micromedex2.0-華中科技大學(xué)圖書館醫(yī)學(xué)分館

1、1、據(jù)國(guó)外有關(guān)文獻(xiàn)報(bào)道，藥物不良反應(yīng)的發(fā)生率如下：（1）住院病人：10%~20%；（2）住院病人因藥物不良反應(yīng)死亡者：0.24%~2.9%；（3）因藥物不良反應(yīng)而住院的病人：0.3%~5.0%。2、有媒體報(bào)道稱“中國(guó)每年有250萬(wàn)人因藥物不良反應(yīng)入院，20萬(wàn)人死于藥品不良反應(yīng)，40%死于抗菌藥物濫用。”對(duì)此，衛(wèi)生部官員進(jìn)行了澄清，稱國(guó)家食品藥品監(jiān)督管理局藥品不良反應(yīng)監(jiān)測(cè)中心2009年和2010年分別接到的藥品不良反應(yīng)的數(shù)字是65萬(wàn)

2、和69萬(wàn)，而兩年報(bào)告的死亡病例加起來(lái)是1100例。衛(wèi)生部4月11日召開(kāi)例行新聞發(fā)布會(huì)，衛(wèi)生部醫(yī)政司副司長(zhǎng)趙明鋼在回答記者提問(wèn)時(shí)作出如上表述。,前言,1974 年成立于美國(guó)費(fèi)城, 為美國(guó) Thomson Healthcare (湯姆生衛(wèi)生保健信息集團(tuán)) 生產(chǎn)的世界上最大、最權(quán)威之事實(shí)型臨床醫(yī)藥知識(shí)數(shù)據(jù)庫(kù)成立宗旨 提供醫(yī)療專業(yè)人員實(shí)時(shí)且權(quán)威的醫(yī)藥咨詢數(shù)據(jù)庫(kù), 以期降低因醫(yī)療行為所造成的危險(xiǎn)或意外案例目前已有超過(guò) 90國(guó), 900

3、0 個(gè)醫(yī)療教學(xué)及醫(yī)療機(jī)構(gòu)使用 Healthcare 系列數(shù)據(jù)庫(kù),前言,MICROMEDEX 數(shù)據(jù)庫(kù)編輯群介紹聘請(qǐng)超過(guò) 100 名全職的臨床醫(yī)療專業(yè)人員臨床醫(yī)師藥師護(hù)理人員藥理研究專家醫(yī)學(xué)圖書館館員針對(duì)世界上1000多種醫(yī)學(xué)相關(guān)文獻(xiàn)進(jìn)行閱讀與評(píng)論, 并經(jīng)由匯整 后撰寫出極具權(quán)威性與實(shí)時(shí)性之評(píng)論文章每周更新除了固定的編輯群外, 還有遍布世界20多國(guó), 超過(guò) 400 名的臨床醫(yī)療人員提供其它專業(yè)的建議與評(píng)論,什么是循證藥學(xué),

4、循證藥學(xué)是徇證醫(yī)學(xué)在藥學(xué)領(lǐng)域的延伸和發(fā)展。是指臨床藥師通過(guò)系統(tǒng)地搜集文獻(xiàn)，評(píng)價(jià)藥物研究的證據(jù)(文獻(xiàn))，獲得藥物療效、安全性、經(jīng)濟(jì)性等方面的研究資料，評(píng)估其在制訂合理用藥方案中的作用，并以此做出臨床藥物治療決策的臨床實(shí)踐的方法與過(guò)程。作為循證醫(yī)學(xué)的一個(gè)分支領(lǐng)域，循證藥學(xué)遵循循證醫(yī)學(xué)的原則，結(jié)合臨床藥學(xué)和藥物流行病學(xué)的知識(shí)基礎(chǔ)來(lái)研究評(píng)價(jià)藥物的臨床應(yīng)用，其側(cè)重在藥物的療效、安全性、經(jīng)濟(jì)學(xué)意義等方面。循證藥學(xué)與循證醫(yī)學(xué)是緊密相關(guān)的，其研究方法

5、和對(duì)結(jié)果的評(píng)價(jià)也同樣遵循循證醫(yī)學(xué)的方法學(xué)和進(jìn)行嚴(yán)格的評(píng)價(jià)。,什么是綜述性文獻(xiàn),三次文獻(xiàn)是在一、二次文獻(xiàn)的基礎(chǔ)上，經(jīng)過(guò)綜合分析而編寫出來(lái)的文獻(xiàn)，人們常把這類文獻(xiàn)稱為“情報(bào)研究”的成果，如綜述、專題述評(píng)、學(xué)科年度總結(jié)、進(jìn)展報(bào)告、數(shù)據(jù)手冊(cè)等。 綜述是查閱了某一專題在一段時(shí)期內(nèi)的相當(dāng)數(shù)量的文獻(xiàn)資料，經(jīng)過(guò)分析研究，選取有關(guān)情報(bào)信息，進(jìn)行歸納整理，作出綜合性描述的文章。 綜述的特點(diǎn) ①綜合性：綜述要“縱橫交錯(cuò)”，既要以某一專題的發(fā)展

6、為縱線，反映當(dāng)前課題的進(jìn)展；又要從本單位、省內(nèi)、國(guó)內(nèi)到國(guó)外，進(jìn)行橫的比較。 ②評(píng)述性：是指比較專門地、全面地、深入地、系統(tǒng)地論述某一方面的問(wèn)題，對(duì)所綜述的內(nèi)容進(jìn)行綜合、分析、評(píng)價(jià)，反映作者的觀點(diǎn)和見(jiàn)解，并與綜述的內(nèi)容構(gòu)成整體。 ③先進(jìn)性：綜述不是寫學(xué)科發(fā)展的歷史，而是要搜集最新資料，獲取最新內(nèi)容，將最新的信息和科研動(dòng)向及時(shí)傳遞給讀者。,MICROMEDEX® 2.0,不只是搜尋，而是發(fā)現(xiàn)！(Not Sea

7、rching. Finding.),飛資得信息技術(shù)(上海)有限 公司FlySheet Information Services (Shanghai), Inc.上海：上海市成都北路333號(hào) 招商局廣場(chǎng)南樓13A電話：+86-21-52980395/6傳真：+86-21-52980397 北京：北京市朝陽(yáng)區(qū)朝陽(yáng)公園西 路景園小街1號(hào)景園大廈3棟12A號(hào) 電話：+86-10 65383610傳真：+86-10-65383

8、611,,全新體驗(yàn)，就在MICROMEDEX® 2.0,干凈、整齊的界面與臨床相關(guān)的檢索結(jié)果最全面的藥物信息,,傾聽(tīng)來(lái)自使用者的建議,Trusted Content 值得信賴的內(nèi)容MicroMedex提供了非常完整的臨床信息，但是有時(shí)要找到需要的信息卻有些困難Simplicity 更簡(jiǎn)單的檢索方式讓醫(yī)師、藥師、護(hù)士、治療師或者圖書館員都可使用User Interface 以用戶為導(dǎo)向的界面設(shè)計(jì)提供一個(gè)網(wǎng)絡(luò)

9、上常見(jiàn)的直觀式用戶界面Fast Answers 快速的獲得解答我們沒(méi)有時(shí)間去通過(guò)好幾個(gè)步驟才找到答案。我們需要一種可以快速、直接獲得答案的方式,,現(xiàn)在您可以輕松地訪問(wèn)最新及全面的臨床內(nèi)容你可以獲得已整合全部?jī)?nèi)容的臨床信息87％的中大型醫(yī)院都使用MicroMedex的資源MicroMedex持續(xù)被評(píng)比為最準(zhǔn)確的藥品信息資源美國(guó)毒物中心使用MicroMedex來(lái)回答每年超過(guò)1百萬(wàn)通的詢問(wèn)電話,,Trusted Informat

10、ion,值得信賴的內(nèi)容：通過(guò)臨床循證與同行審查,OVERVIEW,,詳細(xì)、 當(dāng)前及最完整的綜合臨床內(nèi)容,,,,每頁(yè)都會(huì)提供一個(gè)簡(jiǎn)單的檢索框，可快速且方便您執(zhí)行新的查詢自動(dòng)在藥物、疾病、實(shí)驗(yàn)室檢驗(yàn)、傳統(tǒng)醫(yī)學(xué)或醫(yī)療咨詢等信息內(nèi)容中作整合檢索提供常見(jiàn)的檢索術(shù)語(yǔ)，像是 ‘treatment for …’,或是 ‘causes of ….’,,Simplicity,簡(jiǎn)單:讓檢索引擎為您找到最佳答案,簡(jiǎn)單的檢索框 –用你選擇的關(guān)鍵詞來(lái)找到

11、相關(guān)內(nèi)容,在所有臨床內(nèi)容信息中找到答案–包括藥物、疾病、實(shí)驗(yàn)室檢驗(yàn)、傳統(tǒng)醫(yī)院及醫(yī)療咨詢等信息內(nèi)容,,在執(zhí)行包含多個(gè)關(guān)鍵詞的檢索時(shí)，運(yùn)用常見(jiàn)的檢索術(shù)語(yǔ)如 “cause of”或 “treatment for”來(lái)幫助找到更具體的結(jié)果,,檢索實(shí)例,,,,Intuitive,直觀：就像在互聯(lián)網(wǎng)上搜索信息一樣,內(nèi)建的檢索建議幫助我們快速的建立檢索問(wèn)題就像網(wǎng)絡(luò)上常見(jiàn)的搜索引擎一樣的操作方式提供一個(gè)干凈、整齊的用戶界面,Micromedex

12、2.0在您輸入主題或是像“treatment for”等關(guān)鍵詞時(shí)會(huì)不斷的提供檢索建議，幫助我們縮小檢索范圍并且得到關(guān)聯(lián)度較高的答案,,,直接鏈接到匯整數(shù)據(jù)、用藥信息、詳細(xì)藥物專論、全面的藥物比較、靜脈注射兼容性等多樣信息直觀的導(dǎo)覽菜單可以快速展開(kāi)或收合檢索結(jié)果依據(jù)檢索結(jié)果關(guān)聯(lián)度來(lái)更快速的獲得解答快速的進(jìn)入檢索主題的所有相關(guān)內(nèi)容,Fast Answers,,快速：更快速、簡(jiǎn)易的獲得解答,OVERVIEW,,,檢索結(jié)果會(huì)依據(jù)與關(guān)鍵

13、詞的關(guān)聯(lián)度來(lái)排列，同時(shí)直接鏈接如 “Treatment”等的相關(guān)主題,,,,點(diǎn)擊展開(kāi)相關(guān)信息或?yàn)g覽其它類別信息。也可以在左方側(cè)欄直接點(diǎn)擊展開(kāi),點(diǎn)擊瀏覽完整的藥物信息,點(diǎn)擊完整疾病信息,瀏覽其它資源,OVERVIEW,,Need even more detail? Micromedex 2.0 delivers the amount of information you need and the time you need it.,,,,

14、直接可以瀏覽循證等級(jí)及臨床問(wèn)題類型：Efficacy 有效性Strength of Evidence證據(jù)強(qiáng)度Strength ofRecommendation推薦等級(jí),提供完整的藥物信息,,,,,,,,相關(guān)疾病信息,相關(guān)檢驗(yàn)和診斷信息,Micromedex 2.0有求必應(yīng),Trusted Content值得信賴的內(nèi)容更容易利用多個(gè)主題檢索模式直接找到適當(dāng)?shù)拇鸢窼implicity更簡(jiǎn)單的檢索方式通過(guò)單一檢索框馬上找到包

15、括藥物、疾病、實(shí)驗(yàn)室檢驗(yàn)及傳統(tǒng)醫(yī)學(xué)等各方面的臨床信息User Interface以用戶為導(dǎo)向的界面設(shè)計(jì)一個(gè)直觀的用戶界面就像平常網(wǎng)絡(luò)上的搜索引擎一樣Fast Answers快速的獲得解答在可識(shí)別的檢索詞和查詢建議的協(xié)助下，快速的依據(jù)關(guān)聯(lián)度直接鏈接到解答,,,馬上體驗(yàn)MICROMEDEX® 2.0http://www.thomsonhc.com/micromedex2/librarian,,培訓(xùn)課程,瀏覽界面功能發(fā)現(xiàn)

16、MicroMedex 2.0藥物、疾病、實(shí)驗(yàn)室信息交互作用、兼容性及比較信息保存MicroMedex 2.0實(shí)例演練,,瀏覽界面功能,,,,相關(guān)資源鏈接,工具欄,輸入關(guān)鍵詞、檢索主題或句子,相關(guān)資源鏈接,1.0：返回MicroMedex 1.0界面使用MOBILE：使用手機(jī)版MicroMedexMY SUBSCRIPTION：訂購(gòu)的數(shù)據(jù)庫(kù)內(nèi)容MICROMEDEX GATEWAY：登入頁(yè)面LOG OUT：注銷數(shù)據(jù)庫(kù)HEL

17、P：在線幫助,,1.0,,,,MY SUBSCRIPTION,發(fā)現(xiàn)MicroMedex 2.0,,,發(fā)現(xiàn)MicroMedex 2.0,藥物信息完整信息特定主題商品名查詢警告信息使用咨詢疾病信息,實(shí)驗(yàn)室數(shù)據(jù)藥物交互作用多種藥物單一藥物靜脈注射兼容性藥物辨識(shí)查詢藥物比較工具,簡(jiǎn)單易使用的檢索框,關(guān)鍵詞查詢：輸入藥物、疾病或檢驗(yàn)的名稱兩個(gè)以上的藥物名稱同時(shí)查詢藥物與疾病簡(jiǎn)單的問(wèn)題/概念What is the

18、treatment for hypertensionWhat is the dosing for propofol,,,ate,,,藥物查詢,,,,快速瀏覽如給藥方式、劑量、交互作用、副作用等臨床相關(guān)內(nèi)容,,,,點(diǎn)擊上一頁(yè)回到360º View Dashboard,在左側(cè)大綱中點(diǎn)擊需要的信息,,View summary document,,View detailed document,,提供與檢索結(jié)果相關(guān)或合適使用的工具,,

19、,,,,,,,,Heart,fail,,疾病查詢,,,,,,,,,,,View detailed document,,Clinical Checklist,,,,dosa,,,,簡(jiǎn)單的問(wèn)題,空一格輸入下一個(gè)關(guān)鍵詞,nilo,,,,,,也可點(diǎn)擊其它內(nèi)容瀏覽,,,,工具欄,Drug Interactions：藥物交互作用Trissels?2 IV Compatibility：靜脈注射兼容性Drug Identification：藥物辨識(shí)

20、Drug Comparison：藥物比較Calculators：各式醫(yī)學(xué)公式及計(jì)算器,,,藥物交互作用,war,提供的交互作用信息：藥物與藥物藥物與酒精藥物與食品藥物與實(shí)驗(yàn)室藥品,,ginse,,,penic,,,,,,,,,,,,,靜脈注射兼容性查詢,提供查詢兼容性信息：使用Y型導(dǎo)管時(shí)的藥物與溶劑兼容性藥物混合使用兼容性注射給藥時(shí)的藥物與溶劑兼容性,hep,,藥物辨識(shí),可使用藥物的印痕或形狀、顏色以及大小等物理性質(zhì)辨

21、識(shí)丸劑和片劑藥物。,,藥物比較,提供藥物比較訊息：提供全方位的藥物信息比較每次可比對(duì)2種，最多可同時(shí)比較20種藥物,,各式醫(yī)學(xué)公式及計(jì)算器,提供計(jì)算工具包括：解毒劑劑量與計(jì)算模式實(shí)驗(yàn)室數(shù)據(jù)劑量計(jì)算工具臨床數(shù)據(jù)計(jì)算測(cè)量計(jì)算公式,保存MicroMedex 2.0,,實(shí)例演練,,查詢靜脈注射兼容性,Scenario:一位78歲的男性病人有高血壓以及老年癡呆的病史。到醫(yī)院就診后發(fā)現(xiàn)有高燒、高血壓以及心房纖維性顫動(dòng)的病狀。Ad

22、mitting physician starts patient on intravenous (IV) potassium chloride, IV diltiazem , IV rocephin, and ordered urine cultures.醫(yī)生決定給病人先靜脈注射intravenous (IV) potassium chloride（氯化鉀）, IV diltiazem（地爾硫卓 ) , IV rocephin(羅氏芬

23、 ）, and ordered urine cultures（尿液培養(yǎng)）.You want to double-check the IV compatibility of all prescribed drugs.,請(qǐng)你跟我這樣做……,Select Trissel’s? 2 IV Compatibility from the toolbar and build the IV profile with:Diltiazem HCLPo

24、tassium chlorideRocephinClick Check Compatibility,辨識(shí)不明藥物,Scenario:35 year female presents to ED with a high fever and no other symptoms.When interviewed about current medications, the patient hands you a box of pills

25、.You are able to identify all but one, which has an imprint of MRK on one side and 951 on the otherYou want to identify the unknown pill.,請(qǐng)你跟我這樣做……,Select the Drug Identification link on the toolbar.Type the imprint o

26、n the pill:MRK (side 1)951 (side 2) and click SEARCH.Select the COZAAR (United States) link to view drug info and drug image.,LAB INFORMATION,Scenario:You have an infant patient and have been asked to collect blood f

27、or a blood culture test. You want to know:1.How much blood is needed for this test2.What tube to use,請(qǐng)你跟我這樣做……,In the search field type blood cu, select Blood culture and click Search.Select the Blood culture link.

28、Select Collection/ Storage Information from the left hand navigation list.Scroll to the Guidelines for infants.,DRUG COMPARISIONS,Scenario:A 49 yr/old male presents in the ER with chest pain that has been occurring ove

29、r the past 48 hours. The patient’s history includes coronary artery disease, gastro esophageal reflux disease (GERD), asthma, and hypertension.一位49歲男性病人因?yàn)樾乜谕幢话才旁诩痹\病房。并且已經(jīng)發(fā)病超過(guò)48小時(shí)。病人病史有冠狀動(dòng)脈疾病、胃食管返流病、哮喘以及高血壓His current m

30、edications include Advair Diskus 1 inhalation twice daily, albuterol PRN, aspirin 325mg daily, Plavix 75mg daily, Prilosec 20mg daily, and Singulair 10mg daily. The nurse chest pain determines that the patient is 14 days

31、 post-op from a percutaneous transluminal coronary angioplasty (PTCA).他目前使用的藥物有Advair, albuterol PRN,aspirin,Plavix,Prilosec， SingulairThe patient is negative for an acute MI, and the physician has also ordered a CBC w

32、ith differential, bleeding time, and hepatic function panel to rule out potential bleeding due to concomitant anticoagulant therapy.The nurse wants to check monitoring parameters for Plavix and Prilosec, and potential d

33、rug-drug interactions for all of the patient’s medications.,請(qǐng)你跟我這樣做……,Monitoring Parameters:Select the Drug Comparison tool from the toolbar.Add Prilosec and Plavix to compare monitoring parameters for the two medicati

34、ons.Click SUBMITSelect Administration/Monitoring link to “jump to” specific information about monitoring parameters. Scroll through the monitoring section or select View Detailed Information in DRUGDEX for more detaile

35、d information.,請(qǐng)你跟我這樣做……,Interactions:Select Drug Interactions from the toolbar.Search for: Advair Diskus, albuterol, Plavix, aspirin, Prilosec, and Singulair.Click SUBMITThere is a major interaction for the concurre

36、nt use of Plavix and Prilosec.There is a minor interaction for the concurrent use of aspirin and Plavix.,DRUG DOSING,Scenario:A nurse from 4N has a patient that is being started on nilotinib hydrochloride for chronic m

37、yeloid leukemia as a result of intolerance to matinib. The physician orders 400mg orally every 12 hours and serial electrocardiograms for the patient.The nurse has never given this medication before and wants to confirm

38、 the ordered dosage and monitoring parameters.The nurse also wants to know when the electrocardiograms (ECG) should be completed and why.,請(qǐng)你跟我這樣做……,In the search field type dosage of nilo, and select nilotinib hydrochlo

39、ride.Click SEARCHSelect the Adult Dosing link to confirm the correct dosage of nilotinib hydrochlorideClick on the ADMINISTRATION/MONITORING link in the outline on the left hand side of the pageExpand the Monitoring

40、information bar for information on monitoring parameters and information on the frequency of ECGsFor more detailed information about the ordered serial ECGs and other monitoring parameters select the View Detailed Infor

41、mation in DRUGDEX located towards the top of the monitoring section,DISEASE,Scenario:You are an oncology nurse, and you are interested in learning more about the most recent guidelines for treating nausea and vomiting i

42、n chemotherapy and radiotherapy patients.,請(qǐng)你跟我這樣做……,In the search field type guidelines for nausea and vomiting and select Search.On the intermediate search results page select CHEMOTHERAPY AND RADIOTHERAPY TREATMENT GU

43、IDELINES FOR NAUSEA AND VOMITING.You are provided with a drug consult that addresses the most recent guidelines for treating nausea and vomiting.These guidelines are used as the standard of care for cancer patients and

44、 offer factual information on the incidence of nausea and vomiting due to various chemotherapeutic agents as well as the best practices in preventing and treating it.,DIRECT TO TOPIC DRUG SEARCH,Scenario:A physician is

45、treating a 52 year old female with type 2 diabetes and read that the FDA recently approved bromocriptine (溴隱亭 )for treatment of diabetes. The physician needs up to date information on bromocriptine to determine if it wou

46、ld be appropriate for the patient.,請(qǐng)你跟我這樣做……,Type indicat, pause and select indication for.Type a space and type Bromoc, pause and select BromocriptineClick SearchThe result page opens to the FDA-Labeled Indication se

47、ction of the Bromocriptine summary documentSelect the View Detailed information in DRUGDEX to view more detailed information,感謝您的參與,飛資得信息技術(shù)(上海)有限 公司FlySheet Information Services (Shanghai), Inc.上海：上海市成都北路333號(hào) 招商局廣場(chǎng)南樓