Point-of-care resources offer synthesized information evaluated by experts that often includes rating scales or graded recommendations. Most of this information is secondary, and has been pre-appraised to allow for quick, on-the-spot decision making.
Benefits of point-of-care tools include:
From a point-of-care perspective, we can place evidence into four categories:
Systems |
DescriptionTextbook-like resources that summarize evidence, often intended to aid clinical decision making. Resource examplesDatabases: Cochrane Answers | DSM V TR | UpToDate |
Synopses |
DescriptionSummaries of expertly assessed studies and systematic reviews with advice for application. Resource examplesDatabases: ACP Journal Club | TRIP (Open Access) | ECRI Guidelines (Open Access) |
Syntheses |
DescriptionSystematic reviews and clinical practice guidelines that critically assess the state of the research. Resource examplesDatabases: Cochrane Library of Systematic Reviews | PubMed Clinical Queries (Open Access) |
Studies |
DescriptionIndividual clinical studies (ie. randomized controlled trials) in peer-reviewed publications. Resource examplesDatabases: PubMed (MEDLINE, PMC) | CINAHL | PsycINFO | SocINDEX |
When searching for best evidence in clinical decision making, start at the the top of the hierarchy with systems and work your way down to synopses, syntheses, and studies. Opt for databases like PEPID or UpToDate, which present information quickly, clearly, and efficiently.
Remember that point-of-care tools are meant to save time in a fast-paced clinical environment. Even so, it is important to maintain proficiency in larger databases such as MEDLINE, in order to locate new research studies as they are published.
Mobile Applications can also be very helpful at the point-of-care, however, use caution since nearly anyone can develop an app! You must carefully evaluate the information & source. STAT!Ref is a library resource with a mobile app that is recommended to NAU students, as it provides access to ACP Smart Medicine, 5 Minute Clinical Consult, Red Book, and more.
The following websites and portals provide quick access to summative evidence corresponding with different clinical domains.
UpToDate is used across healthcare as a go-to resource for point of care information. It is a complex platform with a host of resources. These include:
UpToDate can be easily accessed from the web or mobile after following a few simple steps!
Search functions in UpToDate are similar to those in Google Search. Boolean operators are not necessary. Additionally, UpToDate will associate search terms with controlled vocabulary (ie: a search for "heart attack" delivers results for "myocardial infarction").
Information in UpToDate is subject to consistent peer review and editing daily. Review is conducted by authors and editors based on their specialty. Following evidence-based practice, decisions are made following a hierarchy of evidence, beginning with meta-analysis of randomized clinical trials.
Based on the amount of research available, and the quality of that research, UpToDate reviewers provide recommendations for practice, with focus on the following: 1) quality of evidence; 2) relative importance of the outcomes; 3) magnitude of effect; 4) absolute magnitude of the effect; 5) precision of the estimates of the effects; 6) cost.
Many results in UpToDate will carry a graded weight that falls anywhere between strong recommendations with high quality evidence and weak recommendations with low quality evidence. See this page for more in-depth information.
| Grade of recommendation | Clarity of risk / benefit | Quality of supporting evidence | Implications |
|---|---|---|---|
|
1A Strong recommendation, high quality evidence |
Benefits clearly outweigh risk and burdens, or vice versa. | Consistent evidence from well performed randomized, controlled trials or overwhelming evidence of some other form. Further research is unlikely to change our confidence in the estimate of benefit and risk. | Strong recommendations, can apply to most patients in most circumstances without reservation. Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present. |
|
1B. Strong recommendation, moderate quality evidence |
Benefits clearly outweigh risk and burdens, or vice versa. | Evidence from randomized, controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise), or very strong evidence of some other research design. Further research (if performed) is likely to have an impact on our confidence in the estimate of benefit and risk and may change the estimate. | Strong recommendation and applies to most patients. Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present. |
|
1C. Strong recommendation, low quality evidence |
Benefits appear to outweigh risk and burdens, or vice versa. | Evidence from observational studies, unsystematic clinical experience, or from randomized, controlled trials with serious flaws. Any estimate of effect is uncertain. | Strong recommendation, and applies to most patients. Some of the evidence base supporting the recommendation is, however, of low quality. |
|
2A. Weak recommendation, high quality evidence |
Benefits closely balanced with risks and burdens. | Consistent evidence from well performed randomized, controlled trials or overwhelming evidence of some other form. Further research is unlikely to change our confidence in the estimate of benefit and risk. | Weak recommendation, best action may differ depending on circumstances or patients or societal values. |
|
2B. Weak recommendation, moderate quality evidence |
Benefits closely balanced with risks and burdens, some uncertainly in the estimates of benefits, risks and burdens. | Evidence from randomized, controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise), or very strong evidence of some other research design. Further research (if performed) is likely to have an impact on our confidence in the estimate of benefit and risk and may change the estimate. | Weak recommendation, alternative approaches likely to be better for some patients under some circumstances. |
|
2C. Weak recommendation, low quality evidence |
Uncertainty in the estimates of benefits, risks, and burdens; benefits may be closely balanced with risks and burdens. | Evidence from observational studies, unsystematic clinical experience, or from randomized, controlled trials with serious flaws. Any estimate of effect is uncertain. | Very weak recommendation; other alternatives may be equally reasonable. |
The following list of tools are available for online access through a web browser. They are designed to provide immediate reference for questions relating to measurement, definitions, ICD codes, and clinical inquiries.
Unless otherwise noted, the following list mobile apps are available on both Android and iOS devices.
Mobile apps are useful tools for having immediate access to information in the moment. They are also particularly useful for medical translation (see MediBabble and Canopy Speak). Additionally, you'll find apps for calculation, definitions, and shared-decision making. Of course, patients might also find value in these and other mobile apps.
Many of the following resources are freely available to patients as consumer health information resources. However, in some cases, providers might also want to access these resources so as to provide them to patients during / after any patient-provider interview.