Book Review

UpToDate in Nephrology and Hypertension

N Engl J Med 1993; 329:284July 22, 1993

Article

UpToDate in Nephrology and Hypertension
Edited by Burton D. Rose; System designed by Joseph Rush. Eight diskettes with manual, 44 pp. System needed: Apple Macintosh with minimum 14 MB free hard-disk space. Wellesley, Mass., Carol Peckham, 1992. $495 (individual); $250 (partner); $135 (fellow); $1550 (institution).

Keeping current with new information and changing practices is a constant challenge in any subspecialty. Fortunately, UpToDate makes this task a lot easier in the field of nephrology.

Uptodate is a HyperCard application that covers all the major areas of the field, including clinical nephrology, mineral metabolism, drug interactions and dosing, hypertension, dialysis, and renal transplantation. The program is more than a computerized textbook; it is extensively cross-indexed, allows searches by key word as well as subject, and has other useful functions. For instance, the program includes a helpful calculator function that prompts the user for the relevant data to determine such indexes as creatinine clearance, transtubular potassium gradient, and time-average concentration of urea for peritoneal dialysis. UpToDate also features a good selection of charts and tables, as well as light, immunofluorescent, and electron micrographs.

As an example of what you can do with this program, you might choose the search function and enter “hyperkalemia.” The program presents you with a list of 28 relevant phrases, such as “causes of hyperkalemia,” “potassium balance in acid-base disorders,” and “NSAID: electrolyte complications.” If you select “causes of hyperkalemia,” a screen of text appears that presents an orderly, brief discussion of potassium balance followed by a description of the major causes of hyperkalemia. You can refine your search by selecting from a list of modifier terms supplied by the program, such as “treatment” or “etiology.” Embedded in the text descriptions are underlined phrases, such as “show table,” “show graph,” or in other sections “show histology,” which you can select to see additional material. Also included at various points is the underlined phrase “see card,” followed by a description such as “potassium balance in uncontrolled diabetes mellitus.” Choosing this phrase allows you to flip to a more detailed discussion of this topic.

Another noteworthy feature of the program is that you can print the card you are viewing; this can be useful in consultations, by supplying the referring physician with a brief explanation of the pathophysiologic features of the case and some recent journal references. Finally, the program is updated quarterly. The cost of such a comprehensive system is that it requires a fairly large chunk of space on a hard disk (15 megabytes if the pictures are included and 10 megabytes without them), and there is a pause as you flip from card to card. However, the many efficient features and other advantages of UpToDate more than compensate for these minor inconveniences.

Uptodate is a welcome improvement over paperbound textbooks. It facilitates searches and allows selective reading without the constant need to flip to the index to see where to go next. Its information and functions can be useful learning tools for residents and fellows and can also help guide patient care by providing a quick reference to the current therapeutic interventions for specific problems.

Theodore Danoff, M.D., Ph.D.
University of Pennsylvania, Philadelphia, PA 19104