Drug Information Drug Information Resources ReviewResources Review

Jennifer L. Rodis, PharmD, BCPSJennifer L. Rodis, PharmD, BCPSThe Ohio State University College The Ohio State University College

of Pharmacyof PharmacyOctober 25, 2011October 25, 2011

ObjectivesObjectives

Review the differences between Review the differences between primary, secondary, and tertiary primary, secondary, and tertiary resourcesresources

Discuss the value of each resources Discuss the value of each resources typetype

Provide a refresher on searching Provide a refresher on searching PubmedPubmed

Types of LiteratureTypes of Literature

Types of literatureTypes of literature

3 main types of drug information 3 main types of drug information literatureliterature– TertiaryTertiary

Interpretation of primary dataInterpretation of primary data

– SecondarySecondary No interpretation, just helps you find sourcesNo interpretation, just helps you find sources

– PrimaryPrimary Original research & analysisOriginal research & analysis

Real-life ResearchReal-life Research

Tertiary LiteratureTertiary Literature

Summarizes and interprets the Summarizes and interprets the primary literatureprimary literature

Information generally well acceptedInformation generally well accepted Place to start for basic information Place to start for basic information

and guidanceand guidance Can inform your subsequent researchCan inform your subsequent research

Tertiary LiteratureTertiary Literature

AdvantagesAdvantages– Convenient, accessibleConvenient, accessible– Often available onlineOften available online– Review process of information is already Review process of information is already

donedone DisadvantagesDisadvantages

– Lag timeLag time– Not as completeNot as complete– Author’s interpretationAuthor’s interpretation

Tertiary LiteratureTertiary Literature

TextbooksTextbooks– Electronic alsoElectronic also

CompendiaCompendia– Electronic alsoElectronic also

Full-text computer databases (Internet)Full-text computer databases (Internet)

Review articlesReview articles

Tertiary Resources – Drug Tertiary Resources – Drug DatabasesDatabases

Online Online – Lexi Comp CRLLexi Comp CRL– MICROMEDEXMICROMEDEX– Drug Facts and ComparisonsDrug Facts and Comparisons– MD ConsultMD Consult– AHFS Drug InformationAHFS Drug Information– EpocratesEpocrates

PrintPrint– PDR (Physician’s Desk Reference)PDR (Physician’s Desk Reference)

Tertiary Resources - BooksTertiary Resources - Books Print BooksPrint Books

– Remington’sRemington’s– Trissel’s (2 titles)Trissel’s (2 titles)– Handbook of Nonprescription DrugsHandbook of Nonprescription Drugs– RedbookRedbook– Drugs in Pregnancy & Lactation (aka: Drugs in Pregnancy & Lactation (aka:

Brigg’s)Brigg’s)– Martindale: The Complete Drug Martindale: The Complete Drug

ReferenceReference

Tertiary Resources - OtherTertiary Resources - Other UpToDateUpToDate Pharmacist’s LetterPharmacist’s Letter Natural Medicines Comprehensive DatabaseNatural Medicines Comprehensive Database Ohio Administrative Code Ohio Administrative Code

(pharmacy.ohio.gov)(pharmacy.ohio.gov) FDA.gov (Orange Book, Drugs@FDA)FDA.gov (Orange Book, Drugs@FDA) CDC.govCDC.gov Professional OrganizationsProfessional Organizations

– APhA’s MTM Central APhA’s MTM Central Package InsertPackage Insert Manufacturer web sitesManufacturer web sites

Using Tertiary LiteratureUsing Tertiary Literature

1.1. Does author have expertise?Does author have expertise?2.2. Is the information current?Is the information current?3.3. Is the information supported with Is the information supported with

citations?citations?4.4. Does the resource contain relevant Does the resource contain relevant

information?information?5.5. Is the resource free of bias or Is the resource free of bias or

errors?errors?6.6. Is it clear/concise/easy-to-use?Is it clear/concise/easy-to-use?

Secondary LiteratureSecondary Literature

Guides you to the primary and Guides you to the primary and tertiary literaturetertiary literature

IndexingIndexing– Bibliographic info onlyBibliographic info only

AbstractingAbstracting– Bibliographic citation plus brief Bibliographic citation plus brief

summary of article or resourcesummary of article or resource Almost all are electronic formatAlmost all are electronic format

Secondary LiteratureSecondary Literature

AdvantagesAdvantages– Simple search strategiesSimple search strategies– Very current citation informationVery current citation information– Access point for tremendous amount of Access point for tremendous amount of

primary sourcesprimary sources DisadvantagesDisadvantages

– Understanding coverage of the databaseUnderstanding coverage of the database– Tweaking search strategies unique to Tweaking search strategies unique to

each databaseeach database

Secondary ResourcesSecondary Resources

ClinAlertClinAlert EMBASE (Elsevier)EMBASE (Elsevier) International Pharmaceutical International Pharmaceutical

Abstracts (IPA)Abstracts (IPA) Iowa Drug Information System (IDIS)Iowa Drug Information System (IDIS) Journal WatchJournal Watch Lexis-NexisLexis-Nexis MEDLINE / PubMedMEDLINE / PubMed

Primary LiteraturePrimary Literature

Primary researchPrimary research– Journal articles that are:Journal articles that are:

Case reportsCase reports Drug studiesDrug studies Original reports of dataOriginal reports of data

– Meta-analysis?Meta-analysis?– Unpublished studiesUnpublished studies

Primary Literature Primary Literature ConsiderationsConsiderations

Evaluating the basicsEvaluating the basics– Peer-reviewedPeer-reviewed– Journal reputationJournal reputation– Source of fundingSource of funding

Digging deeperDigging deeper– Study methodologyStudy methodology– Clinical relevanceClinical relevance– Patient populationsPatient populations

Primary LiteraturePrimary Literature

AdvantagesAdvantages– Most current published sourceMost current published source– Tremendous range of informationTremendous range of information– Personally assess utility/validityPersonally assess utility/validity

DisadvantagesDisadvantages– Overwhelming volumeOverwhelming volume– Interpretation of resultsInterpretation of results– Not yet vetted by expertsNot yet vetted by experts

Primary LiteraturePrimary Literature

Peer-reviewed journalsPeer-reviewed journals– JAMAJAMA– New England Journal of MedicineNew England Journal of Medicine– American Journal of Health-system American Journal of Health-system

PharmacyPharmacy– Annals of Internal MedicineAnnals of Internal Medicine

Non-peer reviewed journalsNon-peer reviewed journals– SupplementsSupplements– Pharmacy TodayPharmacy Today

What’s the difference?What’s the difference?

Ease of UseEase of Use

Tertiary Tertiary

SecondarySecondary

PrimaryPrimary

What’s the difference?What’s the difference?

Most CurrentMost Current

Primary Primary

SecondarySecondary

TertiaryTertiary

Alternate Sources of DIAlternate Sources of DI

Internet, Listservs, and medical news Internet, Listservs, and medical news briefsbriefs

Local and national professional Local and national professional organizations and meetingsorganizations and meetings

Pharmaceutical manufacturersPharmaceutical manufacturers Drug information and poison control Drug information and poison control

centerscenters

Searching StrategiesSearching Strategies

Begin broad, then narrow your searchBegin broad, then narrow your search– Start with tertiary sourcesStart with tertiary sources

Use “related articles”Use “related articles”– BibliographiesBibliographies– Secondary resource guidesSecondary resource guides

Always be sure to assess most up to Always be sure to assess most up to date information availabledate information available– Primary sourcesPrimary sources

Searching PubmedSearching Pubmed

Searching StrategiesSearching Strategies

1.1. Develop focused question and break into Develop focused question and break into partsparts

What is the question asking?What is the question asking? ““Is peptic ulcer prevention with proton Is peptic ulcer prevention with proton

pump inhibitors and NSAIDs dose-pump inhibitors and NSAIDs dose-related?”related?”

– proton pump inhibitors, dose, non-steroidal proton pump inhibitors, dose, non-steroidal anti-inflammatory agents, prevention of anti-inflammatory agents, prevention of peptic ulcer diseasepeptic ulcer disease

– Other forms of the above words and phrasesOther forms of the above words and phrases

Searching StrategiesSearching Strategies

Putting together an answerable Putting together an answerable question is key to successful question is key to successful evidence-based medicine practiceevidence-based medicine practice– Use PICO methodUse PICO method

Patient or problemPatient or problem InterventionIntervention Comparative interventionComparative intervention OutcomeOutcome

Be Specific!Be Specific!

Example: PICOExample: PICO What is the What is the

minimum or minimum or maximum dose of maximum dose of NSAIDs at which NSAIDs at which

proton-pump proton-pump inhibitors are inhibitors are

effective for peptic effective for peptic ulcer disease ulcer disease prophylaxis?prophylaxis?

Patient or Patient or problemproblem

InterventionIntervention

ComparisonComparison

OutcomeOutcome

Searching StrategiesSearching Strategies

2.2. Read up on the basics of the Read up on the basics of the questionquestion

Start with tertiary resources for Start with tertiary resources for foundationfoundation

Build on information gathered from texts, Build on information gathered from texts, review articles, and drug databases with review articles, and drug databases with a primary literature searcha primary literature search

Searching StrategiesSearching Strategies

3.3. Gather as many articles as possible Gather as many articles as possible for all of the parts of the searchfor all of the parts of the search

Use MeSH headings to help narrow or Use MeSH headings to help narrow or broaden your searchbroaden your search

MeSH = Medical Subject HeadingsMeSH = Medical Subject Headings– Official indexing terms for MEDLINEOfficial indexing terms for MEDLINE

Searching Databases: Basic Searching Databases: Basic BooleanBoolean

““AND”AND”– Combines 2 terms (shrinks search)Combines 2 terms (shrinks search)

““OR”OR”– Gives database more choices (broadens Gives database more choices (broadens

search)search)

““NOT”NOT”– Limits search (removes undesired terms)Limits search (removes undesired terms)

Basic BooleanBasic Boolean

Both words must be present in results

paroxetine AND suicide

Basic BooleanBasic Boolean

Either word can be present in results

paroxetine OR suicide

Basic BooleanBasic Boolean

The first but not the second term will be present in the results

paroxetine NOT suicide

Pubmed Search Pubmed Search ExampleExample

What is the minimum or maximum dose What is the minimum or maximum dose of NSAIDs at which proton-pump of NSAIDs at which proton-pump

inhibitors are inhibitors are effective for peptic ulcer disease effective for peptic ulcer disease

prophylaxis?prophylaxis?

Search keywordsSearch keywords

Proton pump inhibitors and dose and Proton pump inhibitors and dose and non-steroidal anti-inflammatory non-steroidal anti-inflammatory agentsagents

proton pump inhibitors and dose and proton pump inhibitors and dose and non-steroidal anti-inflammatory non-steroidal anti-inflammatory agents and prevention of peptic ulcer agents and prevention of peptic ulcer diseasedisease

MeSH term search: PPIs, NSAIDs, PUDMeSH term search: PPIs, NSAIDs, PUDhttp://www.ncbi.nlm.nih.gov/pubmed/19240698

ResourcesResources Adapted from lectures by Bridget Protus, PharmD, CGP, MLS Adapted from lectures by Bridget Protus, PharmD, CGP, MLS

delivered 1/2010.delivered 1/2010.

Thrower MR. Literature retrieval and Finding Resources Thrower MR. Literature retrieval and Finding Resources Electronically. In: Felkey BG, Fox BI, Thrower MR. Electronically. In: Felkey BG, Fox BI, Thrower MR. Health Health care informatics: a skills-based resourcecare informatics: a skills-based resource. Washington DC: . Washington DC: American Pharmacists Association; 2005. p. 191-228.American Pharmacists Association; 2005. p. 191-228.

West, PM. Literature evaluation. In: West, PM. Literature evaluation. In: Pharmacotherapy self-Pharmacotherapy self-assessment program: science and practice of assessment program: science and practice of pharmacotherapypharmacotherapy, 5, 5thth ed. (PSAP V). Kansas City: American ed. (PSAP V). Kansas City: American College of Clinical Pharmacy; 2005. p. 93-110.College of Clinical Pharmacy; 2005. p. 93-110.

Shields, KM. Drug information resources. In: Malone PM, Shields, KM. Drug information resources. In: Malone PM, Kier KL, Stanovich JE. Kier KL, Stanovich JE. Drug information: a guide for Drug information: a guide for pharmacistspharmacists, 3, 3rdrd ed. New York: McGraw Hill; 2006. p.61-101. ed. New York: McGraw Hill; 2006. p.61-101.

ResourcesResources Thrower MR. Literature retrieval and Finding Thrower MR. Literature retrieval and Finding

Resources Electronically. In: Felkey BG, Fox BI, Resources Electronically. In: Felkey BG, Fox BI, Thrower MR. Health care informatics: a skills-Thrower MR. Health care informatics: a skills-based resource. Washington DC: American based resource. Washington DC: American Pharmacists Association; 2005. p. 191-228.Pharmacists Association; 2005. p. 191-228.

West, PM. Literature evaluation. In: West, PM. Literature evaluation. In: Pharmacotherapy self-assessment program: Pharmacotherapy self-assessment program: science and practice of pharmacotherapy I, II, III. science and practice of pharmacotherapy I, II, III. Kansas City: American College of Clinical Kansas City: American College of Clinical Pharmacy; 2005. p. 93-5.Pharmacy; 2005. p. 93-5.