DynaMed (EBSCO)

Type of evidence used to support content - Ketchum, 2009

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Introduction

See also Point of care decision-making tools - Overview and UpToDate

DynaMED is a terrific clinical reference tool on the EBSCO platform. It was created for physicians and other health professionals at 'point-of-care' with summaries for nearly 3,000 topics.

Based on the results of a 2005 study published in Annals of Family Medicine, primary care clinicians answer more clinical questions with DynaMED and found more answers that changed their clinical decision-making. DynaMED is updated daily and monitors over 500 medical journals and databases directly through journal review services. Each publication is reviewed from cover-to-cover and evaluated for clinical relevance and scientific validity. New evidence is then integrated with existing content and conclusions are changed as appropriate to represent syntheses of the best evidence. Through a process of systematic literature surveillance, the best available evidence determines the content of DynaMED.

Strangely enough, despite its excellent updating of entries (see Banzi et al, 2011), some clinicians still prefer its competitor UpToDate.

Selection criteria

DynaMED employs the following rigid approach to the process of material selection:

Literature surveillance

DynaMED monitors over 100 journals each day. An additional 400 medical journals are monitored through journal review services along with systematic reviews, guidelines, and drug information sources. Each publication is reviewed cover-to-cover, and each article evaluated for clinical relevance and scientific validity. DM's mission is "to provide the most useful information at the point of care for health care professionals". Librarian and user input is continually sought. A DynaMed Librarian Advisory Council assists in product development, and the site has feedback links within each disease summary. A user reports that emailing Dynamed about content that she wanted to see, resulted in the content being added within the same day. Although one paper states that "peer-reviewed summaries form the core of DM", another cautions that only 10% of summaries are peer reviewed. Each disease summary is formatted as an outline, with sections and subcategories. Users may open (expand) sections or subcategories. In this way, users can quickly locate specific information or more comprehensive overviews, as required. Information is selected based on validity, relevance, convenience and affordability.

Disease summary overview

• Description: include definitions, applicable ICD-9 codes, types, organs involved, and prevalence
• Causes and Risk Factors: causes, pathogenesis, risk factors
• Complications and Associated Conditions
• History: chief complaint, history of present illness, meds, past medical history, family history and review of systems; categories use shortcut codes used in the U.S.; for non-U.S. users, DynaMed will change these to the full terms and phrases
• Physical: general physical; skin; head, ears, nose, and throat (HEENT); neck; chest; cardiac; lungs; abdomen; back; extremities; neurological; rectal; pelvic; and miscellaneous
• Diagnosis: making the diagnosis, rule out, tests to order, blood tests, urine studies, imaging studies, CKG, CSF analysis, pathology tests, and other diagnostic tests
• Prognosis
• Treatment overview, diet, activity, counseling, medications, surgery, consultation and referral, other management, and follow up
• Prevention and Screening
• References: general references used, reviews and guidelines
• Patient Information
• Acknowledgements: author, maintainer, and reviewer information

When new information is found, it is added to related disease summaries. These changes are noted by date on the disease summaries. Topics may be reorganized or new topics added in response to new evidence. Each summary has hyperlinks to access content and subscription-based resources such as the Cochrane Library and Medical Letter. Brief information is included, and includes LinkOut to PubMed. Dynamed plans to provide LinkOut to EBSCO eJournals, to upgrade entries to a standard template and include evidence scoring. Evidence reports are labeled as level 1 (likely reliable), level 2 (mid-level evidence), and level 3 (lacking direct evidence). Recommendations are labeled as grade A recommendation (high-quality evidence), grade B recommendation (limited evidence), or grade C recommendation (lacking direct evidence). Haynes found that most of the summaries contained some high quality evidence but few had been assigned evidence rankings. Barton found in 2005 that the disease summaries in the database have been reviewed using the new template, and that upgrading continues.

Usefulness

DynaMED conforms to principles of the Health on the Net (HON) code; and, recognized by the American Academy of Family Physicians as a resource that "may be of assistance to Family Physicians in answering clinical questions with a high quality of evidence. (" Access is provided to health providers in developing countries at a discount. Free access can often be obtained by becoming a contributor or reviewer of Dynamed's content. The project is funded by the National Science Foundation, a Small Business Initiative Research Grant, and subscription fees. No advertisement money is accepted. Like First Consult, DynaMED on EBSCO is targeted to primary care providers, while UpToDate is aimed at internal medicine and selected subspecialties. DM's structure and content format is designed for quick lookup at the point of care. Primary care providers including physicians, residents, physicians' assistants, and nurse practitioners are the target users.

References

• Alper BS. Review of online evidence-based practice point-of-care information summary providers: response by the publisher of DynaMed. J Med Internet Res. 2010 Sep 9;12(3):e39.
• Alper BS. Usefulness of online medical information. Am Fam Physician. 2006 Aug 1;74(3):482, 485.
• Alper BS. DynaMed is evidence based. Fam Med. 2003 Sep;35(8):540-1.
• Alper BS, White DS, Ge B. Physicians answer more clinical questions and change clinical decisions more often with synthesized evidence: a randomized trial in primary care. Ann Fam Med. 2005 Nov-Dec;3(6):507-513.]
• Alper BS, Hand JA, Elliott SG, Kinkade S, Hauan MJ, Onion DK, et al. How much effort is needed to keep up with the literature relevant for primary care? JMLA. 2004 Oct;92(4):429-437.
• Alper BS, Stevermer JJ, White DS, Ewigman BG. Answering family physicians: clinical questions using electronic medical databases. J Fam Pract. 2001;50:960-965.
• Alper BS. Practical Evidence-Based Internet Resources. Fam Pract Manag. 2003;10(7):49.
• Banzi R, Cinquini M, Liberati A, Moschetti I, Pecoraro V, Tagliabue L, Moja L. Speed of updating online evidence based point of care summaries: prospective cohort analysis. BMJ. 2011 Sep 23;343:d5856.
• Banzi R, Liberati A, Moschetti I, Tagliabue L, Moja L. A review of online evidence-based practice point-of-care information summary providers. JMIR. 2010;12(3):e26, 1-16.
• Barton H. DynaMed. Journal of the Medical Library Association 2005 July;93(3):412-414.
• Ely JW, Osheroff JA, Ebell MH, et al. Obstacles to answering doctors' questions about patient care with evidence: qualitative study. BMJ. 2002;324:710.]
• Felter LM. DynaMed for Better Health: Evidently EBSCO. Searcher 2006 September;14(8):8-10, 12-15.
• Goodyear-Smith F, Kerse N, Warren J, Arroll B. Evaluation of e-textbooks. DynaMed, MD Consult and UpToDate. Aust Fam Physician. 2008 Oct;37(10):878-82.
• Haynes J, Haynes R. Resource review. Evidence-Based Medicine 2005 10;10(5):160-160.
• Ketchum A, Saleh A. The evidence behind point of care products. Pittsburgh: Health Sciences Library System, University of Pittsburgh and UPMC 2009.
• Ketterman, E. & Besaw, M. E. (2010). An Evaluation of Citation Counts, Search Results, and Frequency of Updates in DynaMed® and UpToDate®. Journal of Electronic Resources in Medical Libraries, 7(4), 273-280.
• Mallett S, Clarke M. How many Cochrane reviews are needed to cover existing evidence on the effects of health care interventions? ACP J Club 2003;139:A11.
• Moja, L. and Banzi, R. (2011), Navigators for medicine: evolution of online point-of-care evidence-based services. International Journal of Clinical Practice, 65: 6–11