Margaret MacDougall1, Liu Zhaobo2

1. Centre for Population Health Sciences, University of Edinburgh Medical School (Margaret.MacDougall@ed.ac.uk) 2. undergraduate medical student, University of Edinburgh

The principal aim of this summer vacation project was to use the University of Edinburgh (UoE) Central Wiki System to create a readily accessible and updatable Wiki for use by medical students and clinicians on an international scale. This Wiki should enhance efficiency in clinical decision making and patient risk assessment within a wide range of contexts pertaining to cardiovascular medicine and surgery.

 This is being achieved through:

•use of a comprehensive literature review and a survey of the perspectives of clinical specialists at the UoE to identify the most contemporary and frequently used health measurement scales and their relative effectiveness; •use of a Wiki system to highlight the findings from the above enquiry, deficits in provision of suitable measurement scales and the associated opportunities for research in these areas;

•dissemination of project output internationally through the Higher Education Academy (HEA), the Association for the study of Medical Education (ASME) and MedEdWorld websites and mailing lists, so as to encourage use of and contribution to the existing Wiki content by Health Sciences professionals.

Cardiovascular health measure scales is a rapidly expanding field and challenging to research. Key factors in this respect are the lack of consistency and clarity in the presentation of validation procedures and the conflicting findings of the associated validation studies. There is some confusion in the literature about the naming of the scales. This is especially true for the Framingham cardiovascular scale, which in reality, encompasses a variety of scales, formulated using distinct algorithms and predicting risk for different endpoints. These scales were developed within different time periods and even the oldest of these are still in use or recommended by guidelines.

Relevant validation studies around the world often draw conflicting conclusions. Few studies converge to the same conclusion and when they do, the conclusion is often that the scale needs to be re-calibrated or that there is a call for a new scale to be developed that will hopefully surpass its predecessors in terms of generalizability. Even today, a new predictive scale is being developed by the Joint British Societies in anticipation that it will set the benchmark for primary preventionof cardiovascular disease. In 2010, NICE ceased recommending any single risk assessment scale for the primary prevention of cardiovascular diseases due to the lack of evidence that the previously recommended Framingham scale was more predictive than other existing scales. This has left clinicians requiring to determine for themselves which scale is appropriate when assessing their patients. Despite the huge amount of prospective validation studies conducted to evaluate the relative predictive abilities of these scales, such studies typically target unique population profiles. As patients come from different socioeconomic, ethnic and medical backgrounds, clinicians may often find that none of these validation studies address the particular type of profile that suits their patient. Thus, new scales are constantly being developed in the field of cardiovascular primary prevention due to the lack of evidence that any one is able to function effectively for clinicians across a range of contexts. The difficulties of obtaining concrete validation evidence for these scales has also led to them being under-utilised by clinicians.

Such findings contribute considerable weight to the need for offering relevant content in a readily accessible and updatable form and on an international scale.

• the influence of technological changes on undergraduate research

• undergraduate research generating transformative learning

Council for Undergraduate Research (CUR)workshop themes

Although the project has been fine-tuned to target risk assessment scales for primary prevention, the Wiki has also been constructed for additional categories of cardiovascular health measurement scales. Areas where other interested parties should contribute to the Wiki are identified and pointers are displayed throughout the Wiki to encourage contributions once the Wiki is launched internationally.

Furthermore, this Wiki is intended to serve as a child Wiki to a much more general Health Measurement Scales Wiki and therefore, there is a wealth of opportunities available for student projects in Wiki design aimed at meeting similar needs in alternative clinical fields where health measurements have a role to play in clinical evaluation and decision making. This includes such diverse areas as orthopaedic surgery, mental health testing and diabetes-specific quality of life assessment.

This Wiki explicitly links a wide range of validated scales for primary prevention to the corresponding literature for further reading. Recommendations for future research and comprehensive information regarding each of the scales are also provided. It is anticipated that the current version of the Wiki will help clinicians make informed choices in the use of these scales and direct them towards future research needs.

Recognizing the need for greater clarity in consolidating published findings, a timeline is provided to represent the developmental stages of the Framingham cardiovascular risk assessment scales so that Wiki participants will be able to appreciate the wide variety of these scales that is available.

By means of the Wiki, an attempt has been made to make the findings of relevant studies much more accessible by means of an easy-to-read table format with links to relevant literature. This is with the intention that future clinical researchers and practitioners will more informatively and efficiently evaluate the potentially overwhelming range of validation results that are available prior to choosing the optimal one for their needs in research or clinical practise.

Aim

Methods

Key findings

Existing project output in response to findings

Opportunities for collaboration in Wiki design

Cardiovascular health measurement scales at our finger-tips: improving the efficiency of clinical decision-making through a futuristic Wiki