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PBC Library

The NAU library website for the Phoenix Biomedical Campus Library

Point of Care

Point-of-Care in EBP

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:

  • more efficient search structure than in large, "academic" databases
  • results in the form of systematic reviews, meta-analyses, guidelines, and critically appraised topics
  • immediate access to full text (in most cases)

Resource Types: Systems, Synopses, Syntheses, Studies

From a point-of-care perspective, we can place evidence into four categories:

Resource Types
Systems
Description

Textbook-like resources that summarize evidence, often intended to aid clinical decision making.

Resource examples

Databases: BMJ Best Practice | Cochrane Answers | DSM V TR | PEPID UpToDate

Synopses
Description

Summaries of expertly assessed studies and systematic reviews with advice for application.

Resource examples

Databases: ACP Journal Club | Rehab Reference Center TRIP (Open Access) | ECRI Guidelines (Open Access)

Syntheses
Description

Systematic reviews and clinical practice guidelines that critically assess the state of the research.

Resource examples

Databases: Cochrane Library of Systematic Reviews | PubMed Clinical Queries (Open Access)

Studies
Description

Individual clinical studies (ie. randomized controlled trials) in peer-reviewed publications.

Resource examples

Databases: 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 synopsessyntheses, 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.

Clinical Practice Guidelines - Websites

The following websites and portals provide quick access to summative evidence corresponding with different clinical domains.


 

Click here to go to UpToDate

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:

  • Practice Changing Updates | updates to the biomedical literature which might necessitate a change in practice.
  • Drug Information | Pharmaceutical information for providers and patients, with further breakdown by pediatrics and international care
  • Patient Education | Consumer health information presented in basic overviews and more advanced, detailed reviews
  • Calculators | a wide range of measurements divided up by discipline / specialty (ie: anesthesiology)
  • Drug Interactions | an experimental calculator that identifies potential interactions when combining different medications

Accessing UpToDate

UpToDate can be easily accessed from the web or mobile after following a few simple steps!

  1. Click on the UpToDate link on the NAU A-Z Databases page: https://libraryguides.nau.edu/az.php;
  2. You will most likely be prompted to login with your NAU credentials;
  3. You will be redirected to the UpToDate homepage (which looks a lot like Google!);
  4. Go ahead and click "Register" in the top right corner of the screen, and enter your information;
  5. Now that you've registered, you can bypass the NAU website, and go to UpToDate at www.uptodate.com;
    1. Keep in mind, you will sometimes be prompted to authenticate from the NAU website, but not often;
  6. You can now download the UpToDate Mobile App by following the instructions on the this page: https://www.uptodate.com/home/how-access-uptodate
  7. You are all set! If you have any questions, you can always reach out to NAU Library for answers!

Searching UpToDate

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"). 

An example of search optimization in UpToDate


Reviewing results in UpToDate

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. 

An example of a results page in UpToDate


Graded recommendations in UpToDate

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.

UpToDate Grading Recommendations
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.

 

Point-of-care tools

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.


 

Mobile apps

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.


 

Patient education

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.


 

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