So long, farewell, auf wiedersehen, goodbye

This is the final posting on the blog, as I am off to pastures new. The blog itself will remain as an archive. I hope you'll find useful snippets in it.

If you work in the NHS then please hot foot it down to your nearest NHS library and make use of it. You may feel that books on shelves are old hat, or that you have better studying facilities at home, or that your own laptop is preferable to library PCs. That's fine - library's are a broad church and can accommodate a variety of wants and needs. If there is only one thing you use in the library it has to be the staff. Library staff are what makes a library. Without them there would be no carefully selected and regularly updated books on shelves. There would be no one to take old books off the shelves and dispose of them. There would be no access to electronic journals because no one would set up all the behind the scenes admin for them. There would be no photocopier filled with paper, no posters on the walls. Most of all, there would be no one to guide, advise and lead you through the information maze.

If you do use your local library then three cheers for you. Please cherish it, tell your colleagues about it, support it.

Thanks for reading. Goodbye!

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Searching and shopping

Someone recently asked me if I thought it was OK to do more than one literature search for her dissertation. Searching is not a science so much as an art. It's a puzzle, a challenge - something to come at from first one angle then another. It's a treasure hunt. It should make your brain ache, and give you a thrill when you finally find what you are looking for.

So how do you search? I like to use a shopping analogy. Going to Google and asking it tell you something about diabetes is information suicide. You'll die under the avalanche of hits, relevant and irrelevant, that it throws at you. It's the equivalent of wandering into Bluewater on a Saturday afternoon thinking that you want to buy a present for your mother. There are just too many things to buy. You can't possibly look at everything so you have to narrow your search.

Do you want to buy your mother jewellery, books, CDs, DVDs, perfume....? How about something nice to wear? Now the first question is where do you look? You can't buy clothes in Boots, Halfords, Waterstones, HMV or Jessops. On the other hand some shops sell just clothes and others while other sell clothes in among other things (Sainsbury's , Tesco, M&S).

As with shopping, so with searching. For evidence you use Cochrane, for policy you choose HMIC, for nursing issues you try Cinahl, for mental health it's Psychinfo. The Sainsbury's option (for some of everything) is Medline - it's a big database and covers most things, although perhaps not in as much depth as specialist databases.

We're going to go into the first ladies' dress shop in the mall. Now a search engine is something like a rather unhelpful shop assistant. If you are vague and say you want something for your mother to wear she will toss back her hair, examine her nails and inform you that there are five floors of ladies' fashion in the store. Too much information.

On the other hand, if you ask if she has any blouses in a size 14, cotton, with three quarter length sleeves, plain, in a dark rose, she'll just say no. She wont tell you that they have the very thing you want in red, or something similar with full length sleeves. So you need to ask a question at a time until you find what she does and doesn't have. Blouses? Yes. In a size 14? yes. Any size 14 blouses in cotton? Yes. And so on.

The same with searching. Type in "diabetes" and you'll get the look of scorn and far too many hits. Race in to Medline requesting a paper published in the UK in the last 6 months on inhaled insulin for women under 25 with children who are failing to keep their diabetes under control and you get a straight "no". You need to build up your search piece by piece.

Perhaps your mother isn't quite so fussy about her sleeves. Rather than asking for blouse, 14, cotton with 3/4 sleeves (the equivalent of using AND in a search) you could try using OR. So - I want a blouse AND it has to be size 14 AND it has to be cotton. The sleeves can be 3/4 length OR full length. The colour could be dark rose OR red. You're expanding your options with OR, your limiting your options with AND.

So, shop number one has a size 14 cotton blouse in dark red with 3/4 sleeves, or one with long sleeves in dark rose. Neither are quite what you are looking for. Do you go home? Certainly not. You treat yourself to a coffee, and maybe a pastry, and plunge into the next shop and start asking the same questions.

If Cinahl doesn't deliver the goods then try Medline. If HMIC is hopeless then try searching the Department of Health website direct.

You may need to think laterally, too. If there is nothing in cotton then do they have other natural fibres? If they say they don't stock blouses, what about women's shirts? Maybe you'd be better off asking for dark pink or crushed raspberry colour instead of dark rose.

Sometimes after a few shops you find you're going round in circles. You keep finding cotton blouses in size 14, but nothing in dark rose or nothing with 3/4 length sleeves. Finally, after visiting several shops, and asking the questions in slightly different ways you realise that 2/4 sleeves just aren't available this year, or that nowhere stocks dark rose blouses.

At this point you probably can stop. It doesn't mean that nowhere has what you are looking for, but you can feel confident that you've looked as much as possible for now, you've done your best. Sometimes we just have to accept that the particular item we had in mind doesn't exist.

Sometimes the papers you do find wont have the answer you want, but will have extra clues. It's like coming home from Bluewater and finding the Boden catalogue on your doormat. In it there is a shirt. It's blue and it's silk - but look at this. Those are 3/4 length sleeves, but what does the description say? It says those are "bracelet length sleeves". Now why didn't you think of that? Looks like you'll be going back to Bluewater tomorrow.

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This mortal coil

The deathbed is a cornerstone of fiction. Miners coughing themselves to death in back rooms, Victorian ladies expiring on large, linen-draped feather beds, night nurses snoozing over their charges, doctors with whiskers and black bags recommending bed rest, tonics and purges.

These days things have changed and death is not something we do at home. Four out of five people die in hospital or hospice, although many would prefer to die at home. Now the Department of Health is preparing to outline plans for an end of life care strategy. Marie Curie have been campaigning on this issue for over four years.

One of the reasons it is difficult to organise end of life care is that we don't like to talk about death. Half the time we can't even say it. We don't die - we pass on, go home, are gathered in, go to sleep, are called to the Lord, pop our clogs, kick the bucket, croak, cross the bar or shuffle off this mortal coil. Discussing this issue on the Today programme this morning Health Secretary Alan Johnson said some programmes had refused to discuss this issue as it was "too depressing".

Death cannot be swept under the carpet. We may use surgery to make us look younger, but death will still come. It affects every one of us. We should all have a say in care of the dying because one day we will all breathe our last.

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Baby love

This morning's big health story is the latest Healthcare Commission report. Towards Better Births looks at maternity services and the news is not good. It suggests that there is a lack of choice around how and where a woman can give birth, a lack of beds and a lack of staff.

This report follows on from a King's Fund paper in February, which itself came hot on the heels of an earlier Healthcare Commission review. Both were rather negative (the review presumably provided the basis for today's report).

All this hoo-ha reminded me of article by Rowan Pelling, published in the Independent. This was early last year and speaks of a "midwife crisis". The article refers to a programme Ms Pelling made on this same topic back in 2004, when the view was no rosier.

Also in early 2007 the BBC ran a story on choice, reminding us that the government pledged in 2005 to offer choice to all expectant mums on place of birth (home, midwife-led unit or hospital) by 2009.

It is not just services during birth that are being criticised. Last March the National Childbirth Trust said there was a lack of support for pregnant women and new mothers.

I've mentioned CEMACH before. This organisation (the Confidential Enquiry into Maternal and Child Health) produces regular statistical reports on maternal deaths and perinatal mortality.

UNICEF has some comparative figures (from the early 1990s) on maternal deaths worldwide. The UK is shown as having 9 maternal deaths for every 100,000 live births. This compares with just 7 deaths in Sweden and Spain, and 6 in Switzerland and Norway. The other end of the scale in Europe shows 130 deaths in Romania. In the rest of the world Sierra Leone is at the bottom of this league with 1300 deaths - ten times the Romanian figure.

For more information on pregnancy care there is the Royal College of Midwives, the Royal College of Obstetricians and the NLH's Women's Health library.

Campaigning organisations include One Woman, One Midwife and the Independent Midwives Association. The anthropologist and campaigner Sheila Kitzinger also has a website. NHS careers has information on the varied role of midwives - a lot more to it than attending births!

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Fat cat or wage slave?

I recently almost overlooked a round robin email from HR. It's a good job I didn't hit "delete" because it contained the good news that NHS staff on Agenda for Change pay rates (that means everyone except doctors, dentists and "very senior" managers) have been awarded an inflationary pay increase.

Actually, it wouldn't have mattered if I had missed the email. I can always find out about inflationary increases and other changes to terms and conditions in the pay circulars posted on the NHS Employers website, where I can also find the current pay rates.

This one website is a huge resource for all aspects of pay, terms and conditions. On it you'll find information on everything from equal pay and mileage allowances to your rights in case of redundancy. It is the place to go if you want to see a job profile for your role, or find out about Knowledge and Skills Frameworks.

Medical staff aren't neglected on the site - it covers everything from accommodation (an issue which has hit the headlines today) to flexible training and consultant job planning toolkits.

Obviously NHS Employers is not the only source of information on employment conditions - there is the BMA , UNISON and other unions, as well as your own HR department - but it's a good place to start.

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Britain needs lerts

Keeping up to date - being alert to new things coming up - can be quite straightforward using the alert service on Search 2.0 at the National Library for Health. The nice people at Shrewsbury and Telford Health Libraries have put together a short guide, but a guide is barely needed. There is (once you have logged in and run your first search) a pair of buttons "save selected rows" and "save all". Select rows, or click "save all" and the next screen has a "save and create alert" button. Then all you need to do it give it your email address and tell it how often you want to be emailed. The system will then run that search for you once a week, month or fortnight, and email you the results. The search can be as basic or as complex as you like, focus on a topic, or an author, or even a particular journal.

If you are asking the system to email alerts to you at work then you must give it your full email address. So if you are at Colchester Hospital University NHS Foundation Trust, and your name is Rafael Nadal then your email address is rafael.nadal@colchesterhospital.nhs.uk. If you'd rather give it your Hotmail, Gmail, BT or other address, then feel free.

For other ways to keep up to date (our own current awareness service aside) think about using RSS feeds. This is a ways of making headlines or new items from news sites or journals or even blogs pop up on a single page. It saves you having to look at lots of other pages. You can gather together as many - or as few - feeds as you like through a "news reader" or "feed reader" service. NLH has a tutorial using the example of Bloglines as a feed reader.

A second option is to personalise your home page (the page you see when you first go in to the internet) to include news feeds. If you use the personalised version of Google (just sign up for a free account) you can "add stuff" using the link at the right hand side of your page and then "add a feed" using the link on the left of the page.

If you have Internet Explorer 7 on your PC then you can add feeds as you would favourites, and you can look at those no matter which page on the internet you are on. However, this only works on a PC where you have Explorer 7 and have set up the feeds. A news reader or personalised Google can be reached whichever PC you are using, at work or home.

Keeping up to date is a "little and often" activity. If you leave it for months you've got more to look at and it becomes a huge chore. If you make a date in your diary every Thursday morning, or every other Tuesday afternoon, or whatever suits you, you'll keep on top of it much more easily.

As we used to say at school - "be alert - Britain needs lerts."

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A walk in the woods

A return to ethical issues today. As ever, what makes a story interesting is when a second story causes you to look at the first in a new way.

The papers today have been looking at a Joseph Rowntree Foundation report that claims a single person needs a minimum of £13,400 gross a year to maintain a good standard of living. That standard will include bottles of wine, film tickets, bird feeders, a mobile phone and a bicycle. It excludes access to a car - apparently this is a luxury, not a necessity.

Meanwhile, in Cardiff, a small girl has Infantile Tay-Sachs disease. In her short life (she's only six) she has needed intensive care five times to get her through chest infections. Doctors apparently want the option not to treat her aggressively when she falls ill. Her parents say she has a right to life. They say (here is where the two stories collide) that she has a "marvellous" quality of life that includes foreign holidays, Centre Parcs and woodlands near by.

Standard of living is not the same as quality of life, of course, but the two are intertwined. You can be poor and happy, being rich doesn't necessarily make you happy. Back in April this year the Telegraph ran a story showing that although Britain is the world's 5th biggest economy it ranks only 17th in the world for quality of life. The Evidence Based Medicine series from the Hayward Group doesn't mention money at all in its definition of quality of life. The Quality of Life Challenge looks only at environmental issues - energy efficiency, lower taxes for "green" homes.

Psychologists consider that there is a heirarchy of needs. Basic needs come first. If you don't have a home and don't know if you'll eat this evening those needs are more pressing that whether or not you've seen the latest film or own a bird feeder. Certain basics need to be in place before we start to focus on the fancier things. Indeed, psychologust Oliver James says this very hankering after the fancier things can actually make us less happy.

So what makes good quality of life and standard of living? Is it a bottle of wine a week, a bird feeder and a trip to the pictures? Is it fast cars , fame and fortune? Or is it a walk in the park? The Telegraph reminds us today that the happiest people on the planet are the Danes. They quote Professor Ron Inglehart as saying "Ultimately, the most important determinant of happiness is the extent to which people have free choice in how to live their lives."

For me, this is the key in all this. Because your idea of happiness, quality of life, standard of living (and these aren't quite synonymous, but are surely intertwined) might be my idea of hell, and vice versa. You may feel that to be happy and have a good quality of life you need the fitness to climb mountains, bungee jump, hang glide, or just go jogging. I'd hate to be subjected to any of those things and would be happy to think I never had to do any of them. So if I were paralysed I might consider my life still to be worth living, but in the same situation you might wish yourself dead.

So you might look at the story of the little girl in Cardiff and feel sorry for her parents who think that having woodland nearby constitutes good quality of life when their daughter has epilepsy, is unable to speak and is almost totally paralysed. Or you applaud a couple who can see happiness in small things.

In the end it perhaps means that only an individual can decide what makes good quality of life for them; to decide when life is worth fighting for or when they would rather die. There can be no formula, policy or guideline to define these decision, which is why the Cardiff case will not be an easy one for the courts to consider.

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Darzi, Darzi, give me your answer do

At long last Lord Darzi, surgeon and Parliamentary Under Secretary of State, has published his report on the future of the NHS.

For those of you who can't face reading the entire 92 pages, complete with a preface by the Prime Minister and a foreword by the Secretary of State for Health, various newspapers and other sources have digested it for you and published nuggets and highlights. The BBC manages to sum up the report in 14 bullet points. It offers reactions from a range of people and focuses on how quality of care will be linked to payments.

The Guardian offers a brief review on what the report says, and focuses on the NHS constitution, with some Q&As. The Times lists rights and pledges found in the constitution and also has plenty to say in its analysis column.

NHS Choices - the site for patient information - has a run down of the key points of the constitution and background to the review. The same page offers links to guides and leaflets, for staff and patients, on the constitution.

The Daily Mail tells us that funding in future will be dependant upon patient happiness. Professor Sikora says we must "stop treating the NHS like a national religion." The comment page isn't happy - it opens its remarks with mutterings around deckchairs ands the Titanic. Comment in the Telegraph comes from John Appleby of the King's Fund, who feels it's a step in the right direction.

For those of you after basic facts about the NHS the BBC has a rundown covering life expectancy, vaccinations, budgets and staff numbers. There is a brief history of the NHS and a fuller history and archive include clips from programmes and even an audio clip of Nye Bevan talking about his creation.

For a thorough, balanced and considered set of links to Darzi-related material, visit Newham library's excellent blog.



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Same old, same old

Research and Development had a bit of a spring clean recently and found some notes for a library user group meeting held back in March 2001. Much has changed since then - not least the library user group closing - but much has stayed the same.

The notes show that 24 hour access was the top of the agenda. The situation now is the same as it was then - we're housed in an old building that is a little off site, and is vulnerable to break in and vandalism. There is therefore no out of hours access. Eventually there will be a new library, and rooms offering 24 hour access are right at the top of the wish list. They will probably be study rooms or computer rooms, rather than access too books and journals. Some books and journals are, of course, available 24 hours online with Athens.

In 2001 we proudly announced 12 (yes - twelve) online full text journals. Now we have over 1000 to offer you. In 2001 there were concerns over lack of databases for literature searching, now we offer you seven different databases through NLH.

In those days databases were bought on CD and copied onto the library servers for use on the library network. Eventually a select few pilot sites were granted access outside the library! The user group was busy discussing pay as you surf internet access. Now, of course, the library is on the Trust next work and everyone can access intranet and internet for free, and all the databases you need are internet-based. What progress!

In 2001 we were just finding our feet with offering training for you on literature searching. We started advertising courses in the Trust Training Prospectus and and handing out certificates to people who completed training. Now we offer very little training, as a team restructure left us without the relevant team members to train.

The issue of quiet study space over a space where people can chat still rumbles on. Again, we still lack the space to offer separate areas for different uses. Keep your fingers crossed for that new library where break out rooms are heading the wish list.

Finally, the user group asked about bibliographic software including Reference Manager or Endnote. We declined to buy it then, and don't buy it now, simply because demand is very low.

We no longer have a user group - sadly, it died young. However, its ghost lives on as we are always happy to have feedback, suggestions, compliment and complaints from you through any of our contact channels. You could even leave a comment on the blog!

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Anyone for tennis elbow?

Ah - Wimbledon. There's nothing like it. The crowds, the strawberries, the top players, the strapped knees, the ice packs, the players forced to withdraw due to injury. We're constantly reminded, it seems, of the dangers of exercise. So now seems a good time to have a look at resources for sports medicine and physiotherapy.

For literature searches of any kind around physiotherapy issues Cinahl is always useful. This is one of the databases you can access through the National Library for Health with your Athens password.

NLH has no dedicated library for sports medicine, but there is a section in the orthopaedics and trauma library dedicated to sports injuries.

Visit the Intute website and type "sports medicine" into the search box and you'll find links to various journals, clinics and institutes of sports medicine.

There is the Association of Chartered Physiotherapists in Sports Medicine - complete with a call for physios to work at the 2012 Olympics, and the British Association of Sport and Exercise Medicine.

Sports injury is a real problem, with guidelines being issued to American schools to ensure they enable their athletes to remain healthy and fit. NICE is currently working on guidance for promoting physical activity in children, although the scoping paper doesn't suggest that injury prevention will be a big part of the guidance.

The BBC has information for people wanting to do some sport without injuring themselves, including advice on warming up. NHS Direct has a sports injuries section.

Beware when Googling for sports injury information - a lot of results are private clinics advertising their services. While they may produce good quality information don't forget that they might have reasons to be biased toward suggesting treatment is necessary.

It's no surprise that a third of us prefer not to do any sport. Most of those blame poor health - perhaps sports injuries preventing them being active? Even sitting at home playing imaginary sport on computers can be bad for you. Best sit still on the sofa, crack open a punnet of strawberries and watch the rain fall on centre court.

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Dead or alive?

The BBC is running story today about a family in Mumbai who were taking their "stillborn" baby to the cemetery and when she began to gurgle. They were apparently "astonished". There is no indication as to how a man in Paris felt when he woke up on the operating table to find he was being prepared for surgery to remove his organs for transplantation.

In both cases the issue was around defining and diagnosing death. In the second case, which happened in Paris, the man had been diagnosed as dead under new experimental rules brought in to ensure that more organs are available for transplant. The article is vague about the rules, but refers to "heart stopped" which I assume is similar to "non-heart-beating organ donation" described in the Journal of Hospital Medicine. In the UK the criteria is brainstem death.

UK Transplant has a number of FAQs, including "how do they know you are really dead?" I'm surprised not to see listed as an FAQ "will doctors make an attempt to save my life if I am a donor or will they be more worried about having my organs?" It's certainly an objection I've heard from people- a fear of being used as a source of organs rather than being treated as a patient in need of care. It's a question more people will ask while incidents such as this French case continue to appear in the news.

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Guess how much I love you

Some things in life can be counted, weighed and measured. Two books, half a bar of chocolate, three pounds of cherries, 50g of hand dyed cashmere yarn, a metre of string. Or perhaps two hours wait in in A&E, one hairline fracture, three beds, fifteen stitches.

Other things are less measurable, expect perhaps by comparison. How funny is Jeremy Hardy? Does he make you laugh more or less than Andy Hamilton? Is an oak tree lovelier than a copper beech? Is Brief Encounter the saddest film you've ever seen?

The government thinks nurses should be more compassionate. It also thinks this is something that can be measured. How do you measure compassion? If I am compassionate towards one old lady in the morning can I treat a second old lady like second class citizen in the afternoon and still reach my compassion target? How many times do I need to say "there, there" before I can record it as compassionate activity? Is mopping a brow more or less compassionate that fetching someone a cup of tea? What is compassion, anyway? What happens if I feel as though I am being compassionate, but the recipient of my compassion feels I am being patronising, maudlin, overly familiar or intrusive?

Compassionate care is a good idea - as is treating patients with dignity. We should also treat our colleagues with compassion and dignity. We know what these things are - we certainly recognise when they are absent. But there are some things in life that just can't be measured (Elizabeth Barrett Browning not withstanding) or made into targets. They are the very things that are most important.

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Invasion of the body snatchers?

I'm not a great fan of sci-fi, but those films I do enjoy are the older ones that raise philosophical questions (The Fly considers a classic question in philosophy around identity and the mind/body problem) or political questions (the original Body Snatchers airs concern over communism). The Invasion of the Body Snatchers is particularly scary because the point is that you can't tell who is still human and who is now alien. When you can't tell it's so easy to get yourself trapped with the wrong sort of person.

This conundrum - how do you tell good from bad, real from fake - arose this morning. There was an item on the news about a man whose skin cancer had been cured by an injection of his own cloned immune cells. The report is full of detail - the cancer was advanced, had spread, five billion cloned cells were used. It all sounds plausible to the lay person, and it's on the BBC website and in the Guardian so it must be true, mustn't it?

It's certainly a rather bizarre story. For years we've been told cancer can be cured only through radical surgery, chemotherapy that makes you feel worse then the cancer ever did, and a very large dose of luck. Now we're being told that our own immune systems can reverse very advanced cancer.

Only two days ago the American Food and Drug Administration warned people off products sold on the internet as cancer cures. These "cures" include shark cartilage, coral calcium and various mushrooms. To the untutored eye shark cartilage is no more or less mad an idea than injections of cloned cells. Quackwatch even has a section refuting claims that animal cells injected into the body can cure cancer, which seems very similar to this current story.

This story comes from good sources, and I hope that the research will be proved to be correct, verifiable and repeatable. But in the meantime people with cancer - and other diseases - will continue to clutch at straws, to take the hands of Pod People and to chose the fake and the dangerous over the safe and the real. Who can save them? Perhaps a well informed, thoughtful, understanding clinician with time to listen and explain?

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A brief history of books in libraries

Prehistory. Ugh?

Ancient and Classical world. Scrolls? Yes. Are you a member?

Mediaeval. Book? Yes - over there, chained to the wall. Wash you hands before you look at it.

1439. Books? Yes - piles, thanks to that Gutenberg chap. What's that? You can't read? Oh well, never mind. Mass literacy will be upon us one day.

1700 - 1900s. Books? Certainly sir. Why not take one home with you to read it there? This is a modern circulating library, after all.

21st Century. Books? Books? Bless you, no, madam, this is a LIBRARY! Computers that way, CDs and DVDs that way, children's entertainment upstairs, cafe in the basement. Have you had a look at the art exhibition? Knit your own community classes start in 5 minutes in the foyer.

2008. Click, tap, tap, tap, click. Aha!

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Three of a kind

Today I wanted to draw together some information about our local Strategic Health Authority. I hoped to open with a snappy analogy to explain exactly how and where the SHA sits - between the Department of Health and individual trusts, commissioning but not providing services, providing strategic leadership, considering finance.

However, try as I might I cannot find a good analogy for the NHS and its different layers and functions, so we'll go straight to the SHA and let it speak for itself, as it were.

The SHA has existed for almost two years, being established on 1st July 2006. It describes itself as "the regional headquarters of the NHS". The current SHA strategy, "Towards the Best, Together" is out for consultation now. There are also various consultations on local services and what they should include.

The SHA website is part of a triumvirate of lookalike websites. The second is the website of the East of England Multi-Professional Deanery. Deaneries used to oversee eduction for doctors and dentists, but have now expanded their remit. There are sections on the website for AHPs and Healthcare Scientists. The deanery is also concerned with workforce development.

The final strand of this online trio is Leadership and Talent Management. This strand focuses on developing leaders and on succession planning. Their document library covers everything from Action Learning to happiness.

Each of the three sites can be reached from the home page of the others. It's a clear indication that, however things work, strategic planning, delivery of services, education and training for staff, and leadership and workforce planning go hand in hand.

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Money down the drain

Recently we suggested an easy way to do your bit towards saving the planet. Today we extend our advice to encompass ways of saving money.

We recently paid in all the cash we'd taken off you in the last month or so. Over half of it - and it was a good chunk of cash - was fines for late return of books. Fines are like tooth - decay easy to avoid if you follow a few simple rules. Here's how (to avoid fines, I mean - for tooth decay, make friends with a dentist and buy a good toothbrush)

1. Bring your books back on time. (I like this option - simple, but effective).

2. Renew your books by phone or email on or before the day they are due and write the new date on the handy date stamp label in the front of the book to remind you.

3. Bring the books to the postgrad centre when we're closed and post them in the big blue book drop box outside the door.

4. Make sure we have your current full and correct postal address and email address so we can remind you when your books are overdue.

5. Let us know when you borrow books that actually you will be out of the country in the week the books are due.

6. Let us know if you are sick/have been kidnapped by aliens and will not be able to get your books back on the due date.

The one thing not to do is to ignore any letters or emails we send out as this tends to make us rather cross and less inclined to be nice to you when we do finally see you and your books. The thing is, we don't really want you to waste you money on fines. We just want our books in circulation for everyone to share.

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What are you looking for?

A reminder for those of you who use Dialog for searching that it is shortly to be withdrawn. We suggest you use the new NLH Search 2.0 instead.

Do I hear you say "PubMed"? Feel free, but don't forget that PubMed is just Medline - you'll be missing out on Cinahl, EMBASE and Psychinfo. What's that at the back? Oh - you use Google. Again - fine. I use it myself and we're here to offer useful suggestions, not to run a library dictatorship.... Try Google advanced searching, Google Scholar and the advanced scholar.

Any other options? Well, you could always try asking a librarian to search for you. It's a free service.

Oh - and a final word to the Google addicts. You are sitting in an aeroplane and you hear the following: "Ladies and Gentlemen, good afternoon. This is your captain speaking. We have an unexplained fault in our engines. However, the Chief Engineer is looking it up on Google and hopes to get it all fixed soon." How do you feel about that? Maybe a phone call to your lawyer. "What are your rights in case of mid Atlantic air failure? One moment - I'll just need to Google that before I can give you can answer..."

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Read all about it!

I've mentioned the "Behind the Headlines" service before. It replaced the "Hitting the Headlines" service that the National Library for Health used to produce. Although still available through the National Library for Health it's actually produced as part of NHS Choices - the patient information site.

As with Hitting the Headlines this takes stories that are in the news looks at the science behind it. It presents the information in a really useful way. Take a recent example - reports in various papers that chlorinated water causes birth defects. Scary stuff - but it is it true?

The report on this topic is broken down into sections. There's a brief explanation an summary of what the news stories were about, what the stories were based on, and a brief appraisal of that original source. This section alone is useful, but there is more.

There are details of who wrote the paper, the researchers' affiliations, and the publication it appeared in. There is a longer section looking at the study and explaining what sort of study it was an how it was carried out. This is rounded off with an explanation of the researchers' findings and conclusions.

The next section is what the National Knowledge Service thinks about the paper - basically a critical appraisal of the original research. It looks at how the study was carried out, considers the statistical significance of figures in the study, and highlights gaps in the information presented.

The whole piece concludes with links to the original newspaper stories and also to the actual paper that sparked off the whole debate.

I think this is an excellent resource. It's a useful example of how we should look at evidence and appraise it, but also useful for sitting down with patients and explaining to them why they don't need to worry about the latest doom and gloom health headline.

In fact, I like these so much I have a nice RSS feed to bring Behind the Headlines to my Google Reader and from there I often flip them into the current awareness service.

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Save the planet!

OK - so you may not expect to get environmental tips from a health library, but we're currently selling these very fetching natural hessian, biodegradable bags. They are sturdy and stylish, and just the thing for filling with a spot of shopping or even an armful of library books. How do you get your mitts on these limited edition lovelies? Why - you trundle down to the library, of course. At just £2 each you wont find a cheaper way to save the planet this year!

Shamans, charlatans and quacks?

Prince Charles popped up on the Today Programme this morning. He seemed in jovial mood and chortled his way through an interview on using the rain forests to protect us all against climate change. HRH has long been interested in alternative issues, and is as well known for talking to his plants as for his ill-fated marriage to Diana.

Last month the Prince was in the news as a professor from Exeter university criticised guides to alternative medicine produced by the Prince's Foundation for Integrated Health. At the time the Today programme ran an interview with someone speaking for the Prince, suggesting that the important thing was that people should have information to help them make up their own minds, and that the guides presented the facts for them to consider.

CAM can be an easy target. Ben Goldacre, debunker of health myths, is not keen on it and practitioners of all its various aspects are regularly criticised on his blog. The good folk at Quackwatch also list many "alternative" therapies on their pages. A possible antidote to DR Goldacre is the NHS Alternative Medicine blog.

CAM has no Royal College or regulatory body, as as such. The Institute of Complementary Medicine exists to provide people with information on "safe and best practice" They keep a British Register of Complementary Practitioners and publish a code of ethics for practitioners.

There is also the British Complementary Medicine Association. The ICM's website has pictures of people in white coats, the BCMA has graphics of doors opening onto bright lights, but they also have a list of registered therapists and a code of conduct.

Some individual therapies have their own organisations - reflexologists, acupuncturists, Alexander teachers. How are these bodies regulated? Can they stop people from setting themselves up as practitioners without training? What training can there be? How about a postgraduate diploma in crystal therapy, complete with bibliography, continuous assessment and learners' portfolio? There are 61 complementary medicine courses available from bona fide UK universities.

There is a NLH Specialist Library for CAM. This covers the more mainstream end of things - herbal medicine, massage and art therapy. There is no section for crystals, reiki or macrobiotic diets. The NLH also offers a database of papers on alternative medicine - AMED.

Bandolier has a page of evidence on CAM. Cancer Research UK has a page of resources as does the Department of Health. Dr Foster has a search facility for finding CAM practitioners, although this only covers acupuncture, chiropractice, herbalism, homeopathy and osteopathy. Natural Standard is an American website that aims to provide "high quality, evidence based information about complementary and alternative therapies." You need to register to read anything on this site, although their blog is freely available. There is also a NHS Directory of complementary and alternative practitioners. As well as information on therapies it will tell you where to find your nearest crystal therapist. The Open University, working with the BBC, has a web resource on alternative medicine.

The Student BMJ has a basic run down of CAM issues. Further reading on this topic available in the library - natch.

CAM continues to strike up debate and controversy. It seems to me that one of the main problems is the attempt to lump together everything that is not mainstream medicine. Perhaps we need to stop thinking about CAM and think instead about the individual therapies, taking each one on its merits. More research might help. And in the end if we believe it makes us feel better, and it's not doing us harm, then why should we knock it?

With thanks to Newham Knowledge for suggesting the topic for this posting.


(c) creative commons attributed