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Medical Resources

Lewis P. Gundry Health Sciences Library

900 S Caton Ave, Baltimore MD 21229
Phone: 667-234-3134
Email: stagneslibrary@ascension.org

1st Floor (main building)

Library Open Hours: 7:30AM - 4:00PM (Monday - Friday)

After Hours Access limited (door unlocks at 6:30AM weekdays) 

Librarian: Lucinda Bennett

Medical Databases & Platforms

Access Medicine

Cochrane Database of Systematic Reviews

PubMed

PICO Search

Mobile Apps

http://www.imedicalapps.com/

"iMedicalApps is the leading online publication for medical professionals, patients, and analysts interested in mobile medical technology and health care apps. Our physician editors lead a team of physicians, allied health professionals, medical trainees, and mHealth analysts in providing reviews, research, and commentary of mobile medical technology. Our publication is heavily based on our own experiences in the hospital and clinic setting."

 

http://www.medscape.com/public/iphone?src=emed-call

8,500+ prescription and OTC drugs, herbals, and supplements
6,200+ Reference articles for decision-making support
Clinical tools: drug interaction checker, calculators, and pill identifier
And more!

 

sanfordguide.com/coronavirus

"In the interest of providing the medical community with concise information about the rapidly changing SARS-CoV-2/COVID-19 situation, Sanford Guide has made its resources related to the pandemic available without a digital subscription."
Access is available on the Web, on IPhone or IPad, and Android devices.

 

Access App

"Learn when you want, where you want, and how you want. Access is your personal medical resource library that makes studying easier and more efficient. Currently available in its preview phase, as early adopters, you have the opportunity to shape the future of optimized and personal medical education. Access personalizes and tailors your medical education experience, giving you the healthcare content you need, on the go, even when you’re offline."

Be sure to create an account on Access Medicine first (on a desktop) and then use those credentials to log into the app.

Inclusive Language & Mental Health Environments

Healthcare is an ever-changing and dynamic environment. It is important that providers in all fields learn the language and skills to compassionately care for patients of vast backgrounds and mental health status. The following PDFs are crafted by the American Hospital Association to help healthcare workers practice such language. Take a look and feel free to print, share and spread the word in your department.

Compassionate SUD Language

Culturally Aware Language

Mental Health Conditions

People First Language

PTSD Supportive Language

Suicide Destigmatizing Language

Medal - The Medical Algorithms Company

Check out the Medical Algorithms Project, now called Medal The Medical Algorithms Company. 

It has been around for over a decade, and has 1,000s of medical care algorithms for over 45 different specialties in medicine and nursing.  

It was developed by Dr. Sriram Iyengar, Ph.D., of the School of Health information Systems, University of Texas, Houston, and the Institute for Algorithmic Medicine.  For individuals, it is still freely accessible at the URL below. 

You will need to register to gain access; it has iOS and Android apps available. This is an evidence-based clinical decision support tool, with over 22,000 plus calculators and risk scores.  

Here is the URL below:

https://www.medicalalgorithms.com/ 

Open Access Journals & Other Resources

 

Top Medical Journals

Citation Matcher

Titles From Our Print Collection

Catalog: Search for Print Resources 

ABOG Recertification

Reading List for January 2024 is now available!

Access the electronic readings lists below. Note, there will be no August reading list. The Library will no longer be providing print copies of the articles, but we will announce the full reading lists here with live links to each citation. 

 

 

 

  • August 2024 Reading List - Coming Later this year

 

The ACOG Practice Advisory linked below has been added to the 2023 MOC from ABOG in the Emerging Topics section:

Maternal Respiratory Syncytial Virus Vaccination

Articles of Interest - From our Subscriptions

Perioperative Primary Care Utilization and Postoperative Readmission, Emergency Department Use, and Mortality in Older Surgical Patients

Ron, D. , Abess, A. , Boone, M. , Martinez-Camblor, P. & Deiner, S. (2024). Perioperative Primary Care Utilization and Postoperative Readmission, Emergency Department Use, and Mortality in Older Surgical Patients. Anesthesia & Analgesia, 139 (2), 291-299. doi: 10.1213/ANE.0000000000007036.

Abstract

BACKGROUND:

Postdischarge primary care follow-up is associated with lower readmission rates after medical hospitalizations. However, the effect of primary care utilization on readmission has not been studied in surgical patients.

METHODS:

Retrospective cohort study of Medicare beneficiaries aged 65 and older undergoing major inpatient diagnostic or therapeutic procedures (n = 3,552,906) from 2017 through 2018, examining the association between postdischarge primary care visits within 14 days of discharge (primary exposure), and Annual Wellness Visits in the year prior (secondary exposure), with 30-day unplanned readmission (primary outcome), emergency department visits, and mortality (secondary outcomes).

RESULTS:

Overall, 9.5% (n = 336,837) had postdischarge visits within 14 days, 2.9% (n = 104,571) had Annual Wellness Visits in the year preceding the procedure, 9.5% (n = 336,401) were readmitted, 9% (n = 319,054) had emergency department visits, and 0.6% (n = 22,103) of the cohort died within 30 days. Our fully adjusted propensity-matched proportional hazards Cox regression analysis showed that postdischarge visits were associated with a 5% lower risk of readmission (hazard ratio [HR], 0.95, 95% confidence interval [CI], 0.93–0.97), 43% higher risk of emergency department use (HR, 1.43, 95% CI, 1.40–1.46) and no difference in mortality risk (HR, 0.98, 95% CI, 0.90–1.06), compared with not having a visit within 14 days of discharge. In a separate set of regression models, Annual Wellness Visits were associated with a 9% lower risk of readmission (HR, 0.91, 95% CI, 0.88–0.95), 45% higher risk of emergency department utilization (HR, 1.45, 95% CI, 1.40–1.49) and an 18% lower mortality risk (HR, 0.82, 95% CI, 0.75–0.89) compared with no Annual Wellness Visit in the year before the procedure.

CONCLUSIONS:

Both postdischarge visits and the Medicare Annual Wellness Visit appear to be extremely underutilized among the older surgical population. In those patients who do utilize primary care, compared with propensity-matched patients who do not, our study suggests primary care use is associated with modestly lower readmission rates. Prospective studies are needed to determine whether targeted primary care involvement can reduce readmission.

 

Paternal Use of Metformin During the Sperm Development Period Preceding Conception and Risk for Major Congenital Malformations in Newborns

Rotem, R. S. , Weisskopf, M. G. , Huybrechts, K. F. & Hernández-Díaz, S. (2024). Annals of Internal Medicine, 177 (7), 851-861. doi: 10.7326/M23-1405.

Abstract

Background:

Metformin is the most used oral antidiabetic medication. Despite its established safety profile, it has known antiandrogenic and epigenetic modifying effects. This raised concerns about possible adverse developmental effects caused by genomic alterations related to paternal use of metformin during the spermatogenesis period preceding conception.

Objective:

To assess the potential adverse intergenerational effect of metformin by examining the association between paternal metformin use during spermatogenesis and major congenital malformations (MCMs) in newborns.

Design:

Nationally representative cohort study.

Setting:

A large Israeli health fund.

Patients:

383 851 live births linked to fathers and mothers that occurred in 1999 to 2020.

Measurements:

MCMs and parental cardiometabolic conditions were ascertained using clinical diagnoses, medication dispensing information, and laboratory test results. The effect of metformin use on MCMs was estimated using general estimating equations, accounting for concurrent use of other antidiabetic medications and parental cardiometabolic morbidity.

Results:

Compared with unexposed fathers, the prevalence of cardiometabolic morbidity was substantially higher among fathers who used metformin during spermatogenesis, and their spouses. Whereas the crude odds ratio (OR) for paternal metformin exposure in all formulations and MCMs was 1.28 (95% CI, 1.01 to 1.64), the adjusted OR was 1.00 (CI, 0.76 to 1.31). Within specific treatment regimens, the adjusted OR was 0.86 (CI, 0.60 to 1.23) for metformin in monotherapy and 1.36 (CI, 1.00 to 1.85) for metformin in polytherapy, a treatment that was more common in patients with more poorly controlled diabetes.

Limitation:

Laboratory test results for hemoglobin A 1c to assess underlying diabetes severity were available only for a subset of the cohort.

Conclusion:

Paternal use of metformin in monotherapy does not increase the risk for MCMs. Association for metformin in polytherapy could potentially be explained by worse underlying parental cardiometabolic risk profile.

Primary Funding Source:

None.
Metformin has an excellent safety profile. But it also has antiandrogenic and epigenetic modifying effects that might affect sperm development and produce congenital malformations in newborns. In addition, a recent article in this journal concluded that preconception paternal metformin treatment was associated with major birth defects. This article describes a study by different investigators who used different data and analyses and reached a different conclusion.

Curing pediatric cancer : A global view. Examples from acute lymphoblastic leukemia

Duffy, C. , Hunger, S. P. , Bhakta, N. , Denburg, A. E. , Antillon, F. & Barr, R. D. (2024). Curing pediatric cancer. Cancer, 130 (13), 2247-2252. doi: 10.1002/cncr.35290.

Excerpt:

"Curing children and adolescents with acute lymphoblastic leukemia (ALL) is a 60‐year story of steady, incremental success. Today, for those living in high‐income countries (HICs), more than 90% of children survive at least 5 years and, despite this originally being a universally fatal diagnosis, encouragingly, a definition of cure has also been proposed: remaining in remission at 5 years after completion of treatment, not including cranial radiation.
However, the picture is often very different and highly variable for patients in low‐ and middle‐income countries (LMICs). Several single‐center and countrywide studies in upper middle‐income countries have demonstrated event‐free survival comparable to but slightly lower than in Western Europe (71%–78% in the same era), such as 66% at 15 years in Brazil. However, in low‐income countries, prospects for curing children with ALL are at most 10%, which corresponds to an estimated 9‐ to 10‐fold difference in overall 5‐year survival rates compared to HICs. This difference in global survival rates is termed the “pediatric cancer survival gap.” Although this discrepancy is multifactorial, it highlights an underlying “discovery–delivery gap,” where inequity exists because of failure to translate science for global impact."
 
Lee, S. , Park, M. , Oh, D. & Lim, C. (2024). Validation of Adult Sepsis Event and Epidemiologic Analysis of Sepsis Prevalence and Mortality Using Adult Sepsis Event’s Electronic Health Records-Based Sequential Organ Failure Assessment Criteria: A Single-Center Study in South Korea*. Critical Care Medicine, 52 (8), 1173-1182. doi: 10.1097/CCM.0000000000006270.
 

Abstract

OBJECTIVES:

In 2018, the Centers for Disease Control and Prevention introduced the Adult Sepsis Event (ASE) definition, using electronic health records (EHRs) data for surveillance and sepsis quality improvement. However, data regarding ASE outside the United States remain limited. We therefore aimed to validate the diagnostic accuracy of the ASE and to assess the prevalence and mortality of sepsis using ASE.

DESIGN:

Retrospective cohort study.

SETTING:

A single center in South Korea, with 2732 beds including 221 ICU beds.

PATIENTS:

During the validation phase, adult patients who were hospitalized or visiting the emergency department between November 5 and November 11, 2019, were included. In the subsequent phase of epidemiologic analysis, we included adult patients who were admitted from January to December 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

ASE had a sensitivity of 91.6%, a specificity of 98.3%, a positive predictive value (PPV) of 57.4%, and a negative predictive value of 99.8% when compared with the Sepsis-3 definition. Of 126,998 adult patient hospitalizations in 2020, 6,872 cases were diagnosed with sepsis based on the ASE (5.4% per year), and 893 patients were identified as having sepsis according to the International Classification of Diseases , 10th Edition (ICD-10) (0.7% per year). Hospital mortality rates were 16.6% (ASE) and 23.5% (ICD-10-coded sepsis). Monthly sepsis prevalence and hospital mortality exhibited less variation when diagnosed using ASE compared with ICD-10 coding (coefficient of variation [CV] for sepsis prevalence: 0.051 vs. 0.163, Miller test p < 0.001; CV for hospital mortality: 0.087 vs. 0.261, p = 0.001).

CONCLUSIONS:

ASE demonstrated high sensitivity and a moderate PPV compared with the Sepsis-3 criteria in a Korean population. The prevalence of sepsis, as defined by ASE, was 5.4% per year and was similar to U.S. estimates. The prevalence of sepsis by ASE was eight times higher and exhibited less monthly variability compared with that based on the ICD-10 code.
 
Shepherd, E. , Goldsmith, S. , Doyle, L. , Middleton, P. , Marret, S. , Rouse, D. , Pryde, P. , Wolf, H. & Crowther, C. (2024). Magnesium Sulfate Before Preterm Birth for Neuroprotection. Obstetrics & Gynecology, 144 (2), 161-170. doi: 10.1097/AOG.0000000000005644.
 

Abstract:

OBJECTIVE:

To systematically review the evidence for the effectiveness and safety of magnesium sulfate as a fetal neuroprotective agent when given to individuals at risk of preterm birth.

DATA SOURCES:

We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov , the World Health Organization International Clinical Trials Registry Platform (through March 17, 2023), and reference lists of relevant studies.

METHODS OF STUDY SELECTION:

Randomized controlled trials (RCTs) assessing magnesium sulfate for fetal neuroprotection in pregnant participants at risk of imminent preterm birth were eligible. Two authors assessed RCTs for inclusion, extracted data, and evaluated risk of bias, trustworthiness, and evidence certainty (GRADE [Grading of Recommendations Assessment, Development and Evaluation]).

TABULATION, INTEGRATION, AND RESULTS:

We included six RCTs (5,917 pregnant participants and 6,759 fetuses at less than 34 weeks of gestation at randomization). They were conducted in high-income countries (two in the United States, two across Australia and New Zealand, and one each in Denmark and France) and commenced between 1995 and 2018. Primary outcomes: up to 2 years of corrected age, magnesium sulfate compared with placebo reduced the risk of cerebral palsy (risk ratio [RR] 0.71, 95% CI, 0.57–0.89; six RCTs, 6,107 children) and death or cerebral palsy (RR 0.87, 95% CI, 0.77–0.98; six RCTs, 6,481 children) (high-certainty evidence). Magnesium sulfate had little or no effect on death up to 2 years of corrected age (moderate-certainty evidence) or these outcomes at school age (low-certainty evidence). Although there was little or no effect on death or cardiac or respiratory arrest for pregnant individuals (low-certainty evidence), magnesium sulfate increased adverse effects severe enough to stop treatment (RR 3.21, 95% CI, 1.88–5.48; three RCTs, 4,736 participants; moderate-certainty evidence). Secondary outcome: magnesium sulfate reduced the risk of severe neonatal intraventricular hemorrhage (moderate-certainty evidence).

CONCLUSION:

Magnesium sulfate for preterm fetal neuroprotection reduces cerebral palsy and death or cerebral palsy for children. Further research is required on longer-term benefits and harms for children, effect variation by participant and treatment characteristics, and the generalizability of findings to low- and middle-income countries.

SYSTEMATIC REVIEW REGISTRATION:

The review protocol was based on a standard Cochrane Pregnancy and Childbirth template and our previous Cochrane Systematic Review (doi: 10.1002/14651858.CD004661.pub3 ; published before the introduction of PROSPERO).

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American Academy of Pediatrics Resources

As of November 2021, all publications via the AAP have been on a single platform All journals subscribed to by the Library will be housed on the following pages, which will be made available on the Library site:

Briggs

These helpful guides on how to access Briggs Drugs in Pregnancy have been shared by a fellow Ascension Librarian in Wisconsin.

How to get to Briggs Drugs in Pregnancy & Lactation through Lexicomp

Briggs Drugs in Pregnancy & Lactation – via LexiComp [Direct Link]

MKSAP

Medical Knowledge Self-Assessment Program 19: Parts A & B now available for check-out!

Print copies of the latest Parts A & B are available for check-out in the Library Office - not in the stacks! MKSAP 18 IS in the stacks.

The borrowing time for each volume is 2 weeks. There is only a single copy of each volume so please be mindful of your due dates.

If you have a personal subscription to the online content of MKSAP, using the print resource as a supplement is an excellent way to diversify your study game.

Blogs & Podcasts

  • Elsevier Clinical Insights
     
     
  • Not Otherwise Specified 
    • "In “Not Otherwise Specified,” Dr. Lisa Rosenbaum, cardiologist and national correspondent for the New England Journal of Medicine, defies our sound-bite culture to go deep with some of medicine’s most innovative thinkers. Her guests’ stories and ideas about health care’s toughest challenges and greatest promise may change the way you think about medicine, health, and society."

Guideline Resources

Academy Websites & Publisher's Open Access  

Official Government Guidelines

The US government's National Guideline Clearinghouse is a repository of US clinical practice guidelines as well as some international guidelines with the goal of improving patient safety standards and healthcare measures.  Click on the NGC links below to take you to the URLs, to the link for the Agency for Healthcare Research and Quality, and to the link to the US government site for the Preventive Taskforce guidelines.

Governments & Free Agency Websites

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