Topic Creation, Maintenance and Quality Process

For a clinical reference to truly be called evidence-based, guidance for clinical practice must be based on the best available evidence interpreted with clinical expertise and incorporating multiple perspectives.

Clinical reference topics can only provide such guidance if they are consistently and systematically developed with attention to clinical practice information needs, best practices for evidence interpretation, integration of current authoritative guidelines, and synthesis of all these factors to support consistent guidance and discover and explain inconsistent interpretations.

Expert or specialist-identified and contracted

Identify content domain expert(s) for the topic development effort. The typical expert is a physician who is active in academic and clinical practice and is board-certified in the appropriate specialty or devotes a portion of time caring for patients with the clinical entity in question. Most experts are physicians although DynaMed Plus at large takes a multidisciplinary view toward meeting the needs of health care professionals so other experts (such as pharmacists) may be appropriate for selected topics.

Clinical framework for topic completed by expert or specialist

Scope the topic development needs with a clinical framework, a set of key clinical questions to address during topic development, and suggested seminal studies, important supporting primary data, and guidelines to use. When scoping, consider multiple perspectives reflecting the needs, expectations and understanding of clinicians who are diverse in discipline, training, experience, setting, and culture.

Comprehensive literature search performed by in-house team

Conduct a comprehensive literature search where needed. To understand “where needed” see the evidence capture from the ongoing evidence-based methodology process. The results from this process and from key guidelines are compared against the information needs identified in topic scoping to determine where focused comprehensive evidence searching is needed to address apparent gaps (inconsistencies or absence of current systematic reviews). This supplements Step 1 of the evidence-based methodology process.

Best evidence merged with clinical framework

Select the most useful evidence for inclusion, critically appraise it, summarize it, and organize it within the clinical framework to create the topic. This is steps 2-6 of the evidence-based methodology process.

Topic reviewed for accuracy and adherence to DynaMed style

Review the entire topic for accuracy and adherence to DynaMed Plus style. Evidence summaries are checked for accuracy of data and critical appraisal.

Topic reviewed for clinical usability at the point of care

Review the entire topic for clinical relevance and usability at the point of care. Evidence summaries are checked for clinically meaningful conclusions and summary of appropriate clinical variables.

Topic reviewed by external expert or specialist

Review the entire topic by content domain expert(s) selected in step 1.

Independent Overview & Recommendations verification

Review the Overview & Recommendations section for adherence to sound recommendations, and consistency across the topic. This includes independent evaluation by clinicians with methodological expertise to ensure that any Strong recommendations are adequately supported. This process is described in “Synthesized Recommendation Grading”.

Final review

Final review by Deputy Editor, including repeat of any of steps 1-8 as necessary.

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