Trip Database Blog

It’s just over 6 weeks old and TRIP Answers seems to have taken off.

Since January 1st we’re seen the following:

• Had over 26,000 visits
• Added over 350 new Q&As, all quality marked
• Main users from UK, USA, Canada, Australia and Spain
• We’ve been approached by 3 large organisations looking to add our content to their sites

The top 3 Q&As viewed are:

• A 38-year-old lady who is a smoker is having amenorrhoea on the progesterone only pill. She has a strong family history of osteoporosis. What are the current guidelines/evidence on investigations for this lady; i.e. when should she have a bone scan or plasma oestordiols?
• What are the expected disease prevalences in wales for the purpose of the New Contract registers (i.e. CHD/LVD, CVA/TIA, diabetes, asthma, COPD, epilepsy cancer, mental health, hypothyroidism.)
• I have a 17-year-old female patient, normotensive, non-smoker, not overweight, with 21day heavy cycle; I’d like to start her on oral contraceptive pills. Her mother had proven DVT aged 45 on HRT when no other risk factors present. Should I do thrombophilia screen before prescribing oral contraception?

We’ve got a slight issue with the Tag Cloud of Clinical Uncertainty so we’re not pushing that part of the site yet. Aside from that, the site is going pretty well and seems stable. We’re planning a slight redesign to help usability, but again nothing too major.

So far, I’d give the site 9/10!

A great news story on the BBC news website, it starts:

“Before take-off, every pilot needs to brief their crew about what to expect.

At the end of each flight, they talk briefly about what went right, what went wrong and what could be done better.

Pilots say this brief and debrief system has reduced errors and made flying safer, and a growing number of NHS medics think this system should be adapted – to make surgery safer.”

Click here to read the full story.

A great new resource from Scotland has been brought to my attention – Hands on Scotland – and we’ve added to TRIP patient information. The site reports:

“The HandsOnScotland Toolkit is an online resource for anybody working with children and young people.

This website is designed to help you make a difference to children and young people’s lives, by
giving you tools to respond helpfully when they are troubled.

It is a one-stop shop for practical information and techniques on how to respond helpfully to children and young people’s troubling behaviour, build up their self-esteem and promote their positive mental wellbeing.”

Also, last week I posted that I’d updated the British Association of Dermatologists guidelines. Unfortunately, I forgot about their patient information leaflets, which I’ve now updated. These should be fully searchable on Monday morning.

Not related to TRIP, but two blog posts relating to yesterday’s inauguration:

• President’s speech meets Wordle.
• A bird’s eye view.

Blog’s can give perspective that mainstream media often avoids or is too slow to get to! This follows on quickly from twitter being quicker to report on the recent plane crash in the Hudson.

Whether speed is always crucial or even welcome is another issue. I don’t remember, as a child/teenager, being too bothered by there being no internet, 3/4 TV channels (that’s ‘3 to 4’ not 0.75 ) and a hand-delivered newspaper!

TRIP has a long-standing interest in answering clinical questions.

We’re wondering if the large number of users of TRIP can be used to help us with clinical Q&As. We aim to test this over the coming weeks, starting with this difficult question:

• What creates the ‘popping’ when you ‘click’ your joints?

As you will see (the link is below) the existing answer highlights a high degree of uncertainty. What we want people to do is to read the Q&A and leave suggestions via this blog or via the comment form at the bottom of the answer.

To see the existing answer click here.

Around 5 years ago I had the pleasure in visiting the College of Medicine at King Saud University, Riyadh, Saudi Arabia. I visited to present and help run a EBM conference. Since that time I have kept a keen interest in their work (and I’m an ‘international advisor’ to the group). They have recently released a new website (click here) which you may enjoy.

As part of our monthly update of TRIP we have just added 587 new articles.

In addition we have ‘refreshed’ the content of the following providers due to URL changes:

• British Association of Dermatologists.
• Crest (from Northern Ireland) has merged with another organisation – new URLs and new name GAIN.
• European Society of Cardiology.

I’ve been on twitter for a few months now, but only recently have I started to take it ‘seriously’. To be fair you shouldn’t take twitter too seriously. When you post a message (a maximum of 140 characters) it’s actually called a tweet. Below are a selection of the tweets I’ve appreciated and posted myself (I’m JRBtrip). As you’ll see there are tweets covering a wide variety of subject areas. For me twitter allows a great way of keeping up to date, sharing in other people’s experiences and finding random serious and not so serious links.

mdconsult FDA launches program to improve safety of drugs and active drug ingredients produced outside the US http://tinyurl.com/95225h

TechCrunch Yahoo Search Adds Deep Links To Wikipedia Via Search Monkey http://twurl.nl/fs2ux7

markhawker In fact, the whole OurNHS YouTube channel is pretty good http://tinyurl.com/7lcavn

AllergyNotes Women living in poor countries are 300 times more likely to die during pregnancy or childbirth http://tinyurl.com/7mcqbq

AllergyNotes Food allergy as “Yuppie anxiety”? — Food allergies are nothing to laugh about http://tinyurl.com/7z8vtb

amcunningham http://tinyurl.com/7j4daj understanding students (non)use of IT

JRBtrip Twitter set for its mainstream telly moment on Jonathan Ross’s comeback show http://tinyurl.com/8uodkh

JRBtrip Twitter set for its mainstream telly moment on Jonathan Ross’s comeback show http://tinyurl.com/8uodkh

JRBtrip SIGN’s new stroke guideline & they do a gr8 job of haemorrhagic stroke – most tend 2 focus on ischaemic http://tinyurl.com/9yg8eo (4Mb!!)

stephenfry Funny how loyal to your cities you Aussies are. And not content with loving Melbourne, Brisbane etc, you have to diss Sydney. Love them all!

JRBtrip Can you improve on this Q&A on the etiology of the popping when you click your joints http://tinyurl.com/9nnk8l

brownleader @JRBtrip discussed this with 3 GP’s who I work with and none of us could shed any light on the aetiology of popping/clicking joints

As you’ll see from the last two tweets that I asked a question (which can be viewed by all the people who ‘follow’ me) and brownleader responded. So twitter can be social as well.

If you’re tempted to get involved drop me a line and I’ll happily be your guide.

The BBC report:

“Using a simple surgical checklist during major operations can cut deaths by more than 40% and complications by more than a third, research has shown.”

While the full article “A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population” has been published on the NEJM site.

A few quick observations:

• It’s not a randomised trial, which could have been very easy to arrange.
• Not all outcomes in every site are favorable.
• Significant positive results for ‘any complication’ were seen in only half of the organisations.
• Pharma sponsored trials are often criticised for not using absolute risk reduction, I note that this trial also avoids that statistic.

Irrespective of the above, brief criticisms, any article that helps highlight simply ways to improve quality of care has to be applauded.