Point of care decision-making tools - Overview

From UBC Health Library Wiki

Jump to: navigation, search
Are you interested in contributing your expertise to writing some of the wiki entries?
contact: dean.giustini@ubc.ca

To browse other articles on a range of HSL topics, see the wiki index.

Contents

Introduction

See also Filters (ie. hedges), How to appraise POC tools, TRIP Database, SumSearch and Sources by clinical domain

Physicians at the frontlines of clinical care have insufficient time to search the literature. Meanwhile, iterative browsing for answers in discovery tools like Google scholar and Bing are wholly inadequate for the purpose of sound decision-making. However, appraisal tools are increasingly used to free doctors from the task of locating reliable evidence by presenting them with expert summaries of the evidence. Many physicians are accustomed to reading digested, summaries of evidence to guide them in their clinical thinking and decision-making processes. The point-of-care sources below aim to synthesize all available evidence for major clinical topics (especially the top layers of the evidence-based pyramid). By summarizing medical knowledge, it is easier to apply the best evidence within the context of providing patient care.

Features of POC tools

  • syntheses of current evidence for diagnosis, tests and treatments
  • designed for rapid consultation at the point of patient care
  • evidence-based and frequently updated, with links to relevant literature
  • include drug information, ICD coding, information for patients, PDA application, and provision for links to electronic health records

Access and navigation issues

Point-of-care decision-making tools make a physician's retrieval of evidence easier. However, many of these tools are accessed by keyword or textword searching (ie. no MeSH searching). They also rely on point-and-click findability, browsing and scanning of web pages to find what is needed. That said, some POC tools are easier to navigate than others due to the use of structured abstracts and well-designed interfaces. Keep in mind that POC tools tend to answer very broad clinical questions and are not as helpful for specific foreground questions.

Point-of-care tools are small in size compared to millions of citations in MEDLINE, or EMBASE; and tiny compared to the mammoth Web or Google scholar. In addition, as proprietary tools, they are owned by commercial vendors and are generally marketed as tools that synthesize medical evidence from the major medical databases.

Background vs. foreground clinical questions

Some health librarians view point-of-care tools as tertiary sources of information ie. a synthesis of primary and secondary research articles, and evidence, from the major biomedical journals. An example of a primary research article would be a recently published clinical trial of a new drug that is indexed in MEDLINE; an example of a secondary research article might be a review of the latest clinical trials in a specific area of medicine. See systematic review, for examples.

Finding answers to clinical questions may require a search for general, background information about the who, what, where, when or why about a disease, or its process. Examples of background questions include What is Down's syndrome? or What is trisomy 21? Background questions are simple questions about the basic facts of a disease, and some of the point-of-care tools provide excellent context (or background) for these questions. Two examples of tools strong in providing background are UpToDate and BMJ's Clinical Evidence.

Gordon Guyatt et al suggest that background questions are most often asked by medical students. As medical training continues through residency and practice, clinical questions get more and more specific - part of the foreground of medical evidence. Many research studies indexed in MEDLINE answer specific foreground questions, for example.; textbooks answer the background questions.

ACP Journal Club

ACP Journal Club 's general purpose is to select from the biomedical literature articles that report original studies and systematic reviews that warrant immediate attention by physicians attempting to keep pace with important advances in internal medicine. These articles are summarized in value-added abstracts and commented on by clinical experts. ACP Journal Club is available via OVID EBM Reviews.

ACP PIER (Physicians' Information and Education Resource)

ACP PIER is an evidence-based point-of-care decision tool, available through Stat!Ref. In keeping with PIER's motto, "Clinical Guidance from ACP", each entry contains practice guidelines developed from evidence found in peer-reviewed journal articles and traditional textbooks. More...

BMJ 'Point-of-Care'

BMJ Point of Care is a new clinical resource designed specifically to deliver highly relevant diagnosis and treatment guidance at the immediate point of care. It has been jointly developed by the BMJ Group, a global authority on evidence-based medicine, and Epocrates, a recognized U.S. leader in mobile healthcare technology and high-quality drug information.

Conceived and created to meet the challenging information demands of the clinical care setting, BMJ Point of Care offers:

  • Comprehensive disease monographs that include competing diagnoses, treatment approaches, tests to order, guidelines and
  • A unique patient-centered approach to information delivery, with treatment details organized by patient group
  • Embedded links to drug dosing information and the best available medical evidence from BMJ Clinical Evidence (with paid subscription)
  • Information on over 3,300 drugs and 400 alternative medicines, with a comprehensive drug interaction checking tool
  • Up-to-date, detailed formulary information for top national and regional healthcare insurance plans
  • A useful pill identifier tool plus hundreds of helpful medical tables and calculators.

Clin-eguide (Wolters-Kluwer-OVID)

Clin-eguide is a Wolters-Kluwer-OVID product that presents a synthesis of the best available evidence on diagnosis, management, and treatment of high-cost problems occuring in inpatient, outpatient and emergency department settings. This new product has over 900 topics covering 270 medical conditions. As a unique clinical decision support system designed to meet the needs of clinicians, Clin-guide provides structured diagnostic, management and treatment recommendations, referenced to the primary literature.

Clin-eguide employs a rigorous EBM approach to content creation and maintenance, so that all treatment guidance is based on the best research evidence. A broad coverage of medical topics and disease states is provided, with particular emphasis on areas where significant controversy exists, practice variation is high, or standards of practice have not fully incorporated recent strong evidence.

The EBM approach is evident in Clin-eguide content by:

  • Referencing all primary literature sources.
  • Displaying strength of evidence grades next to recommendations.
  • Including Number Needed to Treat (NNT) tables, where appropriate.
  • Providing EBM Insights - alerts that highlight specific clinical issues.

Clinical Evidence (BMJ)

Clinical Evidence, published by the BMJ Publishing Group, draws on the evidence from systematic reviews to address broad, clinical questions - for example, what is effective in treating common cold? As an international source of the best available evidence for effective health care, CE promotes informed decision-making by summarising what's known -- and not known -- about 200 medical conditions and 2000 treatments. CE is based on questions that clinicians and patients want answered. This may be the right starting place for a search for relevant evidence on major topics. More...

Clinical pharmacology

Clinical pharmacology provides up-to-date, peer-reviewed, clinically-relevant information on all U.S. prescription drugs, as well as off-label uses and dosage, herbal supplements, nutritional and over-the-counter products and new and investigational drugs.

Cochrane Library

See The Cochrane Library

Cochrane Database of Systematic Reviews (Cochrane Reviews)

Database of Abstracts of Reviews of Effects (DARE)

Cochrane Central Register of Controlled Trials (Clinical Trials)

The Cochrane Methodology Register (Methods Studies)

Health Technology Assessment Database (Technology Assessments)

NHS Economic Evaluation Database (Economic Evaluations)

Cochrane Database of Systematic Reviews

Since 1996, systematic reviews prepared and maintained by the Cochrane Collaboration have been published in The Cochrane Database of Systematic Reviews. CDSRs are regularly updated as more information becomes available and in response to comments from physicians. Systematic reviews are now widely regarded as being of better quality, on average, than their counterparts in print journals.

Cochrane Database of Systematic Reviews is one of the most important databases in evidence-based medicine. It is on par with MEDLINE in the view of many and provides quick access to the systematic reviews of randomized controlled trials (RCTs) undertaken by the international Cochrane Collaboration. Its strength is providing easy access to RCTs that deal with drugs, interventions and therapies.

More...

Database of Abstracts of Reviews of Effects (DARE)

DARE is the only database to contain abstracts of systematic reviews that have been quality assessed. Each abstract includes a summary of the review together with a critical commentary about the overall quality.

The database is a key resource for busy decision makers and can be used for answering questions about the effects of specific interventions, whether such questions arise from practice or when making policy. DARE covers a broad range of health related interventions and includes over 3000 abstracts of reviews in fields as diverse as diagnostic tests, public health, health promotion, pharmacology, surgery, psychology and the organization and delivery of healthcare.

DARE complements the Cochrane Database of Systematic Reviews by quality-assessing and summarizing reviews that have not yet been completed by the Cochrane Collaboration. DARE is produced by the Centre for Reviews and Dissemination (CRD), University of York, UK.

DynaMed (EBSCO)

DynaMed (EBSCO) is a just-in-time reference tool integrating evidence-based and practical information for clinical practice. It provides clinically-organized summaries for more than 3000 topics, reflecting the most-common problems in primary care. These summaries are formatted to provide easy access to information, and findable using a simple yet powerful topical menu. See also DynaMed_(EBSCO)...

eMedicine

eMedicine comprises the largest and most current Clinical Knowledge Base available freely to physicians and other healthcare professionals. eMedicine's subscription site for point-of-care use for institutions is iMedicine. Nearly 10,000 physician authors and editors contribute to the eMedicine multimedia Clinical Knowledge Base, which contains articles on 7,000 diseases and disorders. The evidence-based content, updated regularly, provides the latest practice guidelines in 59 medical specialties. eMedicine's professional content undergoes 4 levels of physician peer review plus an additional review by a PharmD prior to publication.

Essential Evidence Plus - formerly 'InfoPOEMs/InfoRetriever'

Essential Evidence Plus, formerly 'InfoPOEMs/InfoRetriever', is the only database system of filtered, synopsized, evidence-based information. InfoRetriever searches a full spectrum of evidence-based content, tools and POEMs - or, Patient-Oriented Evidence that Matters™. POEMs meet three criteria: 1) they address a question that we face as clinicians 2) they measure outcomes that we and our patients care about: symptoms, morbidity, quality of life, and mortality; 3) they have the potential to change the way we practice. As POEMs are valid, they improve important patient outcomes and change what physicians do.

Evidence-Based Medicine Reviews (EBMR) - OVID

See The Cochrane Library

  1. Cochrane Database of Systematic Reviews (Cochrane Reviews)
  2. Database of Abstracts of Reviews of Effects (DARE)
  3. Cochrane Central Register of Controlled Trials (Clinical Trials)
  4. The Cochrane Methodology Register (Methods Studies)
  5. Health Technology Assessment Database (Technology Assessments)
  6. NHS Economic Evaluation Database (Economic Evaluations)

Evidence Matters

Evidence Matters (EM) is a user-friendly clinical knowledge management system to help support the use of research in decision-making. It answers questions on the effectiveness, safety, and costs of therapy options for a particular patient, in an evidence-based manner. Designed by clinicians, users of EM include clinicians, decision-makers, managers, medical librarians, and those who create guidelines, careplans, and formularies. EM creates patient-customized answers via summarized, instant meta-analyses (more accurately a "meta-graph") of all current research and best practices from thousands of peer-reviewed journals. More...

FirstConsult (Elsevier)

FIRSTConsult - used in conjunction with Elsevier's MDConsult - is a relatively new, evidence-based primary care clinical information system that provides continuously updated thinking on the latest in evaluation, diagnosis, therapeutics, patient management and outcomes. Designed to give you rapid access to concise point-of-car information, FIRSTConsult provides both practical information and diagnostic tools. It is both Web, and PDA-based.

FIRSTConsult provides information on over 20,000 disease-specific topics, presented in a consistently ordered, rapidly accessible format.

  • Differential Diagnoses provides a rapid evaluation of your patient's chief complaint with interactive access to lists of over 1,800 potential diagnoses sorted by age and prevalence
  • Medical Topics are FIRSTConsult's comprehensive database of clinically compiled, weeky updated information on patient evaluation, diagnosis, treatment, tests, prevention and much more
  • Patient Education provides clearly written handouts for patients in both English and Spanish
  • Procedures provide clear, systematic guidance, inclugin videos and medical animations of the procedures integral to practising medicine across many specialities

FC is edited by practicing physicians who ensure that FIRSTConsult content is accurate and clinically relevant. They work with Elsevier to ensure that content is constantly updated with the latest action-oriented recommendations that are supported by evidence-based medicine.

Access to FIRSTConsult, through a computer or handheld device, is via the internet, local area networks, and intranets, on an annual subscription basis, FIRSTConsult can also be embedded in other applications and programs such as patient health records via iCONSULT. More...

JBI COnNECT

JBI COnNECT (Clinical Online Network of Evidence for Care and Therapeutics) is a charitable, not for profit organization, and COnNECT is its online repository of pre-appraised evidence and resources to facilitate getting that evidence used in practice.

NHS Clinical Knowledge Summaries

NHS Clinical Knowledge Summaries (formerly Prodigy): U.K. National Health Service product designed to provide "a reliable source of evidence-based information and practical ‘knowhow’ about the common conditions managed in primary care. CKS provides quick answers to real-life questions that arise in the consultation, linking to detailed answers that clearly outline the evidence on which they are based”. Searchable by topic or alphabetically or by clinical topic, includes patient information, drug data, links to Cochrane and Dynamed. ‘My CKS’ allows storage of CKS content and web links. Simple, easy-to-use interface.

Nursing Reference Centre (EBSCO)

Nursing Reference Centre is a comprehensive reference tool designed to provide relevant clinical resources to nurses and other health care professionals. NRC covers conditions and diseases, drug information, patient education , diagnostic details, best practice guidelines, point-of-care reference books and evidence-based care sheets (as in CINAHL).

Thomson Clinical Xpert

Thomson Clinical Xpert powers your handheld device with a wealth of clinical knowledge from Thomson Healthcare, the industry’s leading provider of evidence-based decision support. It is available for download to any handheld device running on the Palm OS® or Pocket PC Operating System, and is updated instantly at each sync with the latest information. Your download gives you access to:

  • disease information
  • laboratory test information

Plus free access to information about:

  • drugs
  • interactions
  • alternative medicine
  • toxicology
  • news & alerts
  • convenient calculators

UpToDate

UpToDate is specifically designed to answer major clinical questions that arise in daily practice and at the point-of-care. Physician editors and authors at UpToDate review and update content on a continuous basis. New, peer-reviewed versions of each topic are issued quarterly by summarizing published evidence for patient care.

In September 2008, Wolters-Kluwer reportedly paid the equivalent of $400 million US dollars to acquire UpToDate. More...

References

  1. Catran DC, Appel GB, Hebert LA, et al. randomized trial of cyclosporine in patients with steroid-resistant focal segmental glomerulosclerosis. North America Nephrotic Syndrome Study Group. Kidney Int 1999; 56: 2220-2226.
  2. Chatellier G, Colombet I, Degoulet P. Computer-adjusted dosage of anticoagulant therapy improves the quality of anticoagulation. Medinfo 1998; 9 Pt 2: 819-823.
  3. Chitalia VC, Wells JE, Robson RA, et al. Predicting renal survival in primary focal glomerulosclerosis from the time of presentation. Kidney Int 1999; 56: 2236-2242.
  4. Early Breast Cancer Triallists' Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomised trials. Lancet 1998; 351: 1451-1467.
  5. Giustini D. EBM Sources of Information on the Web. November 2006 update
  6. Glasziou PP, Irwig LM. An evidence based approach to individualising treatment. BMJ 1995; 311: 1356-1359.
  7. 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.
  8. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993; 342: 1317-1322.
  9. How to Answer Your Clinical Questions More Efficiently
  10. Krumholz HM, Radford MJ, Ellerbeck EF, et al. Aspirin for secondary prevention after acute myocardial infarction in the elderly: prescribed use and outcomes. Ann Intern Med 1996; 124: 292-298.
  11. Liddle J, Williamson M, Irwig L. Method for evaluating research and guideline evidence. Sydney: NSW Health, 1996.
  12. Mitchell JB, Ballard DJ, Whisnant JP, et al. What role do neurologists play in determining the costs and outcomes of stroke patients? Stroke 1996; 27: 1937-1943.
  13. Montgomery AA, Fahey T. A systematic review of the use of computers in the management of hypertension. J Epidemiol Community Health 1998; 52: 520-525.#Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ 1995; 153: 1423-1431.
  14. Scott I, Heyworth R, Fairweather P. The use of evidence-based medicine in the practice of consultant physicians. Results of a questionnaire survey. Aust N Z J Med 2000; 30: 319-326.
  15. SFU EBM Resources page
  16. Smith R. What clinical information do doctors need? BMJ 1996; 313: 1062-1068.
  17. Soumerai SB, McLaughlin TJ, Spiegelman D, et al. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. JAMA 1997; 277: 115-121.
  18. Towler B, Irwig L, Glasziou P et al. A systematic review of the effects of screening for colorectal cancer using the faecal occult blood test, hemoccult. BMJ 1998; 317: 559-565.
  19. UMDNJ Physician's Core Toolkit
  20. Veenstra DL, Saint S, Saha S, et al. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. JAMA 1999; 281: 261-267.
  21. Vine R, Shaughnessy R, Thuna M. EBM Tool-Picking Made Easy. Presented at Medical Library Association Annual Meeting 2008.
  1. Walton R, Dovey S, Harvey E, Freemantle N. Computer support for determining drug dose: systematic review and meta-analysis.BMJ 1999; 318: 984-990.
  2. Williamson JW, German PS, Weiss R, et al. Health science information management and continuing education of physicians. A survey of U.S. primary care practitioners and their opinion leaders. Ann Intern Med 1989; 110: 151-160.
Retrieved from "http://hlwiki.slais.ubc.ca/index.php/Point_of_care_decision-making_tools_-_Overview"
Personal tools