Internet Information on Urology

Web Update

WEB UPDATE Internet Information on Urology Cynthia L. Shamel Poway, Calif Keeping up with all the current information in the field of urology is not as difficult anymore, with the many sources available on the World Wide Web. But which sites will give you the most and best data? Where can you go for continuing medical education? For sources of patient education information? For a list of upcoming meetings? Check below for recommendations on general medical, urology-specific, and reference resources. [Rev Urol. 2000;2(4):246-252] Key words: Continuing medical education • Health care data • Information • Internet • Urology P hysician use of the Internet jumped 875% from 1997 to 1999, according to an ongoing survey by the Healtheon Corporation, with 85% of physicians currently using the Internet.1 In spite of this phenomenal increase, physicians surveyed indicated lack of time (49%) and lack of meaningful content and services (20%) as stumbling blocks to Internet adoption. This article addresses both of these concerns by identifying and describing those Web sites most likely to interest and to assist practicing urologists (Table 1). The Internet Web sites discussed fall into 3 categories: General Medical Resources, Urology-Specific Resources, and Reference Resources. For a good overview of the wide variety of medical resources on the Web, begin with the General Medical section. If you prefer to focus on urology, skip to the section on Urology-Specific Resources. The Reference Resources section features the online version of traditional printed reference sources. Each category contains descriptions of sites that offer reliable and current information. Depending on the site’s publisher and purpose, each site fills a different information need (Table 2). Keep in mind the dynamic nature of the World Wide Web, and expect frequent changes to site content. Many of these Web sites have corporate, private, or educational sponsors. In many cases, this sponsorship represents a bias that influences content. Generally, information sources are published with a purpose in mind. Knowing that purpose will enhance your understanding of the information that site offers. A bias is not necessarily a bad thing, as long as the user is aware of it. General Medical Resources WebMD—http://www.webmd.com—Healtheon/WebMD strives to lead the evolution of health care and empower its participants by connecting physicians and consumers to the entire health care industry. The WebMD home page offers news, medical content, references, discussions, education, and more, by user type. WebMD classifies users as consumer, physician members, physician nonmembers, 246 REVIEWS IN UROLOGY FALL 2000 Web Update nurse, and office manager. Each section has content and advertising appropriate to that group. Physician membership fees of $29.95 per month are currently being underwritten by a grant. This affords access to information and services not available to nonmembers. Members can obtain administrative support in addition to full reference service and access to all information content. Currently, the medical information available to urologists has breadth but not depth. Other sites described below can better serve that need. Practicing urologists, however, may want to visit WebMD to become familiar with a source widely used by patients. HealthGate®—http://www3. healthgate.com/index.asp—This is another site very popular with health care consumers (Figure 1). Founded in 1994, HealthGate’s Web site outlines its mission: “To be the world’s preeminent electronic source of objective and credible health and medical information for health care professionals, their patients, and consumers.” The site’s home page targets the patient or consumer, but 1 click leads to the Professionals’ Center. This page offers free research tools, such as MEDLINE® and CANCERLIT®, as well as PsychINFO, AgeLine, and EMBASE for a fee. To use the fee-based services, you must register and supply billing information. HealthGate also provides news and online continuing medical education through Boston University and HealthStream University, with course offerings that are constantly being updated. Hardin MD—http://www.lib.uiowa. edu/hardin/md/index.html—Hardin Meta Directory takes its name from the Hardin Library for Health Sciences at the University of Iowa (Figure 2). Since this site comes from a university, its focus differs from the commercial sites already discussed. Rather than creating or generating site content, Hardin MD is a list of lists. “Its purpose is to provide easy access Table 1 Uniform Resource Locators for Web Sites General Medical Resources WebMD—http://www.webmd.com HealthGate®—http://www3.healthgate.com/index.asp Hardin MD—http://www.lib.uiowa.edu/hardin/md/index.html Centers for Disease Control and Prevention—http://www.cdc.gov National Institutes of Health—http://www.nih.gov cancerfacts.com—http://www.cancerfacts.com Urology-Specific Resources Uroweb—http://www.uroweb.org UrologyChannel—http://www.urologychannel.com American Urological Association—http://www.auanet.org National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)— http://www.niddk.nih.gov/health/kidney/nkudic.htm UroHealth—http://www.urohealth.org Reference Resources and Online Journals PDR.net—http://pdr.net The Merck Manual of Diagnosis and Therapy—http://www.merck.com/pubs MEDLINE—http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed WebMedLit—http://webmedlit.silverplatter.com/index.html Digital Urology Journal—http://www.duj.com Urology News Online—http://www.uronews.com to comprehensive resource lists in health-related subjects.” Compilers have chosen sites cited by people in the field, and the links are checked frequently to ensure that they will connect. Hardin MD has been featured in the British Medical Journal. The home page offers links to authoritative Figure 1. HealthGate, for professionals, patients, and consumers (www3. healthgate. com/index. asp). FALL 2000 REVIEWS IN UROLOGY 247 Web Update continued Table 2 Recommended Sources to Find Specific Information Clinical trials NIH Continuing medical education AUA, HealthGate, Uroweb, WebMD Directory to urology sites Hardin MD Forums, online chats, and experts Uroweb, UrologyChannel Full-text online Digital Urology Journal, Merck Manual, PDR.net, UrologyNews Online Health and industry statistics AUA, CDC, NKUDIC Literature searching HealthGate, MEDLINE, WebMedLit News HealthGate, UrologyChannel, Urology News Online, WebMD Patient resources HealthGate, NKUDIC, UrologyChannel, WebMD Physician administrative support services AUA, WebMD Professional meeting and Congress information AUA, Uroweb Scientific data and ongoing research CDC, NIH Visual and slide libraries Uroweb AUA, American Urological Association; PDR, Physicians’ Desk Reference; NKUDIC, National Kidney and Urologic Diseases Information Clearinghouse. sites in dozens of specialties, including nephrology, urology, and men’s health; oncology; and telemedicine. The Hardin site should prove valuable Figure 2. Hardin MD, easy access to resource lists (www.lib.uiowa. edu/hardin/ md/index.html). 248 REVIEWS IN UROLOGY FALL 2000 as a catalog of urology Web sites. Centers for Disease Control and Prevention—http://www.cdc.gov—In his book, Medical Information on the Internet, Robert Kiley lists the CDC as “the site to visit if you are looking for information on chronic diseases, injuries and disabilities, or guidelines on their prevention.”2 The site includes links to CDC health data standards, scientific data, surveillance, health statistics reports, and laboratory information. Under a link called Health Topics/Cancer, the site includes an article titled, “Prostate Cancer: Can We Reduce Deaths and Preserve Quality of Life?” Since this is a government site, all information is free. National Institutes of Health— http://www.nih.gov—The NIH is another government site offering excellent, free information for health professionals. According to the site, “The NIH mission is to uncover new knowledge that will lead to better health for everyone.” Furthermore, “the goal of NIH research is to acquire new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.” Knowing this, one might expect cutting-edge medical information from this organization and, indeed, they provide just that. The NIH Health Information Index lists diseases currently under investigation by NIH or NIHsupported scientists, including links to the investigating agency. The NIH provides a comprehensive database of public information about ongoing clinical research studies at http://clinicaltrials.gov/ct/ gui. A sample search for urology trials retrieved 34 studies currently recruiting new subjects. cancerfacts.com—http://www. cancerfacts.com—Cancerfacts.com aims to provide cancer patients with information to make educated, informed treatment decisions (Figure 3). The site currently offers patients a means to create an individualized prostate cancer profile. The profile puts the patient’s case into context with treatment options and expected outcomes, to help guide the patient’s decision making. This site focuses on cancer and continues to grow, offering profiles for blad- Web Update der cancer, breast cancer, and more. Urology-Specific Resources Uroweb—http://www.uroweb.org— The spring 1999 issue of Reviews in Urology published Anne Landry’s excellent review of this site.3 Landry notes that the European Association of Urology developed this Web site to link educational and practical information from a variety of sources (Figure 4). The site requests registration, but the contents are free. The slide library of clinical images and the urology congress agendas should be especially helpful to practicing urologists. This Web site also offers links from the home page to 12 urologic specialties, including pediatric urology, urologic surgery, and bladder cancer. These pages encourage communication about the topic and include literature, case studies, posters, and slide libraries focused on that specialty. UrologyChannel—http://www. urologychannel.com—UrologyChannel is only 1 of many health care specialty sites offered by HealthCommunities. They also sponsor OncologyChannel and RadiologyChannel, among others. UrologyChannel.com intends to deliver exposure for its corporate underwriters and to gain a solid reputation for sound urologic content. This site clearly serves the patient more effectively than the physician. For the patient, there is a discussion of 17 urologic conditions, an MDLocator, and urology videos. The site offers interaction with physicians through the UrologyForum™ question-and-answer section, and its Live MD Chat between patients and urologists. For the physician, the UrologyChannel contains an interesting news section called UrologyWorld that provides Urology News, STD News, Incontinence News, and Men’s Health News. Finally, this site gives physicians free Web site space. American Urological Association— http://www.auanet.org—The American Urological Association (AUA) offers urologists unique resources not Figure 3. cancerfacts. com, information for cancer patients (www. cancerfacts.com). Figure 4. Uroweb, links educational/practical information from many sources (www.uroweb.org). available anywhere else on the World Wide Web (Figure 5). The home page links to Meetings & Events, Publications/Catalog, Membership, Members Only, Students & Residents, Practice Management, Government Affairs, UROmart®, Patient Info, and Media/Press Info. The Meeting & Events section addresses the Annual Meeting as well as the calendar of educational, section, and international meetings. While Membership offers information on how and why to join the AUA, the Members Only section provides access to the online membership directory, Medline, and The Journal of Urology. Practice Management includes guidance on coding and reimbursement, as well as interesting statistics. For example, the most frequently performed procedure for benign prostatic hyper- plasia (BPH) is transurethral resection of the prostate. Urologists report performing, on average, 31 procedures per year. Finally, the AUA home page links to UROmart®, “your single Internet source for all urological needs.” Products offered through this source are arranged by company name, treatment or diagnostic area, product name, and nonmedical products. Each category offers a list of links to pursue for the desired product. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)—http://www.niddk.nih. gov/health/kidney/nkudic.htm—Part of the NIH, the NKUDIC represents the best source this author found for educational materials for health care professionals and patients. The site contains an excellent page of statistics on FALL 2000 REVIEWS IN UROLOGY 249 Web Update continued kidney and urologic diseases, including incidence, prevalence, costs, and outcomes. For instance, for urinary incontinence, government figures indicate that about 13 million adults are affected. The agency publishes fact sheets, booklets, and other publica- Some publications also are available in Spanish and easy-to-read versions. UroHealth—http://www.urohealth. org—UroHealth, created by Newman Carter Hill Healthcare and Isis Medical Media using an unrestricted grant from Abbott Laboratories, claims to be Figure 5. American Urological Association, unique resources for urologists (www.auanet.org). tions on topics ranging from Bladder Control for Women to Your Urinary System and How It Works. They are available free or at minimal cost. “the primary on-line reference source for urologists in both practice and training.” That may be an overstatement, since site coverage is limited to erectile dysfunction, BPH, and prostate cancer. UroHealth does offer some apparently unique content, however, in its Conference Reports. At this writing, the site covered the European Society for Impotence Research (ESIR ’99), 10th International Prostate Cancer Update, 9th European Urological Winter Forum, Apoptosis Advisory Panel, XVth Congress of the European Association of Urology (EAU), and the AUA 95th Annual Meeting. Reference Resources and Online Journals Figure 6. PDR.net, access to drug and medical information, journals, and magazines (pdr.net). 250 REVIEWS IN UROLOGY FALL 2000 PDR.net—http://pdr.net—Published by Medical Economics, Inc, this site offers links to information grouped according to user: physicians, pharmacists, physician assistants, oncologists, nurse practitioners, nurses, and consumers (Figure 6). From PDR.net for Physicians, the user can access drug information, journals and magazines, and medical information. While the online version of Contemporary Urology and Stedman’s Medical Dictionary may be of interest, the main attraction at this site is the Physicians’ Desk Reference Online (PDR). The PDR® Online is free to “US-based MDs, DOs, and PAs in full-time patient care practice.” All others must pay $9.95 per month. Once you have registered and logged on, you can search the PDR® Index by product name, manufacturer, product category, indication, contraindication, side effect, or drug interaction. You can also search the full text of the PDR and the PDR Addenda. For example, a simple search for “bph” yielded 5 articles from the PDR. The articles relate to Cardura tablets, Proscar tablets, Hytrin capsules, Flomax capsules, and Propecia tablets. For the record, a search for the phrase “benign prostatic hyperplasia” returned the 5 articles above, plus 1 on Testoderm Transdermal Systems. Once you have an article on your screen, you can use the “find” function of your Internet browser to scan for the topic of interest. The Hytrin article contains almost 6000 words, a drawing of the chemical structure, and photographs of Hytrin tablets. Scanning the article, using the find function, for the term “bph” leads directly to a discussion of the pharmacodynamics of Hytrin in BPH. This search feature offers the potential for significant timesaving. The Merck Manual of Diagnosis and Therapy http://www.merck.com/ pubs—Many physicians keep a copy of The Merck Manual in their personal library. You can now access the 17th edition, ©1999, on line, free of charge at the Merck & Co Web site. From the Merck Publications page, click on the picture of The Merck Manual of Diagnosis and Therapy to go to the search screen. From here, you can either view the book’s table of contents or enter a Web Update search term. MEDLINE—http://www.ncbi.nlm. nih.gov/entrez/query.fcgi?db= PubMed—Compiled by the National Library of Medicine (NLM), MEDLINE represents the premier bibliographic database covering the field of medicine. MEDLINE contains citations and abstracts from more than 3900 biomedical journals from the United States and 70 foreign countries. The database contains more than 9 million records dating back to 1966. All of this became available free on the World Wide Web beginning on June 26, 1997. The NLM created PubMed (Figure 7) and Internet Grateful Med to provide access. Both of these tools will search the MEDLINE database; however, PubMed also has links to molecular biology databases, while Internet Grateful Med includes other NLM databases on AIDS, bioethics, the history of medicine, and other topics. PubMed seems to be the first choice for most medical searches. The search screen allows a keyword search or a more advanced search using the MeSH terms of medical subject headings. You can limit the search by date and to include only those with abstracts. A search for the phrase “benign prostatic hyperplasia” returned 10,231 articles. The NLM also facilitates the Loansome Doc program. This allows users to establish an account with a local medical library that will deliver articles by mail or by fax for a fee. WebMedLit—http://webmedlit. silverplatter.com/index.html—While MEDLINE indexes thousands of medical journals published worldwide, WebMedLit indexes 30 medical journal Web sites (Figure 8). Sponsored by Silverplatter Information, a provider of electronic information, this site presents articles from each source in a streamlined, consistent format. A search on the term “bph” located 17 articles from the following journals: American Journal of Epidemiology, Journal of Urology, Endocrinology, Journal of Cancer Research, Cancer Figure 7. MEDLINE, access through PubMed to Medline and molecular biology databases (www.ncbi.nlm.nih. gov/entrez/query. fcgi?db=PubMed). Research, and Journal of Clinical Oncology. A search for the phrase “benign prostatic hyperplasia” returned 40 articles from an even wider selection of journals. Users should not consider WebMedLit a comprehensive source for medical information. The service does, however, offer a good look at some of medicine’s leading journals. Digital Urology Journal—http:// www.duj.com—While the electronic sources cannot duplicate the volume of information in print, a few reputable publications have emerged in a solely electronic format. Digital Urology Journal describes itself as “a peerreviewed journal of adult and pedi- atric urology on the World Wide Web.” The journal welcomes original didactic or research articles relevant to physicians and scientists in the area of urology. In addition to published articles, this site also offers rounds, poster presentations, grants in urology, patient information, and a link for urology nurses online. This site does not seem to contain advertising, but the online journal acknowledges the support of Boston Scientific. Urology News Online—http://www. uronews.com—According to its Web site, Urology News Online is a bimonthly Internet supplement to the printed journal offering similar content in an interactive format. The site Figure 8. WebMedLit, indexes 30 medical journal Web sites (webmedlit. silverplatter.com/index.html). FALL 2000 REVIEWS IN UROLOGY 251 Embolization Web Update continued continued from page 245 requires users to register, but registration is free. Each issue contains an editorial, a lead article, a special feature, literature and book reviews, diary dates, course and conference listings, and reader inquiries. The special feature at the time of this writing discusses a fresh approach to understanding childhood nocturnal enuresis. The site offers searchable archives beginning in 1997 and, in this publication, the sample search for “benign prostatic hyperplasia” retrieved 53 citations. The content for this site comes from CyberMedical, Inc. Besides its online newsletters, CyberMedical offers a full range of Web site creation, maintenance, and hosting services. This article in no way encompasses the totality of medical and health care information available on the World Wide Web. Instead, it features 16 sites deemed most valuable to practicing urologists. While visiting these sites and considering their potential, remember to take note of the opportuni- ties for interaction that each site offers. Collectively, individuals throughout the profession know more than any Web site can publish. Use the Internet to contact the experts who compile and contribute to the urology sites discussed. Take advantage of the forums, e-mail lists, and discussion groups to exchange knowledge and ideas among colleagues worldwide. Editor’s note: http://www.medreviews.com provides electronic versions of articles in Reviews in Urology as well as CME courses, research articles, industry news, and information on upcoming events in the field of urology. ■ References 1. “Research Shows 42 Percent Growth in Physician Use of Internet in Last Three Months” [press release]. Healtheon Internet Survey of Medicine; May 6, 1999. Available at: <http://www. healtheon.com/ news/pr_5_06a_99.html>. 2. 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