The Internet is just one place where one could search for evidence to substantiate practice. There is a vast quantity of information available, and in addition it is becoming possible to search more traditional sources via the Internet. The problem however lies in locating the information, and once found, in verifying its validity.

"…current estimate of 180 000 000 Web pages, which are constantly changing" [John Dvorak, Inside Track, PC Magazine SA Sep 1997]

"With an estimated 10 000 medical and health-related Web sites, it’s no wonder that the topic of health accounts for an estimated one-third of all Internet searches." [Trends, PC Magazine SA Oct 1997]

There are a number of sites that provide printed assistance on all stages of the Evidence Based Medicine searching process. These include:

• Searching for the Best Evidence < http://cebm.jr2.ox.ac.uk/docs/searching.html >
• An Evidence-Based Practice Approach To Searching for Information < http://www.ogh.on.ca/library/ebm.htm >
• Evidence Based Medicine: Finding the Best Clinical Literature < http://www.uic.edu/~jod/ebm.html >

The School of Health And Related Research (ScHARR) within the University of Sheffield is involved in finding the evidence (expertise in literature searching); appraising the evidence (critical appraisal training) and producing the evidence (systematic reviews). One of their web pages, "Netting the Evidence: A ScHARR Introduction to Evidence Based Practice on the Internet" <http://www.shef.ac.uk/uni/academic/R-Z/scharr/ir/netting.html > has extensive collections of references, software and publications on the topic of evidence-based medicine.

The vast amount of documentation purely on how to search and appraise the literature suggests, quite correctly, that skill and technique is required to find evidence. While there is no shortage of data or interpretation thereof, the key is in how to assess, interpret and apply the information found. Particularly now, with the ease of information dissemination via the Internet, it is necessary to check the validity of any information found. Even the peer-reviewed literature is not above reproach!

For some time various mechanisms have been available to search Medline through the Internet, such as the Grateful Med system offered through the MRC. However these were often cumbersome to use, and a few searches could clock up a substantial bill in US$! Subsequently various web sites offered form-based searching, but still some of these attracted a fee, or only provided access to a limited part of the database.

Last year the National Library of Medicine has opened MEDLINE to the public for free, with a web form-based search called PubMed <http://www.ncbi.nlm.nih.gov/PubMed/   >. (MASA have attempted to route South African searches through their site, but there do not appear to be any benefits to the user.)

Medical Matrix has a useful Medline access comparison table <http://www.medmatrix.org/info/medlinetable.asp > that will enable you to choose the most appropriate place to search.

Peer-reviewed journals are generally an excellent source of information, and in many cases it is now possible to peruse or even search some of the major journals online, without having to go scrounging through a medical library. Journals may include papers of original research, review articles or areas of specific interest such as evidence-based care.

A database of useful journals may be found at < http://www.healthlink.org.za/hlink/links/health1.idc?Categories=Journals >. This includes a link to Medweb - one of the most comprehensive databases of health-related scientific literature, a service of Emory University Health Sciences Center Library < http://www.gen.emory.edu/MEDWEB/keyword/electronic_publications.html   >. (Note: this URL is case sensitive; type it exactly as it appears.)

ACP Online: Evidence-Based Medicine < http://www.acponline.org/journals/ebm/ebmmenu.htm >

An example, from the Jan/Feb 98 edition: Review: Corticosteroids reduce relapse rate, Beta-agonist use, and hospitalisation rate in acute asthma exacerbation after initial assessment

Evidence-Based Health Policy and Management < http://www.ihs.ox.ac.uk/jebhpm/index.html >

The principal purpose of this journal is to provide managers with the best evidence available about the financing, organisation and delivery of health care.