Global Conference

Drug Information PRN Focus Session—When Time is of the Essence: Efficiently Finding and Evaluating the Evidence to Make Individual Patient Decisions Activity Number: 0217-0000-15-131-L04-P, 1.50 hours of CPE credit; Activity Type: An Application-Based Activity Tuesday, October 20, 2015 10:15 a.m. to 11:45 a.m. Plaza Room A Moderator: Dianne W. May, Pharm.D., BCPS Clinical Professor, University of Georgia College of Pharmacy and Clinical Pharmacy Specialist, Georgia Regents Medical Center, Augusta, Georgia Agenda

10:15 a.m. Looking Beyond PubMed: Making the Most of Google Power Searching and Use of Grey Literature in Pharmacy Practice

Philip J. Gregory, Pharm.D., MS Director, Center for Drug Information & Evidence-Based Practice, Associate Professor, Pharmacy Practice, Creighton University, Omaha, Nebraska

11:00 a.m. When Time Matters: Innovative Tools and Techniques to Evaluate the

Quality of a Clinical Trial Quickly and Efficiently Melissa M. Blair, Pharm.D., FCCP, FASHP, BCPS

Associate Editor, Therapeutics Research Center, Stockton, California; Pharmacist III, New Hanover Regional Medical Center, Wilmington, North Carolina

Conflict of Interest Disclosures Melissa M. Blair: no conflicts to disclose. Philip J. Gregory: Consultant/member of advisory board for Therapeutic Research Center-Publisher of Pharmacist’s Letter and Natural Medicines Comprehensive Database, and US Antidoping Agency. Dianne W. May: no conflicts to disclose. Learning Objectives

1. Differentiate the value of Google Power Searching compared to a PubMed search in answering drug

information questions that arise in your daily practice. 2. Evaluate the value of grey literature as it might be applied to your clinical practice. 3. Identify other useful resources used to find drug information. 4. Execute a google power search and find grey literature when presented a case-based scenario. 5. Identify essential elements of a clinical trial and practical strategies that can be used by the busy

practitioner for evaluating the evidence. 6. Differentiate key concepts that should be considered based on type of the trial reviewed (e.g., meta-

analysis, randomized-controlled trial, non-inferiority trial, effectiveness trials, etc.) 7. Apply the tools and techniques described to evaluate a clinical trial quickly and efficiently.

© American College of Clinical Pharmacy 1

Global Conference

8. Use strategies discussed to draw conclusions related to quality in daily practice. Self-Assessment Questions

Self-assessment questions are available online at www.accp.com/gc15.

© American College of Clinical Pharmacy 2

Looking Beyond PubMed – Making the Most of Google Power Searching, Grey Literature, and Other Tools

Philip J. Gregory, PharmD, MS, FACNOctober 20, 2015

2015 ACCP Global Conference on Clinical Pharmacy

Conflict of Interests

Consultant Therapeutic Research Center

Learning Objectives

Evaluate the value of grey literature as it isapplied to clinical practice

Differentiate the value of Google PowerSearching and PubMed searching

Identify other useful resources used to finddrug information

Execute a Google Power Search and findgrey literature when presented a case

Grey Literature

Literature that isn’t in a book, journal, orpublished newsletter Not controlled by commercial publishing

Governmental publications

Academic / Business / organizational documents

Print or electronic formats

4th International Conference on Grey Literature, 1999

Grey Literature –Examples Conference abstracts, posters, proceedings

Hospital protocols, reports, monographs

Governmental reports and documents

Theses, Dissertations

Listserv communications

Social media or personal communications

Grey Literature –Where can you find it?

Specialty databases International Pharmaceutical Abstracts (IPA)

Web of Science

Guidelines.gov / Clinicaltrials.gov

Many others

Institutional Repositories

Organizational websites

Search engines (e.g., Google, Bing)

© American College of Clinical Pharmacy 3

Grey Literature –You’re already using it

Drug manufacturer data Package insert / data on file

Medical information communications

FDA documents Safety alerts / recalls

Orange book, Purple book

Drugs@FDA

Hospital Protocols

PRN Communications

Grey Literature –You’re already using it

Organizational websites Treatment guidelines

Health statistics

Position papers

CDC website Immunization schedules

Guidelines / statistics

Some favorites…VA Pharmacy Benefits Management Services (www.pbm.va.gov/PBM/)

Some favorites…FDAble (www.fdable.com)

Some favorites…Canada Vigilance Adverse Reaction Database (webprod3.hc-sc.gc.ca/arquery-rechercheei/index-eng.jsp)

Some favorites…AHRQ Evidence-Based Practice Center Reports(http://www.ahrq.gov/research/findings/evidence-based-reports/a-z/index.html)

© American College of Clinical Pharmacy 4

Grey Literature

Advantages Abundant

Complementary to published literature Fills in gaps

Cutting edge data

Decrease publication bias

Pulse of the community

Currency

Low-cost

Grey Literature

Limitations Lack of peer review or quality control

Disorganized

Varied formats

Agenda of mission-based organizationalpublications

Currency

INCORPORATING GREY LITERATURE

Answering Drug information Questions

Search Triad

PubMed

GoogleGoogle Scholar

Focused Review Literature Search

Focused Specialty Resource Search

What is the role of triple antithrombotic therapy?

-Guidelines-Reviews-Trials

-Protocols-Guidelines-Reports (AHRQ)

-Guidelines-Reviews-Trials

•UptoDate•DynaMed•-Pharmacist’sLetter

•Known Guidelines(CHEST, ACC/AHA)

Search Triad

PubMed Google Scholar Google

•Precision search•Controlled vocabulary•Extensive filters

•Known journal index•Grey literature access

•Search flexibility•Natural vocabulary•Full-text search

•Broad literaturecoverage•Limited advanced search•More grey literature access

•Search flexibility•Natural vocabulary•Full-text search

•Questionable sources•Limited advanced search•Extensive grey literature access

PubMed vs. Google Scholar

0%

5%

10%

15%

20%

25%

RelevantArticles

Precision Full-Text Link

PubMed

Google Scholar

P<0.001

P=0.07

P<0.001

Shariff SZ, et al. J Med Internet Res 2013;15(8):e164

© American College of Clinical Pharmacy 5

PubMed vs. Google Scholar

62%

64%

66%

68%

70%

72%

74%

76%

78%

80%

82%

Relevant Hits

PubMed

GoogleScholar

0

5

10

15

20

25

30

35

40

# ofcitations

JournalImpact

Nourbakhse E, et al. Health Info Libr J 2012;29(3):214-22.

P<0.0001

P=0.036

P=0.116

PubMed vs. Google Scholar

0%

10%

20%

30%

40%

50%

60%

70%

80%

Relevant Hits Full-text Precision

PubMed

Google Scholar

Anders ME, et al. Respir Care 2010;55(5):578-83

P<0.001

P=0.87

P=0.44

Google Power Searching

Maximizing Google search features to findrelevant drug information Primary literature, review literature, grey literature

Advanced Search

Search operators

Review top 50-100 hits

Google Power Searching

Filetype: Find articles of specific file types

Example: filetype:pdf

filetype:doc

filetype:ppt

Google Power Searching

Site: Find content from specific sites

Example: Site:.org

Site:.gov

Site:.edu

Site: accp.com

Google Power Searching

Intitle: and allintitle: Narrow search findings to title only

Example: Intitle: therapeutic interchange

allintitle:ondansetron safety pregnancy nausea

© American College of Clinical Pharmacy 6

Google Power Searching

Related: Finds websites with similar content

Related:cdc.gov

Related:cebm.net

Google Power Searching

Other Tools “Word” – turns off spell check and synonym

search

“Search phrase” – forces specific order of words "bulk drug storage" expiration

- to eliminate a word from search results “Triple antithrombotic therapy” -”atrial fibrillation”

Case

How should vancomycin be dosed for sepsisin patients on dialysis?

filetype:pdf vancomycin sepsis dialysis

Case

Does ginger increase the risk of bleeding inpatients taking antiplatelet or anticoagulantdrugs?

Site:.gov ginger “bleeding” -ulcer

© American College of Clinical Pharmacy 7

Case

http://www.powersearchingwithgoogle.com/

Grey Literature

Resources About Grey Literature Grey Literature Report (www.greylit.org)

Grey Matters (www.cadth.ca/resources/finding-evidence/grey-matters-practical-search-tool-evidence-based-medicine)

OpenGrey (www.opengrey.eu/)

GreyNet International (www.greynet.org/)

Philip J. Gregory, PharmD, MS, FACN

Director, Center for Drug Information & Evidence-Based Practice

Creighton University

pgregory@creighton.edu

© American College of Clinical Pharmacy 8

When Time Matters:  Innovative Tools and Techniques to Evaluate the Quality of A Clinical Trial 

Quickly and Efficiently ‐ Selected References 

Melissa M. Blair, PharmD, BCPS, FCCP, FASHP mblair@pletter.com 

 

Practice References: Translating Research Into Practice (TRIP) ‐ search engine for high‐quality evidence 

www.tripdatabase.com Essential Evidence ‐ EBM summaries of over 13,000 topics 

www.essentialevidenceplus.com Cochrane Library ‐ systematic reviews 

www.cochrane.org ACP Journal Club ‐ trial summaries 

annals.org/journalclub.aspx BMJ Clinical Evidence ‐ systematic reviews 

www.clinicalevidence.com/x/index.html Dynamed ‐ EBM summaries of drug therapy, diseases 

www.dynamed.com Pharmacist's Letter ‐ EBM summaries of drug therapy 

www.pharmacistsletter.com Medical Letter ‐ EBM summaries of drug therapy 

www.medicalletter.org  PURLs/FPIN (Priority Updates from the Research Literature Surveillance system/Family Physicians Inquiries Network) ‐ trial summaries and monthly journal 

www.fpin.org/purls‐info/  Evidence‐Based Medicine References: Center for Information Mastery (Tufts University) ‐ resources, worksheets 

medicine.tufts.edu/Education/Academic‐Departments/Clinical‐Departments/Family‐Medicine/Center‐for‐Information‐Mastery 

Centre for Evidence‐Based Medicine (CEBM) ‐ resources, teaching tools, worksheets 

www.cebm.net User's Guide to the Medical Literature ‐ articles on how to evaluate different trial types 

jamaevidence.mhmedical.com/book.aspx?bookID=847 ‐ compiled book for sale 

www.hopkinsmedicine.org/gim/training/Osler/osler_Jama_Steps.html ‐ links to all articles  Practice‐Based Journal Clubs: iForumRx ‐ Ambulatory Care  

www.iforumrx.org Pharmacist's Letter ‐ Part of Preceptor Toolbox 

www.pharmacistsletter.com Hospital Pharmacy 

www.thomasland.com/HPJ_journalclub.html  

© American College of Clinical Pharmacy 9