Evidence-Based/Knowledge Management Librarian, KnowledgeShare, The Library, Audrey Emerton Building, Royal Sussex County Hospital, Brighton, UK
Electronic books (or e-books) have not quite caught on in the same way that electronic journals have in the last few years, but their availability and usage are increasing. Much has been written about their take-up by students in higher education,[1–3] but studies in health-care settings are still few and far between. Certainly their usage is likely to be greatest in an educational context, for example by junior doctors or nurses as they increase their qualifications. Just as experienced clinicians are likely to favour printed journal articles over printed text books, so too will they make more use of e-journals than e-text books. Nevertheless, e-books do have a role to play for all staff as Reference texts with which to look up unfamiliar conditions or therapies.
All the usual advantages of electronic information are evident in electronic books; most notably that one can easily search for the occurrence of a word within the text of the book, or indeed search across a whole collection of books in one go. They do away with the bulk of a thick medical textbook and (with the aid of a hand-held computer or PDA) hundreds can be carried around in a back-pocket. Another feature of e-books, which provides added value over and above printed books, is the facility to hyperlink two words or sections within the text. The most widespread use of hyperlinks is to connect Reference in the text of a chapter to their citation in the bibliography.
All of these advantages are encouraging more and more publishers and online information services to make books available electronically. Google is cur-rently fighting to be able to digitise millions of vol-umes and make the content freely available through their search engine. Google only allow access to one or two pages from the book at a time (so that one can check the odd quotation but not print out an entire copy), but many publishers are contesting their right to do even this. If you are interested in browsing the digital library that they have assembled so far, most of which is already in the public domain, you can do so at https://books.google.com.
The Open Access movement, as discussed in detail in the March 2006 issue of this journal, is also adding to the quantity of e-books that one can access. Authors are attracted to the idea of making their medical texts more widely available by providing them free online. Most of the resources highlighted below work on this principle, with the exception of the first collection which has been purchased by the NHS nationally. Readers may find that their local NHS library has taken out its own subscriptions to electronic books, perhaps through the providers MDConsult or Ovid. Always check with your library to see what resources are available.
The National Core Content Group (NCC), part of the National Library for Health, has purchased a collec-tion of electronic books for use by NHS staff across England. This collection can be accessed through the MyiLibrary portal by entering an NHS Athens username and password. (NHS staff in England can register for an Athens password at www.athens.nhs.uk.)
MyiLibrary is one of the leading providers of e-books and their website has been custom-built to provide easy navigation through their content, and within each book. The introductory screen allows you to select a book in one of three ways: you can browse by author, by title, or by subject. The subjects are arranged in a hierarchy, allowing you to ‘drill down’ to more specific topics. For example, selecting ‘Medi-cine’ from the first screen provides a range of narrower options including ‘Pathology’, ‘Surgery’, ‘Internal medicine’, and so on.
The majority of titles currently included in this collection are related to mental health as this is the package that was initially purchased for the NCC (strangely enough you will need to select ‘Internal medicine’ followed by ‘Neurosciences’ in order to find these). However, the range is expanding to include many other aspects of health care, and is worth inves-tigating no matter what your specialty or profession. One of the publishers that has contributed most to the collection is the World Health Organization, and so the range is also strong on epidemiology, public health and world health.
As well as being able to browse in this way, one can also search MyiLibrary for the appearance of particu-lar words. The advantage of an advanced portal such as this is that the search function delves beyond the titles and authors of books, and looks for the appearance of your search term anywhere in the text. Search results can be sorted by relevance, publication date, or alpha-betically by book title. It is even possible to save a search and come back to it later.
Once you have selected a book to read, a new window opens with the full table of contents down the left-hand side, allowing you to easily jump to a particular section. This screen is based on the portable document format (PDF), and so all the usual func-tions are available, such as being able to enlarge or rotate the page (for easier reading), to highlight text for copying into another document, and to print out pages. Of course it is important to be aware of copy-right restrictions when using these facilities. This document-reading window has tabs at the top left that allow you to search for words in the book, make notes on what you are reading, or link directly to a dictionary to look up unfamiliar words. A final, helpful addition is being able to click the ‘Citation’ link at the top right of the screen and see a citation for the book you are reading presented in a variety of different styles, such as Chicago or Harvard.
Bookshelf is a small but growing collection of elec-tronic books made available by the National Center for Biotechnology Information (NCBI), the same organ-isation that provides access to the Medline database through PubMed. The collection is currently strongest in the area of biomedicine (Molecular Biology of the Cell by Alberts was the first title added and proved to be very popular), but more clinical topics are also covered. Asthma, epilepsy, obesity, cancer and alter-native medicine all feature in the list.
Most of the books included here are electronic versions of printed textbooks, but there are a few entries that are more ‘dynamic’; books that consist of a regularly updated collection of articles on a theme. Examples include Coffee Break, which is a series of short reports on recent biological discoveries, and the Collective Expert Evaluation Reports from INSERM (the Institut National de la Sante et de la Recherche Medicale).
Navigation through these electronic books is not seamless, due to differing agreements made with the various publishers. Some allow the user to browse through books page-by-page or chapter-by-chapter, whereas others only allow you to search for the appearance of a keyword within the text and jump to the relevant chapters. Many of the books can be downloaded as PDF files and some have versions for the PDA or handheld computer. Users can enter a search term on the home page (anyone familiar with PubMed will recognise the interface) and are pre-sented with a list of all the books containing this term. The list shows the number of times the search term appears in each book, and puts the book with the most occurrences at the top. Full details of how to search the collection can be found within one of the books themselves: the NCBI Help Manual.
This site was set up to promote the availability of free online textbooks and contains a large selection of titles. For the most part these are simply links to Open Access books hosted elsewhere by a range of publishers, including many universities from around the world. Consequently it is not possible to search for occur-rences of terms across the whole collection (although one can almost always search for a word within the text of a particular e-book). Browsing the content is pos-sible by either title or specialty.
Some of these e-books have been produced by the originators of the site itself, the Amedeo Literature Project and their publishing arm Flying Publisher (www.flyingpublisher.com). Their aim is to raise money through donations to fund the production of a whole range of Open Access textbooks. The Flying Publisher e-book HIV Medicine has been available for a number of years, others have recently been added, and many more are planned. The site is looking for authors and if you are interested in getting involved in the newest publishing trend you can find details at www.freemedicalinformation.com/freemedicalinformation.pdf.
Created by an American doctor, this digital library of authoritative electronic books should prove useful for anyone studying medicine. There are books on all the specialties one might expect, from physical examin-ation to psychiatry, and a few surprising ones (‘wilder-ness medicine’ for example). There are also a few links to books on epidemiology and evidence-based medicine.
In addition to text books the site also contains patient simulations, resources for handheld com-puters and a large section on patient information. All the content has been quality assured to make sure that authorship is clear and that the information contained within it is current and fully Referenced. This is an unpretentious site and has no search facility, simply a categorised list to browse through. Never-theless, the content is regularly checked and updated, and the site has garnered a number of favourable reviews as well as winning awards for quality online medical information.
Exeter Health Library: www.services.ex.ac.uk/eml/textbook.html
This page has been produced by an individual NHS library based in Exeter but is one of the most com-prehensive lists of electronic medical books available. Beginning with collections of online books, such as the examples already presented, the site goes on to list individual books according to their National Library of Medicine class-mark (in other words, they appear on the webpage in the same order as they would appear on the shelves of most medical libraries). As well as clinical textbooks there are books covering healthcare finance, research, and medicine compen-diums. Note that occasionally you will see a padlock symbol next to a book in the list; this means that an NHS Athens password is required. In a few cases you may need to find out whether your local NHS library has taken out a subscription.
This resource is aimed at (and free to) UK medics and has been written by a team of primary and secondarycare doctors and medical researchers. The site is made up of a collection of articles on clinical topics and is intended to be used as an encyclopaedia of medical knowledge. As the encyclopaedia has no print equiva-lent, one might argue that it is not so much an e-book as a simple website. Discussion of electronic books often gets bogged down in such issues of definition, but whatever you decide to call it, this is a useful resource, which the authors hope will be used during the patient consultation itself.
There are over 26 000 pages of information based on knowledge taken from literature reviews, original research and national guidelines. As an encyclopaedia it is also collaborative in a way that is difficult for printed publications as the site relies on feedback from expert readers to verify or challenge the content. Editorial decisions are not influenced by any funding body, and the GPnotebook has been recommended by the National Library for Health.
The previous resource, GPnotebook, claims to de-velop or correct content based on user comments, but Ganfyd, another online medical encyclopaedia, goes one step further: it is entirely written by its users. Visitors to the site may create an account and proceed to add entries or alter existing entries as they see fit. This idea is based on the increasingly popular Wikipedia site (www.wikipedia.org), a general encyclo-paedia that uses the same collaborative creative pro-cess. Unlike Wikipedia, Ganfyd entries are written for healthcare professionals, not for the public, and only registered medical practitioners are able to edit them.
No one would be blamed for feeling sceptical about the quality of information produced in such an uncontrolled way. Wikipedia has received as much criticism as praise for the accuracy of its content. A recent research article in Nature showed very close correlation in terms of accuracy between Wikipedia and the Encyclopaedia Britannica, although the methods of the study have been called into question.[5,6] At the moment Ganfyd is still in its infancy, but any readers who are interested in emerging web technologies should have a look, and perhaps contribute an article. (For those who are curious about the name, Ganfyd stands for Get A Note From Your Doctor.)
Local experience has shown that constant publicity is required to make NHS staff aware of the electronic book content that is available to them. There still remains some reluctance over their use, perhaps because of the discomfort involved in reading large amounts of text on a computer screen. But of course, no one is suggesting that an entire textbook should be read online; e-books are there to be dipped into as and when they are needed. The sites listed above provide at least one or two texts on a whole range of topics and specialties, and will hopefully prove useful in both the classroom and the consultation.
Thanks to Jil Fairclough, Medical School Librarian at Brighton and Sussex Medical School for her contrib-utions.