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Trip Database Blog

Liberating the literature

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.

What we’re working on

The new upgrades have been well received and appear stable (phew).  But we’re not resting and we’re working on a  number of projects; the main ones being:

  • Learning to rank: The search algorithm decides what order the results appear in Trip.  Ours has been unchanged for many years and this shows how good it is.  However, technology has moved on over the years and one of the most exciting developments has been the technique known as learning to rank (LTR or L2R).  This uses machine learning to help understand what attributes of a result make them most likely to be clicked.  It then uses this to rank articles on the likelihood of being clicked.  This will be properly tested using a technique known as interleaving.  Timescale: We’re hoping to start testing in the next 2-3 months.
  • Community rapid review: Early days in the plans but there has been considerably enthusiasm from Trip users wanting to get involved.  An outline can be seen here while an important aspect, an educational environment, is also an important consideration (click here). Timescale: Finalised outline by July with system released by the end of the year.
  • Automated rapid reviews: Is it possible to create automatic reviews?  We think so and have started out exploring this as an option.  While not as detailed as the semi-manual community rapid review system it will still be really useful and in ways that many will not expect.  In addition, the methods used lend themselves to visualisations which will further enhance their impact. Timescale: By the end of the year, hopefully sooner.
  • Strategy: I have started reviewing the next steps of Trip with an external strategy expert.  It’s not been the most comfortable experiences (strategy is not my favoured environment), but I feel we’re making real progress. Timescale: Within 3-4 months.

At the same time we’ll continue to focus on the quality of the content and our new manual broken link system’s really useful in that respect.  We’re also working through our major providers of content to completely refresh their links. Last month was the National Guideline Clearinghouse and this month was Cochrane and CKS.

The above seems lovely an ambitious and we’re loving it!

 

What’s new for early 2017

We’re really excited by the release of the latest upgrade to the Trip Database.  There are a number of major upgrades to the site:

The Answer Engine: delivers answers to your clinical questions, quickly, with a single click!  For more information see this post for more details.

ae

 

SmartSearch: an amazingly useful system to help speed up your search and to help users avoid missing important documents.  More information can be seen here.

ss1

 

Search suggestions: a pre-existing system that has been integrated much more intimately with your search experience.  Now appearing mid-way down the page; designed to prompt users to use it if the initial results aren’t focused enough.

search-suggestions

 

Broken links: broken links are problematic for any search system.  We have an automated system which works reasonably well, but not perfectly.  Our new manual system should allow users to easily let us know if one of our links to a dead end!  Take our your frustration by clicking the link!

broken-links

 

Other improvements: there are a number of other, minor changes:

  • We have improved the display and integration of the automatic assessment of bias via the RobotReviewer system.  For details of this automated system see this article.
  • We have tidied up the top of the results making it all much cleaner.

SmartSearch

SmartSearch is an amazingly useful tool designed to help you avoid missing any important articles you may have missed. Or, it can be seen as a tool that speeds up your searching!

After you’ve searched our systems monitor the articles you’ve clicked to give us a better idea of your specific intention for this particular search.  If our system find articles it believes are relevant it pops an alert below the last article you clicked on:

ss1

 

Clicking on that reveals your suggested results:

 

ss2

SmartSearch is powered by our unique clickstream data.  In that respect SmartSearch is based on the collective wisdom of Trip users.  Or, to paraphrase the Isaac Newton quote, you’ll be ‘standing on the shoulders of giants‘.

Pro users get full access to this feature while free users use is restricted.  Users can upgrade here. Institutional subscriptions are also available (click here).

The Answer Engine

Many year ago Muir Gray stated – in relation to the access to evidence – that ‘Three clicks are two clicks too many’.  This statement inspired the invention of the Trip Answer Engine and we have delivered on Muir’s vision.  Answers to clinical questions, quickly, with a single click!

So, what is the answer engine?

ae

The answer engine explores the search terms used to try to understand the intention.  In this case the likely interest of the user is ‘Is minocycline useful in the treatment of acne?‘.  Our system then finds the best available answer to that question; in this case a Cochrane Systematic Review.

Incredibly simple (conceptually) powered by some incredibly powerful/clever/magical systems behind the scenes!

Currently, the system is semi-automated and will answer around 1000 of the most common questions asked of Trip.  We hope to move to a fully automated system in mid-2017 and that will then answer hundreds of thousands of questions.

 

2016 – the impact of Trip

For the first time we have breached 5 millions minutes of usage on the site.  Granted a weird metric, but it just stands out!  As does the over 1 million separate sessions on the site.

Lots of big numbers, but what was the impact?  We were searched around 7.8 million times in 2016.  We estimate, from previous work, that 40.8% of searches help improve patient care (NOTE: see our post on why this figure might underestimate and/or overestimate the impact).

So, 40.8% of 7.8 million indicates the number of times Trip has improved patient care.  Therefore we can happily/proudly announce:

3,182,400 times!

That’s a huge number.

 

Top Trip articles for 2016

A list of the top twenty most popular articles via Trip (in reverse order):

20) Adult chest infections – Community-acquired pneumonia. CKS
19) Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Canadian Diabetes Association
18) Acute low back pain (up to 6 weeks). CKS
17) What is the effect of family presence on the efficacy of pediatric trauma resuscitation? BestBETs
16) Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study. NIHR HTA
15) Migraine in Adults: Preventive Pharmacologic Treatments. AHRQ
14) Dementia – Managing end-of-life problems. CKS
13) Type 2 diabetes – Managing glucose control. CKS
12) Effectiveness of Family and Caregiver Interventions on Patient Outcomes among Adults with Cancer or Memory-Related Disorders. Veterans Affairs Evidence-based Synthesis Program Reports
11) Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada : Diabetes in the elderly. Canadian Diabetes Association
10) Chronic heart failure – End-stage chronic heart failure. CKS
9) Randomised controlled trial: Presence during cardiopulmonary resuscitation is beneficial to family members in the out-of-hospital setting. Evidence-Based Medicine
8) Family presence during resuscitation attempts is associated with positive psychological effects for the observers. Evidence-Based Mental Health
7) Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. Anxiety Disorders Association of Canada
6) Saline versus Heparin for Maintaining Patency of Central Venous Catheters: A Review of Clinical Effectiveness and Safety. CADTH
5) Acute pain management: scientific evidence. Australian and New Zealand College of Anaesthetists
4) Chronic low back pain (more than 6 weeks). CKS
3) Vitamin C for preventing and treating the common cold. Cochrane
2) A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. NIHR HTA
1) Australian Guidelines for the Prevention and Control of Infection in Healthcare. National Health and Medical Research Council

If you want more list of top results we’ve created a number of speciality specific top fives (note there are separate lists for each category, we’ve placed multiple lists per page):

Top articles last year – Ophthalmology, Pediatrics, Mental health and Women’s health

Ophthalmology

  1. Type 2 diabetes – Managing eye problems. CKS
  2. Amblyopia. BMJ Clinical Evidence
  3. Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of glaucoma in the adult eye. Canadian Ophthalmological Society
  4. National retinoblastoma strategy Canadian guidelines for care. Canadian Retinoblastoma Society
  5. Acute infective conjunctivitis. CKS

Pediatrics

  1. Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study. NIHR HTA
  2. What is the effect of family presence on the efficacy of pediatric trauma resuscitation? BestBETs
  3. Infant Feeding Guidelines: information for health workers. National Health and Medical Research Council
  4. Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia. National Health and Medical Research Council
  5. Otitis Media – Acute Otitis Media & Otitis Media with Effusion. Clinical Practice Guidelines and Protocols in British Columbia

Mental health

  1. A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. NIHR HTA
  2. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. Anxiety Disorders Association of Canada
  3. Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study. NIHR HTA
  4. Psychosis and schizophrenia, The routine schizophrenia or psychosis review. CKS
  5. The clinical effectiveness, cost-effectiveness and acceptability of community-based interventions aimed at improving or maintaining quality of life in children of parents with serious mental illness: a systematic review. NIHR HTA

Women’s health

  1. Urinary tract infection (lower) – women, Asymptomatic bacteriuria in pregnancy. CKS
  2. Osteoporosis – prevention of fragility fractures: Management. SIGN
  3. Urinary tract infection (lower) – women, Recurrent UTI ? (no visible haematuria, not pregnant or catheterized). CKS
  4. Hypertension in pregnancy – Pre-existing hypertension, or hypertension before 20 weeks. CKS
  5. Osteoporosis – prevention of fragility fractures: Assessment. CKS

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