Case Files Collection on AccessMedicine

The Case Files® Collection on AccessMedicine® features a wide range of popular Case Files® series books. The collection delivers close to 1,175 real-life cases spanning the basic biomedical sciences and clinical medicine.

Designed to help students and residents learn in the context of real patients, rather than merely memorize facts. Includes real-life scenarios foster better understanding of frequently encountered cases as well as physician-patient interaction.”

Faculty can use this collection as a valuable resource for coursework, clinical rotations and to enhance preparation for shelf exams and the USMLE. Each case includes a complete discussion, clinical pearls and references, definitions of key terms, and USMLE-style review questions with detailed explanations of the correct answers.

Also, 15 additional titles are now available in the USMLE First Aid Review books collection.

Posted in Front Page, Library News, New Resources

DynaMed Plus is Now Available!

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PCOM now has access to DynaMed Plus! Get answers to your clinical questions fast!

DynaMed Plus presents critically appraised evidence from more than 500 medical journals in a quick, easy-to-read format designed for use at the point of care.

With DynaMed Plus, you will get:

  • Concise Overviews and Recommendations – accurate overviews for the most common conditions as well as evidence-based recommendations for action.
  • Micromedex® Clinical Knowledge Suite* drug content –includes medication management and lab recommendations, including IV screening, medication advisory screening and summary drug info.
  • Graphics and Images – includes over 2,500 medical graphics and images with over 1000 images from ACP.
  • Specialty Content – DynaMed Plus includes a wide array of specialty topics in areas such as infectious disease and immunology, cardiology, oncology and emergency medicine.
  • Mobile Access – DynaMed Plus is easy to access from any mobile device, from anywhere in the world. Download instructions are available here.
  • Expert Reviewers – DynaMed Plus includes subject-specific experts who review topics using the DynaMed Plus proprietary 7 Step EBM Process and the 9-Step Quality Process for creating content.

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Contact us if you have any questions.

Posted in Front Page, Library News, New Resources

Detyrosinated microtubules buckle and bear load in contracting cardiomyocytes

Detyrosinated microtubules buckle and bear load in contracting cardiomyocytes

The microtubule (MT) cytoskeleton can transmit mechanical signals and resist compression in contracting cardiomyocytes. How MTs perform these roles remains unclear because of difficulties in observing MTs during the rapid contractile cycle. Here, we used high spatial and temporal resolution imaging to characterize MT behavior in beating mouse myocytes. MTs deformed under contractile load into sinusoidal buckles, a behavior dependent on posttranslational “detyrosination” of α-tubulin. Detyrosinated MTs associated with desmin at force-generating sarcomeres. When detyrosination was reduced, MTs uncoupled from sarcomeres and buckled less during contraction, which allowed sarcomeres to shorten and stretch with less resistance. Conversely, increased detyrosination promoted MT buckling, stiffened the myocyte, and correlated with impaired function in cardiomyopathy. Thus, detyrosinated MTs represent tunable, compression-resistant elements that may impair cardiac function in disease.

Posted in Cardiology, Hot Topics in Research, June

Medical error—the third leading cause of death in the US

Medical error—the third leading cause of death in the US

Analysis. Medical error is not included on death certificates or in rankings of cause of death. Martin Makary and Michael Daniel assess its contribution to mortality and call for better reporting.

 

BMJ 2016;353:i2139

Posted in Hot Topics in Research, June, Research Commentary

ILLiad – InterLibrary Loan

Can’t find the full-text journal article in one of our many collections? The PCOM Library is proud to announce  24/7 delivery for articles with this new update for ILLiad!

ILLiad is the electronic system that allows PCOM faculty, students, and staff to request articles, books and book chapters not owned or licensed by the PCOM Library.

ILLiad improves service for students, faculty, and staff by giving them the ability to initiate and track their Interlibrary Loan requests every step of the way through a personal ILLiad account.

24/7 delivery of electronic articles direct to your desktop!

First time users will now need to create an account before accessing ILLiad. If you have already created an ILLiad account, this update will not affect you.

More information can be found on our Interlibrary Loan page as well as our ILLiad FAQ.

Contact us if you have any questions.

Posted in Front Page, Library News, New Resources

New Shelf Exams at Board Vitals

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​The National Board of Medical Examiners (NBME) Shelf Exams are now available to all current PCOM students and faculty. These test prep resources make it easier to comprehend the materials you’ll need to know to pass your exam. Simply sign up for any one of the exams, as well as study tips. The shelf exams are divided into 7 specific practice categories:

  • Neurology
  • OBGYN
  • Family medicine
  • Pediatrics
  • Internal medicine
  • Surgery
  • Psychiatry
Posted in Front Page, Library News, New Resources

Risk literacy in medical decision-making

Risk literacy in medical decision-making – How can we better represent the statistical structure of risk?

Imagine that you have received a positive result on a routine cancer screening test. Follow-up biopsies were inconclusive, and the decision to treat aggressively or monitor conservatively is yours. Consider the following information: 0.1% of the population has a terminal version of this form of cancer, 99% of those people will appear positive on the test you have been administered, and 5% of those without terminal cancer will still have a benign condition that tests positive. Given your test result, what is the probability that you have terminal cancer and should treat it aggressively? When judging risks and trying to predict the future, how should you decide? We need to better understand the structure of risks and how the human mind creates representations of risk and probability.

 

Posted in Hot Topics in Research, May, Research Commentary

Dietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease

Dietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease

Objectives To determine whether dietary pattern assessed by a simple self-administered food frequency questionnaire is associated with major adverse cardiovascular events (MACE) in high-risk patients with stable coronary artery disease.

Background A Mediterranean dietary pattern has been associated with lower cardiovascular (CV) mortality. It is less certain whether foods common in western diets are associated with CV risk.

Methods At baseline, 15 482 (97.8%) patients (mean age 67 ± 9 years) with stable coronary heart disease from 39 countries who participated in the Stabilisation of atherosclerotic plaque by initiation of darapladib therapy (STABILITY) trial completed a life style questionnaire which included questions on common foods. A Mediterranean diet score (MDS) was calculated for increasing consumption of whole grains, fruits, vegetables, legumes, fish, and alcohol, and for less meat, and a ‘Western diet score’ (WDS) for increasing consumption of refined grains, sweets and deserts, sugared drinks, and deep fried foods. A multi-variable Cox proportional hazards models assessed associations between MDS or WDS and MACE, defined as CV death, non-fatal myocardial infarction, or non-fatal stroke.

Results After a median follow-up of 3.7 years MACE occurred in 7.3% of 2885 subjects with an MDS ≥15, 10.5% of 4018 subjects with an MDS of 13–14, and 10.8% of 8579 subjects with an MDS ≤12. A one unit increase in MDS >12 was associated with lower MACE after adjusting for all covariates (+1 category HR 0.95, 95% CI 0.91, 0.98, P = 0.002). There was no association between WDS (adjusted model +1 category HR 0.99, 95% CI 0.97, 1.01) and MACE.

Conclusion Greater consumption of healthy foods may be more important for secondary prevention of coronary artery disease than avoidance of less healthy foods typical of Western diets.

 

 

Ralph A. H. Stewart1*, Lars Wallentin2, Jocelyne Benatar1, Nicolas Danchin3, Emil Hagstro¨m2, Claes Held2, Steen Husted4, Eva Lonn5, Amanda Stebbins6, Karen Chiswell6, Ola Vedin2, David Watson7, and Harvey D. White

Posted in Cardiology, coronary artery disease, Hot Topics in Research, May

Pioglitazone after Ischemic Stroke or Transient Ischemic Attack

Pioglitazone after Ischemic Stroke or Transient Ischemic Attack

BACKGROUND Patients with ischemic stroke or transient ischemic attack (TIA) are at increased risk for future cardiovascular events despite current preventive therapies. The identification of insulin resistance as a risk factor for stroke and myocardial infarction raised the possibility that pioglitazone, which improves insulin sensitivity, might benefit patients with cerebrovascular disease.

METHODS In this multicenter, double-blind trial, we randomly assigned 3876 patients who had had a recent ischemic stroke or TIA to receive either pioglitazone (target dose, 45 mg daily) or placebo. Eligible patients did not have diabetes but were found to have insulin resistance on the basis of a score of more than 3.0 on the homeostasis model assessment of insulin resistance (HOMA-IR) index. The primary outcome was fatal or nonfatal stroke or myocardial infarction.

RESULTS By 4.8 years, a primary outcome had occurred in 175 of 1939 patients (9.0%) in the pioglitazone group and in 228 of 1937 (11.8%) in the placebo group (hazard ratio in the pioglitazone group, 0.76; 95% confidence interval [CI], 0.62 to 0.93; P=0.007). Diabetes developed in 73 patients (3.8%) and 149 patients (7.7%), respectively (hazard ratio, 0.48; 95% CI, 0.33 to 0.69; P<0.001). There was no significant between-group difference in all-cause mortality (hazard ratio, 0.93; 95% CI, 0.73 to 1.17; P=0.52). Pioglitazone was associated with a greater frequency of weight gain exceeding 4.5 kg than was placebo (52.2% vs. 33.7%, P<0.001), edema (35.6% vs. 24.9%, P<0.001), and bone fracture requiring surgery or hospitalization (5.1% vs. 3.2%, P=0.003).

CONCLUSIONS In this trial involving patients without diabetes who had insulin resistance along with a recent history of ischemic stroke or TIA, the risk of stroke or myocardial infarction was lower among patients who received pioglitazone than among those who received placebo. Pioglitazone was also associated with a lower risk of diabetes but with higher risks of weight gain, edema, and fracture. (Funded by the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00091949.)

 

W.N. Kernan, C.M. Viscoli, K.L. Furie, L.H. Young, S.E. Inzucchi, M. Gorman, P.D. Guarino, A.M. Lovejoy, P.N. Peduzzi, R. Conwit, L.M. Brass,* G.G. Schwartz, H.P. Adams, Jr., L. Berger, A. Carolei, W. Clark, B. Coull, G.A. Ford, D. Kleindorfer, J.R. O’Leary, M.W. Parsons, P. Ringleb, S. Sen, J.D. Spence, D. Tanne, D. Wang, and T.R. Winder

 

N Engl J Med 2016;374:1321-31. DOI: 10.1056/NEJMoa1506930 Copyright © 2016 Massachusetts Medical Society

Posted in Cardiology, Hot Topics in Research, May

10 top patient safety issues for 2016

10 top patient safety issues for 2016

Healthcare has no doubt made giant strides in patient safety in recent years: According to an HHS report released in December, hospital-acquired condition rates dropped 17 percent from 2010 to 2014, leading to 87,000 fewer patient deaths in hospitals.

 

Becker’s Hospital Review,  January 12, 2016

Shannon Barnet, Max Green and Heather Punke

Posted in Hot Topics in Research, May, Research Commentary

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