What We Publish

The Overview and Recommendations provides a concise summary with guidance and recommendations designed to answer the most common clinical questions.

Recommendations are developed using the internationally accepted Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The Overview and Recommendations undergoes additional review by an independent Recommendations Editor chosen for his or her expertise in evidence-based medicine, methodology, and guideline development. These Recommendations Editors ensure that all recommendations are sound, supported, and evidence-based.

Some Overview & Recommendations related to conditions in internal medicine also undergo additional review by our partners at the American College of Physicians (ACP).

A Synthesized Recommendation Grading System is used in which DynaMed synthesizes current evidence, current clinical practice guidelines, and clinical expertise to provide recommendations to support clinical decision-making in the Overview and Recommendations. The GRADE system is used to classify synthesized recommendations as Strong or Weak.

• Strong recommendations are used when, based on the available evidence, clinicians (without conflicts of interest) consistently have a high degree of confidence that the desirable consequences (health benefits, decreased costs and burdens) do, or do not, outweigh the undesirable consequences (harms, costs, burdens).
• Weak recommendations are used when, based on the available evidence, clinicians believe that desirable and undesirable consequences are finely balanced, or appreciable uncertainty exists about the magnitude of expected consequences (benefits and harms). Weak recommendations are also used when the range of patient values and preferences suggests that informed patients are likely to make different choices.

Clinicians’ Practice Points provide guidance and opinion from our expert physician editors on what is perceived to be good clinical practice in the absence of robust evidence from clinical research studies.

Clinicians’ Practice Points are presented in the most clinically useful context within topics. They can appear in the Overview and Recommendations or within topic detail. See an example.

An Evidence Synopsis answers a clinical question as rapidly as possible by presenting a brief structured summary of a body of evidence along with the clinical “take-away.”

Evidence Synopses are presented within topic details, commonly in sections discussing screening, diagnosis, management, and prevention. See an example.

DynaMed Commentaries provide information about the methodology or other significant technical aspects of the clinical studies that are critically appraised in the study summaries.

DynaMed Commentaries are always presented in the context of a study summary. See an example. 

A Guideline Synopsis provides a high-level summary of clinical practice guidelines and answers a clinical question based on guideline recommendations. Guideline Synopses are presented within topic details, commonly in sections discussing diagnosis, management, prevention, and screening.

DynaMed includes recommendations and background information from clinical practice guidelines. When recommendations are presented, the strength of recommendation and the grading system from the organization are also presented.

A DynaMed study summary is a brief and clinically oriented description of a clinical research study, placed in context within the clinical framework. Key elements of a DynaMed study summary include the study conclusion, level of evidence rating, study type, reference, and study details. The study conclusion is written in language that reflects the soundness of the findings, with more directive language being associated with Level 1 evidence. Clicking on the study details will expand the summary to show additional information about the rationale for the level of evidence rating, methods, and pertinent results.

Study summaries undergo a rigorous writing and review process that includes methodologists trained in evidence-based medicine and critical appraisal of scientific/medical research, physician experts or specialists, and experts in evidence-based medicine.

New research may not be included if the data is of lesser methodological quality or if it does not add substantially new or different information. Study summaries may also be removed when newer or higher-quality data becomes available, or when the information is no longer relevant.

Levels of Evidence

DynaMed applies Level of Evidence labels (ranging from Level 1 to Level 3) to evidence summaries using a systematic critical appraisal process. This simple rating system makes it easy for users to quickly understand the quality of the evidence being reported, and the primary rationale behind the rating.

Evidence Ratings

Level 1 (likely reliable) evidence 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

Food and Drug Administration (FDA) and European Medicines Agency (EMA) Summaries provide a succinct and timely synopsis of recently approved drugs, biological products, and medical devices, as well as important drug safety updates.

FDA and EMA summaries include published and unpublished study data and are commonly presented in topics discussing management, efficacy, and prevention. See an example.

DynaMed algorithms are a visual representation of diagnostic and/or treatment processes related to content from DynaMed topics. They are developed by the DynaMed algorithm team using evidence-based information and are reviewed by multiple clinical editors and specialists for accuracy and utility.

Approach to Patient topics focus on the evaluation and initial management of an undifferentiated symptom, sign, or abnormal laboratory finding. The content is organized to support the clinical workflow in differential diagnosis.

Condition topics focus on specific diseases or conditions. They provide a comprehensive review and best available evidence for all aspects of the disease or condition, including epidemiology, pathogenesis, diagnosis, management, and prognosis. The content is organized to support learning about the condition, with easy access directly to key areas in the clinical workflow like diagnosis and management.

Device topics focus on the therapeutic use or application of a device that is not specific to use for a single disease or condition. The content is organized to support the clinical workflow.

Drug Monographs contain prescribing information for specific drugs, including dosing, indications and contraindications, drug interactions, and adverse effects. Drug Monographs are developed and maintained by Micromedex.

Drug Review topics focus on drugs or drug classes that is not specific to use for a single disease or condition. Content includes efficacy, relevant recommendations from clinical practice guidelines, adverse effects, and inappropriate prescribing criteria for older adults. The content is organized to support learning about the drug/drug class.

Evaluation topics focus on assessment, evaluation, and diagnostic testing to confirm or exclude a diagnosis. The content is organized to support the clinical workflow.

Lab Monographs contain pertinent information related to the basics and procedures of laboratory tests, including indications, reference ranges, and collection/storage information. Lab Monographs are developed and maintained by Micromedex.

Management topics focus on treatment and management of a specific condition. They provide the best available evidence and relevant recommendations from clinical practice guidelines related to all aspects of managing a condition, including emergency department, inpatient and outpatient management, when to consult a specialist, and palliative care (where applicable). The content is organized to support the clinical workflow.

Prevention topics focus on primary prevention or screening for a specific disease or condition. This also includes content related to health maintenance, concentrating on general prevention and routine care such as wellness visits, immunization schedules, and preventive tests. The content is organized to support the clinical workflow.

Procedure topics focus on surgery or procedures used for therapeutic purposes that is not specific to use for a single disease or condition. Procedures used to support diagnosis are considered as Diagnostic/Diagnosis/Evaluation topics. The content is organized to support the clinical workflow.

Quality Improvement topics focus on information related to optimizing care and minimizing unnecessary or harmful interventions.

Shared Decision-Making topics focus on facilitating shared decision-making between clinicians and patients. The content is organized according to patients’ frequently asked questions and compares different treatment or screening options.

The DynaMed Drug Interactions tool provides a fast and efficient way to check for potentially harmful drug interactions and provides users with useful clinical information on how to manage the potential effects. Some combinations of medications should be avoided or used with caution because they may reduce or potentiate the effect of drugs and/or cause serious side effects.

The Drug Interactions tool enables a user to check a patient’s entire medication list at the same time for interacting drug ingredients and their effects along with their clinical significance.

The Drug Interactions tool presents both brief and detailed summaries of drug interactions that are referenced and allows the user to:

• View results by severity, documentation and type of drug interaction
• Search by brand and generic names of drugs
• Check an unlimited number of drugs and/or substances at once
• Understand the severity of the interaction using the 5-point severity rating and supporting evidence
• Interpret quality and type of interaction evidence with a four-level documentation rating system

Potentially harmful interactions can be identified, and their severity ratings that may range from contraindicated to minor can be viewed with the goal of aiding clinicians in reducing the risk of adverse drug events for patients. The drug interaction facts obtained via the Drug Interactions tool support the critically appraised clinical research and provide the clinician with evidence-based information to inform their clinical practice.

The Drug Interactions tool is provided by Micromedex and can be accessed from the home page.

DynaMed calculators provide a fast and efficient way to input patient data and calculate a variety of relevant scores and indices. DynaMed calculators are developed and updated by EBMcalc. EBMcalc references hundreds of medical journal and textbook articles comprising a wide array of medical equations, clinical criteria sets, and decision trees.

All the calculators can be accessed from primary navigation available on all product pages. They may also be embedded within relevant DynaMed topics.