Trip Database Blog

Liberating the literature

Automated rapid reviews

As part of the KConnect work (EU funded Horizon 2020 project) we have been doing a fair bit of work exploring the automatic extraction of various elements from RCTs and systematic reviews.  If we can automatically understand what a paper is about it can open up all sorts of avenues with regard search and evidence synthesis.

The KConnect output is virtually ready for Trip to use and it will allow us (with decent, but not perfect accuracy) the following elements from a RCT or systematic review:

  • P – population/disease
  • I – intervention
  • C – comparison (if there is one)
  • Sentiment – does the trial favour the intervention or not
  • Sample size – is this a large or small trial
  • Risk of Bias – via RobotReviewer, which is already on the site (see this post)

So, what can we do with this?  A few examples:

  • For a given condition we can identify all the trials in this area and what the interventions are.
  • We can rank the interventions on likely effectiveness
  • For a given intervention we can look at what conditions it’s been used it.
  • We could present graphic like Information is Beautiful’s Snake Oil for a given condition and/or intervention.
  • We can massively increase the coverage of our Answer Engine.

Also, all this will be fully automatic, as new trials are added to Trip they will get processed and added to the system.

We’ve got a few technical issues to go (integrating the various systems) but we are so close. You will have no idea how long I’ve fantasised about the system.  And, even though it won’t be perfect, it should stand as a very good proof of concept.

Cochrane records on Trip

Last month we reported repeated problems keeping our Cochrane records up to date and asked users to decide what we should do.  Overwhelmingly people said we should stop linking to Wiley’s Cochrane Library domain and link to PubMed.

We have now moved all the links over:

So, Trip now has all the Cochrane systematic reviews and, given our experience of PubMed, we’re confident we’ll continue to properly reflect Cochrane’s records from now on.

For those of you who miss the direct links to the Cochrane Library, you can still easily get there via PubMed:

Evidence Live: Community Rapid Review

The Community Rapid Review idea has been discussed for a while now and the final stage, before we move to production, is coming very soon.  Next week I will be running a workshop at Evidence Live on the idea.  It’ll be an interactive exploration of the thinking behind the idea and will hopefully see some final constructive criticism to guide the final product.

If you’re going to Evidence Live you can reserve a place via this link.

Medicines information coming to the Answer Engine

The Answer Engine started less than 6 months ago and has firmly established itself as a well-loved feature on Trip.  Currently, the answers are mainly linked to intervention efficacy style questions.  But, in around 4-6 weeks, we’ll be rolling out medicines information.  So, for a given drug we’ll allow users to easily see answers to questions about contraindications, warnings, interactions etc.  For instance:


Cochrane records on Trip – opinions please

Cochrane is one of the most popular resources in Trip.

Historically we have received automated updates from Wiley with the intention of ensuring we were always up to date with the records. It has come to our attention that there had been some problems with the process and that we were missing a number of key Cochrane reviews.

We have reached out to Wiley to help us resolve these issues.  Unfortunately, this is taking far too long for my liking and so we’re faced with a dilemma:

  • Continue – indefinitely – waiting for Wiley to support Cochrane’s inclusion in Trip = not up to date records of Cochrane.
  • Move to Cochrane’s records on PubMed = up to date records but not as seamless access to full-text as if it were Wiley’s.

I’d welcome peoples views as to which is the better option, please let us know in the vote below:



The evidence pyramid

A great explanation of the evidence pyramid (taken from this Walden University site):

We use this concept in Trip to help users navigate the results (helping indicate the likely reliability of the evidence):

The main place to see it is slightly to the right of the result.  Here you see the pyramid, a colour-banded representation of where the evidence lies in the pyramid and a phrase describing the content (e.g. systematic review, guideline etc). You’ll note the colour coding which can be found to the left of each result and it is carried through to the ‘Refine by’ area.

We’ve just had a large usability study of the site and this is what the report states:

  • Users from research or information management backgrounds understood the pyramid icon, but users who were new to it wondered what it was.
  • When they figured out what it was, or I talked them through it, they appreciated it and it appeared to add to their experience.
  • Recommend adding a mouse-over explanation or some kind of ‘Introducing the pyramid of evidence’ box somewhere, as part of onboarding or in help.

Bottom line: it’s useful but only when you know what it means!  With no understanding of the concept it’s just confusing.

I need to go and sit on the ‘naughty step’ and contemplate why I fell in to the trap of assuming users know all this sort of stuff (oh yes, and to fix it).



Top oncology articles

From the last month, the top ten most viewed oncology articles on Trip:

  1. Screening for breast cancer with mammography. Cochrane
  2. Interventions for the treatment of oral and oropharyngeal cancers: targeted therapy and immunotherapy. Cochrane
  3. A systematic review and economic evaluation of intraoperative tests [RD-100i one-step nucleic acid amplification (OSNA) system and Metasin test] for detecting sentinel lymph node metastases in breast cancer. NIHR HTA
  4. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement
  5. Multiple myeloma. BMJ Best Practice
  6. Guideline Summary: Oncology evidence-based nutrition practice guideline. Academy of Nutrition and Dietetics
  7. Parental decision making about the HPV vaccine. Cancer Epidemiology & Biomarkers and Prevention
  8. Immunotherapy for advanced renal cell cancer. Cochrane
  9. Cancer and Rehabilitation (Treatment). eMedicine
  10. Cervical cancer and HPV. NICE CKS

Two stand out articles in the list for me – 7 and 9.  All the other articles are ‘secondary evidence’.

In the case of 7 it’s a primary research article and it’s from 2010. So, as well as being primary research, it’s also relatively old. This is significant as it potentially links in with our efforts to gather uncertainties (to improve research procurement – both primary and secondary research).  We’re always looking to analyse click patterns to see if we can unearth uncertainties but finding the rights signals is problematic.  The fact that a significant number of users have an information need met by an oldish article from down the evidence pyramid suggests it’s a ‘hot topic’. Perhaps one for a systematic review or further research?

Number 9 is an eTextbook – the lowest level of evidence (in the Trip hierarchy).  Again, lots of interest and users are not finding their information need met by higher quality research.

I’m excited by this ‘discovery’ one to discuss with my research funding colleagues!

Highlighting new research: the results

Last week I asked users from primary care to rate a series of new articles added to Trip.  We asked them to let us know which of 12 articles they thought looked interesting/important.  With 342 votes the results are in:

  1. Systematic literature review on effectiveness of self-management support interventions in patients with chronic conditions and low socio-economic status. EvidenceUpdate
  2. Shared decision making in primary care can reduce antibiotic prescribing. NIHR Dissemination Centre
  3. Multimorbidity and polypharmacy. NICE, advice
  4. Extended hours in primary care linked to reductions in minor A&E attendances. NIHR Dissemination Centre
  5. Antimicrobial stewardship: changing risk-related behaviours in the general population. NICE, Clinical Guideline
  6. Capsaicin 8% Patch in Painful Diabetic Peripheral Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Study. EvidenceUpdates
  7. Support at Home: Interventions to Enhance Life in Dementia (SHIELD) evidence, development and evaluation of complex interventions. NIHR HTA
  8. Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction). NIHR HTA
  9. Cutaneous melanoma. SIGN Guideline
  10. Nitric oxide breath analysis for the management of asthma. HTA Database
  11. Long-Term Continuous Ambulatory ECG Monitors and External Cardiac Loop Recorders for Cardiac Arrhythmia. Health Quality Ontario
  12. Canadian Youth Perceptions on Cannabis. Canadian Centre on Substance Abuse

Presented graphically:

Systematic literature review on effectiveness of self-management support interventions in patients with chronic conditions and low socio-economic status won by a single vote.

What was most interesting to me was that it still only obtained 13% of the votes (while those towards the bottom received only 4%).  So, only around 1 in 8 people voted for it.  I was expecting higher scores.  Perhaps that’s a reflection on the diversity of primary care and the diversity of our users.  Perhaps one to test in a different speciality!

Helping highlight the most important new documents on Trip: Primary care

This is an experiment to see if Trip users find it helpful and interesting to try and highlight which article, aimed at primary care, is of most use.  Below are a number of articles that we have identified as being high quality and suitable for primary care.  But the question is are they of use and/or interesting?  Can you look through the list and tick those that you think meet the criteria of being interesting or useful.

We’ll post the results in the very near future.  This will show if people enjoy rating articles and also if there are clear favourites!  And, if it works for primary care, we’ll explore other areas as well.

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