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Health information: finding reliable sources on the internet

• Introduction
• Articles and guidance on searching for health information
• Key medical gateways and health information databases:
• NHS National Library for Health
• NHS Social and Health Electronic Resources Portal
• BMJ Group
• US National Library of Medicine
• Other useful medical gateways
• Individual healthcare organisations and voluntary groups

• Is the site regularly updated? Information on the review process, for example the most recent review date, should be given on the site.
• Does the site give references and sources for the information it provides?
• Does the site provide information about who compiled the site (the organisation or individual)?
• Are details provided on who sponsors the site eg in the 'About us' section?
• Does the organisation give an address / other contact details?
• Spelling and grammatical mistakes – more than a couple of these indicate a weak site that has not been properly edited or reviewed.
• Is the organisation trying to sell something?

• The BMA’s General Practitioners Committee guidance on searching the internet for medical information - tips for patients (Reference 3).

• The Health On the Net Foundation (HON) is a not-for-profit organisation based in Switzerland. HON was established to guide lay persons and medical practitioners to useful and reliable sources of online medical and health information. They have produced a simple code of conduct for medical and health websites.

• The Judge project has developed guidelines for assessing the quality of health information on websites, based on the views of health consumers and support groups. Two sets of guidelines have been produced (i) to help health consumers make informed choices about health websites and (ii) to assist support groups produce their own high quality websites for patients. You can access the Judge website and guidelines here.
  

  (The Judge project is a partnership between Contact a Family, a UK charity helping families to care for children with disabilities and/or special needs, and the Information, Knowledge and Systems Research Group at Northumbria University).
  
  

• Medline Plus, a service of the US National Library of Medicine and the National Institute of Health in the US, offers useful advice on its website about how to assess medical information resources on the internet.

Evidence-based health care "is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services" (Reference 4).

The following resources are two of the key evidence-based resources on the NLH.

• Bandolier
  Bandolier first appeared as an independent journal about evidence-based healthcare in February 1994. It has appeared monthly ever since and has become a respected source of evidence-based healthcare information in the UK and worldwide, for both healthcare professionals and patients. Most of Bandolier's online health information is located in the 'Knowledge Library.'
  
  Although Bandolier has had to rely on sponsorship to develop its health information resources, sponsorship is acknowledged at the top of each topic heading and sponsors have no say or control over the information produced.
  
  Bandolier also has a Healthy Living section on its website, which looks at the latest research and advice on staying healthy, including healthy eating, healthy exercise, healthy use of alcohol, tea and coffee, weight control and smoking, and more specialised subjects such as the use of mobile phones. You can access Bandolier's Healthy Living zone here.
  
  Bandolier also recently started a new section on its website about the risks associated with different forms of treatment (for example the harms and benefits of taking low dose aspirin) entitled Risk, chance and probability. This resource should help patients to understand the risk factors associated with some types of treatment.
  
  
• The Cochrane Library
  The Cochrane Library is another very useful source of independent evidence online about the effectiveness of different forms of medical treatments. It includes reliable evidence from Cochrane reviews, other respected medical treatment reviews, and the results of clinical trials.
  
  Cochrane systematic reviews are based on the best available information about the use of different types of medical treatments. They explore the evidence for and against different treatments (including medication, surgery, education, etc) to treat specific medical conditions.
  
  The Cochrane Library is freely available to NHS staff, patients and the public in England through Wiley InterScience. It is also available in some countries outside the UK.
  
  There is a special section for Patients on the Cochrane Library website, which explains more about the content of the Library, including definitions of terms such as 'evidence-based healthcare' and 'systematic review'. There is a Search facility on the home page, enabling users to retrieve relevant Cochrane medical reviews. One can also search by Topic or for New Reviews.
  
  To give an example of the very wide types of medical topics covered by Cochrane reviews, just two of the 97 reviews in Issue 2, 2007 included: wholegrain cereals for coronary heart disease; and steroids for acute sinusitis. Previous reviews are also updated.
  
  

• Clinical Knowledge Summaries (CKS)
  Clinical Knowledge Summaries (CKS) are supported by the NHS and accessible via the NHS NLH. They represent up-to-date sources of clinical knowledge which are intended to help healthcare professionals and patients manage the conditions most commonly seen in general practice.

  From the home CKS page, one can browse clinical topics (under headings from allergies to urology) and find out about the medicines used to treat these specific conditions.
  
  Around 500 topics are covered in all, including many conditions that are routinely managed by non-medical health professionals, such as nurses and pharmacists. All the information, is freely available to the public, including the full text of the Topic Reviews intended for health professionals.
  
  There is also a Patient Information Section, providing health leaflets on over a hundred health subjects (which can be browsed and downloaded) and an 'answers to common health questions' section, for example on accidents and first aid, lifestyle and travel health (based on the kinds of questions asked by the public when they use the NHS Direct call centre service).
  
  

• National Institute for Health and Clinical Excellence (NICE)
  On 1 April 2005, the former National Institute for Clinical Excellence - NICE - joined with the Health Development Agency to become the National Institute for Health and Clinical Excellence (also known as NICE).
  
  NICE is an independent organisation responsible for providing national guidance on promoting good health and on preventing and treating ill health. Information about NICE can be accessed via the NLH website or you can go directly to the NICE website.
  
  NICE clinical guidance covers hundreds of topics in almost all areas of medicine, including assessments of laser eye surgery, cancer treatments and treatments for mental health problems. NICE guidance falls into several different categories:
  
  
• cancer service guidance: the focus of this guidance is to ensure the appropriate commissioning of services to treat cancer in England and Wales;
• clinical guidelines: covering the appropriate clinical treatment of people with a very wide range of diseases and conditions, including cancer, in England and Wales;
• interventional procedures: guidance making recommendations about whether interventions used for the diagnosis or treatment of diseases are safe enough and effective enough for routine use within the NHS (for example the use of electromagnetic radiation);
• public health intervention guidance: providing recommendations on types of activities (interventions) that should help to reduce people’s risk of developing a disease or condition eg smoking cessation
• public health programme guidance: currently under development;
• technology appraisals: providing guidance on the use of new and existing medicines and treatments within the NHS in England and Wales;
  
  The NICE website also provides updated compilations of their treatment guidance, by broad medical condition:
• behavioural
• cancer
• cardiovascular
• central nervous system
• dental, oral and facial
• endocrine and metabolical
• ear, nose and throat
• eye
• gastrointestinal
• gynaecology, pregnancy and childbirth
• infections and infectious diseases
• injuries and accidents
• mental health
• musculoskeletal
• nutritional disorders and weight control
• renal and urinary
• respiratory
• skin disorders and wounds
• miscellaneous and appendices

• British National Formulary
  The British National Formulary (BNF) provides up-to-date information on the selection, dispensing and administration of medicines. It is aimed at health professionals, but is also a useful reference work for the interested lay person. You can access the latest edition of the BNF (BNF 54, September 2007) here. Access requires user registration, although it is free.
  
  A new BNF for Children (BNFC) was launched in September 2005 with updated editions published in 2006 and 2007. Link to the BNFC website here. Access to this website also requires user registration.
  
  

• Bandolier (see above);
• Centre for Evidence Based Dentistry;
• Centre for Evidence Based Mental Health;
• Clinical Knowledge Summaries (CKS) (see above);
• Critical Appraisal Skills Programme (CASP) - a programme to help professionals use high quality evidence to support their treatment decisions);
• Effectiveness Matters (which provides updates on the effectiveness of important health interventions for practitioners and decision-makers in the NHS);
• NHS Centre for Reviews and Dissemination - promoting the use of research-based knowledge in healthcare;
• the TRIP database (Turning Research Into Practice) - a leading internet resource for evidence-based medicine;

• BMJ Clinical Evidence

• BMJ BestTreatments

• Medline Plus
  Medline Plus provides information on over 750 conditions and diseases (see the Health Topics section), and access to information about medicines and supplements, in addition to a medical encyclopaedia, a medical dictionary and a medical news section. It is updated daily.
  
  
• PubMed
  PubMed, a service of the National Library of Medicine, includes over 17 million citations for biomedical articles back to the 1950s. These citations are from MEDLINE and additional life science journals. It includes links to both full text articles and other related resources. Medline is the largest component of PubMed.
  

• Chemicals and Drugs
• Diseases and the Environment
• Environmental Health
• Occupational Safety and Health
• Poisoning
• Risk Assessment and Regulations
• Toxicology
• Pesticide Exposure

• a guide to finding health information
• a tutorial on evaluating health information
• health information for older adults
• a household products database offering health and safety information
• a genetic conditions and treatments reference guide

Other useful medical gateways and databases

• BBC News Online (Health) includes a Medical Notes Library, covering more than 150 specific medical/health topics (arranged in an A-Z index). The BBC's Health section also provides up-to-date news on health issues and in-depth information on heart disease, stroke, cancer and pregnancy. Access BBC News Online Health here.

• Database of Individual Patient Experiences (DIPEx)
  The DIPEx website is designed for patients who have to undergo treatment and who would like to find out from other patients what the treatment was like - or what it is like to live with a particular condition. It is also aimed at carers, the families of patients and healthcare professionals.

  The organisers of DIPEx are hoping to extend their database to include modules on over 100 illnesses and conditions, as well as covering topics such as immunisation, rare diseases, skin conditions, infertility and chronic illness.

  Currently, DIPEx has 'patient experience' databases on:

• Cancer and screening: breast cancer; breast screening; cervical cancer; bowel cancer; bowel screening; lung cancer; lymphoma; ovarian cancer; prostate cancer; PSA testing; teenage cancer; and testicular cancer
• Chronic health issues: chronic pain; rheumatoid arthritis; and HIV
• Young people's experiences: Sexual health of young people aged 18-25; teenage cancer; diabetes type 1 in young people; and young people with long-term health conditions
• Women's health: pregnancy and screening: pregnancy; antenatal screening; ending a pregnancy for a fetal abnormality; screening for sickle cell, beta thalassemia and other variants; breastfeeding; and making decisions about birth after a caesarian
• Heart disease: parents of children with congenital heart disease; heart attack; heart failure; and high blood pressure
• Immunisation
• Intensive care: patients' experiences; experiences of families and friends
• Living with dying
• Neurological: epilepsy; carers of people with dementia; and stroke
• Mental health: depression
  
  Access the DIPEx website here.
  
  
  

• Dr Foster is an independent organisation which collects and analyses information on the availability and quality of health services in the UK. Dr Foster guides include the Consultant Guide and the Hospital Guide. In addition, Dr Foster has produced treatment/information guides for patients on finding a birth unit, a breast cancer clinic, a complementary practitioner or an infertility clinic. All of this information is available on its website.
  
  Dr Foster also offers a useful A-Z of Health section, providing information on more than a 1,000 common medical conditions and treatments.
  
  Access the Dr Foster website here.
  
  
• The Health on the Net Foundation (HON), based in Switzerland, provides access to an extensive database of articles on health issues via its Medical Web search facility. Access the HON website here.

• Intute: Health and Life Sciences is a gateway to evaluated, high quality internet resources in the following subject areas:
  
  Medicine
  Nursing, Midwifery and Allied Health
  Agriculture, Food and Forestry
  Veterinary Medicine
  Bioresearch
  Natural history
  
  From the Medicine section of the Intute website (formerly known as OMNI), you can search their extensive medical database of articles using any simple medical term eg eczema or arthritis.
  
  The Wellcome Trust provides additional information for Intute in the following areas, which you can link to from the Intute home web page (via the top menu):
  
  Biomedical ethics - BioethicsWeb
  History of medicine - MedHist
  Public engagement with science and technology - Psci-Com
  
  Intute is the result of a collaboration by a network of UK universities and partners, with subject specialists selecting and evaluating websites. It offers a free online search service.
  
  
• Malehealth, a website produced by the Men's Health Forum, is a comprehensive, independent online source of information on men's health problems. Access Malehealth here.

• NHS Choices is the newly launched NHS website. It hosts a Live Well section, aimed at providing advice on diet and exercise etc and a Health A-Z, offering the public information about hundreds of conditions and treatments, ranging from asthma to depression and hip replacements, with the help of a Body Map. Access NHS Choices here.

• NHS Direct Online is a useful gateway to patient-friendly health information, including NHS Direct Online's own online Health Encyclopaedia, a self-help guide for the management of common health problems and a 'common health questions' section (all of which is available in a number of different languages). It also provides information about local NHS services. Access NHS Direct Online here.

• Patient.UK, a health information website, is based on a collaboration between Patient Information Publications (a partnership between two GPs), in association with EMIS (Egton Medical Information Systems). It features over 735 online patient information leaflets, some of which have been translated into other languages, and additional information on finding specialists and condition-specific support groups.

There are also sections on lifestyle and medicines. The aim of the Patient UK website is "to provide non-medical people in the UK with high quality information about health and disease".

Patient.UK now includes a section entitled PatientPlus which is more particularly aimed at health professionals, but which can also be accessed by the public. Access the Patient UK website here.

(Please note that the Patient UK website now carries commercial advertising, sometimes for products related to particular health conditions).

• Many of the Royal Colleges of medicine now provide health information for patients on their websites. For example, the Royal College of Psychiatrists provides information on depression, post traumatic stress disorder and sleep problems, while the Royal College of Anaesthetists offers information to patients on anaesthesia, including the risk factors associated with having an anaesthetic.

You can access a full list of the medical Royal Colleges here.