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Secondary Evidence Based Medicine Rsources SC

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A hyperlinked Ppt presentation on Evidence-based secondary resources.

A hyperlinked Ppt presentation on Evidence-based secondary resources.

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  • SmartArt custom animation effects: pictures peek-in(Basic)To reproduce the SmartArt effects on this page, do the following:On the Home tab, in the Slides group, click Layout, and then click Blank. On the Insert tab, in the Illustrations group, click SmartArt.In the Choose a SmartArt Graphic dialog box, in the left pane, click Matrix. In the Matrix pane, double-click Titled Matrix (second option from the left) to insert the graphic into the slide. Select the graphic. Under SmartArt Tools, on the Format tab, click Size, and then do the following:In the Height box, enter 5.67”.In the Width box, enter 8.5”.Under SmartArt Tools, on the Format tab, click Arrange, click Align, and then do the following:Click Align to Slide.Click Align Middle. Click Align Center. Select the graphic, and then click one of the arrows on the left border. In the Type your text here dialog box, enter text in the top-level bullet only (text for the rounded rectangle at the center of the graphic). To remove the [Text] placeholder in the second-level bullets, select each bullet and press SPACE.On the slide, select the graphic. Under SmartArtTools, on the Design tab, in the SmartArtStyles group, click More, and then under Best Match for Document click Moderate Effect.Select the rounded rectangle at the center of the graphic. On the Home tab, in the Font group, select 28 from the Font Size list, click the arrow next to Font Color, and then click White, Background 1 (first row, first option from the left).With the rounded rectangle selected, under SmartArtTools, on the Format tab, in the bottom right corner of the ShapeStyles group, click the FormatShape dialog box launcher. In the FormatShape dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Linear.In the Direction list, select LinearUp (second row, second option from the left).Under Gradient stops, click Add or Remove until three stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click White, Background 1, Darker 35% (fifth row, first option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 80%.Click the button next to Color, and then under Theme Colors click White, Background 1, Darker 35% (fifth row, first option from the left).Select Stop 3 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click White, Background 1, Darker 15% (third row, first option from the left).Right-click the top left shape in the graphic, and then click Format Shape. In the Format Shape dialog box, in the left pane, click Fill. In the Fill pane, click Picture or texture fill,and then under Insert from, click File.In the Insert Picture dialog box, select a picture and then click Insert. Right-click the top right shape in the graphic, and then click Format Shape. In the Format Shape dialog box, in the left pane, click Fill. In the Fill pane, click Picture or texture fill,and then under Insert from, click File.In the Insert Picture dialog box, select a picture and then click Insert. Right-click the bottom left shape in the graphic, and then click Format Shape. In the Format Shape dialog box, in the left pane, click Fill. In the Fill pane, click Picture or texture fill,and then under Insert from, click File.In the Insert Picture dialog box, select a picture and then click Insert. Right-click the bottom right shape in the graphic, and then click Format Shape. In the Format Shape dialog box, in the left pane, click Fill. In the Fill pane, click Picture or texture fill,and then under Insert from, click File.In the Insert Picture dialog box, select a picture and then click Insert. To reproduce the animation effects on this slide, do the following:On the Animations tab, in the Animations group, click CustomAnimation.On the slide, select the graphic, and then do the following in the CustomAnimation task pane: Click Add Effect, point to Entrance, and then click MoreEffects. In the Add Entrance Effect dialog box, under Subtle, click Expand. Under Modify: Expand, in the Speed list, select Fast.Under Modify: Expand, in the Start list, select After Previous.Also in the Custom Animation task pane, click the arrow to the right of theanimation effect, and then click EffectOptions. In the Expand dialog box, on the SmartArt Animation tab, in the Group Graphic list, select One by one.Also in the Custom Animation taskpane, click the double-arrow below the animation effect to expand the list of effects, and then do the following:Press and hold CTRL, and then select all five animation effects in the Custom Animation task pane. Under Modify: Expand, in the Start list, select With Previous.Press and hold CTRL, select the second, third, fourth, and fifth animation effects (expand effects for the picture-filled rectangles), and then do the following:Click Change, point to Entrance, and then click MoreEffects. In the Change Entrance Effect dialog box, under Basic, click Peek In. Under Modify: Peek In, in the Speed list, select Fast.Select the second animation effect. Under Modify: Peek In, in the Start list, select After Previous.Select the third animation effect. Under Modify: Peek In, in the Direction list, select From Left.Select the fourth animation effect. Under Modify: Peek In, in the Direction list, select From Right.Select the fifth animation effect. Under Modify: Peek In, in the Direction list, select From Top.To reproduce the background effects on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Corner (fifth option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 71%.Click the button next to Color, and then under Theme Colors click White, Background 1, Darker 15% (third row, first option from the left).

Transcript

  • 1. Secondary EBM Resources Dr. Imad Salah Ahmed Hassan MD FACP FRCPI MSc MBBS Chairman, Knowledge Translation Committee Department of Medicine, KAMC,KSA
  • 2. What is Best Evidence? Hierarchy of Levels of Evidence
  • 3. Acquire the Best Evidence: Finding the Best Evidence First Hierarchy of Sources of Evidence Pyramid Pre-appraised, systematic reviews: Cochrane Pre-appraised, individual studies: ACP Journal Club 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 *Adapted from Shaughnessy and Slawson
  • 4. 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) Pre-appraised, individual studies: ACP Journal Club 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 *Adapted from Shaughnessy and Slawson
  • 5. 5S Information Resources: Information in top 4 are used Computerized Decision Support System (CDSS) Systems Evidence based textbooks: UpTo POCRaTs Summaries Synopses Syntheses Studies Date, DynaMed, ACP PIER, BMJ Clinical Evidence Evidence based journals EBM, EBN, EBMH, ACP J club Systematic Review Cochrane reviews Original articles: BMJUpdates, PubMed Clinical Queries Haynes, R. (2006, November). Of studies, syntheses, synopses, summaries, and systems: the 5S evolution of information services for NCKUFM-YCY 2009 evidence-based health care decisions. ACP Journal Club, 145(3), A8-A9.
  • 6. 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.
  • 7. Examples of POCR&Ts
  • 8. EBM-based Summaries (regularly updated e-text books)
  • 9. 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.
  • 10. 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.
  • 11. 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.j sp 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
  • 12. Clinical Knowledge Summaries (CKS) :National Library for Health (Free*) http://cks.library.nhs.uk/ Clin-eguide (Wolters-Kluwer Ovid) http://www.clineguide.com/MarketingSiteMa p.aspx OvidMD™ http://login.ovidmd.ovid.com/login.aspx?disa bleIP= PEMSoft (Pediatrics) http://www.pemsoft.com/ ProQuest Nursing & Allied Health Source http://www.proquest.com/enUS/products/default.shtml Rehabilitation Reference Center™ (RRC) http://www.ebscohost.com/pointOfCare/rrcabout Thomson Clinical Xpert http://truvenhealth.com/your_healthcare_foc us/hospital_management_decisions/ ZynxEvidence website http://www.zynxhealth.com/Solutions/ZynxE vidence.aspx Epocrates (Free*) http://www.epocrates.com/online eMedicine (FREE) http://emedicine.medscape.com/
  • 13. Resource Rx DxPlain Online DDx Dx LAB Calcs X Epocrates Essentials PDA X Epocrates Online X UpToDate X X X X X PEPID Online and PDA X X X X X Dynamed Online and PDA X X Harrison's Practice Online and PDA X X Essential Evidence Plus Online and PDA X Pediatric Care Online Online X X* X X X X X X Online X X X X
  • 14. Point of Care Clinical Resources: Systematic Reviews & CATs Websites
  • 15. Cochrane: http://www3.interscience.wiley.com/cgibin/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/clini cal AHRQ EPC Evidence Reports: Agency for Healthcare Research and Quality: http://www.ahrq.gov/CLINIC/epcquick.htm Best BETs: http://bestbets.org/database/browsebets.php Attract: http://www.attract.wales.nhs.uk/
  • 16.    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
  • 17. Point of Care Clinical Resources: Clinical Pathways & Protocols
  • 18. 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/Na vigationMenu/QualityImprovement/QIClinical Tools/Quality_Improvement.htm ICSI Institute for Clinical Systems Improvements: http://www.icsi.or g/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=9 8&catalog_search_panel_label_ids%5B%5D =99&catalog_search_panel_label_ids%5B% 5D=102&catalog_search_panel_label_ids%5 B%5D=141&catalog_search_panel_label_ids %5B%5D=101#results_header
  • 19. Point of Care Clinical Resources: Decision Tools
  • 20. Point of Care Clinical Resources: Decision Tools Resources For EBM Knowledge Translation 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
  • 21. 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 22
  • 22. 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 23
  • 23. 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 24
  • 24. Diagnosaurus
  • 25. CDSS: Drawbacks 26
  • 26. Point of Care Clinical Resources: Decision Tools • 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/Arc himedes360BySpecialty.aspx •Emergency Medicine on the Web: Best viewed on Internet Explorer not Google Chrome. http://www.ncemi.org/ •MedicineWorld.Org: http://medicineworld.org/online-medicalcalculators.html •Clinical Decision Making Calculators: http://www.fammed.ouhsc.edu/robhamm /cdmcalc.htm
  • 27. 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 28 Session 5
  • 28. EPR 29 HealthCare Informatics: The big picture
  • 29. Disease Specific CDSS
  • 30. Bronchial Asthma
  • 31. 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)
  • 32. Point of Care Clinical Resources: Patient Education
  • 33. Patient Education: Multiple Tools
  • 34. Point of Care Clinical Resources: Patient Education 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.as px The NNT: •http://www.medicine.ox.ac.uk/bandolier/ba nd50/b50-8.html •http://www.thennt.com/ •http://www.nntonline.net/visualrx/v3/display .aspx King Abdullah Encyclopedia: http://www.kaahe.org/ar/
  • 35. Health Care Literacy Around the World
  • 36. Explaining NNT to Patients: http://www.nntonline.net/visualrx/
  • 37. 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 Aids http://decisionaid.ohri.ca/AZlist.html
  • 38. Shared Decision Making Resources  DHMC Center for Shared Decision Making   Ottawa Health Research Institute   http://www.webmd.com/ Foundation for Informed Medical Decision Making   http://www.healthwise.net/preferredcare WebMD   http://decisionaid.ohri.ca/index.html Healthwise Preferred Care   http://www.dhmc.org/dept/csdm http://www.informedmedicaldecisions.org Health News Review  http://www.healthnewsreview.org