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

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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

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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!