Research Guides: Point of Care Tools: Featured Tools

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What are Point of Care Tools?

Syntheses of current evidence for diagnosis, tests and interventions (e.g. treatments, drugs)

Designed for rapid consultation at the point of patient care

Evidence-based and frequently updated, with links to relevant literature

May include drug information, ICD coding, information for patients, and provision for links to electronic health records

Point of Care Tools

BMJ Best Practice
Best Practice is a completely new concept for information delivered at the point of care. In a single source we have combined the latest research evidence, guidelines and expert opinion – presented in a step-by-step approach, covering prevention, diagnosis, treatment and prognosis. Best Practice provides a second opinion in an instant, without the need for checking multiple resources. Its unique patient-focused approach represents a major new advancement in information delivery at the point of care. Mobile access available.
DynaMed Plus
DynaMed Plus is a next-generation clinical reference resource useful for getting answers to clinical questions quickly and easily. Content is written and reviewed by a team of physicians who synthesize the evidence and provide objective analysis. Dynamed Plus includes: Overviews and Recommendations for the most common conditions as well as evidence-based recommendations for action, Micromedex® Clinical Knowledge Suite drug content, and over 2,500 medical graphics and images. Also included is a wide array of specialty topics in areas such as infectious disease and immunology, cardiology, oncology and emergency medicine. Mobile access available.
Isabel
By entering the information normally captured in a patient workup, physicians are provided with a list of potential diagnoses to help them make accurate diagnosis quickly and easily at the point-of-care and provides easy access from mobile devices. On the homepage of Isabel, select "Mobile Access" from the top banner for mobile instructions.

Isabel and DynaMed Plus work together to give physicians the information they need to provide the best care to their patients. Isabel and DynaMed Plus’ integration provide a powerful combination of differential diagnosis support backed by the most current clinical evidence about diseases, drugs, and treatments.

Clinical Search Engines

Trip Database - For Evidence Based Medicine (EBM)
TRIP was created in 1997 to bring together all the evidence-based healthcare resources available on the Internet. TRIP Plus was created in April 2003; this greatly enhanced version includes coverage of peer-reviewed journals, medical images and patient information leaflets, and is updated monthly. Tutorial

Product Reviews and Comparisons

Charbonneau, D. H., & James, L. N. (2018). DynaMed Plus®: an evidence-based clinical reference resource. Medical Reference Services Quarterly, 37(2), 168-176.

Table 1. Comparison of DynaMed Plus and UpToDate

Feature	DynaMed Plus	UpToDate
Update Frequency	Daily	Daily
Number of Clinical Topics	2,500+	10,500+
Peer-Reviewed Content and Evidence Appraisal	3 Tiered System of Evidence Rating	2 Levels of Grading
Peer-Reviewed Content and Evidence Appraisal	(Level 1 = likely reliable; Level 2 = mid-level evidence; Level 3 = lacking evidence)	(Grade 1 = Strong; Grade 2 = Weak)
Journals Monitored	529+	440+
Section for Guidelines in Topics	Yes	No
Section for Guidelines in Topics	(“Guidelines and Resources” Section in each topic summary)	(Guidelines may be cited in “References;” but not consistently collected and presented)
Graphics/Images	Yes	Yes
Mobile Version	Yes	Yes
Off-Campus Access	Yes	Yes
Clinical Calculators	Yes	Yes
Patient Education Materials	Yes	Yes
CME/CE Credit Available	Yes	Yes

Andrews, R., Mehta, N., Maypole, J., & Martin, S. A. (2017). Staying afloat in a sea of information: point-of-care resources. Cleveland Clinic Journal of Medicine, 84(3), 225-235.

"Each of the resources [UpToDate, DynaMed, First Consult etc.] has strengths and weaknesses. For example, UpToDate offers the most topics, but its articles tend to be too long to be practical to read at the point of care."
"Physicians should familiarize themselves with these resources and use the ones that best suit their needs."

Johnson, E., Emani, V. K., & Ren, J. (2016). Breadth of coverage, ease of use, and quality of mobile point-of-care tool information summaries: an evaluation. JMIR mHealth and uHealth, 4(4).

"Overall, there was no significant difference between the point-of-care tools [Medscape, UpToDate, DynaMedPlus, EvidencePlus, DynaMed and Epocrates] with regard to coverage on common topics used by internal medicine clinicians. Selection of point-of-care tools is highly dependent on individual preference based on ease of use and cost of the application."
Appendix 5: Calculation of General Linear Regression Model for the Breadth of Coverage, Ease of Use, and the Quality Measures for the comparison on the Mobile Point of Care Tools

Kwag KH, González-Lorenzo M, Banzi R, Bonovas S, Moja L. (2016). Providing doctors with high-quality information: an updated evaluation of web-based point-of-care information summaries. J Med Internet Res.,18(1):e15.

Five products (ACP Smart Medicine, BMJ Best Practice, Dynamed, Essential Evidence Topics, and UpToDate) received the maximum score for editorial quality. Six (ACP Smart Medicine, BestBets, BMJ Best Practice, Dynamed, EBM Guidelines, and UpToDate) received the maximum score for evidence-based methodology.
The ranking of point-of-care information summaries based on their strength of volume, editorial quality, and evidence-based methodology is shown in Figure 3 (full data reported in Multimedia Appendices 4-6). Best Practice, Dynamed, and UpToDate scored in the highest quartile across all three dimensions.

Campbell JM, Umapathysivam K, Xue Y, Lockwood C. (2015). Evidence-based practice point-of-care resources: a quantitative evaluation of quality, rigor, and content. Worldviews Evidence-Based Nursing, 12(6):313–27.

Table 2. Content Presentation

	Type of output	Formal ontology	Flexibility of summary	Reference	Formal grade of recommendation	CME	Education other material	Patient handout	Clinical tools
BMJ Best Practice	Key point summaries	Yes	Yes	Yes, specific	No	Yes	Yes	Yes	Yes
DynaMed	Key point summaries	Yes	Yes	Yes, specific	Yes	Yes	Yes	Yes	Yes
UpToDate	Book chapter like summaries	Yes	Yes	Yes, specific	Yes	Yes	No	Yes	Yes

Table 3. Editorial Quality

	Authorship stated	Peer review	Frequency of updates	Conflict of interest	Commercial support	Total
UpToDate	3	3	1	3	3	13
BMJ Best Practice	3	3	1	3	3	13
DynaMed	1	1	1	1	0	4

Table 4. Evidence‐Based Methodology

	Literature search/surveillance	Method of critical appraisal	Type of evidence	Grading of evidence	Expert opinion given	Total
UpToDate	3	1	3	3	3	13
BMJ Best Practice	3	3	3	1	1	11
DynaMed	3	3	3	1	0	10