1. The pace of change in practice-driving medical knowledge in new models of publishing May 5, 2013 Brian S. Alper, MD, MSPH, FAAFP Editor-in-Chief, DynaMed Medical Director, EBSCO Publishing

2. Introduction/Disclosures Rural family medicine in 1995 Mission to provide most useful information to healthcare professionals at point of care Now working full-time as Editor-in-Chief, DynaMed Medical Director, EBSCO Publishing

3. Half of what is taught in medical education is wrong, but we don’t know which half. Attributed to Dr. C. Sidney Burwell, Dean of Harvard Medical School 1935-1949, in Pickering GW. The purpose of medical education. BMJ 1956 Jul 21;2:113

4. 45 highly-cited original research publications Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294(2):218-228

5. 124 original articles in NEJM in 2009 Prasad V, Gall V, Cifu A. The frequency of medical reversal. Archives of Internal Medicine 2011 Oct 10;171(18):1675-1676

6. The pace of change is accelerating. “Medicine will change more in the next 20 years than it has in the past 2000.” Smith R. Thoughts for new medical students at a new medical school. BMJ 2003 Dec 20;327(7429):1430-1433

7. How quickly does core evidence change? Management overviews of top DynaMed topics evaluated - Maintained via 7-step evidence-based methodology - Updated daily - Standardized templates with outline format (overviews represent most important evidence and guideline for practice) Compared to 1-2 years ago, how many lines have changed (addition, deletion, modification)? Classify change due to - New evidence - New guidance - External feedback - Internal quality improvement

10. How quickly does core evidence change? Interim results: 80 topics (mean time 1.5 years)

11. Examples of new evidence changing overviews  Dyspnea: midazolam may reduce unexplained dyspnea more than morphine in advanced cancer  Gallstones: cholecystectomy within 48 hours in mild gallstone pancreatitis may safely reduce hospital stay  MS: dextromethorphan/quinidine sulfate may reduce frequency/severity of pseudobulbar affect episodes  MRSA: comparative efficacy for linezolid, telavancin, vancomycin  PE: Pulmonary Embolism Rule out Criteria (PERC)  PE: less bleeding with oral rivaroxaban vs. LMWH/warfarin  Stroke: graduated compression stockings do not appear to reduce DVT and may cause skin damage

12. How quickly does core evidence change? Interim results: 4,411 lines, 2,532 lines changed (mean time 1.5 years)

13. Of 2,532 lines changed How quickly does core evidence change?

14. Interim results: 4,411 lines (mean time 1.5 years)  Adjusted for 1-year timeframe: 16.2% practice-guiding information changes in 1 year due to new evidence or guidance

15. Questions? Brian S. Alper, MD, MSPH Editor-in-Chief, DynaMed Medical Director, EBSCO Publishing