Search

Trip Database Blog

Liberating the literature

Open Search
Month

September 2025

Introducing Beyond Trip: Expanding the Evidence Horizon

Sometimes the best answer isn’t within Trip’s core collection. That’s why we’ve introduced Beyond Trip, a new feature designed to broaden the search and deliver stronger, more reliable answers when evidence is limited.

How It Works

Beyond Trip is automatically triggered when AskTrip produces an answer that’s judged to be poor:

  • Limited answers, or
  • Moderate answers with three or fewer references.

When this happens, AskTrip seamlessly expands the search to Google Scholar and OpenAlex, scanning the wider research landscape for additional evidence.

You don’t need to take any action – the process happens automatically. It adds about 20–30 seconds to generating the answer.

What You’ll See

New answers created through this process are clearly labelled as having used Beyond Trip.

Two outcomes are possible:

  1. A stronger answer: If new evidence is found, the revised response will be presented with its expanded reference base. You’ll see a note confirming that the answer has utilised Beyond Trip.
  2. A genuine evidence gap: If evidence remains poor, we’ll highlight that even after Beyond Trip, good-quality evidence could not be found. In these cases, we’ll offer five broader or related searches you can try, helping you explore areas where stronger evidence may exist.

Why It Matters

In testing, results have ranged from no change (confirming a genuine lack of evidence) to major improvements – for example, an answer going from zero references in the original output to six references after Beyond Trip.

By intelligently expanding the search only when needed, Beyond Trip ensures you’re not just getting an answer – you’re getting the best possible evidence available.

1

What’s on Nurses’ Minds? Four Emerging Themes

A nursing friend recently asked me about the types of questions we’re receiving from nurses via AskTrip. Since we don’t record the profession of everyone who submits a question, I can’t say exactly what nurses are asking. What I could do, however, was analyse the 40 questions that directly focused on nursing – a reasonable sample to identify patterns. And 4 themes emerged:

Clinical Practice & Patient Care
This theme captures the heart of nursing – the direct application of skill and evidence to improve patient outcomes. The questions reveal a profession dedicated to continuous quality improvement and safety, seeking out evidence-based practices (EBP) in everything from preventing infections like CLABSIs to the simple act of bathing in a nursing home. There is a strong focus on highly specialised areas (e.g., managing chest drains in neonates after cardiac surgery, providing palliative care education), and a push to empower patients, such as assessing the competence of diabetic patients to self-manage. Ultimately, this theme is about defining and standardising the best possible care across all clinical settings, from the Emergency Department (ED) to the community.

Example questions:

  • What are some nurse-driven evidence-based projects by nurses?
  • How can nurses care for and manage chest drains in babies following cardiac surgery?

Nursing Roles & Specialisation
Nursing is no longer a one-size-fits-all profession! These questions underscore the dramatic specialisation and diversification occurring within the field. From comparing the functions of a State Diploma Coordinator Nurse versus an Advanced Practice Nurse (APN) in oncology, to understanding the implementation experiences of APNs, nurses are constantly negotiating their scope of practice. The demand for specialist roles – like the Frailty Nurse Specialist who optimises patient flow, or the Head and Neck Cancer Nurse Specialist – shows that hospitals rely on nurses to manage complex patient pathways and drive efficient, coordinated care. This theme explores how nurses are elevating their professional role to meet sophisticated healthcare demands.

Example questions:

  • What are the roles or functions of a State Diploma Coordinator Nurse versus an Advanced Practice Nurse in oncology?
  • What is the role of a frailty nurse specialist in front-door assessment, admission avoidance, safe discharge planning, and the implementation of least restrictive options in acute care settings?

Education & Professional Development
This grouping dives into how the next generation of nurses is trained, supported, and nurtured. It’s not just about skills; there is a deep academic interest in how nurses acquire professional virtues – the ethical and moral compass – which is fundamental to the profession. Practically, the questions stress the importance of effective teaching and mentorship, focusing on tools like preceptor feedback instruments to improve communication on placement and the use of ePortfolios to support student learning. Whether it’s through innovative continuous professional development (CPD) methods like “Tea-Trolley Teaching” or formalised annual competencies, this theme highlights the commitment to ensuring all nurses remain highly skilled and ethically grounded throughout their careers.

Example questions:

  • How do nurses acquire, develop, or learn virtues for practice?
  • Are there preceptor feedback tools that facilitate communication between preceptors and preceptees to improve nursing academic outcomes?

Workforce, Organisation & Policy
The final theme addresses the crucial, high-level issues impacting the sustainability and health of the nursing workforce. Questions here center on policy and operational efficiency, including the search for safe staffing ratios and frameworks, particularly in high-demand areas like the ED. The profession is actively tackling burnout and retention by seeking organisational interventions to support new nurses. Furthermore, the interest in creating nursing float pools speaks to the need for flexible, effective staffing solutions. This theme encompasses the external factors that influence the profession, including the impact of social media portrayal on public perception and recruitment, making it a critical area for leadership and policy reform.

Example questions:

  • What is the evidence base for safe nursing staffing in emergency departments internationally?
  • What organisational interventions have been used to reduce burnout and increase retention in new nurses?

    Taken together, these 40 questions paint a picture of a profession that is dynamic, diverse, and deeply committed to improvement. Nurses are seeking evidence not only to refine clinical practice at the bedside, but also to expand their roles, strengthen education and professional development, and influence the policies that shape their working lives. The themes suggest a workforce that is both responsive to today’s challenges and actively shaping the future of healthcare.

    0

    AskTrip v2 being tested

    With nearly 3,700 questions answered, we’ve gained a wealth of learning. From the very beginning, we’ve closely tracked both the questions and the answers, giving us valuable insights into the system’s strengths and areas for improvement.

    Behind the scenes, we’ve been working on a major upgrade (our “v2”), which is now in testing. The key enhancements include:

    • Improved search: A new approach that strengthens the link between a user’s question and the articles we identify, ensuring more relevant candidates are surfaced.
    • Greater coverage: A more sensitive system that draws on a wider range of articles identified through the improved search.
    • Reduced hallucinations: Specific safeguards to minimise inaccurate or invented content.
    • Beyond Trip: If evidence is scarce in Trip, the search will automatically expand into the broader academic literature [learn more here].
    • Answer scoring: A more refined and nuanced way of rating responses.

    Each of these features has been tested individually, and we’ll soon begin testing them together as an integrated system. We’re optimistic these changes will deliver a step change in performance.

    And, a final comment, we’re already working on v2.1…

    0

    What Makes a Clinical Question Interesting?

    Every day, health professionals grapple with countless clinical questions. Some are straightforward, with clear answers found in guidelines or textbooks. Others spark debate, inspire curiosity, and feel worth sharing. But what makes one question stand out as more “interesting” than another?

    At AskTrip, we’ve spent a lot of time thinking about this. For us, an “interesting” clinical question isn’t simply unusual — it’s one that resonates with professionals because it touches on the realities of care, challenges assumptions, or sheds light on evolving areas of medicine.

    To bring some structure to this, we’ve developed a scoring system. It looks at elements such as:

    • Clinical impact — will the answer meaningfully affect decisions or outcomes?
    • Breadth — is it relevant across specialties or patient groups?
    • Uncertainty or controversy — are there conflicting views or evolving evidence?
    • Novelty and timeliness — does it involve new drugs, recent guidelines, or emerging issues?
    • Complexity and nuance — does it require careful reasoning beyond the obvious?

    Each question is scored across these dimensions (maximum score = 5). Here are some examples:

    As these results show, the most interesting questions tend to blend impact, breadth, and uncertainty, while also tapping into novelty or a strong curiosity hook. These are the ones that spark debate, inspire teaching moments, and make clinicians pause to think differently about care.

    At AskTrip, we’re building this scoring into our platform, so health professionals can quickly discover the questions most likely to provoke insight, debate, and better decision-making. After all, the right question is often the first step toward the right answer.

    0

    The evolution of clinical questions over the years

    One of the most fascinating aspects of running clinical Q&A services is seeing what questions clinicians actually ask. Looking back at questions submitted to the UK primary care Q&A services – ATTRACT in Wales and the NLH Q&A Service in England (both ended by early 2010s)- and comparing them with questions submitted to AskTrip (from 2025 onwards) gives us a rare opportunity to see how frontline clinical uncertainty has evolved over two decades.

    There’s an important distinction: ATTRACT and NLH Q&A were exclusively used by primary care clinicians, while AskTrip has always had a broader, less clearly defined user base. This makes the comparison even more interesting: we’re contrasting the firmly primary care questions of the 2000s with a more mixed set of modern-day queries.

    For this analysis, we focused on four common clinical areas: asthma, hypertension, depression, and diabetes. We identified relevant questions from AskTrip, then selected a matching set of questions from the historical ATTRACT/NLH archives. To give balance, we used the same number of questions for each condition across both sources. This approach doesn’t capture every question ever asked, but it provides a structured way to compare themes and see how the nature of clinical uncertainty has shifted over time.

    Asthma: Same Worries, New Tools

    • Then (ATTRACT & NLH Q&A): Questions often focused on inhalers and safety: Should LABAs always be combined with steroids? Does tiotropium help in asthma? Is chlorine in swimming pools a trigger for atopic kids? These were very patient-specific, case-driven questions.
    • Now (AskTrip): Questions reflect newer therapies and broader patient groups: When should biologics be started? What’s the role of immunotherapy? How do you manage asthma in pregnancy or elite athletes?

    The safety theme is consistent, but modern queries also ask about biologics, prevention, and life stages – reflecting advances in care and broader evidence.

    Hypertension: From Protocols to Personalisation

    • Then: Practical queries dominated: How often should hypertensives have bloods checked? Which drugs are safe in pregnancy? These questions often referenced NICE guidelines or practical case scenarios.
    • Now: Broader and more diverse: What’s the best treatment for hypertension? Is renal denervation worth considering? What’s the malpractice risk of hypertension?

    We’ve moved from nuts-and-bolts case management to personalised medicine (pharmacogenetics), lifestyle interventions, digital tools, and even system-level concerns.

    Depression: Beyond Antidepressants

    • Then: Most questions were about drugs and safety: long-term use of dosulepin, SSRI interactions, depression risk from antihypertensives, safe prescribing in pregnancy, and whether statins cause low mood.
    • Now: The scope has widened: How effective is CBT vs medication? What about ketamine or esketamine for resistant depression? Does partner involvement help postnatal depression? Is St John’s Wort useful?

    Clinicians still worry about safety, but there’s now far greater interest in therapy modalities, novel treatments, and patient-centred care.

    Diabetes: Core Concerns, Expanding Horizons

    • Then: Focused on early prevention debates and older drugs: Is aspirin useful for primary prevention? Metformin vs sulfonylurea first-line? How much does each drug lower HbA1c? When to stop metformin in renal impairment?
    • Now: Questions reflect a complex therapeutic landscape: What’s the role of GLP-1s, SGLT2s, tirzepatide? How effective are lifestyle interventions in preventing diabetes? Is AI ready for diabetic retinopathy screening? Should podiatrists be embedded in primary care teams?

    The fundamentals (glycaemic control, complication prevention) remain, but questions now incorporate new drug classes, technology, prevention strategies, and system-level solutions.

    Cross-Cutting Themes

    Looking across all four areas, some common threads emerge:

    1. “What’s the best treatment?” never goes away. Whether in 2005 or 2025, clinicians want to know the most effective, safest option.
    2. Safety is a constant. Every era has questions about drug harms, interactions, and risks in special populations.
    3. Shifts in framing. The early services captured questions often phrased as case vignettes; AskTrip includes both detailed scenarios and broad, almost textbook-like questions.
    4. Lifestyle and holistic care. Far more visible in modern questions – from mindfulness to diet, fasting, exercise, and patient communication.
    5. Technology and innovation. Biologics, pharmacogenetics, AI, apps, and new drug classes appear only in the newer questions.
    6. From patient to system. Modern queries also touch on malpractice, prevalence in specific countries, and team-based care.

    Conclusion

    Comparing two decades of clinical questions is like holding up a mirror to how medicine itself has changed. The essence of what clinicians want – safe, effective treatments backed by evidence – has never shifted. But the tools, therapies, and perspectives have expanded dramatically.

    ATTRACT and the NLH Q&A Service captured the day-to-day dilemmas of UK primary care in the 2000s, while AskTrip reflects a wider, global audience with questions ranging from basic management to cutting-edge therapies and system-level challenges.

    In 2005, a GP in Wales might have been asking whether to taper clonidine slowly; in 2025, someone on AskTrip is asking whether AI is ready to screen for diabetic retinopathy. The questions evolve, but the clinician’s need for trustworthy, evidence-based answers remains constant.

    0

    Thinking Out Loud – Emergency Departments as Systems

    We noticed a clump of Qs around emergency departments (ED) systems, workforce, and patient experience. And following on from the approach we used yesterday, we analysed and expanded these into wider topics

    1. Reducing Demand / Preventing Admissions

    Existing Qs:

    • Effectiveness of community-based models of emergency care.
    • Best strategies to prevent unnecessary admissions.
    • Effectiveness of advance care planning in preventing admissions.

    Potential additional Qs:

    • What is the impact of urgent care centres, walk-in clinics, and out-of-hours GP services on ED demand?
    • How effective are paramedic-led interventions (e.g., treat-and-refer pathways, community paramedicine) in reducing ED conveyance?
    • Do public education campaigns (on appropriate ED use) reduce unnecessary visits?
    • What role do integrated care systems (linking primary, community, and social care) play in reducing ED demand?
    • What is the cost-effectiveness of these demand-reduction strategies?

    2. Workforce & Staffing in EDs

    Existing Qs:

    • Impact of ED layout on staffing levels.
    • Frameworks for ensuring safe nursing staffing.
    • International evidence base for safe staffing.

    Potential additional Qs:

    • How do staff-to-patient ratios correlate with patient safety outcomes in EDs?
    • What is the impact of skill mix (nurses, nurse practitioners, physician associates, consultants) on ED performance and safety?
    • How does burnout and turnover among ED nurses and physicians affect patient outcomes?
    • What is the evidence for flexible staffing models (e.g., surge staffing during peaks) in maintaining safety?
    • How does the physical environment (e.g., single rooms vs. open bays, digital monitoring systems) influence staff workload and efficiency?

    3. Stakeholder Perspectives & Communication

    Existing Qs:

    • Perceived role of EDs among the public, professionals, and policymakers.
    • Interventions to improve nurse–family communication in paediatric EDs.

    Potential additional Qs:

    • How do patients with frequent ED use perceive the role of emergency departments?
    • What is the impact of shared decision-making tools on communication and satisfaction in the ED?
    • How do cultural and language barriers affect communication and outcomes in ED settings?
    • What interventions improve staff–patient communication in high-stress environments (e.g., triage, resus)?
    • How do media portrayals of EDs shape public expectations and demand?

    Bringing these strands together, what stands out is just how multi-dimensional the evidence needs to be. Emergency departments are not only clinical environments but also systems under pressure, workplaces with unique staffing challenges, and touchpoints where public expectations, professional realities, and policy goals all collide.

    By clustering the questions in this way, we can start to see where the gaps lie: for example, plenty is known about demand reduction through community models, but far less about the cultural narratives that shape how people view and use EDs. Likewise, staffing frameworks exist, but how they interact with design, technology, and wellbeing is less clear.

    This sort of mapping doesn’t provide the answers, but it does highlight the terrain — showing where a stronger evidence base could make the biggest difference to practice and policy.

    We’ll continue to explore these clusters in future posts. In the meantime, we’d love to hear from readers: which of these areas feels most pressing in your context? And are there other questions you’d add to the mix?

    0

    Thinking out loud – stroke Q&A clusters

    In recent AskTrip activity we’re seeing clusters of related Q&As around stroke. These clusters may reflect how evidence is used in practice. We tried mapping the questions along a stroke care continuum – from Acute & Emergency through Secondary Prevention to Rehabilitation & Recovery – and then added logical “next questions” we haven’t been asked yet.

    So, below are a list of Qs, those with a hyperlink have been asked already and suggested Qs are listed as ‘supplementary’.

    As mentioned in the title this is a ‘thinking out loud’ post – seeing what things look like. It’s helpful to air these ideas…. One can see issues immediately, for instance ‘What are the most effective secondary prevention strategies for reducing stroke recurrence?‘ and ‘What are the current best practices for managing patients with a history of stroke to prevent recurrence?‘ are very similar in scope. But that’s the nature of posting this sort of thing – helps you highlight the issues.

    While there are still some rough edges, the bottom-up nature of this approach feels refreshing. I can’t help but wonder: might this become part of Trip/AskTrip’s future?

    A structured map of evidence questions from acute care to recovery

    1. Acute & Emergency Management

    2. Secondary Prevention (Reducing Recurrence)

    3. Rehabilitation & Recovery

    Cross-cutting Priorities

    • Supplementary questions:
      • How should patients and caregivers be educated about stroke warning signs and secondary prevention?
      • What are the cost-effective models of long-term follow-up in primary vs. specialist care?
      • How can access to stroke rehab services be improved in underserved populations?

    1

    113 Questions in a Day: What Clinicians Are Asking on AskTrip

    Yesterday was a momentous day for AskTrip. We recorded the highest number of clinical questions ever asked in a single day – 113 in total.

    That’s 113 moments where a health professional turned to AskTrip for support: to check a management decision, clarify a diagnosis, weigh risks and benefits, or simply explore the evidence behind a difficult case. To mark the occasion, we took a closer look at what those questions were about – and what they reveal about the daily reality of medicine.

    The Constant Search for Better Treatment

    It’s no surprise that most questions revolved around treatment and therapeutics. Clinicians want to know: What’s the best, safest option for my patient?

    • Should methotrexate be taken at a particular time of day?
    • Is aspirin a valid long-term option after anticoagulation for pulmonary embolism?
    • What are the benefits and risks of SGLT2 inhibitors in elderly patients with diabetes and heart failure?

    These queries show not just an appetite for the latest trials and guidelines, but also a desire to tailor care to unique patient circumstances — like whether stenting is safe in someone with a nickel allergy or why bile acids might be elevated after a cholecystectomy when bilirubin is normal.

    Surgery: When to Cut, and How to Do It Better

    Surgery questions revealed two strands of curiosity: when to intervene and how to do it better.

    • Should a neonatal hernia be repaired early, and if so, when?
    • Should proximal humerus fractures be managed surgically or non-surgically?
    • How does robotic prostate surgery compare to conventional approaches in cost and outcomes?
    • Is transoral thyroidectomy a safer, less invasive option than open surgery?

    These questions highlight a thoughtful balancing of risks and benefits, as well as a hunger for innovations that promise quicker recovery and fewer complications.

    The Rise of “Prehab” and Non-Drug Strategies

    One of the strongest clusters was around prehabilitation — preparing patients physically and mentally before major interventions like surgery or CAR-T therapy.

    • What is the evidence for prehabilitation in thoracic surgery?
    • How does it affect recovery after esophagectomy or cancer treatment?

    This shows a shift from reactive medicine to proactive strengthening, where the goal is not just survival but resilience and long-term outcomes.

    Other questions highlighted rehabilitation and lifestyle: the role of exercise in chronic fatigue syndrome, the best exercises for thumb extension, and safe activity for patients with PICC lines. These aren’t about treating disease alone, but about restoring function and quality of life.

    Complications and Safety First

    Again and again, clinicians asked not just “Does it work?” but “What could go wrong?”

    • Can proton pump inhibitors cause myalgia?
    • Is intracameral cefuroxime safe in penicillin-allergic patients?
    • What complications occur after augmentation mastopexy or breast reduction?

    This emphasis on adverse effects shows how safety considerations shape clinical decisions as much as effectiveness.

    Beyond the Bedside

    Not all questions were about patient management. Some reached into the systems that underpin healthcare:

    • How does plagiarism in nursing programs impact education quality?
    • What are the benefits of grounded theory research in healthcare?
    • Does using a template reduce variation in nursing records?

    These reflect a broader concern with the integrity of training, the quality of evidence, and the consistency of documentation.

    Children and Adolescents in Focus

    Children and young people also featured prominently:

    • Do sleep disorders contribute to anxiety and depression?
    • What’s the evidence for scoliosis screening in Europe?
    • Are team sports or meditation beneficial for children?
    • How should screen time be limited?

    These queries show clinicians thinking beyond immediate symptoms, grappling with prevention, wellbeing, and the challenges of modern childhood.

    Non-Pharmacological Interventions

    About one in six questions were not about drugs at all, but about lifestyle, rehabilitation, or supportive care.

    • What lifestyle changes can slow cognitive decline?
    • How should screen time be managed in children?
    • What is the role of exercise in chronic fatigue syndrome?
    • What are the most effective prehabilitation interventions before surgery?

    This cluster shows a strong appetite for evidence beyond prescribing — emphasising prevention, recovery, and wellbeing.

    What Stands Out from 113 Questions

    Looking across the day’s record activity, three things stand out:

    1. Breadth of curiosity – From thumb exercises to the global burden of dementia, clinicians are asking at every scale.
    2. Safety vs efficacy – Many questions probed not “does it work?” but “is it safe?”
    3. System-level thinking – Alongside bedside care, clinicians are worried about education, documentation, and societal health.

    Why This Matters

    Guidelines and textbooks provide frameworks, but frontline clinicians constantly face edge cases, overlaps, and grey zones. The 113 questions asked yesterday show where evidence support is most needed — in diabetes, dementia, oncology, paediatrics, and in the systems that support safe care.

    Closing Thought

    Clinical questions aren’t abstract. They emerge from real patients, puzzling scans, unexpected complications, and the human urge to do better. Yesterday’s record-breaking 113 questions are more than just a number — they’re a window into the everyday challenges of healthcare, and a reminder that curiosity is alive and well in medicine.

    At AskTrip, we’re proud to help clinicians find answers to those questions — big and small — that matter most to their patients.

    0

    Hallucinations in AskTrip – Let’s Be Honest About Them

    At AskTrip, we’ve always believed that transparency builds trust. That’s why I want to talk about something that’s getting a lot of attention in the world of AI: hallucinations.

    What are hallucinations?

    In simple terms, hallucinations are when a large language model (LLM) generates something that sounds convincing but isn’t entirely accurate. These models are incredibly powerful, but they don’t “understand” in the way humans do. Most of the time this works brilliantly, but sometimes it can slip.

    How we keep an eye on quality

    We don’t just leave this to chance. AskTrip has an active quality control system in place that monitors for hallucinations and other errors. We log, track, and learn from every issue that we find. On top of that, we’re finalising a test bed – a safe environment where we can trial new methods specifically aimed at reducing hallucinations – and we’re doing this in collaboration with AI experts.

    The kinds of hallucinations we’ve seen

    Being upfront means sharing real examples. Here are three patterns we’ve spotted:

    1. Condition mismatch – A paper was returned as though it was relevant to one condition, but in fact, it wasn’t.
    2. Inserted numbers – The LLM provided a recovery figure. The number itself was correct (from the paper), but the way it was presented made it look like it came from somewhere else.
    3. Inference over quotation – Not quite a hallucination, but worth noting. Sometimes the LLM infers from a study instead of sticking strictly to the words on the page.

    How often does this happen?

    Thankfully, not very often. Importantly, none so far have drastically changed the clinical answer — but even minor inaccuracies can matter in a clinical setting. That’s why we take this so seriously, and why it’s equally important that users uphold their responsibility too. This is why we require all users to agree to a responsibility statement, which includes checking the facts and applying their own critical judgement.

    What we’re doing about it

    We’re working hard to make AskTrip even more reliable. That means:

    • Partnering with AI experts.
    • Stress-testing new approaches in our test bed.
    • Constantly monitoring, learning, and refining.

    Why this matters for you

    As a user, it’s important you know that hallucinations can happen. We’ll always be open about this. The frequency is low, we’re actively addressing it, and improvements are underway. But awareness is part of safe use – just as it is with any evidence-based tool.

    Pulling it all together

    So here’s the bottom line: hallucinations exist. We’re aware of them. We’re working hard to reduce them. And we want you, our users, to be aware too.

    AskTrip is built on trust – and that means being transparent, even when it’s uncomfortable. By working together, we can keep improving and make evidence access safer and more reliable for everyone.

    1

    Blog at WordPress.com.

    Up ↑