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Variable quality and readability of patient-oriented websites on colorectal cancer screening

Schreuders EH, Grobbee EJ, Kuipers EJ, Spaander MC, Veldhuyzen van Zanten SJ. Variable Quality and Readability of Patient-Oriented Websites on Colorectal Cancer Screening. Clin Gastroenterol Hepatol. 2016 Jul 9. pii: S1542-3565(16)30376-7. doi: 10.1016/j.cgh.2016.06.029. [Epub ahead of print].

The efficacy of colorectal cancer (CRC) screening is dependent on participation and subsequent adherence to surveillance. The internet is increasingly used for health information and important to support decision-making. We evaluated the accuracy, quality, and readability of online information on CRC screening and surveillance.

Twenty websites were included. The mean Website Accuracy Score was 26 out of 44 (range 9-41). Websites with the highest scores were cancer.org, bowelcanceraustralia.org and uptodate.com.

There is marked variation in quality and readability of websites on CRC screening. Most websites do not address polyp surveillance. The poor correlation between quality and Google ranking suggests that screenees will miss out on high-quality websites using standard search strategies.

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Medical students’ use of information resources: Is the digital age dawning?

Peterson MW, Rowat J, Kreiter C, Mandel J. Medical students’ use of information resources: is the digital age dawning? Acad Med. 2004 79(1):89-95.

Investigators at the University of Iowa monitored the use of UpToDate by second-year students as they transitioned to their clinical years. Students rapidly adopted UpToDate. By the end of their third year:

  • More than 85% of medical students identified electronic sources as their primary resource for medical information (UpToDate 53%, MDConsult 33%). UpToDate was preferred significantly more often than other resources.
  • They used electronic information resources daily and required less than 15 minutes to answer most of their clinical questions.

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Multiprogram evaluation of reading habits of primary care internal medicine residents on ambulatory rotations

Lai CJ, Aagaard E, Brandenburg S, Nadkarni M, Wei HG, Baron R., Multiprogram evaluation of reading habits of primary care internal medicine residents on ambulatory rotations. J Gen Intern Med. 2006 May;21(5):486-9.

Of online sources, 98% of residents reported using UpToDate regularly, 44% used literature search, and 35% used Google.com or other search engines.

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The reading habits of medicine clerks at one medical school: frequency, usefulness, and difficulties

Leff B, Harper GM, The reading habits of medicine clerks at one medical school: frequency, usefulness, and difficulties. Acad Med. 2006 May;81(5):489-94.

Among medical students at Johns Hopkins, UpToDate was the most commonly used reading source and was rated as the most useful.

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An evaluation of five bedside information products using a user-centered, task-oriented approach

Campbell R, Ash J. An evaluation of five bedside information products using a user-centered, task-oriented approach. J Med Libr Assoc 2006 Oct; 94(4):435-41, e206-7.

  • Participants successfully answered more clinical questions with UpToDate than with any of the other resource (P < 0.0001).
  • In response to the question, “Overall, did this database satisfy your needs?,’ UpToDate ranked significantly higher than all other resources (P = 0.006). UpToDate also ranked significantly higher on ease of use (P < 0.0001).
  • Most users (76%) ranked UpToDate to be the best product while none rated it the worst.

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Speed, accuracy, and confidence in Google, Ovid, PubMed, and UpToDate: results of a randomised trial

Robert H Thiele, Nathan C Poiro, David C Scalzo, et al. Postgrad Med J 2010 86: 459-465 doi: 10.1136/pgmj.2010.098053

  • Google was the most popular search tool.
  • Users of Google and UpToDate were more likely than users of PubMed to answer questions correctly.
  • Subjects had the most confidence in UpToDate.
  • Searches with Google and UpToDate were faster than searches with PubMed or Ovid.

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To compare PubMed clinical queries and UpToDate in teaching information mastery to clinical residents: A crossover randomized controlled trial

Sayyah Ensan L, Faghankhani M, Javanbakht A, Ahmadi SF, Baradaran HR. Center for Educational Research in Medical Sciences, Medical Education and Development Center, Tehran University of Medical Sciences, Tehran, Iran PLoS One. 2011;6(8):e23487. Epub 2011 Aug 12.

  • Based on intention-to-treat analysis, participants retrieved the answer of 67 (76%) questions using UpToDate and 38 (43%) questions using PubMed Clinical Queries (P<0.001).
  • The median time to answer retrieval was significantly faster with UpToDate.
  • The satisfaction with the accuracy of retrieved answers, interaction with UpToDate and also overall satisfaction were higher among UpToDate users compared to PubMed Clinical Queries users (P<0.001).

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A comparison of answer retrieval through four evidence-based textbooks (ACP PIER, Essential Evidence Plus, First Consult, and UpToDate): A randomized controlled trial

Ahmadi SF, Faghankhani M, Javanbakht A, Akbarshahi M, Mirghorbani M, Safarnejad B, Baradaran H. Tehran University of Medical Sciences, Iran Med Teach. 2011;33(9):724-30.

  • The rate of answer retrieval was 86% in UpToDate, 69% in First Consult, 49% in ACP PIER, and 45% in Essential Evidence Plus (p<0.001).
  • The mean time to answer retrieval was significantly faster with UpToDate.
  • UpToDate seems more comprehensive in content and also faster than the other three evidence-based textbooks. Thus, it may be considered as one of the best sources for answering clinicians’ questions at the point of care.

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Utility of the electronic information resource UpToDate for clinical decision-making at bedside rounds

Phua J, MBBS, MRCP, See KC, MBBS, MRCP, Khalizah HJ, MBChB Manc, MRCP, Low SP, MBBS, MRCP, Lim TK, MBBS, FRCPE. Utility of the electronic information resource UpToDate for clinical decision-making at bedside rounds. Singapore Med J 2012; 53(2): 116-120.

  • Each search took a median of three minutes (first quartile: two minutes, third quartile: five minutes).
  • UpToDate led to a change in investigations, diagnosis or management 37% of the time
  • Conclusion: “Incorporating UpToDate searches into daily bedside rounds was feasible and useful in clinical decision-making.”

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Survey of user preferences from a comparative trial of UpToDate and ClinicalKey

Michael R. Kronenfeld, MLS, MBA, AHIP, R. Curtis Bay, PhD, William Coombs, MA. Survey of user preferences from a comparative trial of UpToDate and ClinicalKey. J Med Libr Assoc. 2013 April; 101(2): 151–154.

The Journal of the Medical Library Association (JMLA) recently published, and released to the general public, a study conducted by the A. T. Still University of Health on a side-by-side comparison of UpToDate and ClinicalKey. The survey study was completed by 23 faculty members and 292 students from two osteopathic schools of medicine and a physician assistant program.

  • UpToDate scored higher than ClinicalKey on overall satisfaction, particularly by those in clinical rotation or teaching in the clinic who strongly preferred UpToDate.
  • UpToDate was strongly favored for ease of use, efficiency in answering specific questions, organization and depth.
  • UpToDate was the preferred choice by a large margin if the library could only purchase one product.
  • Respondents reported that Clinical key was valued for its library of full texts by those in the didactic or classroom phase of training, but that its use as a point-of-care tool was limited.

Study authors conclude that UpToDate was preferred in the clinical setting. They further concluded that “not only was it heavily used in the clinical setting,” but that respondents reported students “were at a competitive disadvantage if they did not have access to it.”

The authors noted that ClinicalKey, in advance marketing “implied its use as a point-of-care product for physicians.” However, the authors conclude that ClinicalKey’s “use as a point-of-care product was limited by the fact that the survey respondents did not find First Consult, which represents the major point-of-care content in ClinicalKey, to be at all comparable to UpToDate.”

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The value of library and information services in patient care: Results of a multisite study

Marshall JG, Sollenberger J, Easterby-Gannett S, Morgan LK, Klem ML, Cavanaugh SK, Oliver KB, Thompson CA, Romanosky N, Hunter S. The value of library and information services in patient care: Results of a multi-site study. Journal of the Medical Library Association 2013 Jan; 101(1):39-46.

A large-scale, multi-site study on the value and impact of library and information services on patient care was conducted by the National Network of Libraries of Medicine, MidAtlantic region and researchers at the University of North Carolina at Chapel Hill. The respondents were 16,122 clinicians at 56 library sites serving 118 hospitals in urban and rural areas.

Survey respondents were asked to report on a recent incident in which they had sought information for patient care. The study found:

  • UpToDate was the most used CDS tool by physicians and residents, used significantly more than any other CDS tool. Use of UpToDate followed closely behind only research studies
  • Clinicians reported that patient mortality was avoided in 6% of patient care incidents
  • Clinical decisions changed as the result of consulting resources: diagnoses (25%), choice of drugs (33%), other treatment (31%), ordered tests (23%) and patient advice (48%)
  • Clinicians reported that adverse events were avoided including, misdiagnosis, patient mortality, adverse drug reactions, medication errors and ordering of unneeded tests
  • 85% of respondents reported that the information saved them an average of 2.5 hours per incident

graphic from research study

Used with permission from the Medical Library Association

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Answering physicians’ clinical questions: Obstacles and potential solutions

Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME. Answering physicians’ clinical questions: obstacles and potential solutions. J Am Med Inform Assoc. 2005 Mar-Apr;12(2):217-24.

A study of generalist physicians in Iowa investigated the obstacles preventing physicians from answering their patient care questions. Physicians asked 5.5 questions per half-day but pursued answers to just 55% of them. Of the 55% of questions pursued, UpToDate was used the most (41%) out of over 10 information resources consulted during the study. Other resources on the list included Epocrates (25%), MICROMEDEX (15%), and the Sanford Guide to Antimicrobial Therapy (14%).

  • The typical primary care physician has approximately 11 questions a day. While they pursue answers to 55% of questions, only 40% get answered.
  • Answering all questions would change up to 5 management decisions per day.
  • The most common reason for not pursuing an answer was that they doubted that an answer existed.

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