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MISSION Committed to improving patient care by providing the most CURRENT CLINICAL EVIDENCE TO CLINICIANS so they can make the best decisions for their patients. The Next Generation Clinical Information Resource • Re-created from the ground up • New search algorithm • New physician leadership • New interface • New platform • New content • New features Created by physicians who are A TOOL …Not a textbook EXPERTS in their respective fields who provide OBJECTIVE ANALYSIS of the evidence & recommendations in an easily digestible format with access anytime, anywhere from any device or system TOP FIVE OBJECTIONS to DynaMed vs. UpToDate • It doesn’t tell me what to do • Lack of expert reviewers • Lack of specialty content • There are no images • It’s hard to get an answer quickly It doesn’t tell me what to do OVERVIEWS AND RECOMMENDATIONS • Overviews and Recommendations provide clinicians with concise, accurate overviews for highly relevant topics and evidencebased recommendations for action. • Topics have been re-written from scratch to provide immediate context and direction New Overviews and Recommendations at the top DynaMed Plus offers many examples of strong and weak recommendations Clicking on a link provides the user with levels of evidence and guidelines behind each recommendation DynaMed Plus provides links to the levels of evidence and the guidelines behind each recommendation The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was created in 2000 by a dedicated group of guideline developers. What is GRADE? RECOMMENDATIONS are graded as Strong or Weak EVIDENCE is graded for the body of evidence as High, Moderate, Low or Very low quality (A, B, C, or D). QUALITY grading for evidence is based on the risk of bias introduced by study methodology, the precision the consistency of studies, the directness to the conclusion being made, and the likelihood of publication bias. GRADE is now the standard GUIDELINE GROUPS More than 80 of the world’s leading organizations which produce guidelines formally use GRADE: SYSTEMATIC REVIEWS Independent systematic review organizations such as Cochrane have incorporated GRADE • WHO • CDC • The Endocrine Society • AGA • ACCP • AASLD • ACP • ICSI • American Thoracic Society • NICE • NKF/KDOQI • SIGN • KDIGO • NHS • Norwegian Knowledge Center / Norwegian Directorate of Health • Kaiser Permanente • Dutch College of GPs • Canadian Cardiovascular Society • Multiple Red Cross groups • IDSA DynaMed Plus EVIDENCE-BASED METHODOLOGY Lack of expert reviewers Editorial LEADERSHIP BRIAN S. ALPER, MD, MSPH, FAAFP Founder of DynaMed, VP of EBM Research & Development, Policy and Content Quality, EBSCO Information Services, Clinical Research Assistant Professor Department of Family and Community Medicine, University of Missouri School of Medicine Columbia, MO ALAN EHRLICH, MD SHEILA BOND, MD Executive Deputy Editor Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School Worcester, MA Deputy Editor of Infectious Disease, Clinical Instructor in Medicine Harvard Medical School Boston, MA PETER OETTGEN, MD, FACC KEVIN LOUGHLIN, MD, MBA, MA(HON) Deputy Editor of Cardiology Director of Preventative Cardiology, Beth Israel Deaconess Medical Center, Associate Professor Harvard Medical School Boston, MA Deputy Editor of Oncology and Hematology, Senior Surgeon Brigham & Women's Hospital Professor of Surgery, Harvard Medical School, Boston, MA FULLY INTEGRATED EXPERTS • An extensive network of physicians • Experts in their particular fields • Select the best and most appropriate evidence • Confirm the clinical applicability of content • Peer-review topics Matthew Coggins, MD Michelle Lin, MD Instructor of Cardiology Harvard Medical School Beth Israel Deaconess Medical Center Associate Professor of Clinical Emergency Medicine Academy Endowed Chair for Emergency Medicine Education University of California San Francisco Kevin Ard, MD Instructor of Medicine Harvard Medical School Assistant in Medicine Division of Infectious Diseases Massachusetts General Hospital Jennifer Nan-Wah Wu, MD Instructor of Pediatric Oncology Dana-Farber Cancer Institute Boston Children's Hospital Dawn Abbott, MD, FACC, FSCAI Jennifer Johnson, MD Instructor in Medicine Division of Infectious Diseases Harvard Medical School Brigham and Women's Hospital Muhammad Mir, MD, FACP Assistant Professor of Hematology and Blood/ Marrow Transplant Penn State University Milton S. Hershey Medical Center Obinna O. Adibe, MD Assistant Professor of Pediatric Surgery Duke University Medical Center Associate Professor of Medicine, Brown University Director of Interventional Cardiology Fellowship Rhode Island and Miriam Hospitals Christian Jackson, MD Assistant Professor of Gastroenterology Loma Linda University Chief of Gastroenterology Loma Linda VA Healthcare System Kenneth Weiss, MD, FACP Professor of Medicine Cleveland Clinic Lerner College of Medicine Physician Executive Board We have established an EXECUTIVE BOARD charged with advising on editorial, EBM, and editorial policy Members represent JAMA, McMaster, Penn, Emory, MGH, ACP and other healthcare organizations. Betsy Jones Ilkka Kunnamo, MD, PhD Vice President of Medical Product Management and Chief Content Officer, EBSCO Health Founder and Editor-in-Chief of EBM Guidelines and EBMeDS decision support program Amir Qaseem, MD, PhD, MHA, FACP Michael Berkwits, MD, MSCE Deputy Editor for JAMA Director of the Department of Clinical Policy at the American College of Physicians Robert M. Centor, MD, MACP Dr. Surendra K. Sharma, MBBS, MD, PhD Chair of the Board of Regents for the American College of Physicians Chief of the Division of Pulmonary, Critical Care, and Sleep Medicine at the All India Institute of Medical Sciences Julie Hollberg, MD CMIO for Emory Healthcare Craig Umscheid, MD, MSCE William A. Kormos, MD, MPH Assistant Professor of Medicine and Epidemiology at the University of Pennsylvania School of Medicine Chief of Medicine at the James Howard Means Firm, Department of Medicine Holger Schünemann, MD, MSc, PhD Professor and Chair of the Department of Clinical Epidemiology & Biostatistics Lack of specialty content Editorial team structure SPECIALTY PUBLISHING GROUPS: • General Internal Medicine • Cardiology/Pulmonology/Critical Care • ID/Immunology • Oncology/Hematology • Emergency Medicine Editorial team structure EXPERTS RECRUITED FROM: • Harvard University • Massachusetts General Hospital • Beth Israel Deaconess Hospital • Yale • Brigham and Women’s Hospital • Dana Farber Cancer Institute • University of California San Francisco • Cleveland Clinic AND MORE… ROBUST SPECIALTY CONTENT • Allergy • Obstetrics and Gynecology • Cardiology • Oncology • Critical Care • Orthopedics • Dermatology • Pediatrics • Infectious Disease • Primary Care • Emergency Medicine • Psychiatry • Endocrinology • Rheumatology • Gastroenterology • Sports Medicine • Hematology • Surgery • Nephrology • Urology There are no images DynaMed Plus includes more Selecting imagewith provides than 4,000animages more the user a larger view than 2000 from ACP. Images are searchable as well as embedded in relevant topics It’s hard to get an answer quickly Precise Search Results Search employs a brand-new, proprietary, semanticallypowered search engine, significantly improving discoverability and speed-to-answer DynaMed Plus employs intelligent auto-suggest, which identifies the user’s query and allows direct navigation to highly-accessed areas within topics Convenient filters allow quick access to images and calculators that are relevant to the user’s query DynaMed Plus offers superb navigation within the results display With exact-match queries, DynaMed Plus displays a medical information placard, offering topic-specific links, images, and information By understanding the user’s intent, DynaMed Plus’ intelligent search is able to identify queries that yield robust image results and display them in a time-saving image carousel This same technology presents the user with query-specific calculators Grouped results allow the clinician to quickly understand the context of the result EXAMPLE: Result shows Pulmonary embolism within the Heart failure with reduced Relevant results ejection fraction topic, and will the navigate userstodirectly path provides the context thethe specific understandto that result section refers DynaMed Plus’ to treatmentwithin medications clinically relevant outline-based structure Topic view offers nextgeneration navigation, Location within the topic providing immediate is dynamically context to the userupdated both in the navigation bar, as well as within the breadcrumb trail at the top of the screen DynaMed Plus offers all of the same quickaccess features users have come to expect, including search within and highlighting DynaMed Plus employs a FULLY RESPONSIVE DESIGN, which means it renders ideally for any device or orientation iPhone Small Tablet iPad - Portrait iPad - Landscape iPhone Small Tablet iPad - Portrait iPad - Landscape EHR Integration EBSCO Health listens to the needs of our customers and users which helps us build better products DynaMed Plus has…. overviews and recommendations well-known expert reviewers increased breadth/depth of specialty content multimedia content better search & discovery MICROMEDEX DRUG CONTENT Micromedex evidence-based content is presented in concise, sourced, and referenced blocks of information to help you get answers quickly when the situation demands. • Medication Management Standard Drug Information • Drug Information for Medication Safety • IV Compatibility for Reduced Complications • Lab Recommendations ACP Partnership • ACP clinical leadership develops and maintains DynaMed Plus internal medicine topics • Multiple members of ACP are part of the DynaMed Plus Executive Board Access anywhere, anytime SUMMARY OF NEW FEATURES Graphics & Images Access thousands of graphics and images Overviews & Recommendations Precise Search Results Read concise overviews and detailed recommendations Get precise search results every time Specialty Content DynaMed Plus includes robust specialty content Expert Reviewers Mobile App Drug Content Deputy Editors are supported by an extensive network of clinical experts The mobile app is complimentary with every subscription, at no extra cost Drug content to help with diagnosis with Micromedex® Clinical Knowledge Suite GRAZIE Fabio Di Bello | Regional Manager Italy & Israel [email protected] 349.4157827 Resources to Consider: ACP Pier BMJ Point of Care Cochrane Library DynaMed Up-to-Date Who can find the answer most quickly? Use any resource. Round 1, Question 1 • Is glatiramer acetate effective for relapsingremitting multiple sclerosis? How does it compare to interferon beta? Round 1, Question 2 What antibiotic should you use for a pregnant woman with acute cystitis? Round 1, Question 3 • What is the dose of famciclovir for treating zoster in an immunocompetent patient? Round 1, Question 4 • Are graduated compression stockings effective for reducing the risk for venous thromboembolism after acute stroke? Round 1, Question 5 • You have a new patient who is an adolescent with obsessive-compulsive disorder. Her parents state this is due to a strep throat. What are the criteria for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection (PANDAS)? Round 1, Question 6 • How do you diagnose chronic fatigue syndrome? Round 1, Question 7 • A 45-year-old man complains of shortness of breath for two hours and there was a sudden onset. Two days ago he traveled 12 hours by airplane. He has no history of prior thromboembolism, cancer, or other medical conditions. He has tachycardia (pulse 106 beats/minute) but otherwise normal findings on physical examination. Would you classify his risk for pulmonary embolism as high, Round 1, Question 8 • For the man with an intermediate risk of pulmonary embolism, what testing should you do? Consider the resources available for testing in your setting. Round 1, Question 9 • How do triflusal and cilostazol compare to aspirin for secondary prevention of stroke in a patient with a history of transient ischemic attacks (TIAs)? Round 1, Question 10 • What is the most effective antibiotic for uncomplicated symptomatic urinary tract infection in women? Round 2 • Check different resources to see if the answers are consistent. If not, why not? Round 2, Question 1 • A 3 year-old girl weighing 13.3 kg (30 lbs) has rotaviral gastroenteritis and moderate dehydration. How do you start fluid replacement? Round 2, Question 2 • A man complains of sudden sensorineural hearing loss. You prescribe steroids. Should you also include antiviral therapy as part of your treatment plan? Round 2, Question 3 • You are establishing a protocol for response to patients who develop anaphylaxis in your medical practice. The nurse asks if epinephrine administration can be given subcutaneously instead of intramuscularly. Is there a difference in efficacy between the subcutaneous and intramuscular routes? Round 2, Question 4 • You are seeing a 22-month-old boy in follow-up after treatment for a urinary tract infection (UTI). He was found to have grade II vesicoureteral reflux (VUR). You wonder if you should start an antibiotic for prophylaxis, and if so, which antibiotic? Round 2, Question 5 • How do you diagnose irritable bowel syndrome (IBS)? What evaluation is indicated? Round 2, Question 6 • You diagnosed irritable bowel syndrome. Is fiber an effective treatment? Round 2, Question 7 • Do antihypertensive medications reduce cardiovascular events in a patient with mild hypertension (blood pressure 145/95 mmHg) and no other cardiovascular risk factors?