Within a few weeks we expect to be opening our branch library at Knollwood Hospital. It will be primarily an electronic library in that there will be few print materials. But there will be PC workstations to access all of the library’s online resources, including full text journals. The facility will be staffed for a few hours certain days of the week. Check our library webpage for specific times http://southmed.usouthal.edu/library . The library will be located in the hospital building, first floor, where the Doctor’s Lounge currently is. The lounge has been renovated to divide the room. Half will be the library and the other half will remain as the Doctor’s Lounge. Although the lounge will still be available to physicians only, the library section will be open to students, faculty and staff, including hospital medical personnel.

- Tom Williams

The Biomedical Library recently cut 107 print journal subscriptions in order to have a balanced budget. A list of targeted journals, developed based on usage, was submitted to the faculty for review. The final list resulted in a savings of $37,104. However, this is less than 5% of our total journal costs for 2005.

Another way that we have determined that can save costs is to convert from print to electronic whenever possible. This was done for 30 titles this year, for a savings of approximately $2,835. A recent study by the Council on Library and Information Resources looked at the cost of print subscriptions vs. the cost of electronic subscriptions. The authors looked at costs, excluding subscription fees for print and electronic formats at 11 institutions of various sizes. They found that “over time, non-subscription costs are lower, on a per-title basis, in electronic than in print format.” The authors note that the cost of long-term archiving of the electronic journals was not factored into the analysis. Another study published in D-Lib Magazine in October 2002 indicated that when all costs are considered, electronic journals are more cost effective than bound print journals on a per use basis – over 7 times more cost effective. In addition to storage space, print journals also incur binding costs and manpower to re-shelve after use. Feedback from USA faculty indicates that they prefer electronic over print. For 2006, the journal subscriptions will be reviewed to see if other titles can be converted from print to electronic. One obstacle that will have to be overcome is that not all publishers supply statistics for electronic journal usage.

A recent report on journal costs (Library Journal, April 15, 2004) indicated that the average cost of a journal for 2004 in the health sciences is $975. This is an increase of 10% since 2003 and an increase of 39% since 2000. According to a study from the Association of Research Libraries, the cost of journals has risen more than three times the rate of inflation since the 1980’s.

- Judy Burnham

Geneva Staggs exhibited health information on the web (MedlinePlus, MLA’s Top Ten Sites, AVL) at the Goodwill-Easter Seals Child Development Center August 24, 2004.

Tom Williams, Clista Clanton and Justin Robertson, along with other members of the committee, have completed work on the cookbook being published by the Southern Chapter of the Medical Library Association. The cookbook, You Say Cuisine; I Say Vittles; The Southern Chapter Compendium of Recpes and Reminiscences, will go on sale at the upcoming meeting of the association that will be held in Biloxi, MS, Oct 21-25, 2004.

- Geneva Bush Staggs

Because of cost concerns, we have had to limit the number of users that can access our electronic resources at one time. However, if you have an class assignment for your students that requires access to one of the Biomedical Library electronic resources, please notify Justin Robertson, jroberts@bbl.usouthal.edu, (251) 460-7045, so we can try to temporarily add some access to meet student needs.

- Judy Burnham

The Biomedical Library’s Medical Specialties pages (http://southmed.usouthal.edu/library/specialt/index.html) are currently under “renovations.” New links are being added, broken ones repaired and the pages are also getting a new look. These pages have been created by the departmental library liaisons (see: http://southmed.usouthal.edu/library/liaisons/index.html) in an effort to highlight valuable online resources dedicated to particular medical specialties/careers (e.g. Neurology, Adult Health Nursing, Cardiorespiratory Care etc.). The links in these pages have been carefully reviewed and selected by the biomedical librarians to ensure reliability and informational value.

We value your opinion and urge you to let us know how we can make these pages as useful and accurate as possible. Please send comments to: medlib@bbl.usouthal.edu or the particular library liaison responsible for the page in question.

-Justin Robertson

The accuracy of references in these documents is as important to future research as it is to the academic credibility and reputation of the author and the University.

In order to insure the accuracy of your references, bring your reference pages by the library to have them checked by a librarian before submitting your paper for the final approval process.

For more information contact Geneva Bush Staggs at (251) 460-6890 or gbush@jaguar1.usouthal.edu.

According to the Besthesda Statement
(http://www.earlham.edu/~peters/fos/bethesda.htm), open access journals must meet two requirements:

1. The author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship as well as the right to make small numbers of printed copies for their personal use.
2. A complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving (for the biomedical sciences, PubMed Central is such a repository).

Open Access journals are becoming important in the scientific world. Below are some recent updates concerning Open Access journals.

*Some journals, i.e., Neurobiology of Lipids, are making a search box available on their web site to search PubMed Central or PubMed.

*Elias Zerhouni, NIH Director suggested in a recent meeting with scientific journal publishers that all articles based in NIH-funded research will soon have to be available for free. (http://sippi.aaas.org/ipissues/updates/?res_id=365)

-Judy Burnham

Mobile MerckMedicus comes with the Merck- Medicus (http:www/merckmedicus.com). Any health care professionals may register for MerckMedicus free. Mobile MerckMedicus contains the Merck Manual, Pocket Guide to Diagnostic Tests, Reuters Medical News, and Journal Abstracts. Users may also input terms for future MEDLINE searches on MerckMedicus. It requires Palm OS 3.0 or higher, 8.0MB free memory for Mobile MerckMedicus and 1.0 MB for Mobile MerckMedicus Lite (without Merck Manual). For Pocket PC, it requires 9.0MB free memory for Mobile MerckMedicus and 1.2MB for Mobile MerckMedicus Lite.

TheraDoc Antibiotic Assistant is available through MerckMedicus. TheraDoc Antibiotic Assistant provides the clinician the ability to generate a patient-specific and disease-specific evidence-based antibiotic recommendation. The clinician can enter key patient demographic information and then by answering a series of disease specific questions, receive an antibiotic recommendation tailored to the needs of the patient. The Antibiotic Assistant is a tool that can provide true point of care clinical decision support. TheraDoc Antibiotic Assistant requires Palm OS 3.0 or higher, and at least 1.9MB free memory and Pocket PC 2.0MB.

-Jie Li

A systematic review has a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyze data from the studies that are included in the review. A study reported in BMC Medicine (http://www.biomedcentral.com/content/pdf/1741-7015-1-2.pdf) indicated that 80% of the systematic reviews published by clinical scientists are published in about 11% of the journals. The twenty clinical journals that published the most systematic reviews during the study period (2000) were:

Cochrane Library Lancet Arch Intern Med BMJ Ann Intern Med JAMA J Fam Pract Chest Obstet Gynecol Spine	Am J Med Stroke Neurology J Clin Oncol CMAJ J Adv Nurs Schizophr Bull J Rheumatol Diabetes Care J Gen Intern Med

-Judy Burnham

“My guess is about 300 years until computers are as good as, say, your local reference library in doing search. But we can make slow and steady progress, and maybe one day we will get there.”
--Craig Silverstein, Google director of technology,
on CBS Sunday Morning, 3/28/04

Evidence-based medicine (EBM) has been defined as the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”* The biomedical library subscribes to a variety of EBM resources, a few of which are described below:

Cochrane Library: A regularly updated collection of evidence-based medicine databases, including the Cochrane Database of Systematic Reviews and the Database of Reviews of Effectiveness (DARE), two databases that contain systematic reviews. Systematic reviews are summaries of the medical literature that use explicit methods to perform a thorough literature search and critical appraisal of individual studies and then use appropriate statistical techniques to combine these valid studies. They can be a very important tool in the practice of EBM, as they give a specific answer to a specific question. The Cochrane databases are available under Databases/Resources on the Biomedical Library’s web site.

ACP Journal Club: The editors of ACP Journal Club screen the top clinical journals on a regular basis, identifying studies that are both methodologically sound and clinically relevant. Enhanced abstracts of the chosen articles are written, providing a commentary on the value of the article for clinical practice. This source can be used by clinicians to quickly understand and apply important changes in medical knowledge, without having to read and synthesize for themselves thousands of journal articles. Check SOUTHcat for locations.

Clinical Evidence: Based on thorough searches and appraisal of the literature, Clinical Evidence summarizes the current state of knowledge and uncertainty about the prevention and treatment of clinical conditions. It describes the best available evidence from systematic reviews, random clinical trials and observational studies where appropriate, and if there is no good evidence it will state so. Check SOUTHcat for locations.

Evidence-Based Practice: This newsletter from the American Academy of Family Physicians addresses the most important questions asked by practicing family physicians, using the best sources of evidence in a brief, clinically relevant format. The answers are explained by members of the Family Practice Inquiries Network, a national consortium of academic and practicing family physicians, medical librarians, and others dedicated to translating research into practice. Available at the Medical Center Library (Mastin).

Evidence-Based Gastroenterology: The editorial board of this journal evaluates all of the latest developments by systematically searching a core group of more than 40 journals for each quarterly issue. Key studies are summarized on one page with concise structured abstracts and editorial commentaries. In-depth subject reviews are also included that examine the evidence supporting different therapeutic options for specific gastrointestinal and hepatic diseases. Methodology reviews show how to incorporate evidence-based guidelines into practice, and offer new insights into cost-effectiveness analyses, case-control studies, and randomized clinical trials. Available online under the Online Journals & Books link of the Biomedical Library’s web site.

* Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence-based medicine: what it is and what it isn’t. BMJ 1996; 312: 71-2.

-Clista Clanton

STAT!Ref has recently upgraded your online product! New features: “Include Related Concepts” search function; the addition of concept expansion details on the Search Summary page; a “Did You Mean:” spelling suggestion on the Results page for incorrect spelling of search terms; improved Alternative Terms page to allow selection of replacements for multiple terms; and the ability to expand/collapse bibliographic information at the bottom of content documents.
In addition to these features, users will now be asked to agree to terms of use for STAT!Ref. This feature has been implemented to protect institutions from possible end-user misuse. Users will see an End-User License Agreement (EULA) at the beginning of their session. They will only see this once per user, per machine, and usage can resume by simply clicking “Agree.”

In spite of Alabama’s current financially challenging situation, the Biomedical Library remains committed to providing the best collection possible. With that in mind, we want to encourage our students and faculty to suggest books that should be added to our collection. If you can think of a book that is related to medicine, nursing, and the various allied health disciplines, don’t be shy, feel free to make a suggestion.

There are a variety of ways in which you can make book requests. You can:

• Send an email to Michael Lindsay at jmlindsay@bbl.usouthal.edu, with the book’s name, author and publication date and why you think it should be added to our collection.

• Call our Reference Desk at 460-7044.

• Drop by the Biomedical Library and give us a note with the book’s information on it.

• Complete the materials request form at: http://southmed.usouthal.edu/library/docdel/forms/requform.html

If you have any questions regarding book requests, please call Michael Lindsay at (251) 460-6894.

You can access Lancet electronically via ScienceDirect all the way back to Volume 1, Issue1 - October 5, 1823

New features of MDConsult include:

• Can search journal citations with the focus based on diagnosis, etiology, prog- nosis or therapy
• Over 1000 new patient education handouts added
• Clinical Insights added under Current Practice – gives prevalent thinking on current topics by leading specialists
• Printing will now expand images to full size and users will be able to specify which pages they would like to print
• A “Sort By” dropdown box will make sorting easier

-Judy Burnham

"In the nonstop tsunami of global information, librarians provide us with floaties and teach us how to swim". -
- Linton Weeks, Washington Post Staff Writer

These have been challenging times for the library in terms of providing journals to our students and teaching faculty. A quick glance at the last Biofeedback tells the tale:

• 91% of the Library’s material budget allocated for periodicals in 2003-2004.
• 39% average increase in cost of journal subscriptions between 2000-2004.*
• 8.5% projected increase in cost of U.S. science periodicals for 2005.*
• 9.0% projected increase in cost of non-U.S. science periodicals for 2005.*

Given these facts, the library must make changes in the way in which we obtain journals. With this in mind, we will explore moving as many journals as possible from print to electronic, where that is cost-effective. I would urge faculty members to inform me if there is a journal that you feel must be kept in print. My email is jmlindsay@bbl.usouthal.edu and I can be reached by telephone at (251) 460-6894.

*Van Orsdel L, Born K. Closing in on Open Access. Library Journal, 129(7):45-50, April 15, 2004.

-Michael Lindsay

TOXNET is a group of databases on toxicology, hazardous chemicals, and related areas. Databases included are:

• HSDB® (Hazardous Substances Data Bank) is a comprehensive, scientifically reviewed, factual database for toxic or potentially toxic chemicals. It contains extensive information in such areas as toxicity, environmental fate, human exposure, chemical safety, waste disposal, emergency handling, and regulatory requirements.
• TOXLINE® is a bibliographic database covering the biochemical, pharmacological, physiological, and toxicological effects of drugs and other chemicals. ChemIDplus provides access to structure and nomenclature information for the identification of chemical substances cited in NLM databases. A new ChemIDplus Lite version is available for Name and Registry Number searching without the need for plug-ins or applets.
• IRIS (Integrated Risk Information System) is an online database that contains
• EPA carcinogenic and non-carcinogenic health risk assessment and regulatory information on over 500 chemicals. The risk assessment data have been scientifically reviewed by groups of EPA scientists and represent EPA consensus. IRIS also contains literature references.
• ITER (International Toxicity Estimates for Risk) contains data in support of human health risk assessments. ITER provides a comparison of international risk assessment information in a side-by-side format and explains differences in risk values derived by different organizations
• TRI (Toxic Chemical Release Inventory) contains information on the annual estimated releases of toxic chemicals to the environment for the reporting years 1987-2001.
• CCRIS (Chemical Carcinogenesis Research Information System) is a factual data bank that contains evaluated data and information, derived from both short and long-term bioassays on over 8,000 chemicals. Studies relate to carcinogens, mutagens, tumor promoters, cocarcinogens, metabolites and inhibitors of carcinogens.
• GENE-TOX is a data bank with genetic toxicology test results on over 3,000 chemicals.
• DART®/ETIC (Developmental and Reproductive Toxicology/Environmental Teratology Information Center) is a bibliographic database covering teratology and developmental toxicology literature published since 1950.

Now three additional databases can be searched via TOXNET:

• HPD (Household Products Database) is a resource that provides information on the potential health effects of chemicals contained in more than 4,000 common household products used inside and around the home.
• Haz-Map® is an occupational toxicology database designed primarily for health and safety professionals, but also for consumers seeking information about the health effects of exposure to chemicals at work.  It links jobs and hazardous tasks with occupational diseases and their symptoms.
• TOXMAP uses maps of the United States to show the amount and location of toxic chemicals released into the environment.

An article in the July-September 2003 issue of the Journal of Medical Internet Research indicated that 85% of patients have come to the office visit with information obtained from the Internet. Some of the information obtained on the Internet by consumers may be inaccurate or biased. The AVOCADO mnemonic (http://southmed.usouthal.edu/library/ref/pathfinders/avocado.htm) can help you and your patients determine the quality of health information from the Internet:

Accuracy, Value, Organization, Coverage,
Authority, Date and Objectivity

-Judy Burnham

.911 is a resource that incorporates content from Outlines in Clinical Medicine/Medical Emergencies (OCM/911), The Medical Letter and the Centers for Disease Control and Prevention (CDC) to provide medical professionals with the latest information on SARS and other potentially rapidly-spreading diseases, including bio-terrorism agents. It also includes all CDC-SARS health alerts, recommended responses, and an FAQ about SARS, along with the latest information on signs and symptoms, treatments, as well as specific recommendations for prevention and control. Other topics via .911 include information on bio-terrorist agents including Anthrax and Smallpox. This can serve as a reference for diagnosis to treatments to available vaccines, and provides doctors, nurses, EMTs and other medical professionals information on these new threats on via their handheld computers at the point of care.

ARTbeat provides continuously updated content with gold-standard medical references. PCD is a free channel that’s included with every download of ARTbeat. Additional free channels include: CDC Spotlights, MedWatch and Connections. ARTbeat channels automatically smARTlinks with other channel information and with traditional “powered by Skyscape” reference content on the handheld.
Both resources can be downloaded from http://www.skyscape.com using Internet Explorer.

-Judy Burnham

The National Library of Medicine Division of Specialized Information Services has released a PDA system that is designed to assist first responders during hazardous materials incidents. WISER (Wireless Information System for Emergency Responders), http://wiser.nlm.nih.gov, provides a wide range of information on hazardous substances, including chemical identification support, physical characteristics, emergency medical treatment, containment and suppression information. It is currently available only on Palm OS.

-Judy Burnham

In the pharmacy, at the office, at the hospital, in the classroom, in the examination room, while traveling – wherever you are, you can make informed medication decisions by insuring that you always have the best possible drug information resource on hand – Clinical Pharmacology OnHand. A ground breaking leader in cutting-edge electronic drug information, tools and delivery for over a decade, Gold Standard has leveraged its award-winning Clinical Pharmacology drug database and interactive technology to design an “OnHand” application that provides the most comprehensive drug information and medication management resource to fit on a PDA.

Written by pharmacists who have been formally trained in drug information, Clinical Pharmacology OnHand excels in providing up-to-date, peer-reviewed, clinically-relevant drug content and the necessary tools critical to efficient job performance, effective “think on your feet” medication management skills, enhanced patient care for better health outcomes, and the avoidance of costly and hazardous medication errors to safeguard patients and the healthcare professionals/organizations who care for them. Fast, reliable and easy-to-use, OnHand supplies you with a mountain of important, need-to-know drug data that fits right in your pocket, and instantly gives you the accurate answers you need – when, where and how you need them.

Clinical Pharmacology OnHand

• Extensive, peer-reviewed drug content
• Drug descriptions, indications, interactions, precautions/contraindications, classifications, adverse reactions, pregnancy/ lactation, administration and dosage forms/strengths
• Pediatric, adult, geriatric, hepatic and renal dosing, and dosage limits, specific to indication, including off-label uses
• Search capabilities by generic or brand name, indication, classification, precaution or adverse reaction
• Personal notes capabilities to save your individual reminders and records

PLUS, you get a quick-acting, intuitive drug interactions report tool for checking combinations of prescription drugs, OTC, herbal and nutritional products for potential interactions – includes severity rankings and screening for lifestyle factors such as caffeine, food, alcohol, enteral feedings, grapefruit juice and tobacco.

Clinical Phamacolocy OnHand (http://www.cponhand.gsm.com/) is available free for faculty and students of the University of South Alabama and can be downloaded when connected at a University IP authenticated site.

An article published in a 2004 issue of Quality and Safety in Healthcare revealed that librarians could improve the safety of medical care by participating in patient safety initiatives. With patient safety an emphasis by the Joint Commission on Accreditation of Healthcare Organizations, the skills of a librarian would be an asset to hospitals. The article states that “A librarian’s expertise in accessing the evidence base could enhance the safety and appropriateness of care in a clinical environment.” Librarians could apply the knowledge management skills to enhance patient safety. This article recounts the incident at Johns Hopkins where a 24-year-old female volunteer died during the course of a research study because an adequate literature search had not been conducted. These same knowledge management skills can also contribute to the business side of medicine.

For information on how the SOUTHmed Information Network can provide you with library resources and services, contact Judy Burnham, jburnham@jaguar1.usouthal.edu or (251) 460-6888. SOUTHmed can provide searches of the literature, copies of articles, training sessions and much more. Information on SOUTHmed can be found at http://southmed.usouthal.edu/library/outreach/index.html

-Judy Burnham

BIOFEEDBACK, New Series, Issue #62, Fall 2004
Biofeedback, the Biomedical Library Newsletter, a publication of the University of South Alabama Biomedical Library, is published at irregular intervals. Editor: Geneva Staggs. Contributors to this issue were Judy Burnham, Clista Clanton, Jie Li, Michael Lindsay, Justin Robertson, Geneva Staggs, Diane Williams and Tom Williams. Comments should be addressed to Geneva Staggs, Biomedical Library, University of South Alabama, Mobile, AL 36688-0002 or by email at: gstaggs@bbl.usouthal.edu.