DRUG INFORMATION RESOURCES

PHCL 312
Jamilah Alsaidan, MSC

DRUG INFORMATION RESOURCES

Learning Objectives: The student should differentiate between primary, secondary, and tertiary sources of information. Select resources relevant to different pharmacy practice areas. Identify the most appropriate resource for a specific drug information request. Describe the role of the internet and PDA resources in the provision of drug information. Critique tertiary resources to determine appropriateness of information.

DRUG INFORMATION RESOURCES

Learning Objectives cont.: Describe appropriate search strategy for use with computerized secondary databases. Recognize alternative resources for provision of drug information.

DRUG INFORMATION RESOURCES

Introduction: The quantity of medical information and literature is growing at an outstanding rate. The technology with which this information can be accessed is also improving. Its not about simply selecting the easiest, most familiar resource to find information, its about using the best resource to answer the query at hand. Generally, the best method to find information includes a stepwise approach moving first through tertiary, then secondary, finally primary.

DRUG INFORMATION RESOURCES

Introduction cont.: Often, a search for information will not employ all of these steps or require the use of all three types of resources. The type of requestor may also substantially influence the resources used to respond to a question. Generally, a request from a consumer or patient could be answered more appropriately from available tertiary resources rather than a stack of clinical trials.

DRUG INFORMATION RESOURCES

Tertiary
Secondary
Primary

DRUG INFORMATION RESOURCES

Tertiary Resources: Consist of: textbooks compendia (Balanced Summary of a larger body of information) review articles in journals general information found for example online These references may often serve as an initial place to identify information due to the fact that they provide a fairly complete and concise overview of information available

DRUG INFORMATION RESOURCES

Tertiary Resources Advantages: Tertiary Resources Disadvantages:

Provide a fairly complete and concise overview of information available on a specific topic. Excellent to use first line Convenient Easy to use Familiar

Lag time associated with publication Less current information Possible its out of date even before its published Possible its incomplete Errors in transcription Human bias

DRUG INFORMATION RESOURCES

When selecting a tertiary reference for use: Differences in practice setting, available funding, patients seen, and types of information most commonly needed all have an impact on which tertiary resources are available at a specific practice site. Selection according to the type of information needed for a specific request or situation. Consider the categories of requests received in a practice setting to ensure that the appropriate texts are available. References for PDAS or on CD are available

DRUG INFORMATION RESOURCES

Evaluation of Tertiary Literature: Does the author have appropriate experience/expertise to publish in this area? Is the information likely to be timely based on publication date? Is the information supported by appropriate citations? Does the resource contain relevant information? Does the resource appear to be free from bias or blatant errors?

DRUG INFORMATION RESOURCES USEFUL RESOURCES FOR COMMON CATEGORIES OF DRUG INFORMATION
Type of Request General Product information Adverse Effects Useful Tertiary Source Handbook of Clinical Drug Data, Handbook of Nonprescription drugs

Availability of Dosage Forms

AHFS DI/ USP DI/ Drugdex Lexi-comp Reference Handbook, Drug Information Handbook

DRUG INFORMATION RESOURCES

Type of Request Dosage recommendations Drug-Drug interactions Drug- food interactions Drug Identification Toxicology information IV or IM incompatibilities Useful Tertiary Source Drugdex/ USP DI/ AHFS DI USP DI Vol. I, AHFS DI, Drugdex USP DI Vol. II Identidex Poisondex Handbook of Injectable Drugs

DRUG INFORMATION RESOURCES

Type of Request Useful Tertiary Source

Pediatric dosage recommendation Drug use in Pregnant or lactating female Drug Laboratory Interference

Pharmacokinetics

The Harriet Lane Handbook Drugs in Pregnancy or Lactation Basic skills in interpreting Laboratory data Clinical Pharmacokinetics

DRUG INFORMATION RESOURCES

Tertiary
Secondary
Primary

DRUG INFORMATION RESOURCES

Secondary Resources: Are used to locate primary literature and generally include indexing and/or abstracting services Indexing: providing bibliographic citation information (e.g. title, author, and citation of the article) Abstracting: provides a brief description (abstract) of the resource cited.

DRUG INFORMATION RESOURCES

Secondary Resources

Indexing services
bibliographic citation information (e.g., title, author, and citation of the article)

Abstracting Services

a brief description (or abstract) of the information provided by the article or resource cited

DRUG INFORMATION RESOURCES

The main purpose is to provide summaries of primary literature articles in addition to the citation for that article They are essential tools for locating and using the primary literature Various systems will index or abstract literature from different journals, meetings, or publications, therefore, in order to perform a comprehensive search different databases must be used.

DRUG INFORMATION RESOURCES

Availability Hard Copy Print (Paper) Electronic Format CD-ROM Online

The vast majority of secondary resources are utilized primarily in electronic format, although some may have a print form.

DRUG INFORMATION RESOURCES

Advantages of Printed Secondary Resource Disadvantages of Secondary Resources

Less costly than electronic Used to browse for new information

Might require more time than an electronic listing due to need to look at multiple editions and indexes. Can be searched by only one user at a time.

DRUG INFORMATION RESOURCES

Advantages of electronic databases Disadvantages of electronic databases

Faster retrieval The more frequent updating of listings and information is very important

Require knowledge of search strategy suitable for particular database Different database systems use different indexing terms Costly except for PubMed

DRUG INFORMATION RESOURCES

In general secondary resources must be updated frequently on regular basis Users must be familiar with their structure, format, and frequency Proficiency in searching skills must also be developed through practice and experience

DRUG INFORMATION RESOURCES

Efficient Search Strategies: Systems do not index all terms in the same manner therefore it is necessary to determine what terms a database is using to conduct a successful search. E.g. databases in the NLM index terms by their Medical Subject Heading (MeSH term), while the IOWA Drug Information Service (IDIS) uses the United States Adopted name and International Classification of Diseases.

DRUG INFORMATION RESOURCES "Is clonidine effective in the treatment of attention deficit hyperactivity disorder (ADHD) in adolescents?"

BOOLEAN OPERATORS

AND

OR

NOT

DRUG INFORMATION RESOURCES

The Boolean Operator AND often used to combine two terms; it limits retrievals, returning only citations that contain both these concepts or terms. The Boolean Operator OR often used to broaden a search; it returns citations where either term is used. Using the Boolean operator NOT will always decrease the number of retrievals. It eliminates any references having the term that follows the NOT operator. Should be used with caution.

AND
will

combine two terms, returning only citations containing both of those concepts or terms.

For example The use of clonidine for ADHD the appropriate search terms (clonidine AND attention deficit hyperactivity disorder)

DRUG INFORMATION RESOURCES

Search Term Clonidine

Number of results 16001

ADHD

19763

Clonidine AND ADHD

224

DRUG INFORMATION RESOURCES

OR:

will

have an equal or greater number of returns since it will include any citation where either term is used. searching for a term with synonyms )attention deficit disorder OR ADHD ( A search using OR will return a number of results equal to or greater than a search using the term AND

DRUG INFORMATION RESOURCES

Matching Results

The use of either clonidine or guanfacine for ADHD

ADHD
guanfacine Clonidine

DRUG INFORMATION RESOURCES

OR:
Search Term Clonidine Number of results 16001

ADHD
Guanfacine Clonidine OR Guanfacine ADHD AND Clonidine OR Guanfacine

19763
717 16406 897

DRUG INFORMATION RESOURCES

NOT: will always decrease the number of responses, since it eliminates any references having the term that follows that operator.

therefore it should be used with caution, since it may eliminate articles that may be appropriate, simply because the term being eliminated happens to appear somewhere in the article.

DRUG INFORMATION RESOURCES

NOT: The

operator NOT would be helpful if a user wants to exclude certain topics, for example, a specific disease state.
this case, a search might be performed for ADHD NOT Tourette's disorder . the use of the term NOT will exclude any article mentioning Tourette's disease, an article focused on treatment of ADHD with a small section about Tourette's disease would also be excluded.

In

Since

DRUG INFORMATION RESOURCES

NOT
Search Term Clonidine 19763 ADHD 224 Clonidine AND ADHD Clonidine AND ADHD NOT Tourettes disease 180 Number of results 16001

DRUG INFORMATION RESOURCES

Efficient Search Strategies cont. Some databases will also use the terms WITH or NEAR. These operators are similar to AND, however, they require the terms to be within a certain number of words of each other. These terms may be useful when other searches are identifying a large number of articles where both terms are mentioned, but not in conjunction with each other.

DRUG INFORMATION RESOURCES

Efficient Search Strategies cont. The same search phrase could be indexed under a variety of search terms, and in order to provide a comprehensive search it is important to address all of those. For example, ginkgo "ginkgo", "ginkgo biloba", the Latin name "Ginkgoaceae", as well as the misspelled word "gingko". This same principle holds true when considering disease states whose names may have changed over time.

DRUG INFORMATION RESOURCES

Limits: Some databases allow searches to be limited by a variety of factors, including: Language of publication Year of Publication Type of article (e.g. case review) Type of journal This is most helpful when the initial search terms return a large number of possible matches. Using too many limits with the initial search may eliminate articles or citations that might be helpful.

DRUG INFORMATION RESOURCES SEARCH STRATEGY STEPS

Identify the key words

Understand the indexing terminology

MeSh, thesaurus

Use Limits

Use Boolean Operators

DRUG INFORMATION RESOURCES

Questions to ask before choosing a database: Does it allow you to have a Boolean Operators to connect terms when searching? Does it assist you in locating Mesh terms to use in searching? Does it allow you to apply specific limits? Does it provide links to full texts? Does it allow manipulation of the search results?

DRUG INFORMATION RESOURCES

Questions to ask before choosing a database: Does it contain a journal index that can be browsed to determine the exact way in which a journal can be abbreviated Does it provide detailed online help? Does it cost anything to access? Does it allow for an easy way to identify additional articles related to a particular citation?

DRUG INFORMATION RESOURCES

Examples of Secondary Resources: IOWA drug information services (IDIS) PubMed International Pharmaceutical Abstracts (IPA) OVID

DRUG INFORMATION RESOURCES

Medline: National Library of Medicine http://www.nlm.nih.gov. Coverage includes basic and clinical sciences as well as nursing, dentistry, veterinary medicine, and many other health care disciplines. Information comes from more than 3900 journals in 40 different languages. This database is available through a variety of services including PubMed

DRUG INFORMATION RESOURCES

Pubmed: PubMed comprises approximately 20 million citations for biomedical literature from MEDLINE, life science journals, and online books. PubMed is a FREE resource that is developed and maintained by the National Center for Biotechnology Information (NCBI), at the U.S. National Library of Medicine (NLM), located at the National Institutes of Health (NIH). Publishers of journals can submit their citations to NCBI and then provide access to the full-text of articles.

DRUG INFORMATION RESOURCES

IOWA DRUG INFORMATION SERVICE Division of Drug Information Service, University of Iowa, http://itsnt14.its.uiowa.edu/. This is an indexing service that allows retrieval of complete articles from a variety of biomedical publications. Articles from 1966 to present The data base is updated monthly With about 1700 articles added /month Useful Self-contained

DRUG INFORMATION RESOURCES

The articles focus on drug therapy in humans. CD-ROM format and web version. It is unique in that it provides full articles, in either PDF form or, for older articles, microfiche. Term index by the United States Adopted Name and the International Classification of Diseases

Descriptors >150 Either the name or 1-3 digit

DRUG INFORMATION RESOURCES

International Pharmaceutical Abstracts IPA American Society of Health-System Pharmacists, http://www.ashp.org. Coverage includes drug-related information, including drug use and development. This database also abstracts a variety of meeting presentations. The main focus of this database is pharmacy information, including pharmacy administration and clinical services, making it the most comprehensive database for pharmacyspecific information.

DRUG INFORMATION RESOURCES

International Pharmaceutical Abstracts IPA cont.: It abstracts more than 750 journal Since 1988,abstracts from all ASHPs meeting have been included Updated monthly online Biweekly in print

DRUG INFORMATION RESOURCES

Adverse Drug Reactions Biopharmaceutics Drug Analysis Drug Evaluations Drug Interactions Drug Metabolism and Body Distribution Drug Stability History Information Processing and Literature Institutional Pharmacy Practice Investigational Drugs Legislation, Laws, and Regulations

Methodology and Drug Testing Pharmaceutical Chemistry Pharmaceutical Technology Pharmaceutics Pharmacoeconomics Pharmacognosy Pharmacy Practice Pharmacology Sociology, Economics, and Ethics Toxicity

IPA

DRUG INFORMATION RESOURCES

Drawbacks of IPA: Requires significant practice and experience Lag time(months to 1 yr) between when the article is published and when it is available on IPA Time consuming to identifying all the appropriate descriptors to use Non full text journal ,difficult to locate some journals

DRUG INFORMATION RESOURCES

OVID DATABASES: Ovid offers more than 90 databases collectively known as Databases@Ovid, many of which are in the areas of the health and life sciences.

DRUG INFORMATION RESOURCES

OTHER PRODUCTS AND SERVICES: Online Books

Books@Ovid
Journals@Ovid

Online Journals

Decision Support

MedWeaver Cilneguide
MedCases

Education

Evidence-Based Medicine Personal Digital Assistants

Ovid@Hand

DRUG INFORMATION RESOURCES PUBMED VS. OVID

PubMed Advantages

Ovid Advantages

Fast Free Growing number of links from PubMed citations to online resources (e.g., electronic journals) Multiple search modes Multiple document delivery options. Ability to store searches

Well-designed search Multiple-database searching (with duplicate deletion) Excellent phrase and adjacency search options Ability to rerun saved searches automatically and to receive results via e-mail

DRUG INFORMATION RESOURCES

DISADVANTAGES OF OVID: Web connection sometimes slow but is improving.

Not free; subscription is required.

Only a small percentage of Joumals@Ovid articles in PDF (changing).

Lacks some of the fancy search features offered by PubMed (e.g., Clinical Query).

GETTING STARTED

BASIC SEARCH
D

ADVANCED SEARCH SCREEN

A

B
C

FIND CITATION

DRUG INFORMATION RESOURCES

Basic Tools: Boolean Operators And combining searches. Truncation and Wild cards. Nesting with parentheses. Adjacency searching Phrase search.

DRUG INFORMATION RESOURCES PRIMARY LITERATURE:

Tertiary
Secondary
Primary

DRUG INFORMATION RESOURCES

PRIMARY LITERATURE Primary Literature consists of clinical research studies and reports, both published and unpublished. NOT ALL literature published in a journal is classified as primary literature, for example review articles or editorials are not primary literature. Controlled trials Are Considered Cohort studies Primary Case Series Literature Case Reports

DRUG INFORMATION RESOURCES PRIMARY LITERATURE

Advantages of the use of primary literature Disadvantages of the use of primary literature alone

Access to detailed information The ability to personally assess the utility and validity of study results When groundbreaking medical information is first available its usually in the form of primary literature.

Misleading conclusions based on only one trial The need to have good literature evaluation skills Time needed to evaluate the number of literature available for a certain topic

DRUG INFORMATION RESOURCES

PRIMARY LITERATURE The number of journals available is growing Each practice setting will require slightly different primary literature based on the specific areas that are of greatest importance to that facility

DRUG INFORMATION RESOURCES

PRIMARY LITERATURE Obtaining the Primary Literature: Once the literature has been identified using a secondary searching system, the actual article can be obtained in several ways: Library Drug Information Center Online through publisher websites Through NLM Articles identified through Pubmed can be easily ordered from that database through a system called Loansome Doc.

DRUG INFORMATION RESOURCES INTERNET RESOURCES:

Sometimes as a starting point a general internet search can be made Especially helpful about: unusual diseases about marketed over the counter products combination dietary supplements.

DRUG INFORMATION RESOURCES INTERNET RESOURCES:

Different search engines use different techniques to identify web pages No search engine will identify all websites Some engines geared toward scholarly content e.g. <<scholar.google.com Geared toward scientific research e.g. Scirus <<www.scirus.com

DRUG INFORMATION RESOURCES INTERNET RESOURCES:

Generally sites maintained by educational institutions, not for profit information, or a division of the U.S government are likely to contain high quality information Whereas information maintained by a company selling or promoting a specific product may be more questionable.

DRUG INFORMATION RESOURCES ALTERNATIVE INFORMATION SOURCES

Occasionally, sufficient information can not be obtained from standard resources requiring the use of some alternative sources of information. E.g. If a question involves a recent news story about the withdrawal of a medication from the market, a logical first place to find information would be to identify the original news story. This can be done by searching various newswire services.

DRUG INFORMATION RESOURCES ALTERNATIVE INFORMATION SOURCES

Another example of when an alternative information source might be needed is when there is so little information published about the topic. It would wise to contact persons: performing research in that particular novel area, practioners currently using that therapy Experts via medical organizations Authors of reputable papers Actual manufacturing company of a particular product

ACKNOWLEDGEMENTS TO LOBNA ALJUFFALI, MSC