Trip Database Blog

Liberating the literature


January 2009

TRIP Answers, why interaction is good!

One feature we were keen on with TRIP Answers was interaction. We have made it relatively straight forward to feedback comments and we intend to make it even easier in the future.

We realised, long ago, that there are many people out their with knowledge and experience that can be useful to improve an answer. A clear example was the Q&A “Is there any GOOD evidence to support the use of honey as a treatment for leg ulcers?”. This was initially answered in January 2006 by the ATTRACT service (for initial Q&A click here). In this answer there was reference to a Cochrane Systematic Review protocol (which is a notification of a review in progress), other than that there was little else.

An e-mail over the weekend was from a clinician who highlighted new research. This research had been incorporated into the Cochrane Systematic Review that was published in late 2008. It was a relatively simply job to update the Q&A (click here to see the updated answer).

If you see an answer that needs attention, let us know – it’ll always be appreciated and it helps share your knowledge with the wider world.

How to use the Tag Cloud of Clinical Uncertainty

After posting the blog about the Tag Cloud of Clinical Uncertainty (TCoCU) I received a comment asking to explain how to read the page. So, here is an explanation of what the page represents and how to use it.

  • Tags are keywords that help describe a piece of information, in this case a clinical Q&A. A typical Q&A will have 3-7 associated tags (or keywords). You can see these tags underneath a particular question.
  • A tag cloud is visual representation of these tags. They are listed alphabetically, and the importance of a tag is shown with font size or color. The more prominent a single tag appears the more times this tag appears within the collection. Looking at the TCoCU shows that terms such as Cardiovascular disease, Women’s health and Musculoskeletal disease are prominent. This shows that there are lots of questions with uncertain answers in these areas.
  • The tag cloud on the homepage aggregates all the tags in the system. However, if you do a search, the resultant tag cloud only shows tags associated with the returned search results.
  • If you click on a single tag in the TCoCU this takes you to a new page, with two main areas. Firstly, there is a list of Q&As. These are all Q&As with the tag you had clicked in the TCoCU. Secondly, there is another tag cloud. When you initially clicked on a tag in the TCoCU you created a subset of Q&As and this new tag cloud is an aggregate of the tags for that subset only.

To try and make better sense of all the above go and try the following, go and click on the diabetes tab in the TCoCU. At the time of writing this shows a list of 47 Q&As which relate to diabetes that have highly uncertain answers. The tag cloud to the right of the page shows a different list of tags from the TCoCU as the new tag cloud only shows the aggregated tags from the 47 Q&As.

I hope the above helps, if not leave a comment and I’ll try and clarify further.

The Tag Cloud of Clinical Uncertainty

NOTE: We recommend you read our other recent blog on this topic ‘How to use the Tag Cloud of Clinical Uncertainty‘, it’ll help you orientate yourself!

NOTE 2: It appears the Tag Cloud of Clinical Uncertainty isn’t behaving itself. When I click on the diabetes tab I get taken to one place (click here) while others report being taken here. All users should be seeing what I see. So one for the techies to sort out next week – SORRY!

Over the years our team has answered over 10,000 clinical questions and our life is made easier when we find recent research/evidence to answer questions. Unfortunately, this is frequently not the case.

Historically, the most frequently asked question has been the frequency of vitamin b12 injections in pernicious anaemia. In the UK the recommendations are typically every 3 months (although recent guidance has lowered this) while in North America the suggestion is monthly. We have never been able to find any substantial evidence to support this. What is needed is a relatively simple RCT of 1 month versus 3 month injections, but that has not been done. There are a large number of other examples, all genuine clinical uncertainties, all requiring research. It was because of my desire to try and influence the research agenda that we got involved with DUETs an Iain Chalmers initiative to map out clinical uncertainties.

When we created TRIP Answers we introduced a scoring system for each Q&A and this allowed us to easily identify questions with little or no research to answer them. As well as being utilised by DUETs it allowed us to visualise uncertainties via the wonderfully named Tag Cloud of Clinical Uncertainty. While utilising a different methodology (and hence getting different results) to DUETs we have been very successful in highlighting hotspots of uncertainty. A ‘thumbnail’ of the main tag cloud can be seen below but it’s best seen via the site (click here).

Ultimately, our desire with the Tag Cloud of Clinical Uncertainty is to highlight real clinical uncertainties, promote debate and who knows – improve research procurement/production. In the interim, we’d love you to visit the Tag Cloud of Clinical Uncertainty (click here) and explore the uncertainties, you’re in for a few surprises!

Video: Learning occurs in social networks

Thanks to the Clinical Cases and Images Blog:

How to intubate yourself

This video is doing the rounds at the moment!

Advanced search fixed

TRIP’s advanced search may be modest, but it’s well used and when it broke late last year we had a large number of e-mails asking for a fix.

After what seems like an age, the fix has been rolled out.

Twitter to update TRIP Answers

I’ve just finished updating a Q&A on the role of statins in preventing dementia (click here). This was stimulated by a simple message published by AllergyNotes. His message was simply:

“New study supports statin’s anti-dementia effects

I followed the link which led me to a news article on Reuters and from there to the new study in JNNP.

So, well done Twitter and AllergyNotes!

One thing that struck me in the Reuters article is a quote from a commentator that states:

“He points out that nearly 20 previous studies have assessed the effect of statin use on later risk of Alzheimer’s disease in older people, and the majority found substantial benefit.”

Interestingly, the other reference we use was a 2007 meta-analysis of seven trials of statins in the prevention of dementia (click here) which has the conclusion:

“The current evidence does not show any beneficial effects of statins on the prevention of dementia or AD.”

My point is that the Reuters commentary says the majority support the beneficial effects of statins in preventing dementia while a recent meta-analysis finds no evidence. Why might that be? I’m thinking that it might be down to the trial methodologies.

The truth is out there….

TRIP Answers – one month old

TRIP Answers has now been out for a little over a month and so far it has been very well received and it is starting to grow:

  • Since launch, we’ve added around 500 new Q&As on the site from a number of sources.
  • Site traffic is starting to increase, yesterday we had 1,489 visits with 3,545 page views.
  • Comments are slowly coming in
  • We’ve been approached by a variety of people/organisations wishing to get involved.
  • One large website wants to use the content.

This is the first new website that I’ve been really involved in since the start of the main TRIP Database. However, that grew in a different manner. So, this has been a new learning experience. By using the site and listening to initial comments there are a number of minor changes I’d like to make. Some of these are to make the site slight clearly while others are to boost interaction.

But get in touch and let us know what you feel about the site.

The Media and the Evidence

We were asked a question about beetroot and its effect on blood pressure earlier today. This as stimulated by an article by ‘Dr Know’ in the Sunday Times (click here). This reported:

“Bizarrely, recent medical research backs this theory up. A study from Barts and the London School of Medicine showed that drinking 500ml of beetroot juice a day significantly reduced blood pressure levels in healthy volunteers. This benefit occurred within an hour of drinking it and was more pronounced after four hours; a degree of reduction continued to be observed for up to 24 hours.

The key beneficial ingredient appears to be nitrate, typically found in leafy green vegetables. Although the quantity consumed in this trial is more than most people would probably wish to ingest every day, it is likely some benefit still occurs if smaller quantities are drunk or indeed eaten.”

However, our search for the evidence highlighted an entry in TRIP Answers “What is the evidence of beetroot juice to lower blood pressure?“. This included the following:

“The study was very small and therefore should be repeated in more people.

It was conducted in healthy volunteers and should be repeated in people with hypertension or at increased risk of heart attacks.

Long-term beneficial effects of beetroot juice were not investigated, nor were any potential harms measured.”

The Sunday Times gracefully published my comment!

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