Trip Database Blog

Click here for the free-access TOC. Lots of really interesting articles, honest

An interesting use of search data from Google, this time the search terms associated with flu recorded over time (click here for full post). The hypothesis is that people search for flu when they think they have it.

It would be interesting to overlay the search term graph with recorded incidence; I imagine that will follow.

The search results count for each category is now back.

The search results count was disabled due to excessive load on our servers. Now we’ve sorted out the servers, we have reinstated the counts.

A brilliant bit of news for Monday morning!

For interest: So many filters, so little time: the development of a search filter appraisal checklist

Historically, TRIP has used number of searches as a sign of usage/success. However, we have begun to question the merit of this for a number of reasons:

• The search statistics also included third-party sites that use TRIP via web-services, so users never actually come to the site (the 3rd party site sends a search string to TRIP and we return the results which the site integrates into their pages).
• The number of searches doesn’t take into account how people interact with the site. For instance a user searching on TRIP might look at 2 categories (e.g. EB synopses and guidelines) and that counts as 3 page views (first results page, EB synopses and guidelines). We feel this is much more meaningful.
• On a more pragmatic basis, our advertising income is based on page views not searches!

In reality this means that in September we had 740,697 page views while we were searched 1,138,699 times. The discrepancy can be explained in part due to 3rd-party access via our web-services, but also because our page views are based on Google Analytics, which can give a conservative view of actual page views (as it requires things like java to be activated to work!). Irrespective of potential discrepancies we still feel the page views are more meaningful.

So, goodbye to search numbers and hello to page views….

A boring extention of the last post, but the effect of the speed increases in TRIP are continuing to be impressive. Comparing the last 4 full days (22nd-25th Oct) with the same 4 days of the previous week (15-18th Oct) has seen the following:

• Visits: +21%
• Pageviews: +92%
• Bounce rate: -41%

It’s hardly surprising, but the increase in speed means people are more prepared to hang around and explore the site. I imagine the overall satisfaction with the site will increase making it more likely that people will come back.

The speed increase and its impact has given us all a real boost.

This may be stating the obvious, but people seem to really like fast websites! It’s only been 36 hours of a ‘fast’ TRIP, but some interesting figures already (compared with the weekdays of last week):

• 24% increase in visits.
• 30% increase in page views.
• 27% reduction in bounce rate (proportion of people visiting the site and leaving without exploring).

As it happens, the number of visits is the highest one-day figure we’ve ever had.

I’m almost scared to admit it, but I think we’ve finally made a significant breakthrough on the speed of TRIP. For what seems like forever search speeds have been between 10-20 seconds. Today, most of my searches have been under 2 seconds with the odd one hitting 5 seconds.

We’ve commented here before about improvements in speed (most recently in July 2008), but this time I think it’s sustainable. As well as optimising various sections of code we’ve increased our search capacity by nearly 600%.

What we have noticed in the past has been an increase in usage as soon as our speed increases. However, given the improvements the system is much more resilient to future usage increases.

TRIP is a complex beast made up of new code built upon old code. Our recent investigations have taught us a lot about the system and allowed us even to plan for future hardware/software developments.

We’re pleased, I hope you are too.

I heard an interview on today’s Today programme on Radio 4 with Sir Michael Rawlins, the chairman of NICE. In the interview he highlighted the need for post-research evaluation to ensure the research promise of an intervention is realised.

This notion of experience as a form of evidence has been of interest to me for many years, ever since I was approached by a GP who was using bupropion in smoking cessation. His perspective was that bupropion was pretty rubbish for his patients and wanted to understand why the discrepancy with the evidence (which stated it was effective and evidence-based).

My own perspective is that the experience of ‘coal face’ clinicians is crucial in addressing some of the biases seen in clinical research. In a very nicely funded and implemented randomised controlled trial (RCT) you may very well exclude patients with co-morbidities – alas, in the ‘real world’ clinicians don’t have that luxury. Take an intervention such as cognitive behaviour therapy (CBT) for depression, those carrying out the trial will use an experienced CBTer as opposed to a ‘coal face’ clinician who may have basic training in the matter. The bottom line is that conditions in a RCT cannot be the same as those of the ‘coal face’ – that should surely be a worry.

Currently, the ‘evidence’ used in EBM is overwhelmingly devoted to the hard evidence obtained from trials such as a RCT. I’m not suggesting that RCTs are not useful, far from it. However, I’m increasingly of the opinion that harnessing the experience of clinicians is vital to supplement the evidence found in clinical trials. Experience can be a form of evidence.
Interestingly, in my previous post highlighting 16 years of EBM (that linked to this JAMA article) the JAMA article had the following passage (from their 1992 article):

“A new paradigm for medical practice is emerging. Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research. Evidence- based medicine requires new skills of the physician, including efficient literature searching and the application of formal rules of evidence evaluating the clinical literature.”

In the passage they highlight that EBM de-emphasises, amongst other factors, the ‘unsystematic clinical experience’. While I completely agree with that sentiment, it opens the door for the emphasis of SYSTEMATIC clinical experience.

So, who’s for the systematic collection of clinical experience?