Levy Library Blog

Each month Levy Library showcases the achievements of Mount Sinai faculty and researchers by highlighting an article and its altmetrics. Altmetrics are alternative measures of impact that capture non-traditional data like abstract views, article downloads, and social media activity. Our altmetrics data is provided by the PlumX platform. 

This month we highlight Outcomes of Neonates Born to Mothers with Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City. This article was written in part by Dani Dumitriu MD, PhD and Melissa E Glassman MD.

Importance 

Limited data on vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and health outcomes of neonates born to mothers with symptomatic or asymptomatic coronavirus disease 2019 (COVID-19) are available. Studies are needed to inform evidence-based infection prevention and control (IP&C) policies.

Objective

To describe the outcomes of neonates born to mothers with perinatal SARS-CoV-2 infection and the IP&C practices associated with these outcomes.

Design, Setting, and Participants

This retrospective cohort analysis reviewed the medical records for maternal and newborn data for all 101 neonates born to 100 mothers positive for or with suspected SARS-CoV-2 infection from March 13 to April 24, 2020. Testing for SARS-CoV-2 was performed using Cobas (Roche Diagnostics) or Xpert Xpress (Cepheid) assays. Newborns were admitted to well-baby nurseries (WBNs) (82 infants) and neonatal intensive care units (NICUs) (19 infants) in 2 affiliate hospitals at a large academic medical center in New York, New York. Newborns from the WBNs roomed-in with their mothers, who were required to wear masks. Direct breastfeeding after appropriate hygiene was encouraged.

Exposures 

Perinatal exposure to maternal asymptomatic/mild vs severe/critical COVID-19.

Main Outcomes and Measures

The primary outcome was newborn SARS-CoV-2 testing results. Maternal COVID-19 status was classified as asymptomatic/mildly symptomatic vs severe/critical. Newborn characteristics and clinical courses were compared across maternal COVID-19 severity.

Results

In total, 141 tests were obtained from 101 newborns (54 girls [53.5%]) on 0 to 25 days of life (DOL-0 to DOL-25) (median, DOL-1; interquartile range [IQR], DOL-1 to DOL-3). Two newborns had indeterminate test results, indicative of low viral load (2.0%; 95% CI, 0.2%-7.0%); 1 newborn never underwent retesting but remained well on follow-up, and the other had negative results on retesting. Maternal severe/critical COVID-19 was associated with newborns born approximately 1 week earlier (median gestational age, 37.9 [IQR, 37.1-38.4] vs 39.1 [IQR, 38.3-40.2] weeks; P = .02) and at increased risk of requiring phototherapy (3 of 10 [30.0%] vs 6 of 91 [7.0%]; P = .04) compared with newborns of mothers with asymptomatic/mild COVID-19. Fifty-five newborns were followed up in a new COVID-19 Newborn Follow-up Clinic at DOL-3 to DOL-10 and remained well. Twenty of these newborns plus 3 newborns followed up elsewhere had 32 nonroutine encounters documented at DOL-3 to DOL-25, and none had evidence of SARS-CoV-2 infection, including 6 with negative retesting results.

Conclusions and Relevance 

No clinical evidence of vertical transmission was identified in 101 newborns of mothers positive for or with suspected SARS-CoV-2 infection, despite most newborns rooming-in and direct breastfeeding practices.

View the PlumX article profile 

Gali Halevi, MLS, PhD

Associate Dean of Libraries and Information Sciences

I am a well-known documentaries enthusiast. I find them to be informative and insightful. The main streaming channels like Netflix, Hulu, Amazon and others have plenty to offer but they each require a subscription. Lately, I began to look for documentaries that are legally free to watch and do not infringe on copyrights and found a few good options. 

A simple Google search for “free documentaries” has a curated list of documentaries organized by topics. Each movie option lists all the channels where it is available to watch, including those that are free of charge:

Top Documentaries Films has a vast collection of free-to-watch documentaries. Organized by topics, this site makes it easy to browse which films are new or most popular:

Documentary Heaven has a big collection of free documentaries that are free to watch. Also organized by category and rankings, this easy-to-navigate site will help you find your next documentary to watch:

Finally, Documentary Tube includes a wide variety of full-length documentaries covering twenty-two categories:

What's your favorite documentary available for free? Let us know on Twitter! 

Chelsea Rein, BS, MLIS

Reference and Instruction Librarian, Phillips School of Nursing at Mount Sinai

There are many online resources where nursing professionals can find evidence-based practice information. Evidence-based practice (EBP), known as “judicious use of current best evidence in conjunction with clinical expertise and patient values” is an instrument of great utility in nursing care, helping to reduce both cost and variability in clinical practice. ^1,2 Evidence-based Nursing (EBN) integrates best evidence available, nursing expertise, and preferences of individuals, families, and communities in a holistic care model that broadly encompasses patient preferences as well as effectiveness of treatment. EBN is often a five-step systematic process including: asking the clinical question, evidence acquisition, evidence appraisal, evidence-application, and outcome evaluation. ³  It is also known as a 5-step model - Assess, Ask, Acquire, Appraise, and Apply. ⁴

Asking the Clinical Question:

The first step of the evidence-based nursing process involves taking the clinical issue under consideration and formulating it into a searchable and answerable question. ⁵ The model which is frequently used for this part of the process is termed “PICO,” containing the following components: 

• P – Patient or Population or Problem

• I – Intervention of Interest, Proposed Intervention

• C – Comparison or Control, (there might be no Intervention)

• Outcome (Anticipated) 

Also may be included:

• T – Type of Question (Diagnosis, Prognosis, Therapy etc.) 

• T – Type of Study Design (RCT, Cohort Study, Case Series etc.)

• Time 

Example: In POPULATION does INTERVENTION as compared to COMPARISON/CONTROL result in OUTCOME?⁵

In adult patients hospitalized in a long-term acute care facility (P), how does the use of a nurse-driven protocol for evaluating the appropriateness of short-term urethral catheter continuation or removal (I), compared with no protocol (C), affect the number of catheter-days (O1) and CAUTI rates (O2) over a six-month post-intervention period (T)? ⁶

Internet Resources for Creating a Well-Built Clinical Question:

• Duke University Medical Center Library and Archives - Evidence-Based Practice: PICO 

• Icahn School of Medicine at Mount Sinai Levy Library – PICO and the Question Statement 

• Yale University Harvey Cushing/John Hay Whitney Medical Library – Framing Questions with PICO

Evidence Acquisition: 

The hierarchy of evidence is a core principle of Evidence-Based Medicine. EBM hierarchies rank study types based on the strength and precision of the research methods done. Most experts consider well done systematic reviews, with or without meta-analysis, to provide the best evidence for all question types. If a current, well designed systematic review is not available, primary studies can sometimes answer a PICO question. ⁷

The type of PICO question will often dictate the best study design to address the question. For example, a suggested study for a PICO question based on a diagnosis could be a prospective, blind comparison to the gold standard, whereas a PICO question on a therapy intervention could be to use an RCT or Practice Guideline. The EBM Pyramid shown lists a variety of evidence types and levels. The quality of evidence is highest among filtered information and lowest among unfiltered information with degrees of evidence level. ⁸ 

Internet Resources for Evidence Acquisition:

• Icahn School of Medicine at Mount Sinai – Evidence Based Medicine Guide: What’s Best: The Evidence Hierarchy

• Sigma Repository – Browsing by Evidence 

• University of Michigan Library – Sources for Evidence Based Research – Hierarchy of Evidence

Databases – Finding Evidence: 

Using available databases, journals and point-of-care tools are good places to start while looking for evidence. Some databases have items available like evidence-based care sheets (CINAHL) or clinical content synthesized into graded evidence based recommendations (UptoDate). In PubMed, the Clinical Queries page allows you to enter one search query and launch two EBM filters: Clinical Study Categories and Systematic Reviews. Mount Sinai’s Levy Library provides access to a multitude of resources accessible online including databases, clinical mobile apps, e-journals, and e-books. 

Internet Resources for Finding Evidence: 

• Icahn School of Medicine at Mount Sinai Levy Library – Filtering PubMed for Best Evidence 

• Icahn School of Medicine at Mount Sinai Levy Library – Using MeSH to Find Evidence

• Icahn School of Medicine at Mount Sinai Levy Library – Databases A – Z 

• Icahn School of Medicine at Mount Sinai Levy Library – Journal Search 

Appraising Evidence: 

When appraising websites, some important criteria to consider include - authority, accuracy, bias, currency, and comprehension. ¹⁰

• Authority – is the author listed, domain (org, edu, com)?

• Accuracy – is the information reproducible? 

• Objectivity - are there any conflicts of interest? Are the goals and aims of the website clear? 

• Currency – when was the webpage updated? Are the links up to date?

• Coverage - can you view the information properly? ¹⁰ 

Critical appraisal worksheets can help guide evidence appraisal among different topics.

Internet Resources for Apprising Evidence:

• CASP Checklist – Critical Appraisal Skill Program 

• Duke University Medical Center Library and Archives – Evidence-Based Practice: Appraise 

• Duke University Medical Library and Archives – Teaching Table for Common Summary Articles 

• Evidence-Based Medicine Toolkit - Critical Appraisal Worksheets Logbook

• Icahn School of Medicine at Mount Sinai Levy Library – Appraise Evidence

Applying Evidence:

When you have asked your question, found the evidence, and critically appraised the evidence, it is time to implement that evidence. Implementation of evidence into practice may be challenging and usually involves working out how the results of your research apply to the patient, taking into consideration your own clinical expertise and the patient's situation and preferences. This is sometimes called the "external validity", or "generalizability" of the research results.¹¹

Questions to ask at this stage include:

• Is the intervention feasible in my setting?

• What else do I need to apply this evidence?

• Is my patient similar enough to the subjects of the study so that the results can apply?

• Will the potential benefits of treatment outweigh any potential harm?

• What are the views of my patient?¹¹

Internet Resources for Models of Evidence-Based Nursing Practice and Applying Evidence:

• Iowa Model of Evidence-Based Practice to Promote Quality Care 

• Johns Hopkins Nursing Evidence-Based Practice Model 

• Larabee Emerging Model of Quality

• PARiHS Framework for Putting Research Into Practice 

• Stetler Model of Evidence-Based Practice

Outcome Evaluation:

The final step involves Assessing or “Auditing” the research process. This involves evaluating the effectiveness and efficiency of the process and practice of evidence-based practice, identifying strengths and weaknesses and ways that it might be improved the next time.¹² 

Self-reflective questions that might be asked include:

• Did I ask a well-formulated clinical question?

• Did I consider the best sources of evidence for the type of clinical question?

• Have I searched the databases efficiently? 

• Did I use the hierarchy of evidence as my guide for the type of evidence that I should be searching for?

• Am I integrating critical appraisal? ¹²

Internet Resources for Outcome Evaluation:

• Cochran Audit and Feedback: Effects on Professional Practice and Patient Outcomes

• Evidence-Based Medicine Toolkit – EMB Calculators 

• Evidence-Based Medicine Toolkit – Self-Evaluation

Other Online Resources for EBM/EBN:

• AHRQ Clinical Guidelines and Recommendations

• American Association of Critical Care Nurses Clinical Resources

• American Journal of Nursing: Evidence-Based Practice Step-by-Step

• Duke University Medical Center Library and Archives: EBP Tutorial 

• Ichan School of Medicine at Mount Sinai Levy Library: Evidence Based Medicine Guide 

• Ichan School of Medicine at Mount Sinai Levy Library: Nursing Resources – Evidence Based Practice

• Phillips School of Nursing Information Commons: Evidence Based Medicine in Nursing 

• PubMed: Evidence-Based Practice Training

References

1. Titler MG. Translating research into practice. Considerations for critical care investigators. Critical care nursing clinics of North America. 2001;13 (4):587–604. Available from: https://icahn-mssm.primo.exlibrisgroup.com/discovery/openurl?institution=01MSSM_INST&vid=01MSSM_INST:DEFAULT&id=pmid:11778346&sid=Entrez:PubMed

2. McGinty J, Anderson G. Predictors of Physician Compliance With American Heart Association Guidelines for Acute Myocardial Infarction. Critical Care Nursing Quarterly. 2008; 31(2). Available from: https://journals.lww.com/ccnq/Fulltext/2008/04000/Predictors_of_Physician_Compliance_With_American.9.aspx

3. Honor L. Resource Guides: Evidence-Based Nursing: Available from: https://libraryguides.umassmed.edu/EBN/home

4. de Groot M, van der Wouden JM, van Hell EA, Nieweg MB. Evidence-based practice for individuals or groups: let’s make a difference. Perspect Med Educ. 2013 Sep;2(4):216–21.

5. Rein C. Levy Library Guides: Phillips School of Nursing Information Commons: PICO & Searching. Icahn School of Medicine at Mount Sinai. Available from: https://libguides.mssm.edu/PSON/PICO

6. Magers TL. Using evidence-based practice to reduce catheter-associated urinary tract infections. Am J Nurs. 2013 Jun;113(6):34–42; quiz 44, 43.

7. Pinotti R. Levy Library Guides: Evidence Based Medicine Guide: What’s Best: The Evidence Hierarchy. Icahn School of Medicine at Mount Sinai. Available from: https://libguides.mssm.edu/ebm/hierarchy

8. Cantrell S. LibGuides: Evidence-Based Practice: PICO. Available from: https://guides.mclibrary.duke.edu/ebm/pico

9. Saylor K. Research Guides: Nursing: Hierarchy of Evidence Resources. Available from: https://guides.lib.umich.edu/nursing/evidence 

10. Kapoun J. Teaching undergrads WEB evaluation: A guide for library instruction. College & Research Libraries News. 2020; 59 (7). Available from: https://crln.acrl.org/index.php/crlnews/article/view/23707/31079

11. Phillips R, Glasziou P. Evidence based practice: the practicalities of keeping abreast of clinical evidence while in training. Postgraduate Medical Journal. 2008; 84(995):450–3. 

12. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Effective Practice and Organisation of Care Group. Cochrane Database of Systematic Reviews. 2012. Available from: http://doi.wiley.com/10.1002/14651858.CD000259.pub3