Quality Help for Quality Care Including Free Evidence-based Resources & Tools
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Delfini Seminars open to the public
About PMID Numbers: We frequently utilize a PMID number in place of a citation. Where PMID numbers are available, enter that number into the PubMed search box to retrieve that citation and listing.
An evidence-based healthcare approach matters to care for patients effectively, improve patient safety and reduce waste.
Help in evidence-based medicine (EBM) and evidence-based practice (EBP) in other disciplines as well such as critical appraisal of the medical literature to help you with—
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Medical literature evaluation
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Medical education
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Health care quality improvement
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Medical decision-making
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Health care quality
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Patient-centered care
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Doctor patient communications
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Decision support
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Committee work such as pharmacy and therapeutics and medical technology assessment including tips for drug monograph development
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Formulary work
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Leadership help
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Clinical guideline development
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Scientific reviews,
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Cost analysis and more...
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02/01/2012: Our Irritable Bowel Syndrome Guideline has been updated. Note: the update is a stand-alone document and has not been specifically incorporated in all the guideline materials, so you need both. It will be stored on our website at Resources, under I or go to Success Stories.
01/24/2012: Many healthcare practices become established before there is sufficient evidence to conclude that the intervention is beneficial and that benefits outweigh harms. Reversal of established practices has been recently discussed by Prasad, Gall, Cifu and Ioannidis. Abandoning a practice because evidence demonstrates that the practice is not beneficial is an important issue and frequently is very slow to happen. Read Reversal of Established Practices—Unringing the Bell—at the DelfiniClick ™.
01/10/2012: One of the most challenging areas in critical appraisal is in the area of missing data points and attrition. We have updated our Attrition Bias primer which is available here and is stored in our Tools & Educational Materials.
01/02/2012: Happy New Year, everyone! In the spirit of happiness, (wholly ironically this), our Antidepressants Messaging Script has been updated.
12/28/2011: It isn't something new, but as a recent patient, I was reminded of our Patient Encounter Map tool. Most people know us for our work in medical science, but our reach is the expanse of clinical care improvement, and effective communications with patients is of the utmost importance in caring for them. Our GLIDE strategy was promoted by the late and wonderful Dr. John Coombs of the University of Washington as an effective way to help patients: Greet . Listen . Inquire and Exchange Information . Determine and Decide . Effectively End. Happy Holidays, all!
12/05/2011: Attrition Bias & A Biostatistician Weighs In: Dr. Steve Simon on "Why is a 20% dropout rate bad?"
11/28/2011: Confidence Intervals: Overlapping Confidence Intervals—A Clarification—at the DelfiniClick ™.
From
Our DelfiniGram™ November
2011
11/05/2011: Our online critical appraisal tutorial has been updated—now enhanced with downloadable notes and short readings and more.
10/31/2011: "Real World" Data Considerations: Evidence-based medicine and comparative effectiveness research (CER) movements have increased interest and activity in relative effectiveness of interventions. There is an expressed need for innovative approaches to clinical trials to be conducted under conditions of actual practice, enabling estimates of real-world effectiveness. There is an expressed need for statistical and epidemiological methods to predict patient responses to interventions. There are opportunities, and there are critically important challenges to be mindful of to avoid misleading information. We've prepared a primer on "Real World" Data to address some of these issues, which is also available at Tools & Educational Materials.
10/16/2011: Breast and Prostate Cancer Screening—It's a Gamble, But Is It A Good One?—at the DelfiniClick ™.
10/07/2011: Congratulations and thank you, DynaMed, for all your hard work and wonderful service in your efforts to provide high quality health care information! A BMJ article (BMJ 2011 Sep 23;343:d5856) reported that DynaMed is 78% faster at including evidence than EBM Guidelines, 86% faster than UpToDate, 95% faster than eMedicine, and 97% faster than Clinical Evidence. We also know first hand that they also work hard to make information truly evidence-based, which we cannot say about many sources. As ever, we always caution that it is to be expected that there is variability everywhere so we always recommend direct critical appraisal or audit—but we love DynaMed and frequently it is a first source of clinical information for us.
From the DynaMed site:
DynaMed™ is a clinical reference tool created by physicians for physicians and other health care professionals for use at the point-of-care. With clinically-organized summaries for more than 3,200 topics, DynaMed provides the latest content and resources with validity, relevance and convenience, making DynaMed an indispensable resource for answering most clinical questions during practice.
Updated daily, DynaMed editors monitor the content of over 500 medical journals on a daily basis. Each article is evaluated for clinical relevance and scientific validity. The new evidence is then integrated with existing content, and overall conclusions are changed as appropriate, representing a synthesis of the best available evidence. Through this process of Systematic Literature Surveillance, the best available evidence determines the content of DynaMed.
DynaMed: a recommended site (with usual cautions) for evidence-based medical content
10/04/2011: Note about Cochrane systematic reviews. A frequent problem readers have is finding Cochrane reviews published before 2005 when searching in the Cochrane Library. Cochrane updates reviews and drops the original publication date. To find the review with the original publication date you need to search from Medline (e.g., PubMed).
09/26/2011: A brief update to our menopause decision support. Will be available at On the Same Page™ under Samples.
09/23/2011: Numerous authors cite problems with using Last-observation-carried-forward (LOCF) for data imputation, and yet numerous researchers use it. Are we always stuck in uncertainty? Or might there be some clues at times to help us deal with the "grey zone?" Intention-to-Treat & Imputing Missing Variables: Last-Observation-Carried-Forward (LOCF)—When We Might Draw Reasonable Conclusions—at the DelfiniClick ™.
09/10/2011: AHRQ Breast Cancer: Medications for Primary Prevention will be available at On the Same Page™ under Samples.
09/07/2011: Pointers on Number-Needed-to-Treat—at the DelfiniClick ™.
08/30/2011: Thanks to our friends at Kaiser Permanente Hawaii, the Kaiser Permanente Chronic Kidney Disease Guideline has been updated. See Chronic Kidney Disease guideline and related information at the nephrology project showcase.
From
Our DelfiniGram™ August
2011
08/16/2011: Two items. We are very pleased to announce the release of a systematic review that has taken us the better part of a year to produce: Systematic Review: Comparative Safety of Six Biologic Agents For The Treatment of Rheumatoid Arthritis, Psoriasis and Psoriatic Arthritis. We were commissioned to do this work by Amgen, and we had full control of the project. The safety review is available at our website at the Delfini Showcase under Success Stories and has information of import to patients: http://www.delfini.org/index_DelfiniShowcase.htm#DMARDS
We are also very pleased to make available our wonderful interview with Dr. Martin Gabica, Chief Medical Officer of Healthwise. Healthwise is an industry leader in health content and patient education. Marty talks with us about, “The Empowered and Motivated Patient,” and includes his prescription for the solution to the healthcare crisis. Read it at www.medicalleaders.org.
08/08/2011: Advice about significance issues when secondary outcomes are significant, but primary outcomes are not—at the DelfiniClick ™.
08/02/2011: There are always different ways to look at different things. We have a new flavor for framing critical appraisal in the context of medical decision making. New at Tools & Educational Materials is our Framework For Evidence-based Critical Appraisal & Decision-making.
08/01/2011: Updated Chronic Kidney Disease information for patients at the nephrology project showcase.
07/26/2011: Delfini Critical Appraisal Seminar April 4 & 5, 2012 in beautiful Portland, Oregon
07/07/2011: Summarizing the Strength of the Evidence: AHRQ-EHCP Grading System at the DelfiniClick ™.
06/24/2011: Get Delfini's favorite sources for medical information. See Utility Tools at Tools & Educational Materials.
06/21/2011: Time-to-Event Analysis pearls have been updated. Download the new 2-pager at Tools & Educational Materials—search for "time-to-event."
06/17/2011: California Pharmacist student evidence-based review—Two Statin Combination Therapies. Chien M, Yee J, Stern C. Arbiter 6 Halts Trial. [evidence-based medicine review]. California Pharmacist 2011. Vol. LVIII, No.2 Spring 2011: 54-57. (Stuart ME, Strite SA, peer reviewers and guest eds.) At our California Pharmacist Journal publication page.
06/13/201: New 1-pager on Correlation Analysis. In Tools & Educational Materials, search for "correlation."
06/08/2011: A number of our key tools have been updated. In Tools & Educational Materials, search for "06/08."
05/19/2011: Attrition Bias and Baseline Characteristic Testing (Esp for Non-Dichotomous Variables) new at the DelfiniClick ™. Our white paper on Missing Data Considerations has been updated. In Tools & Educational Materials. Search for "missingness."
05/18/2011: Sample 12 minute voice-over-PowerPoint tutorial now available: Video Tutorial: Measures of Outcomes. Will also be available at our Online Tutorial link.
From
Our DelfiniGram™ May
2011
04/15/2011: Our Messaging Script for Hormone Replacement Therapy has been updated. In the future, will be available through On the Same Page™.
04/13/2011: Our Grading, Conclusions and Results Tool is now updated to including information about grading systems for GRADE and AHRQ-EHCR. In Tools & Educational Materials. Search for "wording conclusions."
04/11/2011: A blog we like as been added to our Recommended Reading: The Blog of Scott K. Abergg, MD MPH: medicalevidence.blogspot.com
04/08/2011: Advice about Key Clinical Questions & PICO at the DelfiniClick ™.
04/08/2011: The Cochrane Handbook for Systematic Reviews of Interventions has been updated. It is a useful resource for all healthcare professionals doing critical appraisal of the medical literature. It was created to assist authors preparing systematic reviews (SRs) but is of great value to all of us who are assessing validity of studies. Chapter 8 deals with assessing bias and is well worth looking at. They recommend judging bias in a trial as ‘Low risk’ of bias, ‘High risk’ of bias or ‘Unclear risk’ of bias. You may wish to look at table 8.5 which provides criteria to inform the rating of risk of bias. The handbook can be found at http://www.cochrane-handbook.org/ The URL is available at our Links.
04/03/2011: More decision support samples from the Mayo Clinic at On the Same Page™. See newest at the left for Decision Support.
03/28/2011: Food for thought on blinding and objective outcomes at the DelfiniClick ™.
03/22/2011: Can you claim superiority from a non-inferiority or equivalence trial? We and the CONSORT group say yes. See our updated reading below. We have also updated our one-pager on equivalence and non-inferiority trials at Tools & Educational Materials. Search for "non-inferiority."
03/22/2011: We have updated our reading on equivalence and non-inferiority trials filed in our Recommended Reading.
03/21/2011: Great fun and information on placebo effect—a wonderful You-Tube discovery—thanks to Dr. Ash Paul of Bedfordshire. You can view The Strange Powers of the Placebo Effect here. Link will be filed in our Recommended Reading.
03/12/2011: Blood pressure management may be one of the most important health care areas to attend to. And Kaiser Permanente does some of the best evidence-based work in the world. We are pleased and grateful that they have given us permission to make available online their guidelines for management of hypertension.
From
Our DelfiniGram™ March
2011
03/01/2011: New Decision Support & Summarization Tool: Do you struggle with how to present and summarize complex evidence-based information and other considerations in a condensed way that can help decision-makers? We are very pleased to present what we affectionately call our “Semaphore” decision support tool (so nicknamed as it is a color-coded tool that points to various considerations and helps sort out complexities). The tool provided here is an example that you can adapt, as we have, to other evidence reviews. The history of the development of the tool is this: Last fall we completed a systematic review on the use of MRI for women at high risk of breast cancer. As is frequently the case, the evidence was a mixed bag, and the decision considerations were highly complex. Inspired by Dr. Jeff Thompson of the Washington State Health Care Authority, we created a tool to summarize these complexities. We’ve used the concept for several other projects since that time with great results! We hope it is helpful to you. Both the WORD version and the PDF Will be posted in Tools & Educational Materials.
ALSO, The wonderful and brilliant Dr. Bat Shunatona gives us some guidance for quality improvement and more in an interview at www.medicalleaders.org.
02/23/2011: Just a reminder that we are frequently improving and upgrading our tools. So it is good to check periodically at our Tools & Educational Materials to see what has been refreshed. I have started adding version dates. Most recent updates have been to our critical appraisal pearls and tools for primary studies. Search on the date for this entry.
02/14/2011: Happy Valentine's Day! It's good to have various formats to report evidence findings depending on needs. We have just posted our Quick Appraisal Topic Report Form. This tool is a shorty for when your time is limited and you need to keep the report brief. Quick process steps included. Also includes a short list of our favorite sources. Will be posted in Tools & Educational Materials.
02/09/2011: Why Almost Everything You Hear About Medicine is Wrong by Sharon Begley in Newsweek, January 24, 2011. Also available in our Recommended Reading.
02/06/2011: When implementing clinical improvements, it is important to assess the impacts of practice change. Balance sheets are a method of assessing the impacts of practice change and were first proposed by evidence-based medicine leader, Dr. David Eddy. Through his work developing over 35 clinical practice guidelines, our very own Mike Stuart, MD, has vast experience with balance sheets. An article on balance sheets by Mike and colleagues while Mike was at Group Health Cooperative in Seattle has now been made available online with kind permission of the Journal of the American Board of Family Medicine. Also available in our Recommended Reading.
01/11/2011: Interesting reading on regression-to-the-mean.
01/06/2011:We are published in The Atlantic. Read our Letter to the Editor, How to Evaluate Medical Science, our response to "Lies, Damned Lies, and Medical Science" by David H. Freedman in The Atlantic, November 2010. You can read our full commentary and link to the article at the above links as well.
01/06/2011: Read our Rapid Response Letter to the BMJ on attrition bias—Attrition Bias Caution: Non-differential Loss Between Groups Can Threaten Validity. Also available at the DelfiniClick™ in Primary Studies.
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