Trip Database Blog

Liberating the literature


November 2006

Search engine failure?

Many of the answers we give on the Q&A service have only one reference. In other words we feel that the answer has been adequately answered with that single resource. Often these are from excellent sources such as PRODIGY. I’m meeting the clinical lead for PRODIGY, Sharon Smart, on Monday to hopefully forge closer links between PRODIGY and the Q&A services.

Aside from that, what does it mean when the user doesn’t find the information we do?

  • Are they ‘unmotivated’ to try the search?
  • They try the search and can’t find anything?
  • They try the search, find something promising but can’t find the information within the document?

One problem, linked with the last point, is that documents such as PRODIGY is their sheer size. It’s fine to find the document you’re interested – but in a document that size how do you find the ‘needle in a hay stack’? The PRODIGY guideline is split into many sections. For instance the PRODIGY guideline on antiplatelets answers many specific questions e.g.

  • How do antiplatelet drugs reduce cardiovascular risk?
  • How should I manage people who develop an ulcer while on low-dose aspirin?
  • What should I do if a person on aspirin is at increased risk of gastrointestinal adverse effects, or develops severe dyspepsia?

My view is that these should be separate documents. As well as a global ‘Antiplatelets’ guidelines why not have small documents such as “How do antiplatelet drugs reduce cardiovascular risk?” with just the specific text associated? PRODIGY have moved towards that with their structured view. However, it’s not particularly user friendly and doesn’t allow users to get straight to the ‘good stuff’ – the fewer the clicks the better.

This principle could easily be extended to other documents e.g. other guidelines, NICE documents, systematic reviews ie what questions do these documents answer?

I remember Ben Toth (his blog) talking about this a good few years ago! Always a great source of information and advice!


At the weekend my broadband broke so I was left with my thoughts. On Sunday morning I has a ‘Eureka’ moment and worked for about 3 hours on a new project, codenamed ‘Socrates’. I presented my work on Tuesday morning to a potential partner. Today they called me to say they were ‘in’.

So work will start on Socrates almost immediately.

It’s too soon to give out details and these will filter out, via this blog, over the coming months. But I’m hoping that it’ll be released early 2007. It has the potential to be truly massive.

Watch this space.

Web-based diagnosis

Following on from the earlier post on Google diagnosis I have come across a paper using the Isabel system. The paper Diagnostic omission errors in acute paediatric practice: impact of a reminder system on decision-making is available as a provisional PDF. This gave the following results and conclusion:

Results: Subjects attempted to access the diagnostic aid on 595 occasions during the study period (8.6% of all medical assessments); subjects examined diagnostic advice only in 177 episodes (30%). Senior House Officers at hospitals with greater number of available computer workstations in the clinical area were most likely to consult the system, especially out of working hours. Diagnostic workups construed as ‘unsafe’ occurred in 47/104 cases (45.2%); this reduced to 32.7% following system consultation (McNemar test, p<0.001).

Conclusions: We have shown that junior doctors used a Web-based diagnostic reminder system during acute paediatric assessments to significantly improve the quality of their diagnostic workup and reduce diagnostic omission errors. These benefits were achieved without any adverse effects on patient management following a quick consultation.

A thought provoking article, especially given the recent debate surrounding the Google diagnosis story.

New look NLH

I wrote on the 7th August about the NLH’s plans to revamp their site and more specifically their search. Well it has just gone live (click here). They’ve introduced the ‘title’ and ‘title and text’ distinction. As I mentioned previously I’m flattered with them copying the old style TRIP method.

But I’d be interested to see the rationale for the changes. Our move from ‘title’ and ‘title and text’ to the current method has dramatically improved our search results.

Aside from that I do like the new layout and colour scheme.

Googling for a diagnosis

This article will no doubt feature highly in the blogs (click here) and create much controversy! It reminded me of the Isabel decision support tool.

Basically, the authors took a years worth (n=26) of diagnostic cases from the NEJM and, after reading the article, they selected 3-5 pertinent search terms. Added these to google and somehow selected the 3 most likely diagnoses. They then compared these 3 diagnoses with the actual result from the NEJM.

Overall result – ‘correct’ in 58% of cases (CI – 38-77%).

I’m not sure if I find this disturbing or not, it’s certainly too small to make conclusions. But once again Google (not deliberately on their part) have set a standard…..

Another record

Another record, this time in Q&A. Today – my birthday – saw the NLH Q&A Service answer and published 22 questions. The previous record was 17.

Happy birthday!

October – Record Month

It has been two whole months since we went free. Before going free we averaged 22,500 searches per month. In September we were searched 132,538 times. For October, another huge increase – 191,581 searches. This represents a increase of nearly 50% since September and over 800% increase from our subscription days!

Onwards and upwards!

October Zeitgeist

  1. Chickungunya fever (Ganfyd) – viewed 396 times.
  2. Guidelines for the administration of blood components (ANZSBT) – 342
  3. Failure to thrive (Ganfyd) – 276
  4. Guidelines for Blood Grouping & Antibody Screening in the Antenatal & Perinatal (ANZSBT) – 272
  5. Asthma (PRODIGY) – 254
  6. Rheumatoid Arthritis: Diagnosis and Management (British Columbia Medical Association Guideline) – 251
  7. Nutrition support in adults (NICE) – 214
  8. Moxibustion (CAM) – 214
  9. Diabetes services for adults (RCN) – 201
  10. Good practice in infection control (RCN) – viewed 197 times.

What is a wiki?

Found by Ben and a very useful intro (click here). I’m seriously considering using a wiki in at least one new project I’ve got in the pipeline, possibly TRIP Answers.

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