An excellent, US-certified health site written by a registered nurse (last updated February 2006), which provides a wealth of educational and comprehensive information targeting patients with tracheostomies and their carers. The topics covered include concise and accurate explanations of the types of tracheostomies including the surgical procedure, complications, tracheostomy care and practical issues with excellent clear illustrations provided. This easy-to-navigate site also facilitates patient-to-patient networking and support via a forum, provision of support groups and opportunities to attend conferences. Overall, a highly recommended site for the unwary patient or carer presenting detailed information on tracheostomies and an insight into lives affected by them.****

A service of the US National Library of Medicine and National Institutes of Health, this patient-orientated extensive encyclopaedia can be approached via its A–Z index of medical topics. The page on tracheostomy is disappointing; it discusses briefly, and with limited (but reliable) factual content, the indications, description (percutaneous method not included) and risks after surgery with equally disappointing illustrations. The website itself is worth visiting as other topics are well written and it provides links to most if not all US organisations.**

Providing instant access to over 6500 peer-reviewed clinical review articles, this extensive, comprehensive and easy-to-navigate US website is aimed at healthcare professionals. Launched in 1996, it claims to provide the largest and most current clinical knowledge-base covering 59 specialities for healthcare professionals. Its subsidiary website, e-medicine consumer health, provides patient information. Overall, most topics are covered in great detail. The article on tracheostomy comes under otolaryngology/facial plastic surgery going into oral medicine/otolaryngology. The layout is clear and organised; its contents well detailed, consistent and reliable, including anatomy, indications and contra-indications, treatment, complications, outcome and prognosis. The overall comprehension is to a standard for the trainee, not the patient. A medical dictionary is available though not clearly advertised. Pictures are available but access to these requires paid subscription. Overall, a good web site but orientated towards the trainee. It does state that articles are regularly updated although this particular one was updated in 2002.***

This US webpage, written by physicians, claims ‘easy to read, in-depth authoritative medical information’. Launched in 1996, it provides a free interactive service directed at the patient. Although pages are cluttered with adverts, easy access to topics is via an index. Contents are written clearly and in simple terms, the layout being well organised. A medical dictionary is also available with clear illustrations. The discussion on tracheostomy includes the relevant indications but states the rarer complications such as airway obstruction, need for blood transfusion, damage to larynx with resultant permanent change and need for further and more aggressive surgery, a somewhat daunting prospect for the patient. It also lacks detail on the surgical procedure itself. The page links to a ‘tracheostomy center’ revealing doctors' responses to patient questioning. There are better sites available for accurate patient information.*

This site is aimed at the graduate trainee preparing for graduate examinations, and remains an all-time favourite. Written by a consultant general surgeon, last updated in 2006, this is purely for educational purposes providing succinct, bullet-point revision information including a radiology, pathology and slide library (you have to submit three images to gain access to the latter). A surgical resource section provides information on evidence-based medicine and links to British organisations and surgical journals. A section on the relevant guidelines issued by NICE is also available. The tracheostomy page has a simple, clear and well-structured layout with factual content presented in salient, concise, bullet-point format. Not including a definition, it does, however, state relevant indications, advantages over endotracheal intubation, surgical techniques (including percutaneous method), complications and postoperative care. The only disadvantage is in its lack of illustrations but, overall, an extremely useful revision aid.****

This excellent joint website of Great Ormond Street Hospital for Children NHS Trust and UCL Institute of Child Health is praised for its content, its simplicity and its patient-friendly, personal step-by-step approach to child-health issues. Last updated in February 2006, it targets patients, carers and health professionals. Contents are easy to obtain, well-organised and written with clear explanations. A glossary is also included. Information for patients covering an extensive range of conditions are obtained from over 300 fact-sheets, health advice by Dr Jane Collins (Consultant Paediatric Neurologist) and access to complete archives of their nursery world magazine (A–Z health). Patients are encouraged to get involved in hospital issues via a forum. Advice is also given on how to obtain and evaluate medical information online with useful links. The fact-sheet on tracheostomy re-assuringly takes the carer through the steps from the child's hospital stay through to home care. Emphasis is on patient care. Little is mentioned on surgical techniques or types of tracheostomies and tubes. Pictures are available but limited. Overall, the site is very patient-orientated but services for healthcare professionals including a library with key website links, a research review and publication section are equally useful.****