Influenza

This updates an earlier post about "Australian" flu.

This Guardian story has some statistics in it and reports that the present outbreak is not just of the H3N2 "Australian" variant.

Here are some places to find out more about what is happening:

North West Ambulance Service NHS Trust Library and Knowledge Service has produced this guide to sources.

Public Health England has a page about seasonal flu, with links to information from the four nations of the UK, Europe generally and the WHO. 

Health Protection Scotland, in addition to the link from PHE, has a page about seasonal influenza for this season. 

Public Health England produce Weekly national flu reports, which include information on hospitalisations, vaccinations and include data from other nations of the UK.

For surveillance data, try PROMED-Mail or the WHO's FluNet.    PROMED-Mail covers all infectious diseases, including outbreaks affecting animals and plants, and FluNet, as the name suggests, covers just influenza.  

CIDRAP, from the University of Minnesota, is useful for information on outbreaks of influenza in the USA.   It also has a more global list of literature.

H3N2 influenza (Australian flu)

This post has been updated here.

Finding case reports

I searched PubMed for a rare topic and found 361 references.

Filtering to “case reports" left 197.

Of the 164 not tagged in this way, some do appear to be case reports, with titles involving phrases like “two cases”, “a rare case”.  (See below for a discussion about whether reports of more than one case are a “case report”!).

Why are these 164 not tagged?   A glance at the titles suggests some are case reports.  Some of these will be PubMed Central and some very new, so therefore not indexed.   What about the rest?  The publication type "Case Report" was first used in 2008, but then applied retrospectively back to 1966, although I wonder how consistently it was applied to older material.  

Of the 361, 73 have the word "case" in the title and 20 have “cases”.   Some of those are general articles (“associated malformations… in cases of…”) but some are definitely reporting actual cases.   76 have “cases” in the title or abstract, and some of those are definitely reporting actual cases, without mentioning that in the title.

43 have “case” or “cases” in the title, but are not indexed as Case Reports.  

Some of the items mentioning “case(s)” in the title or abstract could be case control or case series, rather than a case report.   A case series is “A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment.”  (NCI Dictionary of Cancer Terms).   There is a discussion of how this differs from a cohort study in this Annals of Internal Medicine article (subscription needed).   A case control study involves a control group.

I couldn’t find a search filter for case reports (if you know of one, please let me know!).   For HDAS,  

(case or cases).ti,ab may be enough, although that will also find case series and case control studies, as well as things which are nothing to do with specific cases.      

To be more specific, you could try my filter suggested below, although that will miss titles like “two cases”, “a new case”, “a case of”.

Does a case report have to be a single case?   BMJ Case Reports require prospective authors to contact the office if there are more than three cases. Oxford Medical Case Reports and European Heart Journal Case Reports don’t specify, but the latter uses the CARE reporting guideline, which seems to imply a “case report” is one single case.   And certainly cases presented to our Cardiology Education Meeting are single cases.

MeSH defines “Case Reports” as “Clinical presentations that may be followed by evaluative studies that eventually lead to a diagnosis”, which could mean one case or more.

If you don’t want to use just the word case(s), here is my possible filter, for HDAS Medline, with my search topic:

1          ("ectopia cordis").ti,ab            (340)
2          "ECTOPIA CORDIS"/    (108)
3          (1 OR 2)           (355)
4          ((case OR cases) ADJ2 (report OR review)).ti,ab       (533,996)
5          ("Case Reports").pt     (1,857,467)
6          (4 OR 5)           (2,020,257)
 7         (3 AND 6)        (229)
 8         (3 AND 5)        (197)

Changing set 4 to (case or cases).ti,ab makes set 4 3,015,101 but set 7 275.

Why that topic?   Read more about Vanellope Hope Wilkins in the Leicester Mercury (she and her parents have featured in many other media outlets too).    

The HDAS search was run on 22nd December 2017 and all the links worked on that date.

NOACs and DOACs - a search strategy

Newer anticoagulant drugs, alternatives to warfarin, are a frequent talking point at Cardiology meetings, and I am making links with our Anticoagulation Service, which also needs to know about them.

These drugs are referred to as "novel (or new) oral anticoagulants" or NOACs, or "direct (or direct acting) oral anticoagulants", or DOACs.  They are, as I have heard pointed out, not so "new", now.

But how to find literature about them?   Some literature will of course use these phrases, but some will refer to specific drugs.    I have come up with:

MEDLINE

1.  doac* OR noac*).ti,ab 

2. DABIGATRAN/ OR "FACTOR XA INHIBITORS"/ OR ANTITHROMBINS/      

3. ((direct OR novel) ADJ2 "oral anticoagulant*").ti,ab

4.  “Direct thrombin inhibitor*”

5.  “factor xa inhibitor*” or “fxa inhibitor*”

6.  (dabigatran OR rivaroxaban OR apixaban OR edoxaban OR ximelagatran OR “fondaparinux sodium” OR bivalirudin OR argatroban OR angiox OR pradaxa OR xarelto OR eliquis OR Arixtra OR exembol).ti,ab             

7.  1 OR 2 OR 3 OR 4 OR 5 OR 6)     

EMBASE

1.  (doac* OR noac*).ti,ab 

2.  exp "BLOOD CLOTTING FACTOR 10A INHIBITOR"/ OR exp "THROMBIN INHIBITOR"/

3.  ((direct OR novel) ADJ2 "oral anticoagulant*").ti,ab

4.  “Direct thrombin inhibitor*”

5.  “factor xa inhibitor*” or “fxa inhibitor*”

6.  (dabigatran OR rivaroxaban OR apixaban OR edoxaban OR ximelagatran OR “fondaparinux sodium” OR bivalirudin OR argatroban OR angiox OR pradaxa OR xarelto OR eliquis OR Arixtra OR exembol).ti,ab             

7.  (1 OR 2 OR 3 OR 4 OR 5 OR 6)      

A PowerPoint from Imperial College Healthcare NHS Trust, called To DOAC or not to DOAC (Googling the title finds it!), provided three names (dabigatran, rivaroxaban, apixaban).  I added more names from the BNF.    Embase's indexing is extremely thorough, with a lot more individual drug names which I have not included in the free text search.

This post from Life in the Fast Lane explains some things about the names (as well as looking at the agents from a critical care perspective).

And this article from the Journal of Thrombosis and Haemostasis (subscription required) discusses recommendations for nomenclature.

East Midlands Congenital Heart Centre - adding research to a campaign

Our Congenital Heart Centre, at Glenfield Hospital, was scheduled to close, following a proposal from NHS England to decommission services.  Other centres in England were affected by the proposals too.

Following a big local campaign, a synergy of Trust board, communications staff, doctors and nurses, patients, support groups, local MPs, the press and the local community, the Trust presented alternative proposals to NHS England, and last week at a board meeting, NHS England announced that EMCHC would remain open.   

Some agenda items got a lot of national publicity, so many watched the live feed for those.  But we, and colleagues elsewhere too were watching it for this particular item. 

What has this to do with Clinical Librarians?

Well, I set up a weekly Medline alert to look for research articles discussing complications of, and mortality following, congenital heart surgery, and looking for articles using audit or registry data.  I wanted to make sure colleagues knew of any new research that might be useful to our alternative proposals.   The alert went straight to senior clinicians and the project manager, but also to me so I could check the search was finding what I had in mind, and so I could check for things I thought would be worth reading in full.   

UHL's press release about the announcement.

More about the Centre, including press releases and information from the campaign.

Lyme disease - some resources

Lyme disease, first identified in the town of that name in Connecticut in the 1970s, is a bacterial infection spread by ticks.   Lyme disease is mainly found (according to Fit For Travel) in Europe, North America and temperate areas of Asia.  The ticks pick up the infection from infected animals, then get attached to humans, who they bite.   Being bitten is a risk in wooded areas, moors and heaths.

It has been in the news in the UK lately following reports that Matt Dawson contracted it, was misdiagnosed, and had to undergo heart surgery.

Here are some resources about it, that you could bring to the attention of clinical colleagues who might encounter it (although those clinicians are perhaps more likely to be GPs).

Fit For Travel - travel health information from NHS Scotland. 

NHS Choices -  this also lists areas of England and Scotland reported to have a high population of ticks, and information on how to remove one.

Public Health England - includes information about diagnosis, signs and epidemiology, as well as a Factsheet about tick bite risks and prevention of disease.  Under diagnosis and treatment there is a suggested referral pathway for patients.

Outside the UK, there is:

CanLyme   

CDC  - a very comprehensive site.   This site also includes information about "Lyme carditis" .   

A PubMed search for lyme carditis will also search for lyme myocarditis, another name.   Any search of the literature also ought to take into account that Lyme disease (or its causative agent Borrelia burgdorferi) can cause heart block, pericarditis and heart failure!

Patient support groups include Lyme Disease UK, and Lyme Disease Action.

(Links were checked on 6th February 2018)

Pre International Clinical Librarian Conference Meal Opportunity and optional Orientation Walk

Coming to the International Clinical Librarian Conference or thinking of coming?

Then join us for a pre-Conference meal and start that your networking super early. On Wednesday 20^th of September, we will be going to Zizzi an Italian Restaurant on Belvoir Street in Leicester (for non Leicestershire people that’s pronounced Beaver! – weird but true). Just email sarah.sutton@uhl-tr.nhs.uk. if you are interested in joining us.

 We will be having a special set menu, with plenty of choices for £19.95.That way that everyone can have their own bill and we don’t have to hire a statistician to work out who had the deep fried camembert (that’s not on the menu, so sorry to fried cheese lovers amongst you).

The table(s) are booked for 7pm to allow those of you with jetlag to get to bed early and play catchup on your sleep. If anyone would like a city walking tour before the meal, meet Sarah at the restaurant at 6 pm and she will take you for a quick look at the highlights of Leicester’s City Centre. This walk is not suitable for those with mobility issues because of the time limitations, but those with such issues are welcome to contact Sarah for a slower paced tour earlier in the day.