Wednesday, 21 June 2017

World Sickle Cell Day

Better late than not at all... 

Monday 19th June was World Sickle Cell Day and our local CLAHRC has been conducting a survey, which found that a greater awareness of sickle cell disease would improve patients' experience, and that staff in emergency settings had a relatively poor knowledge.

They have produced an infographic.

To improve your clinicians' and practitioners' knowledge, here are some resources:


Professor Simon Dyson, De Montfort University,  especially the Resources and Information page, which lists UK organisations and resources for schools.  Professor Dyson has also produced some open educational resources.

Rest of the UK

Clinical Knowledge Summaries for an evidence based summary.

HealthTalk for patient experiences of screening.

NHS Choices for an overview and links to other NHS resources.

NICE material is included in the set relating to blood conditions - a clinical guideline (CG143) and a quality standard (QS58)

Sickle Cell Society - UK based patient support organisation

Rest of the world

emDOCS - The sickle cell patient: ED management of acute complications.   Detailed discussion from this US based emergency medicine blog.  

Life in the Fast Lane (LITFL) - Sickle cell crisis.  Another blog for emergency medicine and critical care, based in Australia and New Zealand.

MedGen for everything genetic.

Wednesday, 14 June 2017

Bicuspid aortic valve - Medline search strategy

The aortic valve should have three "leaflets", so is "tricuspid".    Sometimes it has only two, because two are fused together, and then it is "bicuspid".

Bicuspid aortic valve (BAV) is a congenital condition.  It is linked to aortic aneurysms.

How to find literature about BAV?

There is no MeSH term for bicuspid aortic valve, although there is a "supplementary concept" Bicuspid aortic valve.  This is searchable in PubMed as [Supplementary Concept], but as far as I can work out, is not searched or searchable in HDAS.

In PubMed, the freetext term "bicuspid aortic valve" maps to the supplementary concept.

So is it enough to rely just on the phrase "bicuspid aortic valve(s)"?   I think not, because: 

a) I have seen phrases like "bicuspid and tricuspid aortic valve" and "bicuspid aortopathy".  The latter, I think, relates to the aorta, not the valve, but the aorta as it is affected by the valve.  

b) Perhaps there is literature where BAV is indexed under Heart Defects, Congenital/ and a MeSH term relating to the aortic valve but where phrases describing BAV itself are not used.

I was working on a search about fusion patterns in BAV, that is, which leaflet is joined to which, and that gave me some more terms.

So, taking all that into account, here is my draft of a search strategy for Medline via HDAS:

1. ("bicuspid aort*").ti,ab
2. (BAV).ti,ab
5. exp "AORTIC VALVE STENOSIS"/         
8. (fusion OR fused OR fusing OR morphol* OR morphotyp* OR phenotyp* OR habitus OR raphe).ti,ab
9. ("right noncoronary" OR "left noncoronary" OR "right left" OR "left right").ti,ab
10. ((left OR right) ADJ2 "non coronary").ti,ab
11. (classif* OR pattern* OR commissur*).ti,ab
12. 1 OR 2
13. (3 OR 4 OR 5) AND 6
14. 3 AND 7
15. (8 OR 9 OR 10 OR 11)
16. ("aortic valve*").ti,ab
17. (3 AND 15)
18. (15 AND 16)

19. (12 OR 13 OR 14 OR 17 OR 18)

Lines 3 - 7 are an attempt to capture the way BAV is indexed in the absence of a single MeSH heading.

Lines 8 - 11 describe the fusion patterns and other features of a BAV, although some words are possibly too general ("pattern" for example could be referring to something else, not the valve).

On 14th June 2017, line 1 found 2454, line 19 found 12693.    How many of these extra ones are relevant, but not found in set 1 or 2, is not clear.


12 or 13 or 14 

would be enough (this finds 9939).

All of this, of course needs, testing.  

Perhaps which strategy you use (assuming you think it worth using!) would depend why you are searching, and if there were other aspects to the search, it may matter less.