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. 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.

2. Selecting the best available evidence

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..

3. Critical appraisal

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.

4. Objectively reporting the evidence

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.

5. Synthesizing multiple evidence reports

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 superceded 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.

6. Basing conclusions on the evidence

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.

7. Updating daily

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.