Trip Database Blog

I’ve been on twitter for a few months now, but only recently have I started to take it ‘seriously’. To be fair you shouldn’t take twitter too seriously. When you post a message (a maximum of 140 characters) it’s actually called a tweet. Below are a selection of the tweets I’ve appreciated and posted myself (I’m JRBtrip). As you’ll see there are tweets covering a wide variety of subject areas. For me twitter allows a great way of keeping up to date, sharing in other people’s experiences and finding random serious and not so serious links.

mdconsult FDA launches program to improve safety of drugs and active drug ingredients produced outside the US http://tinyurl.com/95225h

TechCrunch Yahoo Search Adds Deep Links To Wikipedia Via Search Monkey http://twurl.nl/fs2ux7

markhawker In fact, the whole OurNHS YouTube channel is pretty good http://tinyurl.com/7lcavn

AllergyNotes Women living in poor countries are 300 times more likely to die during pregnancy or childbirth http://tinyurl.com/7mcqbq

AllergyNotes Food allergy as “Yuppie anxiety”? — Food allergies are nothing to laugh about http://tinyurl.com/7z8vtb

amcunningham http://tinyurl.com/7j4daj understanding students (non)use of IT

JRBtrip Twitter set for its mainstream telly moment on Jonathan Ross’s comeback show http://tinyurl.com/8uodkh

JRBtrip Twitter set for its mainstream telly moment on Jonathan Ross’s comeback show http://tinyurl.com/8uodkh

JRBtrip SIGN’s new stroke guideline & they do a gr8 job of haemorrhagic stroke – most tend 2 focus on ischaemic http://tinyurl.com/9yg8eo (4Mb!!)

stephenfry Funny how loyal to your cities you Aussies are. And not content with loving Melbourne, Brisbane etc, you have to diss Sydney. Love them all!

JRBtrip Can you improve on this Q&A on the etiology of the popping when you click your joints http://tinyurl.com/9nnk8l

brownleader @JRBtrip discussed this with 3 GP’s who I work with and none of us could shed any light on the aetiology of popping/clicking joints

As you’ll see from the last two tweets that I asked a question (which can be viewed by all the people who ‘follow’ me) and brownleader responded. So twitter can be social as well.

If you’re tempted to get involved drop me a line and I’ll happily be your guide.

The BBC report:

“Using a simple surgical checklist during major operations can cut deaths by more than 40% and complications by more than a third, research has shown.”

While the full article “A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population” has been published on the NEJM site.

A few quick observations:

• It’s not a randomised trial, which could have been very easy to arrange.
• Not all outcomes in every site are favorable.
• Significant positive results for ‘any complication’ were seen in only half of the organisations.
• Pharma sponsored trials are often criticised for not using absolute risk reduction, I note that this trial also avoids that statistic.

Irrespective of the above, brief criticisms, any article that helps highlight simply ways to improve quality of care has to be applauded.

Twitter: an introduction to microblogging for health librarians well worth a rea to whet your appetite. Courtesy of Dean Giustini’s UBC Academic Search – Google Scholar Blog

This post starts with an apology to Douglas and Hywel at the Centre for Evidence Based Dermatology up at Nottingham, UK. Our analysis of dermatology Q&As should have been finished early last year. No excuses really, other than my inability to write papers!

One feature we were keen on with TRIP Answers was interaction. We have made it relatively straight forward to feedback comments and we intend to make it even easier in the future.

We realised, long ago, that there are many people out their with knowledge and experience that can be useful to improve an answer. A clear example was the Q&A “Is there any GOOD evidence to support the use of honey as a treatment for leg ulcers?”. This was initially answered in January 2006 by the ATTRACT service (for initial Q&A click here). In this answer there was reference to a Cochrane Systematic Review protocol (which is a notification of a review in progress), other than that there was little else.

An e-mail over the weekend was from a clinician who highlighted new research. This research had been incorporated into the Cochrane Systematic Review that was published in late 2008. It was a relatively simply job to update the Q&A (click here to see the updated answer).

If you see an answer that needs attention, let us know – it’ll always be appreciated and it helps share your knowledge with the wider world.

After posting the blog about the Tag Cloud of Clinical Uncertainty (TCoCU) I received a comment asking to explain how to read the page. So, here is an explanation of what the page represents and how to use it.

• Tags are keywords that help describe a piece of information, in this case a clinical Q&A. A typical Q&A will have 3-7 associated tags (or keywords). You can see these tags underneath a particular question.
• A tag cloud is visual representation of these tags. They are listed alphabetically, and the importance of a tag is shown with font size or color. The more prominent a single tag appears the more times this tag appears within the collection. Looking at the TCoCU shows that terms such as Cardiovascular disease, Women’s health and Musculoskeletal disease are prominent. This shows that there are lots of questions with uncertain answers in these areas.
• The tag cloud on the homepage aggregates all the tags in the system. However, if you do a search, the resultant tag cloud only shows tags associated with the returned search results.
• If you click on a single tag in the TCoCU this takes you to a new page, with two main areas. Firstly, there is a list of Q&As. These are all Q&As with the tag you had clicked in the TCoCU. Secondly, there is another tag cloud. When you initially clicked on a tag in the TCoCU you created a subset of Q&As and this new tag cloud is an aggregate of the tags for that subset only.

To try and make better sense of all the above go and try the following, go and click on the diabetes tab in the TCoCU. At the time of writing this shows a list of 47 Q&As which relate to diabetes that have highly uncertain answers. The tag cloud to the right of the page shows a different list of tags from the TCoCU as the new tag cloud only shows the aggregated tags from the 47 Q&As.

I hope the above helps, if not leave a comment and I’ll try and clarify further.

NOTE: We recommend you read our other recent blog on this topic ‘How to use the Tag Cloud of Clinical Uncertainty‘, it’ll help you orientate yourself!

NOTE 2: It appears the Tag Cloud of Clinical Uncertainty isn’t behaving itself. When I click on the diabetes tab I get taken to one place (click here) while others report being taken here. All users should be seeing what I see. So one for the techies to sort out next week – SORRY!

Over the years our team has answered over 10,000 clinical questions and our life is made easier when we find recent research/evidence to answer questions. Unfortunately, this is frequently not the case.

Historically, the most frequently asked question has been the frequency of vitamin b12 injections in pernicious anaemia. In the UK the recommendations are typically every 3 months (although recent guidance has lowered this) while in North America the suggestion is monthly. We have never been able to find any substantial evidence to support this. What is needed is a relatively simple RCT of 1 month versus 3 month injections, but that has not been done. There are a large number of other examples, all genuine clinical uncertainties, all requiring research. It was because of my desire to try and influence the research agenda that we got involved with DUETs an Iain Chalmers initiative to map out clinical uncertainties.

When we created TRIP Answers we introduced a scoring system for each Q&A and this allowed us to easily identify questions with little or no research to answer them. As well as being utilised by DUETs it allowed us to visualise uncertainties via the wonderfully named Tag Cloud of Clinical Uncertainty. While utilising a different methodology (and hence getting different results) to DUETs we have been very successful in highlighting hotspots of uncertainty. A ‘thumbnail’ of the main tag cloud can be seen below but it’s best seen via the site (click here).

Thanks to the Clinical Cases and Images Blog:

This video is doing the rounds at the moment!