scholarly journals An Evaluation of the Five Most Used Evidence Based Bedside Information Tools in Canadian Health Libraries

2008 ◽  
Vol 3 (2) ◽  
pp. 3 ◽  
Author(s):  
Alison Farrell
Keyword(s):  
Electronic Mail ◽  
Clinical Evidence ◽  
Resource Assessment ◽  
Ease Of Use ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
Information Tools ◽  
Canadian Health ◽  
Clinical Questions

Objective – This project sought to identify the five most used evidence based bedside information tools used in Canadian health libraries, to examine librarians’ attitudes towards these tools, and to test the comprehensiveness of the tools. Methods – The author developed a definition of evidence based bedside information tools and a list of resources that fit this definition. Participants were respondents to a survey distributed via the CANMEDLIB electronic mail list. The survey sought to identify information from library staff regarding the most frequently used evidence based bedside information tools. Clinical questions were used to measure the comprehensiveness of each resource and the levels of evidence they provided to each question. Results – Survey respondents reported that the five most used evidence based bedside information tools in their libraries were UpToDate, BMJ Clinical Evidence, First Consult, Bandolier and ACP Pier. Librarians were generally satisfied with the ease of use, efficiency and informative nature of these resources. The resource assessment determined that not all of these tools are comprehensive in terms of their ability to answer clinical questions or with regard to the inclusion of levels of evidence. UpToDate was able to provide information for the greatest number of clinical questions, but it provided a level of evidence only seven percent of the time. ACP Pier was able to provide information on only 50% of the clinical questions, but it provided levels of evidence for all of these. Conclusion – UpToDate and BMJ Clinical Evidence were both rated as easy to use and informative. However, neither product generally includes levels of evidence, so it would be prudent for the practitioner to critically appraise information from these sources before using it in a patient care setting. ACP Pier eliminates the critical appraisal stage, thus reducing the time it takes to go from forming a clinical question to implementing the answer, but survey respondents did not rate it as high in terms of usability. There remains a need for user-friendly, comprehensive resources that provide evidence summaries relying on levels of evidence to support their conclusions.

scholarly journals Brazilian Society of Rheumatology 2020 guidelines for psoriatic arthritis

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Sueli Carneiro ◽  
Penelope Esther Palominos ◽  
Sônia Maria Alvarenga Anti ◽  
Rodrigo Luppino Assad ◽  
Rafaela Silva Guimarães Gonçalves ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Interrater Reliability ◽  
Biologic Therapy ◽  
Evidence Based ◽  
Review Of The Literature ◽  
Immune Disease ◽  
Level Of Evidence ◽  
Brazilian Society ◽  
Conventional Drug ◽  
Clinical Questions

AbstractPsoriatic arthritis (PsA) is a chronic and systemic immune disease characterized by inflammation of peripheral and/or axial joints and entheses in patients with psoriasis (PsO). Extra-articular and extracutaneous manifestations and numerous comorbidities can also be present. These recommendations replace the previous version published in May 2013. A systematic review of the literature retrieved 191 articles that were used to formulate 12 recommendations in response to 12 clinical questions, divided into 4 sections: diagnosis, non-pharmacological treatment, conventional drug therapy and biologic therapy. These guidelines provide evidence-based information on the clinical management for PsA patients. For each recommendation, the level of evidence (highest available), degree of strength (Oxford) and degree of expert agreement (interrater reliability) are reported.

scholarly journals Contrasting evidence to reimbursement reality for off-label use (OLU) of drug treatments in cancer care: rationale and design of the CEIT-OLU project

ESMO Open ◽  
2019 ◽  
Vol 4 (6) ◽  
pp. e000596
Author(s):  
Amanda Katherina Herbrand ◽  
Andreas Michael Schmitt ◽  
Matthias Briel ◽  
Stefan Diem ◽  
Hannah Ewald ◽  
...  
Keyword(s):  
Cancer Care ◽  
Clinical Evidence ◽  
Patient Characteristics ◽  
Evidence Based ◽  
Cancer Drugs ◽  
Off Label Use ◽  
Level Of Evidence ◽  
Treatment Benefit ◽  
Off Label ◽  
Label Use

BackgroundOff-label use (OLU) of a drug reflects a perceived unmet medical need, which is common in oncology. Cancer drugs are often highly expensive and their reimbursement is a challenge for many healthcare systems. OLU is frequently regulated by reimbursement restrictions. For evidence-based healthcare, treatment ought to be reimbursed if there is sufficient clinical evidence for treatment benefit independently of patient factors not related to the treatment indication. However, little is known about the reality of OLU reimbursement and its association with the underlying clinical evidence. Here, we aim to investigate the relationship of reimbursement decisions with the underlying clinical evidence.Methods/ designWe will extract patient characteristics and details on treatment and reimbursement of cancer drugs from over 3000 patients treated in three Swiss hospitals. We will systematically search for clinical trial evidence on benefits associated with OLU in the most common indications. We will describe the prevalence of OLU in Switzerland and its reimbursement in cancer care, and use multivariable logistic regression techniques to investigate the association of approval/rejection of a reimbursement requests to the evidence on treatment effects and to further factors, including type of drug, molecular predictive markers and the health insurer.DiscussionOur study will provide a systematic overview and assessment of OLU and its reimbursement reality in Switzerland. We may provide a better understanding of the access to cancer care that is regulated by health insurers and we hope to identify factors that determine the level of evidence-based cancer care in a highly diverse western healthcare system.

Comparing UpToDate and DynaMed Plus as medical knowledge resources for clinical decision support: cross-over randomized trial (Preprint)

2020 ◽  
Author(s):  
Sally L Baxter ◽  
Lina Lander ◽  
Brian Clay ◽  
John Bell ◽  
Kristen Hansen ◽  
...  
Keyword(s):  
User Experience ◽  
Medical Knowledge ◽  
Clinical Decision ◽  
Ease Of Use ◽  
Quality Of Information ◽  
Level Of Evidence ◽  
Knowledge Resources ◽  
Clinical Questions ◽  
Time Required

BACKGROUND Electronic medical knowledge resources are frequently used for clinical decision support. Costs vary substantially among vendors, warranting periodic assessment of institution-wide adoption. OBJECTIVE To compare two medical knowledge resources, UpToDate and DynaMed Plus, with respect to facilitating accuracy and efficiency of answering standardized clinical questions and user experience. METHODS Physicians in training at a single academic medical center were randomized to first use one of the two medical knowledge resources to answer six standardized clinical case questions. They were surveyed about their experience using the resource, then completed the questions using the other resource, followed by the user experience survey again. The percentage of accurate answers and time required to answer each question were recorded. The surveys assessed ease of use, enjoyment using the resource, quality of information, and ability to assess the level of evidence. Given the cross-over design, tests of carry-over effects were performed. For open-ended survey items regarding overall user experience, themes were identified, and sentiment analyses were performed. RESULTS Twenty-six physicians in training participated, with a mean (standard deviation, SD) of 5.8 (2.5) years of prior experience using UpToDate. Accuracy of answers when using the two resources generally differed by 4 percentage points or less. For all but one question, there were no significant differences in the time required for completion. Most participants perceived both resources to be easy to use, have high quality of information, and felt able to assess to the level of evidence contained in the information. A greater proportion of participants (23/26, 88%) endorsed enjoyment of use when using UpToDate compared to when using DynaMed Plus (16/26, 62%). Participants were significantly less likely to enjoy DynaMed Plus if they were in the randomization group assigned to use UpToDate first (p=0.006). Themes emerging from open-ended survey comments included interface/information presentation, coverage of clinical topics, search functions, and utility for clinical decision-making. Overall, the majority (59%) of open-ended comments expressed an overall preference for UpToDate, while only 19% expressed an overall preference for DynaMed Plus. CONCLUSIONS DynaMed Plus is non-inferior to UpToDate with respect to ability to achieve accurate answers, time required for answering clinical questions, ease of use, quality of information, and ability to asses level of evidence. However, user experience was more positive with UpToDate, leading to a majority of users stating a preference for UpToDate. Future studies of electronic medical knowledge resources should continue to emphasize evaluation of usability and user experience.

scholarly journals Contrasting Evidence to Reimbursement Reality for Off-label use (OLU) of Drug Treatments in Cancer Care – Rationale and Design of the CEIT-OLU-project

2019 ◽  
Author(s):  
AK Herbrand ◽  
AM Schmitt ◽  
M Briel ◽  
S Diem ◽  
H Ewald ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Clinical Evidence ◽  
Health Care Systems ◽  
Patient Characteristics ◽  
Evidence Based ◽  
Cancer Drugs ◽  
Level Of Evidence ◽  
Treatment Benefit ◽  
Off Label

AbstractBackgroundOff-label drug use (OLU) reflects a perceived unmet medical need, which is common in oncology. Cancer drugs are often highly expensive and their reimbursement is a challenge for many health care systems. OLU is frequently regulated by reimbursement restrictions. For evidence-based health care, treatment ought to be reimbursed if there is sufficient clinical evidence for treatment benefit independently of patient factors not related to the treatment indication. However, little is known about the reality of OLU reimbursement and its association with the underlying clinical evidence. Here we aim to investigate the relationship of reimbursement decisions with the underlying clinical evidence.Methods/DesignWe extract patient characteristics and details on treatment and reimbursement of cancer drugs from over 3000 patients treated in three Swiss hospitals. We systematically search for clinical trial evidence on benefits associated with OLU in the most common indications. We will describe the prevalence of OLU in Switzerland and its reimbursement in cancer care, and use multivariable logistic regression techniques to investigate the association of approval/rejection of a reimbursement requests to the evidence on treatment effects and to further factors, including type of drug, molecular predictive markers and the health insurer.DiscussionOur study will provide a systematic overview and assessment of OLU and its reimbursement reality in Switzerland. We may provide a better understanding of the access to cancer care that is regulated by health insurers and we hope to identify factors that determine the level of evidence-based cancer care in a highly diverse Western health care system.

Levels of evidence of articles in podiatric medical journals

2000 ◽  
Vol 90 (6) ◽  
pp. 300-302 ◽  
Author(s):  
MA Turlik ◽  
D Kushner
Keyword(s):  
Randomized Controlled Trials ◽  
Evidence Based Medicine ◽  
Medical Profession ◽  
Controlled Trials ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Medical Journals ◽  
Levels Of Evidence ◽  
Randomized Controlled ◽  
Based Medicine

The authors reviewed 322 articles in podiatric medical journals to determine their level of evidence. Only 1% of the articles reviewed were randomized controlled trials. The authors concluded that if the podiatric medical profession wishes to become a participant in evidence-based medicine, greater emphasis must be placed on studies that assess hypotheses.

scholarly journals Orthopaedic Surgical Content Associated with Resources for Clinical Evidence

2014 ◽  
Vol 34 (1) ◽  
pp. 17
Author(s):  
Sarah L Turvey ◽  
Nasir Hussain ◽  
Laura Banfield ◽  
Mohit Bhandari
Keyword(s):  
Evidence Based Medicine ◽  
Clinical Evidence ◽  
Medical Literature ◽  
Evidence Based ◽  
Surgical Interventions ◽  
Surgical Practice ◽  
Large Scope ◽  
Clinical Questions ◽  
Based Medicine ◽  
Database Content

Introduction: As evidence-based medicine is increasingly being adopted in medical and surgical practice, effective processing and interpretation of medical literature is imperative. Databases presenting the contents of medical literature have been developed; however, their efficacy merits investigation. The objective of this study was to quantify surgical and orthopaedic content within five evidence-based medicine resources: DynaMed, Clinical Evidence, UpToDate, PIER, and First Consult. Methods: We abstracted surgical and orthopaedic content from UpToDate, DynaMed, PIER, First Consult, and Clinical Evidence. We defined surgical content as that which involved surgical interventions. We classified surgical content by specialty and, for orthopaedics, by subspecialty. The amount of surgical content, as measured by the number of relevant reviews, was compared with the total number of reviews in each database. Likewise, the amount of orthopaedic content, as measured by the number of relevant reviews, was compared with the total number of reviews and the total number of surgical reviews in each database. Results: Across all databases containing a total of 13268 reviews, we identified an average of 18% surgical content. Specifically, First Consult and PIER contained 28% surgical content as a percentage of the total database content. DynaMed contained 14% and Clinical Evidence 11%, whereas UpToDate contained only 9.5% surgical content. Overall, general surgery, pediatrics, and oncology were the most common specialty areas in all databases. Discussion: Our findings suggest that the limited surgical content within these large scope resources poses difficulties for physicians and surgeons seeking answers to complex clinical questions, specifically within the field of orthopaedics. This study therefore demonstrates the potential need for, and benefit of, surgery-specific or even specialty-specific tools.

Evidence-Based Decision Making in Action: Part 1 - Finding the Best Clinical Evidence

2002 ◽  
Vol 3 (3) ◽  
pp. 10-26 ◽  
Author(s):  
Jane L. Forrest ◽  
Syrene A. Miller
Keyword(s):  
Decision Making ◽  
Clinical Evidence ◽  
Online Resources ◽  
Evidence Based ◽  
Online Search ◽  
Case Scenario ◽  
New Concepts ◽  
Valid Evidence ◽  
Clinical Questions ◽  
Evidence Based Decision Making

Abstract The purpose of this article is to introduce evidence-based concepts and demonstrate how to find valid evidence to answer clinical questions. Evidence-based decision making (EBDM) requires understanding new concepts and developing new skills including how to: ask good clinical questions, conduct a computerized search, critically appraise the evidence, apply the results in clinical practice, and evaluate the process. This approach recognizes that clinicians can never be completely current with all conditions, medications, materials, or available products. Thus EBDM provides a mechanism for addressing these gaps in knowledge in order to provide the best care possible. In Part 1, a case scenario demonstrates the application of the skills involved in structuring a clinical question and conducting an online search using PubMed. Practice tips are provided along with online resources related to the evidence-based process. Citation Forrest JL, Miller SA. Evidence-Based Decision Making in Action: Part 1 - Finding the Best Clinical Evidence. J Contemp Dent Pract 2002 August;(3)3: 010-026.

Locating the Best Available Research

2016 ◽  
pp. 29-48
Author(s):  
John C. Norcross ◽  
Thomas P. Hogan ◽  
Gerald P. Koocher ◽  
Lauren A. Maggio
Keyword(s):  
Systematic Reviews ◽  
Information Sources ◽  
Clinical Evidence ◽  
Information Resources ◽  
Background Information ◽  
Evidence Based ◽  
Cochrane Database ◽  
Wild Cards ◽  
Clinical Questions

This chapter discusses the steps EBP clinicians should take in finding evidence that addresses their clinical questions: searching background information resources, which provide overviews of topics, and then moving to filtered information resources, which provide access to timesaving, synthesized information. To help clinicians navigate these resources, the chapter summarizes basic search concepts that are applicable across the resources, such as Boolean operators, truncation, wild cards, and limits. The chapter describes key background information sources, such as eMedicine, textbooks, and Wikipedia. It then discusses key filtered information sources, including the Cochrane Database of Systematic Reviews, BMJ Clinical Evidence, and several evidence-based journals. The chapter provides tailored tips for optimal searching within each resource introduced.

Evidence-Based Medicine

2018 ◽  
pp. 59-63
Author(s):  
S. Nassir Ghaemi
Keyword(s):  
Expert Opinion ◽  
Evidence Based Medicine ◽  
Case Reports ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Levels Of Evidence ◽  
Confounding Bias ◽  
Randomized Studies ◽  
Pros And Cons ◽  
Based Medicine

Evidence-based medicine (EBM) is the view that there are levels of evidence, with higher ones being more valid than lower ones. The higher levels of evidence have less confounding bias, with randomization being the best method to minimize such bias. Lower levels of evidence have more confounding bias, with clinical experience being the worst setting for such bias. However, evidence-based medicine is misinterpreted if it is oversimplified. The EBM literature has various definitions of specific levels of evidence. Standard EBM text uses letters (A through D). One could also use numbers (I through V). The basic idea is that randomized studies are higher levels of evidence than non-randomized studies, and that the lowest level of evidence consists of case reports, expert opinion, or the consensus of the opinion of clinicians or investigators. The pros and cons of the EBM approach are scrutinized in this chapter.

scholarly journals Padrões de cuidados em prevenção e tratamento de extravasamento de antineoplásicos baseado em evidências clínicas

2019 ◽  
Vol 87 (25) ◽  
Author(s):  
Samya Raquel Soares Dias ◽  
Fernanda Valéria Silva Dantas Avelino ◽  
Elaine Cristina Carvalho Moura ◽  
Jéssica Pereira Costa
Keyword(s):  
Risk Factors ◽  
Literature Review ◽  
Antineoplastic Agents ◽  
Clinical Evidence ◽  
Patterns Of Care ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Prevention And Treatment ◽  
Treatment Measures ◽  
Main Strategy

Objetivo: descrever padrões de cuidados em prevenção e tratamento de extravasamento de antineoplásicos baseadoem evidências clínicas. Métodos: revisão integrativa da literatura realizada nas bases de dados Medline/PuBMed, CINAHL, LILACS e Science Direct. Resultados: foram localizados 30 estudos em inglês e espanhol, entre 2005 a 2015.Os temas predominantes quanto ao extravasamento são fatores de risco, medidas de prevenção e tratamento, comoo uso de compressas e antídotos, estes foram organizados em quadros e classificados quanto ao nível de evidência egrau de recomendação. Conclusão: a prevenção é a principal estratégia. Ressalta-se a importância de implementação deprotocolo assistencial.Descritores: Antineoplásicos; Extravasamento de Materiais Terapêuticos e Diagnósticos; Enfermagem.   ABSTRACTObjective: to describe patterns of care in the prevention and treatment of clinical evidence based antineoplastic extravasation. Methods: integrative literature review carried out in Medline/PuBMed, CINAHL, LILACS and Science Directdatabases. Results: 30 studies were conducted in english and spanish between 2005 and 2015. The predominant themesregarding extravasation are risk factors, prevention and treatment measures, such as the use of compresses and antidotes, these were organized in tables and classified as level of evidence and degree of recommendation. Conclusion:prevention is the main strategy. It is important to emphasize the importance of implementing a care protocol.Descriptors: Antineoplastic Agents; Extravasation of Diagnostic and Therapeutic Materials; Nursing.

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