Up to Date is an electronic data source published on the Web and in the form of a CD, which presents detailed information about patient care and clinical cases (clinical symptoms, laboratory methods, and diagnosis and treatment of diseases) and applies to physicians and patients. Every year, more than 80 million patient cases are evaluated by the research teams of Up to Date. In addition, data on the database are updated every four months.

Thematic Coverage of UpToDate

The database provides more than 75,000 pages, contents, and images and more than 250,000 resources. In addition, a pharmaceutical information database and links to Medline abstracts are provided. Up to Date covers more than 7300 topics in 13 specialized medical fields, including:

1. Kidney

2. Nerves

3. Gastroenterology, Liver

4. Hematology

5. Cancer

6. Infectious diseases

7. Lung, Immune sensitivity

8. Pediatrics

9. Rheumatology

10. Gynecology and Women's Health

11. Endocrinology

12. Cardiovascular

13. Family medicine and emergency care, adult primary care

Drug Interactions Database

This database is a program that analyzes the interactions between medicines with drugs, medical plants between drugs, and medicinal plants with medicinal herbs. To search on the database, the desired term is entered in the search box. After observing all names of drugs and compounds interacting with the desired drug, we can click on the medicine name and see a list of drugs and compounds that interact with it. When there is a need to evaluate how interaction occurs between two specific drugs, the name of two drugs are separately searched, followed by selecting the “analyze” item and observing the range of level of interaction between the drugs.

Drugs can be retrieved through their brands; for instance, aspirin drug can be searched using its brand of “Aspirin” and there is no access to information if its scientific name “acetylsalicylicylic acid (ASA)” is searched. When searching, writing the first few letters of the name of a drug will lead to viewing a log of the names of drugs that begin with these letters. However, drugs cannot be retrieved if these letters are in other parts of their name. In other words, the full name of the drug must be put in the search box, and remove the check mark next to the drug name. By doing so, the drug name is removed, and the new list item can be selected to search a new drug in a new page.

Level of Interactions Defined for Drugs

In this database, the drugs that interact with one another are classified in the range of D, C, B, A, X based on their risk level when taken concomitantly.

Code A: shows lack of pharmacodynamics and pharmacokinetics interaction between two drugs

Code B: Shows the possibility of interaction between drugs; however, there is no need for changing the drugs for the patient.

Code C: shows the need to intervene in the drug dose of the patient when taking the two drugs at the same time. Considering the patient's condition and the benefits of co-administration, coordination must be made in the dose of one or two drugs in a small number of patients to reduce their complications.

Code D: shows the interaction between drugs in a way that it could cause risks to patients health depending on their condition and level of benefit of co-administration of drugs. In this condition, the patients’ condition must be precisely observed during consumption to change the dose of drugs depending on the clinical condition of patients and the possibility of substituting the drugs.

Code X: shows the interaction between the drugs. In this situation, the risk of co-consumption of two drugs is greater than its benefits, and two drugs should not be prescribed for the patient at the same time.

Record Sample in the Pharmaceutical Database

Figure 2 shows the range of drug interactions between aspirin and ketorolac.

The name of the two drugs is displayed at the top of the record, and then the code for the range of drug interactions, a summary of impact of the second drug and the function of the first drug, how to manage the use of the two drugs in the patient, a more detailed discussion on the drug interactions and, finally, the extraction source of information are provided in the footnote.

Search on UpToDate

To search for information on UpToDate, the following stages must be followed:

1. Enter the term in the “new search” box.

Note: the search term can be the name of diseases, disease symptoms, laboratory abnormalities and approaches, name of drugs, and classes of drugs.

2. Click “Go”.

3. In the search results page, you can observe the results related to a topic by clicking the title of a subject field.

Specification of the Search Term

To retrieve more precise information, enter a phrase into the box that exactly shows what you want. For example, in order to find information on how to treat hypertension during pregnancy, enter the term "treatment of hypertension in pregnancy" because it will retrieve more accurate information than the term “hypertension”.

Search Notes

1. UpToDate recognizes commonly used abbreviations and synonyms. GERD, for example, recovers the results of gastroesophageal reflux disease (the disease of the esophageal reflux disease).

2. In the search process, the use of upper or lower case retrieves the same results.

3. The search term is automatically searched in all medical specialties covered by UpToDate.

4. In UpToDate, name of an author, title of a journal and year of publication cannot be searched.

Obtaining Thematic Backgrounds from the Search Results Page

After entering the search term by UpToDate, search results are shown similar to Figure 2.

By clicking on the desired subject, you can see the information on that subject field. By pointing the mouse over any of the subject fields, you can see the more detailed information on the right side of the page and make a more appropriate and relevant decision in terms of selecting an entry.

Using Search Suggestions

In some cases, UpToDate suggests alternative or complementary terms when searching for a topic, which is shown at the top of the search results page. These items include:

1. There is more than one definition for an abbreviation used in the search.

2. There are spelling mistakes or other typographical errors in the word or term searched by the user.

3. There are more general categories of information for a term or word searched by the user.

For example: two definitions of carcinoembryonic and carotid endarterectomy exist for the term “CEA”.

As observed in Figure 4, UpToDate provides both suggestions for CEA at the top of the search results page.

By selecting the desired term proposed, UpToDate only retrieves documents about the selected topic and excludes unwanted documents.

Special Patient Information

UpToDate provides hundreds of educational topics for patients, which are updated every four months similar to the information of physicians. Therefore, the most accurate and recent information is provided to patients, which are related to the most prevalent diseases and point out different aspects of the disease, such as risk factors, cause of disease, diagnostic methods, preventive measures, disorders, and proposed treatments.

Information provided in this part is only for the education and increase of knowledge of patients and their families and are not suitable for other groups of readers. To obtain information about other groups of patients, you can refer to “where to get information” section in each subject areas of patient information. Information of patients is available to the public free through the website of www.uptodate.com/patients.