Trip Database Blog

TRIP’s advanced search may be modest, but it’s well used and when it broke late last year we had a large number of e-mails asking for a fix.

After what seems like an age, the fix has been rolled out.

I’ve just finished updating a Q&A on the role of statins in preventing dementia (click here). This was stimulated by a simple message published by AllergyNotes. His message was simply:

“New study supports statin’s anti-dementia effects http://tinyurl.com/86l3se“

I followed the link which led me to a news article on Reuters and from there to the new study in JNNP.

So, well done Twitter and AllergyNotes!

One thing that struck me in the Reuters article is a quote from a commentator that states:

“He points out that nearly 20 previous studies have assessed the effect of statin use on later risk of Alzheimer’s disease in older people, and the majority found substantial benefit.”

Interestingly, the other reference we use was a 2007 meta-analysis of seven trials of statins in the prevention of dementia (click here) which has the conclusion:

“The current evidence does not show any beneficial effects of statins on the prevention of dementia or AD.”

My point is that the Reuters commentary says the majority support the beneficial effects of statins in preventing dementia while a recent meta-analysis finds no evidence. Why might that be? I’m thinking that it might be down to the trial methodologies.

The truth is out there….

TRIP Answers has now been out for a little over a month and so far it has been very well received and it is starting to grow:

• Since launch, we’ve added around 500 new Q&As on the site from a number of sources.
• Site traffic is starting to increase, yesterday we had 1,489 visits with 3,545 page views.
• Comments are slowly coming in
• We’ve been approached by a variety of people/organisations wishing to get involved.
• One large website wants to use the content.

This is the first new website that I’ve been really involved in since the start of the main TRIP Database. However, that grew in a different manner. So, this has been a new learning experience. By using the site and listening to initial comments there are a number of minor changes I’d like to make. Some of these are to make the site slight clearly while others are to boost interaction.

But get in touch and let us know what you feel about the site.

We were asked a question about beetroot and its effect on blood pressure earlier today. This as stimulated by an article by ‘Dr Know’ in the Sunday Times (click here). This reported:

“Bizarrely, recent medical research backs this theory up. A study from Barts and the London School of Medicine showed that drinking 500ml of beetroot juice a day significantly reduced blood pressure levels in healthy volunteers. This benefit occurred within an hour of drinking it and was more pronounced after four hours; a degree of reduction continued to be observed for up to 24 hours.

The key beneficial ingredient appears to be nitrate, typically found in leafy green vegetables. Although the quantity consumed in this trial is more than most people would probably wish to ingest every day, it is likely some benefit still occurs if smaller quantities are drunk or indeed eaten.”

However, our search for the evidence highlighted an entry in TRIP Answers “What is the evidence of beetroot juice to lower blood pressure?“. This included the following:

“The study was very small and therefore should be repeated in more people.

It was conducted in healthy volunteers and should be repeated in people with hypertension or at increased risk of heart attacks.

Long-term beneficial effects of beetroot juice were not investigated, nor were any potential harms measured.”

The Sunday Times gracefully published my comment!

For years TRIP has offered access to its web services. Unfortunately, I’ve never been particularly great at explaining what web services are. But I’ll try and give it another go!

Basically, web services allow a 3rd party website to send a search string to TRIP and instead of showing the results in TRIP show the results in the 3rd party website.

I’m really pleased that a relatively new site QuizMD has come up with a novel use of our webservices. Instead of me trying to poorly explain what’s happening just go and visit their page on postpartum hemorrhage. At the top of the page is their test and below that are related articles loaded from TRIP.

A rough explanation of what is happening is that when this page is loaded, QuizMD send a search string to TRIP via our web services (in this case postpartum hemorrhage). We then send the search results back to them in a special format (XML) and QuizMD reformats the results to match the look and feel of their site.

I think it’s a great example of our web services. So, if you’re interested in utilising this service just let me know.

Rare diseases, by definition, only affect a small number of people.

There are lots of different rare diseases.

Overall, lots of people suffer from rare diseases.

However, the big problem is that – due to small numbers – each individual condition will have very little research carried out.

In the last week or so I’ve come across two resources that cover the area using two different approaches:

• ‘Old style’ web 1.0 Orphanet that covers a lot of conditions and is encyclopedic in nature.
• ‘New style’ web 2.0 RareShare that provides a framework for users, but the users are expected to give their perspective and share their experiences.

Both have merit – but surely more powerful combined?

I’ve had the pleasure of starting to add the Q&As from the Australian Evidence Direct service. Yesterday I added the following:

• What is the evidence on psycho-social support for allogeneic adult bone marrow transplants?
• What are the most effective treatments for impulsivity (personality disorder)?
• What is the best practice (and/or guidance) on the treatment for patients suffering depression and schizophrenia?
• What is the evidence to demonstrate the effectiveness of cognitive and behaviour therapy for panic disorder?
• What is the evidence for case management in mental health patients?
• What is the evidence for perioperative management of patients with sleep apnoea?

The content out there (on Evidence Direct and other Q&As services) really is amazing.

I have a feeling this is not the last post of the year, but I’ve started to wind down and start reflecting on what needs to be done in 2009.

Given my close relationship with the NLH I have often used them to compare TRIP against. Over the years we have exchanged positions regarding usage but since we fixed the speed on TRIP I’m delighted to see us pull away. In the graph below (click on the graph for a clearer view) you’ll see I’ve added NICE as well (given that they are merging with the NLH in April 2009 to create NHS Evidence).

However, while I’m pleased we’re doing well, I acknowledge it’s all relative and the graph below shows us – pitfully small – in comparison with the BMJ!

So, for years I’ve been aiming at improving on the NLH’s position. Now we’ve done this I’m hoping for two things:

1. NHS Evidence will bring some serious innovation into play to pressure us to innovate. In fact, the desire for innovation isn’t restricted to just NHS Evidence, I want to see serious innovation everywhere.
2. We close the gap on the BMJ.