Healthcare Alerts

• Login to TDS Health as you normally do. Click on the Profile link and login to your account. If you do not already have a Profile account, create one by clicking Register and enter your information.
• Click the Alerts tab
• Select ASHP’s Drug Shortages
• Go to the Alert Preferences tab
• If you wish to receive emails, click the box next to “Email me when new bulletins are published.” Make sure to whitelist emails from drugshortages@tetondata.com.

* If you do not wish to receive emails, you can also access the Drug Shortages panel on the homepage or, under the Resources drop-down, you can click Drug Shortages. You can also access Drug Shortages by clicking Alerts under the “Welcome Your Name” drop-down. In that case, you will need to have logged into your TDS Health Profile using your Profile username (email) and password. If you have any questions, please call 800-901-5494 or email Support.

Drug Shortage Bulletins are copyrighted by the Drug Information Service of the University of Utah, provided by ASHP as its exclusive authorized distributor, and used with permission. ASHP and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this Bulletin. Neither ASHP nor the University of Utah endorses or recommends the use of any particular drug.

McMaster University is the birthplace of Evidence-Based Medicine. McMaster PLUS^™ is a product of the McMaster Health Knowledge Refinery (HKR), a continuously updated source of current best research for evidence-informed clinical decisions. Original studies and systematic reviews from over 130 journals are critically appraised to identify those that are methodologically sound, and sound studies are then rated by clinicians for relevance and newsworthiness through the McMaster Online Rating of Evidence (MORE) system.

McMaster Online Rating of Evidence (MORE) Process

Step 1 — Journal Selection
More than 120 journals are read (see Journals Reviewed List) to identify articles with the strongest methods for clinical attention. Journals are selected based on suggestions by librarians, clinicians, editors and editorial staff; Science Citation Index (SCI) impact factors; systematic examination of the contents of each selected journal for at least six months; and by ongoing yield of articles that meet basic Inclusion Criteria for assessing the quality of studies concerning the cause, course, prediction, diagnosis, prognosis, prevention and treatment of medical disorders. Access to foreign-language journals is provided through the systematic reviews we read, especially those in the Cochrane Database of Systematic Reviews, which summarizes articles taken from over 800 journals in many languages.

Step 2 — Article Selection
Research associates trained in health research methodology read all original and review articles in the journals on the Journals Reviewed List and apply the Inclusion Criteria relevant to the purpose category (i.e., therapeutics, diagnosis, prognosis, etc). Articles that pass criteria are tagged for entry in the Critical Appraisal Process (CAP) system.

The process of applying criteria to identify high-quality articles yields relatively few that make it through the methods filter. For example, in 2009 of about 25,000 original and review articles published in 120 journals read, we identified 3,728 articles (15%) for clinical attention.

Step 3 — Critical Appraisal Process (CAP)
PubMed numbers are used as unique identifiers to ensure items are entered into the process only once. Using the PubMed number, the CAP system automatically pulls the article title, authors, and journal citation.

Research associates add the Article Type (i.e., Original or Review), one or more of ten Purpose Categories (i.e., therapy/prevention, diagnosis, prognosis, etiology, quality improvement, economics, clinical prediction guide, differential diagnosis and qualitative), and one or more Patient Populations (i.e., neonates, pediatrics, adolescents, adults, geriatrics, all and indiscernible).

Step 4 — Checked by Clinical Experts
After the data in Step 3 are added, the articles are then passed to the editor stage where one or more clinicians checks the data added by the research associates and indexers.

Step 5 — McMaster Online Rating of Evidence (MORE)
Articles that pass the filter process (Step 2) and the checking process (Step 4) are transferred to the McMaster Online Rating of Evidence (MORE) system. Using the PubMed number, the MORE system pulls in additional article information from PubMed such as the abstract and major and minor MeSH headings.

Step 6 — MORE Raters
The MORE system has a database of > 4000 physician raters. Physician raters in MORE are MDs or equivalent, have completed formal training, and are in independent clinical practice at least part time in internal medicine or its subspecialties.

MORE raters complete a profile page indicating their Patient Populations, Discipline/Specialty selections, and the number of articles they would like to rate each month.

We continue to recruit raters for all disciplines/specialties for all the MORE systems. If you would like to join us as a MORE rater, please contact us at more@mcmaster.ca (physicians), moreebn@mcmasterhkr.com (nurses), or rehab@mcmasterhkr.com (rehab specialists).

Step 7 — MORE Rating Process
Articles in MORE are matched to rater selections and rating requests are sent to at least four raters for each discipline/specialty. For example, the article “Primary angioplasty vs. early routine post-fibrinolysis angioplasty for acute myocardial infarction with ST-segment elevation: the Gracia 2 non-inferiority, randomized, controlled trial,” which is of interest to both physicians and nurses, was sent to 4 raters each for Cardiology, Internal Medicine, and Emergency Medicine for physicians, and to 4 raters each for Cardiology and Emergency/Trauma for nurses.

Ratings in MORE are on two 7-point scales (highest score, 7). The first scale, for Relevance, is for the extent to which the article was pertinent to practice in the rater’s clinical discipline/specialty. If Relevance is rated at least 3, the rater completes a second 7-point scale, on the extent to which the article’s content represented news or something that clinicians in the rater’s discipline were unlikely to know (which we labeled newsworthiness). Optionally, raters also provide up to 1,000 characters of freetext comments (sample Rating Form).

Step 8 — Premium LiteratUre Service (PLUS)
When at least three ratings are received for a discipline, the totals are averaged and articles scoring ≥ 3 of 7 for both Relevance and Newsworthiness for at least one discipline/specialty are transferred to a permanent database, Premium LiteratUre Service (PLUS). Articles not scoring at least 3 of 7 for any discipline/specialty are transferred to a quarantine database.

Step 9 — User End Products
PLUS ratings are used to help select content for evidence-based journals (ACP Journal Club, Evidence-Based Medicine, and Evidence-Based Nursing), evidence-based summary texts (Essential Evidence Plus™ & AHFS DI® Essentials™, BMJ Clinical Evidence, Harrison’s Practice), and alerting services (STAT!Ref Evidence Alerts, EvidenceUpdates, OBESITY+, Medscape Best Evidence Alerts, and nursing+- Best Evidence for Nursing).

• Login to TDS Health as you normally do. Click on the Profile link and login to your account. If you do not already have a Profile account, create one by clicking Register and enter your information.
• Profile has now turned into the greeting (Welcome: Your Name Here!) Click your name and select Alerts.
• Click on STAT!Ref Evidence Alerts.
• Select Alert Preferences.
• If you wish to receive emails, click the box next to “Email me when new articles are published”.
• Fill out the profile based on your preferences of frequency, relevance & newsworthiness.
• Select from Medical, Nursing or Rehabilitaion.
• Select at least one item from each choice of: Disciplines, Categories and Populations. Select as many options in each to meet your criteria.

Please note: those with iOS devices using Safari will need to turn off the “Block Pop-ups” setting before trying to open an Alert sent via email. Additionally anyone else that encounters difficulty opening an Alert should make sure to allow pop-ups from this site in their browser settings.

The information contained in STAT!Ref Evidence Alerts, which is provided through McMaster Premium Literature Service (PLUS), is intended for healthcare professionals and is provided on an "as is" basis without warranty of any kind, express or implied.

STAT!Ref Evidence Alerts provides an educational service for practicing clinicians and providers, designed to alert them to important new research; however, we cannot warrant its accuracy. It is intended to support evidence-based decision making, by providing links to published research reports about the diagnosis, treatment, prediction and prognosis, etiology and economics of medical conditions. However, "evidence does not make decisions," and clinicians making decisions about the care of their patients must take into account the limitations of evidence from research as well as the unique nature of their patients' circumstances and wishes. Readers should also be aware that professionals in the field may have different opinions about the interpretation of evidence from research. Because of this fact and also because of regular advances in medical research, we strongly recommend that readers independently verify any information they choose to rely on. Ultimately it is the readers' responsibility to make their own professional judgments.

STAT!Ref Evidence Alerts attempts to provide access to the best new research of relevance for clinical practice and academic research in a variety of healthcare fields and subspecialties. It does not report all research but uses explicit criteria to define a subset of published research that is likely to be valid and ready for clinical attention in these disciplines. Practicing physicians then provide their assessments of the relevance and newsworthiness of the reports through an online review process, the McMaster Online Rating of Evidence (MORE). Individual clinicians who then receive these reviews must then apply their own judgment concerning the strength and applicability of this evidence to their own patients.

Description or reference to a product or publication does not imply endorsement of that product or publication, unless that product or publication is owned or delivered directly by Teton Data Systems or McMaster University.

To the fullest extent permitted by law, Teton Data Systems, the makers of STAT!Ref, and McMaster University are not responsible for any losses, injury or damage caused to any person or property (including under contract, by negligence, products liability or otherwise) whether they be direct or indirect, special, incidental or consequential, resulting from the application of the information on STAT!Ref Evidence Alerts.