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
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
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
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
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
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
Models of Summary, Synthesis and
Dissemination of
Clinical Medical Evidence
1. Reports of Original Research
2. Summaries, Critiques and Commentaries
on Individual Original Research Studies
(and sometimes systematic reviews and metaanalyses)
3. Systematic Reviews and Meta-analyses
(focus on a topic and often provide a guideline
for practice)
4. Comprehensive Knowledge Bases
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)
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
Reports of Original Research
Pushing
• Regular emails of titles and abstracts
• Selected topics
• Wide range of delivery services
• Single journal, multiple journals
Reports of Original Research
Medical Examples:
• Journal Websites
• OVID Medline
• PubMed
• Web of Science
• SGIM abstract delivery
Reports of Original Research
Public Health Examples:
• MMWR and MMWR Website
• AJPH email services
• SafetyLit
• Healthy People 2010 Information
Access project (Medline Filters)
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
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
Summaries, Critiques and
Commentaries
Format:
• Newsletters and journals in hardcopy
and online
• Searchable electronic databases (CDROM and online)
Summaries, Critiques and
Commentaries
Quality:
• Dependent on qualifications and skills
of editors/commentators
• Related to methodology for
summarization and critique
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
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
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
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
Systematic Reviews,
Meta-Analyses and
Evidence-Based Guidelines
Formats:
• Collections in books and on CD-ROM
• Online collections
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
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
Systematic Reviews,
Meta-Analyses and
Evidence-Based Guidelines
Medical examples:
• Cochrane Database of Systematic
Reviews
• Guide to Clinical Preventive Services
• National Guideline Clearinghouse
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
Guide to
Community
Preventive
Services
Topics Covered
Guide to
Community
Preventive
Services
Topics Covered
The Guide to Community
Preventive Services
Evaluating and making recommendations on populationbased 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
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.
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
Guide to Community Preventive Services:
Diabetes Recommendations Table
GCPS: Oral Health Organization of Links
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
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
Cochrane Review Index (Ovid)
Cochrane Review Index (Ovid)
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
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
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.
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
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
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
Comprehensive Knowledge Bases
Quality:
• Dependent on methodology of editors
and writers for original content
• Dependent on selection of databases
and texts for nonoriginal content
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
Comprehensive Knowledge Bases
Pushing:
• Selected new content can be pushed
or promoted on a home page
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.
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, Harrison’s Online
• Top 3 for effectiveness: UpToDate,
eMedicine, Stanford Skolar MD
*Berkowitz LL. Review and evaluation of internet-based clinical
reference tools for physicians, 2002.
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
UpToDate: Comp. Knowledge
Base Example
• Initial cards created by consulting staff of >7000
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
UpToDate
Comprehensive Knowledge Bases
Public health examples:
• Textbooks of Public Health and
related disciplines
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.
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.