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UpToDate: a comprehensive clinical database.

Article Excerpt
How many clinical questions arise during an average day at the office? How many more questions might one entertain if clear-cut, expert advice were seconds away? Enter UpToDate, an electronic clinical database for, well, acquiring up-to-date clinical information--plus continuing medical education (CME) credits and patient handouts.

Unlike a textbook, UpToDate is not set up for paging through content from beginning to end. Rather, if is designed for searches that yield lists of relevant monographs. UpToDate's initial screen displays simple menu bars and a prominent search box (Figure 1). The next step allows one to narrow the search (Figure 2).

[FIGURES 1-2 OMITTED]

Per its educational objectives, UpToDate provides "instant access to the most current clinical information and recommendations on patient care and treatment," yet is "comprehensive" from "physiological concepts through results of the most recent clinical trials and protocols." Each monograph indicates when the literature was last reviewed and the document updated. The service is available in 3 formats: personal computer-based, online, and Pocket PC. We reviewed these formats using Windows PCs.

* TESTING UPTODATE IN A CLINICAL CONTEXT

Following are a few questions that needed answering during a half-day of practice:

* How effective is topical terbinafine (Lamisil) in treating Candida skin infections?

* What is a reasonable algorithm to determine the cause of chronic renal failure?

* How does one compound nitroglycerin ointment to treat an anal fissure?

* What is the latest thinking on interstitial cystitis?

* What is the preferred empiric antibiotic therapy for presumed bacterial conjunctivitis in adults?

* Does efficacy differ between injectable and intranasal forms of calcitonin for relief of pain from osteoporotic vertebral compression fractures in postmenopausal women?

UpToDate answered 4 of the 6 questions quickly, requiring no more than a few minutes for each search. We found that 2% nitroglycerin must be diluted to 0.2% for use on anal fissures. We also...