Trip Database Blog

ATTRACT is a Q&A service for Primary Care in Wales. It started in 1997/8 and is responsible for my interest in information support for clinicians. When I came to post as ‘Clinical Effectiveness Co-ordinator’ at Gwent Health Authority I was given the task of supporting clinical effectiveness in the county. At the time most similar organisations sent GPs on searching skills training and critical appraisal. After visiting around 75% of practices in Gwent it dawned on me this approach had significant problems. The overwhelming message was – answer our questions for us! ATTRACT was born. For historical interest ATTRACT was an acronym for Ask Trip To Rapidly Alleviate Confused Thoughts! Again, another piece of history – TRIP was a last minute idea for a name – it was going to be GEM (Gwent Effectiveness Matters).

I’m mentioning ATTRACT as it will shortly be gaining a new website in a week or so and as such I thought I’d look at the top ten most frequently viewed papers from the current website – one that was introduced around 2001/2. Here it is:

1. What are the risks of flying while pregnant?
2. Should you treat a low Ferritin (
3. What is the evidence for the recent press about statins and grapefruit juice being harmful?
4. Is there any difference between processed juice and fresh juice?
5. What is Epley’s manoeuvre for the treatment of benign vertigo?
6. What is the best treatment for pompholyx (dyshidrotic eczema, vesicular palmoplantar eczema) of the feet?
7. What is the cause of a black tongue? No hairs present. The tongue is not painful. Swabs are negative.
8. What is the best treatment for benign positional vertigo (BPV?What treatments are available for sebaceous hyperplasia?
9. Is it safe too fly during the first trimester of pregnancy? What are the risks, if any, associated with it?
10. Many of our patients have isolated raised gamma glutamyl transferase. Often these patients are on statins. How should such patients be evaluated?

The numbers are pretty staggering, the most popular question has been viewed 38,853 times and the 10th most popular was viewed 14,890 times.

The current website has seen massive traffic over the years, it deserves a peaceful retirement!

Just a quick update as things have been quiet on the blog. Basically, I’ve been in hospital and recovering from a partial menisectomy.

I injured myself a year ago running and initially I was diagnosed with a medial ligament strain. As a result of this mis-diagnosis (please, no-one mention evidence!) it was 6 months of physical therapy with no tangible results. So, I went to see a consultant orthopaedic surgeon who ruled out – clinically – medial ligament damage and suspected bursitis. However, he suggested I have an MRI scan. When he told me the bursitis was secondary to a meniscal tear I was shocked and hence a rubbish patient. I asked no questions about prognosis, nature of the operation etc.

Anyway, I had the operation earlier this week (partial menisectomy plus a steroid injection for the bursitis) and am recovering well. I’m hoping to run again in 4-6 weeks – hurrah.

If anyone is interested in seeing a bad picture of my knee taken this morning then click here.

Not particularly scientific but here is my attempt at comparing results from Google and Bing (using this rather useful side-by-side tool http://www.blackdog.ie/google-bing/search.php).

I’m based in the UK and the results went to the .com site (as opposed to .co.uk so it’s not clear what impact this might have. I’ve selected five searches which seem fairly reasonable terms.
I’ve also included the URLs so you can better see where the results are from.

Search term: prostate cancer screening

Google top 5

• Cancer – Prostate – Prostate Cancer Screening: A Decision Guide (www.cdc.gov/cancer/Prostate/publications/decisionguide)
• Prostate Cancer Screening – National Cancer Institute (www.cancer.gov/cancertopics/pdq/screening/prostate/patient)
• Prostate Cancer: Screening and Testing – National Cancer Institute (www.cancer.gov/cancertopics/screening/prostate)
• Prostate Cancer Risk Management (www.cancerscreening.nhs.uk/prostate/index.html)
• Prostate cancer screening: Should you get a PSA test? – MayoClinic.com (www.mayoclinic.com/health/prostate-cancer/HQ01273)

Bing top 5

• Prostate Cancer Screening – National Cancer Institute (www.cancer.gov/cancertopics/pdq/screening/prostate/patient)
• Cancer – Prostate – Prostate Cancer Screening: A Decision Guide (www.cdc.gov/cancer/Prostate/publications/decisionguide)
• Prostate cancer – Wikipedia, the free encyclopedia (en.wikipedia.org/wiki/Prostate_cancer)
• Problems with screening aren’t prostate cancer-specific (prostatecancerinfolink.net/2009/05/12/problems-with-screening-arent-prostate-cancer-specific)Prostate Cancer: Screening and Testing – National Cancer Institute (www.cancer.gov/cancertopics/screening/prostate)

Verdict – A marginal win for Google, Bing returned results that were slightly less focussed (e.g. the general Wikipedia article on prostate cancer or slightly less reputable.

Search term: MMR autism

Google top 5

• Does the MMR Vaccine Cause Autism? – DukeHealth.org (http://www.dukehealth.org/HealthLibrary/AdviceFromDoctors/YourChildsHealth/mmr_vaccine_and_autism)
• Autism and the MMR Vaccine (http://www.nichd.nih.gov/publications/pubs/autism/mmr/)
• NIP: Vacsafe/Concerns/Autism/FAQs-Autism and MMR (http://www.cdc.gov/nip/vacsafe/concerns/autism/autism-mmr.htm)
• BBC NEWS Health ‘No link’ between MMR and autism (http://news.bbc.co.uk/2/hi/health/4311613.stm)
• NHS Blog Doctor: Barack Obama : MMR & autism, the wibble and the woo (http://nhsblogdoc.blogspot.com/2009/01/barack-obama-mmr-autism-wibble-and-woo.html)

Bing top 5

• NIP: Vacsafe/Concerns/Autism/FAQs-Autism and MMR (http://www.cdc.gov/nip/vacsafe/concerns/autism/autism-mmr.htm)
• Autism and the MMR Vaccine (http://www.nichd.nih.gov/publications/pubs/autism/mmr/)
• Link Between Autism And the Measles Mumps Rubella Vaccine (http://en.wikipedia.org/wiki/MMR_vaccine_controversy)
• Does the MMR Vaccine Cause Autism? – DukeHealth.org (http://www.dukehealth.org/HealthLibrary/AdviceFromDoctors/YourChildsHealth/mmr_vaccine_and_autism)
• the Mmr Vaccination Causing Autism (http://en.wikipedia.org/wiki/MMR_vaccine)

Verdict – A clear win for Bing. A controversial topic and it returned the most robust sources.

Search term: type 2 diabetes metformin

Google top 5

• Metformin: Oral Medication for Type 2 Diabetes – Metformin and …(http://diabetes.about.com/od/equipmentandbreakthroughs/a/metformin.htm)
• Oral Medications For Managing Type 2 Diabetes – Type 2 Diabetes …(http://diabetes.about.com/od/equipmentandbreakthroughs/p/oralmeds.htm)
• Diabetes – Treatments for Type 2 (http://www.patient.co.uk/showdoc/27000260/)
• Type 2 diabetes treatment (http://medweb.bham.ac.uk/easdec/prevention/HBA1c%20&%20type%202%20diabetes.htm)
• Fighting Type 2 Diabetes With Metformin (http://www.disabled-world.com/artman/publish/metformin.shtml)

Bing top 5

• Metformin: Oral Medication for Type 2 Diabetes – Metformin and …(http://diabetes.about.com/od/equipmentandbreakthroughs/a/metformin.htm)
• Merck Serono Launches Glucophage(R) Powder (innovative Powder … (http://www.medicalnewstoday.com/articles/149042.php)
• Clinical Alert: Diet and Exercise Dramatically Delay Type 2 Diabetes … (http://www.nlm.nih.gov/databases/alerts/diabetes01.html)
• Health Links Content: Lactic acidosis: Lactic acidosis associated with … (http://healthlinks.mediwire.com/main/Content.aspx?ArticleID=197139)
• NEJM — Reduction in the Incidence of Type 2 Diabetes with Lifestyle … (http://content.nejm.org/cgi/content/short/346/6/393)

Verdict – Clear win for Google. I felt the results were more focussed using Google.

Search term: side effects statins

Google top 5

• Statins – drug class, medical uses, medication side effects, and …(http://www.medicinenet.com/statins/article.htm)
• Statins: Side effects of anti-cholesterol drugs questioned Mail …(http://www.dailymail.co.uk/health/article-392689/Statins-Side-effects-anti-cholesterol-drugs-questioned.html)
• Statins: the truth Mail Online (http://www.dailymail.co.uk/health/article-432395/Statins-truth.html)
• Dangers of Statin Drugs: What You Haven’t Been Told About Popular …(http://www.westonaprice.org/moderndiseases/statin.html)
• Statin side effects: Weigh the benefits and risks – MayoClinic.com (http://www.mayoclinic.com/health/statin-side-effects/MY00205)

Bing top 5

• Statins – drug class, medical uses, medication side effects, and …(http://www.medicinenet.com/statins/article.htm)
• Statins Side Effects 2008 « teamrich.wordpress.com (http://teamrich.wordpress.com/2008/03/30/statins-side-effects-2008/)
• In the Real World, a Slew of Side Effects from Statins (http://www.businessweek.com/magazine/content/08_04/b4068057096279.htm)
• Statins’ Side Effects Under Fire – CBS News (http://www.cbsnews.com/stories/2004/10/11/eveningnews/main648685.shtml)
• Statins – Statin Drug Side Effects (http://www.spacedoc.net/statin_side_effects.html

Verdict – A draw, I wasn’t really impressed with either (half a point each)

Search term: acne

Google top 5

• Acne.org – Acne treatment and community (http://www.acne.org/)
• Acne vulgaris – Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Acne_vulgaris)
• Acne Jeans, Shoes & Ready To Wear – Acne Online Shop (http://shop.acnestudios.com/)
• Acne.com – Acne Treatment Information (http://www.acne.com/)
• Acne (http://www.aad.org/public/publications/pamphlets/common_acne.html)

Bing top 5

• Acne (Internal link to content provided by Mayo Clinic)
• Acne.org – Acne treatment and community (http://www.acne.org/)
• Acne.com – Acne Treatment Information (http://www.acne.com/)
• Acne vulgaris – Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Acne_vulgaris)
• Acne (Pimples) Causes, Treatment Information and Types on MedicineNet … (http://www.medicinenet.com/acne/article.htm)

Verdict – A win for Bing.

Overall verdict is – rather boringly – a draw with two ‘wins’ each and the rather disappointing draw. Given that Bing is so new (2 days old) I think it’s pretty remarkable!

NOTE: See techcrunch’s none health comparison: Search Smackdown: Bing Vs. Google

A thought provoking article on doctors use of wikipedia:

“No surprise, these days more and more doctors are searching online for medical information. What is surprising, however, is that in a recent study, nearly 50% of physicians indicated that they use Wikipedia—the open-access encyclopedia that allows anyone to edit articles—as their source for medical information.”

See full article: Beyond Wikipedia

For those long-term users of TRIP you’ll possibly notice that our advanced search is prone to breaking and I have no idea why this is. Only recently we spent an age fixing the previous break (see recent notification of fix). It has now broken again. This is tremendously frustrating for us and our users.

Given our current overhaul of the site we’re going to build the advanced search from scratch. This should mean that previous problems (possible caused by building new code on older unstable code) will be eliminated. Given the history I’m not saying it’ll never break again, but by going back to nothing and starting again we’re giving ourselves the best chance.

Timetable: We envisage the new code being released at the same time as the rest of the new site, so about 4-6 weeks.

Once again apologies for the poor service but bear with us the new site will be well worth the wait.

Our latest development is progressing well, our developers indicate that they are over 50% through the work which is great news. I’ve had an initial look at the early work and I’m genuinely thrilled by the output so far. Far too many highlights to mention, but as we get closer to launch and I get familiar with their workings I’ll review the major ones.

We should also be getting a feel for the new design of the site in the next week or so. With so many new features, especially on the results page, we’ll no doubt be having a major upheaval in the results department – what that looks like, I have no idea. We’re using the eponymous design company called Mark Boulton Design (Mark has recently published ‘A practical guide to designing for the web‘). So far it’s been a rewarding experience and it’s refreshing to use a dedicated design service.

Finally, one ‘stand out’ joy of the re-design has been the new relationships we’ve been building. We’ve reached out to a significant number of new content providers ranging from medical news to medical videos (all aimed at clinicians) and they have all responded favorably to contact. Talking with other clinical web enthusiasts from similar size companies (and some larger ones) has been a real bonus and we’ve learnt so much. The bottom line being that building relationships make us (at TRIP) stronger.

A new ‘search engine’ called Wolfram Alpha has launched. I’ve not had much time to play with it and when I have I’ve rarely got the results I want. It may be early days, but being confusing is not a positive attribute.

Fortunately, others have been more patient and Medgadget have just published Wolfram Alpha and Its Medical Powers. It’s certainly worth a read!

Clinical Correlations is the NYU internal medicine blog. It’s a great blog, so much so it won the 2008 Best Clinical Sciences Weblog award.

We love it at TRIP, and therefore decided to make it the first blog to be searchable via TRIP. With the development of web publishing it’d be a mistake to overlook blogs as a source of good clinical information/evidence. We have little doubt that it’ll be a great resource and that TRIP users will benefit from its inclusion.

Let us know what you think!