mission committed to improving patient care by providing the most current clinical evidence to...
TRANSCRIPT
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MISSIONCommitted to improving
patient care by providing the most
CURRENT CLINICAL
EVIDENCE TO CLINICIANS so they can make the best decisions
for their patients.
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The Next Generation Clinical Information Resource
• Re-created from the ground up
• New physician leadership
• New platform
• New search algorithm
• New interface
• New content
• New features
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…Not a textbook
A TOOL Created by
physicians who are
EXPERTSin their
respective fieldswho provide
OBJECTIVE ANALYSIS of the evidence & recommendations
in an easilydigestible format
with access anytime, anywhere from any device or system
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to DynaMed vs. UpToDate
• It doesn’t tell me what to do
• Lack of expert reviewers
• Lack of specialty content
• There are no images
• It’s hard to get an answer quickly
TOP FIVE OBJECTIONS
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It doesn’t tell mewhat to do
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OVERVIEWS AND RECOMMENDATIONS
• Overviews and Recommendations provide clinicians with concise, accurate overviews for highly relevant topics and evidence-based recommendations for action.
• Topics have been re-written from scratch to provide immediate context and direction
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New Overviews and Recommendations at the topNew Overviews and Recommendations at the top
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DynaMed Plus offers many examples of strong and weak recommendations
Clicking on a link provides the user with levels of evidence and guidelines behind each recommendation
DynaMed Plus offers many examples of strong and weak recommendations
Clicking on a link provides the user with levels of evidence and guidelines behind each recommendation
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DynaMed Plus provides links to the levels of evidence and the guidelines behind each recommendation
DynaMed Plus provides links to the levels of evidence and the guidelines behind each recommendation
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The GRADE (Grading of Recommendations Assessment,
Development and Evaluation) system was created in 2000
by a dedicated group of guideline developers.
RECOMMENDATIONS
are graded as Strong or Weak
EVIDENCE
is graded for the body of evidence as High, Moderate, Low or Very low quality (A, B, C, or
D).
QUALITY
grading for evidence is based on the risk of bias introduced by study methodology, the
precision the consistency of studies, the directness to the conclusion being made, and the
likelihood of publication bias.
What is GRADE?
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GRADE is now the standard
• WHO
• The Endocrine Society
• ACCP
• ACP
• American Thoracic Society
• NKF/KDOQI
• KDIGO
• Norwegian Knowledge Center / Norwegian Directorate of Health
• Canadian Cardiovascular Society
• IDSA
• CDC
• AGA
• AASLD
• ICSI
• NICE
• SIGN
• NHS
• Kaiser Permanente
• Dutch College of GPs
• Multiple Red Cross groups
GUIDELINE GROUPSMore than 80 of the world’s leading organizations which produce guidelines formally use GRADE:
SYSTEMATIC REVIEWS Independent systematic
review organizations such as Cochrane have
incorporated GRADE
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DynaMed Plus
EVIDENCE-BASED METHODOLOGY
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Lack of expert reviewers
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LEADERSHIP
BRIAN S. ALPER, MD, MSPH, FAAFPFounder of DynaMed, VP of EBM Research & Development, Policy and Content Quality, EBSCO Information Services, Clinical Research Assistant ProfessorDepartment of Family and Community Medicine, University of Missouri School of MedicineColumbia, MO
SHEILA BOND, MD Deputy Editor of Infectious Disease, Clinical Instructor in MedicineHarvard Medical SchoolBoston, MA
ALAN EHRLICH, MD Executive Deputy EditorAssistant Clinical Professor in Family Medicine, University of Massachusetts Medical SchoolWorcester, MA
KEVIN LOUGHLIN, MD, MBA, MA(HON)Deputy Editor of Oncology and Hematology, Senior SurgeonBrigham & Women's HospitalProfessor of Surgery, Harvard Medical School, Boston, MA
PETER OETTGEN, MD, FACC Deputy Editor of CardiologyDirector of Preventative Cardiology, Beth Israel Deaconess Medical Center, Associate ProfessorHarvard Medical SchoolBoston, MA
Editorial
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FULLY INTEGRATED EXPERTS
• An extensive network of physicians
• Experts in their particular fields
• Select the best and most appropriate evidence
• Confirm the clinical applicability of content
• Peer-review topics
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Matthew Coggins, MDInstructor of CardiologyHarvard Medical SchoolBeth Israel Deaconess Medical Center
Kevin Ard, MDInstructor of MedicineHarvard Medical SchoolAssistant in MedicineDivision of Infectious DiseasesMassachusetts General Hospital
Jennifer Johnson, MDInstructor in MedicineDivision of Infectious DiseasesHarvard Medical SchoolBrigham and Women's Hospital
Muhammad Mir, MD, FACPAssistant Professor of Hematology and Blood/Marrow Transplant Penn State UniversityMilton S. Hershey Medical Center
Obinna O. Adibe, MDAssistant Professor of Pediatric SurgeryDuke University Medical Center
Michelle Lin, MDAssociate Professor of Clinical Emergency MedicineAcademy Endowed Chair for Emergency Medicine EducationUniversity of California San Francisco
Jennifer Nan-Wah Wu, MDInstructor of Pediatric OncologyDana-Farber Cancer InstituteBoston Children's Hospital
Dawn Abbott, MD, FACC, FSCAIAssociate Professor of Medicine, Brown UniversityDirector of Interventional Cardiology FellowshipRhode Island and Miriam Hospitals
Christian Jackson, MDAssistant Professor of GastroenterologyLoma Linda UniversityChief of GastroenterologyLoma Linda VA Healthcare System
Kenneth Weiss, MD, FACPProfessor of MedicineCleveland Clinic Lerner College of Medicine
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Physician Executive Board
We have established an
EXECUTIVE BOARD
charged with advising on editorial, EBM, and
editorial policy
Members represent JAMA, McMaster,
Penn, Emory, MGH, ACP and other
healthcare organizations.
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Betsy JonesVice President of Medical Product Management and Chief Content Officer, EBSCO Health
Michael Berkwits, MD, MSCEDeputy Editor for JAMA
Robert M. Centor, MD, MACPChair of the Board of Regents for the American College of Physicians
Julie Hollberg, MDCMIO for Emory Healthcare
William A. Kormos, MD, MPHChief of Medicine at the James Howard Means Firm, Department of Medicine
Holger Schünemann, MD, MSc, PhDProfessor and Chair of the Department of Clinical Epidemiology & Biostatistics
Ilkka Kunnamo, MD, PhDFounder and Editor-in-Chief of EBM Guidelines and EBMeDS decision support program
Amir Qaseem, MD, PhD, MHA, FACPDirector of the Department of Clinical Policy at the American College of Physicians
Dr. Surendra K. Sharma, MBBS, MD, PhDChief of the Division of Pulmonary, Critical Care, and Sleep Medicine at the All India Institute of Medical Sciences
Craig Umscheid, MD, MSCEAssistant Professor of Medicine and Epidemiology at the University of Pennsylvania School of Medicine
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Lack of specialty content
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Editorial team structure
• General Internal Medicine
• Cardiology/Pulmonology/Critical Care
• ID/Immunology
• Oncology/Hematology
• Emergency Medicine
SPECIALTY PUBLISHING GROUPS:
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Editorial team structure
• Harvard University
• Massachusetts General Hospital
• Beth Israel Deaconess Hospital
• Yale
• Brigham and Women’s Hospital
• Dana Farber Cancer Institute
• University of California San Francisco
• Cleveland Clinic
EXPERTS RECRUITED FROM:
AND MORE…
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ROBUST SPECIALTY CONTENT
• Allergy
• Cardiology
• Critical Care
• Dermatology
• Infectious Disease
• Emergency Medicine
• Endocrinology
• Gastroenterology
• Hematology
• Nephrology
• Obstetrics and Gynecology
• Oncology
• Orthopedics
• Pediatrics
• Primary Care
• Psychiatry
• Rheumatology
• Sports Medicine
• Surgery
• Urology
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There are no images
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DynaMed Plus includes more than 4,000 images with more than 2000 from ACP. Images are searchable as well as embedded in relevant topics
DynaMed Plus includes more than 4,000 images with more than 2000 from ACP. Images are searchable as well as embedded in relevant topics
Selecting an image provides the user a larger viewSelecting an image provides the user a larger view
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It’s hard to get an answer quickly
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employs a brand-new, proprietary, semantically-
powered search engine, significantly improving
discoverability and speed-to-answer
Precise Search Results Search
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DynaMed Plus employs intelligent auto-suggest, which identifies the user’s query and allows direct navigation to highly-accessed areas within topics
DynaMed Plus employs intelligent auto-suggest, which identifies the user’s query and allows direct navigation to highly-accessed areas within topics
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Convenient filters allow quick access to images and calculators that are relevant to the user’s query
Convenient filters allow quick access to images and calculators that are relevant to the user’s query
DynaMed Plus offers superb navigation within the results display
With exact-match queries, DynaMed Plus displays a medical information placard, offering topic-specific links, images, and information
DynaMed Plus offers superb navigation within the results display
With exact-match queries, DynaMed Plus displays a medical information placard, offering topic-specific links, images, and information
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By understanding the user’s intent, DynaMed Plus’ intelligent search is able to identify queries that yield robust image results and display them in a time-saving image carousel
By understanding the user’s intent, DynaMed Plus’ intelligent search is able to identify queries that yield robust image results and display them in a time-saving image carousel
This same technology presents the user with query-specific calculators
This same technology presents the user with query-specific calculators
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Grouped results allow the clinician to quickly understand the context of the result
EXAMPLE: Result shows Pulmonary embolism within the Heart failure with reduced ejection fraction topic, and the path provides the context to understand that the result refers to treatment medications
Grouped results allow the clinician to quickly understand the context of the result
EXAMPLE: Result shows Pulmonary embolism within the Heart failure with reduced ejection fraction topic, and the path provides the context to understand that the result refers to treatment medications
Relevant results will navigate users directly to the specific section within DynaMed Plus’ clinically relevant outline-based structure
Relevant results will navigate users directly to the specific section within DynaMed Plus’ clinically relevant outline-based structure
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Topic view offers next-generation navigation, providing immediate context to the user
Topic view offers next-generation navigation, providing immediate context to the user
Location within the topic is dynamically updated both in the navigation bar, as well as within the breadcrumb trail at the top of the screen
Location within the topic is dynamically updated both in the navigation bar, as well as within the breadcrumb trail at the top of the screen
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DynaMed Plus offers all of the same quick-access features users have come to expect, including search within and highlighting
DynaMed Plus offers all of the same quick-access features users have come to expect, including search within and highlighting
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DynaMed Plus employs a
FULLY RESPONSIVE DESIGN, which means it renders ideally for
any device or orientationiPhone Small Tablet iPad - Portrait iPad - Landscape
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iPhone
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Small Tablet
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iPad - Portrait
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iPad - Landscape
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EHR IntegrationEHR Integration
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EBSCO Health listens to the needs of our customers
and users which helps us build better products
overviews and recommendations
well-known expert reviewers
increased breadth/depth of specialty content
multimedia content
better search & discovery
DynaMed Plus has….
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MICROMEDEX DRUG CONTENT
• Medication Management Standard Drug Information
• Drug Information for Medication Safety
• IV Compatibility for Reduced Complications
• Lab Recommendations
Micromedex evidence-based content is presented in concise,
sourced, and referenced blocks of information to help you get
answers quickly when the situation demands.
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ACP Partnership
• ACP clinical leadership develops and maintains DynaMed Plus internal medicine topics
• Multiple members of ACP are part of the DynaMed Plus Executive Board
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Access anywhere, anytime
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Graphics & Images
Access thousands of graphics and images
Precise Search Results
Get precise search results every time
Overviews & Recommendations
Read concise overviews and detailed recommendations
Specialty Content
DynaMed Plus includes robust specialty content
Expert Reviewers
Deputy Editors are supported by an extensive network of clinical experts
Mobile App
The mobile app is complimentary with every subscription, at no extra cost
Drug Content
Drug content to help with diagnosis with Micromedex® Clinical Knowledge Suite
SUMMARY OF NEW FEATURES
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Resources to Consider:
ACP Pier
BMJ Point of Care
Cochrane Library
DynaMed
Up-to-Date
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Round 1
Who can find the answer most quickly? Use any resource.
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Round 1, Question 1
• Is glatiramer acetate effective for relapsing-remitting multiple sclerosis? How does it compare to interferon beta?
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Round 1, Question 2
What antibiotic should you use for a pregnant woman with acute cystitis?
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Round 1, Question 3
• What is the dose of famciclovir for treating zoster in an immunocompetent patient?
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Round 1, Question 4
• Are graduated compression stockings effective for reducing the risk for venous thromboembolism after acute stroke?
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Round 1, Question 5
• You have a new patient who is an adolescent with obsessive-compulsive disorder. Her parents state this is due to a strep throat. What are the criteria for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection (PANDAS)?
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Round 1, Question 6
• How do you diagnose chronic fatigue syndrome?
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Round 1, Question 7
• A 45-year-old man complains of shortness of breath for two hours and there was a sudden onset. Two days ago he traveled 12 hours by airplane. He has no history of prior thromboembolism, cancer, or other medical conditions. He has tachycardia (pulse 106 beats/minute) but otherwise normal findings on physical examination. Would you classify his risk for pulmonary embolism as high, intermediate, or low?
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Round 1, Question 8
• For the man with an intermediate risk of pulmonary embolism, what testing should you do? Consider the resources available for testing in your setting.
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Round 1, Question 9
• How do triflusal and cilostazol compare to aspirin for secondary prevention of stroke in a patient with a history of transient ischemic attacks (TIAs)?
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Round 1, Question 10
• What is the most effective antibiotic for uncomplicated symptomatic urinary tract infection in women?
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Round 2
• Check different resources to see if the answers are consistent. If not, why not?
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Round 2, Question 1
• A 3 year-old girl weighing 13.3 kg (30 lbs) has rotaviral gastroenteritis and moderate dehydration. How do you start fluid replacement?
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Round 2, Question 2
• A man complains of sudden sensorineural hearing loss. You prescribe steroids. Should you also include antiviral therapy as part of your treatment plan?
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Round 2, Question 3
• You are establishing a protocol for response to patients who develop anaphylaxis in your medical practice. The nurse asks if epinephrine administration can be given subcutaneously instead of intramuscularly. Is there a difference in efficacy between the subcutaneous and intramuscular routes?
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Round 2, Question 4
• You are seeing a 22-month-old boy in follow-up after treatment for a urinary tract infection (UTI). He was found to have grade II vesicoureteral reflux (VUR). You wonder if you should start an antibiotic for prophylaxis, and if so, which antibiotic?
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Round 2, Question 5
• How do you diagnose irritable bowel syndrome (IBS)? What evaluation is indicated?
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Round 2, Question 6
• You diagnosed irritable bowel syndrome. Is fiber an effective treatment?
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Round 2, Question 7
• Do antihypertensive medications reduce cardiovascular events in a patient with mild hypertension (blood pressure 145/95 mmHg) and no other cardiovascular risk factors?