Trip Database Blog

The greatest use of AI? Possibly some hyperbole, but it certainly made me smile. We’re continuing to experiment with AI and making impressive progress. In automated Q&A one of our techies took the question “Atogepant in preventing migraines?” and ran the test. He then re-ran it with the additional prompt of “Answer as a world-weary, cynical clinician with a mistrust of research“. The results – below – were illuminating. A large caveat is that the answer is not meant to be correct (that wasn’t the aim), it was done on a subset of data. Both answers are below.

1. Initial response, without the cynicism:

Background: Atogepant is an investigational oral medication being developed for the prevention of migraines. It’s a calcitonin gene-related peptide (CGRP) receptor antagonist, which means it works by blocking the activity of CGRP, a neurotransmitter involved in migraine pathophysiology.

Study findings:

1. A recent phase 2 trial published in JAMA Neurology (2022) found that atogepant significantly reduced the frequency and severity of migraines compared to placebo (34407343). Patients taking atogepant experienced a mean reduction of 5.3 migraine days per month, while those on placebo had a mean reduction of 1.4 days.
2. A phase 2b trial registered on ClinicalTrials.gov (NCT04437433) aims to evaluate the efficacy and safety of atogepant in preventing migraines. The study is currently recruiting participants.
3. Another ongoing trial (NCT06241313) is assessing the preventative effect of atogepant on migraines with aura.

Conclusion: Based on the available data, including a published phase 2 trial, atogepant shows promise as a potential preventive treatment for migraines. It appears to be well-tolerated and effective in reducing migraine frequency and severity. While more studies are needed to confirm these findings and establish its long-term safety profile, the initial results suggest that atogepant may become a valuable addition to the arsenal of treatments for migraines.

Please note that this summary is based on publicly available information and should not be considered medical advice.

2. Additional answer, with the cynicism:

“Sigh Fine. I’ll read through these pages and summarize the answer for you.

The study in question is about atogepant, a medication that’s being touted as a possible preventative treatment for migraines. According to the researchers (who are probably just trying to get their names on some fancy journal), atogepant seems to be effective in reducing migraine frequency and severity.

Now, I know what you’re thinking: “What does it do exactly?” Well, allegedly, atogepant works by blocking certain neurotransmitters that contribute to migraines. It’s like a magic pill that silences the pesky signals that make your brain go haywire.

But let me tell you, as a doctor who’s seen my fair share of overhyped research, I’m not convinced. The studies seem to be based on small sample sizes and short durations. And what about the potential side effects? We’re talking about a medication that could be given long-term; have you considered the long-term consequences?

And don’t even get me started on the clinical trials. Oh boy, it seems like every researcher is trying to get in on the atogepant bandwagon. I’ve seen more studies than I can count, all touting its benefits. It’s like they’re trying to convince me that this medication is the answer to all of migraine sufferers’ prayers.

But honestly, as a clinician, I need more convincing. I want to see bigger, longer studies with better controls. I want to know how atogepant interacts with other medications and what kind of monitoring we’ll need to do to ensure its safety.

So, in conclusion (if you can even call it that), atogepant might be a promising treatment for migraines, but I’m not sold just yet. I’ll believe it when I see more robust evidence and a clearer picture of its long-term effects.

Now, if you’ll excuse me, I have better things to do than get bogged down in the latest migraine medication craze. Sigh“

We had an email from a user asking if the search “do not resuscitate” (as a phrase) was possible. I was curious as – surely – it works. Unfortunately I was wrong. The issue being the use of a Boolean term within a phrase – in this case ‘not’. Via the advanced search I used this search:

And the system interpreted the result as:

Odd and, even though it’s a fringe example, it needed exploring. Well, we’ve fixed it – mostly! If you now do the search the results look like this:

But why do I say it’s fixed ‘mostly’? Well, another quirk of the system kicks in – in this case synonyms. In our system we have the following terms as synonyms:

• DNR
• DNAR
• do not attempt resuscitation
• do not resuscitate

So, when you do the search for “do not resuscitate” it also searches for the other synonyms as well, so you get results like this:

So, some “do not attempt resuscitation” in there. These are not the exact phrase the user searched for but there is no way to get round this unless we remove the synonyms in our system. It seems to me to be the lesser of two evils to allow these synonyms in the search. Feel free to tell me I’m wrong 🙂

Helping users keep up to date with the latest evidence is difficult and our latest project is our attempt to help. Starting with primary care we’ve released a ‘digest’ with summaries of the latest relevant evidence. To see the digest click here.

Here’s how it works:

• We take a long list of articles we tag as ‘primary care’ as part of our regular updating of the evidence.
• The long list is sent to an experienced clinician who specialises in primary care (in this case Chris, the general practitioner, who is the medical director of Trip) who selects around 20 articles he feels are most relevant and newsworthy.
• These are then fed into an LLM with a prompt to summarise and give a clinical bottom line.
• We then ask the LLM to write an editorial based on the included documents.
• Finally the digest is published.

This approach is semi-automatic but it could feasibly be fully-automatic, and we’ll investigate that if the digest proves popular. If it does we’ll also expand into other clinical areas and, who knows, one day produce personalised digests.

Please take a look – click here – and let us know what you think.

There is a huge amount of research and evidence published daily, far too much to keep up with. This is an issue we, at Trip, have wrestled with for years. With the advent of LLMs we’re experimenting with a new approach.

Using Primary Care as a launch pad we’re creating a ‘Latest evidence’ review (or is it a digest?). Here are some screengrabs of our test:

Note the ‘September 2024’ which indicates it’ll be monthly. On the left hand side is an ‘editorial’ (LLM generated) and on the right is a list of articles we’re covering. If you scrolled down further you get:

We’re displaying a summary (LLM generated) and a link to the article.

Currently this is semi-automated and when we release it we’ll run it for a few months to see the reaction. If it’s favourable we’ll almost fully-automate it and make it available for multiple clinical areas e.g. oncology, cardiology, rheumatology. etc

Given the focus on quality at Trip we will only report high-quality evidence, much of which is ‘grey‘, hence not published in journals and therefore less likely to be seen. Given the lack of visibility for much of the content it makes this sort of promotion really important; let’s see how this approach is received by our users…!

Systematic reviews are an important component of evidence-based medicine. Over the years we have attempted to support our users by finding as many systematic reviews as possible. Recently we have been lucky enough to work with a number of organisations and start-ups who have helped us find more. And, I’m delighted to say that, as of today, we have 564,350 systematic reviews in Trip.

We compared our coverage with a number of other databases, for example PubMed, and we consistently have more. To compare we used title searches (to overcome the differences between searching mechanisms between databases – something that shouldn’t affect title searches) and here are some examples:

Zinc

• 528 results for Trip
• 286 results for PubMed (using SR filter)
• 19 in the Cochrane Library

 Cancer screening

• 1890 for Trip,
• 646 for PubMed
• 19 for Cochrane

One advantage Trip has is that we also include health technology assessments (HTAs). These are often ‘grey’ and therefore don’t appear in most databases (which typically rely on journal publications).

One final thought, having more systematic reviews is something we’re pleased about, but it’s only part of the story. We introduced our guideline scoring system as many guidelines were not evidence-based and we want to help our users understand this fact. The same is true with systematic reviews, some are better than others. So, we’re restarting our work on automatically assessing the quality of systematic reviews. From our previous work (see here) we had a good system, not a great one. With the advent of LLMs we should be able to improve things considerably – watch this space.

We have now released the mis-spelling feature. It’s pretty simple:

Simply click on the suggested spelling and it repeats the search with the corrected term(s). It can handle multiple terms as well:

Many years ago Trip had a mis-spelling feature – helping users correct mis-spelt search terms. This post is from 2006 (I hope the quality of our blog posts have improved since then)! In it we highlight that hypertension and diabetes were most often mis-spelt and here are the dodgy spellings:

Clearly people struggle with spelling yet, for some unknown reason, we dispensed with this feature. No-one complained and therefore we haven’t tried to replace it. However, even though non-one has complained, we’re going to re-introduce this feature in the next month or so. I’m quite excited by this – another step in making Trip better.

At Trip we use filters to allow users to focus on the data they want. So, users can select to just see systematic reviews, guidelines, controlled trials etc:

A long-time user of Trip approached my today to suggest a Health Economics filter would be really useful. Do you agree?

The user suggested incorporating data from the Ideas/Repec database. A further thought might be to use a search filter/hedge to identify current articles in Trip that qualify as health economic. This is a substantial undertaking so I’m keen to understand if this is a good or bad idea – please take the poll and let me know:

Full-text is really important to our users and is one of the main benefits of Trip Pro. Historically, we have checked for full-text at the time of indexing only (indexing is the the process of taking the uploaded document and making it available to a user to search).

One realisation is that many documents are restricted when they are initially released and then become free full-text after 6-24 months. So, if we only check for full-text close to the time of release we miss those that subsequently turn open access.

So, we’ve introduced a re-sampling process that will periodically check documents in Trip to see if they now have free full-text access. This has been a huge success with a huge number of new full-texts identified. We can even quantity this:

• We have 4,244,009 articles with DOIs.
• We have 3,761,834 that link to full-text.
• Overall, 88.63% of articles with a DOI (typically PubMed articles) link to full-text.

This is spectacular!