secondary evidence based medicine rsources sc
DESCRIPTION
A hyperlinked Ppt presentation on Evidence-based secondary resources.TRANSCRIPT
Secondary EBM
Resources
Dr. Imad Salah Ahmed Hassan MD FACP FRCPI MSc MBBSChairman, Knowledge Translation Committee
Department of Medicine, KAMC,KSA
What is Best Evidence? Hierarchy of Levels of Evidence
Acquire the Best Evidence:Finding the Best Evidence First
Hierarchy of Sources of Evidence Pyramid
Pre-appraised, systematic reviews: Cochrane
Databases with EBM background: CKS, Essential Evidence Plus ®, DynaMed®, ACP’s PIER, BMJ Best Treatment, Guidelines Clearinghouse, Guidelines Finder Highly referenced, current e-
textbook: Up-to-Date
Standard e-textbooks (emedicine)
Primary Resources: PubMed (Clinical Queries), Medline
Pre-appraised, individual studies: ACP Journal Club
*Adapted from Shaughnessy and Slawson
Acquire the Best Evidence:Finding the Best Evidence First
Hierarchy of Sources of Evidence Pyramid
Pre-appraised, systematic reviews: Cochrane, DARE, Clinical Evidence, EPC Evidence Reports (in AHRQ)
Databases with EBM, background, and guideline info.: EvidencePlus, DynaMed®, ACP’s PIER, Guideline Clearinghouse and USPSTF (in AHRQ), NICE
Highly referenced, current e-textbook: Up-to-Date, Scientific American
Standard e-textbooks (emedicine), PDA e-textbook
PubMed (Clinical Inquires), Medline
Pre-appraised, individual studies: ACP Journal Club
*Adapted from Shaughnessy and Slawson
2009 NCKUFM-YCY
Systematic ReviewCochrane reviews
Evidence based journals EBM, EBN, EBMH, ACP J club
Computerized Decision Support System (CDSS)
5S Information Resources: Information in top 4 are used
Original articles: BMJUpdates, PubMed Clinical Queries
Evidence based textbooks: UpTo Date, DynaMed, ACP PIER, BMJ Clinical Evidence
Studies
Syntheses
Synopses
Summaries
Systems
Haynes, R. (2006, November). 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-A9.
POCRaTs
What are Point-of-Care R &T?
Point-of-care resources and tools are those research and reference utilities that a clinician can employ immediately at the point-of-care with a patient: (Clinic, ward, home, ER etc) .
They are often easy to use and contain filtered information.
Most of the evidence-based point-of-care tools include levels of evidence, rating scales or grade recommendations as well as citations back to the original research studies, systematic reviews, or guidelines.
Point of
Care Clinica
l Resources
•EBM-based Summaries (regularly updated e-text books)
Point of
Care Clinica
l Resources
•Systematic Reviews & CATs Websites
Point of
Care Clinica
l Resources
•Clinical Pathways & Protocols
Point of
Care Clinica
l Resources
•Decision Tools
Point of
Care Clinica
l Resources
•Patient Education
Examples of POCR&Ts
EBM-based Summaries (regularly updated e-text books)
General Characteristics Searchable Up-to-Date Medical Databases
Clinically organized summaries and reference tools integrating evidence-based and practical information for decision-making in clinical practice: support in making diagnoses, creating treatment plans, and determining prognoses.
General Characteristics Variable: Diagnosis/Differential Diagnosis aids, Laboratory
Reference Values, Decision Trees, Procedures, Calculators/Unit and Dose Converters, Drug Reference/Interactions, Videos and Images, Patient Information, Links to EBM websites, PDA/Online, emailing facility, notes entry, feedback etc.
DynaMed http://www.dynamicmedical.com/
Essential Evidence Plus (formerly InfoRetriever)
http://www.essentialevidenceplus.com/
First Consult http://www.firstconsult.com/
UpToDate http://www.uptodate.com/
Clinical Evidence http://clinicalevidence.bmj.com/ceweb/index.jsp
ACP PIERS http://pier.acponline.org/index.html
PEPID http://www.pepid.com/
ClinicalKey http://info.clinicalkey.com/
JBI COnNECT (Clinical Online Network of Evidence for Care and Therapeutics)
http://connect.jbiconnectplus.org/Default.aspx
Nursing Reference Centre http://www.ebscohost.com/nursing/products/nursing-reference-center
Clinical Knowledge Summaries (CKS) :National Library for Health (Free*)
http://cks.library.nhs.uk/
Clin-eguide (Wolters-Kluwer Ovid) http://www.clineguide.com/MarketingSiteMap.aspx
OvidMD™ http://login.ovidmd.ovid.com/login.aspx?disableIP=
PEMSoft (Pediatrics) http://www.pemsoft.com/
ProQuest Nursing & Allied Health Source http://www.proquest.com/en-US/products/default.shtml
Rehabilitation Reference Center™ (RRC) http://www.ebscohost.com/pointOfCare/rrc-about
Thomson Clinical Xpert http://truvenhealth.com/your_healthcare_focus/hospital_management_decisions/
ZynxEvidence website http://www.zynxhealth.com/Solutions/ZynxEvidence.aspx
Epocrates (Free*) http://www.epocrates.com/online
eMedicine (FREE) http://emedicine.medscape.com/
Resource Rx DDx Dx LAB CalcsDxPlain Online X
Epocrates Essentials PDA X X* X X X
Epocrates Online X X X
UpToDate X X X X X
PEPID Online and PDA X X X X X
Dynamed Online and PDA X X Online
Harrison's Practice Online and PDA X X
Essential Evidence Plus Online and PDA X
X X X
Pediatric Care Online Online X X X
Point of Care Clinical Resources :Systematic Reviews & CATs Websites
Cochrane: http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME
Database of Systematic Reviews of effectiveness DARE:
http://www.crd.york.ac.uk/crdweb/
Pubmed Systematic Reviews: http://www.ncbi.nlm.nih.gov/pubmed/clinical
AHRQ EPC Evidence Reports: Agency for Healthcare Research and Quality:
http://www.ahrq.gov/CLINIC/epcquick.htm
Best BETs: http://bestbets.org/database/browse-bets.php
Attract: http://www.attract.wales.nhs.uk/
JAMAevidence The JAMAevidence mobile view features a portion
of the site's content optimized for mobile browsers. They are:
“Quick Reference" pocket cards from Users' Guides to the Medical Literature”"Make the Diagnosis" sections from The Rational Clinical Examination
Point of Care Clinical Resources :Clinical Pathways & Protocols
NICE Pathways: guidance at your fingertips- www.nice.org.uk
http://pathways.nice.org.uk/
Society of Hospital Medicine: http://www.hospitalmedicine.org/
http://www.hospitalmedicine.org/Content/NavigationMenu/QualityImprovement/QIClinicalTools/Quality_Improvement.htm
ICSI Institute for Clinical Systems Improvements: http://www.icsi.org/index.aspx(Order Sets)
https://www.icsi.org/guidelines__more/search_results_-_browsing/?catalog_search_panel_query=1&catalog_search_panel_label_ids%5B%5D=98&catalog_search_panel_label_ids%5B%5D=99&catalog_search_panel_label_ids%5B%5D=102&catalog_search_panel_label_ids%5B%5D=141&catalog_search_panel_label_ids%5B%5D=101#results_header
Point of Care Clinical Resources :Decision Tools
Resources For EBM Knowledge TranslationPoint of Care Clinical Resources: Decision Tools
Decision Support Systems
Software to aid clinical decision-making:characteristics of patient are matched to knowledge base,
recommendations are presented to the clinician/patient. (Sim et al, JAMIA, 2001)
Objectives: Diagnostic support Drug dosing Preventive care reminders/risk assessment Disease management (Diabetes, Hypertension, AIDS,
Asthma) Test ordering Drug prescription
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CDSS - Benefits Improve patient safety
Reduce medical errors Improved medication and test ordering
Improve quality of care Application of Clinical Pathways and Guidelines Evidence based Medicine Improved Clinical documentation Increase quality time for direct patient care
Improve efficiency in Healthcare delivery Reduce costs, reduce test duplication, decrease
adverse events
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CDSS: Computerized Physician Order Entry
Growing evidence that CPOE reduce medical errors and adverse drug events.
Effects of Computerized Physician Order Entry and Clinical Decision Support Systems on Medication Safety Rainu Kaushal,MD,MPH et al Arch Intern Med. 2003
http://archinte.ama-assn.org/cgi/content/full/163/12/1409
Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes
Garg et al JAMA. 2005
http://jama.ama-assn.org/cgi/content/full/293/10/1223
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Opposing views…
CPOE facilitate medication error ‘risks’, create new errors.
Role of Computerized Physician Order Entry Systems in Facilitating
Medication Errors. Ross Koppel,PhD et al. JAMA. 2005 http://jama.ama-assn.org/cgi/content/full/293/10/1197
Computer Technology and Clinical Work Robert L. Wears et. al.
JAMA. 2005;293:1261-1263. http://jama.ama-assn.org/cgi/content/full/293/10/1261
Diagnosaurus
26
CDSS: Drawbacks
• Isabel: http://www.isabelhealthcare.com/home/default
•Open Clinical: http://www.openclinical.org/dss.html
• DXplain: http://dxplain.org/dxp/dxp.pl
Calculators, Conversions and Scoring Tools
Skyscape: http://www.skyscape.com/Windows/Archimedes360BySpecialty.aspx
•Emergency Medicine on the Web: Best viewed on Internet Explorer not Google Chrome.
http://www.ncemi.org/
•MedicineWorld.Org: http://medicineworld.org/online-medical-calculators.html
•Clinical Decision Making Calculators: http://www.fammed.ouhsc.edu/robhamm/cdmcalc.htm
Point of Care Clinical Resources: Decision Tools
Types of Calculators
Medical equation calculations i.e. body mass index, dosage calculator, unit
converter – emphasis Patient Safety Largely free online and for PDA
MedMath and MedCalc Clinical rules, decision trees or criteria
calculators i.e. Ottowa ankle rule, NIH Stroke Score, diagnostic
likelihood calculator, mortality calculator, CURb-65, Killip Class, Ranson’s, APGAR et
Session 5 28
HealthCare Informatics: The big picture 29
EPR
Disease Specific CDSS
Bronchial Asthma
The ATHENA/EON Hypertension-Management SystSoftware to aid clinical decision-making; characteristics of patient are matched to knowledge base, recommendations are presented to the clinician/patient (Sim et al, JAMIA, 2001)
Point of Care Clinical Resources :Patient Education
Patient Education:Multiple Tools
WebMD: http://www.webmd.com/
PubMed Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/s/diseases_and_conditions/a/
MedlinePlus: http://www.nlm.nih.gov/medlineplus/
NHS Choices: http://www.nhs.uk/Conditions/Pages/hub.aspx
The NNT: •http://www.medicine.ox.ac.uk/bandolier/band50/b50-8.html
•http://www.thennt.com/•http://www.nntonline.net/visualrx/v3/display.aspx
King Abdullah Encyclopedia: عبدالله الملك موسوعة
عبدالعزيزالعربية بن الصحي للمحتوى
http://www.kaahe.org/ar/
Point of Care Clinical Resources: Patient Education
Patient-Centered Shared Decision Making
Mayo Clinic: http://shareddecisions.mayoclinic.org/
Diabetes: http://shareddecisions.mayoclinic.org/files/2011/08/Diabetes_Medication_Choice.pdf
Patient Decision Aidshttp://decisionaid.ohri.ca/AZlist.html
Shared Decision Making Resources
DHMC Center for Shared Decision Making http://www.dhmc.org/dept/csdm
Ottawa Health Research Institute http://decisionaid.ohri.ca/index.html
Healthwise Preferred Care http://www.healthwise.net/preferredcare
WebMD http://www.webmd.com/
Foundation for Informed Medical Decision Making http://www.informedmedicaldecisions.org
Health News Review http://www.healthnewsreview.org