Trip Database Blog

I’ve been talking with HIFA2015 which is a campaign group hoping to improve access (for patients and health professionals) to health information in developing nations. I commented that, given most of the content of TRIP is aimed at richer nations, it makes it more difficult for users from poorer nations to identify material appropriate for their context.

I’ve thought of a rather simple solution – allow users of TRIP to identify such content. Basically, someone does a search and in the results they see a resource suitable for poorer nations – they click a button next to the record and this is tagged as being suitable for resource poor nations. When someone does a search they could press a button and then restrict the results to ‘resource poor’. To start with this wouldn’t be particularly useful – but with 25,000+ visits a day I’m sure it’d work quite well within a short space of time.

There are quality issues that need working through, and we’re working on these. But I’m hoping this might be a reasonably efficient mechanism to solve a difficult problem.

This paper “Junior physician’s use of Web 2.0 for information seeking and medical education: A qualitative study” has caught the imagination of some of the bloggers I read and admire. The conclusion of the above paper reads:

Web 2.0 use represents a profound departure from previous learning and decision processes which were normally controlled by senior medical staff or medical schools. There is widespread concern with the risk of poor quality information with Web 2.0 use, and the manner in which physicians are using it suggest effective use derives from the mitigating actions by the individual physician. Three alternative policy options are identified to manage this risk and improve efficiency in Web 2.0’s use.

@amcunningham blogged about this on Tuesday (click here) while @DrVes blogged yesterday (click here). Two different angles on the paper, both worth a read!

Things are getting very hectic at TRIP!

As I’ve mentioned previously we’re having a massive overhaul of the site. Coupled to that, as you’ll see from my last post, we’ve been setting up an advisory board. The board is now set-up and the results of which are starting to be realised. The group consists of 70 people with around 50% clinicians, 40% information specialists and the remainder being an esoteric mix. The board is run through Ning, which appears to work very well.

There is still an opportunity to join the board, if you’re interested let me know via jon.brassey@tripdatabase.com

We’re planning on launching the new site towards the end of this month so until then I’ll be quiet on the blog.

TRIP has grown and matured as a site considerably over the years and this change has been particularly rapid in the last 12 months. The next upgrade will mark a significant improvement and it’s a momentum I wish to maintain. To help TRIP in this process I’ve decided to set-up an advisory board.

The TRIP advisory board will be an informal network of clinicians, information specialists and techies and I would expect it to serve the following functions:

• Respond and advise on ideas generated within TRIP
• To suggest ideas for new features/improvements on TRIP
• To generally be an extended pair of ears to highlight new technologies, opportunities for TRIP.

If you are at all interested please e-mail me via jon.brassey@tripdatabase.com

Please don’t be shy, I’d love to hear from you!

This might sound strange but Martin, if you read this I’d like to hear from you, the old e-mail I have doesn’t seem to work!

One massive obstacle to serving up decent search results in a search engine is trying to understand the intention behind the search. The majority of searches undertaken are 1-2 terms e.g. hypertension, diabetes, prostate cancer, migraine triptans. In the latter it might seem obvious they are interested in the therapeutics efficacy of triptans in the treatment of migraine. However, they might be interested in side-effects, prognosis etc.

It’s a tough challenge.

In the new TRIP we’re proposing two ‘features’ to help us deliver even better results:

• Geolocation. There are lots of tools out there that can tell us where our users are from. So why not leverage that information to improve the search results. If you’re from the USA, why not boost content that is USA specific? I’m thinking mainly of guidelines, if you’re from the UK you’d want to see guidance from NICE or CKS ahead of say the New Zealand Guideline Group.
• Specialism. When we release the new TRIP we’re going to significantly boost the My-TRIP functionality to make it really worthwhile for people to register and use TRIP while signed-in. One aspect will be to allow users to show us what speciality they belong to. This will help is a similar way to geolocation in that we can boost speciality specific content. Therefore, if you’re a cardiologist content from the European Society of Cardiology will be boosted, in addition content from primary research journals such as Heart and the American Journal of Cardiology will feature more highly.

So, we hope to benefit from a users location and specialism to serve better content, if anyone can think of anything else – feel free to let me know!

After seeing a couple of twitter-based book clubs including one created by Jonathan Ross I thought ‘why not create a twitter journal club’. So I sent a ‘tweet’ out and it seems to have caught the imagination of a number of people.

So, why not start a twitter-based JC? To be honest, aside from the big picture, I’ve got no idea how it might work. So, if you’ve got a view let me know. Otherwise, I’ll have to think of something 😉

Around 4 weeks we blogged that Clinical Correlations was to be the first blogs whose content would be added to TRIP.

Yesterday, I identified the 2nd blog to be added to TRIP, the rather nice TrustTheEvidence, created by Carl Heneghan, a GP and Deputy Director of the CEBM and Ami Banerjee, Cardiology trainee and clinical research fellow at the University of Oxford. Highly recommended – and they also have a twitter account http://twitter.com/cebmblog

ATTRACT is a Q&A service for Primary Care in Wales. It started in 1997/8 and is responsible for my interest in information support for clinicians. When I came to post as ‘Clinical Effectiveness Co-ordinator’ at Gwent Health Authority I was given the task of supporting clinical effectiveness in the county. At the time most similar organisations sent GPs on searching skills training and critical appraisal. After visiting around 75% of practices in Gwent it dawned on me this approach had significant problems. The overwhelming message was – answer our questions for us! ATTRACT was born. For historical interest ATTRACT was an acronym for Ask Trip To Rapidly Alleviate Confused Thoughts! Again, another piece of history – TRIP was a last minute idea for a name – it was going to be GEM (Gwent Effectiveness Matters).

I’m mentioning ATTRACT as it will shortly be gaining a new website in a week or so and as such I thought I’d look at the top ten most frequently viewed papers from the current website – one that was introduced around 2001/2. Here it is:

1. What are the risks of flying while pregnant?
2. Should you treat a low Ferritin (
3. What is the evidence for the recent press about statins and grapefruit juice being harmful?
4. Is there any difference between processed juice and fresh juice?
5. What is Epley’s manoeuvre for the treatment of benign vertigo?
6. What is the best treatment for pompholyx (dyshidrotic eczema, vesicular palmoplantar eczema) of the feet?
7. What is the cause of a black tongue? No hairs present. The tongue is not painful. Swabs are negative.
8. What is the best treatment for benign positional vertigo (BPV?What treatments are available for sebaceous hyperplasia?
9. Is it safe too fly during the first trimester of pregnancy? What are the risks, if any, associated with it?
10. Many of our patients have isolated raised gamma glutamyl transferase. Often these patients are on statins. How should such patients be evaluated?

The numbers are pretty staggering, the most popular question has been viewed 38,853 times and the 10th most popular was viewed 14,890 times.

The current website has seen massive traffic over the years, it deserves a peaceful retirement!

Just a quick update as things have been quiet on the blog. Basically, I’ve been in hospital and recovering from a partial menisectomy.

I injured myself a year ago running and initially I was diagnosed with a medial ligament strain. As a result of this mis-diagnosis (please, no-one mention evidence!) it was 6 months of physical therapy with no tangible results. So, I went to see a consultant orthopaedic surgeon who ruled out – clinically – medial ligament damage and suspected bursitis. However, he suggested I have an MRI scan. When he told me the bursitis was secondary to a meniscal tear I was shocked and hence a rubbish patient. I asked no questions about prognosis, nature of the operation etc.

Anyway, I had the operation earlier this week (partial menisectomy plus a steroid injection for the bursitis) and am recovering well. I’m hoping to run again in 4-6 weeks – hurrah.

If anyone is interested in seeing a bad picture of my knee taken this morning then click here.