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Using the internet to update practice

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VOL: 97, ISSUE: 03, PAGE NO: 5

John Unsworth, MSc, BA, RGN, PGCE, is a nurse consultant, intermediate care, Northumbria Healthcare NHS Trust

The drive towards evidence-based practice has gathered considerable momentum over the past 10 years (Hamer, 1999). Modern wound care, in common with many other aspects of practice, requires the practitioner to be aware of the best treatments available, as well as evidence of their effectiveness (Stotts, 1999).

The drive towards evidence-based practice has gathered considerable momentum over the past 10 years (Hamer, 1999). Modern wound care, in common with many other aspects of practice, requires the practitioner to be aware of the best treatments available, as well as evidence of their effectiveness (Stotts, 1999).

In order to deliver the best quality care the practitioner needs to be able to gain rapid access to information, as close as possible to the point of care delivery. The internet, or world-wide web, enables practitioners to locate and obtain literature, reports and educational material from across the globe both quickly and at relatively low cost (Unsworth and Boon, 1999).

Benefits and drawbacks
Publication of information on the internet has a number of advantages over other methods of dissemination, for example:

- Literature can be published quickly and easily;

- World-wide delivery is possible, including to very remote areas;

- Web technology allows for the development of multimedia and interactive information sources.

Unfortunately these advantages can also result in a number of drawbacks. Information on the internet is not well regulated, which means that anyone can publish virtually anything they want to. Unlike papers published in most professional journals, those published on the internet are often not peer-reviewed. World-wide dissemination also carries the added disadvantage that cross-cultural differences in care may not be addressed. For example, it is possible that accepted wound care practice in the developing world may lead to litigation in western society.

However, the inherent limitations of some forms of internet information can be overcome through careful and thorough critical appraisal of the information presented. Such critical appraisal skills are an important component of professional practice, whether the practitioner is examining product information provided by a company, internet information or a published research report (Jadad and Gagliardi, 1998).

Accessing the internet
Gaining access to the internet is not difficult, and most people can master the basics within one or two hours. Currently there are three main routes of access:

- Using a personal computer and modem attached to a telephone line;

- Using a computer attached to a network, such as the NHSnet;

- Using digital television.

When using a personal computer and modem, the user will require an account with an internet service provider. There is a wide variety of ISPs to choose from, and account costs vary. Whether using a computer and modem, or a networked system, it is also necessary to have a web browser; examples of those in common use are Internet Explorer and Netscape Navigator. The web browser allows the user to move between pages, using either the web page address or the on-screen forward, back and home buttons. It is also possible to move around using hyperlinks: these are usually icons or words which allow the user to jump to other pages or web sites.

Finding your way around
Probably one of the most difficult aspects of using the internet is locating the information you want. The internet contains many tens of thousands of websites on every conceivable topic, so finding the specific information you require can be quite difficult. However, there are a number of ways to find information: these include using search engines and gateways or link sites.

A search engine is simply a directory of web sites, which can be browsed using key words or phrases. Several different search engines exist; some hunt through entire websites for your key word, while others will search the website title only. Table 1 provides details of some of the most commonly used search engines.

Gateways or link sites provide details of sites that focus on a specific topic. They usually give details of the contents of other web pages or group them together under categories, such as pressure sore sites or evidence-based practice. Some of the most comprehensive wound care gateways and link sites are presented in Table 2.

Wound care resources
There are thousands of wound care-related sites on the internet, often operated by health care companies and wound care organisations. The type of information at each site varies, but almost all contain some educational material.

Wound care websites can be sub-divided into four groups, depending on the type of information they offer:

- Educational: these concentrate on providing practitioners with information on the treatment and management of tissue viability problems;

- Evidence/guidelines: these provide details of systematic reviews conducted on wound care-related topics. Most sites contain recommendations for practice or guidelines for the management of a particular wound care problem;

- Online journals: there are a number of online journals specifically related to wound care. Check if these have a system for the peer review of material before publication.

- Discussion groups: these use 'chat room' technology or electronic mail updates to allow for the exchange of information between professionals. Such forums are used increasingly by the public to access health related information.

Practitioners responding to queries posted by others should be aware of the accountability and possible legal liability associated with providing advice in this manner.

Table 3 gives examples of wound care-related websites, web addresses and a brief outline of their contents.

Clearly the use of the internet as a source of information and education will become increasingly commonplace as the government develops its information for health strategy. The Department of Health (1998) acknowledges that 'better care for patients, and improved health for everyone depends on the availability of good information, accessible when and where it is needed'. The challenge for practitioners will be to know how to access and appraise such information so that care can be improved.

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