Trip Database Blog

Interesting looking at the feedback on the Q&A site. For 2006 we’ve been rated as follows:

• Excellent – 88.3%
• Good – 10.4%
• Average – 1.3%

I tend to view responses other than ‘excellent’, negatively. So I’ve tried to look at our answers to questions which have been rated as ‘good’ or average’ to see if there is a trend. There appears to be two main reasons:

1. When there is little or no evidence to answer the question. From the users perspective they come to us with an uncertainty and sometimes we can’t help. Anecdotally, the lack of evidence can frequently be useful/helpful. However, in a some situations its not as well received – understandably.
2. Not comprehensive enough answer. Although only mentioned twice in the 2000+ questions we’ve answered I guess that might constitute a trend! Our remit is to provide quick responses to the literature. Occasionally we get a GP using us who has already done a good search asking us for information. Unfortunately, they don’t tell us what’s they’ve done so we answer it as normal ie give brief information.

Still with less than 2% of people rating us at less than good – we must be doing something right!

A few posts ago I reported on the mis-spelling frequency on the TRIP Database. I’ve just been looking at the stats and the most frequently ‘mis-spelt’ term is ‘hypertension’ and ‘diabetes’. To clarify that, it’s not a count of the number of actual times it’s been mis-spelt, more the number of different ways it’s been mis-spelt – 27 (see side)

These are confirmed mis-spellings in that people have clicked on the ‘did you mean: prostate’ to confirm spelling correction!

Nice article on search Can we know everything?

The ATTRACT site contains a wonderful counter that counts how frequently an answer has been viewed. The top five being:

1) What are the risks of flying while pregnant?
2) Is there any information on the Novasure system for treating menorrhagia?
3) Should dianette (oral contraceptive pill) only be used for 3 months in treating acne?
4) Should you treat a low Ferritin (

A post on Dean Giustini’s blog highlights Wellcome’s invitation to tender for a UK version of PubMedCentral. See Dean’s blog (click here) for more information.

Dubious question time – “What is the difference between central and peripheral vertigo?”. Is that a clinical question or an essay question? We answered it (http://www.clinicalanswers.nhs.uk/index.cfm?question=2291). If it is an exam question (we’d prefer to think it wasn’t) I hope it gets good marks AND we’re referenced!!

A busy day for adding CAM articles. We already had numerous articles on the subject from the likes of Cochrane and Bandolier. However, we’ve now added records from:

• The American National Centre for Complementary and Alternative Medicine.
• New Zealand Complementary and Alternative Medicine site (linked to the New Zealand Guideline Group)
• Mayo Clinic ‘supplements’ (patient information)
• UK Medicines Information have a small section.

We’ve also been busy adding patient information leaflets (PILS) – from the likes of PRODIGY (their new website launch has resulted in a near doubling of PILs), CancerBACUP and New Zealand Guideline Group’s consumer information.

This expansion of PILs is no doubt motivated by the free version of the site. Currently at the planning stage but more than likely they’ll be 3 separate searches – clinical information, medical images and patient information. These will be accessible in much the same way as google allows people to switch between searches for ‘web’, ‘images’, ‘groups’ etc. Essentially, a tab link above the search box.

Something wonderful happened today. We officially set in motion the road to free access to the TRIP Database. For various contractual reasons free access won’t start until 1st September 2006. However, we’re hoping to publish a ‘beta’ version of the free site ASAP (probably 3-4 months). The free version will actually be an enhancement on the current version – the next step in the evolution of the site. But, as mentioned, contractually we’re not able to push anything ‘official’ out until September.

When answering clinical questions we give a range of answers. Some are answered very well and others less well. If the evidence is there – great, if not the answers are less complete. Already, today, we’ve answered two questions at the different end of the spectrum.

The ‘good’ answer “Can you prescribe HRT for someone with focal migraines. If not what can be tried for her flushes? Also would HRT be advisable to protect her bones?” . This uses a number of evidence sources, principally PRODIGY. This answer links a number of separate sources of good evidence to ‘weave’ a ‘good’ answer.

The ‘bad’ answer “Can raised uric acid or gout could cause tinnitus?” We only found one reference in Medline and that was from Medical Hypotheses. So as we point our in our answer – it’s a hypothesis not evidence.

On one level the latter answer is bad. It’s bad as it doesn’t resolve the uncertainty for the GP. However, it’s an appropriate answer as that is the only evidence.