Die Amsterdamer Medizinbibliothekarin Jacqueline stellt in Ihrem Blog Laikas die nicht ganz unwichtige Frage, How Evidence Based is UpToDate really? Dabei faßt sie eine interessante Twitter-Diskussion zusammen:
- 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 UpToDate calls its database an evidence based, peer reviewed information resource.
- 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.
- She cites: „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.
- It is also not clear what peer reviewed implies, i.e.can articles (chapters) be rejected by peer reviewers?
- As a consequence the chapters differ in quality. Regularly I don’t find the available evidence in UpToDate. That is also true for students and docs preparing a Critically Appraised Topic (CAT). In my experience, UpToDate is hardly ever useful for finding recent evidence on a not too common question. @Allergynotes tweeted a specific example on chronic urticaria and H. pylori, where the available evidence could not be found in UpToDate.
- … many of the authors have substantial ties to the pharmaceutical industry, meaning that UptoDate (although not financed) is not completely unbiased.
- @Allergynotes rightly states that usability/perceived usefulness may be more important to physicians (than real usefulness) and that we should look at what make UpToDate so useful rather than just say “it’s not EBM”. In one of his posts Ves Dimov (@allergynotes) refers to a (Dutch) paper showing that answers to questions posed during daily patient care are more likely to be answered by UpToDate than PubMed. At my hospital some doctors (especially intern med docs) consider UpToDate as their Bible. It is without doubt that UpToDate is a very useful source both for clinicians, patients and even librarians. It is ideal for background questions (How can disease X be treated, what is the differential diagnosis?, what might be the cause of this disease?), to look up things and as a starting point. And it has a broad coverage.
Schauen Sie auch in die vielen, lesenswerten Kommentare, denn es geht auch um ein viel tieferes Problem: Der Bias durch Industrie-gesponserte Studien macht auch vor UpToDate et al nicht halt.