Search

Trip Database Blog

Liberating the literature

Open Search
Author

jrbtrip

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

AskTrip: Beyond Trip

AskTrip currently generates answers from content in the Trip Database. When little is available, we “back fill” using ChatGPT. While answers are clearly labelled, relying on ChatGPT alone (or mostly) doesn’t feel entirely comfortable.

Twenty years ago, when we answered clinical questions manually, we often had to search beyond Trip or Medline to find reliable evidence. That spirit of search expansion has inspired Beyond Trip (working name). If AskTrip finds little or no evidence in Trip, it will now automatically search other sources to strengthen the answer.

Our approach now searches both OpenAlex and Google Scholar – two vast, general academic databases. Even when limited to peer-reviewed medical journals, this still represents a huge increase in coverage compared to Trip alone.

Take one example question What psychiatric adverse effects are associated with the use of antileukotrienes in asthma treatment? that was asked today. AskTrip’s standard answer cited 2 references. With Beyond Trip, the system retrieved 11 references, including:

  • Adverse drug reactions of leukotriene receptor antagonists in children with asthma: a systematic review
  • Neuropsychiatric reactions with the use of montelukast
  • Psychiatric adverse effects of montelukast—a nationwide cohort study
  • Suspected Adverse Drug Reactions Associated with Leukotriene Receptor Antagonists Versus First Line Asthma Medications: A National Registry-Pharmacology Approach
  • Risk of psychiatric adverse events among montelukast users

Beyond Trip won’t activate for the majority of questions. But when AskTrip turns up little or no supporting evidence, it will automatically engage, taking around 60 seconds longer while drawing on a much broader pool of references.

We expect to release it within the next two weeks. Believe me, this is a major step forward for AskTrip 🙂

1

Responding to Concerns About AI at Trip

As part of our commitment to quality with AskTrip (and Trip more broadly), we actively encourage feedback. We recently received the following comment, which I’d like to respond to in case it reflects a view held by others:

“I believe that generative AI tools should not be promoted and positioned as equivalent to expert searching, and feel that it is completely inappropriate that TRIP has devoted so many resources to this. There is extensive evidence that AI tools lack the precision and recall of equivalent systematic searches performed by human beings, and treating them as search engines — especially in medicine and healthcare — causes serious risks when it comes to the reliability of evidence used to support clinical practice. Generative AI is fancy predictive text, not a search engine, and the fact that TRIP has devoted significant resources towards this pivot to AI is extremely disappointing. This irresponsibility has meant that I am less likely to use TRIP as a database, and less likely to recommend it to the healthcare professionals I support.“

My response is:

Thank you for taking the time to share your concerns. We take all feedback seriously, and it’s important to us to listen and reflect when people raise issues around the use of AI in healthcare.

We’d like to reassure you on a few points. AskTrip is not designed to replace systematic searches or the expertise of information professionals. Instead, it builds on our nearly 30 years’ experience in making high-quality evidence accessible to healthcare professionals. The system is supported by extensive quality-control processes, which we’ve written about in more detail on our blog. These safeguards mean that AskTrip is very different from generic generative AI tools, even if it may look similar on the surface.

We also want to emphasise that using AskTrip is entirely optional – it sits alongside the existing Trip Database, which continues to work as it always has. For some clinicians, especially those without ready access to specialist librarian support, AskTrip provides an additional way to quickly access evidence in a clinically relevant timeframe. For others, it won’t be the right fit, and that’s absolutely fine.

More broadly, we recognise that AI is here to stay. The real challenge – for Trip and for information specialists – is to understand where it adds value, where it falls short, and how to use it responsibly in service of healthcare professionals. Ultimately, both Trip and expert searchers need to offer solutions that meet user needs. If we don’t, clinicians will inevitably look elsewhere.

Finally, on resources – while we have invested in this area, it’s relative and has not been at the expense of our core database. We remain committed, as ever, to delivering trusted evidence to healthcare professionals worldwide.

We share your belief that evidence in healthcare needs to be robust, reliable, and used responsibly. That’s why we’re keen to be transparent and to have these conversations.

0

AskTrip in Trip

We’ve just rolled out an exciting new feature that brings the Q&A power of AskTrip directly into the Trip Database. Using AI, the system predicts questions based on a user’s search terms and the articles they view. By analysing session activity and identifying user intentions, it suggests the most relevant questions to support clinical decision-making.

If a user runs a simple search, there’s little indication of intent, so no questions are shown. Once an article is clicked, the AI gains enough context to understand the intention and generate relevant questions. In this example, a user searches for obesity children (indicating intent) and these are the suggested questions:

The user then scrolls down and clicks on the article Surgery for the treatment of obesity in children and adolescents. This indicates an interest in surgery, so the questions update (appearing above the clicked article):

As a user clicks on additional articles, the suggested questions are updated further.

In short, AskTrip transforms a user’s browsing into a dynamic, question-driven experience—helping clinicians move from search to evidence faster, with AI guiding them to the answers that matter most.

0

Blog at WordPress.com.

Up ↑