Trip Database Blog

TRIP is interested in ensuring clinicians have easy access to the best available evidence. That’s why we’re thrilled to see TRIP available to the users of OSCAR Canada. As the wikipedia article states:

We’re very pleased to announce the launch of the above initiative, generously supported by the BUPA Giving scheme.

We’ve blogged about the above initiative for a while (click here or here). The basic problem being that users in resource poor settings (for example, a rural district hospital in Africa or South Asia) frequently do not have access to the latest health care technologies e.g. the latest diagnostic bit of kit or expensive new medicine. However, much of the evidence is directed at the newer, more expensive, interventions. So, users from these settings have to overcome the additional problem that much of the evidence is not relevant.

As of today under each link on the results page will have a link ‘Developing World?’ If a registered user of TRIP believes the article is appropriate (see definition below) for such setting we encourage them to click on the link. If two separate people click on the link the article is then deemed suitable; these articles will form a sub-set of data in TRIP. Users of TRIP will then be able to search TRIP and then (via a tick box at the bottom of the ‘Filter your search’ box) be able to select only those articles in the subset.

We encourage TRIP users to get involved by either tagging articles or to help spread the word of this project!

A few additional pieces of information:

The term ‘Developing World’ is problematic and controversial. We have used it as it is a widely recognised term which we hope will aid adoption, the reality is that the alternative ‘Low resource?’ carries less meaning. However, we welcome input on the term used (send comments to jon.brassey@tripdatabase.com).

The working definition of an article suitable for this initiative is ‘any clinical evidence that can be implemented in primary care and small-district-hospital settings with basic drugs and equipment.’ As the subset of the database is developed, we expect users to discuss and refine the definition and criteria for inclusion. This highlights the fluid nature of this whole project.

Phew, all the definitions, caveats out of the way.

The bottom line is that we want to make access to the evidence easier for those from poorer setting – please help!

24 days after we reached 5,000 registered users we hit 6,000

It’s only been a few months of us offering a robust MyTRIP and I’m really enjoying it. As part of the testing process I list a number of areas I’m interested in and every month I get an e-mail telling me what’s new in that particular area. For instance, in the area of Cardiology there were 789 new records click here to view them. This shows any new records that are linked to cardiology topics.

As well as broad areas you can look for individual terms. One particular one of interest is vitamin d, which has 33 new records and clopidogrel with 14 new records.

This really is a great way to keep up to date with an area(s) of interest!

To use MyTRIP, register or sign-in via this link.

I had a great meeting yesterday with the medical director of a London Primary Care Trust. We mainly discussed clinical Q&A and part of that was the educational potential of frequently asked questions (FAQs).

We have answered over 10,000 clinical questions of which 6,200+ are available via TRIP Answers. One thing we have noticed is that it is relatively rare to see the same question twice. So, when you do get the same question twice, it’s significant. Our view is that having a question asked frequently indicates that there is probably a widespread knowledge gap in GP-land.

So, why not try and meet the need? The obvious problem is finance, as we want to do it well and therefore it needs funding. But that’s a small detail!!!

What would it look like? Take an example FAQ – Are statins useful in the elderly? I would see the webpage having a number of areas:

• Background to the question
• Clinical bottom line
• Extended material based on the actual answer to the question
• References
• Related content
• Testing component

The last component needs some thought, do you use an MCQ? I’m sure there’s something more sophisticated – but not sure if that’s needed.

So, what have we got? 52 packs (one per week), focussed learning, testing component, certificate to show ‘attainment’.

Now, how to get funding?

I’ve just been reading the above article on the Robert Scoble blog.

In the article he talks about the molecular age of information – he contends we’re currently in the atomic age. He talks about YouTube videos standing alone, each tweet on twitter stands alone. These are all atoms. A user can link these together (to form a molecule) but it takes significant effort and skill.

The molecular age will allow the easy combination of separate elements.

But for me the analogy holds for clinical information. Each article in NEJM or the BMJ is an atom, these can be combined in a systematic review but that takes enormous effort. Similarly, when a clinical question arises the clinician (or information scientist) needs to identify the atoms and bind them together to from the molecule that is an answer. For clinicians, with their clinical background, the merging can be straightforward but the identification of the atoms is problematic. For an information scientist, the opposite is true.

Are there ways we could ease the merging of these atoms to form the molecule (answer)?

I quite like the idea, and have done for years, in cutting up the atoms (documents) into smaller parts (sub-atomic particles). For instance, an atom/article might be 2,000 words long, yet the information the clinician wants might only be 100 words. Is there a way of splitting atoms – creating reactive sub-atomic particles – waiting to easily re-form to create molecules?

As I write this I’m not sure if using the analogy is helpful or instructive. I like it and therefore will reflect and see if it can be utilised further.

Might this all lead to the creation of molecular information scientists?

Sometime last night TRIP received its 5,000 registered user – which is a wonderful milestone. This is how long it has taken each 1,000:

• First 1,000 – 15 days
• Second 1,000 – 24 days
• Third 1,000 – 31 days
• Fourth 1,000 – 37 days
• Fifth 1,000 – 24 days

A quick analysis of the users show the top 15 countries that registered users come from:

1. UK
2. USA
3. Spain
4. Canada
5. Italy
6. Australia
7. Ireland
8. Mexico
9. India
10. Peru
11. Saudi Arabia
12. Netherlands
13. Argentina
14. Columbia
15. Iran

And the professional breakdown:

• Doctor/Physician (1448)
• Nurse (693)
• Student (607)
• Other (335)
• Information specialist (298)
• Pharmacist (245)
• Academic researcher (199)
• Dentist (56)
• Patient/carer (21)

For those eagle-eyed readers the professionals figures add up to less than 5,000. That’s because, for the first few months the completion of the professional group was optional – so in our records we have >1,000 with no assigned profession!

There are many advantages to signing up to My-TRIP and these revolve around keeping up to date with the latest evidence, recording your use of TRIP for CPD/CME and proof of learning and access to the TRIP/doc2doc forum. Also, searching TRIP while registered means we pay a proportion of advertising income to Medecins Sans Frontieres/Doctors without Borders and HIFA2015. For a full list of the advantages of signing up see our list of key features.

So, if you’re not registered, do it now – it’s a powerful tool and it’s free!

Search engines can be strange things. They are principally there to help users, with a gap in their knowledge, gain the information they need. This information may be a phone number, address, opening times, drug interactions.

Needless to say my interest is in clinical uncertainty.

Imagine if search engines were never invented and someone sat down to design a tool that would answer clinical questions. Would anyone really suggest that someone types in a few related terms, hits ‘search’ and then gets presented with 10-20 results that may have the information they’re interested in? It’s laughable really. This is further complicated by the fact that most of the clinical questions we’ve been involved in have needed more than one reference to answer. In our analysis of 350+ dermatology questions the average number of references used was 2.2.

So, the information is in disparate locations and hidden in a mass of other paragraphs (typically the information required is a paragraph or two located somewhere in a document with perhaps 100 paragraphs).

To my mind the ideal solution would be a user, typing in their full question (e.g. what are the causes of raised vitamin b12? as opposed to raised b12) and then they receive a brief response straightaway.

As far as I can tell this is a long way off (although I have seen some half-decent attempts recently). The Q&A services that we run (e.g. TRIP Answers) is another approach but it’s relatively labour intensive. I quite like the approach that Aardvark is using which uses humans to answer the questions. As this wikipedia article states:

“Aardvark is a social search service that connects users live with friends or friends-of-friends who are able to answer their questions. Users submit questions via email or instant messenger and Aardvark identifies and facilitates a live chat or email conversation with one or more topic experts in the asker’s extended social network. Users can also review question and answer history and other settings on the Aardvark website.”

My business partner at TRIP (Chris) a GP says he already knows many of the answers to the questions we receive. He’s always said that if he knows the answer he could return the response in 5 minutes (as opposed to the 60-120 minutes for a relatively easy Q&A for an information specialist).

Perhaps the Aardvark approach is the future – couple people with uncertainty with people who likely know the answer. It requires goodwill, but there’s plenty of that about!

Every now and then, when visiting a familiar website you find a new link and it reveals a wealth of new information.

I’ve been regularly visiting the Canadian Towards Optimized Practice (TOP) website when I noticed the link to Clinical Q&A. This has two sections ‘Tools for Practice‘ and ‘Briefcases‘ which I thought would be a great addition to TRIP (we already link to their clinical guidelines). Shortly after an e-mail to the site I end up discussing all things evidence with the head of TOP – Mike Allan. The short-term outcome was an agreement for TRIP to point to the Tools for Practice and Briefcases. To that end I have just added the Tools for Practice to the site and these will be searchable by the start of next week (at the latest).