by miss joey moon ( 何宗慧 ) tel: 02-87860601#803 e-mail: jher@ebsco
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By Miss Joey Moon ( 何宗慧 ) TEL: 02-87860601#803 E-mail: [email protected]. 大綱. 何為 Dynamed Dynamed 內容 - 資料來源 - 內容架構 Dynamed 編輯群 七大步驟與證據等級 Dynamed 特色 與其他實證資料庫比較 結論. DynaMed 是什麼 …. - PowerPoint PPT PresentationTRANSCRIPT
DynaMed 是什麼…DynaMed is a clinical reference tool
designed for use by physicians and other health care professionals at the point-of-care.
( 重點、快速、正確 )
DynaMed is proven to answer most clinical questions in primary care. 1
1 (Ann Fam Med 2005;3:507)
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
Annals of Family Medicine American Family Physician
Cochrane Database of Systematic Reviews
BMC Clinical Pharmacology
http://www.dynamicmedical.com/sources.php
DynaMed 內容 - 資訊來源
http://www.dynamicmedical.com/organization.php
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, H1N1)• 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
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•Acknowledgement
http://www.dynamicmedical.com/content.php
真正符合實證基礎的資訊Evidence-Based Information
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
實證基礎七大步驟的創設團隊
透明Transparent
持續 Consistent
完整Complete
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 Steps of Evidence-Based Information
http://www.dynamicmedical.com/levels.php
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 - 美國家庭醫學分類Level of Evidence:Level 1 (likely reliable) Evidence: randomized trials with at least 80% follow up, inception cohort studies for prognostic information, systematic review of Level 1 evidence
reports. Level 2 (mid-level) Evidence: randomized trials with less than 80% follow up, non-randomized comparison studies, and diagnostic studies without adequate reference standards.
Level 3 (lacking direct) Evidence: case series, case reports, expert opinion and conclusions extrapolated indirectly form scientific studies.
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)
快速連結 Rx 、 Tx 、 Dx Rx : Dosage and Administration for Drugs 用藥資訊 Tx : Treatment 治療 Dx : Diagnosis 診斷
根據使用者的建議,更新介面,使查詢更有效率
5S EBM Resources ( 非關證據強弱 !
Model from: Haynes, R. B. (2006). Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based health care decisions. ACP Journal Club, 145(3), A8.
整合證據提供特定臨床問題之概述與建議ACP PIERBMJ Clinical EvidenceDynaMedMDconsultUpToDate
對單篇研究或回顧性文獻作摘要與評述 ACP Journal Club, Evidence-Based Medicine(PubMed, Ovid Medline)
特定臨床問題的系統性評論文獻Cochrane Database of Systematic ReviewsDatabase of Abstracts of Reviews of Effects (PubMed, Ovid Medline): Systematic Reviews
連結個別病歷的臨床知識與支援決策系統
原始文獻(PubMed, Ovid Medline, CINAHL, EMBASECochrane CENTRAL, Google ScholarCEPS 中文電子期刊 , 中文期刊篇目索引 )
3.synopses
4.syntheses
5.studies
1.systems
2.summaries
http://www.dynamicmedical.com/technical.php
透過個人電腦經由網際網路使用(院內與院外連線)
透過 PDA手機,同時支援: Palm OS, Windows Mobile, Blackberry i-Phone , i Pod Touch
多元化的使用方式