Trip Database Blog

Earlier this week we created a short survey to try and understand what impact TRIP might have on patient care. There were 4 questions:

• On average, how often do you search TRIP each month?
• Do you ever use TRIP for helping you manage your patients or yourself?
• On average, what percentage of your searches are related to patient care?
• Of those searches that you use for improving patient care or your own care what percentage do you find TRIP actually helps?

We linked to the survey from two places: As a link from the TRIP Database and also from our various social media ‘outlets’ – Facebook, Twitter and this Blog. 

The results were very similar across both data collection methods.  For the sake of clarity I’ll show an average result and in brackets place the separate results from TRIP and then from the social media:

• 14.4 searches (17.2, 11.5)
• 79.1% (74.2, 83.9)
• 72.9% (74.3, 71.5)
• 70.7% (72.3, 69.0)

So, what do all these figures mean? 

Firstly, the methodology is far from ideal, so the results are speculative/dubious.  However, I feel reassured that the figures have been relatively stable from very early on in the data collection.

If we wanted to work out the impact of say 1,000 searches here’s how I’ve approached it:

• 1000 searches of which 79.1% are from users who manage patients or are patients themselves = 791 searches
• Of these 791 searches, 72.9% relate to patient care = 576.6
• Of these 576.6 searches, 70.7% help improve patient care = 407.7

In other words 40.8% of searches on TRIP result in improved patient care.  That’s significantly higher than our estimates and also, what I think is equally significant, is that 70.7% of users actually find TRIP is useful for patient care.

What is clearly needed is some more research (I typically hate seeing that in the discussion of a research article) to try and get a more accurate figure for TRIP’s impact and I’d welcome any comments on the most appropriate methodology.

But, in the interim, I’m happy (with the above reservations) to say that 40.8% of searches on TRIP help improve patient care

I’m really trying to understand the impact of the TRIP Database.  If you care about TRIP please take this very brief survey http://www.surveymonkey.com/s/JJKH25W

Thank you in advance.

At Evidence2010 I was a aware of a number of themes (in reverse order):

• The whole publishing model is wrong.
• Clinicians needs support in using the evidence ie what to do once they read a trial and know an intervention works, how do they actually use or administer it!
• Conflicts of interest (COI) are widespread. Pharma is an obvious COI but also in academia there are significant issues.
• There’s no more money – the healthcare systems in ‘the West’ have no more money to keep pumping into healthcare.
• Need to work more closely with patients to help make them better decision makers.
• Clinicians need to say this phrase more often – I don’t know.
• There’s an awful lot of love for TRIP 🙂

Obviously, I’m very pleased about the last one. Overall, a  very good, thought-provoking conference!

I had the pleasure of attending the Evidence2010 conference.  One role I undertook was to tweet about the presentations, in a way sending a summary of the presentations.  One talk, by Paul Glasziou, highlighted the diversity of conditions a GP will see (compared with specialists). He reported that 30 ‘conditions’ accounted for 50% of consultations.  A number of people wanted to see the 30 conditions and Paul has sent me a spreadsheet.  It’s actually 32 (not 30), so here goes:

1. Hypertension*
2. Upper_respiratory_tract_infection
3. Arthritis—all*
4. Diabetes,_non-gestational*
5. Depression*
6. Lipid_disorders
7. Osteoarthritis*
8. Back_complaint*
9. Immunisation—respiratory
10. General_check-up*
11. Asthma
12. Oesophageal_disease
13. Acute_bronchitis/bronchiolitis
14. General_immunisation
15. Contact_dermatitis
16. Anxiety*
17. Gastroenteritis*
18. Female_check/papsmear*
19. Sleep_disturbance
20. Urinary_tract_infection*
21. Sprain/strain*
22. Medication/script
23. Sinusitis
24. Solar_keratosis/sunburn
25. Cardiac_check-up*
26. Ischaemic_heart_disease*
27. Oral_contraception*
28. Pregnancy*
29. Malignant_neoplasm_skin
30. Acute_otitis_media/myringitis
31. Results_tests/procedures_NOS
32. Viral_disease,_other/NOS

Interestingly (!) the top 10 account for 27%

I highlighted a while ago that I often add small comments to Facebook that I didn’t consider worthy of a blog post.  So, continuing the theme started then, a few highlights of comments I’ve made on Facebook.

• I’ve updated all the Royal College guidelines – nearly 1,000 documents.
• Asked about how to raise money to help to keep TRIP going and improving!
• Highlighted a very nice net website – theNNT.
• Exposed the new TILT logo to the world (see below)
• Asked if people like the Q&A site Gas Exchange.
• Announced that we’ve as good as secured funding for an African clinical search tool.
• Not TRIP related, but what I do part-time for the NHS, is the Q&A service called ATTRACT. One feature we’ve just released in called tripe. 
• Finally, we’re starting to look to improve our links to educational content and we’re starting that process!

As mentioned above – the TILT logo!

I’ve not done this for a while but, for another project, I was checking out the functionality so thought why not!  Below is a list of the top ten articles viewed from TRIP in September 2010:

1. Physostigmine for dementia due to Alzheimer’s disease (Cochrane)
2. Low glycaemic index diets for coronary heart disease (Cochrane)
3. Music for stress and anxiety reduction in coronary heart disease patients (Cochrane)
4. Intensive insulin therapy in the medical ICU — not so sweet? (Critical Care Journal Club)
5. Down Syndrome (eMedicine)
6. Leptin and coronary heart disease: prospective study and systematic review (J Am Coll Cardiol)
7. Lipoprotein-associated phospholipase A2 is an independent predictor of incident coronary heart disease in an apparently healthy older population: the Rancho Bernardo Study (J Am Coll Cardiol.)
8. Sebaceous Cyst – removal (Patient UK)
9. Effect of raloxifene on stroke and venous thromboembolism according to subgroups in postmenopausal women at increased risk of coronary heart disease (Stroke)
10. Coblation Tonsillectomy & Adenoidectomy (ENT USA). Video

An interesting mix of papers and I’m intrigued to see a video in the top ten.  We recently boosted our video ‘collection’ and now have over 3,100 videos, so good to see they’re useful!

Facebook is massive, Microsoft is massive, Bing (Microsoft’s search engine) is less than massive.  Bing want to change this and they’re hoping that a tie-in with Facebook will help.  See this Techcrunch article for further details.  As the article states:

“Starting today…. you will automatically start to see links that your friends have “liked.” These will appear in a separate module, with related social links called out. The example Microsoft gives is if you are searching for San Francisco steak houses and one of your friends liked Alexander’s Steakhouse in San Francisco, that would appear as a result along with the name of your friend.”

I like this idea a lot.  It’s dependent on a number of variables coming together, but at a high-level I like this.

I particularly like it as I can see something similar working in the world of health.  What’s better for a GP searching for an article on the diagnosis of prostate cancer than one that a trusted colleague has approved?  How about, using the extended social graph to identify experts in the field of prostate cancer – what do they like?  Finally, what does the evidence have to say (as shown in the current TRIP search)?

However, this also requires a number of variables coming together.  However, if Facebook/Bing paves the way, then why not?  An important component for this to work is a clinician’s functioning social graph – where can that comes from?

Let’s hope TILT works!!

The launch of TILT (which stands for Today I Learnt That) is fast approaching and we’re pulling together the design and the actual programming – so time for a bit more information.  First the logo, which we love!

At the simplest level TILT is an easy way for users to record any learning they may have experienced.  This was designed principally around clinicians who need to record this sort of information for revalidation/recertification. Although, from our pilot, it became obvious that clinicians like to record their learning even if it’s not specifically for revalidation.

However, the real beauty and strength of TILT is that the ‘TILTs’ are viewable by other clinicians. As in ‘real’ life clinicians can learn from each other.

Some example TILTs include:

• PPIs associated with 1) fractures 2) LRTIs 3) C diff
• There’s not enough evidence to recommend racecadotril in children with acute diarrhoea
• I now (belatedly) appreciate the differences between the old UK90 growth charts and the new WHO charts (and the rationale behind the switch)

The clinicians in the pilot really enjoyed themselves and reported lots and lots of learning.  For me, the biggest joy was seeing the way clinicians transformed complex issues/articles into nuggets of learning.  From an information perspective this is gold dust.

The pilot involved around 10 active users and generated hundred’s of TILTs in 6 weeks. If we have 100 active clinicians what sort of impact will that have? What about 1,000? 

As one clinician fed back “you’ll be amazed at what you don’t know”

After a few false alarms we finally got the 10,000 registered users.  Now these figures have been audited – I’m very very happy with this figure.  I’ve done some analysis and the following are the top 25 countries where registrants come from:

• UNITED KINGDOM
• UNITED STATES
• SPAIN
• AUSTRALIA
• CANADA
• MEXICO
• CHILE
• ITALY
• BRAZIL
• PERU
• INDIA
• IRELAND
• SAUDI ARABIA
• ARGENTINA
• COLOMBIA
• NETHERLANDS
• NEW ZEALAND
• IRAN (ISLAMIC REPUBLIC OF)
• EGYPT
• INDONESIA
• ISRAEL
• BELGIUM
• THAILAND
• CHINA
• PANAMA

TRIP truly is international!  And here’s a selection of countries where we only have a single registrant:

• AMERICAN SAMOA
• ANGOLA
• ANTARCTICA
• BURKINA FASO
• CONGO
• EAST TIMOR
• ERITREA
• GUADELOUPE
• KOREA DEMOCRATIC PEOPLE’S REPUBLIC OF
• LAO PEOPLE’S DEMOCRATIC REPUBLIC
• LUXEMBOURG
• MONACO
• MYANMAR
• NIEU
• PITCAIRN
• SAINT KITTS AND NEVIS
• ST. HELENA
• SURINAME
• SVALBARD AND JAN MAYEN ISLANDS
• TAJIKISTAN

I love running TRIP and this sort of milestone and analysis make me very proud.  I think the next milestone will come relatively quickly via Facebook, where we have 494 ‘fans’ – only 6 to go!