Trip Database Blog

This may seem a strange title as many of you will feel that TRIP is an evidence-based tool already.  Well, TRIP helps users find the best available evidence, I’m comfortable with that.  However, there is more to this than that….

Since the new interface/functionality went live I’ve been tidying up loose ends, fixing a few broken bits of functionality and looking forward to the next changes to TRIP.  This has coincided with a wonderful opportunity to get involved with a research grant that will explore creating a search interface based on academic theories around information gathering.  This will involve creating a series of interfaces which will then be tested with a group of clinicians.  So, we’ll be doing research to explore various aspects of search interface design and results display.  We’ll be creating an evidence-base for clinical search.

I’ve no idea if we’ll get funding but the person in charge is hugely influential so I think we’ve got a reasonable chance.  Even if it doesn’t happen I’ve already learnt an awful lot from just reading the background papers. 

Exciting times!

The latest upgrade to TRIP had lots of new features easily visible to users.  However, for all the external changes we have made a number of internal ones.  One of the unhidden wonders has been a broken link reporter!  Basically, if someone clicks on a link and it doesn’t result in a valid webpage being open we now get an email telling us the link isn’t working.  Previously, we had no system for this and it was down to the goodwill of our users to let us know.

When the new feature went live it was truly depressing as I was personally receiving about an email every minute.  However, it soon showed up that a few particular publications were causing the bulk of the issues. Within 4 days these links were fixed – causing a 90% reduction in the error messages.  Now, 3 weeks later and lots of hard work, we’ve fixed approximately 99% of all the broken links.

For most people they will not notice a difference – but it’s great to know our system’s working well and long may it continue. 

I’m very pleased to announce that we have launched the latest version of the TRIP Database a few hours ago.  New features include:

• Translate function.  Users can translate the site and subsequent links into one of six languages (Spanish, Portuguese, Italian, French, German and Welsh).
• We’ve added the ability to restrict results to only those added in the last month.
• We’ve started searching one of the largest clinical trials databases.
• Started extracting and displaying DOIs against each result (if they exist).
• Included a separate section for clinical calculators.
• Included a separate section for social media results.
• The speed of the site has been improved.
• New design.
• Started to include patient decision aids and medical education content.
• Massively increased our medical video offering, now searching over 6,100 videos.

Feel free to let us know what you think!

We’re building a TRIP app.  Initially it’ll be for the Apple iPhone and if that proves successful we’ll create a version for Android.  It’ll actually be multiple apps, but all following the same format – highlighting the latest content added to TRIP for a given area. 

We see there being two main types of app:

• Clinical area – all the new content in areas such as cardiology, oncology etc.  They’ll be around 25 of these.
• Individual clinical conditions – while we could produce unlimited, we’ll start with 20-30 of the biggest e.g. diabetes, asthma, hypertension.

Each month users will be alerted when the new content is available and will be able to select to see content based on our filtering system (e.g. systematic reviews, guidelines) and then simply scroll through the results.  Below is a screenshot from our prototype – and it’s great!

We’ll have to charge for this, but it’ll be suitably cheap!

For a while now we’ve been exploring linking to full-text articles (currently we only link to abstracts of primary research articles).  It’s an area I have little technical experience in and have allowed myself to avoid the issue.  In the latest version of TRIP (out next week) we’re extracting the DOI for journal articles (and Cochrane), but this is only part of the issue.

To link to a full-text requires an additional step – it requires a link resolver! Trying to keep things simple, it tells the system where to point the full-text request to (ie send the person to Wiley, Ebsco etc).  We’re looking to introduce this and I’m fairly confident we can do it!  It should work like this:

• We extract the DOI for an article – which we’ve done already!
• An institution tells TRIP which full text holdings it has (e.g. NEJM, Thorax etc) and also some details of their link resolver.
• A user comes to TRIP from a given institution and carries out a search and we display a full-text link to all articles the user has full-text access to.  They click on the link and they’ve got access to the full-text (based on an authentication system).

So, to my mind, the hard work lies with the librarian who needs to tell us what full-text holdings they have!  The rest seems relatively straightforward – I must be missing something.

But, bottom line, does easy linking out to full-text excite people?

For those of you who follow TRIP you’ll know that I frequently reveal our lack of money.  It’s something I’ve got used to and learnt to live with.  I like to think of myself as an innovator and product developer, as opposed to a businessman.  I’m not great at the latter, I don’t like asking for money!  However, we’ve survived for over ten years and are still financially viable (I was going to say strong, but that’d be a slight exaggeration)!  What we’ve achieved with a small budget has been spectacular and part of me thinks that being kept hungry keeps the pressure on me to innovate.

But, I do occasionally fret over the lack of business development. I do wonder what we could do with a decent budget.  I do have a realistic set of ideas/innovations that would make TRIP significantly better.  I do think I could make TRIP the Google for medicine – the first port of call when clinicians have knowledge needs.

So, when I was approached 4-6 weeks ago by someone interested in helping TRIP on the business side, I was excited (and apprehensive).  We had some great chats and interesting exchanges of emails.  I’m thinking the approach may well have stalled but I’m not dispondent and that’s for the following reasons:

• I learnt an awful lot during the due diligence process.  I received numerous pieces of advice – all free – around various aspects of business, including corporate structure.  I’ve come out of this stronger and more confident than before. 
• As a result of one thread of advice I’ve been introduced to a venture capital firm.  This relationship isn’t necessarily about raising finance, it’s more about exploring options and business models.

With the new version of TRIP due before the end of the month and all this excitement around business development I can’t help but be excited about the future.  I doubt I’ll ever be a businessman but as long as I keep enjoying my business that’s fine by me 🙂

TILT is our shared learning experiment which allows for clinicians to record and share learning they may have experienced.  We’ve now had over 850 TILTs so it’s getting a useful resource.

Reading today’s BMJ there’s an article on postural hypotension which has a great section called ‘Learning points’.  These are not new but it occurred to me how close TILT is to the concept of learning points.  In other words, what is the take home message from the article.  It’s different from simply the conclusion as it’s more nuanced.  So, two TILTs I added (out of a total of four) are:

• The commonest causes of postural hypotension are medications and conditions that cause hypovolaemia
• Even after extensive evaluation, about a third of patients with persistent, consistent postural hypotension have no identified cause

Whenever I make connections between concepts (in this case TILT and learning points) it makes me contemplate things.  Is TILT too niche?  Should we automatically grab all learning points from BMJ articles?  Why not try and create a database of everything we know – so TILTs, learning points and conclusions.

These issues and othes like it represent challenges, real and important.  This is why I love doing what I do.

TRIP is frequently mentioned in systematic reviews as one of the sources searched for relevant studies.  In fact the mentions seems to be accelerating and below are 5 recent examples:

• Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review (BMJ)
• Adequacy of reporting monitoring regimens of risk factors for cardiovascular disease in clinical guidelines: systematic review (BMJ)
• Available evidence does not support use of oxalates for dentine hypersensitivity (Evidence Based Dentistry)
• Effectiveness of smoking cessation programs for seriously mentally ill (Actas Españolas de Psiquiatría)
• Rigour of development does not AGREE with recommendations in practice guidelines on the use of ice for acute ankle (BMJ Quality & Safety)

I can’t help feeling we’re doing something right!

Quite a milestone, over the weekend we hit 20,000 registered users.

We’re currently adding 1,000 new registered users every 3-4 weeks (this has been consistent over many months).  We’re really pleased with this. However, it does put the onus on TRIP to create an even better product/experience for registrants.