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Liberating the literature

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dental

Dental evidence

As part of a wider piece of work I’ve been looking through the search logs and clickstream data associated with the dental specialty.  It’s interesting, and the following information is based on the 1,100+ registered users on Trip who have ticked the clinical specialty of dentistry. 

Top twenty search terms, most frequently used at the top

  • caries
  • gingivitis
  • periodontitis
  • dentistry
  • orthodontics
  • dental caries
  • dental implants
  • restorative dentistry
  • periodontal disease
  • oral cancer
  • Caries Risk Assessment
  • Medical errors
  • dental public health
  • fluoride
  • hypnosis
  • dental materials
  • endodontic outcome
  • pit and fissure sealants
  • pediatric dentistry
  • Patient Safety

And the top twenty articles are as follows:

  1. Pregnancy and gingival inflammation – Dental Elf
  2. Patients with Amalgam Restorations Are Not at a Significantly Greater Risk for Developing Health Complications Than Those With Composite Restorations – UTHSCSA Dental CATs
  3. The Use of Dental Crowns for Vital and Endodontically Treated Teeth: A Review of the Clinical and Cost-Effectiveness and Guidelines – CADTH
  4. Dental interventions to prevent caries in children – SIGN
  5. Dental Implants and Conventional Prosthetics: Comparative Clinical Effectiveness and Safety – CADTH
  6. Composite Resin and Amalgam Dental Filling Materials: A Review of Safety, Clinical Effectiveness and Cost-effectiveness – CADTH
  7. Conscious (Moderate) Sedation Can Be Used Safely On Patients With Obstructive Sleep Apnea – UTHSCSA Dental CATs
  8. Diagnosis and Treatment of Obstructive Sleep Apnea in Adults – AHRQ
  9. 12-Year Survival of Composite vs. Amalgam Restorations – J Dent Res.
  10. Methods of Diagnosis and Treatment in Endodontics – SBU
  11. A Randomized Clinical Trial Comparing At-Home and In-Office Tooth Whitening Techniques: A Nine-Month Follow-up – J Am Dent Assoc.
  12. Composite resin and amalgam dental filling materials: a review of safety, clinical effectiveness and cost-effectiveness – NHS CRD (HTA record of number 6 above!)
  13. Fluoride varnishes for preventing dental caries in children and adolescents – Cochrane
  14. Community Water Fluoridation in Canada ? Trends, Benefits, and Risks – National Collaborating Centre for Environmental Health
  15. Flossing for the management of periodontal diseases and dental caries in adults – Cochrane
  16. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications – Cochrane
  17. Oral Appliance Therapy and Continuous Positive Airway Pressure Demonstrate Similar Improvements in the Treatment of Mild/ Moderate Obstructive Sleep Apnea – UTHSCSA Dental CATs
  18. Cost-effectiveness of a long-term dental health education program for the prevention of early childhood caries – NHS EED
  19. Prosthetic rehabilitation of partially dentate or edentulous patients – SBU
  20. Primary clinical care manual (7th edition, 2011) – The State of Queensland (Queensland Health) and the Royal Flying Doctor Service (Queensland Section)

     

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The important breakthrough

Trip has been operating for over 15 years and I can easily say we have arrived at the most significant breakthrough yet.  It is still in our ‘labs’ section and still has much work to do before being rolled out.  But, the path is clear and, finance aside, there is no reason why we can’t produce a significant increase in search performance.

In search a really important concept is intention.  So, when a user searches they may add 2-3 search terms but what are they thinking about when they use those terms?  For instance, and this is a true story, I showed Trip to a Professor of Anaesthesiology  and asked for his views on the site.  He came back saying that he was unimpressed!  The reason – his interest was in awareness (as in, when a person is under anaesthetic are they truly anaesthetised or may they be aware) and when you search Trip for awareness you get lots of results, mostly on things like the awareness of public health messages! Another example I use to illustrate the point is the search pain.  We return the same results whether the person is an oncologist or a rheumatologist – which to me is ridiculous – as the intention is likely to be significantly different.  But, to date, there has been no good solution.

The below image (click to enlarge) shows a breakthrough.

In the image above there are 4 sets of results for the same search antibiotics.  This is a test system and not based on the real Trip results.  However, on the left-hand side we have the normal/natural results for the search antibiotics in the test system.  In the top right set of results the natural results have been reordered based on the clickstream activity of the users of Trip, those who have not logged in (85%).  At the simplest level this promotes results that have been clicked on and relegates those that have not been clicked.  It really is more complex than that – but I hope you get the point!

But the bottom right is where the magic it.  Even though it only accounts for 0.2% of the activity, we have reordered the results based on the clickthrough activity of dentists.  There are a few erroneous results, but I’d like to think you can see the effect – dental articles are promoted.

So, the effect of this is that – when we eventually roll out the system – and we know the user is a dentist we improve their results based on the previous activity of other dentists.  The reality is that this technique will work with any speciality and profession.

There are a few issues, the paucity of data is the biggest and we have two significant ways of tackling this:

  • When we roll out the new Trip we will – to a large extent – make login/registration obligatory.  This will mean we get lots more clickstream data which will make the results even better.
  • Machine learning.  We’ve already worked on machine learning and will bring these techniques to the system to enhance/compliment the clickstream work.

Oh yes, we’ve even figured out a way to mitigate the effects of filter bubbles.

This really has been a good few weeks.

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