Medical webwatch.

Treatment Improvement Protocols (TIPs) http://www.kap.samhsa.gov/products/manuals/tips/index.htm are provided by the Knowledge Application Program (KAP) of the Substance Abuse for Mental Health Services Administration (SAMHSA). They are a series of best-practice guidelines for the treatment of substance abuse, and can be explored either by topic or in numerical order. Included in the topics are "Medication Assisted Treatment," and "Co-Occurring Disorders." Each TIP opens in a new window as a Health Services/Technology Assessment Text [HSTAT] from the National Library of Medicine. Access to the numerous chapters and appendices in each TIP is menu driven. The dissemination of a TIP is the last step in a process that begins with the recommendation of an Alcohol and Other Drug (AOD) abuse problem area for consideration by a panel of experts. A panel of non-Federal clinical researchers, clinicians, program administrators, and patient advocates debates and discusses its particular areas of expertise until it reaches a consensus on best practices. This panel's work is then reviewed and critiqued by field reviewers. The very number of TIPs attests to the ubiquity, complexity, and malevolence of substance abuse in society.

Pain and the law http://www.painandthelaw.org/intro/index.php was developed by St. Louis University and the American Society of Law. Medicine, and Ethics, and offers "Statutes and Regulations" including state pain relief acts, "Malpractice and Civil Actions" that include over- and under-prescribing and failure to refer, "Palliative Care and Criminal Action," and "Entitlement Programs." Within each of these sections the side menu offers a commentary on past cases in law and the associated legislation, while links to outsourced providers of more detailed legal information (both free and pay-for-view archives) are provided. Opening in another window from the "Multimedia" tab is a large list of audio-visual presentations. This website, with its enlightening and coordinated approach, is an adroit and anodyne prescription of medical jurisprudence.

Cardiac Auscultation of Heart Murmurs http://egeneralmedical.com/egeneralmedical/listohearmur.html As an adjunct to its stethoscope sales page this medical equipment company proffers a succinct collection of 64 heart sounds associated with cardiac pathology.

The WebPath Internet Pathology Laboratory for Medical Education http://medlib.med.utah.edu/WebPath/webpath.html#GUIDE was created by Edward C. Klatt, MD, Department of Pathology. University of Utah as a useful multimedia teaching resource for second year pathology students. The menu components are: "Case of the Week" with a link to last week's answer, "General Pathology" in 9 subsections with images of both gross and microscopic anatomy. Both are accompanied by short explanatory paragraphs. "Systemic Pathology" has 12 subsections by organ system, "Examinations" is a quiz on the above sections based on patient case notes, and the "Tutorials" section is a series of 20 structured discourses with accompanying images. To complete this excellent resource are "Anatomy/Histology Tutorials" and a section on AIDS pathology.

Ethics in Medicine is from University of Washington School of Medicine http://eduserv.hscer.washington.edu/bioethics/toc.html. Although the website was last modified in 1999 the information presented is still pertinent. There are 35 topics where ethical ramifications are considered at length. Each of the topics is accompanied by a small number of "Cases" where associated ethical questions are put to the reader. A discussion of these can then be "revealed" after due consideration. There are also the "Resources" and "Tools" categories that include clinical ethics, and the principles of bioethics.

NHS History http://www.nhshistory.com/ is a 50 year history of the NHS in UK written by Geoffrey Rivett, Fellow of the Royal College of General Practitioners. Click the "Headline Contents" button to access the history in 9 chapters. To the bottom left of the home page is the tab "Before the NHS" that opens to an exposition called the "Inheritance of the NHS" that gives details of the legacy of the NHS from the previous era. The author says of the website that it "is used as a teaching resource by degree programs in health sciences, and it deals with what has happened, rather than what people hope or think will happen." I have been a beneficiary of this service since 1949.

The Multi-Dimensional Human Embryo http://embryo.soad.umich.edu/index.htm/ is a collaboration funded by the National Institute of Child Health and Human Development (NICHD) that aims to "produce and make available over the internet a three-dimensional image reference of the human embryo based on magnetic resonance imaging." The presentation is fronted by the 11 Carnegie stages where the images can be "clicked" to display the associated MRI slice selector, which in turn opens the selected slices. Each Carnegie stage also has a series of sample animations. It is authored by Bradley R. Smith, PhD, Associate Professor and Director, Biomedical Visualization School of Art and Design, University of Michigan.

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