Using This GuideThe following document represents EBSCO’s recommended outline for a 75-minute overview training session on the main components of DynaMed™.

Session Introduction (allow 10 minutes)

Product Overview (20 minutes)

Training Content (20 minutes)

Practice Exercises (10 minutes)

EBSCO Support Site (5 minutes)

Closing (10 minutes)

This outline can be revised or amended depending upon your allotted time for the session, the level of experience using DynaMed among your participants, or which special features or points your audience wants you to include in your training session. If limited time is available, topic items highlighted in bold are suggested key points.

Note: In preparation for a training session, you may wish to refer to the “Preparing for a Training Session” Trainer Guide for general trainer and presentation tips. This document can be found on the EBSCO Support Site at http://support.ebsco.com/knowledge_base/detail.php?id=6497.

Session Introduction(Allow 10 minutes)

Welcome everyone, introduce yourself, and provide an overview of what you do in your organization, if appropriate.

Provide an overview of topics to be covered during the session and describe what you would like your audience to gain from today’s session.

Ask what additional topics they would like to learn from the training and note all suggestions on a whiteboard or the following outline, for your reference.

Mention that, later in the session, you will cover the EBSCO Support Site, a valuable, easy-to-use source of information for future reference.

Distribute the exercises provided at the end of this guide and tell the group they will have time to practice what they have learned.

Mention that you will ask them to complete a short evaluation form at the end of the session, encourage their candid feedback, and thank them in advance.

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DynaMed Overview(Allow 20 minutes)

Briefly describe the content and key features of the interface. (Please see https://dynamed.ebscohost.com/ for the most up-to-date product description.)

What is DynaMed? An evidence-based, clinical reference tool created by physicians for physicians Contains clinically-organized summaries for more than 3,200 topics Used primarily at the 'point-of-care' Content of over 500 medical journals and systematic evidence review databases is monitored on a daily

basis Utilizes strict 7-step process of systematic literature surveillance to determine the best available

evidence Provides answers that can change clinical decisions and improve outcomes Updated multiple times daily

Validity of Evidence

Point out that DynaMed provides easy-to-interpret Level of Evidence labels so users can quickly find the best available evidence and determine the quality of the best available evidence.

Levels of Evidence

Level 1 (likely reliable) Evidence - Represents research results addressing clinical outcomes and meeting an extensive set of quality criteria which minimizes bias. Examples include rigorous randomized trials, inception cohort studies for prognostic information, and systematic reviews of level 1 evidence reports.

Level 2 (mid-level) Evidence - Represents research results addressing clinical outcomes, and using some method of scientific investigation, but not meeting the quality criteria to achieve level 1 evidence labeling.

Level 3 (lacking direct) Evidence - Represents reports that are not based on scientific analysis of clinical outcomes. Examples include case series, case reports, expert opinion, and conclusions extrapolated indirectly from scientific studies.

Grades of Recommendation

Guideline producers are more frequently using classification approaches for their evidence and recommendations, and these classifications are recognized and requested by guideline users. When summarizing guideline recommendations for DynaMed users, the DynaMed Editors are more frequently using the guideline-specific classifications and providing the guideline classification approach when this is done.

Recommendations without grading systems in the underlying source (or predating this change in editorial policy) may be labeled as one of the following:

Grade A recommendation (consistent high-quality evidence)

Grade B recommendation (inconsistent or limited evidence)

Grade C recommendation (lacking direct evidence)

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This labeling scheme is formally named the Strength Of Recommendation Taxonomy (SORT) and is described in detail, along with the algorithms used for its application, in Am Fam Physician 2004 Feb 1;69(3):548-56.

Best Available Evidence

Evidence-based is a descriptor that is often used to describe medically-related reference resources. Unfortunately, it is often used indiscriminately and without merit. For a clinical reference resource to truly be called evidence-based, conclusions must be based on the best available evidence. Conclusions can be based on the best available evidence only if the evidence is consistently and systematically identified, evaluated and selected. The following steps are part of the DynaMed editorial process:

1. Identify all applicable evidence

2. Select the best available evidence

3. Critical appraisal

4. Objectively reporting the evidence

5. Synthesize multiple evidence reports

6. Base conclusions on evidence

7. Update relevant topics

(Detailed explanations and examples of each step and be found in DynaMed under “About” on the toolbar).

Organization of DynaMed Content

Physicians are trained to approach patient care in a logical process. Explain that content is organized in a clinically practical format. A “topic” in DynaMed is a clinical summary of an area of information with a defined scope. Topic content is organized in an easy-to-use, clinically-practical format and follows a standardized template. DynaMed topics are based on:

Common and uncommon diseases & conditions (e.g., abdominal aortic aneurysm)

Symptoms (e.g., chest pain)

Other clinically-important topics (e.g., breast feeding, cardiac stress testing)

Specific popular interest (e.g., West Nile Virus, Anthrax, SARS)

New scope of information based on developing research (e.g., metabolic syndrome, D-timer testing)

Suggestions and feedback from DynaMed users

Revisions of pre-existing topics are prioritized by frequency of user searches. New topics added to DynaMed are determined by the clinical editorial team and feedback from users.

DynaMed Search/Browse Options

Keyword Search - Enter keyword, partial term, or multiple terms/phrases

Browse Topic Titles Alphabetically using the A-Z links

Browse by Category Name - Use Browse Categories Link

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Search Other Services

You can set up links to other EBSCO services (EBSCOhost, Nursing Reference Center, etc.) as well as links to professional organizations from the Home page.

These links will open in a new window

Up to 20 links can be entered

Must be configured by the DynaMed administrator or EBSCO Customer Support

For instructions, click here: Customize Search Other Services

DynaMed via Mobile Device

DynaMed is available in a mobile-device application compatible with devices such as Android, iPhone, iPad, iPod Touch and others. Point out that the entire application can be loaded and installed within 10 minutes.

A DynaMed serial number will be required to install this application. Click this link: Obtain a DynaMed Serial Number

For technical requirements and complete installation instructions, click on the “Mobile” link in the DynaMed tool bar.

NOTE: Users who prefer to access DynaMed via the web-based interface can do so using the browser on their mobile device. They will need a username and password to authenticate.

DynaMed Home Page

Show the Home Page and briefly list the key features and functionality

Key Features

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DynaMed Search Box – Search by keyword

A-Z Browse – Browse by alphabet

Category Browse – Browse by category/specialty area

Spotlight Section – Highlights clinically relevant news – updated regularly

Search Other Services – Provides access to other resources/websites

Branding – Add institutional logos & graphics to the DynaMed interface

Home – Click to return to DynaMed Home Page

Recent Updates – View list of topics that have been updated

E-Newsletter – View/subscribe to the DynaMed Weekly update newsletter

Mobile – Information on accessing DynaMed on via mobile device

Calculators – Medical Equations, Clinical Criteria, Decision Trees, Unit/Dose Converters

Send Comment – Send question/comment to the DynaMed editorial team

About DynaMed – Learn more about Content/Editorial Process, DynaMed Content Sources, Becoming a Reviewer, Editorial Team, List of Reviewers

Help – View the complete on-line Help system for DynaMed

Training Content(Allow 20 minutes)

Searching in DynaMed – Keyword(s) Search

DynaMed searches titles for a search term or phrase, and also searches the full text within each DynaMed topic.

Enter a keyword(s) in the Search Box and click Search.

Spell-checker may suggest alternate terms if no results are found

If a partial term is entered, a drop down list will suggest topics

A result list containing the keyword(s) (or topics containing keywords) will be displayed

Viewing Results

Provide an overview of the Result List layout:

Hover over the desired topic title to preview table of contents for each topic

Use icon to expand a section or subsection

Click on a topic title to view full DynaMed topic

Navigate topic sections using the left navigation feature

Search within the text of a topic to find all instances of a particular term

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Create an alert to be notified when the topic is updated using this icon

Print or email topic

Use Persistent Link (access using this icon ) to copy/paste link to email or webpage

Change the default font size of the text by using

Browsing in DynaMed

Browse topic titles alphabetically

Use the A-Z links to browse for topic titles alphabetically.

A result list of topics beginning with the letter you clicked is displayed

Browse by category name

Use the Browse Categories link

A list containing available DynaMed categories is displayed

Sub-categories can be displayed using the icon

Linking in DynaMed

List the ways users can access other resources directly from DynaMed. An example of this will be provided in the Practice Exercises on page 11.

Access related search results from other EBSCO databases – i.e. Medline, Cochrane, PERC, etc. (only applicable if your institution subscribes to these resources and the feature is configured in admin)

Access PubMed for abstracts or full text articles where available via hyperlinks provided within context of a DynaMed topic

Access full text articles via EBSCOhost within the context of a DynaMed topic (subscription required)

Link to calculators via a direct link from the topic

Link to drug topics (when applicable) via links in the treatment/medication subsection

Recent Updates

DynaMed is updated daily. To view the topics that have been updated:

1. Click on the Recent Updates Link from the tool bar on the home page. Updates are displayed in descending order with the most current update at the top.

2. To filter by specialty, click on the “Limit by Category” option.

3. To filter by Practice Changing Updates, click the box.

4. Practice changing updates are articles added to DynaMed which may lead a clinician to change practice patterns or medical decisions.

Using Calculators

DynaMed includes over 500 interactive calculators, equations and decision trees.

1. From any screen, click on the Calculators link in the top toolbar

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2. Select a calculator from the browser window

3. Enter figures into the calculator. The result is automatically generated, and interpretation information and references are included.

CME Options

DynaMed users can earn AMA PRA Category 1 Credit™, AAFP Prescribed credit and AANP contact hours for using DynaMed to research clinical questions. There are a number of ways in which institutions can provide CME to DynaMed users:

CME Basic: This option is for institutions that are accredited CME providers. User searches are submitted via DynaMed to the institution’s CME coordinator, who issues the credit.

CME Plus: This option is also for institutions that are accredited CME providers. User searches are submitted via DynaMed to a specified CME system or form, and the institution issues the credit.

CME Complete: User searches are submitted via DynaMed to our CME partner, Tufts Healthcare Institute. Tufts issues the credits and users can log in to the Tufts CME tracking system to access, print and track credits earned.

CME for Canadian Users: DynaMed meets the accreditation criteria of The College of Family Physicians of Canada (CFPC) and has been accredited for up to .5 CFPC Mainpro®-M1 Credits for each search submitted from DynaMed. NOTE: This option is turned on by default for all Canadian DynaMed subscribers.

DynaMed Weekly Update: Readers of DynaMed Weekly Update can receive .25 AMA PRA Category 1 Credit, .25 AAFP Prescribed credits, or .25 AANP contact hours. (Note: you do not have to be a DynaMed subscriber to receive the DynaMed Weekly Update.)

To use the DynaMed Basic, Plus or Complete CME options, you must enable the feature. Contact DynaMed Support at DynaMed support@ebscohost.com for more information.

Accessing DynaMed via Electronic Health Record

EBSCO offers a number of integration options to provide access to DynaMed content directly from electronic medical records systems, giving clinicians the evidence they need at the point-of-care. DynaMed has been integrated with Allscripts, Cerner, Epic, Eclipsys, GE, McKesson, MEDITECH and many other systems.

EBSCO provides a number of levels of access and integration points to DynaMed via EMR systems; however, options will vary from system to system, so be sure to check with your vendor to determine which options are possible at your institution. For more information please contact DynaMed Support at DynaMed support@ebscohost.com .

DynaMed Exercises

Conduct a Keyword Search on “AAA” (Abdominal aortic aneurysm)

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1. Enter ‘AAA’ in the DynaMed Search Box and click ‘Search’ or press enter.

2. Point out that the results are presented in relevance order.

3. Using the hover feature, show the Table of Contents for Abdominal aortic aneurysm (AAA).

4. Expand the Treatment section using

5. (If configured) demonstrate how to access a topic from the result list from other EBSCO databases in the right column.

6. Click on the Abdominal aortic aneurysm (AAA) title in the left column to open the topic.

Navigate topics

1. Note the most current update at the top.

2. Click the ‘View Update’ link to go directly to the update details.

3. Click “Show more updates” to see previous updates.

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4. Click on the Level of Evidence link in Blue to interpret the level of evidence for this update.

5. Click on ‘Treatment’ link in the left column to view all treatment subsections.

6. To view additional search results relating to AAA, use the arrow keys on the result tab.

7. Enter “EVAR” into the ‘Search within the Text’ box

Note the number of instances that the term EVAR is found in the text.

The topic sections are expanded and the active instance of the term is highlighted in green. Additional instances are highlighted in yellow.

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Use the Previous/Next to navigate each instance of EVAR in the topic.

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Conduct a search on ‘Alcoholic Cirrhosis’

1. Click on ‘Treatment’ and then click ‘Surgery’

2. Find MELD On-line Risk Calculator link under Liver Transplantation

3. Click on ‘DynaMed Calculators’ show the calculator for the MELD (Model of End-Stage Liver Disease) Score.

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Recent Updates Page

1. Click on the ‘Recent Updates’ link in the top toolbar

2. Filter by the specialty, ‘Cardiovascular Disorders’

3. Click on the first topic to view it

4. Click the “back” option in the topic to return to the Recent Updates page

5. Filter by ‘Practice Changing Updates Only’

6. Click on the Persistent link icon and copy/paste the link to an email

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Create an alert for Abdominal aortic aneurysm (AAA)

1. Enter ‘AAA’ in the DynaMed Search Box and click ‘Search’ or press enter

2. Click on “Abdominal aortic aneurysm (AAA) topic title

3. Click on the alert icon

4. Select the alert frequency from the How often drop-down menu and enter your e-mail address in the field provided.

5. Click Create Alert.

NOTE: Once the alert is created, the user will receive an email to “verify” the request to set up an alert. Once verified, the user will receive alerts based on the frequency requested. Every alert email includes a link that allows you to cancel the alert at any time (a one click process).

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The EBSCO Support Site(Allow 5 minutes)

(http://support.ebsco.com)

Demonstrate the EBSCO Support Site via the link in the upper right corner of the Select Service Screen in EBSCOhost. You may also access via the link at the bottom of any page in an EBSCO interface.

The Support Site provides an abundance of customer support information, including:

Top Stories are available through RSS feed notification. To subscribe:̶� Drag the orange RSS button into your News Reader.̶� Drag the URL of the RSS feed into your News Reader.̶� Cut and paste the URL of the RSS feed into your News Reader.

Knowledge Base̶� Click Browse Services for an alphabetical list of or select DynaMed from the services drop-down

menu.̶� Browse results list to access FAQs, help sheets, user guides, etc.

Training̶� Select the Training link on the Support Site toolbar.̶� The following training tools are available, select the title to view more choices:

On-Demand Training Videos and Tutorials Trainer Guides Custom Training

Online Training Courses User Guides Help Sheets International Training Sites International Resources

Promotional Resources̶� Select the Promotion Tools link on the Support Site toolbar.̶� Browse product-specific tools – including logos, buttons, posters, flyers, bookmarks, and more – to

help you promote your online resources.

Customer Success Stories and Tools̶� Select the Customer Success link on the Support Site toolbar.̶� Browse Customer Success Stories. Read these best practices case studies to see what EBSCO

customers are accomplishing.̶� Browse tools for Students, Teachers, and Librarians.

Request Printed Materials̶� Select the Contact link on the Support Site toolbar.̶� Under Requests, click Request Printed Materials.̶� Enter quantity of items requested, complete form, and click Submit.

Materials will be shipped to the address entered in the form.

Contact / Email Support̶� Find Hours / Phone Numbers.̶� Form generates an automatic inquiry to Technical Support.

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Case Scenarios

DynaMed - Case Scenario #1 - RLS: Diagnosis, Treatment, Evidence, Educationhttp://support.ebsco.com/knowledge_base/detail.php?id=4222

DynaMed – Case Scenario #2 - Perioperative Guidelines for Prophylaxis of Venous Thromboembolismhttp://support.ebsco.com/knowledge_base/detail.php?id=4223

DynaMed - Case Scenario #3 - Comparing Clinical Prediction Rules for Likelihood of Pulmonary Embolismhttp://support.ebsco.com/knowledge_base/detail.php?id=4224

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Closing(Allow 10 minutes)

1. Restate the objectives of the session as outlined in the beginning and note how they have been accomplished.

2. Reinforce key points.

3. Solicit questions from participants to be sure that everyone appears comfortable with the information you have covered during the session.

4. Briefly discuss ways in which this resource can be promoted at the institution. Provide tips, suggestions, and examples, and direct participants to the Promotion section of the Support Site, as well as the searchable Knowledge Base.

5. Review each source of available assistance and additional information:

Contact EBSCO Technical Support Department:

Telephone U.S. or Canada: (800) 758-5995

Telephone outside the U.S. and Canada: access code + (800) 3272-6000

Email EBSCO Tech Support: support@ebsco.com

Email via the EBSCO Support Site using the E-mail Support link along the top toolbar or the following link: http://support.ebsco.com/contact/askus.php

Remind participants to check EBSCO Support Site: http://support.ebsco.com

Review tutorials on the EBSCO Support Site: http://support.ebsco.com/training/tutorials.php

Contact you or another contact at your organization directly.

6. Hand out evaluation forms (http://support.ebsco.com/knowledge_base/detail.php?id=6474) to participants and ask for their candid feedback.

7. Collect the completed evaluation forms.

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