MIMIC Frequently Asked Questions?

1. How do I do this project if I am a trainee?

Email Taimur Shah to register: taimur.shah@doctors.org.uk
You will need to provide your name, email, phone number, hospital and local lead consultant details. The first 20 sites to contact us to register will be included in the MIMIC study

The project will need to be registered as a service evaluation project with your local audit department. Please download the accompanying “Service evaluation registration” document which you can use as an aid in filling out your local forms. 

This work should fulfill your annual ARCP training program requirements of completing an audit/service evaluation.

2. I am a medical student can I still take part?

Yes, you can – You will also need a lead consultant as your supervisor and will also need to register this project with hospitals audit department prior to any data collection but may wish to involve a junior doctor (FY1 to SpR) to help.

3. How long will it take me to do this?

In the pilot, 50 patients took only 2 days worth of time to collect the data once the notes had been obtained. The time window for data collection is between 12th September 2016 – 7th December 2016. In this time period, you must register the project, order the notes (if necessary) and submit the data.

4. How many patients’ data will I need to collect and how?

Each site needs to collect data on a total of 50 patients.

Once registered you should identify 50 patients admitted with acute ureteric colic with proven single ureteric stone on CT KUB using either your electronic A&E admissions or PACS database.

All patients must have up to 6 months follow up so a good suggest starting time frame for identifying patients would be CT KUBs carried out 1 year prior to the date of data collection.

All patients must have had bloods taken when they presented with ureteric colic. A white blood cell count result is essential to allow inclusion.

Exclusion criteria include patients with renal colic caused by 2 or more stones in the ureter at the same time or patients with renal stones that are in the kidney and not the ureter or pelvic-ureteric junction

Please ensure that data entered is from the first presentation of that particular stone episode i.e. if a patient re-presents with colic - rather than collect data from this admission enter data from their initial admission.

Once you have identified these patients, if your A&E records are not available electronically then please request the hard copy notes (this is usually the slowest process so request them early on). Your audit department or Urology secretary can help here. The majority of the key data required for MIMIC is from electronic records so you can collect the electronically available data whilst waiting for the hard copy notes to arrive.

5. How will I collect the data?

When you register for MIMIC a log in and password will be sent out for an anonymous online database onto which all data should be entered. The link for the online database is: https://redcap.slms.ucl.ac.uk/

No patient identifiers are recorded in the online database but you should keep a key on your local secured NHS network, which allows you to identify which patients you have entered data for should you need to. You should not store any patient identifiable information on personal laptops/computers.

6. How do I get authorship on the paper? How much recognition will I get for my work?

All investigators who submit a data for 50 patients will be included in the authors/collaborator list. We intend for all authors/collaborators to be PubMed Index searchable.

You can work together with other people at your site to help collect data though no more than 2 people from one site can go on the authorship list for every 50 patients a site submits data for.

Some sites who have more than 2 authors have been asked to collect extra data in keeping with a ratio of 2 authors per 50 patients i.e. 3-4 authors will require 100 patients data to be collected.

Lead/supervising consultants will also be on the main author list. This is a BAUS-supported national project so we hope consultants will be supportive.

Investigators who have been involved in the protocol design, statistical analysis, peer-review, and manuscript creation may be named at a higher level/position than those that have not.

In some cases, journals have specific styles in which the authors are listed in a slightly different manner than above but it is our intention to follow the above policy wherever possible. If there are any changes to the planned policy, authors will be informed.

7. What will happen if I don't get the data in on time?

If you feel that you will not be able to get your data in on time then in the first instance contact Taimur Shah.

As recognition via authorship is being given to all those that enter data, non-submission of data or late submission with no prior correspondence will unfortunately mean that we will not be able to include you in the authors list or utilise your data in the analysis.

8. How do I best identify patients with acute renal colic on CT KUB to include in the study in a systematic way?

The method we have found worked best in the pilot phase was to review PACS for all CT KUB’s listed by date. Start from a particular date and confirm the presence of a ureteric stone on the scan report and obtain the patient details for you to search the other electronic records, Confirm that this was an “emergency” CT KUB carried out for a suspected renal colic presentation (rather than an interval CT KUB for patients who already had stone disease and are being monitored) and then you can include this patient.

It is likely that each hospital will have a slightly different method to best identify patients and if you would like some help or advice then please contact Taimur Shah.

9. What sources do I use to obtain the information for the study?

This depends on which section of the data collection you are undertaking and how your local hospital system records data. Some centres in the pilot phase were able to obtain all data electronically. The majority of centres obtained some information electronically and some information from the hard copy notes:

Demographics – majority from electronic records system. The “previous stone former?” question is answered by finding previous imaging confirming stones and clinic letters with the patient history or from past medical history in the A&E clerking.

Admission blood results – all from electronic records

Admission urine dipstick results – majority from the A&E admission/ clerking section which in most cases is available in the hard copy notes.

Admission SIRs criteria – majority from the A&E admission/clerking section which in most cases is available in the hard copy notes 

Admission CT results – all from electronic records

Admission management / treatment – (e.g. whether analgesia, antibiotics or other medications given on admission); majority from A&E admission/clerking section which in most cases is available in the hard copy notes but also commonly medications taken are listed in electronic A&E discharge records

Admission outcome results – if an intervention is carried out, this is commonly stored electronically, either with the operation note or an indication that the patient was admitted and had a procedure. If the patient is discharged from A&E this is always indicated in the A&E clerking outcome. This can also be deduced from follow up clinic letters for the patient which give the patient history and are commonly available electronically

Follow up – this is available from any clinical encounter with the patient. The first source should be clinic letters, which are usually available electronically. The second source should be the electronic imaging system.

Follow up imaging – this is available electronically on the imaging system

10. When I am entering the stone location information the radiologist has not specified the location of the stone clearly. How do I determine where the stone is?

Look at the CT KUB images and use the following guide and picture to help you determine the location of the stone:

Upper Ureter: Renal Pelvis to top edge of Sacrum
Mid Ureter: From top edge to lower edge of sacrum
Lower Ureter: Lower edge of sacrum to urinary bladder