6 weeks ago I posted an article about using TRIP to identify content suitable for resource poor settings click here.
Since then I’ve been busy discussing the idea with a significant number of people including Richard Smith (Director of Ovations and ex-editor of the BMJ), David Lipman (Director of the NCBI and responsible for PubMed) and representatives from WHO. I’ve worked up the idea some more – with the help of those I’ve discussed the idea with – and am currently seeking funding. The idea, as it stands, is as follows:
Problem: A clear problem for resource poor settings is identifying high quality evidence upon which to base clinical decisions. Within TRIP, content suitable for these environments, is frequently ‘hidden’ by the volume of material aimed at resource rich environments, making the identification of appropriate evidence difficult. This problem is not restricted to TRIP: there is no way in Medline (or other databases) to select material suitable for resource poor settings.
Proposal: We propose that users of TRIP would be allowed to ‘tag’ (by pressing a single button) an article if it is suitable for resource poor settings. A user coming to TRIP could then carry out a search and decide if they want to restrict the results to just those tagged as being suitable for resource poor settings.
Quality is an important issue, therefore, we propose a quality system whereby an article would be considered ‘pending’ until it has been selected at least two further times. If a user restricts any subsequent search a pending article would be clearly marked as such.
August 24, 2009 at 6:50 pm
That's a really important problem, and looking for a “crowdsourcing” strategy is an interesting solution. However, it has an important problem: -the motivation to look for tag material when the project starts (as you can miss relevant information if you do it)
– The motivation for tagging: who is going to volunteer when starting? The idea of requesting a second tag sounds promising but it will also delay the selection of relevant material.
Why do not look in sources that have been selected as relevant in resource poor settings?
August 24, 2009 at 8:11 pm
I doubt very much that it will identify all the pertinent material, but that's not the main motivation. We're simply hoping to identify a significant amount of the material to make it a usable resource.
We're also keen to be transparent so people can choose to use it if they wish.
With regard to who will be motivated we're working on the web 2.0 principle of 90, 9 & 1. 90% won't get involved, 10% will loosely engage and make occasional contributions while 1% will actively contribute. With 30,000 users per day 1% would see lots of contributions.
The 2nd and 3rd tag will not delay things. If a user selects the 'only show articles that have been tagged as being suitable for resource poor settings' it will show all articles tagged. However, those with only 1 or 2 'tags' will be clearly labelled as 'pending'.
With regard your latter point – have you any examples?
as even with one tag the record will be
August 24, 2009 at 8:13 pm
I think this is a really important issue. However, what I have seen (we in Mexico have the “best” from both, rich and poor worlds) is that the interventions that works in the “poor” usually are the same on the “rich” nations. What it is different are the diseases and conditions. As an example I could mention malaria, dengue, Chagas, etc. These conditions are more prevalent in the developing world, indeed, but the “valid” articles citing interventions for these conditions are in the Lancet, JAMA, NEJM, which are not free for the doctors seeing these terrible diseases. Perhaps I am wrong, I do not have the evidence (yet) but if I can´t find it, you just give me another thesis dissertation idea!
We should “mind the gap” instead and try to allocate resources equally. I know it is utopic and it looks like I am talking about money, but I am talking about free access to the poor, free access to information. What my students from poor areas asked me is usually the access to high ranking journals.
I think your idea is great and should be leveled on to other to follow the examplo of PlOS, BMC journals and the BMJ.
August 25, 2009 at 5:50 am
Thanks for the input.
I agree, to a point, about the best interventions are no different. However, for many situations, the best evidence is impractical. For instance in a resource poor setting there is no practical benefit of suggesting and MRI scan for knee problems. Another example might be in any condition where the latest drugs are still 'in patent' and generally unaffordable.
From a users perspective they can come to TRIP carry out a normal search and if they feel that the results are not applicable as the interventions are not approrpiate they can restrict the search to resource poor settings.
Ultimately, this is optional and the user can decide.
You mention access, I was thinking that we could take this idea further and possibly work with HINARI in some way. They grant free access to lots of content (including Cochrane, Lancet, BMJ, JAMA etc) but again there is lots of content not suitable for resource poor settings. Could we combine our data (of content suitable for resource poor settings) with HINARI to produce a database of full-text content that could be searchable over the internet or distributed via a pen/flash drive?