Trip Database Blog

Liberating the literature


October 2006

Ethics and Q&A

A bit of a grand title, but what happens when we get a question that has potentially very serious consequences? We had one yesterday. The question:

“A friend presenting with raised ESR, spontaneous bruising and temporal arteritis – any ideas, please? Awaiting haemo consult which could be two months hence.”

I saw it and initially was unhappy as it was about the persons friend. So I asked our medical director for his view. Well, he felt it could be a medical emergency (especially as the GP seemed to have a two month timescale). Apperently, in TA there is a danger of blindness unless suitably managed.

The dilemma we had was how directive we should be? Our answer can be seen by clicking here. I also sent a separate, private e-mail, to the GP reinforcing the need to take this seriously.

I wonder if we’ll hear any feedback from the GP!


Microsoft catering to masses is the title on an article in The Seattle Times. This highlights the embracing of RSS in the new Internet Explorer 7. The authors view is that the move by Microsoft will finally propel RSS into the mainstream.

Currently, we use ‘old fashioned’ e-mail to alert people of new content. Perhaps it’s time to shift to RSS.

Keeping SRs up to date

Clinical Evidence has a chapter on tennis elbow and one of the interventions is corticosteroid injections. For the short-term relief of pain it is rated as likely to be beneficial (based on a search carried out in 2005). Late last month the BMJ published a RCT on tennis elbow and one of the interventions was corticosteroid injections (click here). This concluded:

“Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow.”

The Clinical Evidence chapter relied on a 1999 systematic review and subsequent RCTs.

So, we have one SR (from 1999) and a number of other RCTs. This begs the question ‘how long before these RCTs are incorporated into a new systematic review?’. This question must be true for any number of interventions.

Given the massive changes in technology and open-access, is it really too hard to free up the meta-analyses and allow (with strict conditions) users to simply add new trial data as it comes along? Each review would have inclusion criteria and as long as these were met then the data could be added. Doing this online would allow for the instantaneous updating of the meta-analysis.

This issue came up as a GP contacted the ATTRACT service asking how he should react to the new BMJ article. Our response, probably unhelpfully, is that it is not our role to weigh up new research against prior research. Ultimately, you need to wait for a new systematic review! Using the olds methods we’d need to wait for months or more likely years. With an online system you could update it in hours.

The software, if not already there, would hardly be tough to create. Those wanting up to date information would surely want it. So why is there no pressure for this to happen?

A paper from Pakistan

Open and Free Access to Full Text Journal Articles and Medical Databases in Disaster Affected Developing Countries

Inverse document frequency

My post of two days ago was slightly premature! After using the new algorithm I started noticing some strange results. So much digging around with the maths helped me discover a variable I had overlooked – inverse document frequency. After understanding this concept, a bit, I have now used it to our advantage.

The net result being the algorithm is now, without doubt, a significant improvement on algorithm we launched with – just 7 weeks ago. If the first algorithm was version 1, the version earlier this week must have been version 2, then I guess we’re now at version 2.1.

Happy searching and as ever please let us know if you conduct a search and receive strange results!

IE 7

Internet explorer is now available for download.

It looks very good and seems intuitive and so far no complaints. An added bonus is the embedded search box – which I’ve defaulted to search TRIP. It works in the same way as the recently released firefox extension. (see top right corner of screen shot below).

Search algorithm update – 2

Following on from my earlier post the new algorithm has now been implemented. Our testing regime returned results quicker than anticipated. While still not perfect it is a definate improvement on the previous version. We are not assuming that we cannot tweak the algorithm further. We will continue to monitor performance and anticiapte further testing soon.

Search algorithm update

The new system is gradually being rolled out. No massive changes and whether users will notice much difference is open to debate. I’m sure some will but the majority probably not.

The system works exceptionally well (my view) when a category is selected (e.g. systematic reviews). However, the first set of results, where all the categories are mixed, is more problematic. Generally, it is very good. However, in a small set of results <10% the results trouble me. They're not overly bad but they could certainly be better.

My concern is that users of TRIP do not, necessarily, filter the results by category – so they get the mixed results. So two possible directions – and I’d welcome input from the readers of this blog:

1) Remove the first set of results, so users are forced to select a category to see results.

2) Continue to work with the algorithm and be happy that for the vast majority of searches the results are pretty good.

Over to you……..

How to Answer Your Clinical Questions More Efficiently

An interesting paper I found while looking through the rapidly expanding UBC HealthLib-Wiki. This paper was published in the American Family Practice Management journal – click here to view the paper.

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