Trip Database Blog

Liberating the literature


June 2015

Email problems

We are in the process of switching to a new email system and this is causing problems!  If you’re requesting things such as password renewal your email is in a queue of 28,776 and the rate of sending is 1,006 per hour!  So, another 24+ hours till we’ve got through those.

Prior to the new system we used an in-house email tool we built from scratch.  It worked really well for 7+ years but has recently started to creak at the seams.  So, we’ve upgraded to a paid system called Mandrill

The problem is that when you’re new it doesn’t allow rapid sending of emails as it ‘senses’ your reputation. It looks at things such as number of rejected emails (for instance).  The one thing we have are a load of dormant accounts and currently we’ve got a bounce rate of 20% – so 20% of emails are bouncing back as being undelivered.  This doesn’t help our reputation, which is ‘poor’ – hence being restricted to 1,006 per hour.

The good news is – and Mandrill is great for this – is that it allows us to easily auto-delete these dormant account so next time our reputation will be much higher and therefore we should have a much higher send rate.

That aside Mandrill does all sorts of things which should allow us to create a much better email experience and also it gives us analytics showing how many emails were opened, how many links were clicked etc.  Fascinating reading.

So, apologies if you’re caught in the email queue!

Trip tips: refining your search

One of the many powerful features of Trip is the ability to refine your results based on the type of evidence you’re looking for.  It’s really simple to use and below are some screen shots to walk you through the process.

If you have any questions just ask:

If you’re interested in upgrading, see the main differences in this infographic and upgrade here.

Search safety net

As we move forward after the introduction of our Premium product we can start to plan future developments and one is a search safety net!

Using our click stream data we can see what articles you’re looking at suggest other documents that you should consider.  Take this network map (click to enlarge):

This is based on searches on Trip for urinary tract infections.  Each blue square (node) represents an article and the lines linking them are created when a user clicks on two (or more) articles in the same search session.

If we have this information we can build a really useful system.  A user comes and does a search of Trip for UTI and finds, from articles in the bottom right of the above image, a number of articles (marked in red in the image below):

It is clear that they may have overlooked four articles (marked as blue nodes) so we alert the user.  It gives them a chance to double check the results.  They may have deliberately excluded them or they may have simply made a mistake.  If it’s the latter then the system will have served its function as a safety net.

I’ve started using the phrase ‘Trip makes finding evidence easy’ but with this technique we could also claim that ‘Trip easily helps you not miss key evidence’.  Not quite as succinct, but you get the picture!

This is a value added service so I envisage it only being available to Premium users of Trip.  Hopefully another reason to upgrade.

Automating PICO and searching

I have the great honour of being part of the KConnect consortia, recipients of an EU Horizon 2020 innovation grant. Trip is involved in a number of great projects within KConnect and I plan to blog about them all over the course of the year.  The first to feature is enhancing our PICO interface.

Asking questions may seem straight forward but it can be difficult so by helping users understand the key elements of their questions it typically gives the questions better structure.  PICO stands for:

  • P = Population (eg what condition the user has)
  • I = Intervention (eg a drug, diagnostic test)
  • C = Comparison (eg an alternate drug or test)
  • O = Outcome (eg mortality, QoL)

Take these two, real question:

  • How can you safely treat constipation in pregnancy?
  • In diabetes would an AIIRA benefit over an ACE? 

In the top Q, the P = pregnancy and the O = constipation.  Alternatively the population could be pregnancy and constipation.

The second Q is more complicated but the P = diabetes, I = AIIRA and C = ACE inhibitors

You’ll note that questions don’t need all four elements; it’s a flexible concept!  Irrespective of the number of PICO elements it can be really useful in helping users think about the key elements of the question they may have.

From user feedback I hear time and time again that the PICO interface is great and really helps health professionals think through their questions.

KConnect is helping us improve it still further!  We will simply allow users to type our their question in full and press search.  We will automatically attempt to identify the PICO elements and then pass those elements to our search.  By highlighting the suggested PICO elements it will teach users by experience what the PICO elements are as well as speeding up the question answering process.

A further minor step – which might be really interesting – is to record the full question and the articles the user subsequently clicked on.  It’s not quite the same as a full answer, but a ‘half way house’.

We’ve a good few months of work on this using, various techniques: machine learning, semantic annotation, hard work.

I’ll keep you posted.

Flibanserin and Trip: Making evidence easy

Our previous post Flibanserin and blogs highlighted how adding blogs to the Trip index can be really useful.  But the search for flibanserin on Trip highlights lots of issues.

As you can see from the above image the ‘Ongoing clinical trials’ filter shows 14 closed trials (these are trials that are no longer recruiting) and that there are 8 controlled trials.  So, we can spot a shortfall of 6.  So, is that an issue?  It can be as it can suggest hidden trails, which are never a good thing.  I had a superficial look and found a couple of things of interest:

  • A number of the closed trials were halted for ‘administrative’ reasons.  I’m not sure how satisfactory that is.
  • Our controlled trials are identified via a filter and this has over-identified controlled trials and there are only actually 6 controlled trials in our index.  So, while we over-identified some, we possibly under-identified others.

Irrespective of the above points Trip makes it incredibly easy to spot potential publication bias.  If you’re interested in unbiased evidence this feature alone is very useful!

Medical images on Trip

One great feature on the Premium Trip Database is the huge medical image section.  Below are three examples (click on image to expand):


Metformin pharmacokinetics

MRI Neck

A great range of images all clearly laid out and accessible with the typical ease you’d expect from Trip.  As we’re starting to say Making evidence easy!

Upgrade today and start taking advantage of how powerful and easy to use Trip is. For further information about the benefits of the premium Trip see this beautiful infographic.  To view the prices and benefits of an individual subscription click here and for institutional subscriptions click here.  If you’re unconvinced email me: to arrange a free trial.

Peer-review and journals

Richard Smith (who used to edit the BMJ) has just posted on Facebook:

Publishing in journals is a slow, balls aching process that adds no value. Only academics who need the “points” bother. Far better to blog.

Richard has long argued against the peer-review process and here are two blogs, by Richard, for further reading

A connected article, by John Ioannidis, How to Make More Published Research True, makes a number of assertions, two of which are selectively shown below:

  • Currently, many published research findings are false or exaggerated, and an estimated 85% of research resources are wasted.
  • Modifications need to be made in the reward system for science, affecting the exchange rates for currencies (e.g., publications and grants) and purchased academic goods (e.g., promotion and other academic or administrative power) and introducing currencies that are better aligned with translatable and reproducible research.

 I’ve often marveled at the connected worlds of academia and publishers – two worlds that have a symbiotic relationship, one without the other wouldn’t work.  I am on a few online academic paper repositories and I’m always getting emails from people I follow who have published a new article.  I’m staggered by how often they can churn them out.

I then look at the wonderful EvidenceUpdates (a service funded by the BMJ and supplied by HIRU at McMaster). They scan the ‘top’ 120 journals and do an in-house quality assessment (a form of critical appraisal) and those that pass get sent to a network of clinicians who assess the papers for newsworthiness and relevancy to clinical practice.  Amazingly around 95-96% are rejected.  While I’m not suggesting all 95-96% are junk, I suspect the majority are little more than vanity publishing.  Academics wanting another article for their CV and publishers desperate for content to justify the purchase price.

My own world of Q&A frequently shows how poorly aligned academia is with coal-face clinical information need.  It was one of the reasons I got involved in the setting up of DUETs (DUETs publishes treatment uncertainties from patients, carers, clinicians, and from research recommendations, covering a wide variety of health problems.) The idea is to grab ‘real’ questions with a view to improving research procurement.  There is a suspicion that academics pursue their own interests which may not be aligned with clinical need.  So, DUETs allows for the ‘real’ questions to be raised.  Working with James Lind Alliance it can be a powerful combination.

Flibanserin and blogs

‘Female viagra’: FDA panel backs Flibanserin with safety restriction

Whenever I see stories about new drugs published in the newspapers I turn to Trip to see what we’ve got on the topic. It turns out we’ve got relatively little.  The top trial (SNOWDROP trial) concludes:

In naturally postmenopausal women with HSDD, flibanserin, compared with placebo, has been associated with improvement in sexual desire, improvement in the number of SSEs, and reduced distress associated with low sexual desire, and is well tolerated.

But what I like is that the first result in Trip is Astroturfers rule the day: FDA’s flibanserin reviewers were “emotionally blackmailed” by a slick lobbying campaign, a critical examination of the process.  While many do not like the inclusion of blogs (they can easily be removed from the search results) they can offer a critical insight/context which can be missing from journal articles.

As an aside, another thing I enjoyed seeing was that our clinical trial search found 12 trials, all of which are now classed as closed.  I’d not appreciated the power of having registered trials pulled through in to Trip.

Trip tiles

We’ve been live, as a Freemium service, for a little over two weeks.  In my more pessimistic (pre-launch) moments I was thinking that at this stage I may be having to abandon the whole idea as no-one was purchasing Trip.  However, I’m delighted that this is not the case!  We’re massively ahead of schedule and as such we’re accelerating various upgrades that we’d hoped to do towards the end of 2015.

Even more exciting, we’re thinking of new ideas!

One idea springs from my desire to do something interesting with the Timeline.  The Timeline records your searches and articles viewed on Trip and not much else.  So, one idea is to create something called Trip Tiles!  A fresh tile would be created with every new search and at the top of the tile would be the search terms and underneath would be the articles viewed.  In many ways this is what the timeline currently does.  But I think there’s the potential to link other people’s searches.  So, you might search and find three articles and as part of that process we highlight that 1 or more of the articles has been viewed in someone else’s timeline and offer you the chance to see their tile.

Best illustrate that with one of my legendary attempts at a picture (if we roll out this feature we’ll get them properly designed):

You could go from tile to tile both browsing and looking to see if you’ve missed any useful articles that someone else has already found.  Not only that you can see what search terms they’ve used – again possibly useful.
How we’d implement this would be a challenge, but I’d see that as an interesting challenge not a particularly tough one!  Any feedback on the idea would be appreciated – comments on the blog or via email:

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