The DynaMed evidence-based methodology is the foundation underlying all our 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.
To ensure that DynaMed provides the best available evidence, an extensive set of current literature is monitored daily. A state-of-the-art Systematic Literature Surveillance program continually monitors medical research as it is published, including journals, journal review services, review collections, guideline collections and other relevant sources.
To select the best available evidence, screen published research and clinical practice guidelines are screened for relevance and potential impact on clinical decision-making and patient care. Each relevant article is further assessed for validity relative to what is already known. The most valid articles are summarized and integrated into existing DynaMed content, which may trigger updates to overview statements and the overall outline structure.
Article selection is completed by a team of practicing physicians and methodologists with clinical expertise and/or 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.
Every medical research paper identified and selected for inclusion in DynaMed undergoes an objective critical appraisal process involving consistently applied, systematic identification of potential sources of bias. A simple Level of Evidence rating system makes it easy for users to quickly understand the quality of the evidence being reported. Learn more about the editorial process.
Critical appraisal is completed by an editorial team that is rigorously trained in evidence-based medicine and critical appraisal of scientific/medical research.
The evidence is objectively reported using data from the original study publication, with a focus on clinical outcomes and absolute risk data when available. Levels of evidence are applied according to an explicit protocol. Clinicians review all content for validity and relevance at the point-of-care.
Objectively reporting the evidence for an individual study is necessary but insufficient for a comprehensive point-of-care reference. Understanding the best current evidence requires synthesizing multiple evidence reports. When evaluating multiple evidence reports, preference for inclusion and content organization is based on both clinical relevance and the quality of evidence.
When data of lesser quality is identified but does not add any substantially new or different information, this data is excluded. Lesser quality data is also removed when it is superseded by higher quality evidence. Evidence is also synthesized with clinical practice guidelines, and areas of inconsistency are presented. Clinicians review all content for validity and relevance at the point-of-care.
Multiple evidence reports are organized such that the overall conclusions quickly provide a synthesis of the best available evidence. Overviews (including the Overview and Recommendations, Testing Overview, and Management Overview) are based upon and linked directly to the supporting evidence.
The final step in evidence-based methodology is adjusting conclusions as new evidence is added to the ever-growing evidence ecosystem. This step is crucial because new evidence is published every day.
As soon as new evidence is evaluated using the six steps governing systematic processing, it is integrated into the appropriate DynaMed topic(s). This process allows immediate and complete access to the best evidence as it becomes available.
There are approximately 50 million medical and scientific publications available in public databases, and one new medical or scientific publication is released every 30 seconds. With new information coming out at such a staggering rate, it is virtually impossible for a clinician to keep up with all the newest evidence available daily. Our rigorous editorial process does the work for you.
A state-of-the-art Systematic Literature Surveillance (SLS) program supports DynaMed’s evidence-based methodology by continually monitoring medical research as it is published. A team of practicing physicians and methodologists identify, objectively appraise, and summarize clinical trials and clinical practice guidelines that impact patient care.
To identify the evidence the Systematic Literature Surveillance (SLS) program monitors 250 medical journals and 200 guideline organizations publishing the most clinically relevant research and clinical practice guidelines across 28 specialties.
DynaMed’s partnership with McMaster University adds the power of the McMaster PLUS resource to its monitoring program. McMaster University’s Health Information Research Unit uses its Critical Appraisal Process to identify studies and systematic reviews that are scientifically sound from approximately 120 top journals.
To select the best available evidence DynaMed works with > 50 medical specialists who screen published research and clinical practice guidelines for relevance and potential impact on clinical decision-making and patient care. In addition, McMaster PLUS provides ratings and comments from their global network of more than 8,000 frontline clinicians through the McMaster Online Rating of Evidence (MORETM) system.
Every medical research paper identified and selected for inclusion in DynaMed undergoes an objective appraisal process by an editorial team that is rigorously trained in evidence-based medicine and critical appraisal of scientific/medical research. Critical appraisal is the process of systematically assessing the outcome of scientific/medical research to evaluate its trustworthiness, relevance, and value. It facilitates the application of research into practice, allowing a clinician to understand whether research is reliable and applicable to their patients.
DynaMed’s critical appraisal process involves consistently-applied, systematic identification of potential sources of bias in order to enable objective communication of the relevant clinical message in the context of study’s limitations. A team of practicing physicians and methodologist objectively appraise the most valid clinical trials and clinical practice guidelines and integrate the findings into the existing clinical framework.
A simple Level of Evidence rating system makes it easy for users to quickly understand the quality of the evidence being reported in an evidence summary, and the primary rationale behind the rating.
Level 1 (likely reliable) eevidence represents research results that address clinical outcomes and meet an extensive set of quality criteria that minimizes bias.
Level 2 (mid-level) evidence represents research results that address clinical outcomes and demonstrate some method of scientific investigation but do not meet the quality criteria to achieve Level 1.
Level 3 (lacking direct) evidence represents either of the following:
Reports that are not based on scientific analysis of clinical outcomes (e.g., case series, case reports, conclusions extrapolated indirectly from scientific studies)
Research results that do not address clinical outcomes, regardless of the scientific rigor
In the Overview and Recommendations, DynaMed synthesizes current evidence, current clinical practice guidelines, and clinical expertise to provide recommendations to support clinical decision-making. The internationally-accepted Grading of Recommendations Assessment, Development and Evaluation (GRADE) system is used to classify synthesized recommendations as Strong or Weak.
DynaMed synthesized recommendations are determined with a systematic methodology:
New topics in DynaMed are developed under the direction of a Deputy Editor and undergo a rigorous writing and review process that includes methodologists, physician experts or specialists, and EBM experts. The topic development process leverages the SLS program for identifying evidence and selecting the best available evidence and the critical appraisal process.
DynaMed topics are developed to meet the information needs of clinicians and provide guidance to support effective and timely clinical decision-making. As a result, Topic and Section Editors in active clinical practice play an integral role in the topic development process and are listed on each topic they review.
The typical Topic/Section Editor 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 questions. Other experts (such as pharmacists) may be appropriate for selected topics to support a multidisciplinary approach to meeting the needs of clinicians. The Topic/Section Editor provides an initial clinical framework to guide the editorial team and then reviews the topic once it is developed to ensure that it is comprehensive, clinically relevant, and based on the best available evidence.
Prior to review by the Topic/Section Editor, the editorial team applies DynaMed’s evidence-based methodology to develop the topic, from performing a comprehensive literature search to integrating the best available evidence into the clinical framework. The content is reviewed for accuracy and application of critical appraisal by an editor as well as clinical relevance and usability at the point-of-care by a physician editor.
The final steps in the topic development process consist of an independent review by an EBM expert and review by the Deputy Editor. The EBM expert evaluates the Overview and Recommendations for adherence to sound recommendations and consistency.
DynaMed’s living reviews are updated regularly as new evidence is identified through the SLS program. In addition, topics undergo regular updating and review by the editorial team, Topic/Section Editors, and EBM experts. This ensures that DynaMed content keeps pace with the ever-growing evidence ecosystem and evolving standards of care.
DynaMed editors systematically monitor journals, journal review services, systematic review collections, guideline collections, drug information sources and other relevant sources.