UpToDate 循证医学数据库内容说明以及使用操作

UpToDate循证医学数据库内容说明以及使用操作鄭如雅ccheng@uptodate.com大纲什么是UpToDateUpToDate主要特点EvidenceGrading证据等级检索UpToDate问题与讨论*什么是UpToDate?*填补空白*UpToDate的主要特点*使用UpToDate的医院UnitedStates美国JohnsHopkinsHospitalMayoFoundationUCLCMedicalCenterMassachusettsGeneralHospitalUniversityofCalifornia,SanFranciscoMedicalCenterAustralia澳大利亚QueenslandHealthNorthernSydneyHealthRoyalPerthHospital*亚洲使用UpToDate的医院SingaporeGeneralHospitalNationalUniversityHospital,SingaporeNationalTaiwanUniversityHospitalChangGungMemorialHospitalSeoulNationalUniversityHospital,KoreaYonseiUniversityMedicalCenter,KoreaUniversityofMalayaMedicalCenter,MalaysiaPenangAdventistHospital,MalaysiaKingChulalongkornMemorialHospital,ThailandAngkorHospitalforChildren,Cambodia*UpToDate的主要特点*EvidenceGrading循据等级In2001,webeganacollaborationwithGordonGuyatt,aworldleaderinEBM,andhiscolleaguesintheinternationalGRADEcollaborativetoimplementagradingsystemforrecommendationsUpToDategradesspecifictreatmentandscreeningrecommendations*EvidenceGrading循据等级*RECOMMENDATIONGRADES医嘱的强度Grade1StrongRecommendationBenefitsclearlyoutweightherisksandburdens(orviceversa)formost,ifnotall,patients“Werecommend…”Grade2WeakerRecommendationBenefitsandriskscloselybalancedand/oruncertain“Wesuggest…”EVIDENCEGRADES证据的品质GradeAHighQualityEvidenceConsistentevidencefromrandomizedtrials,oroverwhelmingevidenceofsomeotherformGradeBModerateQualityEvidenceEvidencefromrandomizedtrialswithimportantlimitations,orverystrongevidenceofsomeotherformGradeCLowQualityEvidenceEvidencefromobservationalstudies,unsystematicclinicalobservations,orfromrandomizedtrialswithseriousflaws检索UpToDate*NewSearch单一检索方式Searchdisplayresultstopicreviewoutput检索浏览检索结果如何使用内容输出Others其它功能Evidencegrading如何找到证据等级RECOMMENDATIONSPatientInformation卫教资料What’snew各科新知125Calculators医学电子格DrugInteractions药物交互作用HowtouseUpToDatebasedonaClinicalscenarioA50yearoldwomanisobese(BMI=32)andhashypertension.Shehasnotachievedweightlossdespitecounselingfordietandlifestylechanges.Whatisthebestmedicationforpharmacologicmanagementofherobesity.有一位50岁的女性，BMI是32,而且有高血压;她透过节食和改变生活习惯来减肥,但是失败了;现在希望可以直接吃药来达到减肥的目的;什么药物可以让她减肥又不会影响到她的高血压的症状呢?Keyword:Obesitydrug*Q&A*SpecialtiesAdultandPediatricEmergencyMedicine急诊AdultPrimaryCare&InternalMedicine一般内科AllergyandImmunology过敏免疫CardiovascularMedicine心脏内科Endocrinology&Diabetes内分泌及糖尿病FamilyMedicine家庭医学Gastroenterology&Hepatology肝胆肠胃科Hematology血液科HospitalMedicine医院医学InfectiousDiseases感染科Nephrology&Hypertension肾脏科及高血压Neurology神经内科Obstetrics,Gynecology&Women’sHealth妇产科Oncology肿瘤科Pediatrics小儿科Pulmonary,CriticalCare&SleepMedicine胸腔内科以及重症医学Rheumatology风湿科*SpecialtiesinDevelopmentDermatology皮肤科Psychiatry精神病学Surgery外科–Releasejustnow*