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Sunday
Apr052009

The UpToDate Debate

There's a great post on Laika's MedLibLog about UpToDate and its claim to be an evidence-based resource.  Sure its information is based on some level of evidence - everything is - but the unsystematic manner in which it presents supporting evidence, and its heavy reliance on expert opinion, and its overall lack of transparency certainly positions it well below truly evidence-based resources like ACP-PIER and CDSR.

 

UpToDate used to be entirely an online book with (excellent) narrative reviews written by experts in the field. From 2006 onwards UpToDate began grading recommendations for treatment and screening using a modification of the GRADE system. Nowadays evidence UpToDate calls its database an evidence based, peer reviewed information resource. According UpToDate the evidence is compiled from:

  • Hand-searching of over 400 peer-reviewed journals
  • Electronic searching of databases including MEDLINE, The Cochrane Database, Clinical Evidence, and ACP Journal Club
  • Guidelines that adhere to principles of evidence evaluation
  • Published information regarding clinical trials such as reports from the FDA and NIH
  • Proceedings of major national meetings
  • The clinical experience and observations of our authors, editors, and peer reviewers

Although it is an impressive list of EBM-sources, this does not mean that UpToDate itself is evidence based. A selection of journals to be ‘handsearched’ will undoubtedly lead to positive publication bias (most positive results will reach the major journals). The electronic searches -if done- are not displayed and therefore the quality of any search performed cannot be checked. It is also unclear on which basis articles are in- or excluded. And although UpToDate may summarize evidence from Systematic Reviews, including Cochrane Systematic Reviews it does not perform Systematic Reviews itself. At the most it gives a synthesis of the evidence, which is (still) gathered in a rather nontransparent way. Thus the definition of @kevinmd comes closest: “it gives an evidence based slant”. After all, Evidence-based medicine is a set of procedures, pre-appraised resources and information tools to assist practitioners to apply evidence from research in the care of individual patients” (McKibbon, K.A., see defintions at the scharr webpage). Merely summarizing and /or referring to evidence is not enough to be evidence based.

 

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