When starting the community Q&A I was worried that people would be lazy, not search themselves and simply ask the question. This has not been the case. The overwhelming majority have been complex and legitimately not fully answerable via Trip!  Here are a few examples with my interpretation underneath:

In children with pharyngitis, how useful are prediction tools to select whom to perform microbiological tests?

This was difficult to answer for a couple of reasons:

  • For the person asking the question: He was Spanish and therefore I wonder about the knowledge of synonyms. He asked about ‘prediction tools’ whereas the (English) literature tends to use the phrase ‘decision rules’. So, when searching that starts from a point of great disadvantage!
  • From Trip’s perspective we simply did not index the main document, from CADTH.  We tend to grab all the content from them so I’ll need to understand why it’s not in our index!

The adult patient developed insomnia due to metoprolol, is there B-blocker less associated with causing insomnia?

The main issue is the lack of clarity of evidence – as mentioned in the answer it is often contradictory. So, was the motivation of the questioner to try to get a more definitive answer than suggested by the literature?

What is the possible effect for giving an ACE +NSID+diuretics in elderly patients?

We’ve actually been asked this question twice!  This is a problematic search due to the issue of synonyms. But, for me, the issue of the disparate nature of the literature is the key problem. There are a number of references, none are definitive. So, that induces an uncertainty all of its own.  Clearly a review is needed, and this is what the community Q&A provided, but without it, it’s tough for a health professional to start to make sense of the literature.

I feel there should be more fundamental lessons but I clearly need more thinking time!