2. MISSION Committed to improving patient care by providing the most CURRENT CLINICAL EVIDENCE TO CLINICIANS so they can make the best decisions for their patients.

3. The Next Generation Clinical Information Resource Re-created from the ground up New physician leadership New platform New search algorithm New interface New content New features

4. …Not a textbook A TOOL Created by physicians who are EXPERTS in their respective fields who provide OBJECTIVE ANALYSIS of the evidence & recommendations in an easily digestible format with access anytime, anywhere from any device or system

5. to DynaMed vs. UpToDate It doesn’t tell me what to do Lack of expert reviewers Lack of specialty content There are no images It’s hard to get an answer quickly TOP FIVE OBJECTIONS

6. It doesn’t tell me what to do

7. OVERVIEWS AND RECOMMENDATIONS Overviews and Recommendations provide clinicians with concise, accurate overviews for highly relevant topics and evidence- based recommendations for action. Topics have been re-written from scratch to provide immediate context and direction

8. New Overviews and Recommendations at the top

9. DynaMed Plus offers many examples of strong and weak recommendations Clicking on a link provides the user with levels of evidence and guidelines behind each recommendation DynaMed Plus offers many examples of strong and weak recommendations Clicking on a link provides the user with levels of evidence and guidelines behind each recommendation

10. DynaMed Plus provides links to the levels of evidence and the guidelines behind each recommendation

11. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was created in 2000 by a dedicated group of guideline developers. RECOMMENDATIONS are graded as Strong or Weak EVIDENCE is graded for the body of evidence as High, Moderate, Low or Very low quality (A, B, C, or D). QUALITY grading for evidence is based on the risk of bias introduced by study methodology, the precision the consistency of studies, the directness to the conclusion being made, and the likelihood of publication bias. What is GRADE?

12. GRADE is now the standard WHO The Endocrine Society ACCP ACP American Thoracic Society NKF/KDOQI KDIGO Norwegian Knowledge Center / Norwegian Directorate of Health Canadian Cardiovascular Society IDSA CDC AGA AASLD ICSI NICE SIGN NHS Kaiser Permanente Dutch College of GPs Multiple Red Cross groups GUIDELINE GROUPS More than 80 of the world’s leading organizations which produce guidelines formally use GRADE: SYSTEMATIC REVIEWS Independent systematic review organizations such as Cochrane have incorporated GRADE

13. DynaMed Plus EVIDENCE-BASED METHODOLOGY

14. Lack of expert reviewers

15. LEADERSHIP BRIAN S. ALPER, MD, MSPH, FAAFP Founder of DynaMed, VP of EBM Research & Development, Policy and Content Quality, EBSCO Information Services, Clinical Research Assistant Professor Department of Family and Community Medicine, University of Missouri School of Medicine Columbia, MO SHEILA BOND, MD Deputy Editor of Infectious Disease, Clinical Instructor in Medicine Harvard Medical School Boston, MA ALAN EHRLICH, MD Executive Deputy Editor Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School Worcester, MA KEVIN LOUGHLIN, MD, MBA, MA(HON) Deputy Editor of Oncology and Hematology, Senior Surgeon Brigham & Women's Hospital Professor of Surgery, Harvard Medical School, Boston, MA PETER OETTGEN, MD, FACC Deputy Editor of Cardiology Director of Preventative Cardiology, Beth Israel Deaconess Medical Center, Associate Professor Harvard Medical School Boston, MA Editorial

16. FULLY INTEGRATED EXPERTS An extensive network of physicians Experts in their particular fields Select the best and most appropriate evidence Confirm the clinical applicability of content Peer-review topics

17. Matthew Coggins, MD Instructor of Cardiology Harvard Medical School Beth Israel Deaconess Medical Center Kevin Ard, MD Instructor of Medicine Harvard Medical School Assistant in Medicine Division of Infectious Diseases Massachusetts General Hospital Jennifer Johnson, MD Instructor in Medicine Division of Infectious Diseases Harvard Medical School Brigham and Women's Hospital Muhammad Mir, MD, FACP Assistant Professor of Hematology and Blood/ Marrow Transplant Penn State University Milton S. Hershey Medical Center Obinna O. Adibe, MD Assistant Professor of Pediatric Surgery Duke University Medical Center Michelle Lin, MD Associate Professor of Clinical Emergency Medicine Academy Endowed Chair for Emergency Medicine Education University of California San Francisco Jennifer Nan-Wah Wu, MD Instructor of Pediatric Oncology Dana-Farber Cancer Institute Boston Children's Hospital Dawn Abbott, MD, FACC, FSCAI Associate Professor of Medicine, Brown University Director of Interventional Cardiology Fellowship Rhode Island and Miriam Hospitals Christian Jackson, MD Assistant Professor of Gastroenterology Loma Linda University Chief of Gastroenterology Loma Linda VA Healthcare System Kenneth Weiss, MD, FACP Professor of Medicine Cleveland Clinic Lerner College of Medicine

18. Physician Executive Board We have established an EXECUTIVE BOARD charged with advising on editorial, EBM, and editorial policy Members represent JAMA, McMaster, Penn, Emory, MGH, ACP and other healthcare organizations.

19. Betsy Jones Vice President of Medical Product Management and Chief Content Officer, EBSCO Health Michael Berkwits, MD, MSCE Deputy Editor for JAMA Robert M. Centor, MD, MACP Chair of the Board of Regents for the American College of Physicians Julie Hollberg, MD CMIO for Emory Healthcare William A. Kormos, MD, MPH Chief of Medicine at the James Howard Means Firm, Department of Medicine Holger Schünemann, MD, MSc, PhD Professor and Chair of the Department of Clinical Epidemiology & Biostatistics Ilkka Kunnamo, MD, PhD Founder and Editor-in-Chief of EBM Guidelines and EBMeDS decision support program Amir Qaseem, MD, PhD, MHA, FACP Director of the Department of Clinical Policy at the American College of Physicians Dr. Surendra K. Sharma, MBBS, MD, PhD Chief of the Division of Pulmonary, Critical Care, and Sleep Medicine at the All India Institute of Medical Sciences Craig Umscheid, MD, MSCE Assistant Professor of Medicine and Epidemiology at the University of Pennsylvania School of Medicine

20. Lack of specialty content

21. Editorial team structure General Internal Medicine Cardiology/Pulmonology/Critical Care ID/Immunology Oncology/Hematology Emergency Medicine SPECIALTY PUBLISHING GROUPS:

22. Editorial team structure Harvard University Massachusetts General Hospital Beth Israel Deaconess Hospital Yale Brigham and Women’s Hospital Dana Farber Cancer Institute University of California San Francisco Cleveland Clinic EXPERTS RECRUITED FROM: AND MORE…

23. ROBUST SPECIALTY CONTENT Allergy Cardiology Critical Care Dermatology Infectious Disease Emergency Medicine Endocrinology Gastroenterology Hematology Nephrology Obstetrics and Gynecology Oncology Orthopedics Pediatrics Primary Care Psychiatry Rheumatology Sports Medicine Surgery Urology

24. There are no images

26. DynaMed Plus includes more than 4,000 images with more than 2000 from ACP. Images are searchable as well as embedded in relevant topics Selecting an image provides the user a larger view

27. It’s hard to get an answer quickly

28. employs a brand-new, proprietary, semantically- powered search engine, significantly improving discoverability and speed-to-answer Precise Search Results Search

30. DynaMed Plus employs intelligent auto-suggest, which identifies the user’s query and allows direct navigation to highly-accessed areas within topics

31. Convenient filters allow quick access to images and calculators that are relevant to the user’s query DynaMed Plus offers superb navigation within the results display With exact-match queries, DynaMed Plus displays a medical information placard, offering topic-specific links, images, and information DynaMed Plus offers superb navigation within the results display With exact-match queries, DynaMed Plus displays a medical information placard, offering topic-specific links, images, and information

32. By understanding the user’s intent, DynaMed Plus’ intelligent search is able to identify queries that yield robust image results and display them in a time-saving image carousel This same technology presents the user with query-specific calculators

33. Grouped results allow the clinician to quickly understand the context of the result EXAMPLE: Result shows Pulmonary embolism within the Heart failure with reduced ejection fraction topic, and the path provides the context to understand that the result refers to treatment medications Grouped results allow the clinician to quickly understand the context of the result EXAMPLE: Result shows Pulmonary embolism within the Heart failure with reduced ejection fraction topic, and the path provides the context to understand that the result refers to treatment medications Relevant results will navigate users directly to the specific section within DynaMed Plus’ clinically relevant outline-based structure

34. Topic view offers next- generation navigation, providing immediate context to the user Location within the topic is dynamically updated both in the navigation bar, as well as within the breadcrumb trail at the top of the screen

35. DynaMed Plus offers all of the same quick- access features users have come to expect, including search within and highlighting

36. DynaMed Plus employs a FULLY RESPONSIVE DESIGN, which means it renders ideally for any device or orientation iPhoneSmall TabletiPad - PortraitiPad - Landscape

37. iPhone

38. Small Tablet

39. iPad - Portrait

40. iPad - Landscape

41. EHR Integration

42. EBSCO Health listens to the needs of our customers and users which helps us build better products overviews and recommendations well-known expert reviewers increased breadth/depth of specialty content multimedia content better search & discovery DynaMed Plus has….

43. MICROMEDEX DRUG CONTENT Medication Management Standard Drug Information Drug Information for Medication Safety IV Compatibility for Reduced Complications Lab Recommendations Micromedex evidence-based content is presented in concise, sourced, and referenced blocks of information to help you get answers quickly when the situation demands.

45. ACP Partnership ACP clinical leadership develops and maintains DynaMed Plus internal medicine topics Multiple members of ACP are part of the DynaMed Plus Executive Board

47. Access anywhere, anytime

48. Graphics & Images Access thousands of graphics and images Precise Search Results Get precise search results every time Overviews & Recommendations Read concise overviews and detailed recommendations Specialty Content DynaMed Plus includes robust specialty content Expert Reviewers Deputy Editors are supported by an extensive network of clinical experts Mobile App The mobile app is complimentary with every subscription, at no extra cost Drug Content Drug content to help with diagnosis with Micromedex® Clinical Knowledge Suite SUMMARY OF NEW FEATURES

49. GRAZIE Fabio Di Bello | Regional Manager Italy & Israel 349.4157827 fdibello@ebsco.com

50. Resources to Consider: ACP Pier BMJ Point of Care Cochrane Library DynaMed Up-to-Date

51. Round 1 Who can find the answer most quickly? Use any resource.

52. Round 1, Question 1 Is glatiramer acetate effective for relapsing- remitting multiple sclerosis? How does it compare to interferon beta?

53. Round 1, Question 2  What antibiotic should you use for a pregnant woman with acute cystitis?

54. Round 1, Question 3 What is the dose of famciclovir for treating zoster in an immunocompetent patient?

55. Round 1, Question 4 Are graduated compression stockings effective for reducing the risk for venous thromboembolism after acute stroke?

56. Round 1, Question 5 You have a new patient who is an adolescent with obsessive-compulsive disorder. Her parents state this is due to a strep throat. What are the criteria for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection (PANDAS)?

57. Round 1, Question 6 How do you diagnose chronic fatigue syndrome?

58. Round 1, Question 7 A 45-year-old man complains of shortness of breath for two hours and there was a sudden onset. Two days ago he traveled 12 hours by airplane. He has no history of prior thromboembolism, cancer, or other medical conditions. He has tachycardia (pulse 106 beats/minute) but otherwise normal findings on physical examination. Would you classify his risk for pulmonary embolism as high, intermediate, or low?

59. Round 1, Question 8 For the man with an intermediate risk of pulmonary embolism, what testing should you do? Consider the resources available for testing in your setting.

60. Round 1, Question 9 How do triflusal and cilostazol compare to aspirin for secondary prevention of stroke in a patient with a history of transient ischemic attacks (TIAs)?

61. Round 1, Question 10 What is the most effective antibiotic for uncomplicated symptomatic urinary tract infection in women?

62. Round 2 Check different resources to see if the answers are consistent. If not, why not?

63. Round 2, Question 1 A 3 year-old girl weighing 13.3 kg (30 lbs) has rotaviral gastroenteritis and moderate dehydration. How do you start fluid replacement?

64. Round 2, Question 2 A man complains of sudden sensorineural hearing loss. You prescribe steroids. Should you also include antiviral therapy as part of your treatment plan?

65. Round 2, Question 3 You are establishing a protocol for response to patients who develop anaphylaxis in your medical practice. The nurse asks if epinephrine administration can be given subcutaneously instead of intramuscularly. Is there a difference in efficacy between the subcutaneous and intramuscular routes?

66. Round 2, Question 4 You are seeing a 22-month-old boy in follow-up after treatment for a urinary tract infection (UTI). He was found to have grade II vesicoureteral reflux (VUR). You wonder if you should start an antibiotic for prophylaxis, and if so, which antibiotic?

67. Round 2, Question 5 How do you diagnose irritable bowel syndrome (IBS)? What evaluation is indicated?

68. Round 2, Question 6 You diagnosed irritable bowel syndrome. Is fiber an effective treatment?

69. Round 2, Question 7 Do antihypertensive medications reduce cardiovascular events in a patient with mild hypertension (blood pressure 145/95 mmHg) and no other cardiovascular risk factors?