Trip Database Blog

When answering a clinical question I frequently think of how useful that might be in ganfyd. We got asked, again, about the use of statins in the eldery (click here). As we re-answered this question the link needed updating in ganfyd (click here). Similarly a Q on nitric oxide (NO) in asthmatics (click here) gets added to the NO entry in ganfyd (click here).

This recycling of clinically useful material makes perfect sense and highlights the syngergies between the projects.

In answering clinical questions we occasionally see examples of practice that could be considered wrong. Yesterday, we had two within 20 mins – making it stand out! I say ‘wrong’, that’s probably too harsh. It would be more accurate to say ‘practice considered contrary to best evidence’. But then isn’t that what the Q&A site is all about?

• One was about using a stool test to re-test for H. Pylori eradication. The GP had used one 2 weeks after eradication therapy. In reality, according to the guidelines, you should only use a breath test. For more details click here
• The other example was a 2-year old child being given the Pnuemovax vaccine. In the under fives it should have been Prevenar. For more details click here

A small selection of feedback we’ve received this week, mainly from the NLH Q&A Service:

• I’ve used this service for a few months and find it superb, long may it continue.
• fantastic resource.
• I’d really value this service long-term and not just as a pilot- its far more useful for GPs than a lot of the information sources we have access to.
• I think this is an excellent service and would definately use this service again in the future, the answer was very indepth and extremely helpful. Thank you
• I love you Jon!

We get these comments all the time (except the last one). Makes the ‘job’ very rewarding.

When the TRIP Database goes free access we need to ensure we obtain an income to pay for upgrades, maintainance etc. The main ways we’ve identified are:

• Sales of meta-data
• Adverts

The former we do already and hopefully, as we get more prominent due to our free nature, we’ll be able to increase this side of things. In the case of the latter our initial plan is to create our own in-house adverts which would allow us total control of what is advertised. We envisage these being displayed at the top of the search results page. However, is their a place for a google ads panel towards on the right-hand side of the search results? I have reservations, but the BMJ does it…

I don’t know about nursing research. All I know is that when we get a question that relates to nursing issues there is a very high chance that they’ll be no research around to support it (see our latest example When deflating the balloon to remove a urethral or suprapubic catheter should the syringe stay attached to the tube or removed). One of the projects I’m involved in is DUETs which seeks to capture uncertainty related to therapeutic interventions. How about one for nursing?

In an ideal word people asking our services a question would use the PICO format. I’m not a huge fan of this as its a construct that adds a barrier to using our services – it’s hardly user friendly. So we allow free-text questions which normally works quite well, but in around 15-20% of cases we need to get back to the user asking for clarification. However, we got the following Q the other day “Evidence for using viagra”. We could have got back to the GP, but we decided to interpret the Q to mean “Evidence for using viagra in erectile dysfunction”. Arguably the use of sildenafil citrate (Viagra) for the treatment of pulmonary arterial hypertension comes under a different trade name – Revatio. Still, doesn’t really excuse the poor Q….

Talking of viagra and hypertension, that is how viagra came about as a treatment for erectile dysfunction (ED). Sildenafil citrate was originally intended (and tested) as a treatment for hypertension. In the early trials one of the side-effects was erections. This accidental discovery got the pharma-people interested and viagra, as a cure for ED, was born….

Just got a final proof of a paper I wrote on the TRIP Database. I wrote it in October/November 2005! The paper reports on the recent Centre for EBM review and the planned changes to TRIP. Those changes happened in December 2005. Also by the time the paper is published the site will be free-access (albeit via a beta-test version of the new site). So by the time it’s published the article will be ‘doubly’ out of date.

Something to be said for the instant publishing afforded by blogs 😉

NOTE: I just used the spell check that is part of the blog – guess what it didn’t recognised ‘blogs’ suggesting ‘blocs’….

The TRIP Database has an extensive synonym function. However, we still get terms we don’t fully understand. This time it was a question received on the NLH Q&A Service asking about ‘candidal overgrowth’. How do you search for this? We think we got it right with candidiasis – but how do you verify this? The requesting doctor didn’t know.

We’ve now discussed the specification with our web people, got the quote (ouch) and a rough timetable. The next steps are as follows:

1. Final specification meeting (sometime next week).
2. Web-people to produce specification document including wireframes.
3. A robust test version should (!!) be available by mid-May
4. Fingers crossed, the beta test version will be made publicly available at the start of June.
5. Although free accessible the beta will not become official (for contractual reasons) till September 1st.