Trip Database Blog

I’ve been thinking how useful all the new content added – each month – to TRIP is.  We typically add between 400-700 articles each month manually (these are typically secondary evidence type articles), of these about 60% are recent publications and the rest from previous years.  In addition to this manual update we typically add around 3-5,000 new articles automatically (via various mechanisms). 

I typically view the manually added content as being the ‘best stuff’!  So, can we use this ‘best stuff’ in a meaningful way?  I believe so, but have no idea how!  Identifying it’s easy – displaying it is more problematic.  So, in an effort to help me understand the issues I’ve decided to experiment!  Therefore, I’ve taken March’s new content and extract all recent articles that relate to cardiology – 52 in total.  And below is my first effort at presenting them in a structured form (it’s a pragmatic structure – if that’s not obvious!) – please let me know what you think!

Lipids

• Mipomersen – Familial hypercholesterolemia – third or fourth line (National Horizan Scanning Centre)
• Rosuvastatin and the JUPITER trial. A critical appraisal (DTB, Navarre)
• Continue to follow NICE guidance when prescribing statins (NPC)
• Ezetimibe/simvastatin may reduce CV events in advanced CKD: but is it better than simvastatin alone? (NPC)
• Limited observational evidence for CV risk reduction with exenatide (NPC)
• Managing lipids (National Prescribing Service)
• Protection Against Nephropathy in Diabetes with Atorvastatin (PANDA): a randomized double-blind placebo-controlled trial of high- vs. low-dose atorvastatin (Evidence Updates)
• The cost-effectiveness of C-reactive protein testing and rosuvastatin treatment for patients with normal cholesterol levels (Evidence Updates)

Stroke

• Prognostic Risk Stratification Instruments for TIA (Washington University Emergency Medicine Journal Club)
• Elevation of serum magnesium may improve clinical outcome after aneursymal subarachnoid haemorrhage (BestBETs)
• Current evidence does not support the use of a negative D-dimer to rule out suspected pulmonary embolism in pregnancy (BestBETs)
• Stroke Prevention in the Setting of a Patent Foramen Ovale: A “Hole” in the Evidence (Clinical Correlations)
• Neurothrombectomy devices for the treatment of acute ischemic stroke: state of the evidence (DARE)
• An assessment of the incremental value of the ABCD2 score in the emergency department evaluation of transient ischemic attack (Evidence Updates)
• Computed tomographic angiography and venography for young or nonhypertensive patients with acute spontaneous intracerebral hemorrhage (Evidence Updates)
• Association between obesity and mortality after acute first-ever stroke: the obesity-stroke paradox (Evidence Updates)
• Very early mobilization after stroke fast-tracks return to walking: further results from the phase II AVERT randomized controlled trial (Evidence Updates)
• The safety of proton pump inhibitors and clopidogrel in patients after stroke (Evidence Updates)
• iScore: A Risk Score to Predict Death Early After Hospitalization for an Acute Ischemic Stroke (Evidence Updates)

Myocardial Infarcation

• Long-term effects of an expanded cardiac rehabilitation programme after myocardial infarction or coronary artery bypass surgery: a five-year follow-up of a randomized controlled study (Evidence Updates)
• High-dose tirofiban pretreatment reduces the need for bail-out study medication in patients with ST-segment elevation myocardial infarction: results of a subgroup analysis of the On-TIME 2 trial (Evidence Updates)
• Comparison of thrombolysis in myocardial infarction, Global Registry of Acute Coronary Events, and Acute Physiology and Chronic Health Evaluation II risk scores in patients with acute myocardial infarction who require mechanical ventilation for more than 24 hours (Evidence Updates)
• Clinical Events as a Function of Proton Pump Inhibitor Use, Clopidogrel Use, and Cytochrome P450 2C19 Genotype in a Large Nationwide Cohort of Acute Myocardial Infarction (Evidence Updates)
• With the “universal definition,“ measurement of creatine kinase-myocardial band rather than troponin allows more accurate diagnosis of periprocedural necrosis and infarction after coronary intervention (Evidence Updates)

CV Risk

• Renin-angiotensin system blockade and cognitive function in patients at high risk of cardiovascular disease: analysis of data from the ONTARGET and TRANSCEND studies (Evidence Updates)
• Antidepressant medication use and future risk of cardiovascular disease: the Scottish Health Survey (Evidence Updates)
• Cost-Utility of Aspirin and Proton Pump Inhibitors for Primary Prevention (Evidence Updates)

Clinical Rules

• Prognostic Risk Stratification Instruments for TIA (Washington University Emergency Medicine Journal Club)
• An assessment of the incremental value of the ABCD2 score in the emergency department evaluation of transient ischemic attack (Evidence Updates)
• The Randomised Assessment of Treatment using Panel Assay of Cardiac Markers (RATPAC) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department (Evidence Updates)
• Comparing the diagnostic performance of 2 clinical decision rules to rule out deep vein thrombosis in primary care patients (Evidence Updates)
• Genetic warfarin dosing tables versus algorithms (Evidence Updates)
• Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization (Evidence Updates)
• The cost-effectiveness of C-reactive protein testing and rosuvastatin treatment for patients with

Surgery

• Impact of clopidogrel loading dose on clinical outcome in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis (Evidence Updates)
• Comparison of impact of mortality risk on the survival benefit of primary percutaneous coronary intervention versus facilitated percutaneous coronary intervention (Evidence Updates)
• Predictive accuracy of SYNTAX score for predicting long-term outcomes of unprotected left main coronary artery revascularization (Evidence Updates)
• Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis (Evidence Updates)
• Effect of Timing of Chronic Preoperative Aspirin Discontinuation on Morbidity and Mortality in Coronary Artery Bypass Surgery (Evidence Updates)
• MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) Trial (Evidence Updates)
• Thoracic epidural anesthesia for cardiac surgery: a randomized trial (Evidence Updates)

Other

• Sildenafil (Revatio) IV – for the treatment of patients with pulmonary arterial hypertension who are currently prescribed oral sildenafil and who are temporarily unable to take oral medicine (SMC)
• Estimating lifetime cardiovascular risk – we can, but should we? (NPC)
• Using low molecular weight heparin (LMWH) (WeMeReC)
• Haematological interventions for treating disseminated intravascular coagulation during pregnancy and postpartum (Cochrane)
• Evaluation of the diagnostic and prognostic value of plasma D-dimer for abdominal aortic aneurysm (Evidence Updates)
• Preoperative high-dose atorvastatin for prevention of atrial fibrillation after cardiac surgery: a randomized controlled trial (Evidence Updates)
• Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial (Evidence Updates)
• Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality (Evidence Updates)
• Effect of adding pharmacists to primary care teams on blood pressure control in patients with type 2 diabetes: a randomized controlled trial (Evidence Updates)
• Six-month exercise training program to treat post-thrombotic syndrome: a randomized controlled two-centre trial (Evidence Updates)
• Trimetazidine: a meta-analysis of randomised controlled trials in heart failure (Evidence Updates)
• Early activation of intracranial collateral vessels influences the outcome of spontaneous internal carotid artery dissection (Evidence Updates)
• Minimized cardiopulmonary bypass reduces retinal microembolization: a randomized clinical study using fluorescein angiography (Evidence Updates)
• Effects of n-3 Polyunsaturated Fatty Acids on Left Ventricular Function and Functional Capacity in Patients With Dilated Cardiomyopathy (Evidence Updates)
• Screening for atrial fibrillation: sensitivity and specificity of a new methodology (Evidence Updates)

This is such an crucial video NICE guidance. Is it inaccessible? It’s been produced by a general practitioner from South Wales (Anne Marie Cunningham).  Although Anne Marie focuses on NICE guidance the issues affect other guidelines and many other sources of evidence.

The challenges Anne Marie raise are important and people interested in EBM/EBHC/EBP need to understand the problems front-line clinicians face. When Anne Marie can get the information she needs quickly and with little effort we’ll be in a better place.

However, we’re miles away from there and the challenges are daunting!

Each month we add add content via two main ways:

• Automatically – this uses various mechanisms (e.g. RSS)
• Manually – I go and look at various sites, typically those dealing with secondary evidence and grab any new content.

For this month (March 2011) I’ve just uploaded the monthly manual content.  This consisted of approximately four hundred articles dated 2011 and four hundred from 2010 (or earlier).  As I’m looking at ways of allowing users to more easily view new content I’ve experimented with a wordcloud using Wordle.  As many people have trouble viewing these I’ve embedded a screen grab below. To view it as large size you’ll need to click on it.

NOTE: I’ve edited the words (taken from the document titles only) to exclude certain non-clinical terms (e.g. trial, versus, randomized).

We’ve just had our 16,000 registered user of TRIP, that’s 1,000 new registrants in 3 weeks.

Our 16,000 user was a student from Fiji!

Here are a few recent Facebook posts (to see our full Facebook page click here).  Remember, the Facebook posts are typically small posts that are perhaps not ‘worthy’ of a blog post (but feel free to contradict me!)

• The BNF is now live on the TRIP Database (February 12th)
• Just about to add 300+ clinical guidelines from the Australian guidelines portal (February 15th)
• Just added records from two sites aimed at undergraduate medical students: Almostadoctor & MediVids (February 17th)
• Highlighted how good TILT was at highlighting significant new research (February 25th)
• Work on updating the systematic review filter that auto-searches PubMed (February 28th)
• Reported on the positive response to a training session I ran for a NHS organisation and offering to run more courses – just ask (March 2nd)
• I’m looking to introduce OpenURL into TRIP and gradually understanding the issues/complexity (March 3rd)
• Exploring hooking TRIP up to Google Translate (e.g. Spanish & Welsh) (March 7th)

We’ve been busy!