Following on from yesterday’s post I sent a quick e-mail to Dean (Giustini) over at Open Medicine asking about their software platform. They use Open Journal Systems, which is free, obviously robust and fit for purpose. I’m intrigued by their document “OJS in an Hour”
Q&A services support clinicians by offering clinically relevant information with minimal effort. One of my most frequent moans (aside from middle-lane hoggers on the motorway) has been the poor sharing of answered questions.
Many of our questions are dealt with ‘sorry, we found no evidence’, which may seem a poor answer, but clinicians seem to be happy with these. However, a number also receive more complex answers with multiple evidence sources.
Why not create a journals to formalise these answers? Why not have our answer followed by a ‘commentary’ by a clinician (be it a generalist or specialist)? The format of the journal ‘Evidence-Based Medicine’ springs to mind (see for an example). This has the abstract followed by a commentary. See below for truncated image.
Another ‘random’ title for a blog entry – I’ve been looking for an excuse!
Things have been fairly hectic of late. The NLH Q&A Service continues to move on with an expansion in questions we can answer (35-50 per week). The new arrangement also gives us greater flexibility, which suits us all very well.
My encounter with Facebook is proving interesting. Still not 100% sure why, although I’ve recently been contacted by a friend I lost track off after college (1991).
I’m very excited about a meeting next week – to finalise the next update to TRIP. There are 3 main planks, the first I’ve discussed before, a significant overhaul in the search algorithm. One of the others I’ve mentioned in the past – the content/quality slider. However, the big enhancement I’ll leave for another day.
Finally, I’ll be gone for most of this week, at the Manchester International Festival.
I blogged about this a while ago in relation to our Socrates project. Well, the results are now out (click here) and make fascinating reading.
There were 3 treatment options (see article for more details) and the results were split fairly evenly (37.5%, 37.4% and 25.2%). I wonder what that indicates about the roll of evidence? How much does it influence practice?
A recent review of TRIP in Comprehensive Ophthalmology Update (click here for PubMed entry) was very flattering. Some of the snippets:
“..it is clear that the number of sources included in the database is impressive in both quantity and quality”
“…this is really an exhaustive resource for virtually any clinical scenario you can imagine.”
“The TRIP Database is a remarkable combination of simplicity and expansive depth. It is hard to imagine that a physician looking for evidence-based information on any entity likely to be encountered in clinical practice would ever need another resource other than the TRIP page.”
Another recent article (Click here for PubMed entry) looked at TRIP’s performance compared to a number of other high profile resources. It used an interesting methodology (perhaps strange would be a more accurate description). Basically, it used two main resources to answer clinical questions and then, if the answer was not found in these, the other resources (including TRIP) got used by the clinicians.
In short, TRIP answered more questions than any other single resource. This is made all the more impressive in that TRIP was only used when ‘easier’ questions had already been answered by the two ‘main’ resources.
I’m not sure why but I’ve started using Facebook. I think my profile is available via this link http://www.facebook.com/profile.php?id=759565005. However, you need to login to Facebook to see some of the stuff and need to be ‘my friend’ to see all the stuff.
The NHS Choices website has launched, it’s a patient-focused site “that aims to put you at the centre of your healthcare.” It looks nice and has some interesting areas that help users to find suitable health services. It also gives you an online health check. Apparently I have no risks for cardiovascular diseases. There is also as extensive list of patient information leaflets, which I may have to add to TRIP (after checking they are not copies of those on NHS Direct).
My main interest is in search, so that’s what I’ve spent most time on. A search for prostate cancer was interesting. The ‘hottest’ part of the results page was a set of options showing me what my GP was reading (and similar options). Lower down you actually get to the results, which seem appropriate. It seems strange that, as a user, the main results are not displayed in the most obvious part of the page. However, given the prominence of the link, I imagine an awful lot of people will be interested in what their GP was reading. The 2 results are below
- Clinical Knowledge Summaries: Clinical topics full list Breast cancer — suspected … GI (lower) cancer — suspected … Prostate — benign hyperplasia
- Clinical Knowledge Summaries: Clinical knowledge DH referral advice for suspect cancer
As a patient I would find that list slightly alarming! So, he’s looking at breast cancer, GI cancer, BPH – surely he should be looking at information relevant to my condition!
Apparently, my GP is reading the following in relation to my search of hypertension:
- Diabetes — hypertension
- Diabetes — hypertension … Hypertension … Hypertension in pregnancy
- Alcohol — problem drinking
- Alcohol — problem drinking
This site has obviously had large sums of money spent on it (I hear £3.5 million), it just seems a shame that it is let down by the poor implementation of search….
So far the overwhelming support (5 out of 6 responders) has been for option one – using a quality slider.
One respondent (Ben) came up with a wonderful idea that ties in very well with a historical feature of TRIP – colour coding. Around 5-7 years ago, when TRIP introduced results categorisation (‘evidence based’, ‘primary research’ ‘Q&A’ etc) we gave each category a colour. However, over time things got complicated and we decided to drop the colour coding.
Ben suggested we try giving the ‘quality slider’ a visual colour change. I’m guessing this could be multiple colours or different shades of the same colour. In the latter case it could be something like the darker the colour the higher the quality. How this might manifest itself in the results page I’m not sure, some immediate thoughts (so not necessarily well though out):
- Each result has a coloured box or bar representing the likely quality.
- The results themselves are written in a particular shade.
- Each result has the underlined hyperlink given the particular colour.
Something for the design guys to get their heads round – assuming we go with the quality slider!
We are currently planning our next upgrade to TRIP and we need your help! Let us know via the comments facility below, via the TRIP Database contact form (click here) or e-mailing me. The planned upgrade will go ‘hand in hand’ with a significant improvement in the search algorithm.
BACKGROUND: TRIP has a reputation for offering access to high-quality clinical literature. We wish to retain that reputation.
PROBLEM: Many clinical questions cannot be answered using high-quality material. Therefore, currently, users would need to go to other websites to find their answer. We are exploring the possibility of adding a broader range of material to support enhanced questions answering. However, simply adding lesser-quality material into the main search would ‘dilute’ the quality.
PROPOSAL: To add extra, lower-quality, material into TRIP in such a way as to ensure we retain our high-quality reputation while still enhancing our ability to facilitate clinical question answering. To that end I can see three main possibilities:
1) Auxiliary search: I’d envisaged an initial search to cover the higher quality material. If the user feels they need additional information they move a ‘slider’ (click on image below) to include a wider variety of content. This would sit at the top of the search results.
Pros: Allows users to easily include/exclude content.
Cons: Sliders are not a widely used ‘technology’ and users might not fully understand them.
2) Exclude from core search. This would be to include all the material in the search but only include the core ‘quality’ material in the main search (where all the results are ‘mixed’ together and returned on the first results page after a search). To select the lower quality material a user would need to click on the particular category section.
Pros: Cheap.
Cons: Users might not use the category search therefore never seeing the results.
3) Contingency. We could get the system to carry out a search as outlined in point 2) above. However, if there are less than, say, ten results which are highly textually relevant, the system adds the additional content to help boost the number of relevant results.
Pros: Should work very well, with little user intervention.
Cons: The inclusion of lesser quality material will not be explicit which might impact on our ‘high quality’ reputation.
Alternatively, if you can think of any other solution we’d be delighted to hear from you!
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