Nursing research

I don't know about nursing research. All I know is that when we get a question that relates to nursing issues there is a very high chance that they'll be no research around to support it (see our latest example When deflating the balloon to remove a urethral or suprapubic catheter should the syringe stay attached to the tube or removed). One of the projects I'm involved in is DUETs which seeks to capture uncertainty related to therapeutic interventions. How about one for nursing?

Bad Q

In an ideal word people asking our services a question would use the PICO format. I'm not a huge fan of this as its a construct that adds a barrier to using our services - it's hardly user friendly. So we allow free-text questions which normally works quite well, but in around 15-20% of cases we need to get back to the user asking for clarification. However, we got the following Q the other day "Evidence for using viagra". We could have got back to the GP, but we decided to interpret the Q to mean "Evidence for using viagra in erectile dysfunction". Arguably the use of sildenafil citrate (Viagra) for the treatment of pulmonary arterial hypertension comes under a different trade name - Revatio. Still, doesn't really excuse the poor Q....

Talking of viagra and hypertension, that is how viagra came about as a treatment for erectile dysfunction (ED). Sildenafil citrate was originally intended (and tested) as a treatment for hypertension. In the early trials one of the side-effects was erections. This accidental discovery got the pharma-people interested and viagra, as a cure for ED, was born....

Behind the times

Just got a final proof of a paper I wrote on the TRIP Database. I wrote it in October/November 2005! The paper reports on the recent Centre for EBM review and the planned changes to TRIP. Those changes happened in December 2005. Also by the time the paper is published the site will be free-access (albeit via a beta-test version of the new site). So by the time it's published the article will be 'doubly' out of date.

Something to be said for the instant publishing afforded by blogs ;-)

NOTE: I just used the spell check that is part of the blog - guess what it didn't recognised 'blogs' suggesting 'blocs'....

Synonyms

The TRIP Database has an extensive synonym function. However, we still get terms we don't fully understand. This time it was a question received on the NLH Q&A Service asking about 'candidal overgrowth'. How do you search for this? We think we got it right with candidiasis - but how do you verify this? The requesting doctor didn't know.

Free access timeline

We've now discussed the specification with our web people, got the quote (ouch) and a rough timetable. The next steps are as follows:

1. Final specification meeting (sometime next week).
2. Web-people to produce specification document including wireframes.
3. A robust test version should (!!) be available by mid-May
4. Fingers crossed, the beta test version will be made publicly available at the start of June.
5. Although free accessible the beta will not become official (for contractual reasons) till September 1st.

Latest 'daft' idea

Why not create a TRIP Database toolbar with an embedded search box.

I spoke with my webpeople and they suggested creating a bookmarklet as an interim measure to see if there is any demand. For search examples see bookmarklets.com

Viagra and retinitis pigmentosa

Had one of those interesting questions today:

"In patients who are totally blind from retinitis pigmentosa and who have erectile dysfunction, do the usual contraindications to viagra apply?"

What's interesting is that viagra is contra-indicated in people with retinitis pigmentosa as it may lead to blindess (or that's the assumption). So what do you do if the person is already blind?

Desire for an answer

Interesting looking at the feedback on the Q&A site. For 2006 we've been rated as follows:

• Excellent - 88.3%
• Good - 10.4%
• Average - 1.3%

I tend to view responses other than 'excellent', negatively. So I've tried to look at our answers to questions which have been rated as 'good' or average' to see if there is a trend. There appears to be two main reasons:

1. When there is little or no evidence to answer the question. From the users perspective they come to us with an uncertainty and sometimes we can't help. Anecdotally, the lack of evidence can frequently be useful/helpful. However, in a some situations its not as well received - understandably.
2. Not comprehensive enough answer. Although only mentioned twice in the 2000+ questions we've answered I guess that might constitute a trend! Our remit is to provide quick responses to the literature. Occasionally we get a GP using us who has already done a good search asking us for information. Unfortunately, they don't tell us what's they've done so we answer it as normal ie give brief information.

Still with less than 2% of people rating us at less than good - we must be doing something right!

Diabetes or Hypertension?

A few posts ago I reported on the mis-spelling frequency on the TRIP Database. I've just been looking at the stats and the most frequently 'mis-spelt' term is 'hypertension' and 'diabetes'. To clarify that, it's not a count of the number of actual times it's been mis-spelt, more the number of different ways it's been mis-spelt - 27 (see side)

These are confirmed mis-spellings in that people have clicked on the 'did you mean: prostate' to confirm spelling correction!

Nice article on search Can we know everything?

The ATTRACT site contains a wonderful counter that counts how frequently an answer has been viewed. The top five being:

1) What are the risks of flying while pregnant?
2) Is there any information on the Novasure system for treating menorrhagia?
3) Should dianette (oral contraceptive pill) only be used for 3 months in treating acne?
4) Should you treat a low Ferritin (<10)>

A post on Dean Giustini's blog highlights Wellcome's invitation to tender for a UK version of PubMedCentral. See Dean's blog (click here) for more information.

Dubious question time - "What is the difference between central and peripheral vertigo?". Is that a clinical question or an essay question? We answered it (http://www.clinicalanswers.nhs.uk/index.cfm?question=2291). If it is an exam question (we'd prefer to think it wasn't) I hope it gets good marks AND we're referenced!!

Complementary and Alternative Medicine (CAM)

A busy day for adding CAM articles. We already had numerous articles on the subject from the likes of Cochrane and Bandolier. However, we've now added records from:

• The American National Centre for Complementary and Alternative Medicine.
• New Zealand Complementary and Alternative Medicine site (linked to the New Zealand Guideline Group)
• Mayo Clinic 'supplements' (patient information)
• UK Medicines Information have a small section.

We've also been busy adding patient information leaflets (PILS) - from the likes of PRODIGY (their new website launch has resulted in a near doubling of PILs), CancerBACUP and New Zealand Guideline Group's consumer information.

This expansion of PILs is no doubt motivated by the free version of the site. Currently at the planning stage but more than likely they'll be 3 separate searches - clinical information, medical images and patient information. These will be accessible in much the same way as google allows people to switch between searches for 'web', 'images', 'groups' etc. Essentially, a tab link above the search box.