In the previous post (Turning Research Into Practice – Except When the Research Isn’t There), we showed that nearly half of real clinical questions asked through AskTrip sit in areas with only moderate or limited evidence. These are not marginal issues – they are everyday decisions affecting millions of patients.

If we take those questions seriously, the obvious next step is to ask:

What should we actually research next?

Rather than starting from theory, funding trends, or academic fashion, we start from real clinical uncertainty. In other words, from the questions clinicians are already asking, repeatedly, because existing evidence does not give them confident answers.

How we selected the research priorities

For this exercise, we prioritised questions using two simple criteria:

  • Impact – disease burden, severity, mortality, long-term disability, and healthcare cost.
  • Scope – the number of people affected, and whether answers would apply broadly.

We assume, following standard health policy principles, that:

  • High-impact conditions (major disability, mortality, or healthcare cost) merit priority.
  • Interventions that could improve outcomes for large numbers of people have added value.
  • Questions that fill persistent, well-recognised evidence gaps are especially important.

Using those assumptions, a small number of clear research priorities emerge directly from the AskTrip data.

A caveat is important: we have not independently verified the full evidence base for each question. Some may already have better answers than are reflected here. This represents an initial, data-driven approach to research prioritisation based on clinical uncertainty, which we intend to refine through ongoing evidence review.

1. Diabetes in Critical Illness (GLP-1 agonists in ICU)

Research question:
In critically ill adult patients, do GLP-1 receptor agonists improve glycaemic control and clinical outcomes compared with standard insulin-based management?

Why this matters:
If new evidence shows GLP-1 drugs improve ICU glycaemic control or outcomes, this could significantly benefit many hospitalised diabetics (high incidence, high severity). ICU patients with uncontrolled diabetes face organ damage risks, so a positive finding would be high impact per patient.

2. COPD and Pneumonia Prevention

Research question:
In patients with COPD, does pulmonary rehabilitation reduce the incidence of recurrent pneumonia compared with usual care?

Why this matters:
COPD is a prevalent chronic disease. Demonstrating that pulmonary rehabilitation (or other intervention) lowers pneumonia risk could reduce hospitalisations and mortality in a large population. Even a moderate reduction in pneumonia incidence would scale to many lives saved, given COPD’s prevalence. This combines moderate per-person effect with large population benefit.

3. Pain Management (Opioid Side-Effects)

Research question:
Among patients requiring opioid analgesia, which opioid is associated with the lowest incidence of clinically significant constipation and treatment discontinuation?

Why this matters:
Opioids are widely used across many conditions. Identifying the least constipating (or safest) opioid could improve quality of life for countless patients. We assume this is important as opioid-induced constipation is a common, burdensome side effect.

4. Autonomic Disorders (Gabapentin for POTS)

Research question:
In patients with postural orthostatic tachycardia syndrome (POTS), does gabapentin improve symptoms and functional outcomes compared with placebo or standard management?

Why this matters:
POTS is relatively rare but can be severely disabling. Proving efficacy (or not) of gabapentin would directly change care for those patients (high individual impact), even if the population is smaller.

5. Fall Prevention (Decaffeinated Drinks and Other Interventions)

Research question:
In older adults, do simple behavioural or environmental interventions (such as caffeine reduction) reduce the incidence of falls compared with usual care?

Why this matters:
Falls in older adults cause major morbidity. If simple interventions can reduce falls, small individual benefits could prevent serious injuries at the population level. This merits research given the high burden of falls, even if any single intervention has a modest effect.

6. Neonatal and Paediatric Best Practice

Research questions:
In preterm infants, what is the optimal timing for feeding tube placement to maximise growth and minimise complications?
In infants, does early introduction of allergenic foods reduce the long-term risk of food allergy compared with delayed introduction?

Why this matters:
These address early-life interventions with potentially lifelong consequences. Even small nutritional or developmental improvements can drastically affect a child’s trajectory, making these high impact for individuals despite smaller population sizes.

7. Mental Health Interventions

Research questions:
In veterans with PTSD, which psychological therapies produce sustained functional improvement?
In autistic individuals, which interventions improve long-term quality of life and independence?

Why this matters:
Mental health conditions account for large disability burdens. Better evidence here could be transformative for patients and families.

8. Vaccination and Screening Strategies

Research questions:
Which asymptomatic populations benefit from routine screening, and at what intervals?
What vaccination schedules maximise population-level benefit while minimising harm and resource use?

Why this matters:
These questions shape national guidelines and affect very large populations. Even minor changes in evidence can influence millions of clinical decisions.

Systems like AskTrip do not just answer questions – they reveal where the research system itself is failing.


In the end, the most important research questions are not the ones that sound exciting, but the ones clinicians keep asking because no one has ever given them a reliable answer.