Trip Database Blog

This article will no doubt feature highly in the blogs (click here) and create much controversy! It reminded me of the Isabel decision support tool.

Basically, the authors took a years worth (n=26) of diagnostic cases from the NEJM and, after reading the article, they selected 3-5 pertinent search terms. Added these to google and somehow selected the 3 most likely diagnoses. They then compared these 3 diagnoses with the actual result from the NEJM.

Overall result – ‘correct’ in 58% of cases (CI – 38-77%).

I’m not sure if I find this disturbing or not, it’s certainly too small to make conclusions. But once again Google (not deliberately on their part) have set a standard…..

Another record, this time in Q&A. Today – my birthday – saw the NLH Q&A Service answer and published 22 questions. The previous record was 17.

Happy birthday!

It has been two whole months since we went free. Before going free we averaged 22,500 searches per month. In September we were searched 132,538 times. For October, another huge increase – 191,581 searches. This represents a increase of nearly 50% since September and over 800% increase from our subscription days!

Onwards and upwards!

1. Chickungunya fever (Ganfyd) – viewed 396 times.
2. Guidelines for the administration of blood components (ANZSBT) – 342
3. Failure to thrive (Ganfyd) – 276
4. Guidelines for Blood Grouping & Antibody Screening in the Antenatal & Perinatal (ANZSBT) – 272
5. Asthma (PRODIGY) – 254
6. Rheumatoid Arthritis: Diagnosis and Management (British Columbia Medical Association Guideline) – 251
7. Nutrition support in adults (NICE) – 214
8. Moxibustion (CAM) – 214
9. Diabetes services for adults (RCN) – 201
10. Good practice in infection control (RCN) – viewed 197 times.

Found by Ben and a very useful intro (click here). I’m seriously considering using a wiki in at least one new project I’ve got in the pipeline, possibly TRIP Answers.

A bit of a grand title, but what happens when we get a question that has potentially very serious consequences? We had one yesterday. The question:

“A friend presenting with raised ESR, spontaneous bruising and temporal arteritis – any ideas, please? Awaiting haemo consult which could be two months hence.”

I saw it and initially was unhappy as it was about the persons friend. So I asked our medical director for his view. Well, he felt it could be a medical emergency (especially as the GP seemed to have a two month timescale). Apperently, in TA there is a danger of blindness unless suitably managed.

The dilemma we had was how directive we should be? Our answer can be seen by clicking here. I also sent a separate, private e-mail, to the GP reinforcing the need to take this seriously.

I wonder if we’ll hear any feedback from the GP!

Microsoft catering to masses is the title on an article in The Seattle Times. This highlights the embracing of RSS in the new Internet Explorer 7. The authors view is that the move by Microsoft will finally propel RSS into the mainstream.

Currently, we use ‘old fashioned’ e-mail to alert people of new content. Perhaps it’s time to shift to RSS.

Clinical Evidence has a chapter on tennis elbow and one of the interventions is corticosteroid injections. For the short-term relief of pain it is rated as likely to be beneficial (based on a search carried out in 2005). Late last month the BMJ published a RCT on tennis elbow and one of the interventions was corticosteroid injections (click here). This concluded:

“Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term. The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow.”

The Clinical Evidence chapter relied on a 1999 systematic review and subsequent RCTs.

So, we have one SR (from 1999) and a number of other RCTs. This begs the question ‘how long before these RCTs are incorporated into a new systematic review?’. This question must be true for any number of interventions.

Given the massive changes in technology and open-access, is it really too hard to free up the meta-analyses and allow (with strict conditions) users to simply add new trial data as it comes along? Each review would have inclusion criteria and as long as these were met then the data could be added. Doing this online would allow for the instantaneous updating of the meta-analysis.

This issue came up as a GP contacted the ATTRACT service asking how he should react to the new BMJ article. Our response, probably unhelpfully, is that it is not our role to weigh up new research against prior research. Ultimately, you need to wait for a new systematic review! Using the olds methods we’d need to wait for months or more likely years. With an online system you could update it in hours.

The software, if not already there, would hardly be tough to create. Those wanting up to date information would surely want it. So why is there no pressure for this to happen?

Open and Free Access to Full Text Journal Articles and Medical Databases in Disaster Affected Developing Countries