate

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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 ?

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Q A
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Thank you for your attention
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Specialties

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