TRIPanswers is a repository of clinical questions and answers drawn from a wide number of sources around the world and builds on TRIP’s ten years experience of answering clinical questions. Ultimately, we want to create a resource where clinicians can easily find answers to their question and, who knows, create a clinical Q&A ‘space’ where users can share their own Q&As (it’s always struck us as wasteful that clinicians around the globe answer questions and this effort is never shared!)
Locating answers can be achieved by searching or browsing (we’ve tagged each Q&A and have some spectacular tag clouds!) and where possible we’ve added a quality scoring system to highlight possible answer shortcomings. Of great importance to us is the ability of users of the site to feedback so we’ve tried hard to make commenting on individual Q&As as easy as possible; we’re really hoping users will highlight ways in which individual answers can be improved! In addition to the main section of TRIPanswers we’ve created a Tag Cloud of Clinical Uncertainty, an area dedicated to questions with poor answers to highlight research gaps.
For more information,see below.
BACKGROUND
TRIPanswers has been created to act as a repository of clinical questions. We, at TRIP Database, have been answering clinical questions for over ten years and in that time have answered over 10,000 clinical questions. We have interacted with large numbers of clinicians and have learnt a considerable amount from how clinicians use and interact with the various Q&A services we run.
TRIPanswers can (to an extent) be seen as a distillation of our experience, coupled with our desire to see clinicians and other information specialists sharing their experience. As part of this sharing process we have already been joined by a significant number of other Q&A services – all willing to share their Q&As.
TRIPanswers will act, we hope, as a major agent for change. We know that clinicians generate significant number of clinical questions every day. The important aspect being THEY ASK QUESTIONS. Unfortunately most information/knowledge packaged in one of these forms:
• Chapters in textbooks – requiring clinicians to wade through large tracts of text to try and find the nugget of information they need, often a frustrating waste of time.
• Clinical guidelines – as above, large amounts of text to look through, often a frustrating waste of time.
• Systematic reviews – it would appear that the majority of systematic reviews are generated, not from a ‘front-line’ clinical need but from other motives. For instance, our analysis of over 300 Q&As in dermatology found that systematic reviews answered just two questions.
• Primary research – often poor quality, often difficult to find.
As far as we can tell, specialist clinical Q&A services are the only way to meet the information needs of clinicians with patient-generated questions. So, by harvesting Q&As from a large number of sources, coupled with excellent search and browsing functionality will create a truly powerful tool to enhance front-line clinical care.
TRANSPARENCY
Transparency is a very important aspect of clinical question answering. Q&A services tend to have a rapid turnaround and therefore have to take methodological shortcuts compared with a systematic review. For instance, a literature search for a systematic review will take months while a clinical Q&A may take only hours. We feel it’s important to highlight potential shortcoming and therefore we have devised a novel scoring system to help guide clinicians in using any particular answer. This scoring system uses three variables:
Search
• Strong will be as good, or close, to a systematic review.
• Moderate will be a search carried out using multiple databases and carried out by experienced searches
• Weak will be one carried out on only a single database and/or carried out by an inexperienced searcher.
Appraisal
• Strong will be as good, or close, to a systematic review.
• Moderate will be a critical appraisal ‘light’ and this will often rely on just the abstracts. Appropriate methodologies, sample size et can be considered, although issues such as appropriate randomisation, intention to treat analysis may be overlooked.
• Weak is anything less than moderate and may well include no appraisal.
Confidence
This has proved the most difficult for us to utilise and are aware of potential deficiencies. Is this variable to do with evidence, confidence, robustness? We struggled, but have gone with confidence. We sought the opinion of numerous information specialists with experience in answering clinical questions.
• Strong, where the question is answered well by secondary review articles
• Moderate, where the question is answered by primary research of eTextbooks
• Poor is where there is little research or the primary and secondary literature highlights great uncertainty.
FEEDBACK
Over the years clinicians have occasionally contacted us highlighting an potential problem with an answer. This might range from missing an important reference to using inappropriate measures in reporting (e.g. using American measures for an English question). To help facilitate feedback we have made it exceptionally easy to obtain user feedback. At the foot of each answer they’ll be a ‘call to action’ button allowing easy feedback on a particular answer.
The bottom line is that we want and need interaction to improve TRIPanswers. Coupled with transparency of process we hope we’ll be offering a significant innovation in clinician information support.
If you have any questions or feedback - let us know!!!