Trip Database Blog

TRIP has grown and matured as a site considerably over the years and this change has been particularly rapid in the last 12 months. The next upgrade will mark a significant improvement and it’s a momentum I wish to maintain. To help TRIP in this process I’ve decided to set-up an advisory board.

The TRIP advisory board will be an informal network of clinicians, information specialists and techies and I would expect it to serve the following functions:

• Respond and advise on ideas generated within TRIP
• To suggest ideas for new features/improvements on TRIP
• To generally be an extended pair of ears to highlight new technologies, opportunities for TRIP.

If you are at all interested please e-mail me via jon.brassey@tripdatabase.com

Please don’t be shy, I’d love to hear from you!

This might sound strange but Martin, if you read this I’d like to hear from you, the old e-mail I have doesn’t seem to work!

One massive obstacle to serving up decent search results in a search engine is trying to understand the intention behind the search. The majority of searches undertaken are 1-2 terms e.g. hypertension, diabetes, prostate cancer, migraine triptans. In the latter it might seem obvious they are interested in the therapeutics efficacy of triptans in the treatment of migraine. However, they might be interested in side-effects, prognosis etc.

It’s a tough challenge.

In the new TRIP we’re proposing two ‘features’ to help us deliver even better results:

• Geolocation. There are lots of tools out there that can tell us where our users are from. So why not leverage that information to improve the search results. If you’re from the USA, why not boost content that is USA specific? I’m thinking mainly of guidelines, if you’re from the UK you’d want to see guidance from NICE or CKS ahead of say the New Zealand Guideline Group.
• Specialism. When we release the new TRIP we’re going to significantly boost the My-TRIP functionality to make it really worthwhile for people to register and use TRIP while signed-in. One aspect will be to allow users to show us what speciality they belong to. This will help is a similar way to geolocation in that we can boost speciality specific content. Therefore, if you’re a cardiologist content from the European Society of Cardiology will be boosted, in addition content from primary research journals such as Heart and the American Journal of Cardiology will feature more highly.

So, we hope to benefit from a users location and specialism to serve better content, if anyone can think of anything else – feel free to let me know!

After seeing a couple of twitter-based book clubs including one created by Jonathan Ross I thought ‘why not create a twitter journal club’. So I sent a ‘tweet’ out and it seems to have caught the imagination of a number of people.

So, why not start a twitter-based JC? To be honest, aside from the big picture, I’ve got no idea how it might work. So, if you’ve got a view let me know. Otherwise, I’ll have to think of something 😉

Around 4 weeks we blogged that Clinical Correlations was to be the first blogs whose content would be added to TRIP.

Yesterday, I identified the 2nd blog to be added to TRIP, the rather nice TrustTheEvidence, created by Carl Heneghan, a GP and Deputy Director of the CEBM and Ami Banerjee, Cardiology trainee and clinical research fellow at the University of Oxford. Highly recommended – and they also have a twitter account http://twitter.com/cebmblog

ATTRACT is a Q&A service for Primary Care in Wales. It started in 1997/8 and is responsible for my interest in information support for clinicians. When I came to post as ‘Clinical Effectiveness Co-ordinator’ at Gwent Health Authority I was given the task of supporting clinical effectiveness in the county. At the time most similar organisations sent GPs on searching skills training and critical appraisal. After visiting around 75% of practices in Gwent it dawned on me this approach had significant problems. The overwhelming message was – answer our questions for us! ATTRACT was born. For historical interest ATTRACT was an acronym for Ask Trip To Rapidly Alleviate Confused Thoughts! Again, another piece of history – TRIP was a last minute idea for a name – it was going to be GEM (Gwent Effectiveness Matters).

I’m mentioning ATTRACT as it will shortly be gaining a new website in a week or so and as such I thought I’d look at the top ten most frequently viewed papers from the current website – one that was introduced around 2001/2. Here it is:

1. What are the risks of flying while pregnant?
2. Should you treat a low Ferritin (
3. What is the evidence for the recent press about statins and grapefruit juice being harmful?
4. Is there any difference between processed juice and fresh juice?
5. What is Epley’s manoeuvre for the treatment of benign vertigo?
6. What is the best treatment for pompholyx (dyshidrotic eczema, vesicular palmoplantar eczema) of the feet?
7. What is the cause of a black tongue? No hairs present. The tongue is not painful. Swabs are negative.
8. What is the best treatment for benign positional vertigo (BPV?What treatments are available for sebaceous hyperplasia?
9. Is it safe too fly during the first trimester of pregnancy? What are the risks, if any, associated with it?
10. Many of our patients have isolated raised gamma glutamyl transferase. Often these patients are on statins. How should such patients be evaluated?

The numbers are pretty staggering, the most popular question has been viewed 38,853 times and the 10th most popular was viewed 14,890 times.

The current website has seen massive traffic over the years, it deserves a peaceful retirement!

Just a quick update as things have been quiet on the blog. Basically, I’ve been in hospital and recovering from a partial menisectomy.

I injured myself a year ago running and initially I was diagnosed with a medial ligament strain. As a result of this mis-diagnosis (please, no-one mention evidence!) it was 6 months of physical therapy with no tangible results. So, I went to see a consultant orthopaedic surgeon who ruled out – clinically – medial ligament damage and suspected bursitis. However, he suggested I have an MRI scan. When he told me the bursitis was secondary to a meniscal tear I was shocked and hence a rubbish patient. I asked no questions about prognosis, nature of the operation etc.

Anyway, I had the operation earlier this week (partial menisectomy plus a steroid injection for the bursitis) and am recovering well. I’m hoping to run again in 4-6 weeks – hurrah.

If anyone is interested in seeing a bad picture of my knee taken this morning then click here.

Not particularly scientific but here is my attempt at comparing results from Google and Bing (using this rather useful side-by-side tool http://www.blackdog.ie/google-bing/search.php).

I’m based in the UK and the results went to the .com site (as opposed to .co.uk so it’s not clear what impact this might have. I’ve selected five searches which seem fairly reasonable terms.
I’ve also included the URLs so you can better see where the results are from.

Search term: prostate cancer screening

Google top 5

• Cancer – Prostate – Prostate Cancer Screening: A Decision Guide (www.cdc.gov/cancer/Prostate/publications/decisionguide)
• Prostate Cancer Screening – National Cancer Institute (www.cancer.gov/cancertopics/pdq/screening/prostate/patient)
• Prostate Cancer: Screening and Testing – National Cancer Institute (www.cancer.gov/cancertopics/screening/prostate)
• Prostate Cancer Risk Management (www.cancerscreening.nhs.uk/prostate/index.html)
• Prostate cancer screening: Should you get a PSA test? – MayoClinic.com (www.mayoclinic.com/health/prostate-cancer/HQ01273)

Bing top 5

• Prostate Cancer Screening – National Cancer Institute (www.cancer.gov/cancertopics/pdq/screening/prostate/patient)
• Cancer – Prostate – Prostate Cancer Screening: A Decision Guide (www.cdc.gov/cancer/Prostate/publications/decisionguide)
• Prostate cancer – Wikipedia, the free encyclopedia (en.wikipedia.org/wiki/Prostate_cancer)
• Problems with screening aren’t prostate cancer-specific (prostatecancerinfolink.net/2009/05/12/problems-with-screening-arent-prostate-cancer-specific)Prostate Cancer: Screening and Testing – National Cancer Institute (www.cancer.gov/cancertopics/screening/prostate)

Verdict – A marginal win for Google, Bing returned results that were slightly less focussed (e.g. the general Wikipedia article on prostate cancer or slightly less reputable.

Search term: MMR autism

Google top 5

• Does the MMR Vaccine Cause Autism? – DukeHealth.org (http://www.dukehealth.org/HealthLibrary/AdviceFromDoctors/YourChildsHealth/mmr_vaccine_and_autism)
• Autism and the MMR Vaccine (http://www.nichd.nih.gov/publications/pubs/autism/mmr/)
• NIP: Vacsafe/Concerns/Autism/FAQs-Autism and MMR (http://www.cdc.gov/nip/vacsafe/concerns/autism/autism-mmr.htm)
• BBC NEWS Health ‘No link’ between MMR and autism (http://news.bbc.co.uk/2/hi/health/4311613.stm)
• NHS Blog Doctor: Barack Obama : MMR & autism, the wibble and the woo (http://nhsblogdoc.blogspot.com/2009/01/barack-obama-mmr-autism-wibble-and-woo.html)

Bing top 5

• NIP: Vacsafe/Concerns/Autism/FAQs-Autism and MMR (http://www.cdc.gov/nip/vacsafe/concerns/autism/autism-mmr.htm)
• Autism and the MMR Vaccine (http://www.nichd.nih.gov/publications/pubs/autism/mmr/)
• Link Between Autism And the Measles Mumps Rubella Vaccine (http://en.wikipedia.org/wiki/MMR_vaccine_controversy)
• Does the MMR Vaccine Cause Autism? – DukeHealth.org (http://www.dukehealth.org/HealthLibrary/AdviceFromDoctors/YourChildsHealth/mmr_vaccine_and_autism)
• the Mmr Vaccination Causing Autism (http://en.wikipedia.org/wiki/MMR_vaccine)

Verdict – A clear win for Bing. A controversial topic and it returned the most robust sources.

Search term: type 2 diabetes metformin

Google top 5

• Metformin: Oral Medication for Type 2 Diabetes – Metformin and …(http://diabetes.about.com/od/equipmentandbreakthroughs/a/metformin.htm)
• Oral Medications For Managing Type 2 Diabetes – Type 2 Diabetes …(http://diabetes.about.com/od/equipmentandbreakthroughs/p/oralmeds.htm)
• Diabetes – Treatments for Type 2 (http://www.patient.co.uk/showdoc/27000260/)
• Type 2 diabetes treatment (http://medweb.bham.ac.uk/easdec/prevention/HBA1c%20&%20type%202%20diabetes.htm)
• Fighting Type 2 Diabetes With Metformin (http://www.disabled-world.com/artman/publish/metformin.shtml)

Bing top 5

• Metformin: Oral Medication for Type 2 Diabetes – Metformin and …(http://diabetes.about.com/od/equipmentandbreakthroughs/a/metformin.htm)
• Merck Serono Launches Glucophage(R) Powder (innovative Powder … (http://www.medicalnewstoday.com/articles/149042.php)
• Clinical Alert: Diet and Exercise Dramatically Delay Type 2 Diabetes … (http://www.nlm.nih.gov/databases/alerts/diabetes01.html)
• Health Links Content: Lactic acidosis: Lactic acidosis associated with … (http://healthlinks.mediwire.com/main/Content.aspx?ArticleID=197139)
• NEJM — Reduction in the Incidence of Type 2 Diabetes with Lifestyle … (http://content.nejm.org/cgi/content/short/346/6/393)

Verdict – Clear win for Google. I felt the results were more focussed using Google.

Search term: side effects statins

Google top 5

• Statins – drug class, medical uses, medication side effects, and …(http://www.medicinenet.com/statins/article.htm)
• Statins: Side effects of anti-cholesterol drugs questioned Mail …(http://www.dailymail.co.uk/health/article-392689/Statins-Side-effects-anti-cholesterol-drugs-questioned.html)
• Statins: the truth Mail Online (http://www.dailymail.co.uk/health/article-432395/Statins-truth.html)
• Dangers of Statin Drugs: What You Haven’t Been Told About Popular …(http://www.westonaprice.org/moderndiseases/statin.html)
• Statin side effects: Weigh the benefits and risks – MayoClinic.com (http://www.mayoclinic.com/health/statin-side-effects/MY00205)

Bing top 5

• Statins – drug class, medical uses, medication side effects, and …(http://www.medicinenet.com/statins/article.htm)
• Statins Side Effects 2008 « teamrich.wordpress.com (http://teamrich.wordpress.com/2008/03/30/statins-side-effects-2008/)
• In the Real World, a Slew of Side Effects from Statins (http://www.businessweek.com/magazine/content/08_04/b4068057096279.htm)
• Statins’ Side Effects Under Fire – CBS News (http://www.cbsnews.com/stories/2004/10/11/eveningnews/main648685.shtml)
• Statins – Statin Drug Side Effects (http://www.spacedoc.net/statin_side_effects.html

Verdict – A draw, I wasn’t really impressed with either (half a point each)

Search term: acne

Google top 5

• Acne.org – Acne treatment and community (http://www.acne.org/)
• Acne vulgaris – Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Acne_vulgaris)
• Acne Jeans, Shoes & Ready To Wear – Acne Online Shop (http://shop.acnestudios.com/)
• Acne.com – Acne Treatment Information (http://www.acne.com/)
• Acne (http://www.aad.org/public/publications/pamphlets/common_acne.html)

Bing top 5

• Acne (Internal link to content provided by Mayo Clinic)
• Acne.org – Acne treatment and community (http://www.acne.org/)
• Acne.com – Acne Treatment Information (http://www.acne.com/)
• Acne vulgaris – Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Acne_vulgaris)
• Acne (Pimples) Causes, Treatment Information and Types on MedicineNet … (http://www.medicinenet.com/acne/article.htm)

Verdict – A win for Bing.

Overall verdict is – rather boringly – a draw with two ‘wins’ each and the rather disappointing draw. Given that Bing is so new (2 days old) I think it’s pretty remarkable!

NOTE: See techcrunch’s none health comparison: Search Smackdown: Bing Vs. Google