American College of Physicians: Internal Medicine — Doctors for Adults ®

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Three government Web sites a boon for patient care

From the March 1998 ACP Observer, copyright 1998 by the American College of Physicians.

By Chris Dwyer

Not so long ago, Michael W. Jacobson, FACP, found giving patients advice about international travel a somewhat laborious process.

The New York City internist and cardiologist would typically start by checking the Centers for Disease Control and Prevention's (CDC) "Yellow Book" of immunization requirements and recommendations. But because disease outbreaks and emerging infections change so frequently, he would often have to call the CDC for an update and consult the CDC's "Blue Sheet," which lists hot spots for yellow fever and cholera.

Today Dr. Jacobson can find all this and more simply by accessing the "Traveler's Health" section of the CDC's Web site (www.cdc.gov)."The travel pages are indispensable for getting the most up-to-date information for patients who are traveling to exotic places," Dr. Jacobson said. "Because of the constant changes in this area, this is the sort of resource for which the Internet is ideal."

The CDC is one of many U.S. government health agencies using the Internet to distribute clinical information previously available only in print.

To get a better idea of which government-sponsored health sites are most useful for physicians, we asked several internists to list their favorite sites. Here are their responses:

  • Medline

    www.nlm.nih.gov/databases/freemedl.html

    Last year, the National Library of Medicine (NLM) put its Medline database, which contains 9 million citations from 4,000 biomedical journals, available on the Internet free of charge. The NLM maintains two Medline search tools, Internet Grateful Med (IGM) and PubMed. IGM gives sophisticated searchers full access to the medical subject heading hierarchy (MeSH), as well as Loansome Doc, a fee-based document delivery service. PubMed features beginning and advanced search modes and provides users with lists of "related articles" with each search.

    Paul N. Gorman, FACP, assistant professor of medicine and health informatics at Oregon Health Sciences University, consults Medline whenever he is seeing clinic patients. Dr. Gorman says, "I continue to be surprised by the number of clinical questions that can be answered by searching Medline."

  • NCI CancerNet

    cancernet.nci.nih.gov/

    CancerNet, which has separate sections for patients, clinicians and researchers, features the National Cancer Institute (NCI)'s peer-reviewed statements on cancer treatment, supportive care, prevention and screening. It also provides a registry of thousands of open and closed clinical trials throughout the world, directories of physicians and organizations offering cancer care, and the ability to search NCI's bibliographical database.

    Stuart J. Nelson, FACP, head of the NLM's MeSH Section, has found NCI's resources helpful when treating newly diagnosed cancer patients. "I have used it to find specialists interested in specific diseases," he said, "and it is always useful in trying to find protocols in which to enroll patients."

  • AHCPR guidelines

    text.nlm.nih.gov/ftrs/gateway

    At NLM's HSTAT site, internists may browse, search and download Agency for Health Care Policy and Research (AHCPR)-supported guidelines covering more than 20 primary care topics. The agency presents information on most issues in several formats: a clinical practice guideline, a quick reference guide for clinicians and patient handouts in both English and Spanish. Sample titles include "Depression in Primary Care: Detection and Diagnosis" and "Heart Failure: Evaluation and Care of Patients With Left-Ventricular Systolic Dysfunction."

    Daniel C. Davis Jr., FACP, medical director of clinical informatics at The Queen's Medical Center in Honolulu and a practicing internist, said the AHCPR guidelines are useful "in answering patient-specific problems, such as 'What is the recommended maximum dose of ACE inhibitor in managing a patient with CHF?' "

Chris Dwyer is Medical Informatics Program Associate in ACP's Education Division. He can be reached at medinfo@mail. acponline.org.

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