~Costa Rican Physicians Use DynaMed™ to Create National Clinical Guideline for Breast Cancer ~

IPSWICH, Mass. — October 16, 2012 — DynaMed™, the clinical reference known for timely updates and its strong evidence-based approach, has become more well-known among clinicians and other healthcare professionals and now guideline developers, adapters, implementers and users are taking notice. A recent breast cancer guideline commissioned by Seguro Social (La Caja Costarricense de Seguro Social-CCSS), Costa Rica’s public health system, was completed in a much shorter timeframe, with a smaller staff and for less money by using DynaMed plus two existing guidelines as the starting point.

Guidelines, whether commissioned by a government agency or professional association, are typically developed using a lengthy process to identify the current evidence related to any intervention (diagnosis, treatment, prevention, screening, etc.) for a particular condition, evaluate the current evidence and summarize the evidence. Development can take between 18-24 months and cost hundreds of thousands of dollars. The Costa Rican development team was given six months. The guideline was completed in five months and was completed on budget.

Dr. Mario Tristan is the Chairperson and Director-General of the International Health Central American Institute and the Director of Cochrane Central America and the Spanish Caribbean Branch. He, along with the CCSS Medical Advisor, Dr. Anggie Ramirez, was tasked with creating the breast cancer guideline in Costa Rica. He says by using DynaMed guideline developers were able to dramatically reduce the time it takes to perform a comprehensive search of the literature and find relevant studies. “In the course of compiling the resources for clinicians, DynaMed editors and contributors have already searched the available literature and targeted what is clinically relevant. The DynaMed process for critical appraisal and its summaries of clinically relevant results allows guideline developers to spend more time on discourse and guideline creation; shortening the entire guideline timeframe while producing a comprehensive guideline that can better instruct clinicians on how to treat patients and introduce the latest medical evidence into patient care at a more rapid rate.”

The Costa Rican team’s use of DynaMed was presented at the recent Guidelines International Network Conference (G-I-N) piquing the interest of many guideline developers wanting to know more about the methodology used in Costa Rica and evaluating how DynaMed can be used for guideline development support. Dr. Yasser Sami Amer is Founding member, Advisor and Former General Coordinator of the Egyptian Alexandria Centre for Evidence-Based Clinical Practice Guidelines, Healthcare Quality Directorate of Alexandria University Hospitals (which was the second member to join G-I-N from the African and Arab countries in 2009). Dr. Amer says the Costa Rican case study is a promising example of how DynaMed can impact clinical practice guideline production. “Using the Costa Rican guideline methodology as a model we may well be able to produce more comprehensive clinical guidelines faster and at a fraction of the required resources and we are already planning to use DynaMed to compile updated evidence and recommendations for three of our newest guideline adaptation projects in the field of Child Health Care.”

Dr. Brian Alper, the founder of DynaMed says the benefits don’t stop with guideline creation since DynaMed is also able to disseminate the guidelines to clinicians and provide alerts to guideline developers when new evidence is introduced — evidence that may impact existing guidelines. “There are more than 12,000 clinical practice guidelines in DynaMed. Part of the guideline development process includes plans for publicizing the guidelines once they are created so clinicians know which treatments are preferred and why. Adding guidelines to DynaMed allows more doctors access to the content they provide. As part of its core service to clinicians, DynaMed also publishes practice changing information which will alert guideline developers to new evidence and can be used to determine when updates to existing guidelines are needed.”

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