Trip Database Blog

Answering clinical questions is at the heart of the TRIP Database.  We’ve been answering clinical questions for over 10 years and answered well over 10,000.  Most of these questions have been answered using a standard methodology:

• Receive and clarify the question
• Conduct a search
• Read and appraise the articles
• Write and answer
• Post answer on the website

This can frequently be time-consuming and therefore relatively expensive.  Search systems, even the TRIP Database, doesn’t answer questions – it returns articles that may help the clinician answer their question.

There are alternate models of answering questions and from the research evidence the most consistent source of answers for clinicians is their own colleagues.  But, there are half-way houses and my current favourite is facilitated by a service called StackOverflow which is a Q&A service for those involved in IT.  The company behind StackOverflow have recently been increasing the availability of the underlying software to power other Q&A systems and this was featured, today, on the ReadWriteWeb blog. 

One of the first non-IT uses for StackOverflow that I was aware of was GasExchange, a Q&A service for anaesthesia (check it out, it’s great).  It’s been running for many months and has an active community.  I’d love to see this sort of thing happen for other specialities – including primary care. 

I spend a lot of time pondering how best to serve up the results on TRIP.  Currently all results are merged with the ability to filter the results by category (systematic reviews, guidelines etc).

But, there are clearly different types of content:

• Research evidence – systematic reviews, synopses, guidelines, primary research etc.
• Background knowledge – eTextbooks.
• News
• Patient information

The mock-up below (click to enlarge) shows a way of making this distinction clearer.  Let me know what you think!

TRIP has become increasingly interested in improving access to the best available evidence for the developing world (see our crowdsourcing initiative).  In launching the initiative I’ve managed to meet a number of interesting people. 

Yesterday I had the pleasure of meeting the editor of the Africa-Health journal who’s knowledge and experience of the issues facing health professionals in the developing world was impressive.  We talked about a number of potential new projects but as ever funding is an issue.

I recommend readers of this blog, especially those in the so-called ‘developed world’ to spend some time reading the journal – it highlights the issues facing health professionals in these areas and gives a sobering perspective.

Excelencia clinica (ec.net) was launched in December 2008 as a collaboration between TRIP, the Spanish Ministry of Health and the Iberoamerican Cochrane Center.  ec.net was a bilingual (Spanish:English) clinical search engine modelled on the TRIP Database.

Our contract to work on ec.net finished yesterday and the work is now being carried out in-house.  It has been a great experience working with the Iberoamerican Cochrane Center (our main point of contact) and it has been a pleasure seeing the site grow and to develop. 

We wish them well for the future and hope the growth of ec.net continues.

Our latest medical image update has occured and we’ve now got 113,876 images in our index.

Wow, I’m impressed!

Last week I posted that we’re moving servers and TRIP is now on there. For a few days it’ll redirect to www.tripdatabase.co.uk but that’s only while we muck around with some DNS issues.

Why am I impressed?

It is super, super quick – amazingly so.

I’m very, very happy.

Just a quick note that we’re in the process of moving servers. We’ve been using the same servers for a number of years and one in particular is getting ancient and needs replacing. So, instead of buying new servers we’ve decided to move to the industry leader – Rackspace.

Our sites will be sitting on a brand new, high specification server. We’ll also get better backup and support and most importantly we won’t get charged extra if we’re well used (we currently get penalised if we exceed a particular bandwidth figure).

The transfer is currently happening with TRIP Answers sitting on the new server and the main TRIP Database should follow as soon as the whole database (90 Gb) has transferred over. Once on the new servers we’ll need to alter something called the DNS (the internet’s address book) and then everything will be fine and much faster. In the interim you’ll note that certain addresses re-direct to temporary addresses on the new server (for instance www.tripanswers.org points to http://tripanswers.tripdatabase.co.uk/). This should be no reason for concern.

It’s been a while since I last posted, it’s been a busy reflective time at TRIP. We’ve been preoccupied with our new project called TILT as well as looking at our business model. At the same time we’re questioning the ‘worth’ of search (which overlaps with our TILT work).

Looking at the business model is difficult at the best of times and this is especially difficult when the people at TRIP are not natural business people. We’re good at innovating and developing products, but turning these into commercial products has always proved difficult. At the heart of this is how to make ‘search’ profitable. In the mainstream world of Google there is the advertising model which works wonderfully for them. However, our efforts at TRIP to use such a model have never really delivered, even with our hundreds of thousands of searches per month.

We’ve been in a few discussions with bigger companies recently (and these are ongoing) looking at working more closely with them to benefit from the better business brains. It’s very early stages but we’re hoping that more formal arrangements will be forthcoming, giving TRIP a firm foundation to carry on and develop. One of these developments is to move on from the current state of search.

I’ve posted a few times on the limitations of search but will briefly recap here. Imagine if search engines had not been developed and you got 10,000 clinicians in a room and asked them what product would they like to see if they had a clinical question. I would be surprised if a single one would say they wanted to see a screen of 10-20 results which may contain the answer to their question – based on searching with 1-3 search terms related to their clinical question. Yet, this is the current situation. While TRIP is a great search engine, search is limited.

The next stage of TRIP is to try and move on from the above paradigm and TILT is our approach. Without giving too much away, TILT seeks to extract clinically useful content from a wide range of sources. So, you may have a research article which contains multiple nuggets of evidence/knowledge. Why leave them hidden in the document? So, much of TILT is about deconstructing evidence into constituent parts. However, there is another very important layer above that. The layer is how to decide what nuggets are clinicially useful/relevant.

We’re mid-way through piloting our approach and we’re very close to being able to deliver on the above. How our approach is initially received and adopted will decide it’s success and having decent partners to help market and approach TILT will be invaluable. We’re also looking to content providers to work with us and we’re currently in discussions with a few groups we’d like to have on-board at launch.

After over ten years working in search and information support for clinicians I’m getting really excited as TILT has the potential to move significantly closer to where we need to be in helping clinicians practice better healthcare.

I’ve just seen this rather nice paper about TRIP. The article is from an Italian publication, so all I can go on is the abstract. As such I’m not sure how they searched TRIP and what other databases were involved. Irrespective of that it’s quite pleasing!

Bibliographic research of efficiency tests: analysis of the validity of the meta-database
Galbiati G, Casati M.
Prof Inferm. 2010 Jan-Mar;63(1):3-8.

Aims: The use of a meta-database as a first approach to bibliographic research can be just as efficient asinterrogating single data-bases of the litature. The advantages and drawbacks of the two strategies are compared .
Method: A comparison of the results obtained using an identical interrogation made using the TRIP meta-database and different single databases (15 of guide-lines, 4 of systematic reviews, 3 prevalently consisting of primary studies) made it possible to analyse these methods as well as to study 4 meta-databases and identify the most efficient one.
Results: Using the same MeSH terms in both strategies, the following results were obtained: 204 publicationsusing TRIP and 475 using different databases. Evaluation demonstrated the pertinence of 142 (69,6%) of the 204 found using TRIP compared to 185 (38,9%) of those elicited by single data-bases.
Conclusions: The TRIP meta-database yields a lower number of documents but with a higher degree of pertinency, meaning that the researcher employs less time finding pertinent documents. With respect to the traditional approach, beginning research by testing the efficiency of the TRIP meta-database proved advantageous.