UpToDate is a commercial product available for purchase. In medical education, UpToDate is reported to be a highly effective resource for learning 11 and is preferred by early career doctors 12. UpToDate has been shown to answer clinical questions effectively, with one study citing an 86% answer retrieval rate for UpToDate 10. Recent research demonstrates that the use of UpToDate was associated with improved quality of care, shorter lengths of stay, and lower mortality rates over a three-year period 1. UpToDate is used in over 190 countries and by 90% of US academic medical centers 4. The tool is authored by 7,100 physicians who continuously synthesize the most recent medical information across specialties into evidence-based recommendations that can support point-of-care decisions. It can be accessed on digital devices such as computers, tablets, or mobile smart phones in hospitals, clinics, or homes. UpToDate is a clinical decision support resource that can be used on or offline and provides evidence-based information for medical doctors. Sub-Saharan African medical schools have faced insufficient access to digital clinical resources, with medical schools rating their technological resources somewhat to severely inadequate on average 9. However, there has been limited research on this topic, likely due to limited access to such tools whose cost can be prohibitive. Research conducted by the authors of this study at the University of Rwanda suggests that early introduction of an evidence-based tool to medical students leads to habit formation and use of the tool in later clinical practice 8. Though medical students in the US are likely to be introduced to these digital tools early in their career 6, the use of digital tools has not gained the same momentum in sub-Saharan African medical education 7. However, significant gaps exist in the implementation of these tools into healthcare providers' routine practice in low-resource settings 5. Integrating these tools into practice, particularly in sub-Saharan Africa, is an important component of improving the overall quality of healthcare. The clinical decision support resource UpToDate is used in over 190 countries and by 90% of US academic medical centers 4. An American Medical Association survey showed that 57% of physicians use or plan to use a digital clinical support tool in their work 3. A majority of the increased use is happening in North America, though Asia Pacific is anticipated to be the fastest growing region in adopting these tools 2. The use of such tools is becoming increasingly popular throughout the world. If one or more nodes are in SYNCING state, you cannot update Sophos UTM.Digital point-of-care tools can provide easy-to-use, high-quality information that is regularly updated in line with the science and have been shown to improve diagnostic accuracy and promote quality, efficient care 1. Therefore you have no service disruption. Then the other nodes start the update process. When the installation is finished, the slave node gets the role of the master. If an update is available, the slave node and half of the worker nodes install the recent update. In a cluster you have several nodes: Master, Slave and Worker. After that, the new passive node also starts the update process. When a new update is available, the passive node installs the most recent update and takes over the role of the active node. In a high availability system there is an active and a passive node. Updates in High Availability and Cluster Mode However, if there is another firewall in between, you must explicitly allow the communication via the port 443 TCP to the update servers. In order to download Up2Date packages, Sophos UTM opens a TCP Transmission Control Protocol connection to the update servers on port 443-allowing this connection without any adjustment to be made by you. Pattern updates: A pattern update keeps the antivirus, antispam, intrusion prevention definitions as well as the online help up-to-date.Firmware updates: A firmware update contains bug-fixes and feature enhancements for Sophos UTM Software.There are two types of updates available: This option can be configured in the Management > Up2Date > Configuration menu. By default new update packages are automatically downloaded to Sophos UTM. Each update is digitally signed by Sophos-any unsigned or forged update will be rejected. Regularly installed updates keep your Sophos UTM up-to-date with the latest bug fixes, product improvements, and virus patterns. The Management > Up2Date menu allows the configuration of the update service of Sophos UTM.
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