Published on March 1, 2014
PowerPoint Presentation: Dr. Imad Salah Ahmed Hassan MD FACP FRCPI MSc MBBS Chairman, Knowledge Translation Committee Department of Medicine, KAMC,KSA PowerPoint Presentation: What is Best Evidence? Hierarchy of Levels of Evidence PowerPoint Presentation: A cquire 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 PowerPoint Presentation: 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 PowerPoint Presentation: 2009 NCKUFM-YCY Systematic Review Cochrane 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 PowerPoint Presentation: 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. PowerPoint Presentation: Examples of POCR&Ts PowerPoint Presentation: EBM-based Summaries (regularly updated e-text books) General Characteristics: 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: 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. PowerPoint Presentation: 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 PowerPoint Presentation: 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/ PowerPoint Presentation: Resource Rx DDx Dx LAB Calcs DxPlain 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 O nline 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 PowerPoint Presentation: Point of Care Clinical Resources: Systematic Reviews & CATs Websites PowerPoint Presentation: 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/ PowerPoint Presentation: 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 PowerPoint Presentation: Point of Care Clinical Resources: Clinical Pathways & Protocols PowerPoint Presentation: 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 PowerPoint Presentation: Point of Care Clinical Resources: Decision Tools PowerPoint Presentation: Resources For EBM Knowledge Translation Point 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 CDSS - Benefits: 22 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 CDSS: Computerized Physician Order Entry : 23 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 Opposing views…: 24 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 : Diagnosaurus CDSS: Drawbacks: 26 CDSS: Drawbacks PowerPoint Presentation: 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: 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 EPR: HealthCare Informatics: The big picture 29 EPR PowerPoint Presentation: Disease Specific CDSS PowerPoint Presentation: Bronchial Asthma PowerPoint Presentation: The ATHENA/EON Hypertension-Management Syst 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) PowerPoint Presentation: Point of Care Clinical Resources: Patient Education PowerPoint Presentation: Patient Education: Multiple Tools PowerPoint Presentation: 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: موسوعة الملك عبدالله بن عبدالعزيز العربية للمحتوى الصحي http://www.kaahe.org/ar/ Point of Care Clinical Resources: Patient Education Health Care Literacy Around the World: Health Care Literacy Around the World PowerPoint Presentation: Explaining NNT to Patients: http://www.nntonline.net/visualrx/ Patient-Centered Shared Decision Making: 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 Shared Decision Making Resources: 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://w ww.informedmedicaldecisions.org Health News Review http://www.healthnewsreview.org
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