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Are You Up To Date?
Central and Eastern Europe & Turkey
Bogdan Czubak
| UpToDate
“Clinicians don’t need more
information.
They need the right information.”
John Halamka, MD , CIO
CareGroup Healthcare System , Boston, MA
Multiple Studies have shown
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A clinical question arises in 50 – 70 % of the visits / patient contacts
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80 % of these questions are about management
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Only 30 % of questions are answered during or after clinic visits
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Approximately 70 % of answers would have changed patient management
Why don’t they look up the answers?
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They don’t have time.
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They don’t have confidence they’ll actually find the answer with the resources and time
they have.
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The sheer volume of clinical information being published is overwhelming (eg. 800 new
articles are added to Medline each day).
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All of the above.
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Increasing Demands on Clinician Productivity : Less Time and an Increasing Focus on
Quality and Error Reduction causes Immense Stress on Medical Delivery Systems and
Providers
Doctors Challenges
Amount of information
Knowledge
Gap
Time to meet information needs
Years
What is UpToDate?
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UpToDate is a comprehensive evidence-based clinical information resource
UpToDate is designed to get physicians the concise, practical answers they need when
they need them the most - at the point of care.
Our topic reviews are written exclusively for UpToDate
by physicians for
physicians. Over 4,000 physicians serve as authors.
Our content is comprehensive yet concise, and it is fully referenced.
It goes through an extensive peer review process to ensure that the information and
recommendations you access from our service are accurate and reliable. (Regular
revision of contents at least in each 4 months )
UpToDate enables physicians to:
• Access the most current information within your specialty.
• Recognize the clinical manifestations of a wide variety of disorders
• Describe current options for diagnosis, management and therapy, including the
efficacy, doses, and interactions of individual drugs.
• Identify optimal screening and prevention strategies
Quick Facts about UpToDate
(version 18.2)
4000+ (international) world-renowned Authors
8.500+ clinical topics in 16 specialties
956 Topics with graded recommendations
4.300+ unique drug entries
95.000+ pages
22.400+ graphics
250.000+ Medline references
400+ journals reviewed
380,000+ users in 130+ countries
Available on CD – Rom (individual, library), on PDA (individual) and online (site,
individual)
• Updated every 4 months (44 % of the Topics updated and 188 new Topics in 17.2)
• New Specialties added soon
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Written by Physicians for Physicians
Funded by Subscribing Physicians and Hospitals
Using UpToDate
Is as simple as
1, 2, 3
test
UpToDate is Evidence Based
• See our editorial policy (www.uptodate.com)
• “EBM is more then only grading” (by G. Guyatt)
• UpToDate executes a systematic review of the most
important resources (including Cochrance, Best Evidence,
377+ Journals)
• UpToDate follows a hierarchy of evidence consistent with
most evidence – based resources
• UpToDate gives multi-level peer-reviewed
recommendations, based upon evidence but also on
clinical experience ( „Real world recommendations”)
Evidence Based Medicine
Best Clinical
Evidence
Clinical
Expertise
Patient’s Values &
Circumstances
Features & Specialities
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Adult and Pediatric Emergency Medicine
Adult Primary Care and
Internal Medicine
Allergy and Immunology
Cardiovascular Medicine
Endocrinology and Diabetes
Family Medicine
Gastroenterology and
Hepatology
Hematology
Infectious Diseases
Nephrology and Hypertension
Neurology
Obstetrics, Gynecology
and Women’s Health
Oncology
Pediatrics
Pulmonary, Critical Care
and Sleep Medicine
Rheumatology
Specialties in development:
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Dermatology
Psychiatry
Surgery
UpToDate Endorsements
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UpToDate is an official educational program of or offered in cooperation
with:
– American Academy of Pediatrics
– American College of Obstetricians and Gynecologists
– American College of Rheumatology
– American Gastroenterological Association
– American Society of Nephrology
– Society of General Internal Medicine
– The Endocrine Society
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UpToDate is recommended by:
– American Academy of Family Physicians
UpToDate’s Drug Database
UpToDate includes a full comprehensive drug database including:
• Brand Names, both U.S. and International
• Dosing information
• Pricing information
• Warnings and Reactions
• Links to relevant topics
• Full Natural and Pediatric drug databases included.
• Interaction database.
Improving medical Knowledge
Aquisition with UpToDate
Factors associated with medical knowledge acquisition during internal medicine residency
McDonald FS, Zeger SL, Kolars JC ( Mayo Clinic)
Background: Knowledge acquisition is a goal of residency and is measurable by in-training exams. Little is known about factors associated with medical knowledge
acquisition.
Objective: To examine associations of learning habits on medical knowledge acquisition.
Design, Participants: Cohort study of all 195 residents who took the Internal Medicine In-Training Examination (IM-ITE) 421 times over 4 years while enrolled in the
Internal Medicine Residency, Mayo Clinic, Rochester, MN.
Measurements: Score (percent questions correct) on the IM-ITE adjusted for variables known or hypothesized to be associated with score using a random effects
model.
Results: When adjusting for demographic, training, and prior achievement variables, yearly advancement within residency was associated with an IM-ITE score
increase of 5.1% per year (95%CI 4.1%, 6.2%; p < .001). In the year before examination, comparable increases in IM-ITE score were associated with attendance at
two curricular conferences per week, score increase of 3.9% (95%CI 2.1%, 5.7%; p < .001), or self-directed reading of an electronic knowledge resource 20 minutes
each day, score increase of 4.5% (95%CI 1.2%, 7.8%; p = .008). Other factors significantly associated with IM-ITE performance included: age at start of residency,
score decrease per year of increasing age, -0.2% (95%CI -0.36%, -0.042%; p = .01), and graduation from a US medical school, score decrease compared to
international medical school graduation, -3.4% (95%CI -6.5%, -0.36%; p = .03).
Conclusions: Conference attendance and self-directed reading of an electronic knowledge resource had statistically and educationally significant independent
associations with knowledge acquisition that were comparable to the benefit of a year in residency training.
Abstract in Journal of General Internal Medicine. 2007 Apr 28; [Epub ahead of print].
PMID: 17468889 [PubMed - as supplied by publisher]
Solucient: UpToDate is Associated with
Better Health Outcomes
 UpToDate worked with Solucient(1) to study impact
of UpToDate on length of stay, complications and
patient safety(2)
 Compared hospitals with and without access to
UpToDate
 The study adjusted for hospital size, hospital type
(teaching vs. non) and geographic location
(1) Solucient maintains the nation's largest healthcare database, comprised of more than 26
million discharges per year from 2,900 hospital
(2) Int J Med Inform. 2008 Nov;77(11):745-53.
Solucient: Impact of UpToDate
 Hospitals that used UpToDate had significantly
lower risk-adjusted length of stay, on average
.167 days/discharge (p<.0001)
• UpToDate hospitals also had statistically
significantly lower complication rates (p<.0476)
and lower patient safety outcome rates (p<.0001)
Summary:Impact of usage UpToDate
Answering clinical questions at the point of care (bedside usage)
Helps to answer questions both for clinicians and residents, students on spot
Constantly updated medical infromation results further increase of level of professionalism and
knowledge
UpToDate has no pop-ups, advertising or sponsors and written by Doctors to Doctors
Certified by groups of specialties societies and 16 Covered Specialties and growing (3 in progress
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Evidence based recommendations in associtaion with leading medical Soceties
Feedback and e-mail features to spread out the professional knowledge
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UpToDate helps to improve the quality of medical care:
may change the way patient is managed resulting in better patient outcomes / better quality of
care.
may improve physicians ,residents and students medical knowledge and training results –
higher reputation of the site
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Usage of UpToDate may save time & money (increase efficacy)
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time savings ranged from 44 minutes to 2.6 hours per week
brings savings in hospital length of stay, decreased complication rates, reduce adverse
events, less referrals