Trip Database Blog

Ben Toth has raised an interesting issue relating to the Cochrane (click here). In addition to Ben’s comments I’m going to add a few criticisms of Cochrane. Ben highlights that the UK taxpayer (via the Department of Health) has spent tens of millions of pounds on Cochrane. has that been money well spent?

We answer thousands of clinical questions from primary care every year. You’d like to think Cochrane would answer a significant chunk. In our experience Cochrane rarely answers a genuine clinical query on it’s own. A recent analysis of over 300 dermatology questions revealed that Cochrane systematic reviews answered 2. The analysis was carried out with the help of the Cochrane Skin Group so they cannot be accused of not trying to examine their ‘offering’.

A number of years ago I had a chat with Sir Iain Chalmers (who founded Cochrane). This was while DUETs was being formed. During the course of the conversation it became clear that the choice of systematic reviews (SR) is – generally – not based on any rational system. Generally, a keen researcher has a desire to do a specific SR and Cochrane helps them to do it. The thinking is that they will then go on to do additional SRs. In other words it was personal preference, not clinical need (or should that be information need). Interestingly, the respiratory SRs were much more useful for our Q&A activities than others. Apparently they had a different system. If a researcher wanted to undertake their own SR they were told that the respiratory group (probably the airways group, I forget the proper name) would help them to carry out a SR that was useful to the group. After that the researcher would be trained and could carry out their own personal SR.

The hope is that DUETs will help this situation, but results will not come quickly, if at all. I raise this additional point as many of the uncertainties are generated from within Cochrane. Also, there is currently little input from clinical Q&A services.

Ben highlights that Cochrane is potentially using an outdated business model. Is Cochrane itself outdated?

Last week TRIP (main TRIP Database plus the specialist search engines) were searched a record number of times 187,182. That’s an average of over 26,000 per day!

This article Google’s Marissa Mayer: Social search is the future is fascinating!

We run various Q&A services and a popular theme for questions relates to lab tests. Questions include ‘When should we do one?’, ‘When should we re-test?’ etc.

Around two year ago the Journal of Clinical Pathology ran a series of papers ‘Best practice in primary care pathology’ which proved very useful for our Q&A activities. Now, these papers have been released, free access, on the web – BetterTesting. To make it even more useful the papers have been ‘cut up’ into nearly 120 clinical Q&As. An example Q is:

• When should I request allergen-specific IgE (RAST)?

Why is this resource so important? The disclaimer says:

“Clinical guidance is more difficult to formulate for laboratory medicine as the evidence base is frequently weaker than for medical interventions. The guidance contained in this site must therefore be used in the clinical context and cannot be taken in isolation, as either a minimum or acceptable standard.”

Basically, there is little evidence out there. This collection is a (sort of) current state of our knowledge style resource and is very welcome.

Ever one to be easily pleased, I have to say I’m delighted with the progress of the specialist search engines!

• So if you have any suggestions for improvements, let me know!

Google doing what it does best, offering a potentially useful service and hoovering up yet more information (click here for story).

Following on from the December 2007 BMJ article Comparison of energy expenditure in adolescents when playing new generation and sedentary computer games: cross sectional study is a new study reported in the UK’s Guardian:

Dexterity boost from games consoles hones surgery skills

Update: A letter in today’s BMJ reports:

“In the first clinic after Christmas we encountered a child who was complaining of tiredness and a sore shoulder, having been inactive over the past three years through illness. He had been given a new generation computer game for Christmas, and having checked everything else, we diagnosed Wii shoulder.

Anyone who has played interactive games on Wii sport will relate to this shoulder pain in muscles that have not been used for a long time. Within a day the discomfort wears off, as with exercise after a period of inactivity.”

Great post by David Rothman ‘Online Drug Interaction Checkers’

Mahalo is the world’s first human-powered search engine, or so their website goes. Basically, it uses users to create the search results for a given search term. An interesting, and yet unproven, concept. However, I have a degree of sympathy with the approach. For a given search term you have ten (possibly up to thirty) key documents to deliver. Can an algorithm really figure out which are the ten best. This problem is compounded by users frequently using unsophisticated search terms that return lots of results. Take TRIP, our popular search terms are things such as asthma, hypertension etc.

The introduction of the specialist searches on TRIP has given us some additional information. For instance if a user goes to the cardiology site and searches for the term ‘asthma’ we know that this is likely to be related to cardiology.

However, 95% of our users search TRIP via the main search. So we can assume very little about their intentions when they search. True, if they search for ‘prostate cancer screening’ that’s a specific search and there are not masses of results. But what about the search terms ‘asthma’ or ‘hypertension’? One obvious option is to produce search hints, to allow users to easily select search modifiers. For instance the search term asthma might produce search modifiers such as ‘children’, ‘steroids’, ‘allergy’, ‘education’ etc. A simple click on one of the suggested terms produces a more focused search. This is fairly easy to do and I hope to introduce something sometime this year.

However, I’m particularly interested in the habits of previous searches of a particular term. Can we aggregate these habits to produce a user list of results based on click-through? So, instead of using the algorithm (or as an alternative) why not say – the most popular documents viewed by previous users for the term asthma are… and then list the top ten. I have serious doubts, for instance I know the results will be skewed to the top ten search results. Also, clicking on a paper doesn’t demonstrate that it’s useful – just that the title makes the document sound useful.

I think I need to get the designers in to see if we can re-jig the results page. In that way we might be able to squeeze in a relatively small box that highlights the most popular 5-10 results for a given search. Certainly one to ponder.