The WWW site we review here is HSTAT (Health Services/Technology Assessment Texts) and is maintained by the US National Library of Medicine. The site provides on-line access to a formidable amount of high-quality information, based on undisputable scientific authority. It harbors documents which were produced by several health agencies and institutions belonging to the famous National Institutes of Health, the largest research organization in health and medicine in the world.
Among these agencies, there is AHCPR (Agency for Health Care Policy and Research), which was established by NIH on december 1989, with the aim of increasing quality, efficacy, accessability and adequacy of health care services in the nation. AHCPR's documents are produced by multidisciplinary committees composed by specialists coming from many public and private institutions and are the result of extensive literature reviews, reflecting the best one can find in terms of scientific evidence on a given subject. Furthermore, AHCPR's statements are based on field studies and a peer-review process, in order to asure validity, reliability and usefulness of its clinical guidelines and consensus.
The site gives access to the following collections of on-line documents coded in HTML:
These are monographs produced by the Office of Health Technology Assessment (OHTA), with the purpose of evaluating the risks, benefits and clinical effectivity of new medical technologies which are still not well established. In September 1997, this base had 24 evaluations and 13 reviews, such as: implantable cardiac defibrillators, simultaneous transplantations of pancreas and kidney, MRI angiography, body plethismography, bone densitometry, hyperthermia therapy, diagnosis and treatment of impotence, cochlear implants in outpatients, fetal monitoring, etc.
These are information guidelines with the purpose of providing basic clinical information and recommendations regarding the evaluation and management of patients with given problems, such as acute pain, gastrointestinal ulcers, cataracts, depression, stroke, heart infarct, unstable angina, back pain, urinary incontinence, prostate hyperplasia, etc. (on September 1997 there were 17 documents). For each health problem there are three published documents:
This program, in activity since 1977 has the aim of convening specialists in diverse areas of healthcare, in order to produce clinical consensus documents and of technological evaluation in health, particularly in controversial topics. Ca. 120 documents were produced so far, all of them available through the address http://odp.od.nih.gov/consensus/. They cover a wide and comprehensive range of 63 clinical topics, such as the genetical testing for cystic fibrosis, cervical cancer, hip prostheses, mortality and morbidity in hemodialysis, early diagnosis and treatment of melanoma, acoustic neuroma, panic disorder, clinical use of botulin toxin, surgery for epilepsy, videolaparoscopic colecistectomy, and much more. Other 43 consensus documents are outdated but are still available, due to its degree of clinical interest. The base also has 18 reports on medical technology workshop, on topics ranging from the evaluation of geriatric patients to the impacts of the Gulf War on health.
Navigation through the documents is made easy by a frame-based arrangement
There is also an excellent site for continued medical education (CME) in this consensus program (http://odp.od.nih.gov/consensus/cme/cme.html). This is a new experiment, which aims at delivering on-line, interactive tests of medical knowledge about several topics, after reading the corresponding consensus document. There are topics such as ovary cancer, management of hepatitis C, treatment of cervical cancer, etc. The questions are presented in a multiple-choice format, and small icons make possible the instant linking to the part of the consensus text where the answer to the that question may be find. At the end of the test, the correct results and the scoring are presented immediately to the students. American physicians may apply for the concession of CME credits based on a result higher than 70 % and will receive a CME certificate by mail.
This collection consists of information about clinicall trials which are being carried out by the 15 research institutes in the NIH, and which are coordinated by the Warren G. Magnuson Clinical Center. They contain brief descriptions of the aims of each trial, institute, principal investigator, keywords, drugs and devices that are being investigated, inclusion/exclusion criteria, etc. In some studies, there is the possibility to recruit patients wishing to participate in the study, and details on how to participate are given. The document base can be visualized sorted by diseases/systems (17 classes) or by NIH institute.
Other series of documents are available in thos site: they are TIPS (Treatment Improvement Protocols), which are related to the substance-abuse treatments, produced by the Center for Substance Abuse Treatment (CSAT), a book about preventive services (Guide to Clinical Preventive Services), and several other NIH publications, such as the Weekly Morbidity and Mortality Report (MMWR), with epidemiological data compiled by the Centers for Disease Control and Prevention (CDC) and several documents by the AIDS Treatment Information Service (ATIS).
In conclusion, this site is one of the best and most informative resources one can find today on the Internet. For clinicians, particularly, is an essential resource, due to the richness and scope of the information made available by mighty NIH, and also because is so easy to locate information and to access it. The site' s graphical design is purposefully very simple, with no frills, but very functiona. There is a laudable standardization of the access mechanism to the databases and documents, in order to facilitate the use by non-specialized persons. A frame-based interface is used, together with on-line abstracts, which includes search by keywords and sequential (linear) navigation.
One of the lesser problems we have noted is the enormous size of the document's URL addresses. Since they are included into a database, the URL's are actually very long search phrases, difficult to note down, if you might. Fortunately, the designers have tought in offering a Download Mode, which allows the user to mark down all documents he/she wishes to copy and then download all of them in a single pass, thus facilitating reading and printing (many documents are very long and complex).
Congratulations to AHCPR for this rich and free site.
Center for Biomedical Informatics
State University of Campinas, Brazil
© 1997 Renato M.E. Sabbatini