Entries in UpToDate (7)


How Current Are Point of Care Resources?

I don't think it's reasonable to expect point of care resources to be 100% current all the time, but the number of outdated topic summaries in some is substantial:

Source: PMID 23220465

The authors suggest further research be done to improve updating efficiency, which makes me wonder what a reasonable expectation for currency is.  A new study should be evaluated and considered w/i the context of current recommendations before it's added to one of these resources.  How quickly can this be done?  How much can the process be automated?  

FWIW: Of the 4 in this study, Dynamed seems to balance update speed and quality the best.


UpToDate and Health Care Outcomes

Upon reading the title, my first thought was that hospitals that adopt UpToDate are somehow different than those that do not.  They might be larger, wealthier, have libraries, extensive collections of clinical resources, a different culture of care, etc.  The study accounts for some, but not all, of these.  My suspicion is that the use of point-of-care resources in general, regardless of the specific resource, improves care simply by making evidence more accessible to clinicians.



Dynamed Incorporates New Evidence Quickly 

According to this BMJ study, Dynamed incorporates new evidence more quickly than four other point of care resources (Clinical Evidence, EBMGuidelines, eMedicine, and UpToDate).

Evidence held to be relevant to clinical practice is inserted at different rates in point of care information summaries, and these products vary widely in their speed at updating content. Our citation analysis showed that Dynamed clearly dominates the other products (Clinical Evidence, EBMGuidelines, eMedicine, and UpToDate). Slowness in updating could mean that new relevant information is ignored and could thus affect the validity of point of care information services. Ultimately, whenever the transfer of relevant information is inappropriately slow, this can affect the care of patients, potentially denying treatments of proved benefit. This happens despite the fact that many of these products promote themselves to the clinical community as being regularly updated with the latest evidence.


This conclusion doesn't surprise me.  It's something we usually discuss when we show Dynamed to the med students/residents/fellows/etc.  

~I should mention that I've only spent significant time in Dynamed and UpToDate, so I don't know much about the others in this study.


UpToDate vs PubMed Clinical Queries

This comparison strikes me as unfair.  It's like comparing a textbook to an article.  Apples to oranges. From the discussion:


PubMed Cilnical Queries is a set of search filters for separating valid and relevant articles out of the repository of PubMed citations. Thus limits its clinical efficiency; because: a) Searching for one question may yield multiple high quality articles that present different answers, which the clinician does not have time to evaluate comprehensively. b) Few articles compare all management options for a given health problem. Therefore if the clinicians intend to decide between all possible options, they would have to review several studies systematically to inform their decision making. This is time consuming and also requires expertise.

On the other hand, UpToDate is highly efficient; because a) the information is organized in entries rather than articles; each discusses a complaint (e.g. chest pain), disease (e.g. acute coronary syndrome) or a category (e.g. diagnosis) of a disease; if a special issue needs further discussion, another entry would be specified to it (e.g. cholesterol lowering after an acute coronary syndrome). Thus, the clinician is guided to alternation and is not overwhelmed with information. b) The information is provided by integrating the best available evidence by experts to address all management options for a given health problem and most of the recommendations are graded on the basis of their level of evidence. Thus, clinicians can use the recommendations knowing that all options are considered and the best one is recommended.


Yes, searching PubMed and other citation resources takes time and critically appraising individual studies, even systematic reviews, is impractical.  And, yes, point of care resources that provide topic syntheses are very valuable clinical tools, precisely because they synthesize the literature.  Maybe this comparison would work if PubMed had a team of editors that compiled and summarized studies, and then provided clinical recommendations based on that initial legwork.  But, it doesn't.  It's a database of citations, with a set of (effective) filters that assist searchers in finding evidence.  Very different.   


Continuation of UpToDate

As I stated last week, the library I work at decided not to renew UpToDate this coming year.  Within a week, maybe 8 days - however - the medical school decided to go it alone and purchase the resource themselves.$

This works out well for everyone.  The health care providers who use UpToDate can continue to do so without having to purchase their own subscriptions.  The library can continue to provide access to Dynamed and other (new) resources.  And UpToDate can continue to do its thing at U Michigan... at perhaps a (much?) higher price tag then it would've had otherwise.*

And, so, with that, the 2010 UM / UpToDate cancellation / subscription saga comes to an end. 

*Of course, we'll never know b/c the price tag is - I'm sure - protected by the license agreement.

$Well, that's not exactly true. It turns out the library's splitting the bill w/ the med school this coming year. ~08/27