Clin-eguide

What is Clin-eguide ?

Clin-eguide is the revolutionary point-of-care clinical decision support system that aims to answer most of those routine clinical questions so often encountered at the clinical interface between patient and clinician. Clin-eguide distills disease management, drug therapy and laboratory results knowledge that is essential to good clinical decision-making at the point-of-care into a single resource.

Clin-eguide is unique in that it combines a range of features found in no other single clinical information resource.

• It always recommends a course of action and clearly states the options
• It provides patient- and disease-specific recommendations taking into account patient status and concomitant conditions
• It allows fast, intuitive navigation by anticipating the key issues facing clinicians when making clinical management choices
• It prompts the clinician to consider issues that may influence the patient outcome
• It is extensively and systematically researched and constantly updated.

By using Clin-eguide the result is better decision-making at the point-of-care with the subsequent benefits of better healthcare outcomes and improved efficiency in both time and cost.

For further information on the features and benefits of Clin-eguide see our website: www.clineguide.com.

Back to Top

Search pathways

Disease, pathway

This pathway provides literature-based advice on the management of specific diseases. Within any disease, questions may be asked to define specific patient populations for which the diagnosis and/or therapy guidelines vary. Advice given is specific to the population selected. You are able to access the drug pathway from those points within the disease content where specific drugs or drug classes are recommended.

Disease, selection

Diseases can be accessed in one of 3 ways:

1. Type-and-Go: Enter a partial or full disease name in the Type-and-Go text box.
   • If the entered search term is a full word or the start of a word, then the wildcard character (%) is not necessary.
   • If the entered search term is anticipated to exist in the middle or at the end of a word, then apply the "%" wildcard as a prefix and/or suffix as required.
   • If more than one page of diseases is returned, you can page through the list using the paging tool in the upper right hand section of the content panel to find the disease.
     • Diseases will have been sorted based on the incidence of the search pattern words in the target disease name.
   • Select the disease from the list by placing the cursor over the disease and clicking.
2. Starts With: Use the Starts With option to search alphabetically.
   • Click on the first letter of the disease for which you are searching. Diseases starting with this letter will appear in the main content panel.
   • If more than one page of diseases is returned, you can page through the list using the paging tool in the upper right hand section of the content panel to find the disease.
   • Select the disease from the list by placing the cursor over the disease and clicking.
3. Show Full List: Select the Show Full List option.
   • Page through the list to find the disease.
   • Select the disease from the list by placing the cursor over the disease and clicking.

Once the disease has been selected, you will proceed in one of 2 ways:

1. EITHER question(s) will be asked to define specific subgroups of the disease and/or specific patient characteristics relevant to the management of the disease. These questions enable Clin-eguide to provide more specific information relating to the management of a disease in a particular patient population.
   • Select the appropriate answer(s) to the question(s) by clicking the appropriate radio-button. 
   • Once all questions have been answered, the Management Overview for the specific patient population selected within the disease will appear and you can begin to navigate within the disease content.
2. OR no additional questions will be asked and the Management Overview for the disease will appear so that you can begin to navigate within the disease content.

Drug, pathway

This pathway provides drug information based on manufacturers' data and other standard drug resources.

Drug, selection

A drug or drug class can be accessed in one of 3 ways.

1. Type-and-Go: Enter a partial or full drug/drug class name in the Type-and-Go text box.
   • If the entered search term is a full word or the start of a word, then the wildcard character (%) is not necessary.
   • If the entered search term is anticipated to exist in the middle or at the end of a word, then apply the "%" wildcard as a prefix and/or suffix as required.
   • If more than one page of drugs/drug classes is returned, you can page through the list using the paging tool in the upper right hand section of the content panel to find the drug or drug class.
     • Drugs/drug classes will have been sorted based on the incidence of the search pattern words in the target drug/drug class name.
   • Select the drug/drug class from the list by placing the cursor over the drug/drug class term and clicking.
   • If you selected a drug class name, you will then need to select the specific drug from the drug list provided.
2. Starts With: Use the Starts With option to search alphabetically.
   • Click on the first letter of the drug/drug class for which you are searching. All drugs/drug classes starting with this letter will appear in the main content panel.
   • Select a drug/drug class from the list by placing the cursor over the drug/drug class and clicking.
3. Show Full List: Select the Show Full List option.
   • A list all drugs/drug classes will appear in the main content panel.
   • Select a drug/drug class from the list by placing the cursor over the drug/drug class term and clicking.
   • If you selected a drug class name, you will then need to select the specific drug from the drug list provided.
   • Once the drug has been selected, the Dosage & administration page will be displayed. You can either choose an indication to view Dosage & administration OR you can begin to navigate the drug content.

Back to Top

Laboratory, pathway

This pathway provides information about the clinical significance of abnormal laboratory test results and is derived predominantly from standard laboratory reference texts as well as primary literature. For each laboratory test, the "normal" reference range is given followed by results questions (eg, High, Low, Abnormal).

Laboratory, selection

Laboratory tests can be accessed in one of 3 ways:

1. Type-and-Go: Enter a partial or full laboratory test name in the Type-and-Go text box.
   • If the entered search term is a full word or the start of a word, then the wildcard (%) is not necessary.
   • If the entered search term is anticipated to exist in the middle or at the end of a word, then apply the "%" wildcard as a prefix and/or suffix as required.
   • If more than one page of laboratory test names is returned, you can page through the list using the paging tool in the upper right hand section of the content panel to find the test name.
     • Lab test names will have been sorted based on the incidence of the search pattern words in the target lab test name.
   • Select the laboratory test name from the list by placing the cursor over the test name and clicking.
2. Starts With: Use the Starts With option to search alphabetically.
   • Click on the first letter of the laboratory test name for which you are searching. Laboratory tests starting with this letter will appear in the main content panel.
   • If more than one page of laboratory test names is returned, you can page through the list using the paging tool in the upper right hand section of the content panel to find the test name.
   • Select the laboratory test name from the list by placing the cursor over the test name and clicking.
3. Show Full List: Select the Show Full List option.
   • Page through the list to find the laboratory test name.
   • Select the laboratory test name from the list by placing the cursor over the test name and clicking.

Once the laboratory test name has been selected, the Reference Range page will be displayed and the laboratory test results questions will be asked (eg, High, Low, Abnormal, Positive).

Once a laboratory test result answer has been selected, the Clinical Significance for the laboratory test result will appear and you can begin to navigate within the laboratory test content.

Performance improvement, pathway

This pathway provides examples of how Clin-eguide combines the latest scientific information with concrete clinical outcomes to guide decision-making toward economically beneficial outcomes.

This pathway also provides details of the commonly used performance measures including those from the Centers for Medicare and Medicaid Services (CMS), the Health Plan Employer Data and Information Set (HEDIS), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

• Screening advice button providing a summary of the screening recommendations from the Guide to Clinical Preventive Services, 3rd edition, 2000-2003 Report of the US Preventive Services Task Force.
• Immunization schedules button providing information on, and links to the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices immunization schedules.
  

Navigation tools

Click-to-reveal functionality

At various places within the content click-to-reveal functionality is used to show and hide content under headings on a screen. This type of functionality allows a series of headings to be seen on a screen without necessarily having to scroll down to view the entire content of a screen. Content is revealed by clicking on the "folder" icon beside the heading and hidden again by reclicking on either the same "folder" icon or by clicking on the "folder" icon at the bottom right of the revealed content. For example, when there is information about multiple diagnostic tests, it will often be grouped and hidden under headings and revealed by clicking on the heading.

Hypertext links

All content within all search pathways can be navigated to using the blue hypertext links. These links will either:

• replace the content within the Content Panel or
• open a new Pop-up screen.

Hypertext links are used to navigate within as well as between modules and pathways.

• by selecting a hyperlinked disease from within the disease content.
• by selecting a hyperlinked disease/disease topic from within the drug content.
• by selecting a hyperlinked drug/drug class from within the disease content.
• by selecting a hyperlinked drug/drug class from within the drug content.

Redefine context, disease

The Redefine Patient button allows the current clinical context to be changed and appears only when specific subgroups of the disease and/or specific patient characteristics are defined for the disease content via the question screen. Clicking on the Redefine Patient button navigates you back to the question screen allowing you to change your selection(s) and navigate down an alternative disease subgroup/patient characteristics path within that disease.

Redefine context, laboratory

The Reference Range button allows the laboratory test results and any additional clinical context to be changed. Clicking on the Reference Range button navigates you back to the question screen allowing you to change your selection(s) and navigate down an alternative laboratory test results path within that laboratory test content.

View Disease

The View Disease button in the drug pathway navigates you to the disease pathway. This button is visible only when you are viewing dosage information for which there is a corresponding disease module.

Table of Contents, disease

The content for a disease has been divided into major topics. These topics are represented by the Table of Contents in the left hand panel of the screen.

To navigate using the Table of Contents, place the cursor over an item and click. New content will appear in the Content Panel.

Where a small triangle exists to the left of a Table of Contents item, this indicates that further sub-topics can be revealed. To reveal these place the cursor over the triangle or Table of Contents item and click. The sub-topics can then be selected. New content will appear in the Content Panel.

NB: While the Table of Contents are similar for each disease, most diseases contain additional items with specific information relevant to that disease.

NB: Not all content is available via the Table of Contents. To access more content from sub-topic screens, hypertext links will need to be used.

Table of Contents, drug

The content for a drug is divided into information by resource.

These topics are represented by a Table of Contents in the left hand panel of the screen.

To navigate using the Table of Contents, place the cursor over an item and click. New content will appear in the Content Panel.

Clin-eguide dosage: provides specific dosage recommendations for diseases covered in Clin-eguide, and advice on when and how dosage adjustments need to be made. You will need to select an indication, then there may be further questions asked to define specific patient characteristics. Navigation to the management overview of the relevant drug or condition is made possible by the 'View disease' option on the Table of Content.

• A to Z Drug FactsTM: provides manufacturer's information which is not specific for any particular disease and therefore the clinical status of the patient needs to be taken into consideration.
• Drug Interactions are provided by eFacts Drug Interaction FactsTM.

Table of Contents, laboratory

The content for a laboratory test has been divided into major topics. These topics are represented by the Table of Contents in the left hand panel of the screen.

To navigate using the Table of Contents, place the cursor over an item and click. New content will appear in the Content Panel.

Where a small triangle exists to the left of a Table of Content item, this indicates that further sub-topics can be revealed. To reveal these place the cursor over the triangle or Table of Contents item and click. The sub-topics can then be selected. New content will appear in the Content Panel.

NB: While the Table of Contents are similar for each laboratory test, some tests contain additional items with specific information relevant to that test.

Ovid Medline

"Ovid Medline" gives access to the primary medical literature on which Clin-eguide is based. Our goal is for Clin-eguide to be the definitive source of summarized clinical decision support that physicians use as the first 'port of call' to find an answer to a clinical question. However, we recognize that it may be desirable to drill down into the primary literature to do further research for complex patients. This facility also enhances the usefulness of Clin-eguide as a teaching/educational tool.

Back to Top

Assisted Literature Searching

Assisted Literature Searching allows the insertion of a link from a content module in Clin-eguide to the Ovid MEDLINE^® database to enable sophisticated searching of the literature relevant to the module being viewed. This feature is available to Ovid subscribers.

When viewing Clin-eguide content within the Disease, Drug or Laboratory pathway, selection of the "Ovid Medline" icon will launch an Ovid MEDLINE^® database search which is pre-populated with the module name or its equivalent medical subject heading (MeSH). All hits relevant to the search term are returned.

Assisted Literature Searching is activated within Clin-eguide by clicking on the following logo which is found in the left-hand navigation frame:

Full Text Linking

Full Text Linking allows the insertion of a link from a citation in the References sections of Clin-eguide to the specific reference in the Ovid MEDLINE^® database. This feature is available to Ovid subscribers.

When viewing Clin-eguide content within the Disease, Drug or Laboratory pathway, selection of the "Ovid Medline" link adjacent to a citation will launch an Ovid MEDLINE^® database search for that specific citation. Information provided varies depending on available MEDLINE^® details and licensing rights of the user with Ovid, and may include comprehensive citation details, an abstract (if available), the full text article (if licensed) and evidence-based reviews (if licensed).

Full Text Linking is activated within Clin-eguide by clicking on the "Ovid Medline" link at the end of a citation.

Ovid Subscription

If you currently are not an Ovid subscriber and would like more information on the Ovid MEDLINE^® database service, please contact Ovid at sales@ovid.com or refer to www.ovid.com/sales.cfm for more information.

Back to Top

Printing

Individual content screens can be printed using the right mouse click while the cursor is in the content panel and selecting print. This will print the content exactly as you see it on the screen.

Should you wish to print any content behind click-to-reveals, then these will need to be revealed before selecting print.

Editorial Process

The content in Clin-eguide is prepared by our qualified team of healthcare professionals and reviewed by external experts. The team, including physicians, clinical pharmacists, drug information specialists and QA, database and IT specialists, has developed a rigorous editorial process that ensures the content is evidence-based and clinically relevant, accurate, current, easy to access, transparent and actionable.

The goal within Clin-eguide is to:

• present the best evidence available, with emphasis on therapy and diagnosis
• maintain a realistic approach to answering clinical questions
• supply information that is relevant and actionable
• provide practical, convenient, and useful guidance for physicians and other healthcare professionals.

Back to Top

Evidence-Based Medicine Approach (EBM)

The editorial team evaluates evidence from a spectrum of sources ranging from systematic reviews of large, unbiased, randomized controlled trials to expert opinion based on personal practice experience. The process:

• identifies the best available evidence for a particular clinical question
• grades the strength of evidence associated with specific recommendations for drug therapy and non-drug therapy
• is transparent to the end user.

The evidence-based approach is used to identify gaps in knowledge and provide a structured approach to fill the gap, ie, identifying the best information which underpins a practical recommendation allowing the user to make a well-informed decision. We use this approach to answer questions in areas where there is a large volume of literature of varying quality and conclusions.

Back to Top

Extensive Searching

Diseases and drugs are extensively researched before content is developed. The contents of over 2,300 medical and scientific journals and major medical meetings are reviewed as part of our rigorous process. A standardized approach to literature searching identifies the information sources employed, reduces variation between editors, and allows physicians and other healthcare professionals to better judge the validity of our recommendations.

Back to Top

Clin-eguide Search Strategy

Databases included in our search strategy:

• National Guideline Clearinghouse
• MEDLINE
• EMBASE
• American College of Physicians (ACP) journal club
• Database of Abstracts of Reviews of Effectiveness (DARE)
• Cochrane Library: Cochrane Database of Systematic Reviews
• Cochrane Library: Cochrane Controlled Trials Register

We supplement our searches with current tertiary sources.

This approach ensures that all relevant guidelines and major studies are identified before providing information and actionable advice through Clin-eguide.

Each topic is comprehensively reviewed at 6 to 12 month intervals with another search of all literature sources. Consequently, new information with practical implications for clinical practice is rapidly included in Clin-eguide.

Clin-eguide provides references to the primary literature sources of all content allowing for rapid cross-referencing of information and recommendations.

Back to Top

Meticulous Evaluation

The first stage in developing content from the citations retrieved is evaluating the primary medical literature. This is a meticulous, deliberate process which plays a significant role in determining the quality of the final product.

Back to Top

Writing and Navigation Design

Once the primary literature has been collated and evaluated, clinical management guidance is developed, with full citations provided. Context which differentiates management guidance is critical, and our in-house staff take particular care to separate out context-specific treatment recommendations.

We also take particular care in anticipating physicians' needs at the clinical interface. We design the navigation and organize the clinical content in a clear, intuitive manner to meet those needs.

Regular Peer and Expert Review

Clin-eguide employs a two-tiered review process, which provides checks and tests at key points during the editorial process.

Editorial Advisory Board Members

Michael R. Cohen, RPh, MS, ScD
President
Institute for Safe Medication Practices
Huntingdon Valley, PA

A. Mark Fendrick, MD
Associate Professor of Medicine and Health Management and Policy
Schools of Medicine & Public Health
University of Michigan Medical Center
Ann Arbor, MI

David Nash, MD, MBA, FACP
The Dr. Raymond C. and Doris N. Grandon Professor of Health Policy and Medicine
Jefferson Medical College, Thomas Jefferson University
Philadelphia, PA

Don Nielsen, MD
Senior Vice President for Quality Leadership
American Hospital Association
Chicago, IL

Back to Top

Contact us

If you have any comments regarding the editorial content or presentation of Clin-eguide please feel free to contact us directly: clineguidecomments@clineguide.com. This product is designed for you, the user, and we appreciate any suggestions you may have for improvement.

Technical support

We suggest you contact your own IT Support Service within your organization to establish that the problem is related to the Clin-eguide product.  If the problem is related to Clin-eguide please feel free to contact us directly:  clineguidetechsupport@clineanswers.com.    We will get back to you within 2 hours.

Browsers supported

Clin-eguide is implemented to support the following Web Browser products and versions:

• Microsoft Internet Explorer versions 4.01 to 6.0 (with JavaScript and cookies enabled).
• Netscape versions 6.2 or greater (with JavaScript and cookies enabled).

Slight visual differences are to be expected between the two different browsers when viewing Clin-eguide .

Important Note: When using the Clin-eguide product, browsers MUST have JavaScript enabled. It is possible in Netscape versions 6.2 or greater to disable JavaScript in the Advanced Preferences panel. Clin-eguide will not function properly with JavaScript disabled.

Clin-eguide is not Macintosh compatible.

Disclaimer

Your use of this website (which includes the Licensed Product "Clin-eguide") is at all times subject to the terms and conditions of the Clineanswers Customer License Agreement entered into.

Clin-eguide is intended to be used ONLY by healthcare personnel employed by, contracting with, or affiliated with a Licensee, who utilize Clin-eguide solely in furtherance of Licensee's healthcare functions ("Authorized Users") and who accept to use their clinical judgement in interpreting or applying any of the information contained within Clin-eguide. The institution which has licensed Clin-eguide and made it available to you has signed a Licensing Agreement which includes this following THREE clauses relating to the need for clinical judgement to be used.

1. Licensee acknowledges that Clin-eguide is intended to provide additional information to the Authorized Users solely as a resource to assist in the performance of their professional judgement and activities. The Licensed Product is not intended, nor shall it be construed, to constitute any independent medical judgement, recommendations or advice. Licensee and the Authorized Users are the sole determiners as to the nature of the use to which this information is made. Accordingly, Licensee agrees to indemnify Clin-eguide and Clin-eguide's agents, successors and assigns from any claims and damages, including attorneys' fees, arising from Licensee's breach of any provision of this Agreement and for any claims or damages arising from the conduct by Licensee or any of the Authorized Users of any business or professional activities, including but not limited to any claims alleging breach of any standard acceptable medical care and any claims by patients alleging malpractice.

2. Clin-eguide warrants that the Databases in the Licensed Product have been obtained and created from what Clin-eguide believes are reliable sources. Except as provided above, the Licensed Product is provided "as is" and NO REPRESENTATION OR WARRANTY, EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, ANY WARRANTY OF MERCHANTABILITY OR OF FITNESS FOR A PARTICULAR PURPOSE IS MADE REGARDING THE LICENSED PRODUCT OR ANY UNDERLYING SOFTWARE OR DATABASES.

3. CLIN-EGUIDE SHALL NOT BE LIABLE FOR ANY DAMAGE OR LOSS, WHETHER DIRECT, INDIRECT OR CONSEQUENTIAL, ARISING FROM OR CAUSED BY USE OF OR RELIANCE ON ANY INFORMATION CONTAINED IN THE LICENSED PRODUCT, EVEN IF CLIN-EGUIDE HAS BEEN PREVIOUSLY ADVISED OF THE POSSIBILITY OF SUCH DAMAGE OR LOSSES.

AS AN AUTHORIZED USER, YOU ASSUME FULL RESPONSIBILITY FOR ENSURING THE APPROPRIATENESS OF USING AND RELYING UPON THE INFORMATION IN VIEW OF ALL ATTENDANT CIRCUMSTANCES, INDICATIONS AND CONTRAINDICATIONS.

Copyright © 2004 Wolters Kluwer Health, Inc. All rights reserved.

Back to Top

Field Guide Updated May 26, 2005