Transcript Problems and Situations in Searching the Literature

Problems and Situations in
Searching the Literature
Objectives
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To be aware of the practical approaches to specific
situations and problems in providing drug information
services
Use of Textbooks
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Drug identification
Drug availability
Pharmaceutical compatibility
Poisoning
Drug dosing
Patient related questions
Use of abstracts
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Should be never used
The reason for this is that abstracts may contain out
of context statements and may not always provide
enough information to indicate the true content of the
original article
abstracts can be used in one situation; when an
article is published in foreign language and a
translation is not readily available
Use Of The Earlier Literature
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A search in the past 10-12 years is sufficient to
provide an adequate response to many questions
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If a drug or a therapeutic procedure has not been
mentioned in the last 10-15 years there is a
possibility that it has been proved to be ineffective
E.g. the use penicillinase in the treatment of allergic
reactions to penicillins
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Use Of The Most Current Literature
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It is necessary for provision up to date drug
information
The lag period for most secondary literature sources
Can vary from short as three months to as long a year
more.
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Use Of The Most Current Literature
InPharma
•weekly publication
• presenting abstracts from 1700 journal
•Abstracts covering All major areas of drugs
•Bibliographies on various subjects or specific drugs
from the recent literature are also published
•Lag period 2wks-3months
Use Of The Most Current Literature
MEDLINE and TOXLINE
Online
Index Medicus data base (2500 journals)
Index to Drug Literature
International Nursing Index
Lag period 1-3months
TOXLINE
 Covers all reports on adverse effects
 fee
Use Of The Most Current Literature
Current Contents-Clinical Practice
Lists the table of contents for over 725 medical and
related journals on weekly basis
 Lag period 3-6months
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When Data Cannot be Found in the
Literature
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“There have been no reports in the literature”
Extrapolate with closely related drugs in same situations
Unpublished data? (symposium)
Error in searching
– Improper use of indexing and terms and synonyms
– Misspelling of terms and names
e.g. foreign or investigational drugs and uncommon
disease states
The Complete Search
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Complete Search: every possible information source
has been covered
Depends on the type of question and the access to
the drug literature
Poison cases do not need a complete search due
to the response should be immediate
See Reference pg.148-149
Utilizing Other Information Sources
Use of Specialists
1. To provide any recent drug therapy information in
specific patient –related questions that may not be
published in the literature
2. To verify documented literature findings
 Use of Agencies
FDA,CDC and Public Health Service
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Utilizing Other Information Sources
Use of Drug Manufacture
– Ask about the availability of a drug
product
– Use unpublished available clinical data
– Drug recalls
Physcian Desk Reference (PDR)
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Investigational Drugs and non-FDA
approved indications
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The pharmacist should present complete information
depending on the literature.
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He should not hesitate in presenting unlabeled use
and the final decision must be the physician’s
Formulating A Response
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Majority of questions are answered verbally
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Only a small percentage of the questions are
prepared in a written responses
Written responses
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Depend on documenting the fact and the personnel
clinical expertise
The pharmacist should feel an equal responsibility to
the patient as to the individual requesting
They are valuable in evaluating the effect of the
service on patient care
Written Responces
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written responses are prepared for following reasons:
 to avoid duplication of work especially if the search took
a considerable time
 If the information was difficult to obtain or involved
personnel communications
 If the inquirer requests a written copy of the answer
 If the pharmacist has been asked to place the response
in the patients chart in the form of the consult
Use of Tables and Graphs
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When the response involves a large amount of data
They enable one to organize data available for
presentation over the phone more adequately
Allows the data to be presented in a logical format
Enables the inquirer to receive a summary of the
subject in an easy to read fashion
Graphs (pharmacokinetic data)
Conflicting Reports in the Literature
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Common
Depends on pharmacists skills to evaluate the
studies in the literature and discriminate between a
well designed studies and poorly designed studies
Disease stat Background Knowledge
The pharmacist must have a fundamental knowledge
Of the disease state in question before attempting to
provide a response
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Specific Problems
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Problems with Synonyms, Indexing and Medical
Terminology
The news media
Teratogenicity