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By Miss Joey Moon ( 何宗慧 ) TEL: 02-87860601#803 E-mail: jher@ebsco.com. 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 ….

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slide2
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
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)

slide4

DynaMed內容-資訊來源

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

slide5

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

slide6

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/organization.php

slide7

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

slide8

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

slide9

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

comparisonstudies, 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)

http://www.dynamicmedical.com/levels.php

slide14

增強搜尋功能,降低查詢時間

結合Search 與 Browse 功能,只需一個按鍵即可檢索主題與全文。

自動完成功能,關鍵字詞輸入後檢索欄位即會顯示最接近字與加快檢索速度。

slide15

根據使用者的建議,更新介面,使查詢更有效率根據使用者的建議,更新介面,使查詢更有效率

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

5s ebm resources
5S EBM Resources (非關證據強弱!

1.systems

連結個別病歷的臨床知識與支援決策系統

整合證據提供特定臨床問題之概述與建議

ACP PIER

BMJ Clinical Evidence

DynaMed

MDconsult

UpToDate

2.summaries

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)

3.synopses

特定臨床問題的系統性評論文獻

Cochrane Database of Systematic Reviews

Database of Abstracts of Reviews of Effects

(PubMed, Ovid Medline): Systematic Reviews

4.syntheses

原始文獻

(PubMed, Ovid Medline, CINAHL, EMBASE

Cochrane CENTRAL, Google Scholar

CEPS中文電子期刊, 中文期刊篇目索引)

5.studies

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.

slide17

多元化的使用方式

  • 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

http://www.dynamicmedical.com/technical.php

slide20

DynaMed主畫面

3,000+ topic

by alphabetical

slide40

10. 參考文獻

Including reviews and guidelines

thanks for your attention
Thanks for your attention!!!

報告人:何宗慧TEL: 02-87860601#803E-mail: jher@ebsco.com