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Liberating the literature

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Snippets on Trip

We’ve just released snippets to improve our search results.  Snippets are small, auto-generated, passages of text that appears under the document title:

 

The aim is to make search more efficient as it helps the user to better understand what the article is about before they click on it.

We understand that snippets aren’t for everyone. In our testing health professionals tended to like them and information specialists less so.  As a result, as you’ll see in the image above, there is an ‘on/off’ switch.

One other thing to note, as they’re auto-generated they can sometimes generate strange results.  In which case either ignore or let us know – we can then better understand how we can improve them.

Enjoy.

Ongoing trials and systematic reviews

One of Trip’s strengths is its amazing coverage of content. This ranges from secondary evidence such as systematic review and guidelines through to primary research (ie journal articles) and on to eTextbooks – with much in between.

One of these other areas, which gets relatively little attention, is ongoing clinical trials and ongoing systematic reviews

Ongoing systematic reviews: We include all the ongoing systematic reviews included in PROSPERO; at the time of writing that was over 40,000 reviews.

Ongoing clinical trials: We link to all the trials in ClinicalTrials.gov; at the time of writing that was nearly 300,000 separate trials. NOTE: this is a ‘Pro’ only feature.

These can be specifically looked for via the Trip filtering system on the right-hand side of the results page:

Do your search and click on the link of interest – it really is that simple!

One really important thing to consider, which was highlighted in this NEJM article is:

As of October 2016, ClinicalTrials.gov contained more than 227,000 records, and nearly 23,000 of those records had posted results entries; we estimate that results are published in the literature for only half those trials.

If you’re interested in a broad coverage of the literature the content on clinicaltrials.gov includes unpublished data. Find it easily via Trip.

Trip Rapid Review System – structure

On the Rapid-Reviews blog I highlighted the decision to create the Trip Rapid Review System (TRRS).  It got me thinking that it’s both about RRs and Trip – hence me mirroring this new post below. I suspect there are different audiences for each blog!

In thinking about the TRRS I see it being a multi-step process supported, where possible, with technology to automate the process as much as possible.  The steps are as follows:

  • Question setting/clarification, including the extraction of search terms.
  • Search and document selection, including various techniques to unearth articles that may have been missed.
  • Data extraction to produce an evidence table.
  • Narrative review including a conclusion or clinical bottom line (to be decided).
  • Review finalisation. All the above parts pulled together to produce an easy to read rapid review.
  • Publication and peer review.

Over time I will expand on each step, highlighting how it could work. It’s good for me to do as I need to think through all the issues and it gives readers the opportunity to give feedback.

Trip mobile app. It’s getting there!

We’ve been working on a mobile app for Trip and the trial version I’ve been playing with has been really impressive.  You might say that mine is a biased opinion, but believe me I’m our harshest critic as I always want to exceed expectations. With the app I think we’ve got a great chance!  An annotated screenshot is below.

Not 100% sure when it’ll be out, possibly the biggest hurdle will be app store bureaucracy, but we’ll see.

What we’re up to

We’re currently lovely and busy and working on the following:

  • Evidence Maps. I’m very close to finishing the paper describing our evidence maps. I don’t write many papers so no idea if it’ll get published – hopefully the skills of my co-authors will see it get accepted!
  • MeSH. We’re currently working to add MeSH to Trip. Grabbing the MeSH terms from the articles we grab from PubMed is really easy, auto-annotating non-PubMed articles is more of a challenge – but we think it’s in hand!
  • Algorithm – Search is at the heart of Trip and we’re working with a specialist third-party search company to improve our search results. This could/should be massively important.
  • App – We’re making very good progress on developing our first mobile app.

A lot of work which will hopefully all be finished by the end of the year

Using Trip to support research prioritisation

Research prioritisation is really important – it ensures the research that’s undertaken (be it primary research or evidence reviewing) answers important topics that have – as yet – not been answered.

So, how might Trip help?

We’ve been involved in some research which should be published shortly that explored transforming the search patterns of Trip into clinical questions.  For example, if a search was for acne and minocyline we can infer the clinical question was ‘Is minocycline useful in the management of acne?‘.  Our work focused on a small clinical area and was able to isolate and chart the distribution of searches/questions in a chart – with the condition on one axis and intervention on the other. Interestingly, the majority of questions occurred in a small number of areas.  Using a ficitious example here is how a chart might look:

So, in the above you can see that for condition A there have been eight searches relating to intervention 6 and one search for condition A and intervention 3.

Now, using the automated PICO annotation system we have labelled all the RCTs and systematic reviews (SR) and these can be charted in a similar way:

In the above for condition A and intervention 1 there are five RCTs and zero SRs and for condition A and intervention 6 there are three RCTs and one SRs.

So, how does that help us?

Example one: We can say that there is a lot of interest in condition D and intervention 1 and we can see that it is well served with RCTs (18) and SRs (4).  We could go further and report on how up to date the SRs are and if there are many new RCTs that might not be included in the SRs.  We could even see if users are clicking on the individual RCTs and SRs to see if they are meeting the needs of the user.  In other words, of those 18+4 studies users may click on some and not others and this can give us a further clue as to the users intentions and therefore improve potential procurement of new research.

Example two: Condition B and intervention 9 is popular. We can see there are 4 RCTs but no SRs. Surely a candidate for an SR?

Example three: Condition B and intervention 4 is popular but there are no RCTs and SRs which indicates a potential area for research procurement. This could be verified by exploring what articles the user clicked on when doing that search – again useful insight.

Sounds plausible to me but I’d welcome some insight from others!

Trip and the Evidence Ecosystem

I’ve been trying to see how Trip fits in to the evidence ecosystem and have attempted to draw it.  However, my imagination has let me down so I need some help!  This is what I’ve got so far:

 

So, what am I trying to say?

Funders give money to academics to produce research which is then published.  The published material can be viewed directly by health professionals but it can also be accessed via Trip.

The dotted grey lines, from Trip to those on the right-hand side are relationships that could be developed with regard the needs of the health professionals.  So, we could help funders understand the type of material users are asking for (we have a paper on that due soon) and that should be of use to academics.  And, for publishers, we could give comparative information as to how their content performs relative to other publishers.

We tend to focus our relationships on the left-hand side, but we could – for influence and business purposes – look increasingly to the right-hand side.

So, the help needed is to perfect the image!  Have I missed relationships?  Can you articulate how Trip might support those on the right-hand side?  Anything else obvious that might help me visualise Trip’s role in the evidence ecosystem??

Thank you in advance 🙂

 

A post from Tom Jefferson…

The following post is not a Trip Database post, I have been asked to host it by Tom Jefferson, a colleague/friend who I have a huge amount of respect for….

The Crucifixion of Brother Peter

By Tom Jefferson

I write from Edinburgh, at the 25th Cochrane Colloquium where events are still unfolding.
Given the visibility that the story of the drumming out of Peter Gøtzche from the Cochrane Management Board and the lack of a single source on the story, I shall give a brief account of it and then suggest a way for Cochrane to get out of the pickle. If it pulls together. I have also selected a few sources where readers can go and check up on some of the details. When reading this summary, you must remember that I am a co-worker and friend of Brother Peter and am also one of the two Cochranites who nominated him for election, so my views are probably not impartial.

Peter is Peter. His apparently brash style hides the reality to most of who do not know him well. It also hides his notable accomplishments such as a realistic reassessment of the benefits of mammography and the opening up of the European Medicines Agency regulatory submissions. This last enables independents to incorporate regulatory data in our reviews (https://ebm.bmj.com/content/23/2/46).

At some stage in the past Peter developed a personality clash with Cochrane’ CEO Mark Wilson. Whatever its merits, the clash has been allowed to degenerate into an open confrontation against a background of growing discontent in the organisation about changes: the dropping of the suffix “Collaboration” and the introduction of market terms such as ”brand” are just two examples.

Peter was elected to the Cochrane Management Board over a year ago and probably the confrontations got more frequent and involved other members of the Board.

Peter may not have fallen into line with whatever he was asked to do and this led to an administrative procedure to expel him from the organisation and the Board. In June the Board commissioned a legal review of what evidence there was. This is still confidential. The charge of bringing the organisation into disrepute is vague but we are told that no more information has been released (for the moment) for legal reasons. At the end of July Lars Jørgensen, Peter and I published an analysis of the Cochrane review on HPV vaccines, a delicate topic according to some. Our analysis did not go down well with Cochrane editors and although the Board denies it, our public criticism of the review appeared to be the straw that broke the camel’s back.
Everything came to a head on the 13th of September during a 5-hour hearing at which Brother Peter was given a few minutes to plead his case before being asked to wait in a separate room for the verdict. This was communicated later by email from the co-Chairs of the Board. Next day 4 Board members announced their resignation. Peter’s case was discussed in a heavily stage managed AGM on 17th where a nervous discussion took place. This should be soon available on video. The rump Board made it clear that it felt empowered to oversee elections to fill the vacancies and bring the Board to full strength.
Peter now has until midnight on the 19th to appeal, which he is doing. Both sides feel aggrieved and anyone present at the AGM could witness the emotions in play.

While all this was playing out, a media circus was gathering speed in the background, with delegates being bombarded by scores of emails and tweets by people wanting to know what was going on.
The dispute seems to be assuming large proportions, despite the Board’s efforts to limit available information. The damage to the credibility and unity of Cochrane, however is probably done.

So where to now?

In all the cut and thrust of the dispute those involved may have lost sight of the fact that the only winners in the confrontation are likely to be lawyers, the media and extremists peddling plot theories. There are other casualties, no less regrettable to old timers, such as friendships and relationships. However, resources which should be devoted to producing or updating Cochrane reviews are being used to fuel a war which threatens to split or debase Cochrane. Those that think that the issue may be over, do not take into consideration the strength of feeling between the parts and the personalities involved.
Amongst most of the people I spoke to the feeling is that the rump Board does not have the moral authority to run an election of make decisions on anyone’s behalf. Brother Peter also.

Here is what I would do with a magic wand:

1. Get everyone to step down and step away from the Board, Brother Peter included.
2. Suspend all legal and disciplinary actions currently underway.
3. Nominate a caretaker 3-month Board made up of people who were not in the fight and have not taken sides, including those who spoke at the AGM.
4. Hold elections for a brand new Board with members of the current dispute asked not to run for office.
5. Hold the elections under the auspices of a neutral body such as the Election Commission.
6. Start afresh from a webinar-based extraordinary meeting, if necessary over two days, giving any member the chance to input into policy making. Because of Charity Commission rules, this cannot take place instead of an AGM.

I hereby solemnly declare my undertaking not to run for any position in Cochrane for the next 50 years, only for the one I currently hold: author. So help me God.

Here are a few resources to give some back ground and try and understand what is going on (although they are probably not the full picture)

A statement from the rump Governing Board released before the Annual General Meeting:
https://www.cochrane.org/news/message-governing-board

It is not very informative, possibly for legal reasons.

Peter Gøtzsche’s statement: “I regret to inform you that I have been expelled from membership in the Cochrane Collaboration by the favourable vote of 6 of the 13 members of the Governing Board”. Four other members of the Board have resigned.
https://nordic.cochrane.org/sites/nordic.cochrane.org/files/public/uploads/moral_crisis_in_cochrane.pdf

The 4 Board members who have resigned: Gerald Gartlehner, David Hammerstein, Joerg Meerpohl, Nancy Santesso explain their motives in a statement.
https://austria.cochrane.org/news/why-we-resigned

Two other members of the Governing Board (Rae Lamb and Catherine Marshall) resigned because of governance issues. https://www.cochrane.org/news/message-governing-board

Cochrane – A sinking ship? By Maryanne Demasi.
https://blogs.bmj.com/bmjebmspotlight/2018/09/16/cochrane-a-sinking-ship/

This dispute has been going on for some time but the trigger may have been our critique of the Cochrane review of HPV vaccines (not of the vaccines, but of the methods used): https://ebm.bmj.com/content/early/2018/07/27/bmjebm-2018-111012

And here is the Cochrane Editor in Chief’s response to our critique:
https://www.cochrane.org/news/cochranes-editor-chief-responds-bmj-ebm-article-criticizing-hpv-review

Our response to this is in BMJ-EBM.
https://ebm.bmj.com/content/early/2018/07/27/bmjebm-2018-111012.responses#the-cochrane-hpv-vaccine-review-was-incomplete-and-ignored-important-evidence-of-bias-response-to-the-cochrane-editors

Cochrane HPV vaccine review: BMJ journal defends “inconvenient criticisms”
https://www.bmj.com/content/362/bmj.k3927.full

There is coverage in BMJ, Science, The Lancet and other main stream journals.

Part of what Martin Burton said at the Cochrane AGM
https://www.cochrane.org/news/statement-cochranes-governing-board
There is a lot more but these are all the public facts, up to now.

Ugly scenes in the Cochrane Collaboration as Peter Gøtzsche is expelled

Updates from 17/09/2018

Posts from Ray Moynihan Let’s stop the burning and the bleeding at Cochrane—there’s too much at stake and Trish Greenhalgh The Cochrane Collaboration—what crisis?

Cochrane have also released just released Statement from Cochrane’s Governing Board. This starts with “These are extraordinary times and we find ourselves in an extraordinary situation.” – one can’t really argue with that.

This has been a really interesting day as the story developed. A decent number of people have contacted me expressing disquiet about the situation. My view is that this will quickly blow over. Those who love Cochrane will still love Cochrane and Cochrane will carry on being Cochrane – with perhaps some modifications.  People who are critical of Cochrane will still be critical of Cochrane.  Where the truth is, I’m not sure we’ll ever fully know and then, what we do know, will be clouded by our own values/perspectives.  Good old complexity.

I will try to keep things updated and I’ll continue to reflect on what’s been an “extraordinary situation”.

Richard Smith has written Is Peter Gøtzsche the boy who sees that the emperor has no clothes and says so? where he doesn’t discuss the incident but is full of praise for Peter.

Updated at 9.33 am 16/09/2018 It appears a further 2 members of the Governing Board (Rae Lamb and Catherine Marshall) have resigned.

Update at 1.14 pm 16/09/2018 This was reported to me via Twitter “This situation required further changes in the composition of the Board in order to comply with Cochrane’s Articles of Association, and as a result Rae Lamb and Catherine Marshall, two appointed trustees, volunteered to step down.

Update at 4.47 pm 16/09/2018 Organización Civil Internacional published Cochrane Regeneration which sheds more light on the goings on which includes this section “The “independent review” did not find that Gotzsche has violated the spokesperson policy….No recommendations were made by this Counsel to discipline Peter Gotzsche nor was he found to have violated the spokesperson policy which was the main accusation made against him by the Cochrane leadership.

Update 7.16 pm 16/09/2018 BMJ EBM blog posts Cochrane – A sinking ship? which paints a really damning picture. To be clear, although I’ve been a strong critic of Cochrane I get no joy from how this is unfolding. It’s nothing but a mess.  I hope Cochrane can re-group, learn some lessons, and move forward on a more positive path.

I have also heard that David Tovey (Cochrane chief) has resigned but I’ve not been able to corroborate that.

—————

As Cochrane meet in Edinburgh for it’s latest Colloquium they seem to have got off to a bad start as they have kicked out Peter Gøtzsche from the organisation. Peter was a high-profile and prominent member of Cochrane; occasionally outspoken and controversial – but always passionate and driven by a desire for obtaining good evidence to support decision making.

I found out via this tweet from Trish Greenhalgh:

The link in the tweet points to this article from Peter A moral governance crisis: the growing lack of democratic collaboration and scientific pluralism in Cochrane.

Subsequently a note has been released by the board members who resigned in support of Peter:

I have been asked (alongside others) to highlight this story.

The official and detailed reasons why Peter Gotzche was sacked are not known, the speculation is that the critique of the Cochrane HPV review was the last straw. Monday at the AGM a clearer motivation might be revealed.

Without all the details it’s not clear what’s going on but I think it’s indicative of the direction Cochrane are taking.  Gone are the early ideals of ‘collaboration’ (they jettisoned the term ‘collaboration’ from Cochrane Collaboration a number of years ago) and they’ve now become more of a large corporate publisher, keen to protect the Cochrane brand. Two quotes from Peter’s letter set this out quite nicely:

This growing top-down authoritarian culture and an increasingly commercial business model that have been manifested within the Cochrane leadership over the past few years threaten the scientific, moral and social objectives of the organization.

The Cochrane executive leadership almost always uses the commercial terms of “brand”, “products” and “business” but almost never describes what is really a collaborative network with the values of sharing, independence and openness.

Cochrane have invariably moved this way deliberately and people who are uncomfortable with this are now feeling pressured/unwelcome. Peter is perhaps at the more extreme end of the spectrum but what starts with him, where next?  Will people see this move from Peter as a broad crackdown on dissent?  One can imagine the effect on those left in Cochrane who may have legitimate concerns now not raising them for fear of sanction.

Cochrane is seen by many as being some lovely cuddly charitable organisation that does lots of ‘good’ and that is why it does so well in attracting volunteers. But the more it moves away from this position and into the ‘corporate’ (perhaps being seen as just another large ruthless commercial organisation) they may find their pool of volunteers evaporating rapidly – which would be a disaster.

This story will no doubt run and run but I leave you with two ironies:

  1. Cochrane have something called the Bill Silverman Prize.  “It is offered annually and explicitly acknowledges Cochrane’s value of criticism…
  2. The hashtag for the Colloquium is #CochraneForAll.  #CochraneForAllExceptPeterGøtzsche seems more appropriate.

 

 

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