Trip Database Blog

We occasionally get requests from users for new features. Where possible we try and accommodate these wishes – assuming they make sense to us and we’ve got the money. One feature has recently been requested more than any other is the ability to export TRIP results.

Separately, in the development of the Spanish version of TRIP, it was ‘showcased’ to the Spanish Ministry of Health and they too wanted an export feature.

Bottom line: We’re creating an export feature.

All the results in TRIP will have a tick box and users will be able to select the ones of interest. They will then be able to export the selected records to file or e-mail to a colleague.

This should be out by the start of June

The saddest thing for me about the ending of the NLH Q&A Service is the reaction of the users. We’ve just placed a notice on the site alerting users to the ending of the service. Two comments received within 35 minutes of it the notice going live:

“I have just found this answering service through a colleague. I think it is absolutely brilliant. I have just found the answer to a question within 1 minute which would normally have taken me hours, maybe days of research. I am paid £40k p.a. so this time saving is bound to be very valuable to the NHS when multiplied by all the people who use it. Why is the service ending???”

“Hello. As an EBM practitiopner I am disappointed to read that as of June 27th the NLH Q&A Service will cease operations and be unable to answer any new questions. Could you kindly inform me of the reasons behind this decision, and what will replace this very important and I think successful primary care service. Thanks,”

I’m so proud of what we’re achieved and the fact that clinicians are prepared to contact us to express surprise and disappointment is impressive. The NLH suffers from a lack of engagement with primary care health professionals, an area that needs more support that secondary care (that has access to librarians). By removing of this key service it further hampers engagement.

Still the secondary care clinicians will still have their services…

I’ve been worried about the search speed for some time. The removal of the number of results for each individual category was meant to improve things, it didn’t.

Yesterday (see previous post) I introduced a system that removed search results which we considered not relevant. As well as improving the search relevancy it reduced – dramatically – the number of search results returned. By accident this has resulted in a huge increase in search speed.

Not all accidents are bad!

We have just released a major improvement in the TRIP search results.

This has been brought about by the refinement of our ‘text cutoff tool’. Prior to this introduction a search would return every result that contained the search terms. So a search of acute kidney injury returned the CKS guideline on ankles and sprains! I imagine most people would agree that that is not even an average result – it simply shouldn’t be there. But how has it got there? It contains all the individual terms, so is returned.

So how does the text cutoff tool work?

Each search on TRIP looks for matches to the search term(s) used and these are ordered based on our algorithm. One component of the algorithm is a text score. The higher the text score the more likelt the result is to be pertinent to the search terms. Some factors that affect the text score include:

• Location – where the term occurs (e.g. if someone searches on asthma, documents with asthma in the title tend to get a text score higher than if they are only mentioned in the text).
• Term density. If you have two documents, both 1000 words long and without the search term in the title and one mentions the search term once and the other ten times, the latter will receive a higher text score.

The idea behind the text cutoff is simply to say that all results with a text score of lower than X do not get returned.

This sounds nice and simply but it fairly arbitary and if you set the score too high you may miss important documents out, too low and you allow too many in. It’s also complication that there is no magic score that defines pertinence. We have tested lots of combinations of search terms and text cutoff points and we’ve managed to remove an awful lot of noise from the searches. The cutoff point we’ve used has reduced the number of results from the acute kidney injury from 2,609 to 440.

Ironically, the CKS guideline on ankles and sprains still remains. Lowering the score to remove that caused the removal of other documents from other searches.

We’re not claiming its perfect, but it’s pretty good!

I’ve been on Facebook for a while, for most of that time I have not understood the appeal. I joined due to the buzz and I wanted to understand it.

Similarly I joined Second Life, hoping to understand it. In many ways I can see the appeal of Second Life more than Facebook. I don’t use it but can appreciate the ability to immerse yourself in an alternative reality. Perhaps if I was 20 and had lots of time on my hands I’d be hooked.

But this report Providing Consumer Health Outreach and Library Programs to Virtual World Residents in Second Life has just been released:

“The major accomplishments of the project include: the careful and thorough development of an island in the virtual world called Second Life, replete with buildings, grounds, meeting spaces, exhibits, collections, and other information resources and services; development and deployment of a variety of informational exhibits and displays; and numerous contacts and collaborative efforts with health-related groups and organizations. Overall, HealthInfo Island has become the focal point for many health-related initiatives in Second Life. It has been very successful and well-received by the general public in Second Life, healthcare professionals, and health sciences librarians.”

I’m finding myself increasingly drawn to computer/statistical techniques for helping in the Q&A service. Many papers, such as highlighted below, look at answering the question; my main interested – currently – is in using sematic analysis in updating clinical questions.

Situated Question Answering in the Clinical Domain: Selecting the Best Drug Treatment for Diseases

Abstract: Unlike open-domain factoid questions, clinical information needs arise within the rich context of patient treatment. This environment establishes a number of constraints on the design of systems aimed at physicians in real-world settings. In this paper, we describe a clinical question answering system that focuses on a class of commonly-occurring questions: “What is the best drug treatment for X?”, here X can be any disease. To evaluate our system, we built a test collection consisting of thirty randomly-selected diseases from an existing secondary source. Both an automatic and a manual evaluation demonstrate that our system compares favorably to PubMed, the search system most commonly-used by physicians today.

Just to show our million plus searches wasn’t a fluke for March, we had 1,077,190 searches in April. As April only contains 3o days this is more of an acheivement. Perhaps more meanigful is the average daily searches:

• March – 32,302
• April – 35,906

So roughly a 10% increase…

I’m currently preparing a talk on standards in clinical question answering services. Even though I’ve been involved in Q&A for ten years it’s proving really hard. I’ve been scribbling notes down, trying to decide what is important. Some major issues:

• Transparency, you’re not doing a systematic review – so make that clear. I think the onus is on the Q&A service to ensure users are acutely aware of potential drawbacks in the service.
• Feedback, be it from the person who asked the question or from other readers of the answers (assuming things are web-based). We receive lots of feedback, but we could make it easier – perhaps something as straightforward as a digg style thumbs up or thumbs down.
• Process-standards. These are things such as length of answer, speed of answer, referencing of material etc. Not the most interesting!
• People skills. It’s fine to say that the person asking the question is competent (or even excellent) in searching Medline, but that certainly doesn’t make them good at answering questions! Understanding of the question is important before you consider a search. How can you make a standard around that?
• Quality control. Is there a robust system in place?

The above is not a complete list but some of the more memorable ones.

The biggest drawback I found is that there is very little research in this area on which to base standards! In the area of systematic reviews there are vast amounts of research on the actual process of conducting systematic reviews. In Q&A there is virtually nothing.

For me, and this notion hasn’t changed in ten years, is that we’re not trying to do a systematic review, we’re just trying to improve on what a clinician would do. I remember 8-9 years ago receiving some criticism from a civil servant suggesting what I did was negligent. I suggested to her that if our service is negligent then surely she was in providing Medline to clinicians who are poorly trained to search on them.

Although hard work it has proved very useful preparing for this talk, it’s an area I’ve not spent a great deal of thought on in the past. And there’s still over a week to go, so plenty of time for reflection.

Clinical Knowledge Summaries (CKS) was previously known as PRODIGY and produces some great guidelines. They have just released a redesigned website – it’ll take some getting used to!

I find the browsing of topic confusing but the search is good (powered by Google!). But my biggest concern is – once you find the correct guideline – how long it takes to find the appropriate section. They have split the screen into 3 sections, with the actual content squeezed into 1 section; before the content filled the screen. This effectively means each guideline is now around 3 times longer.

I was involved in the beta-testing and have been waiting for the release of the updated site. Perhaps the problem is that I’m an atypical user of the site, perhaps I’m just like most other people and find change unsettling. In 3 months time I may love it!