Patient education handouts
UpToDate offers patient education handouts; however, these could be made much more accessible. Veteran users know exactly where to look for these handouts, but novices may apply the “3 clicks and you’re out” rule when the process proves too frustrating.
Both “Prostate Cancer Screening” (including PSA testing) and “Screening for Breast Cancer” (including mammography) are about 5 single-spaced pages long when printed using Times New Roman 12-point. Although controversies are covered well, our guesstimate of the reading comprehension level is 1 or 2 years post–high school— maybe too difficult for patient education.
Search engine
UpToDate’s search engine is rudimentary. Multiword medical term searches are supported (eg, “chronic renal failure” and “vertebral compression fracture”), as are initial word fragments (eg, “spondyl”). However, searches incorporating Boolean operators (AND, OR, NOT) and unrelated words are not directly supported, although an obtuse “secondary search” does provide for one AND operation. On this secondary search screen, users may choose to focus on a specific category of information, such as diagnosis, treatment, pathogenesis, or patient information.
The search function can be quirky. Although the words “gluteus medius bursitis” appear in the text, cutting and pasting those words into the search function yields no retrievals; this makes it more difficult to locate information. Searching “restless legs syndrome” produces the suggestion that the user search “restless legs”—which, when searched, produces a most relevant topic: “restless legs syndrome.”
Additional digital tools
Other features of UpToDate take excellent advantage of the electronic environment.
Hyperlinking. Extensive hyperlinking within and between monographs facilitates access to information.
Retracing steps. “Back” and “forward” buttons allow users to navigate linearly.
Text-string searches.The “Find in Text” feature, or its keyboard shortcut, Ctrl-F, allows users to find text string matches within the current monograph.
Search history. A “Recent Topics” button in the menu bar makes it possible to revisit the prior 20 topics viewed by a user.
Accessing citations. Clicking on any reference links users to that article’s citation and, if available, MEDLINE abstract. Citations may be exported to a text file, but may not be directly cut-and-pasted.
Exporting monographs. Users may print a monograph, export a monograph as text or in rich text format (*.rtf), export a monograph’s abstracts into WordPad, or (from the Web version) e-mail a monograph to a colleague with an optional, complimentary 7-day guest pass to UpToDate Online. Graphics can be exported into Windows Paint.
CME tracking. UpToDate keeps track of a user’s “CME time,” crediting up to 10 minutes (in hundredths of an hour increments) per topic per use of UpToDate. CME from the CD is unlimited; up to 50 hours may be accumulated online. Credits may be totalled for submission for a fee of $25 per transmittal.
Room for improvement
Some of UpToDate’s advice is open to question. Although information is generally well-referenced, a few statements should have been referenced but were not.
For example (in reference to bacterial conjunctivitis): “Aminoglycoside drops and ointments (Genoptic®, Tobrex®) are poor choices since they are toxic to the corneal epithelium and can cause a reactive keratoconjunctivitis after several days of use.”
UpToDate prominently advises that the Pediatric module is a work in progress. In searching for “delayed menarche,” the closest match we found was “Pubertal changes (Tanner stages).” Information was sufficient to answer most clinical questions. However, UpToDate did not provide a clinically useful graphic listing sentinel events (Tanner stages, peak height velocity, menarche) in typical chronological order with anticipated normal age ranges.
Digital design problems
UpToDate fails to take full advantage of the electronic environment. Inexplicably, in the Contents menu screens, Find in Text is not active, and users cannot navigate using the Page-Up/Page-Down or (Ctrl+)Home/End buttons on their keypads. For example, following Contents through “Patient Education” to “Women’s Health Issues,” users find 48 topics in 19 sections as they try to locate the one of interest.
“Mammography” is integrated into “Screening for breast cancer,” and is not a separate keyword for users who are visually scanning for that word (the only option).
Right-clicking is not supported.
An Editmenu is absent. Windows’ Cut and Paste keyboard conventions (Ctrl-c/Ctrl-v) are supported in the main UpToDate window—but not in other windows.
Bookmarking—the electronic equivalent of the folded page corner—is unavailable, as is a favoriteslist.
Highlighting—electronic yellow, blue, and pink markers—is not supported.
No facility for user-added annotation is available.
Opening multiple windows of information simultaneously is not possible.
Standard resizing of the main UpToDate window (by “grabbing” edges of the window) is not supported.
Finally, an ability to limit searches from the main screen to patient handouts or Lexi-Comp would be desirable.