The Essential Evidence Plus process for producing and updating EE+ topics

Initial topic development

  1. 1. The Editor-in-Chief (EIC) created a list of about 800 topics based on the National Ambulatory Medical Care Survey, selecting conditions most frequently seen by family physicians. This was supplemented by a review of other standard medical textbooks.
  2. 2. The EIC created a series of standard templates for the following topic types: full (all sections, including diagnosis and treatment with all subheadings); short (including diagnosis and management with an abbreviated list of subheadings); diagnosis (no treatment or prognosis section, for example chest pain); procedure (for topics on how to perform a procedure); toxicity (for topics on toxicities such as mercury poisoning) and special (for selected topics that do not fit any of the previous categories.
  3. 3. Up to three authors were assigned to write each topic. Each author was given an Evidence Summary containing the most recent high-quality evidence on the topic including Cochrane reviews, POEMs, practice guidelines, and trials indexed in Pubmed. Evidence Summaries were derived from the Essential Evidence Plus customized Pubmed search
  4. 4. Authors then worked with an Associate Editor on the initial drafts of the manuscript until the Associate Editor was satisfied with it.
  5. 5. The EIC then reviewed the manuscript and worked with the author(s) to finalize the manuscript.
  6. 6. All SORT recommendations were reviewed for accuracy by the Associate Editor and the EIC; the EIC was the lead author on the article originally defining and describing the SORT taxonomy.
  7. 7. Selected topics that require external peer review due to their highly specialized nature were sent to one or more external peer reviewers for their review.

Updating topics

  1. 1. A schedule is in place so that every four months, a search is run for each topic, looking for all newly published POEMs and new or updated Cochrane reviews that may be relevant. These hits are emailed to the Associate Editors, who if appropriate incorporate them into the topic.
  2. 2. Every one-to two years, depending on the importance of the topic and pace of change in that field as judged by the EIC, each topic is sent to the author for an update. The author receives the EE+ Evidence Summary with a targeted PubMed search and any new POEMs, Cochrane reviews, diagnostic tests, history and physical exam items, and clinical decision rules. If the author fails to complete this update in a timely manner, it is sent to the Associate Editor for them to complete the update. The EIC then reviews and approves all annual updates.
  3. 3. The EIC also keeps a file of articles that are identified during monthly POEMs surveillance as being helpful for updating EE+, although not rising to the level of a practice-changing article. These are added to the appropriate topics by the EIC.
  4. 4. Once a year, the EIC reviews the literature to identify any new or updated clinical decision rules and writes the code for them (typically about 20 per year). The EIC also adds or updates new information for the diagnostic test and history and physical exam items.