Evidence-based Methodology

Best practices for providing the most useful and reliable information

DynaMed’s evidence-based methodology is the foundation underlying all of its content. An evidence-based tool must derive conclusions based on the best available evidence. This can only occur if the evidence is consistently and systematically identified, selected, summarized, synthesized, and interpreted. Conclusions must also be adjusted as new evidence is added to the ever-growing evidence ecosystem.

DynaMed’s editorial processes include the following steps:

1. Identifying the evidence

To ensure that DynaMed provides the best available evidence, an extensive set of current literature is monitored daily. Systematic literature surveillance is conducted using many journals, journal review services, review collections, guideline collections and other relevant sources.

2. Selecting the best available evidence

Each article is assessed for clinical relevance, and each relevant article is further assessed for validity relative to existing DynaMed content. The most valid articles are summarized, summaries are integrated and overview statements and outline structure are updated based on the overall synthesis.

Article selection is completed by editors with clinical expertise and training in scientific analysis. Relevance is determined primarily by results affecting clinical outcomes and clinical decision-making, and secondarily by consideration of popular or frequent clinical questions. Validity is determined by type of conclusion.

3. Critical appraisal

Conclusions may be labeled as Level 1 (likely reliable) evidence where conclusions are based on sound research findings meeting a comprehensive set of criteria to support reliability, Level 2 (mid-level) evidence for comparative evidence regarding clinical outcomes with some potential shortcomings, or Level 3 (lacking direct) evidence where there is no comparative evidence informing effects on clinical outcomes. Learn more about the editorial process.

Full-text evaluation of articles is required for any article potentially rated as Level 1, or if detailed explanation is needed for descriptions of important clinical factors. If serious methodological shortcomings are discovered (enough to affect clinically relevant results), the shortcomings are described. Critical appraisal is completed by trained editors.

4. Objectively reporting the evidence

DynaMed editors check the data against original study reports, and clinical editors review all summaries for validity and relevance at the point-of-care. Level of evidence labeling is done by protocol with explicit reasons stated for downgrading levels of evidence. Short, unambiguous phrasing is used.

Absolute risk data is used and NNT/NNH are presented where available. Clinical editors review all evidence summaries for validity and relevance at the point-of-care.

5. Synthesizing multiple evidence reports

Evidence-based summarization of articles is necessary but insufficient for a point-of-care reference. Understanding the best current evidence requires synthesizing multiple evidence reports. Preference for inclusion and organization is based on the quality of evidence.

When data of lesser quality does not add any substantially new or different information, this data is then deleted. Evidence is also synthesized with guidelines, and areas of inconsistency are presented. Clinical editors review all synthesis results for validity and relevance at the point-of-care.

6. Basing conclusions on the evidence

Multiple evidence reports of similar quality are organized such that the overall conclusions quickly provide a synthesis of the best available evidence. Overviews, testing overviews, treatment overviews, and recommendations are based upon and linked directly to the supporting evidence. Editors confirm that overviews are clinically useful and match supporting data.

7. Updating daily

The final step in evidence-based methodology is changing conclusions when new evidence alters the best available evidence. This step is crucial because new evidence is published every day.

As soon as new evidence is evaluated using the 6 steps governing systematic processing, it is added to the appropriate DynaMed topic(s) in context. This process allows immediate and complete access to the best evidence as it occurs.

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