What is the best test for peripheral vascular disease?

An ankle-brachial index is best for evaluating patients with symptoms of claudication (strength of recommendation [SOR]: B, multiple cohort studies). That said, duplex ultrasonography or magnetic resonance angiography may be a preferable first step if immediate revascularization appears necessary (SOR: C, expert consensus and case reports)

How do we decide when a patient with nonmalignant disease is eligible for hospice care?

Each hospice has its own policy, but Medicare requires 6 months or less life expectancy for certification of eligibility and reimbursement. Other important criteria include patient and family understanding and wishes. Evidence-based guidelines for determining prognosis in some noncancer diseases have been developed. However, despite their widespread use, limited data exist to support their accuracy (strength of recommendation: B). Moreover, a high degree of prognostic accuracy may be unattainable given the unpredictable course of common noncancer chronic diseases. Hospice eligibility for patients with nonmalignant disease is based on clinical judgment

Managing Journals by Committee

What do you do when your serials librarian retires and there is no option to hire a replacement? You form a committee. When the University of Cincinnati (UC) Health Sciences serials librarian retired in early 2010, budget cuts required that the position be eliminated from the personnel lines. While other aspects of her position could be redistributed, rather than reassign another librarian to manage the collection development tasks, the library director decided to pool the responsibilities for serials selection, faculty contact, subscription termination, and all other tasks relative to serials collection maintenance. With varying knowledge of journal management, the committee of five (the director, two information services librarians, one informationist, and a technical services librarian) has worked as a team through journal cancellations, continued format switches, and new acquisitions for 3 years. Over those 3 years, we have systematically addressed new requests, budget impact, journal usage, the balance between clinical versus research faculty requests, and a significant change in our user mix that continues to inform us that, no matter the number of journals in our collections, if the desired journal title is not among them, there are not enough journals. This paper will describe the myriad challenges, changes, and lessons learned plus our successes and a few missteps along the way during the last 3 years of managing the UC Health Sciences Library journal collection by committee