Models of Information Summary, Synthesis, and Dissemination In Clinical Medicine

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Models of Information Summary, Synthesis, and
Dissemination In Clinical Medicine

• Sources and Organization of Evidence-based
  Knowledge
• Principal Investigator Elaine Martin, MSLS, MA
• Project Coordinator Hathy Simpson, MPH
• Project Consultant Roger Luckmann, MD, MPH

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Evolution of Medical Models of Information
Dissemination

• Information explosion
• Increasing expectations of EBM practice
• Studies documenting information needs
• The Internet and advances in computer hardware

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Evolution of Medical Models of Information
Dissemination

• Improving computer searching strategies and
  results displays
• Development of methodology for EBM critiques and
  systematic reviews
• Market forces driving rapid development of many
  new online resources full text books and
  journals, collections of databases, new original
  online content creatively organized

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Information Needs and Resources in Medicine and
Public Health

• Need for answers to problem-specific questions
  arising frequently in daily practice, not
  answered by common knowledge/guideline.
• Med Most common need usually related to
  individual patients
• PH May be much less common need, more often
  related to a population, sometimes to individual
  clients

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Information Needs and Resources in Medicine and
Public Health

• Need for best information to develop/revise
  policies, programs, and guidelines.
• Med Common need only for select group of
  practitioners
• PH May be most common need

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Information Needs and Resources in Medicine and
Public Health

• Type of information needed
• Med Very large databases of interventional
  studies, observational studies, guidelines,
  accumulated clinical and basic science knowledge
  relevant to both routine questions and
  policy/guideline development
• PH Many fewer community interventional studies,
  similar needs for observational studies and
  guidelines, also evaluation studies, accumulated
  public health knowledge, epidemiologic data,
  policies and procedures

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Models of Summary, Synthesis and Dissemination
ofClinical Medical Evidence

• Reports of Original Research
• Summaries, Critiques and Commentaries on
  Individual Original Research Studies(and
  sometimes systematic reviews and meta-analyses)
• Systematic Reviews and Meta-analyses (focus on a
  topic and often provide a guideline for practice)
• Comprehensive Knowledge Bases

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Reports of Original Research

• Formats
• Hardcopy of journals
• Online journals
• Collections of online journals
• Databases of study titles, abstracts, and
  references (Medline, other relevant databases)

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Reports of Original Research

• Quality
• Varies widely
• Editors and reviewers responsible
• Quality filters for assisting in searching
  databases
• Updating
• Regular and frequent related to schedules of
  journal publication

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Reports of Original Research

• Pushing
• Regular emails of titles and abstracts
• Selected topics
• Wide range of delivery services
• Single journal, multiple journals

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Reports of Original Research

• Medical Examples
• Journal Websites
• OVID Medline
• PubMed
• Web of Science
• SGIM abstract delivery

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Reports of Original Research

• Public Health Examples
• MMWR and MMWR Website
• AJPH email services
• SafetyLit
• Healthy People 2010 Information Access project
  (Medline Filters)

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Reports of Original Research

• Possible Applications in Public Health
• Facilitated access to collections of online
  public health related journals
• Service to push titles and abstracts of relevant
  articles to practitioners
• Filters for searching existing databases for best
  information
• Search engines to search multiple databases
  simultaneously

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Reports of Original Research

• Issues
• Limitations of quality filters
• Information overload from searches of large
  databases
• Problems in customizing content of pushed
  information and avoiding information overload

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Summaries, Critiques and Commentaries

• Format
• Newsletters and journals in hardcopy and online
• Searchable electronic databases (CD-ROM and
  online)

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Summaries, Critiques and Commentaries

• Quality
• Dependent on qualifications and skills of
  editors/commentators
• Related to methodology for summarization and
  critique

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Summaries, Critiques and Commentaries

• Updating
• Periodically as new studies come out
• Driven by publication of new material
• Lag time due to production of summaries and
  commentaries
• Pushing
• Regular mailing of hardcopies

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Summaries, Critiques and Commentaries

• Medical Examples
• Journal Watch
• ACP Journal Club
• Annals of Internal Medicine
• Faculty of 1000
• Public health examples
• Journal Watch Infectious Diseases

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Summaries, Critiques and Commentaries

• Possible Applications to Public Health
• Popular, accessible format for pushing filtered
  information with evidence-based commentary
• Useful format for sections of existing journals

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Summaries, Critiques and Commentaries

• Issues
• Identifying optimum style, structure, and length
  of summaries and commentaries
• Need cadre of volunteer writers with content
  knowledge and evidence-based critical reading
  skills
• Selection of studies relevant to knowledge
  domains
• A single study often does not answer a question

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Systematic Reviews, Meta-Analyses and
Evidence-Based Guidelines

• Formats
• Collections in books and on CD-ROM
• Online collections

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Systematic Reviews, Meta-Analyses and
Evidence-Based Guidelines

• Quality
• Dependent on methodology of review and approach
  to summarization
• Many guidelines may not qualify as
  evidence-based if not supported by a systematic
  review

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Systematic Reviews, Meta-Analyses and
Evidence-Based Guidelines

• Updating
• Periodic without any clear systematic approach
  for existing collections
• May involve adding new topics and/or revising
  existing topics
• Pushing
• Subscriptions to regular new editions

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Systematic Reviews, Meta-Analyses and
Evidence-Based Guidelines

• Medical examples
• Cochrane Database of Systematic Reviews
• Guide to Clinical Preventive Services
• National Guideline Clearinghouse

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Systematic Reviews, Meta-Analyses and
Evidence-Based Guidelines

• Public health examples
• Guide to Community Preventive Services
• Cochrane Public Health topic reviews
• CDC Prevention Guidelines System
• Evidence for Policy and Practice Information
  Centre Health Promotion Reviews
• NHS Centre for Reviews and Dissemination
  Economic Evaluation Database
• The Effective Public Health Practice Project

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Guide to Community Preventive Services Topics
Covered
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Guide to Community Preventive Services Topics
Covered
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• The Guide to Community Preventive Services
• Evaluating and making recommendations on
  population-based and public health interventions 
  
• Reviews
• Evidence on effectiveness
• Applicability of findings to diverse
  populations
• Intervention's other effects
• Economic impact
• Barriers to implementation of interventions

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• The Guide to Community Preventive Services
• The steps for obtaining and evaluation evidence
  into recommendations involve
• Searching for and retrieving evidence on
  effectiveness
• Assessing the quality of and summarizing the
  body of
  
  evidence
• Translating the evidence into recommendations
• Considering information on evidence other than
  effectiveness
• Identifying and summarizing research gaps.

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The Guide to Community Preventive Services

• Summary and recommendations on Website in
  standard formats
• Background systematic reviews published in Am. J.
  Prev. Med.
• Links to Am. J. Prev. Med. And MMWR materials on
  Website
• Links vary in effectiveness

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Guide to Community Preventive Services Diabetes
Recommendations Table
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GCPS Oral Health Organization of Links
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Register of Reviews of Effectiveness in Health
Promotion

• Maintained by the Evidence for Policy and
  Practice Information and Co-ordinating Centre
  (EPPI-Centre)
• Part of the Institute of Education, University of
  London.
• 700 reviews currently referenced (citation only)
• References Cochrane reviews

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Cochrane Database of Systematic Reviews

• Separate Public Health Group
• Standardized approach to systematic reviews
• Individual or institutional subscription required
  for access to full text
• About 50 reviews and many more planned

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Cochrane Review Index (Ovid)
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Cochrane Review Index (Ovid)
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• CDC Recommends The Prevention Guidelines System
• Over 400 documents
• Up-to-date guidance on many public health issues
• Full text or links
• Most published in MMWR
• Sophisticated search engine
• Limited indexing within documents

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Systematic Reviews, Meta-Analyses and
Evidence-Based Guidelines

• Possible applications in Public Health
• Strengthening, expanding, connecting, and
  improving indexing of public health models cited
  may be an attractive approach

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Systematic Reviews, Meta-Analyses and
Evidence-Based Guidelines

• Issues
• Systematic review methodologies and methods for
  rating evidence are increasingly well developed.
• Guidelines can be evidence-based, justified by
  systematic review, and also accessible and
  immediately relevant to practice.

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Comprehensive Knowledge Bases

• Formats
• Paperback and hardback books with indices for
  searching
• Book content on websites and CD-ROM with
  electronic indices and search options based on
  the hardcopy index
• Collections of books on website with
  comprehensive searching across texts
• MD Consult

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Comprehensive Knowledge Bases

• Collections of multiple, carefully selected
  databases, full text journals and texts
• Selective search across databases with
  prioritized display of findings
• Stanford Skolar MD, Merck Medicus

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Comprehensive Knowledge Bases

• Original electronic textbooks (CD-ROM and online,
  without hard copy equivalent)
• Original content prepared and organized to
  facilitate rapid finds of specific information
• May include other databases or texts
• Sophisticated indexing displays and search
  engines
• Cross-referenced links within/between chapters
• External links to article abstracts of
  references, etc.
• ACP Pier Online, eMedicine, Harrison's Online,
  Praxis MD, Sci. Am. Med., UpToDate

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Comprehensive Knowledge Bases

• Quality
• Dependent on methodology of editors and writers
  for original content
• Dependent on selection of databases and texts for
  nonoriginal content

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Comprehensive Knowledge Bases

• Updating
• New editions periodically for texts or new
  additions to databases
• Monthly or more frequent updates based on ongoing
  comprehensive literature review
• Updating usually involves integrating new
  knowledge into the existing text structure for
  those with original content

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Comprehensive Knowledge Bases

• Pushing
• Selected new content can be pushed or promoted on
  a home page

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Comparative Study of Comp. Knowledge Bases,
Medline, Collections of Systematic Reviews

• Standard set of clinical questions used to assess
  14 sources including 9 comprehensive knowledge
  bases
• Scored on effectiveness (valid, specific answers
  to the questions) and efficiency (ease of finding
  answer and time)
• Comprehensive Knowledge Bases all score above
  Medline and Systematic Reviews for efficiency
• Berkowitz LL. Review and evaluation of
  internet-based clinical reference tools for
  physicians, 2002.

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Comparative Study of Comp. Knowledge Bases,
Medline, Collections of Systematic Reviews

• Six Comprehensive Knowledge Bases score above
  Medline and Systematic Reviews for effectiveness
• Top 3 for efficiency UpToDate, ACPR Pier Online,
  Harrisons Online
• Top 3 for effectiveness UpToDate, eMedicine,
  Stanford Skolar MD
• Berkowitz LL. Review and evaluation of
  internet-based clinical reference tools for
  physicians, 2002.

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UpToDate Comp. Knowledge Base Example

• Topics
• Adult Primary Care, Cardiology, Drug
  Information Endocrinology, Family Practice,
  Gastroenterology, Gynecology, Hematology,
  Hepatology, Infectious Diseases, Nephrology,
  Obstetrics, Oncology, Pulmonology, Rheumatology,
  Women's Health
• In Development
• Allergy/Immunology, Neurology, Pediatrics

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UpToDate Comp. Knowledge Base Example

• Initial cards created by consulting staff of
  gt7000 content experts
• In some cases review by practitioners
• Extensive editing for consistency by in-house
  staff of physicians and editors
• Monthly review of 300 key journals by in-house
  staff
• Content experts receive any important new
  studies and must update their card/s
• Authors/editors encouraged to use evidence-based
  methodologies and cite high quality references
  but no specific evidence criteria

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UpToDate
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Comprehensive Knowledge Bases

• Public health examples
• Textbooks of Public Health and related disciplines

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Comprehensive Knowledge Bases

• Possible Public Health Applications
• Consolidating most useful Public Health online
  resources (Cochrane, guidelines, reviews,
  journals) and offering integrated search and
  improved indexing could improve access.
• A comprehensive, regularly updated, well indexed
  electronic knowledge base including original
  content aimed at common public health questions
  could be useful. Guide to Comm. Prev. Serv. And
  Cochrane offer attractive core.

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Comprehensive Knowledge Bases

• Issues
• Consolidating databases and developing an
  effective, efficient search engine is difficult.
• Both initial and ongoing costs may be prohibitive
  especially for developing original content.
• Large numbers of writers and editors required for
  original content.
• Consistency in treatment of evidence difficult to
  achieve in original content.