Aims

EMIS Clinical Immediate Reference articles are written to be used in the consultation by GPs, junior hospital doctors and other healthcare professionals to find out up-to-date key facts about diseases and their management. They may also be useful to "expert patients" when discussing disease progression and treatment options with their clinicians.

• This specific "in the consultation" use-case means that articles must be short and succinct, in a standard format, facilitating scan reading and quick identification of the required part of the article.
• They need to be compatible with current best practice, incorporating National Institute for Health and Clinical Excellence (NICE) and other UK guidance, and be well referenced so that the user can identify and link through to the original sources (to guide their further reading and professional development).
• They are updated regularly to ensure they remain up-to-date and may be amended in the light of user feedback.

Topic coverage

We try to produce articles to cover a wide spectrum of knowledge requirement in primary care, outlining an evidence-based/best practice way of approaching commonly encountered clinical problems:

• Disease articles such as Crohn's disease or diabetes mellitus. Commonly seen diseases with complex management may be split into a main disease article, and several management articles, each considering one or more common scenarios.
• Presentation articles such as "breathlessness", which guide the clinician through the diagnosis, investigation and initial management stages before a diagnosis is made.
• Procedural articles such as sickness certification in primary care, the Mental Capacity Act, etc.
• Articles on specific investigations, e.g. liver biopsy, or treatments, e.g. renal replacement therapy, etc.
• Articles to help with ongoing personal development and appraisal/revalidation, e.g. significant event audit, consultation analysis, etc.

Authoring

Records are allocated to authors based on their stated areas of knowledge and interest. All articles have a printed version number and last reviewed date. In our in-house authoring system there is a transparent audit trail containing author and reviewer comments and other feedback (for example feedback from clinicians and patients on released articles) which is fully considered during each review/revision.

Instructions for authors

Search strategy

Where there has been recent UK NICE or similar guidance issued on the basis of a recent systematic and comprehensive literature search, the clinical article is written to be compatible with this guidance.

Given articles are written to be short and succinct (and need to change rapidly to ensure advice always reflects current UK practice - often well ahead of standard textbooks), it is not feasible to perform extensive comprehensive systematic reviews prior to each authoring cycle in the same way as NICE does, but articles do include evidence and advice from any systematic reviews that are available.

There is a minimum required, systematic document search by author according to the following priority of use which is based on rigour of development and UK applicability:

• Group 1:
  • Any current NICE guidance.
  • Any appropriate UK National Service Framework (NSF) guideline.
• Group 2:
  • Any current Cochrane meta-analyses/clinical evidence.
  • Any other relevant UK or European guidelines (in English only), e.g. Scottish Intercollegiate Guidelines Network (SIGN).
  • Any relevant Drug and Therapeutic Bulletin, or NHS Economic Evaluation Database (e.g. NHS EED at http://www.crd.york.ac.uk/crdweb/ ).
• Group 3:
  • Any recent review articles (2 years) in quality, peer-reviewed journals, e.g. BMJ, The Lancet, New England Journal of Medicine, or appropriate UK professional body journal (e.g. Gut, Thorax) written in English.
  • Medline search for any relevant recent RCTs, systematic reviews or meta-analyses.
  • Check if any UK primary care organisation has issued any relevant recent guidelines (e.g. PCSG, PCSS).

Authors are required to remember the target audience (see 'Aims', above) so, although research will give a good international overview, due prominence is given to UK national guidelines and research based on UK populations.

Incorporation of evidence into summary article

Expert opinion, i.e. UK national guidance (NICE, SIGN, Royal Colleges, Primary Care Societies, etc.) are used as a starting point for the summary article where such exists. Where there is more than one national guideline, and these multiple guidelines are equally current and at variance with each other, the author searches for recent review articles based on a systematic literature review which may advise on whether one or both recommendations still represent acceptable current practice. If they do, then how the guidelines differ is described in enough detail to allow the clinician using the summary to choose the best course of action relevant to the patient in front of him/her.

Some guidelines are comprehensive enough to be the primary source for a clinical article (although links to papers cited by the guideline may be useful for users to drill deeper for information). However, based on their clinical experience or received feedback, authors may feel it necessary to expand the guidelines to answer common questions asked by patients in the consultation.

Note: new, original research (as opposed to older research which is cited in review articles) is not incorporated into the article unless it is of such importance as to change behaviour, e.g. a 'million woman study'. All such research is assessed for weakness of methodology and any possible bias and problems identified are expressly stated in the article.

Links are provided so clinicians can drill down to original research but, again, this research is not normally used as the only basis of management advice, which is based on accepted current best practice as indicated above. Obviously, any recent changes in practice based on safety issues (e.g. Medicines and Healthcare products Regulatory Agency (MHRA) warnings, PCT cascaded warnings, etc.) are immediately incorporated, and linked to the original research or MHRA/DH/CMO bulletin, until they are fully incorporated in newer versions of national guidelines.

Format

Articles are written to a standard template (with individual variation as appropriate to subject) so that the information can be found quickly and absorbed:

• Description
• Epidemiology
• Presentation
• Differential diagnosis
• Investigations
• Associated diseases
• Staging
• Management
• Complications
• Prognosis
• Prevention

Information about management is as comprehensive as possible, so that the clinician can be in a position to respond to all common patient questions. Usual treatment can be described referencing NICE or other guidelines. Treatment risks and benefits are described where such information is available, to help patients and their clinicians be as fully informed as possible when they come to make treatment decisions.

Review

All articles are reviewed by another clinician who adheres to the following procedure:

• Checking the advice given is compatible with their current clinical practice.
• Checking links and references.
• Performing a search on PubMed or similar to check there are no good recent sources that might be included.
• Where doses are used, checking they are correct with the summary of product characteristics (SPC) or current BNF.
• Giving consideration to how useful the article is; does it scan/read easily? Does it contain all information that would be important in the consultation and does not have too much unnecessary detail? If he/she were a GP registrar meeting a patient with the condition for the first time - is the article as helpful as it might be?

Reviewers are able to suggest changes to the article, and such comments are visible in the audit trail. These may involve pointing out omissions, recommending other relevant reference and further reading sources to be examined, or suggesting changes to phrasing or formatting to make reading easier.

All articles are also proofread by a designated member of staff for typographic or grammatical errors, consistency of terminology, adherence to house style, etc.

Updating schedule

All articles have a planned review date set on publication. This provides the basis for a default authoring plan that is mediated and implemented through the online, in-house authoring system. This is usually three years, but may be as little as one year, or up to five years depending on the type of article.

Many articles are brought forward early on an ad hoc basis for a review/rewrite triggered by the release of new NICE or other national guidelines.

Editorial independence

There is complete editorial independence of the EMIS authoring team from any commercial pressure to write about particular subjects or products.