Trip Database

Transcript

Speaker A: Welcome to the Rounds to Residency podcast, brought to you by Med Ed University. Gain residency insights and tips to prepare for your externships, research and professional development in healthcare. We interview preceptors and physician educators who will prepare you for your rotations and improve your clinical experience. Now here’s your host, Chase DeMarco.

Speaker B: Research is an important part of medicine, of science, and even your residency cv. So it’s something that all of us need to consider and need to find tools to make it as easy as possible. And today I have on John Brassy who is going to discuss some of the topics of research, how to approach it, how to monitor what’s out there and know different stages of research, for example, and also discuss his program, trip database. John, welcome to the show.

Speaker C: Yeah, thanks for having me on. I’m looking forward to talking to you about this.

Speaker B: So John, what are some of the issues you find with conducting research? Obviously, if you created this trip database software, you notice a gap, an issue, a problem in conducting research, and you wanted to fill that gap. So what was it that really got you started on this pathway?

Speaker C: I started Trip database 25 years ago now, and it was working for the National Health Service in Wales, which is a country in the United Kingdom. And we were asking, we were sent questions by general practitioners, the equivalent of family physicians in the states, and they wanted to use the best available research evidence to help treat their patients. And so they were sending questions to me. I was trying to find the answers on the Internet, and pubmed back in the day was on six CD roms and he had these six CD ROM stackers and it was an absolute nightmare. But also at that time there was a real interest in higher quality evidence, systematic reviews, high quality clinical guidelines. I was hopping around the early Internet looking for these pieces of information that would help inform clinical practice and it was a nightmare. And so I just started collating all these resources into one spreadsheet. It was an excel spreadsheet to start off with. And then if we had a question on heart failure, I’d use the find function in excel to find any documents on heart failure. So we started off with about 1000 links and we just got noticed. There was a very cool semi underground magazine in the UK called Bandolier, which I think finished probably 15 years ago now. And they mentioned it and said, this is useful. So I found it very useful for my job in answering kind of questions. So getting the research has been done often in academia to the cold face of clinical practice, and someone else found it useful as well. And ego got involved as well. I was being noticed and it just grew from there. And I’ve shepherded it over the 25 years and I’ve had the pleasure of being involved with a lot of interesting people. And that’s got me into the research world as well, because one of the most important things with research is what research question is important? Because often we find, and I’ve been involved in projects looking at research procurements is that they’re often not patient focused. They might be the whim of the doctor, the doctor’s interest or the nurse’s interest. And so it’s interesting when you start collating the questions that you get from the coalface, you can start to see where the research gaps are. So we’ve done some work with something called the James Lind alliance and they do prioritization work. And so we helped get that off the ground because what we wanted were robust research questions and robust responses to those to help support clinical practice. That’s how it all started. It just evolved from there. That’s awesome.

Speaker B: I didn’t realize that pubmed came on a c six CD stack before. That’s pretty intense. That’s a long time ago.

Speaker C: And before that you had it in book form. You had, I think it was called Index Medicus. And I remember when I was at college we used to go and have a look at it. I did biology, I didn’t do medicine or anything. And the library. I’m sure some of your people who listen to you will say they’re not exact synonyms, they’re not overlaps, but they’re all closely linked. But yeah, definitely in my day, six CD roms and yeah, you had to load them up on your pc and search them.

Speaker B: Trip database has been updating over the past 25 years and now there are a lot of other resources. Technology has advanced a lot. What are some of the things that you’re still seeing that maybe researchers are struggling with or disseminating the information is still problematic. What are some of the issues that you’re still trying to fix?

Speaker C: I think there’s lots of them. One of the ones is we’ve had a vast increase in research published. You have a look at the. I’m interested. Randomized controlled trials and systematic reviews. We look at the graphs about the number published year on year. They’ve increased hugely over the last 25 years. And so there’s an issue of findability. How do you find it? But then the more important issue is I always remember once talking to a general practitioner, 20 od years ago. And he says he loves pubmed because he can find any answer he wants because of the vastness of it. There’s always going to be something there. So I think why trip is better in some ways is that we concentrate on the higher quality secondary evidence, the systematic views and clinical guidelines. Pubmed’s primary sort of source is the journal articles. And there can be some systematic views in that, there can be some guidelines in that, but they’re often hidden. They’re hidden within a vast amount of other stuff which might be of lower quality. And so you say with trip, our interest is quality, not quantity. And so at the core of trip and the core of our algorithm, the core of our display, is how can we ensure that the user can get the best available evidence? And I think that’s the problem for a lot of other, you mentioned up to date, that’s a great resource. I see it as like an evidence based e textbook, but again, it’s a different, like, that’s more like an evidence based Wikipedia. We’re more like an evidence based Google. I guess that might be being very unkind to them and very flattering and biased by me, but that’s how I see it in my head.

Speaker B: Okay, that makes sense. I was trying to make a good comparison for the audience. If they’re unfamiliar with these systems, and that sounds like a good one, a textbook versus a Google, we’re going to rate it for you and put the closest or best matched answers on top, because I would say from a student’s point of view, they’re thinking, okay, if I need to find a lot of information to write a case report or something, I’m going to go to Pubmed. Also, I want to publish in a journal that’s going to be indexed in Pubmed. So it’s a decent journal, it’s, well, at least an indexable journal and not a predatory journal. But it sounds like using something like trip database, using a tool that can better sort the information, at least when you’re conducting your literature review for your own research, that would be a more beneficial tool. It’ll give you a higher quality research to really base the starting of your own research on.

Speaker C: Absolutely. I’ve been doing some consultancy work with a large american publisher and they got a tool to help support this process in a way, I don’t see it as pesticide trip. So I was quite happy because again, it’s an intellectual challenge for me, but again, they were only concentrating on primary research. And I said if I was having to do a literature review based on just primary research for a residency or whatever. I’d be really, really annoyed if I find out that there was a guideline published by a large american organization or there was a systematic review published by AHRQ and I’d missed it because you hadn’t covered. Because he wasn’t covered in PubMed. I said, and I’d spent. If you’d spent 1020, 30 hours doing it, and essentially there was a much better, higher quality resource. It was recently published, I would be really frustrated. And so I said, you cannot. I said, I would feel really uncomfortable by that because you don’t want to waste people’s time. And that’s where trip comes in. Often we have multiple uses of trip. One of them, as you say, let’s have a quick look. What’s around there? Let’s have a look. Is there anything that can inform practice or inform the study? And so you can go in there, you can say, okay, brilliant. We found these really high quality sources going off on another tenure I was doing. I still answer some clinical questions nowadays, albeit not for general practitioners. And we found a systematic review from two years ago, three years ago. And so you think, well, okay, for speed, there’s no need to go to look up for analyzed controlled trials prior to that, on the assumption the systematic review found it. And similarly, if you found a guideline, we find in the UK a nice guideline and it’s up to date, you think, brilliant. You only really probably need to look for the research from the sort of perhaps year before. And so to me, you start with the high quality big stuff and then if you can’t find the answer there, because often the answer is not in the higher quality evidence, and we fully acknowledge that you then start going down to the murky world. But again, with trib, we don’t just have systematic views and the guidelines, the higher quality evidence, because we know they will only answer about 25% of the clinical questions. And so what we do, we don’t include all of PubMed. We could, but again, we look for the top 500, 600 journals. So about 10% of the top journals from PubMed are included in trip as well. Again, it’s just trying to make it a balance between usefulness signal to noise ratio. It’s a fine line. I’m not saying we get it right, but we do all right, got it.

Speaker B: If I remember correctly, if you do search within trip, it will give you sort of a grading on how strong it is, how relevant it is to your search query.

Speaker C: We use the evidence pyramid. So it’s crude, but it works reasonably well in that imagine any pyramid at the top, and we also use color grading to sort of emphasize it. So at the top of the pyramid is the green, the so called secondary evidence. So secondary evidence is the systematic views, clinical guidelines that anything that’s gone through another level of quality assurance over and above peer review, because peer review is problematic. And so just because it’s gone through peer review doesn’t mean it’s high quality. You can have peer review and you have a lot of terrible studies that have gone through peer review. Lots of reasons for that. One for another conversation, I’m sure. So when you do a systematic review, you do a second level of review. When you do a clinical guideline, you typically do a second level of reviewing and quality assurance. And so we try to reflect that. And so the higher quality stuff is this stuff that’s gone through another layer of appraisal. But then we go down to the pyramid, and the general journal articles are the second from the bottom of the pyramid, there are five layers of the pyramid. And so we have things such as the certain other sources that take the primary literature, the journal articles, and they will also critically appraise them as well. And so there’s lots of. We try to reflect it. Well, it’s crude, but we’re working, again, we might touch upon it later, but we’re working on ways to further improve that, to make it more granular. So systematic review is not all. Just because it’s a systematic review doesn’t mean it’s great. We can have good systematic reviews and bad systematic views. So again, we’re working on things like that to help our users pick out the really good stuff and the stuff they need to be more skeptical of. Okay.

Speaker B: So if the users are looking to search a topic, whether it be for clinical practice or for a literature view for their own studies, at least it seems like going here might give you the, I don’t want to say cliff notes, but it’ll minimize your time researching so many journals because it’s already sorting out the top 10% of studies in that topic. So it’ll save you a lot of time.

Speaker C: Well, I think that’s a really good summary. I think trip is designed to be easy to use. If you can use Google, you can use trip. When we ask our users what they like about trip, being easy to use is one of the things. So I would say if you’re in this situation, go to trip, bang a few keywords in and see what the results are, it’ll only take you five minutes and it might save you hours and hours of work because you might find some gold, which means you don’t need to go into pubmed because PubMed can be a nightmare because you do a search for prostate cancer screening and you’re going to get tens of thousands, hundreds of thousands of results. We know, and it’s the same with trip. We know people typically don’t go past the second or third page of results. And so what we’re saying is, hopefully that’s our aim, is to get the best results in the sort of top ten. But again, it’s in the eye to behold what the top ten is. We do an all right. So, as I say, it doesn’t take much time just to have a go on trip and just see it, and it could save an awful lot of time. Got it?

Speaker B: Yeah, it sounds like it. I’ve definitely run into issues on PubMed and Google Scholar receiving a lot of information, but a lot of it was not really relevant to what I was trying to find. Even using the filters, it can be a nightmare depending on how niche the research topic is you’re looking for. And I’m kind of curious because I know you’ve been doing this for 25 years and there is a free version and a paid version. What’s the difference between those?

Speaker C: Well, I think this boils down to two main things, content and functionality. And to start off with, unfortunately, I hate having to charge people. I wish I had a rich benefactor who could just throw money. We’re just at the back of three years of rebuilding it. We need is developer, so we need money to keep it going. That’s why we’ve got it. And we’ve gone for this freemium model where a lot of it is free and some of it is paid, and the paid version is there to entice people to subscribe. And so that we have extra content, so we have additional systematic reviews, we have additional things such as ongoing clinical trials and a few other bits and bobs. But the functionality, I think, is the thing that the people like most. I think because a lot of people with a free version, you can’t export the results, for instance, into reference management software. So a lot of the people doing reviews might well use reference management software. With a free version, you can’t do that. And I think that alone is one of the big driver, but there’s lots of other bits and bobs that we do. Again, it’s getting that balance right. But our primary, the people who purchase normally sort of universities or large hospital systems. And so, for instance, the NHS National Health Service in England and Wales pay for it. That covers, well, tens of thousands of doctors and nurses in the UK. And so that’s how we normally do. If you’ve also got personal subscription, which is currently $55 a year anyway, that’s unlike a sales pitch.

Speaker B: That’s not bad at all. I’m thinking of, in comparison to up to date, which I know they have institutional discounts or something along those lines, but it’s, I believe last I checked, something like over $350 per year for an individual account. I could be way off on that, but I thought it was an aggregate there. So $55 a year sounds like a very reasonable cost for something that might act in a similar manner.

Speaker C: One of the things we need to keep, we keep meaning to introduce is allow users who freshly register to sort of have a month free go at the paid for pro version, and then if they don’t like it, they just go back to the free version. It’s one of these things about we’ll never finish trip, we’ll never finish it because it’s always something there that needs doing. But obviously anyone listening to this, by the way, if they want to take advantage of that, I can do it manually for you. So drop me an email. I’m not hard to find. John Brassi@tripdagebase.com and I say, I heard about the offer of a month’s free trip pros. Just send me an email and I will happily oblige.

Speaker B: That was going to be one of my next questions, is how to reach out to you and find out more information. So you already covered that for me? Wrapped it up. Nice. Do you have any last minute thoughts or advice for those that are maybe starting their research journey or going on a trip with Trip database?

Speaker C: Well, when you say starting their research journey, this for them to actually conduct their own research, it could be conducting.

Speaker B: Their own research, literature review for research that they’re going to conduct a study they’re going to conduct, or even just for students finding clinical pearls that can help them with their early patient care.

Speaker C: I think the biggest thing that’s always struck me that I’ve worked with lots of very interesting people over the years, and the ones that inspire me are the ones that are actually really keen on supporting patient care, the ones that really understand the needs of the patient. I’ve met doctors who do research for research’s sake, but I prefer the ones who actually see the patient in front of them, recognize the question there without any reasonable evidence, and then we’ll get their research inspired from that. So it’s about getting strange enough. It’s the same for doing a literature review. You start off with a research question. What is the research question? You do your literature review. Is there any good evidence? Yes. No. If no, you can start planning your research properly. But part of that is learning. And again, something that is a real burden is research waste. There’s lots of waste. There’s lots of rubbish research out there. So if you’re going to go to the effort, I would always suggest you try your best. Have a look what other people doing. Reach out to people who work in this field and try to ask for advice on how you make sure you reduce research waste by doing a good research topic in the first place. Question, then quality. And again, trip is a huge resource of great content and you can learn a lot even if it’s not your field. Just look how other people do it.

Speaker B: I like that question then quality. John Brassy trip database check it out. Try a free version. We will have more notes and contact information in the show. Notes for this episode. Episode John, thank you so much for coming on the show.

Speaker C: That was a pleasure. And yeah, thanks for having me.

#ResidencyResearch #TripDatabase #HealthcareProfessionalDevelopment

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