報告人：黃凡 先生 EBSCO Publishing Taiwan E-mail: mhuang@ebsochost

1. 報告人：黃凡 先生 EBSCO Publishing Taiwan E-mail: mhuang@ebsochost.com

2. Evidence-Based Medicine 明確的分析臨床問題 P I C O 病人問題P: Patient problem 介入因素I: Intervention 比較C: Comparison 結果O: Outcomes 考量最有益於病人、同時考量病人生理、心理、家庭、社會等面向之治療方式

3. Warning of EBM!!! • Not all that “evidence-based” is golden • Evidence-based information is perishable: the date of publication should be recent • Many authors and advertisers use the term “evidence-based” to sell their boo-journals and services Prof. RB Hyanes, Dec 2005

4. 符合實證基礎臨床參考資訊三要素與七大步驟 構成三要素 過程透明性 (明白指出審視的內容與過程:link to reference) 過程完整性 (有無遺漏可能的資訊?) 過程持續性 (有無持續審視相關資訊?)

5. 真正符合實證基礎的資訊 Evidence-Based Information 實證基礎七大步驟的創設團隊 Brian Alper（DynaMed創立者與總編輯） David Tovey（BMJ Knowledge Editor主編、Clinical Evidence主編） Jon Brassey（TRIP Database 編輯） Bruce Arroll（奧克蘭大學 醫療照護與業務系 系主任） 透明 Transparent 持續 Consistent 完整 Complete http://www.dynamicmedical.com/content.php

6. 7 Steps of Evidence-Based Information 1. 以系統性方法鑑別所有的實證案例並分類 Step 1: Systematic identification of evidence 2. 以系統性方法從鑑定過的實證案例選擇出各類別最佳實證案例 Step 2: Systematic selection of the best available evidence from that identified 3. 以系統性方法同時以最嚴謹的態度評價所選出的最佳實證案例 Step 3: Systematic evaluation of the selected evidence (critical appraisal) 4. 對於選出的實證案例提出準確的結論與品質鑑定 Step 4: Accurate summarization of the evidence and its quality 5. 基於這些所選擇的實證案例結論作出總結 Step 5: Making conclusions dependent on the evidence 6. 結合各個類別的實證總結成為一個完整的最後結論 Step 6: Synthesizing multiple bits of evidence for overall conclusions 7. 當有更好的實證案例出現時立即修正最後結論 Step 7: Changing the conclusions when new evidence alters the best available evidence

7. 資訊來源 每日審視逾500種的頂尖醫學期刊 、重要醫學二次文獻、 實證醫學文獻資源、藥物資訊資源、臨床診療指引 BMC Clinical Pharmacology Cochrane Database of Systematic Reviews Annals of Family Medicine American Family Physician http://www.dynamicmedical.com/sources.php

8. DynaMed – Systematic Literature Surveillance • Surveillance of more than 500 journals directly and indirectly through many journal review services • Each article is assessed for clinical relevance andeach relevant article is further assessed for validity relative to existing DynaMed content • The most valid articles are summarized, the summaries are integrated with DynaMed content,and overview statements and outline structure are changed based on the overall evidence synthesis • Systematic Literature Surveillance occurs daily

9. Daily Updated 豬流感最新更新資訊 in DynaMed

10. 最新確認案例統計confirmed case count

11. 每日更新最新確認案例

12. 點選左列Diagnosis, Treatment等最新資訊

13. 最新 Treatment 與 Medication 建議

14. 最新更新時間（美東時刻）

15. 點選Reference檢視CDC, WHO與期刊連結

16. 提供以病患為導向的資訊 Patient-oriented outcomes 提供容易判讀的實證等級 Level of Evidence:Level 1 (likely reliable) Evidence Level 2 (mid-level) Evidence Level 3 (lacking direct) Evidence 提供容易判讀的建議等級 Recommendations: Grade A recommendation (consistent high-quality evidence) Grade B recommendation (inconsistent or limited evidence) Grade C recommendation(lacking direct evidence) http://www.dynamicmedical.com/levels.php

18. Level of Evidence labels

19. 提供3,000個臨床的主題性標題 Offer clinically-organized summaries for nearly 3,000 topics • DynaMed Topics範例 • 一般與異常的疾病或是症狀（Chest Pain） • 特定議題（例:Avian Influenza, SARS） • 正在發展的最新研究或範疇（例:阿斯匹靈可降低心臟病及女性癌症罹患率） • 使用DynaMed的醫生或是專業人員的建議 同時可查詢的正在開發中的標題（in process） 新標題可能來自於DynaMed內部討團隊討論、讀者建議或是 其他可能的優秀作者。 http://www.dynamicmedical.com/organization.php

20. 內容結構基於容易使用、臨床實際應用所開發 Content is organized in an easy-to-use, clinically-practical format. • General Information (including ICD-9 & ICD-10 codes)概述 • Causes & Risk Factors致病因素及危險因子 • Complications & Associated Conditions併發症與相關症狀 • History病史 • Physical理學資訊 • Diagnosis診斷 • Prognosis預後 • Treatment治療 • Prevention & Screening預防與篩選 • References (including reviews & guidelines) 參考文獻 • Patient Information給予病患的相關資訊 http://www.dynamicmedical.com/organization.php

21. Download PDA Version

22. DynaMed PDA Index Session 5

23. 最低的教育訓練成本（近乎無需操作訓練） • 3分鐘內能讓一位臨床醫師找到答案並作好判斷 • 70%的臨床問題可由DynaMed中得到解答(Annals of Family Medicine) • 真正能在臨床診療上應用的醫學電子資源 http://www.dynamicmedical.com/medicalSchools.php

24. Research: supported by the National Science Foundation* Objective: determine if access to DynaMed helps clinicians answer more clinical questions than without access to DynaMed Method: Randomized Controlled Trial of 52 primary care clinicians; 698 clinical questions Results-1 With access to DynaMed, primary care clinicians answered moreclinical questions than without access to DynaMed With DynaMed, primary care clinicians found more answers that changed clinical decisions Answers were found in DynaMed for approximately 70% of clinical questions (far exceeds any other point-of-care resource; UpToDate answers 34% of clinical questions**) Does DynaMed Help PhysiciansAnswer More Questions? * This study is published in Annals of Family Medicine 2005 Nov/Dec; 3: 507 ** Data taken from “www.uptodate.com” on May 30, 2006

25. Results-2: Level of Evidence for answers in DynaMed met or exceeded what could be found in a combination of commonly used point-of-care references 87% of the time Conclusion:DynaMed provides the best available evidence among the most commonly used rapid references Does DynaMed Answer Physicians’ QuestionsWith Better Evidence Than the Competition? * This study is published in Annals of Family Medicine 2005 Nov/Dec; 3: 507

26. EBSCO’s Family of Medical Resources How much time does your user have to answer the question? <5 Minutes for quick answer – point of care 5-15 minutes – synoptic content >15 minutes – research databases

27. 指標用戶 英國英格蘭區域之醫院 香港地區公立醫院體系

29. Rx: Dosage& Administration, Tx: Treatment, Dx: Diagnosis （藥劑與用藥資訊）（治療）（診斷）

32. Links to PubMed

34. Links to EBSCOhost

36. Thank You 報告人：黃凡 先生 EBSCO Publishing Taiwan E-mail: mhuang@ebsochost.com TEL: 02-2729-8821