2 drug information for healthcare practitioners...drug information for healthcare practitioners paul...
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Drug Information for Healthcare Practitioners
Paul L. Doering, MSDistinguished Service Professor, Emeritus
College of PharmacyUniversity of Florida
3Two Types of Informational Needs
1. Reading to re-search a specific question• Example: Does the
dose of gatorcillinneed to be reduced in a patient with renal impairment?
2. Reading for current awareness
• Example: I wonder what new drugs the FDA has approved in the past few days?
4Importance of Critical Evaluation of the Medical/Pharmaceutical Literature
Healthcare is an ever-changing profession
What was right yesterday is wrong today
What is right today is wrong tomorrow
New information is constantly being presented
Yet, much of the literature is unreliable or misleading
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Drug Information…..
Knowledge is of two kinds:we know a subject ourselves,or we know where we can findinformation upon it.”
Samuel Johnson 1775
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Thursday, April 7, 2005, 12:30 pm-phone call received from Health Reporter from local newspaper:
“Professor Doering, can I get your reaction to the removal of Bextrafrom the market?”
Doering: Oh? You mean Bextra was removed from the market?
7From clueless to expert in fifteen minutes
8
Sources of Information
“The Literature”
The Internet
The News
Manufacturers
Professional associations
Governmental sources
Networking
9The Latest in Medical News
10CBS Evening News
May 4, 2011
11
New York Times, May 3, 2011
12Getting the actual paper
JAMA. 2011 May 4;305(17):1777-85.
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The Latest Medical Journals
14Searching the Literature
Search strategy
determine references most
likely to meet your needs
balance all factors (eg, depth, time)
The search
general references, then indexing &
abstracting services, then journal articles
15Primary Literature
Original Research
Journal articles
Meeting symposia
Conference proceedings
Newsletters including original research
16The Secondary Literature
Indexing and Abstracting
ServicesBibliographic
databases
MEDLINE
IPA
IDIS
Current Contents
17The Secondary Literature
Indexing and Abstracting Services
Usefulness of titles & abstracts
Availability of the citations
18Searching Databases
source (ie, journal)
publication type (eg, review)
Limiting searches• language, human, year,
etc• major topic• subheadings (adverse
effects)• operators
• Boolean (and, or, not) and others (adj, with)
19ANTIQUES FROM THE EARLY DAYS
OF DRUG INFORMATION
Paul L. Doering
Class of ‘72
Early Computer for Medlars Searching
20YESTERDAY’S TECHNOLOGY
BECOMES TODAY’S MUSEUM PIECE
Slide Rule
Calculating Machine
21EARLY DAYS OF MEDLINE SEARCHING:
A MYSTICAL EXPERIENCE
Required appointment
Intensive interview by the operator
Hooked up some weird equipment
Typed in a secret language
Stood around watching in awe
Answers looked like hieroglyphics
Leave scratching head
Sent a bill
22Searching Pub Med
PubMed tutorial
• http://www.nlm.nih.gov/bsd/disted/pubmed.html
Single Citation Matcher
• Use when you have partial information about citation
Field Searches• Use boolean operators or limit searches
Type of Article
• Review article, clinical guideline, meta analysis, clinical trial
http://www.ncbi.nlm.nih.gov/pubmed/
23The Tertiary Literature
Textbooks Electronic References
General References
24Tertiary Literature
Textbooks
Handbooks
Manuals
Compendia
Review Articles
Fulltext Electronic Databases
General References
25Some Useful General References
Drug Facts and Comparisons
AHFS Drug Information 2011
The Physician's Desk Reference (PDR)
Handbook of Non-Prescription Drugs
American Drug Index
26Some Other Useful General References
Goodman and Gillman's A Pharmacologic Basis of Therapeutics
Pharmacotherapy : A Pathophysiologic Approach
Martindale's Extrapharmacopoeia
Handbook of Injectable Drugs
Drug Interaction Facts by Facts and Comparisons
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Textbooks
Lag time
• What kind of information is timely enough?
Some available both printed and
electronic
• How often are they updated?
Overview with consensus opinion
• May be someone else's opionion
Less expensive
• Subscription may cost $$$$
28A Trio of Textbooks
DiPiro Herfindal Koda-Kimble
29Electronic General References
Micromedex• DRUGDEX• POISINDEX• Martindale’s
Clinical Pharmacology
Up to DateClinical
Reference Library
Facts, AHFS, etc
30What About Wikipedia?
Originally thought to be a “bad choice”
Contains up to date information
Well referenced
Reliability can be
judged by the user
31What About Wikipedia?
32AHFS
AHFS Drug Informationhttp://www.ahfsdruginformation.com/
33“Facts”Drug Facts and Comparisons
www.factsandcomparisons.com/
34Facts and Comparisons
35Clinical Pharmacology
Never available as a textbook• Designed as a database
Available in different platforms• CD-ROM, Intranet, Internet versions.
http://www.clinicalpharmacology-ip.com/default.aspx
36Micromedex
Extensive menu of database options
Never available as a textbook
• Poisindex, Identidex, Drugdex, Martindale’s, Drug-REAX
• Originally on microfiche
37Micromedex
Extremely comprehensive Well-referenced Extremely
expensive
Only updated quarterly• New monographs
and updates available from website
38PDR
Physicians Desk Reference
39Electronic Textbooks
Stat!Ref• AHFS• USPDI• Medical textbooks
Natural Medicines Comprehensive Database
MD Consult
40Journal Articles
Peer Review
Supplements may not be peer
reviewed
Types of Articles
reviews, original articles, case
reports, letters, editorials
41The Internet
Evaluating web sites• accountability
• authorship• attribution• disclosure & ownership• currency
• editorial oversight
World Wide Webor Wild Wild West
42Governmental Resources
US Government
FDA, CDC, NIH, NCI• www.xxx.gov
except cancer.gov
PubMed is provided by the National Library
of Medicine
DailymedGoogle
“dailymed”
43www.guidelines.gov
National Guideline Clearing House
Agency for Healthcare Research
and Quality (AHRQ)
Evidence-based
guidelinesProvides abstracts
44http://www.healthfinder.gov/?source=govdelivery
45http://www.nlm.nih.gov/medlineplus/druginformation.html
46http://mailview.bulletinhealthcare.com/mailview.aspx?m=2012022901ashp&r=3267606-5888
47http://www.medpagetoday.com/
48WWW.FDA.GOV
49Summary
Many references available
Successful healthcare practice demands a critical evaluation of the primary literature• But you must be able to
find it first
You will use all levels of information • Therefore, it is important
to understand the value and limitations of each level
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Go gators!