Trip Database Blog

As well as our secondary evidence content, Trip also includes a large number of journal articles. The coverage is complicated and this post sets out what we include, journal wise, in Trip.

Key Primary Research: We include all the journal articles from the big 5 internal medicine journals – NEJM, Lancet, JAMA, BMJ and Annals of Internal Medicine. In addition we include all the content from the wonderful EvidenceAlerts.

PubMed’s core content: We include all the articles from PubMed’s core content (~110 journals)

Additional journal coverage: For our clinical areas (we have around 30 and cover topics such as cardiology, oncology) we selected the top journals based on Impact Factor for each area. These were then reviewed to ensure they were clinically focussed (many are at the academic scale of things, so these were excluded).

In total we grab all the articles from around 550 journals.

Randomised controlled trials (RCTs): We grab all the randomised controlled trials from ANY journal in PubMed (I believe they cover 5000 journals).

Systematic Reviews: As with RCTs we attempt to grab all the systematic reviews from PubMed. And we have a separate system to identify systematic reviews in non-PubMed journals.

In total we have approximately 4.5 million journal articles (compared to 33 million in PubMed).

Full-text: Final point! For Pro subscribers we offer links to full-text to approximately 70-75% of all our journal articles (~ 3.1-3.4 million articles).

Trip is well known for being easy to use. However, that doesn’t mean people don’t need a bit of ‘on boarding’ to help them get to grips with the site. To this end we’ve created two videos to help. The first, less than three minutes long, is a high-level take on Trip and should be enough to get people well versed in the basics. The second is longer and covers more ground.

• An introduction to the Trip Database – covers the philosophy of Trip, basic searching, an overview of the results page, the use of colours and the evidence pyramid and how to restrict your search to specific evidence types e.g. systematic review or clinical guidelines.
• Part 2: An introduction to the Trip Database – covers a brief history of Trip, the difference between ‘free’ and ‘Pro’, PICO and advanced searches, explaining results icons, exporting results and registering on Trip.

We hope you find them useful.

Remember, if you need additional help using Trip then reach out to us via jon.brassey@tripdatabase.com, it may be for a specific query or possibly suggestions a new video topic.

Ahead of our 25th birthday later this year we thought it would be interesting to start collecting how users use Trip! This will be interesting for us at Trip to understand but it should be interesting for other Trip users to understand how others use the site.

So, we invite you to submit yours via jon.brassey@tripdatabase.com. We’re not expecting long essays, perhaps 1-3 paragraphs. Some great examples are below:

Example One, from a family physician in the USA

After reading an oncologist opinion suggesting that new diabetes in the elderly should prompt consideration of pancreatic cancer, I searched TRIP for information to both inform my background thinking and help me navigate between over-testing on the one hand and missing an important diagnosis on the other. TRIP seemed to afford the broadest search “net”, and a search with the terms “new onset diabetes pancreatic cancer” lead to two useful resources

• A population study to characterize risk factors
• The initial publication of a clinical risk model

Information from both articles has been directly useful in helping me think through with several patients whether their diabetes is likely “just diabetes” or might be a sign of something more sinister in need of further.

Example Two, from a medical student in Bosnia and Herzegovina

As a medical student interested in therapy comparison and evidence-based medicine, I find it very useful Trip Database’s PICO search tool which provides you with a very systematic and targeted search for papers. Moreover, I truly like that the research results are classified into different categories (e.g. systematic review, primary research, ongoing research, guidelines, etc.) as this makes trawling through the articles much easier.

Example Three, from a professor of dentistry in the USA

Trip and PubMed are the two database we teach to all our dental students and residents for the last 15-20 years. The students use Trip in both the classroom and clinic. It is great. It allows them to quickly keep up to date with the best evidence on patient care.

Thank you so much for developing this worldwide tool for healthcare.

Example Four, from a nurse and academic in Canada

I have been using it for many years (20+) and usually to support nursing students at a variety of academic centres in North America. I know from firsthand experience that many nursing students to whom I suggested using TRIP delivered discussion posts or assignment papers that clearly showed the influence of TRIP resource finding.

So, please, if you can share a case study, that’d be great and send them via jon.brassey@tripdatabase.com.

Having access to full-text documents is often really important and something Trip supports as best as possible. Most of the higher-quality, secondary evidence, is available as full-text; this is not the case for journal articles.

So, to help users understand what’s available, alongside the title of each journal article is at least one icon to signify what is available: full-text or abstract only. This is slightly complicated by the difference between ‘free’ and ‘Pro’ Trip. The subscription (Pro) version links to a huge number of full-text articles; around 70% of journal articles in Trip link to full-text articles. So, how to understand the icons:

Pro (subscription) users

Free users

Note, in this situation you can see the ‘Pro’ wording next to the full-text icon to signify that, if you were a subscriber, you’d be able to link to the full-text.

Things are going well with our integration of OpenAthens into Trip (as announced at the end of last year). We’re on schedule to test from the end of January with a view of rolling this out in February.

Given this was funded by Health Education England (HEE) we are also tying it in with HEE’s purchase of LibKey for the NHS in England – so the two will be released together. LibKey is a great tool to link users with the full-text subscription their institutions subscribe to. Putting it another way, if your institution subscribes to a journal, Trip can see (via LibKey) if you have access to the article in the search results and insert a link directly to the full-text. It’s quick and seamless. We’ve supported LibKey in Trip for over a year and our users love it. When we roll this out we will automatically be adding the link-out credentials to over 250 new insitutions.

We have just uploaded the latest – manual – upgrade of content to Trip. Trip has two main wats of importing new content:

• Automatically
• Manually

Automatically is the easiest and many sites we use have systems to help support our capture of content, mainly via things called APIs. This accounts for around 80-90% of all our content.

Manually is, unsurprisingly, manual and requires us to visit every site – on a monthly basis – to look for new content. This process has been going on since we launched, nearly 25 years ago and we’ve never missed a single month. However, the task has grown considerably and we now visit around 500 sites every month. This has increased dramatically over the years, when we launched we included less than 25 sites. Manual updating takes a week, when before it could be done in less than a day.

This month we added 580 new articles from a large number of global sites, including:

• WHO
• NICE (UK)
• Prescrire (France)
• ACOG (USA)
• Public Health Ontario (Canada)
• RCOG (UK)
• SBU (Sweden)
• Public Health Wales (Wales)
• Agency for Care Effectiveness (Singapore)
• EMA (Europe)
• Scottish Medicines Consortium (Scotland)
• FDA (USA)
• Canadian Paediatric Society (Canada)
• James Lind Alliance (UK)
• National Health Care Institute (Netherlands)
• Norwegian Institute of Public Health (Norway)
• Australasian Society of Clinical Immunology and Allergy (Australia and NZ)

The earliest monthly upload I can find is from June 2009 and it’s interesting to see how many of the publishers have fallen by the wayside e.g. Centre for Reviews and Dissemination , NHS EED, Health Protection Agency, NHS Purchasing and Supply Agency, PedsCCM (Note, many are still actually in existence, they’re just not producing the content they used to)!

3-4 weeks off – doing other essential Trip work – till we start the process again. As long as new content is published, we’ll be grabbing it.

From a Trip perspective 2021 work was led by continued work on the new site. Trip has grown over the years with much of the code very old and very muddled. It was becoming increasingly difficult to maintain and we made a decision to recode the site in 2019! As part of that we took on a new main developer (Abrar) who was supported by Phil (our long-standing developer).

The new site was released as a beta (test) version in April 2021 and fully released in July. It has proved to be remarkably resilient with hardly any issues. This is amazing given the size and complexity of the site.

With all the work going on in the background, Trip has continued to help users to find great evidence. We’ve had millions of searches over the year supporting care across the globe. We’re continuing to attract new subscribers, both organisational and individual – a great sign for the future.

Covid-19

Covid-19 dominated the headlines and, since Jan 2020 (first search was 14/01/2020 for ‘Wuhan coronavirus’), Trip had over 550,000 specific search sessions on the topic. Supplying higher quality research evidence, Trip’s focus, was as valuable as ever.

Linked to that, one related topic is that I’m starting to try to make sense of the clickstream data (see Covid-19 search trends, is there a paper in this data?). I’ve no idea where that journey will take me (but feel free to help)!

2022

The release of the new site in 2021 was only part of the story. What we released was the front end of the site – the bit users interact with. Since then we have been working solidly on the back end – the bit responsible for grabbing and processing the content that is added to the search index. Again, a hugely complex task but we’re getting there. And, hopefully, that’ll be switched on sometime between March and May (users shouldn’t notice)!

After that we can start to introduce the improvements that I’ve wanted to see for years but have been put off as we recode the site. Early releases will hopefully be the guideline scoring work, the improvement to search sensitivity and specificity and a revamped advanced search.

25th Anniversary of Trip.

2022 also marks the 25th year of Trip’s existence. I have no idea when it was went live on the internet (previously it was an excel spreadsheet) and the Internet Archive doesn’t help. So, that’s a bit of a damp squib. If we get any time to think we may try to do something to commemorate!

Bye Bye to the NHS

On a personal level, at the end of March 2021, I left the National Health Service (after nearly 30 years). My final job being Lead for Knowledge Mobilisation at Public Health Wales. It’s nice to now be able to concentrate more of my time on Trip.

When people search on Trip we record – anonymously:

• Time and date
• Search terms used
• Articles viewed

Given Covid-19 is a hot topic I looked at our logs for Covid-19 related queries and found that we had over 500,000 separate search sessions exploring the topic. I’ve had a quick look through the data and found out a number of things that, to me, appear interesting.

Most popular articles

• COVID-19 (Novel Coronavirus) – DynaMed
• Novel coronavirus (COVID-19) guidance for acute care – Ministry of Health, Ontario
• Infection prevention and control for novel coronavirus (COVID-19): interim guidance for acute healthcare settings – Canadian Government
• Interim guidance: public health management of cases and contacts associated with novel coronavirus (COVID-19) in the community – BC Centre for Disease Control
• COVID-19 rapid guideline: managing the long-term effects of COVID-19 – NICE

Timeline

Lots of data relating to the first time something was searched for, for instance:

• 14/01/2020 – the first search for a Covid-19 topic, in this case the search was ‘Wuhan coronavirus’
• 22/01/2020 – personal protection
• 25/02/2020 – vertical transmission
• 02/03/2020 – pcr

‘Timeline’ of a topic

Taking the top seven documents for hydroxychloroquine we charted their popularity over time:

After a very quick burst of interest, attention moved on (probably after people understood the evidence). Imagine if we’d waited 6 months for a systematic review!

Top search terms

• diagnosis
• PPE masks
• screening
• pregnancy
• chloroquine

The above are a few examples of the sort of analysis that could be explored. Another one, not yet explored as it’s difficult to do manually, is to explore topics and see what types of evidence people look at. So, if a topic gets very few clicks does that indicate an evidence gap? If they click mainly on systematic reviews is that a good thing?

Overall, I could do the analysis and report it as a series of blogs. But I feel that there’s probably enough material to make at least one paper. Clearly, it’s not your typical journal article, but there are lots of different article types – so it might fit in somewhere!?

So, I’d appreciate any help thinking this through – for instance:

• What’s the best way of writing this up? In other words, what’s the story behind the date?
• What sort of journal might like this sort of thing? I was thinking of something like the BMJ (yes, ambitious) or Journal of Clinical Epidemiology.
• Any other analyses that might be interesting for people.

If you can help then please send me an email jon.brassey@tripdatabase.com

We are very pleased to announce that we have started the process of introducing OpenAthens as a method of authentication to Trip Pro. We have signed the contracts and started the technical steps with a hope to be testing by the start of February 2022 and a roll-out shortly after. This work has been supported by Health Education England.

Currently, organisational authentication is handled principally by IP. This works remarkably well in most situations but it’s not perfect. By introducing OpenAthens we’ll give organisations a further way of securing access to Trip Pro.