Medical webwatch.

To access Critical Appraisal of Biomedical Literature by Alan O'Rouke of the Wisdom Centre, Sheffield University, free registration is required at http://www.wisdomnet.co.uk/ with the seminar residing at http://www.wisdomnet.co.uk/ebpsem2.html. The appraisal provides algorithms for the evaluation of primary research and review articles. It also introduces critical evaluation of web sites. The pertinence of this seminar is demonstrated by succinct illustrations of patient/physician confrontations in the clinic, where information gleaned from the Internet is often presented by patients in support of their requests for specific treatment modalities. Consideration of the methodology of appraisal will help equip the clinician with the skills to evaluate such propaganda with an objective and academic rigor. The questions of the suitability and relevance to the patient of received information are also considered. This is a pragmatic approach to critical appraisal.

Founded in March 1999, the User Guides to Evidence-based Practice, http://www.cche.net/usersguides/main.asp, is based at the Centre for Health Evidence, part of the University of Alberta, Canada. Operated by informatics researchers Drs. Robert Hayward and Bruce Fisher, it has 28 guides that are explored under three main headings: "Background," "Primary Studies," and "Integrated Studies." In general the guides use the approach: "Case Scenario," "The Search," "Are the Recommendations Valid," "What Are the Recommendations," and "Will They Help You in Caring for Your Patients." This detailed and applied approach, over so many integrative studies, will firm up your expertise in evidence-based medicine.

Two interesting tutorials on the Anaesthesia Education Web site, http://www.aldanesthesia.com/, are "Acid/base Physiology" in 11 chapters with a link to 30 case histories and "Fluid Physiology" in eight chapters. The web site, written by Kerry Brandis of the Australia and New Zealand College of Anesthetists, also offers "Blood Gas Files," to be found in the "Other Material" menu. This menu also presents a small selection of cases where the clinical discourse between registrar and consultant is documented as an interesting and informative educational device. At the bottom of the home page are "Self Education Modules," which offers questions and answers tutorials. This is a rich and interesting web site.

The Digestive Disease Centre, Medical University of South Carolina, http://www.ddc.musc.edu/ddc_pro/index.htm has two interesting sections, "Case Studies" and "Clinical Atlases," "Case Studies" has eight categories of alimentary, hepatic, and pancreatic pathologies that are available as text and graphics, audio-visual, or PowerPoint presentations. The Atlases are subdivided into "Endoscopic Ultrasound (EUS)," which is a large collection of images of "Normal Anatomy," "Cancer Staging for Esophageal, Gastric, Rectal," "Cancer Staging for Pancreatic," "Benign Pancreatico-Biliary Disorders," and "Miscellaneous." Opening in another window, the second atlas "Endoscopic Retrograde Cholangiopancreatography (ERCP)" covers duodenal, biliary, and pancreatic pathologies with images of both normal anatomy and disease processes. It also explains the practice of ERCP. On the home page there is the "EUS" menu tab accessing a video compilation, and a "Basic Science" option for a gentle introduction to this specialty.

Nothing can be more relaxing than to step outside the box and read about scientific developments in fields other than one's own. Select from "Astronomy," "Chemistry," "Physics," "Technology," "Social Sciences," etc, and make Science Daily http://www.sciencedaily.com/ your diversion of choice. The front page displays an eclectic range of "Today's Top Stories," and each one is a suceinct and easily assimilated synopsis of an academic press release or research paper, with a link to the original source at the end. Or you can pursue a particular genre by visiting the thematic archive. To assuage your conscience, you may conclude your visit by reading the "Medicine" option on the side menu. Science Daily was created by Canadian-American science writer/editor Dan Hogan and his wife Michele Hogan in December 1995 and is produced from the couple's home office outside Washington. DC. It truly is one of my favorite favorites.

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