MD Consult & First Consult

1. MDConsult& FirstConsult Presented By: 莊俊彥Andy Chuang a.chuang@elsevier.com 0932.204.079

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

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

4. What is MD Consult? • (49) Leading medical reference BOOKS • Evidence based answers for the point of care – FIRST CONSULT • (89) 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

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

6. 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

7. 49 Reference Books

8. 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

9. 實證期刊（EBM Related Journals） • Evidence-based Cardiovascular MedicineFull text available from April 1997 - June 2006 • Evidence-based Health Policy & ManagementFull text available from March 1997 - December 1998 • Evidence-based Healthcare and Public HealthFull text available from October 2004 - December 2005 • Evidence-based Healthcare: A Scientific Approach to Health Policy Full text available from March 1999 - August 2004 • Evidence-based Obstetrics & GynecologyFull text available from March 1999 - September 2006 • Evidence-based OncologyFull text available from March 2000 - December 2002

10. Searching Tips for Journals and The Clinics

11. Search Journals/MEDLINETips 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.

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

14. 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.

15. 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

16. 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

17. 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…

18. 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

19. 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

21. 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

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

23. Newsletter

24. 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

25. 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

26. 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

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

28. 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

29. First Consult Collaborative Authoring Process

30. 瀏覽 Medical Topics

31. Differential Diagnosis

33. 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 1990. • 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 2006. • 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 1985. 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 2003. He was also included in the Best Doctors in America selection for 2003-4, 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.

34. 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 2005. • 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.

35. 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.    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. • 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.

36. 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.

37. Case Study

38. 實證醫學的五大進行步驟Five Steps to Practice EBM • Formulate an answerable question. (PICO) 由個案的臨床資料形成可回答的臨床問題 • 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﹞ • 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 • 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﹞ • Evaluate our effectiveness and efficacy. 效果評估

39. Case • 對於 慢性蕁麻疹(chronic urticaria)， • Zytec與Allegra的那一種治療效果比較好呢？ PICO

40. Acquire / Search Chronic Urticaria Cetirizine Fexofenadine

41. Search Resules Summary

42. 1 2 Journals

43. Books

44. Medical Topic

50. Lifestyle Level of Evidence