I.  **Training Objectives:** Identify selected websites useful for
    answering consumers' health questions, especially:

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A.  **Disease-specific information**

B.  **Drug information for consumers**

C.  **Herbal information**

D.  **Doctor finders**

This class is not comprehensive, but suggests a few good sites for
answering consumers' health questions. It assumes basic knowledge in
research methods and terminology.

**II. Introduction: consumers' vs. clinicians' health information
needs**

A.  **The public librarian has a hard job**...a harder job than a
    medical librarian in a hospital or medical center.

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1.  The physician's query: I need information on the management of
    hypomagnesemia.

2.  The patient's query: "I had diarrhea and I was in the hospital for
    18 days and now I'm supposed to have transfusions. The doctor says
    it's to fix my muscles and nerves. Can you look this up?"

> Obviously the health professional knows the name of the disease or
> drug s/he needs information about. Consumers often do not. If they
> know the name of the disease or drug, they may not know the clinical
> term or may misspell it.

**Examples:**

+-----------------------------------+-----------------------------------+
| # *Actual reference question*     | # *What the questioner meant*     |
+-----------------------------------+-----------------------------------+
| *sick lick vomiting*              | *cyclic vomiting*                 |
+-----------------------------------+-----------------------------------+
| *vascular urethral reflux*        | *vesicoureteral reflux*           |
+-----------------------------------+-----------------------------------+
| *dropped bladder*                 | *cystocele*                       |
+-----------------------------------+-----------------------------------+
| *peanut butterballs*              | *phenobarbital*                   |
+-----------------------------------+-----------------------------------+
| *upperatory rest infection*       | *upper respiratory infection*     |
+-----------------------------------+-----------------------------------+
| *premium*                         | *premarin*                        |
+-----------------------------------+-----------------------------------+
| *metro valve prolapse*            | *mitral valve prolapse*           |
+-----------------------------------+-----------------------------------+
| *junk-o-vitis*                    | *conjunctivitis*                  |
+-----------------------------------+-----------------------------------+
| *gouge*                           | *gout*                            |
+-----------------------------------+-----------------------------------+
| *tuber grashon*                   | *tubal ligation*                  |
+-----------------------------------+-----------------------------------+
| *crozone injections*              | *cortisone injections*            |
+-----------------------------------+-----------------------------------+
| *hydra hernia*                    | *hiatal hernia*                   |
+-----------------------------------+-----------------------------------+
| *conjunctive heart failure*       | *congestive heart failure*        |
+-----------------------------------+-----------------------------------+
| *post pardon depression*          | *postpartum depression*           |
+-----------------------------------+-----------------------------------+

> **B. Most consumers are not looking for information about wellness**,
> but rather for information about an existing disease, condition or
> treatment. Most frequently asked questions are:

1.  Descriptions of particular procedures

2.  Latest treatment for ....

3.  "Everything" about....

4.  The best doctor or hospital

5.  Drug information

6.  Herbal information

    C.  **Whom do consumers ask first when they need health
        information?** They ask their family, friends, anyone in their
        circle who is a health professional or sort of a health
        professional. This has a couple of implications:

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1.  Example: A woman who is diagnosed with fibrocystic breast disease.
    Her doctor suggested she cut down on caffeine. Her close friend had
    heard about "cystic fibrosis" and knew someone who died of it. The
    patron came into the library in a panic, looking for information
    about cystic fibrosis. Her doctor obviously didn't know anything
    because he told her just to cut back on coffee.

2.  Over 50% of the people who come to the reference desk are asking
    questions not about their own condition, but someone else's, which
    means the information they have is often second- or third-hand.
    Remember that old game of gossip?

Physician  patron  friend/relative  librarian

**III. The websites:** There are so many places to go on the Internet
for quality information. We are going to describe the very best websites
here. These websites are all consumer-oriented, up to date and contain
accurate information.

> **A. MedlinePlus.gov ([www.medlineplus.gov](../www.medlineplus.gov))**
> MedlinePlus.gov is one of the best places of many to go for basic,
> quality consumer health information on the web. In most cases you can
> start here.

1.  Why is it one of the best?

-   The National Library of Medicine produces it

-   The information is reviewed and reliable. It links to governmental
    and non-profit organizations' websites.

-   Continually updated

-   No advertising or links to commercial sites

-   Minimum redundancy

    1.  **MedlinePlus.gov features**: (point to the screen as you
        mention each of these)

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-   Health topics

-   Drugs

-   Dictionary(we will not review this in class...it is pretty
    self-explanatory)

-   Medical Encyclopedia

-   Directories

-   Current Health News

-   Interactive tutorials

    1.  **Health Topics**

***Class example: "I get terrible migraines. Can you tell me if there is
any current information on migraines...like what causes them and how to
treat them?"***

-   **Browsing Health Topics is the preferred way to look for**
    **information**, especially since NLM revised the internal search
    algorithms in November 2002. Using the internal search interface
    doesn't always retrieve the most relevant web pages.

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-   From the MedlinePlus.gov homepage click on **"Health Topics**". The
    Health Topics page shows a list of disorders and conditions which
    are arranged:

    a.  Alphabetically

    b.  By body location

    c.  By demographics, etc etc

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-   **Searching alphabetically is the best way to browse.** It is hard
    to determine what part of the body is involved with certain
    conditions. Where would one find "food allergies" or "bone spurs"??
    Better to go straight to the alphabetical listing. Browse "M" down
    to Migraine. The "Migraine" page provides links to:

a.  Latest News (any news articles about the topic within the last 30
    days)

b.  Websites from the National Institutes of Health

c.  General/Overview websites, including tutorials, if a tutorial is
    available.

d.  Alternate Therapy information (from reliable sources, of course)

e.  Clinical Trials (btw...does anyone know what a clinical trial is?
    Can you tell the class?)

f.  etc

g.  etc

-   Take a minute or two to see all of the categories. Click wherever
    you wish so that you can see the type of information available.

-   There is something called "Interactive Tutorials". These are
    slideshows with sound -- ideal for describing diseases and
    conditions, medical tests and surgeries to those with low reading
    levels, for those with vision problems, or for those who simply
    learn better by listening instead of reading. Patron can just listen
    to the information presented. There are currently 165 + Interactive
    Tutorials at MedlinePlus.gov.

-   Clicking on a link from MedlinePlus.gov opens a new web page; the
    MedlinePlus.gov page remains open. To return to the MedlinePlus.gov
    page, close the new page, instead of clicking on "back".

-   For similar information in Spanish, click on "Español" (the yellow
    box in the upper right corner of the page). Not all of the
    information is available in Spanish.

-   The left column on the Migraine Health Topic page summarizes these
    links. For a pre-formulated search of Medline for professional level
    journal article citations, click on "Search Medline for..." The
    citations retrieved will be a higher level than most patrons want.
    We will cover Medline searching in another class.

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-   **Using search interface to find information**

***Class example: "My doctor is concerned about my baby's growth. He
thinks the baby may have IUGR---intra-uterine growth restriction. Where
can I get information about it?"***

-   Let's try browsing the Health Topics. Nothing is listed under
    **Pregnancy** or under **IUGR.** Type IUGR in the search box. The
    resulting pages may or may not have the most relevant pages listed
    first. You may need to look further than the first listings. The
    words you searched may just be mentioned within the Web page and not
    as a main topic of the page.

-   Notice there is something under "High Risk Pregnancy" and "Growth
    Disorders". Click on one of these to see what the information looks
    like.

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-   Also notice that there is a description under "Medical
    Encyclopedia". Let's look at that next.

    1.  **The Medical Encyclopedia and Dictionary** on MedlinePlus.gov
        is pretty basic. It can be useful for definitions and for
        illustrations. Use this to find simple descriptions.

    2.  **Drug Information**

***Class example: I was just prescribed lopressor for my high blood
pressure. What can you tell me about it?***

-   MedlinePlus.gov uses 2 sources for drug information. US
    Pharmacopeia's *Drug Information Advice for the Patient* and the
    American Society of Health-System Pharmacists' *Medmaster*.

-   From the MedlinePlus.gov homepage, click on "Drug Information."

-   From the Drug Information page, look up Lopressor, a beta-blocker,
    using either browse or search.

-   Compare Medmaster information with USP DI. The latter is very
    confusing for consumers, since it lumps information about all
    beta-blockers together. The handout describing Lopressor and other
    beta-blockers is 13 pages long and very confusing. \[Suggest
    printing out a copy of each to give as class handouts for students
    to compare.\]

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-   All of the drug information provided by Medmaster is available in
    Spanish as well. You can toggle from the English page to the Spanish
    version.

    1.  **Doctor/Hospital Finders**: Click on "Directories". A number of
        general and specialized directories for doctors, dentists,
        hospitals, and other healthcare facilities are listed.

***Class example: "What can you tell me about Dr. XXX\--are there any
malpractice suits against him?" or "I need to find a doctor in Florida
who specializes in pediatric surgery."***

-   **Start with AMA Physician Select.** This is from the American
    Medical Association and lists doctors throughout the country. One
    can search by name or by specialty.

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-   Start with "Search by Name". At a minimum you'll need last name and
    state. Search for a physician, for example, Susan Dorsey, who
    practices in New York State. Describe the results. (Your example
    should be tailored to the class you are teaching). Note how
    difficult it is to find a physician who is not an AMA member.

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-   Do a second search for "Medical Specialty". Find a list of
    cardiologists in Burlington, VT. Once again, notice that they make
    it very difficult to find a physician in a medical specialty who is
    not a member of AMA. **Ask the class if they think it matters
    whether or not a physician is a member of the AMA.** (answer: Not
    really, s/he may be a member of the organization for his/her
    specialty instead....such as the American Academy of Pediatrics, or
    the American College of Surgeons, for example). **It's more
    important that the physician be board certified in his/her
    specialty.**

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-   Another resource to check disciplinary action or licensure isAIM
    Docfinder (link from MedlinePlus.gov directory page) DocFinder lists
    health professional licensing listings by state. (Click on it and
    check the states covered). Not all states are found here. (as a
    search example, search for Dr. Boehme in Alabama) Listings for each
    state are different. For example, in Alabama, if a physician has
    been disciplined, there will be a "yes" in the Public Action row.

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-   Other web sites

> \[Here the instructor may want to mention state-specific websites for
> physician disciplinary action\]

1.  **News**. This is a great place to go to answer those questions
    starting with the phrase "I heard on the news last night..." or "I
    just read that there is a new..."

    -   Current health news goes back 30 days

    -   One can search by date

    -   One can search by topic (as an example, let's see what is new in
        Parkinson's Disease)

2.  **Senior Health ([NIHSeniorHealth.gov](../NIHSeniorHealth.gov))**. A
    new feature on MedlinePlus.gov is a link to Senior Health. This site
    is a collaborative effort between the NLM and National Institute on
    Aging (click on Senior health from the MedlinePlus.gov homepage)

-   This site is still very young, but new topics are being added all
    the time.

-   Can change the page to enlarge the text, turn on sound, or change
    the color contrast on the site.

-   **This is a work in progress**...the speech is computer generated
    and it is may not be straightforward to some on how to activate the
    speech, but it is a great start. Topics will link back to
    MedlinePlus.gov for additional information.

    1.  **About:** Before we leave MedlinePlus.gov, I'd like to show you
        the "about" link.

        -   Because MedlinePlus.gov is so useful to your patrons, you
            may want to put a link to MedlinePlus.gov on your library's
            webpage. The instructions for doing this are under this
            section.

        -   You may also sign up for a weekly newsletter describing
            updates to the site

        -   A lot of additional information about web surfing. Take a
            look at this at your leisure.

**BREAK**

# Other good health web sites

\[Here spend a few minutes on good, local or state-specific health
websites such as NOAH (NYS) or Healthy NJ\]

A.  **American Academy of Family Practitioners (www.familydoctor.org)**

**Class example: How do you stop a nosebleed?**

1.  **Conditions A-Z**: This provides patient handouts covering over 500
    health topics, some also available in Spanish. Excellent for very
    brief overviews and descriptions. Click on "N" and check out
    nosebleeds.

2.  **Healthy Living:** This section focuses on diet, exercise and
    healthy choices.

3.  **Parents & Kids**: The site has an excellent section covering
    health concerns of parent, teens and children. There are 3 levels of
    health information here. Let's say we want information on acne for
    teens -- it is listed under "teens". If we want information on
    asthma written for a child, under "for Kids" click on the "Kids'
    health problems". You will see a link "Jill's asthma story"...This
    information about asthma is written specifically for kids to
    understand. Again, you can also get to this by using the search box
    on the first page which may be less frustrating.

4.  **Other links:** you will see other areas of this website: for
    Women/Men/Seniors, etc. The best way, after browsing A -- Z for you
    topic is to use the search box at the top of the page. It is hard to
    know where to search sometimes as there is a great deal of overlap.

5.  **Health tools:** Various online tools to help with healthy living,
    such as self-care flowcharts (search by symptom). Includes a BMI
    calculator, calorie counter, and a dictionary

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B.  **Clinical Pharmacology 2000 from Gold Standard Multimedia.**

> Clinical Pharmacology is usually a subscription only database, but
> DrugDigest provides it for free through its Web site at
> [**www.drugdigest.org**](http://www.drugdigest.org/).

1.  **To find info about drugs**:

-   Type in "lopressor" into the search box, and find patient
    information. Be sure to then select the right form of the drug
    (injection, tablets, etc). (suggest the lopressor monograph be
    another handout for students use for comparison.)

-   This is also a place to find many of your common herbal
    preparations. Try "ginkgo biloba" (sources for information are
    listed at the end of each herbal section)

2.  **To find information about drug interactions**: Gold Standard
    Multimedia's *Drug Interaction Database* can be clumsy to use, but
    it works.

    -   At the top of each page is a "Check Interactions" link.

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C.  **About Herbs, Botanicals and Other Products
    (<http://www.mskcc.org/aboutherbs>)** This site, although designed
    with the cancer patient in mind, has excellent herbal information.
    One can search either using the searchbox or browse using the
    alphabetical list.

    1.  Based on "evidence". All monographs have citations and are
        updated regularly

    2.  Includes information on use, contraindications, interactions,
        etc.

> ***Class example: I'd like information on green tea. I hear it's
> supposed to help me lose weight.***

-   type green tea in the search box

-   scroll down to see "purported uses"

-   one can also search "weight loss" and see a list of herbals.

D.  **Drugs.com: Drug Information Online
    ([http://www.drugs.com](http://www.drugs.com/))** This site is
    powered by three independent leading medical-information suppliers:
    [Physicians' Desk Reference](http://www.pdrhealth.com/), [Cerner
    Multum](http://www.multum.com/) and [Thomson
    Micromedex](http://www.micromedex.com/). Individual drug (or
    drug-class) information content compiled by these sources is
    delivered complete and unaltered by Drugs.com.

> 1\. Type in "lopressor" into the search box, and find patient
> information.
>
> 2\. To find information about drug interactions:
>
> 3\. There is also a pill identifier (use viagra as an example).

E.  **Cancer.gov ([www.cancer.gov](http://www.cancer.gov/))** This is
    the best cancer website, sponsored by the National Cancer Institute.
    It's also easy to use. Contains information about:

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1.  different types of cancers

2.  coping strategies

3.  alternative therapies

4.  statistics

5.  clinical trials

6.  support and resources

7.  much more

***Class example: "My mother was diagnosed with cervical cancer. I think
they called it stage IIA. What can you tell me about it? Is she going to
have chemo or radiation?"***

-   Click on "Cancer Information", then "Types of Cancer". Scroll down
    to and click on "gynecologic cancers"

    -   "What you need to know about Cancer of the Cervix" is an
        excellent 30 page document about cervical cancer. It includes
        symptoms, diagnosis and treatment, and even questions to ask the
        doctor.

    -   Under "Treatment" are links to information from the PDQ
        (Physicians Data Query) comprehensive cancer database, with
        versions for both consumers and health professionals. Click on
        Cervical Cancer Treatment \[for patients\]. The PDQ documents
        include much more information than just treatment, but also an
        overview of the disease, symptoms, diagnosis, staging, and
        suggestions for finding more information. PDQ documents
        summarize the latest cancer treatment information, and are
        updated monthly.

    -   The Cervical Cancer Home Page also includes information on
        clinical trials as well as a link to the cancer literature for
        those who wish to find more specific information. The General
        Cancer Library provides the latest evidence about complementary
        and alternative therapies and other resources.

> **D.** Two other reliable sites for cancer information are the
> American Cancer Society Web site at
> [www.cancer.org](http://www.cancer.org/) and University of
> Pennsylvania's Oncolink
> ([www.oncolink.org](http://www.oncolink.org/)). (Describe each of
> these if time permits)
>
> **E. Association Websites**

1.  **Health Associations**, such as the American Heart Association and
    the American Cancer Society are great places to find consumer health
    information, and may provide links to local chapters of the
    associations. There are several ways to find the relevant
    association for a particular health concern:

    -   MedlinePlus.gov

-   **DIRLINE** **(dirline.nlm.nih.gov)** DIRLINE is a directory of
    health organizations, research resources and agencies that
    specialize in health and biomedicine.

> ***Search example: A patron came in looking for every disease that
> could be caused by asbestos exposure. Upon further discussion, we
> discover he is wondering if all of his health issues could be caused
> by asbestos. Go to DIRLINE and search "asbestos".***

-   Look at the entry for Asbestos Victims of America

-   Entry includes contact information, abstract and even medical
    subject headings!

2.  **Professional Associations**, such as the American Medical
    Association, the American Academy of Pediatrics and others provide
    patient information. These are brought together at a site called
    Medem ([**www.medem.com**](http://www.medem.com/))

    -   Use the search box in the upper right-hand corner of the screen.
        Remember the question we had earlier on intra-uterine growth
        restriction? Type in IUGR in the search box

    -   Two results look interesting: the first is from the American
        College of Obstetricians and Gynecologists, the second from the
        American Medical Association. Look at both of these to see what
        the information looks like.

    F.  **Lab Tests Online
        ([www.labtestsonline.org](http://www.labtestsonline.org/))**
        This is a very good web site for information about lab tests for
        the consumer; it uses easy to understand language. One can
        search by disease or by the name of the test.

***Class example: "The doctor prescribed a lipid profile for my wife.
What is he looking for?"***

1.  Scroll down to lipid profile on the right. The results of the search
    describe the test, normal values and ends with common questions
    about the test.

2.  Many patrons will ask if their test results are "normal" or what the
    "normal" value of a test is. For many tests, there is no single
    reference range that applies to everyone because the tests performed
    may be affected by the age and sex of the patient, as well as many
    other considerations.

    F.  **Household Product Database
        (**[**http://hpd.nlm.nih.gov/**](http://hpd.nlm.nih.gov/ ) ) --
        this is one of the newer efforts by the NLM. The database has
        information about myriad household products (over 4000) and
        their potential health effects.

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    1.  One can browse by category, alphabetically or use the searchbox
        to find a particular product

    2.  One can browse or search for ingredients in products

    3.  One can search for side effects.

    4.  types of questions that can be answered:

        -   What are the chemical ingredients and their percentage in
            specific brands?

        -   Which products contain specific chemical ingredients?

        -   Who manufactures a specific brand? How do I contact this
            manufacturer?

        -   What are the acute and chronic effects of chemical
            ingredients in a specific brand?

        -   What other information is available about chemicals in the
            toxicology-related databases of the National Library of
            Medicine?

Class Example: My husband is using ant killer around the house and I
think it's toxic to breathe. Can you give me any information about this?
It's *Ortho Ant killer*

-   Click on category/insecticide/ants/ortho ant killer

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-   View the information in the database.

    F.  **ToxTown
        (**[http://toxtown.nlm.nih.gov](http://toxtown.nlm.nih.gov/)**)\
        **This is a website for learning about chemicals that might be
        found in the environment, and their affects on health.

> Using a graphical interface, one can search by Location or Chemical.

1.  One can search for different layers of information about each
    chemical

2.  One can search for potential toxic hazards associated with each
    location

3.  Clicking on a building and then mousing over the chemicals listed
    will highlight areas in the building that may have those chemicals.

***Class Example: My son just caught some fish in the lake near our
cabin, and I heard from a neighbor that the lake is full of Pfiesteria.
Is it safe to eat the fish?***

G.  **Genetics Home Reference (**<http://ghr.nlm.nih.gov/>**)** Genetics
    Home Reference is the National Library of Medicine\'s website for
    consumer information about genetic conditions and the genes or
    chromosomes responsible for those conditions.

Written for the layperson, ***Help Me Understand Genetics*** is a small
online "book" that carefully explains genetics starting with "What is a
Cell?" Excellent linked illustrations make this book even easier to
understand.

There is even a printable version of the book, which includes the
illustrations within the text.

***Class Example: My grandfather was recently diagnosed with Alzheimer
disease. How do people inherit this disease?***

**V. Exercises (see separate sheet)**