Advertising on TRIP

For those of you who do not know, TRIP receives no government (or health service) support to run the TRIP Database. Currently, the TRIP Database is subsidised by other information-style contracts we have with a modest number of organisations.

We have ambitious plans for TRIP and we would like to make it self-sustaining. The only clear route is through advertising. We currently have Google ads on the results page and this brings us relatively little; certainly not enough to expand the service! I think the main reasons for this are (probably) the fact that our users are click averse (the advert has to be clicked for us to raise any money) and that the adverts are not targetted too well.

However, we are currently starting to move over to a new advertising system, which will serve adverts from the pharamaceutical industry. This will involve using an advertising agency - so not dealing with the pharma companies directly. Essentially, the pharma company pays the agency to place adverts on sites aimed at clinicians.

The other key advantage to this system is that we are paid, not on clicks, but on the number of time we display the adverts. So simply showing the advert will gain us some income. Last week we were searched nearly 250,000 times (over 40,000 times on one day), so we're hoping that our income from advertising, while not being spectacular, will give us some extra security and funds to further develop the site.

Is TRIP slow?

I'm finding TRIP noticeably slower than normal. Are others out there experiencing problems or is it just me!?

Re-designing PubMed

David Rothman has written extensively on alternate interfaces to PubMed, a great example can be seen here. As well as highlighting a useful poster it lists loads of other posts on the topic.

I may have missed something, but none of these alternate interfaces allow easy searching of PubMed. Some are wonders of programming, some allow some very neat tricks but none make searching of PubMed easy.

At TRIP we've gained a fair bit of experience with searching PubMed via the front page and also via the very helpful e-Utilities. So I'm starting to explore ways in which TRIP can create something more useful to the clinician. With TRIP I think we've done a pretty good job with the secondary literature. But the primary research literature is another matter. So, I'm hoping we can bring something useful to the table. As ever this tool will not be aimed at information specialists - they know how to use PubMed well. This tool will be aimed at busy health professionals.

I suppose my biggest issue with PubMed is that doing a search of statins returns 18,491 results. Unpicking that a bit:

• Most research shows search engine users finish looking after 3 pages of results.
• From our own experience with TRIP we also know that most users only use single search terms (e.g. asthma, hypertension).

So what I'm saying is that statins is a realistic search term and that suggests that 18,431 (18491-60) results are superfluous.

Therefore, the two challenges to me are:

• Return fewer results in the first place
• Allow users to easily qualify their searches.

I feel we can handle pretty well the above two, but are there any other challenges? If you have any thoughts on this let us know....

BEST in Mental Health

I've recently been made aware of BEST in Mental Health, a specialist Q&A service for mental health. I've very pleased to add this content to TRIP and it should be searchable in the next 24-48 hours.

American Family Physician

The American Family Physician is an incredibly useful publication. We find it very helpful in answering clinical questions. It might not use, exclusively, the highest level of evidence. But when there are no good secondary reviews (or even primary reviews) it'll help out with an answer. So many time I've gone to Google with a search term and restricted to the AFP and got an answer.

So why isn't in TRIP?

Well, I've added it to our system today and it should be searchable from next week.

An interesting feature of the AFP is that it has regular articles and then a number of other useful evidence reviews (e.g. Clinical Evidence, POEMs, STEPs etc). As such we have created two separate entries for AFP:

• American Family Physician - has gone into the eTextbooks section. It was either there or core primary research but on balance we decided eTextbooks was more appropriate.
• AFP Evidence - has been placed in EB synopses. This included all the evidence 'bonuses' that AFP publish.

We should have done it years ago!

Add TRIP to your website

Great news, the new TRIP Database search boxes have been deployed.

These search boxes consist of a few lines of HTML which can be embedded into your website, blog etc. These allow users of your site to search TRIP from within your site - adding great extra functionality. What's equally important the search results open up in a new window, so your users don't get lost to TRIP! To see examples of embedded TRIP search boxes and how they look/function click here.

There is one general search box and every specialist search has it's own separate search box. To access this go to the search engine of choice (be it the main TRIP or one of the specialist searches) and click on the link 'Add TRIP to your website' - found at the top of the page.

Any problems let me know via 'Contact us'

Also, when it's up and running it'd be nice to see what it looks like 'in situ' so please let us know!

Put a contract on yourself

stickK is designed to promote a healthier lifestyle by allowing users to create “Commitment Contracts” that oblige them to follow through with commitments such as exercise and quitting smoking.

Read more here.

Specialist search boxes

We'll shortly be releasing the HTML code to allow 'webmasters' to embed TRIP specialist search boxes into their websites. There will be separate HTML for each specialist search. As an added bonus, the search results will open into a new window - meaning the webpage doesn't lose their users to TRIP! Below is an image of how the search boxes will look.

More on the specialist search engines

My attitude towards the specialist search has been one of curiosity. Technically I'm impressed with them. However, I was curious to see how they were received.

Being curious I wanted to know which is doing well so I did some analysis. Below is a graph of weekly searches on the various search engines (click on the image for a larger version)

So what can we see? Comparing the week ending 7th December 2007 and 6th February 2008, we can see a number of really significant increases in usage. The stars being oral health, infection, respiratory and ophthalmology. We've had a few that have actually been reduced - the main ones being cardiology, orthopedics and urology. Overall, 19 have increased usage, 7 have decreased while one - surgery, has stayed the same.

This analysis doesn't satisfy my curiosity. For the moment the specialist search engines are just there, doing some good, not taking up much of my time. For the first half of this year I'm too busy to give them the thought they deserve. However, perhaps a long period of reflection isn't going to do anyone any harm.

With two major new projects out in the middle of 2008 and the continued development of TRIP I think the challenge will be to maintain the core values of TRIP and ensure the relationship between all the components is clear and understood.

Cochrane

Ben Toth has raised an interesting issue relating to the Cochrane (click here). In addition to Ben's comments I'm going to add a few criticisms of Cochrane. Ben highlights that the UK taxpayer (via the Department of Health) has spent tens of millions of pounds on Cochrane. has that been money well spent?

We answer thousands of clinical questions from primary care every year. You'd like to think Cochrane would answer a significant chunk. In our experience Cochrane rarely answers a genuine clinical query on it's own. A recent analysis of over 300 dermatology questions revealed that Cochrane systematic reviews answered 2. The analysis was carried out with the help of the Cochrane Skin Group so they cannot be accused of not trying to examine their 'offering'.

A number of years ago I had a chat with Sir Iain Chalmers (who founded Cochrane). This was while DUETs was being formed. During the course of the conversation it became clear that the choice of systematic reviews (SR) is - generally - not based on any rational system. Generally, a keen researcher has a desire to do a specific SR and Cochrane helps them to do it. The thinking is that they will then go on to do additional SRs. In other words it was personal preference, not clinical need (or should that be information need). Interestingly, the respiratory SRs were much more useful for our Q&A activities than others. Apparently they had a different system. If a researcher wanted to undertake their own SR they were told that the respiratory group (probably the airways group, I forget the proper name) would help them to carry out a SR that was useful to the group. After that the researcher would be trained and could carry out their own personal SR.

The hope is that DUETs will help this situation, but results will not come quickly, if at all. I raise this additional point as many of the uncertainties are generated from within Cochrane. Also, there is currently little input from clinical Q&A services.

Ben highlights that Cochrane is potentially using an outdated business model. Is Cochrane itself outdated?

Record week

Last week TRIP (main TRIP Database plus the specialist search engines) were searched a record number of times 187,182. That's an average of over 26,000 per day!