Trip Database Blog

I have a real passion for getting answers to people.

I have a passion for search, but search is of limited value in answering questions. The typical search engine returns 10-20 results which the algorithm believes will answer your question(s). Imagine if search engines didn’t exist and you got 100 doctors in a room and asked them what features would they like to see in a system to answer their questions. Do you think any would say ‘give me 10-20 results to articles which may answer my question’ – but here we are.

Anyway, all that preamble is due to news that Facebook is working on Facebook Questions, see this TechCrunch article for more info – this’ll be interesting.

I’ve just finished the monthly update to TRIP with 668 new articles added manually and 2,500+ automatically.

When reviewing the manual uploads I often come across themes and this month the stand out, for me, was wound care. We’ve answered lots of questions on wounds over the years and the lack of evidence if obvious. So, three new reviews are very welcome:

1) Water for wound cleansing (Cochrane)

Conclusion: There is no evidence that using tap water to cleanse acute wounds in adults increases infection and some evidence that it reduces it. However there is not strong evidence that cleansing wounds per se increases healing or reduces infection. In the absence of potable tap water, boiled and cooled water as well as distilled water can be used as wound cleansing agents.

2) Wound cleansing for pressure ulcers (Cochrane)

Conclusion: We identified three small studies addressing cleansing of pressure ulcers. One noted a statistically significant improvement in pressure ulcer healing for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) when compared with isotonic saline solution. Overall, there is no good trial evidence to support use of any particular wound cleansing solution or technique for pressure ulcers.

3) Silver-Releasing Dressings in Treating Chronic Wounds (Swedish Technology Council)

Main conclusion: The scientific evidence is insufficient to determine whether silver dressings differ from dressings without silver in terms of effects on the percentage of healed wounds, wound size, pain, quality of life, percentage of infections, and use of antibiotics in treating chronic wounds. The reason is that too few studies of sufficient quality are available. The studies reviewed have not identified serious side effects or complications related to silver dressings, but they were not designed to study this specifically.

A further update on TILT – it’s generating some very interesting outputs. For those of you unsure of what the TILT project is – it’s an area allowing clinicians to record and share learning. Some examples of the learning we’ve received so far:

• Ropinirole for Parkinson’s disease can cause ankle swelling as a side effect
• For every 1% increase in omega-3 intake, HDL levels rose by 2.5 mg/dL
• DISH is Diffuse Idiopathic Skeletal Hyperostosis and is failry common in men and represents calcification of ligaments tendons etc principally around the Thoracic spine. It has a classical ‘dripping wax’ appearence on plain radiography. There may be an increased risk of diabetes and poss heart disease in patients who have DISH
• Medial arch pain localised to bone rather than soft tissue may indicate an accessory navicular bone! usually unmasked after a twisting injury
• Both antiseptic cream and silver nitrate cautery are likely to be effective in preventing recurrent idiopathic epistaxis in children Cautery is indicated when there are obvious telangiectatic blood vessels

Lots of feedback from users, many reporting very positive examples of learning from others and others impatient to see it being taken out of ‘proof of concept’ and some serious development undertaken.

So far very, very interesting

TILT (see previous blog) has been running for a little over a week and so far so good.

We have had around 50 recorded instances of learning and crucially people have learnt from others. In other words they have seen someone elses recorded learning and reported they have learnt from that. Therefore, it appears that:

• People will record their own learning.
• People will allow the sharing of this learning.
• Other people can learn from other people’s learning.

The pilot still has another 4(ish) weeks to run so we’ll see how things develop. After that a decision will need to be made about if we adopt TILT or not. If we do we’ll need to learn from those involved in the pilot. However, the biggest challenge will be scalability – if we have 10,000 doctors recording one item of learning per week that’s 500,000+ items per year. So, the issue of findability is vital. Thankfully, we have a number of ideas to help deal with this – if we proceed.

It’s not too late to volunteer to take part, let me know via jon.brassey@tripdatabase.com

TRIP’s recent work around supporting access to the evidence for low-resource settings (click here) has exposed TRIP to all sorts of new contacts and some amazing people/resources that are already involved in this field. The Open Access Education Initiative (Peoples-uni) is a great example and was designed to help build Public Health capacity in developing countries.

It uses open-source materials and a dispersed group of volunteer course developers, tutors and infrastructure support, to provide low-cost education for capacity building in Public Health. Over the past two years, it has been able to deliver an educational programme to those who cannot afford overseas student fees charged by most universities. The Peoples-uni has developed a set of course modules, which can be taken individually and used to gain a Certificate, Diploma (and soon a Masters) in Public Health.

Visit the site today (Peoples-uni) and learn much more.

stands for Today I Learnt That and is based on observations on how people have used the reflective elements of TRIP CPD. When you look at an article via the CPD/CME link (under each article) it opens the article with a reflective toolbar at the top of the page. This prompts the user to answer three questions:

1. Why are you looking at this article?
2. What did you learn from this article?
3. How will you apply this in practice?

What we observed was how powerful and useful the middle answer tended to be. This was typically a clinician giving their account of the learning they had undertaken from reading the article. It struck us how powerful this information would be if shared.

TILT allows a user to record any learning they have undertaken (not restricted to TRIP articles). It might be any article they’ve read, a conversation with a colleague – any clinical learning. This is then recorded as a learning log. But the real beauty is that this learning can be shared with other users. In other words, they can learn from your learning and vice versa. Already, after just 3 days and around 10 recorded ‘learnings’ two clinicians have already learnt from others contributions.

Currently, this is a proof of concept model and at the end of the testing period (4-6 weeks) we’ll try and get a feel for the ‘worth’ of the model and make a decision on whether to take it forward or not.

If you’d like to get involved let us know via jon.brassey@tripdatabase.com

While I’m not a librarian I’m clearly heavily involved in information. I’m also aware that a number of librarians read this blog, therefore I feel I should highlight the above article, written by Dean Giustini (click here to read the article).

Essential reading.

18 days after hitting 7,000 users we make it 8,000, at this rate we should hit 10,000 sometime in June.

I mentioned Aardvark in a previous post. Basically, it allows you to send questions to people who might know the answer. They seek to send questions to a users ‘extended social network’. I’m not sure how this is defined, but it’s probably based on the ‘friend of a friend’ principle. Google bought Aarvark a while ago (surely a vote of confidence) and have just started to roll it out on YouTube (click here for post).

I’d love this sort of service on TRIP and we could launch something similar. However, for this to work well we need to have a good idea where people’s expertise lies. Currently, the only details we consistently have on users is what their broad area of interest are (e.g. cardiology, oncology). If there are 100 questions covering cardiology topics – what’s the best way of getting them sent to people who may know the answer? If I had some expertise in, say, stable angina I would find it very off-putting to be asked to help answer questions on cholesterol, stroke, hypertension etc. What would be much better would be to send the user only questions relating to stable angina.

So, to do this requires some sort of profiling. In other words recording and trying to understand a user’s habits on TRIP and making assumptions based on their search terms, click-throughs etc. And, if we had a decent profile, as well as forwarding appropriate questions to them (assuming they’d be predisposed to answering them) we could arguably push new research, conferences, even jobs of interest.

It’s a big task to undertake and requires users to consistently login (to help assign behaviours to an individuals profile). However, I think it’s well worth the effort.