DynaMedTM: Impacting Healthcare around the World

Guideline developers in Costa Rica used DynaMed to create a high-quality, evidence-based breast guideline—which was the first guideline developed for a national cancer network to establish a model for future guideline development methods. Problem:

Creating clinical guidelines, whether commissioned by a government agency or professional association, is generally a lengthy process—from identifying the current evidence related to any intervention (diagnosis, treatment, prevention, screening, etc.) for a particular condition to evaluating and summarizing the current evidence. Development can take between 18-24 months and cost hundreds of thousands of dollars. Seguro Social (La CAJA Costarricense de Seguro Social-CCSS), Costa Rica’s public , recently commissioned the development of a breast cancer treatment guideline. The Costa Rican development team’s deadline? Six months.

An extremely tight deadline wasn’t the only issue Costa Rica faced:

• Their support staff was limited, comprised only of two physicians (mostly part-time), two consultants and two administrative support members

• There was a small budget of $10,000 available for this effort, a fraction of the typical allowance

Solution:

Dr. Mario Tristan, the Chairperson and Director-General of the International Health Central American Institute and the Director of Cochrane Central America and the Spanish Caribbean Branch, and CCSS Medical Advisor, Dr. Anggie Ramirez, were in charge of the project to create the breast cancer guideline in Costa Rica. To begin the process, they selected two existing guidelines to be used as starting points for identification, evaluation and summarization of underlying evidence. In addition, they enlisted the help of DynaMed, the clinical reference known for timely updates and its strong evidence- based approach to providing the latest content and resources with validity, relevance and convenience.

By using DynaMed, guideline developers were able to dramatically reduce the time it takes to perform a comprehensive search of the literature and find relevant studies. “In the course of compiling the resources for clinicians, DynaMed editors and contributors have already searched the available literature and targeted what is clinically relevant,” says Dr. Mario Tristan. “The DynaMed process for critical appraisal and its summaries of clinically relevant results allows guideline developers to spend more time on discourse and guideline creation; shortening the entire guideline timeframe while producing a comprehensive guideline that can better instruct clinicians on how to treat patients and introduce the latest medical evidence into patient Dr. Mario Tristan care at a more rapid rate.” Chairperson and Director-General of the International Health Central American Institute and the Director of Another advantage to using DynaMed was the development team Cochrane Central America and the Spanish Caribbean could communicate directly with DynaMed editors to clarify any Branch variance in evidence analysis. Results:

With the help of DynaMed, Dr. Mario Tristan, Dr. Anggie Costa Rican case study is a promising example of how Ramirez and the rest of the Costa Rican development team DynaMed can impact clinical practice guideline production. were able to complete the breast cancer guideline in just “Using the Costa Rican guideline methodology as a model five months and within budget—the same guideline we may well be able to produce more comprehensive would have cost $500,000 using standard guideline clinical guidelines faster and at a fraction of the required development methods. resources and we are already planning to use DynaMed to compile updated evidence and recommendations for three The Costa Rican breast cancer guideline was the first of our newest guideline adaptation projects in the field of guideline developed for a national cancer network to Child .” establish a model for future guideline development methods and is to be used by national general & , Dr. Brian Alper, the founder of DynaMed says the benefits secondary care and 1,000 clinics. The don’t stop with guideline creation since DynaMed is also information found in this guideline will affect local able to disseminate the guidelines to clinicians and practice—mastectomy has been the first line of treatment, provide alerts to guideline developers when new evidence but lumpectomy is now considered a good alternative. is introduced—evidence that may impact existing guidelines. “There are more than 12,000 clinical practice The Costa Rican team’s use of DynaMed was presented at guidelines listed in DynaMed. Part of the guideline the recent Guidelines International Network (G-I-N) development process includes plans for publicizing the Conference piquing the interest of many guideline guidelines once they are created so clinicians know which developers wanting to know more about the methodology treatments are preferred and why. Adding guidelines to used in Costa Rica and evaluating how DynaMed can be DynaMed allows more doctors access to the content they used for guideline development support. Dr. Yasser Sami provide. As part of its core service to clinicians, DynaMed Amer is Founding member, Advisor and Former General also publishes practice changing information which will Coordinator of the Egyptian Alexandria Centre for alert guideline developers to new evidence and can be Evidence-Based Clinical Practice Guidelines, Healthcare used to determine when updates to existing guidelines Quality Directorate of Alexandria University Hospitals are needed.” (which was the second member to join G-I-N from the African and Arab countries in 2009). Dr. Amer says the

Summary:

Along with helping Dr. Tristan and his team develop this guideline on time and within budget, it also provided them with the information they needed to create a higher quality guideline-—some evidence criticisms reported in DynaMed critical appraisal may not have otherwise been recognized, especially under tight time constraints. The impact that DynaMed has had on guideline creation makes it more than a point-of-care reference tool DynaMed is a substantial resource in national medical guideline creation. DynaMed is an evidence-based clinical reference tool used by more than 500,000 clinicians around the world to answer clinical questions at the point of care. DynaMed provides the latest content and resources with validity, relevance and convenience.

Independent research shows that DynaMed is the most current clinical information tool available: • Journal of Clinical Epidemology 2012 https://dynamed.ebscohost.com/about/news/dynamed-ranks- highest-among-clinical-reference-resources-fourth-independent-report • British Medical Journal, 2011 https://dynamed.ebscohost.com/about/news/new-study-top-five-point- care-tools-finds-dynamed%E2%84%A2-most-current • KLAS Enterprises, 2011 https://dynamed.ebscohost.com/about/news/dynamed-rated-higher-other- disease-reference-tools-new-klas-report-healthcare-clinical-d • Journal of the Medical Librarian Association 2011 https://dynamed.ebscohost.com/about/news/new- study-top-five-point-care-tools-finds-dynamed%E2%84%A2-most-current