Zynx Health Newsletter Methodology

Overview
Zynx Health employs a systematic approach to selecting articles and ensuring the quality of each edition of the Zynx Health Evidence Alert^TM and other newsletters.

The Zynx Health clinicians who coordinate newsletter development use a specific strategy to search the peer-reviewed medical literature each month. Candidate articles are reviewed and selected from literature published between 2 and 8 weeks prior to the newsletter’s distribution date on the first day of each month. Content generally must pertain to the conditions, procedures, and topics covered by Zynx Health solutions. The 4 to 5 articles chosen for inclusion are sent to medical writers for development of synopses, which are then edited for style and technical accuracy by Zynx Health editors. Synopses and other content are reviewed and approved by the responsible Zynx Health clinicians, formatted by editors, and distributed electronically. Details of this methodology are provided in the following sections.

Medical Literature Search
For each monthly edition, the tables of contents of selected physician-oriented journals generally recognized as reliable sources for evidence-based approaches to healthcare are examined. These include:

• Annals of Internal Medicine
• American Journal of Obstetrics & Gynecology
• Archives of Internal Medicine
• Archives of Surgery
• Annals of Surgery
• BMJ
• Chest
• JAMA
• Lancet
• New England Journal of Medicine
• Pediatrics

Interdisciplinary Literature Search
For each monthly edition, the tables of contents of selected nursing and interdisciplinary care journals generally recognized as reliable sources for evidence-based approaches to healthcare are examined. These include:

• American Journal of Occupational Therapy
• Clinical Nurse Specialist
• International Nursing Review
• Journal of Advanced Nursing
• Journal of Cardiovascular Nursing
• Journal of Nursing Scholarship
• Journal of Obstetric, Gynecological, and Neonatal Nursing
• Journal of Wound, Ostomy, and Continence Management
• Nursing Research
• Physical Therapy

• MEDLINE
• Cochrane Database of Systematic Reviews
• HealthStar
• CINAHL

Search terms may be selected on an ad hoc basis to help insure coverage of a range of topics that represents the full spectrum of Zynx Health modules.

Article Selection
During the search process, articles for potential inclusion are identified and reviewed by the responsible Zynx Health clinician, either online or via reprints obtained by the Zynx Health librarian. The articles are selected based on various factors, including their implications for inpatient or outpatient diagnosis and management, strength of evidence, and timeliness.

Choice of Articles for Inclusion
Final choice of articles for inclusion is based on the following order of priority:

1. "Landmark" articles that contain research findings that substantively change clinical practice in conditions, procedures, and topics covered by Zynx Health solutions
   
   
2. Publications of major new guidelines from professional organizations or changes in performance or regulatory standards applicable to Zynx Health modules from The Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations), Centers for Medicare & Medicaid Services, National Quality Forum, the Leapfrog Group, and the American Nurses Association (National Database of Nursing Quality Indicators).
   
   Citations for guidelines from any of the organizations below will be included when published between 2 and 8 weeks prior to release of the Zynx Health Evidence Alert:
   
   
   • American College of Cardiology
   • American College of Chest Physicians
   • American Diabetes Association
   • American Heart Assocation
   • American Society of Clinical Oncologists
   • American Stroke Association
   • American Thoracic Society
   • Centers for Disease Control and Prevention
   • Infectious Diseases Society of America
   • US Preventive Services Task Force
   
   
3. Randomized controlled trials that provide evidence to support new therapeutic interventions not previously included in Zynx Health modules
   
   
4. Meta-analyses or systematic reviews that substantiate evidence in favor of or against processes of care covered within Zynx Health modules
   
   
5. Randomized controlled trials, nonrandomized prospective studies, retrospective studies, or economic analyses that add new information to topics within Zynx Health modules

Editorial Process/Quality Control
After the articles have been chosen, they are synopsized either by professional medical writers or by the responsible Zynx Health clinicians. The synopses are edited for technical accuracy and copyedited for spelling, grammar, and readability by at least one qualified editor. The synopses are subsequently reviewed and amended as necessary by the Zynx Health clinicians. Each edition is then formatted by Zynx Health editors to incorporate the appropriate synopses and other content for distribution.

Literature Classification
Articles synopsized in Zynx Health Evidence Alerts are classified according to the same "Class of Evidence" scheme as in Zynx Health quality improvement solutions, which is based upon study design (see Appendix A).

Appendix A: Zynx Health Evidence Classification System

Class A Evidence
Randomized controlled trials. These studies generally have the following characteristics:

• Study participants are randomized to an intervention or control group.
• Study participants are enrolled prior to measurement of outcomes.

Class B Evidence
Nonrandomized prospective studies. These include the following study designs:

• Comparisons are made between contemporaneous patients, or between current and former patients.
• Ten or more patients are studied in noncontrolled case series.

Class C Evidence
Retrospective analyses.

Class E Evidence
Articles that are based on or represent the following:

• Expert opinion
• Guidelines
• Consensus statements
• Articles that catalogue or summarize data and/or results contained within other articles (without performing any further statistical analysis)
• Case reports of fewer than 10 patients
• Summary data presented in textbooks

Class M Evidence
Meta-analyses. Meta-analyses use an explicitly stated methodology to identify literature to address a specific question and involve the calculation of pooled effect sizes.

Class P Evidence
Performance measures. Performance measures are quality metrics that relate to a process of care or outcome.

Class Q Evidence
Studies in which the primary goals, methods, and results represent economic evaluations involving any one or more of the following analyses:

• Cost-benefit
• Cost-effectiveness
• Cost-identification
• Cost-minimization
• Cost-utility
• Decision analysis (eg, Markov model) with or without economic outcomes

Class S Evidence
Systematic reviews. Systematic reviews use an explicitly stated methodology to identify literature to address a specific question; however, they do not calculate pooled effect sizes.