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How do Medical Professionals


Find Accurate, Trusted Health Information Online?


Rob Styles Jeremy Walker Nicole Chalmers Charles Care
the medical search the medical search the medical search the medical search
rob@themedicalsearch.com jeremy@themedicalsearch.com nicole@themedicalsearch.com charles@themedicalsearch.com

Abstract

Medical professionals rely on accurate, trusted information much of which is found, and consumed, online. Little research has
been done into the behaviour of those involved in healthcare when looking for and assessing healthcare information online.
This paper reports the findings of a survey of 313 medical professionals, medical students and non-medical professionals
working in a health context.

Keywords

Healthcare Professionals, Medical Professionals, Healthcare, Medicine, Health Information, Health Informatics, Search,
Discovery, Provenance, Web, Internet, Online.

1. Introduction additional analysis.

The survey, How Do You Find Health Information


Online, ran from 15 August 2014 until 31 August 2014 as Q1 Role
a web-based survey. It was promoted via targeted emails Respondents were asked to self-report their role or job
to medical professionals and via the Facebook and Twitter title. 85% of respondents completed this information with
social networks. In total 412 responses were submitted. a recognisable role. 15% of respondents either provided
Some of these were discarded as they contained no no information or provided information that could not be
answers and others as the respondent reported no construed as a role.
connection to the medical profession. After qualification
there were 313 suitable responses from 49 countries. The reported roles were then grouped 5 high-level
categories for broad analysis and reporting. These 5
2. Qualifying and Context Questions groups are shown in Table 1.
The first 6 questions of the survey were used to
understand the context of the respondent, including
nationality, language and role. These context questions
allow for the survey to be filtered and analysed on these
axes. The qualifying questions are included in the
supporting data for this paper to allow others to provide

Copyright © 2014, the medical search


This paper is research conducted by the medical search
and can be found at http://themedicalsearch.com/research

Figure 1 — Respondents by group


This work is licensed under a Creative Commons The five high-level roles of Medical Professional,
Attribution 4.0 International License. Medical Student, Unknown, Educator and Non-Medical

15 September 2014 http://themedicalsearch.com/research 1


Professional are used to split reporting of answers to the Q4 Country of Residence
remaining questions.
Respondents to the survey were asked to report their
country of residence. The largest country represented is
Q2 Age the UK, with 51% of respondents stating UK residence.
Respondents were asked to give their age. This is useful The US and India account for 5% of respondents each and
in indicating potential career position, experience and also Egypt and Pakistan account for 4% each. The remaining
has implications for behaviour. We have not analysed responses come from 44 further countries. The sample
reported behaviours by age and the data is available for size for each of the remaining countries is very small with
those who would wish to do this. just one or two respondents. We must be cautious to draw
conclusions and have worked mostly with the data in
The distribution of age reported by respondents shows an aggregate as a result.
expected spread, with students featuring in the 18-29-age
range and medical professionals covering the ages above Countries represented in the 313 qualifying responses are
that. Afghanistan, Australia, Bahrain, Brazil, Brunei, Canada,
Catalonia, China, Congo, Democratic Republic of the,
Egypt, Estonia, Ghana, Greece, Hong Kong, Hungary,
India, Indonesia, Ireland, Italy, Japan, Jordan, Kenya,
Macedonia, Malaysia, Mozambique, Netherlands,
Netherlands Antilles, New Zealand, Nigeria, Pakistan,
Peru, Portugal, Qatar, Saudi Arabia, Slovenia,
Somaliland, South Africa, Spain, Sudan, Switzerland,
Tanzania, Thailand, Trinidad and Tobago, Turkey, USA,
United Arab Emirates, United Kingdom, Uzbekistan, and
Figure 2 — Distribution of Respondent's Ages
Vietnam.

Q3 Language

Respondents reported reading regularly in 36 different


languages. 95% of respondents read regularly in English
despite only 55% living in the UK or US (see Q4). This
result will also have been affected by the promotional
activity for the survey, and the survey itself, being in
English.

Figure 4 — Countries of residence

Figure 3 — Languages read most often by respondents


Q5 Working Style
A more useful consideration is that the variety of
languages used suggests the survey achieved a good level Respondents were asked if they work on their own or as
of diversity in the non-UK/US 45% of respondents. part of a team. Medical professionals generally work as
part of a team (84%), while medical students are more
split with 57% working on their own. Analysis to
understand correlation with more detailed role (Q1) or

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country (Q4) may provide further insight but has not been Figure 7 shows that our respondents overwhelmingly have
performed as part of this work. internet access at work. Educators all have access, and
almost all medical professionals have access.

Grouping by country shows a slightly different picture —


that our respondents almost all have internet access at
work regardless of the country they are in. Figure 8 —
Internet access by country shows this clearly. Number of
respondents has been shown on this chart to indicate the
Figure 5 — Team working by group small sample sizes involved.

Q6 Patient Contact Internet access at work for medical professionals around


the globe is extremely encouraging for anyone
The majority of respondents spend at least half their
considering the ability of medical professionals to
working time directly with patients (68%), higher when
network, learn and reference critical information in a
considering only medical professional (80%) and lower
timely way.
when considering students (61%).

Figure 6 — Percentage respondents working time with patients


A minority of respondents had no direct contact with Figure 8 — Internet access by country
patients (23%). Lower when considering only medical Q7 also asked about the device used to access the internet
professionals (16%). Of note is that even those we while at work, distinguishing between computers and
consider non-medical professionals, more than half work mobile devices — tablets or smartphones.
directly with patients.
Use of mobile devices is high across all of the respondent
3. Quality and Method of Internet Access groups (65%), highest as a proportion amongst educators
(83%) and a majority of medical professionals (67%) and
Q7 Access and Device students (67%).

Respondents were asked a dual-axis question used to


indicate how they access the internet while at work. This
is analysed in two ways: what percentage have internet
access at work; of those who have internet access what
kind of device is used.

Figure 9 — Internet access devices by group


For those building information access solutions for
medical professionals this suggests that mobile
compatibility, if not a mobile-first strategy, will be
essential to adoption.
Figure 7 — percentage internet access by group

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Q8 Quality of access parts C — The internet access I have at work is outdated

Q8 is broken down into a number of parts, each a question Asked in a related way, in reverse, we maintain a similar
in it’s own right. The respondents are asked to record their outcome. A significant 1/3 minority agree that their
agreement with a statement, choosing from strongly internet access at work is outdated (33%) with just over
disagree, disagree, neither agree nor disagree, agree, and half disagreeing (51%).
strongly agree. Respondents may choose not to answer. A
number of the statements form re-phrased pairs.

Statements a, b, c, d, f, and h cover the quality of internet


access a respondent has at work.

A — The internet access I have at work is excellent

A majority of respondents feel the level of internet access


they have at work is excellent (59%) while a substantial Figure 12 — The internet access I have at work is outdated
minority do not (27%). No significant variance is seen in
The large minority of medical professionals and non-
this between the groups. As a similar percentage of the
medical staff working in healthcare that consider their
survey respondents are using their own mobile devices to
internet access to be outdated and failing to meet their
access the internet, presumably unhampered by corporate
needs is disappointing.
IT policy, this may be connected.

D — I can access all the sites I need

Figure 10 — The internet access I have at work is excellent

Figure 13 — I can access all the sites I need


B — The internet access I have at work meets my needs
Again, a significant minority (35%) of respondents
When asked if the internet at work met their needs a disagreed with the statements I can access all the sites I
slightly higher proportion agreed (65%) and a slightly need. Qualitative conversations with healthcare
lower number disagreed (23%). professionals following this survey suggest the
commonest issue here is corporate IT policy. This is
confirmed by related statements f and h.

Figure 11 — The internet access I have at work meets my needs

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F — Often a site I need is blocked through the internet E — It is easy to find the information I need online while
access I have at work at work

Surprisingly, given the dominance of Google, one-fifth of


respondents (21%) disagreed with this statement. Two-
thirds agreed (65%). Combined with later statements we
can see that providers of medical information still have
much work to do in making the information readily
discoverable.

Figure 14 — Often a site I need is blocked through the internet


access I have at work
Consistent with the responses for statement d, more than
one-third of respondents (36%) experience that sites they
need are blocked at work.

H — I have to use my internet at home to use some sites


Figure 16 — It is easy to find the information I need online
Asking the question in a broader phrasing gives an even while at work.
stronger signal with a majority of respondents (62%)
agreeing with the statement I have to use my internet at G — All the health information I need is on Google
home to use some sites. The increase here may be due to
an omission in the statement — other statements refer to
sites I need implying strongly that the statement refers to
health information sources. This statement could be
interpreted more broadly to include all sites, including
social networks and other sites some would consider
legitimately blocked. Qualitative conversations with
medical professionals lead us to believe this wasn’t a
significant factor and that the phrasing of this statement Figure 17 — All the health information I need is on Google
simply elicits a more complete picture of limited access
Almost half of respondents (48%) disagreed with this
for medical professionals.
statement confirming that, while Google is good, it fails to
meet all of the needs of medical professionals. Only one-
third of respondents agreed with this statement.

Disagreement was similar for medical professionals and


medical students. There was a significant difference for
educators who disagreed (83%) and non-medical
respondents (27%). This indicates that Google serves non-
medical personnel better than medical professionals.
Google is not able to completely meet the needs of four-
Figure 15 — I have to use my internet at home to use some sites
fifths of educators.
4. Ease of Discovery of Trusted Health Information
I — Google gives me great results for medical searches

Half of respondents agreed with this statement (50%), just


less than two-fifths disagreed, with the remaining third
undecided.

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W — I know how to find trusted, up-to-date health
information online

Later in the survey respondents were asked a broader


variation of statement j where find it easy is replaced with
know how.

Figure 18 — Google gives me great results for medical searches


The large undecided response, along with the low
responses strongly agreeing or strongly disagreeing,
suggests that the statement involved a complex response
process amongst participants.

Qualitative questioning of a small sample of medical Figure 20 — I know how to find trusted, up-to-date health
professionals suggests that the tension in the statement is information online
caused by the lack of coverage reported in statement g. In this variant of the question, agreement increase from
That is, Google produces very good search results over three-fifths (61%) to three-quarters (74%), and
the content that it has indexed, yet does not index all the disagreement decrease from one-sixth (15%) to around
information medical professionals need. This dichotomy one-eighth (12%).
of good, but incomplete, search results is what we believe
explains the responses to this statement. This suggests that, the process of finding trusted, up-to-
date, accurate health information is understood by most,
J — I find it easy to find accurate, up-to-date, trusted but not necessarily considered easy.
information
K — I can easily assess how trustworthy online
Three-fifths of respondents agreed with this. Superficially
information is
this seems to contradict the responses to statements g and
i yet read in combination with later statements, s and t, on Being able to assess if content found online is trustworthy
behaviour can be understood. or not is fundamental to being able to use that information
to inform patient treatment. One-in-five (20%)
respondents are not able to easily assess how trustworthy
the information they find really is.

Figure 19 — I find it easy to find accurate, up-to-date, trusted


information
A fair explanation would that healthcare professionals feel
able to find trusted, accurate information online by Figure 21 — I can easily assess how trustworthy online
directly visiting a small number of sites they have learnt information is

to trust. Three-fifths agree here (61%) while around one- Three-fifths of respondents (57%) are able to easily assess
sixth disagreed (15%) how trustworthy the information is. This may be related to
the behaviour of visiting known, trustworthy, sites.

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L — I rely on subscription sites that do not appear in T — I look for health information by going to specific
Google sites (e.g. Pubmed, UpToDate, WebMD)

With many medical sites, journals in particular, being


behind pay-walls, this statement was expected to elicit
overall agreement. Only one quarter (25%) of respondents
agreed with this statement and almost half (48%)
disagreed. Qualitative research to understand this result
would be beneficial but we have not done this yet.

Figure 24 — I look for health information by going to specific


sites (e.g. Pubmed, UpToDate, WebMD)
A significantly higher proportion, four-fifths (86%) of
respondents report going to specific sites to look for the
information they need, with just one-in-ten (9%) not
doing this. A significant response (37%) strongly agreed.

Figure 22 — I rely on subscription sites that do not appear in


S & t combined
Google
When we consider responses to statements s and t in
S — I search for health information using a mainstream combination we see a strong correlation between the two
search (e.g. Google or Bing) questions. This indicates that for the majority of
respondents use mainstream search engines and go to
With the capabilities of mainstream engines, Google in
specific sites directly; employing both strategies.
particular, it is no surprise that almost three-quarters
(72%) of respondents use a mainstream search engine to
find health information. A slightly higher proportion of
students (76%) and non-medical respondents (80%) use
mainstream search engines.

Figure 25 — Statements s and t combined

5. Types of information searched for online


Figure 23 — I search for health information using a mainstream
search engine (e.g. Google or Bing)
M — I often look up drug dosages and/or interactions
online

Three-fifths (62%) of medical professional responding


agreed that they often look up drug dosage and/or
interactions online. One quarter of medical professionals
do not report this behaviour.

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P — I read detailed research into conditions and
treatments online

Figure 26 — I often lookup drug dosages and/or interaction


online
The lowest agreement was amongst non-medical
Figure 29 — I read detailed research into conditions and
respondents where less than of respondents (45%) agreed treatments online
with statement m.
Three quarters of our respondents read detailed research
online (75%) with more than one quarter (27%) agreeing
N — I refer to clinical guidelines online strongly. One-in-ten (12%) disagreed.
Agreement for this statement was strong across all groups
with four-fifths (81%) agreeing and only one-in-ten (10%) Q — I use the internet to find guidance to give to my
disagreeing. patients

Figure 30 — I use the internet to find guidance to give to my


Figure 27 — I refer to clinical guidelines online
patients
Two-thirds (66%) of respondents reported using the
O — I sometimes lookup summaries of conditions online
internet to find patient guidance. When considering
responses to Q6 where one quarter of respondents
reported not working directly with patients this signal
may be stronger still.

Only one-sixth of respondents disagreed suggesting that


some respondents do not have patients contact but do
search for patient guidance.

Figure 28 — I sometimes lookup summaries of conditions online


The strongest agreement on our types of content, nearly
nine-tenths (87%) look up summaries of conditions online
while only one-in-twenty (5%) do not.

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R — I subscribe to online journals

Figure 33 — My colleagues share health information they find


online with me
Figure 31 — I subscribe to online journals
Our respondents report that they share more than they
More than half (55%) of respondents report subscribing to receive.
online journals. Medical professionals are slightly lower
than the overall average (53%) with the highest subscriber
group being non-medical respondents (69%).

A quarter (26%) of medical professionals do not subscribe


to online journals.

6. Sharing of information found online

U — I share health information I find online with


colleagues

Figure 32 — I share health information I find online with


colleagues
Three quarters (72%) of respondents report that they share
information they find online with colleagues. Only one-
in-ten respondents report not sharing.

V — My colleagues share health information they find


online with me

Two-thirds (67%) of respondents report that their


colleagues share content with them. This figure is lower
than the response to statement u.

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7. Referenced Sites

Respondents listed a total of 172 sites they felt were important to their use of health information online. This list included
some that we were unable to find under the name given or that have been discontinued (these are prefixed with ** in the table
below).

The sites are a mix of reference sites, educational content, journals and professional bodies. Some cover quite wide areas of
medicine and others are focussed on a specialty. The sites are a mixture of open content, available for anyone to read and
closed, where users are required to sign-in. Some students reported “Athens” which we assume is shorthand for their
institutions journal access.

Further analysis of this list of sites to understand their scope, geographic relevance, and access policies would be valuable.

AAP Policy http://pediatrics.aappublications.org/


ALIEM Academic Life in Emergency Medicine http://www.aliem.com/
ACEM https://www.acem.org.au/
Adjuvant! Online https://www.adjuvantonline.com/
AHA Australian Heart Association http://www.heart.org/
AJR http://www.ajronline.org/
Almost a Doctor http://almostadoctor.co.uk/
American Thoracic Society http://www.thoracic.org/
AMH Australian Medicines Handbook https://www.amh.net.au/
BJA Anaesthesia http://www.aagbi.org/publications/anaesthesia
The Aspergillus Website http://www.aspergillus.org.uk/
** Athens
BloodMed http://www.bloodmed.com/
BMA http://bma.org.uk/
BMC BioMed Central http://www.biomedcentral.com/
BMJ http://www.bmj.com/
BMJ Clinical Evidence http://clinicalevidence.bmj.com/
BMJ Best Practice http://bestpractice.bmj.com/
BMJ Learning http://learning.bmj.com/
BNF British National Formulary http://www.bnf.org/
British Journal of Anaesthesia http://bja.oxfordjournals.org/
BSSH British Surgical Society of the Hand http://www.bssh.ac.uk/
School of Clinical Medicine, University of Cambridge http://www.medschl.cam.ac.uk/
CAPHIS http://caphis.mlanet.org/consumer/
CDC Centers for Disease Control http://www.cdc.gov/
CEACCP http://ceaccp.oxfordjournals.org/
NICE Clinical knowlegde summaries http://cks.nice.org.uk
ClinicalKey, Elsevier https://www.clinicalkey.com/
Clinical Radiology (Journal) http://www.clinicalradiologyonline.net/
The Cochrane Library http://www.thecochranelibrary.com/
Cochrane Journal Club http://www.cochranejournalclub.com/
Critical Care Reviews http://www.criticalcarereviews.com/
DermNet NZ http://dermnetnz.org/
Doctors.net.uk http://www.doctors.net.uk/
DrugBank http://www.drugbank.ca/

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DVLA http://www.gov.uk/dvla
** DXS core
Dynamed https://dynamed.ebscohost.com/
E-Anatomy http://www.imaios.com/en/e-Anatomy
Medscape emedicine http://emedicine.medscape.com/
EBSCO Health http://health.ebsco.com/
emc Electronic Medicines Compendium https://www.medicines.org.uk/emc/
EMCrit Blog http://emcrit.org/
emDocs http://www.emdocs.net/
EMIS web http://www.emis-online.com/emis-web
Epocrates http://www.epocrates.com/
eTG Electronic Therapeutic Guidelines http://www.tg.org.au/
ERS European Respiratory Society http://www.ersnet.org/
https://www.evidence.nhs.uk/about-evidence-services/bulletins-and-
NICE Evidence Updates alerts/evidence-updates
NICE/NHS Evidence Search http://evidence.nhs.uk/
** Expert Consult
** Facebook
First Word Pharma http://www.firstwordpharma.com/
Fisterra http://www.fisterra.com/
FOAM Search http://foamsearch.net/
FOAM EM RSS http://www.foamem.com/
GINA Global Initiative for Asthma http://www.ginasthma.org/
CGHR Centre for Global Health Research http://www.cghr.org/
GMC General Medical Council http://www.gmc-uk.org/
Google http://google.com
Google scholar scholar.google.com
GP Notebook http://www.gpnotebook.co.uk/
GP http://www.gponline.com/
RCOG Royal College of Obstetricians and
Gynaecologists "greentop" Guidelines http://www.rcog.org.uk/guidelines
Harrison's Principles of Internal Medicine http://accessmedicine.mhmedical.com/book.aspx?bookId=331
The Healing Foundation http://www.thehealingfoundation.org.uk/
WHO HMN Health Metrics Network http://www.who.int/healthmetrics/en/
HIV Drug Interactions http://www.hiv-druginteractions.org/
HSE Health and Safety Executive http://www.hse.gov.uk/
iSEEK Medical http://medical.iseek.com/
The JAMA Network http://jamanetwork.com/
John Hopkins University http://www.jhu.edu/
The Lancet http://www.thelancet.com/
LITFL Life in The Fast Lane http://lifeinthefastlane.com/
** Local formulary
Mayo Clinic http://www.mayoclinic.org/
McMaster PLUS http://hiru.mcmaster.ca/hiru/
MD Consult http://www.mdconsult.com/
Measure Evaluation http://measureevaluation.org/
University of Groningen Central Medical Library http://www.rug.nl/bibliotheek/services/bibcmb/?lang=en
Medical Teacher http://www.medicalteacher.org/

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Medicines Complete https://www.medicinescomplete.com/
MedLine http://www.nlm.nih.gov/pubs/factsheets/medline.html
Medline plus http://www.nlm.nih.gov/medlineplus/
Medlinx http://medlinx.me/
Medscape http://www.medscape.com/
MedsDaily http://www.medsdaily.com/
MedSource http://www.medsource.com/
Meducation https://www.meducation.net/
Mercola http://www.mercola.com/
The Merck Manual http://www.merckmanuals.com/professional/
Micromedex http://micromedex.com/
MIMS http://www.mims.co.uk/
MJA The Medical Journal of Australia https://www.mja.com.au/
MSH Management Sciences for Health http://www.msh.org/
** msn
MyPath http://mypath.uscap.org/
National Guidelines Clearinghouse http://www.guideline.gov/
NCBI National Center for Biotechnology Information http://www.ncbi.nlm.nih.gov/
NEJM The New England Journal of Medicine http://www.nejm.org/
NHS (Choices) http://www.nhs.uk/
NHS Direct (now closed)
NICE bites http://www.elmmb.nhs.uk/newsletters-minutes/nice-bites/
NICE CKS Clinical Knowledge Summaries http://cks.nice.org.uk/
NICE Guidelines https://www.nice.org.uk/guidance
NICE Pathways http://pathways.nice.org.uk/
NIH National Institutes of Health http://www.nih.gov/
BHIVA British HIV Association http://www.bhiva.org/
BASHH British Association for Sexual Health and HIV http://www.bashh.org/
NJM The Netherlands Journal of Medicine http://www.njmonline.nl/
NLM National Library of Medicine http://www.nlm.nih.gov/
NORA The Neuro-Optometric Rehabilitation Association https://nora.cc/
NYSORA The New York School of Regional Anesthesia http://www.nysora.com/
OBG Management http://www.obgmanagement.com/
ObGyn http://www.obgyn.net/
The Society of Obstetric Medicine http://www.obmed.org/
Ophthalmology http://www.aaojournal.org/
Orthobullets http://www.orthobullets.com/
Orthopedics Hyperguide http://www.ortho.hyperguides.com/
Ovid http://www.ovid.com/
OvidSP https://ovidsp.ovid.com/
Oxford Handbooks Online http://www.oxfordhandbooks.com/
WHO PAHO Pan-American Health Organization http://www.paho.org/
Pathfinder International http://www.pathfind.org/
Patient.co.uk http://www.patient.co.uk/
Patient.co.uk Pro http://www.patient.co.uk/patientplus
The Pharmaceutical Journal http://www.pharmaceutical-journal.com/

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Physical Therapy http://ptjournal.apta.org/
PLOS Public Library of Science http://www.plos.org/
Podmedics https://www.podmedics.com/
NHS Predict http://www.predict.nhs.uk/
psycINFO http://www.apa.org/pubs/databases/psycinfo/index.aspx
PubMed http://www.ncbi.nlm.nih.gov/pubmed
Pulse http://www.pulsetoday.co.uk/
QxMD http://www.qxmd.com/
Radiology Assistant http://www.radiologyassistant.nl/
Radiopaedia http://radiopaedia.org/
RCGP Royal College of General Practitioners http://www.rcgp.org.uk/
RCP Royal College of Physicians https://www.rcplondon.ac.uk/
RCR Royal College of Radiologists http://www.rcr.ac.uk/
RCS Royal College of Surgeons of England http://www.rcseng.ac.uk/
** rebelme.com
Resus.Me http://resus.me/
Royal College of Anaesthetists http://www.rcoa.ac.uk/
Royal College of Psychiatrists http://www.rcpsych.ac.uk/
RSNA Radiological Society of North America http://rsna.org/
Sanford Guide http://www.sanfordguide.com/
Science Direct http://www.sciencedirect.com/
SIGN Scottish Intercollegiate Guidelines Network http://www.sign.ac.uk/
Skyscape Medical Library http://www.skyscape.com/
SonoWorld http://sonoworld.com/
The Lancet http://www.thelancet.com/
Thorax http://thorax.bmj.com/
TripDatabase http://www.tripdatabase.com/
UNAIDS http://www.unaids.org/
UNICEF http://www.unicef.org.uk/
United Nation Population Fund http://www.unfpa.org/
** Unity for Health
Univadis http://www.univadis.co.uk/
UpToDate http://www.uptodate.com/
Rx List http://www.rxlist.com/
European Association of Urology http://www.uroweb.org/
YouTube https://www.youtube.com/
Vademecum http://www.vademecum.es/
Vietnam MOH http://www.moh.gov.kh/
Vumedi https://www.vumedi.com/
WebMD http://www.webmd.com/
Web of Knowledge/Science http://webofknowledge.com/
** webmed
WHO World Health Organization http://www.who.int/
WHO Hinari http://www.who.int/hinari/
Wikipedia http://wikipedia.org/

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