UBC Pharmacy Residents 2013
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

UBC Pharmacy Residents 2013

on

  • 26,880 views

The powerpoints we used for the pharmacy residents 2013

The powerpoints we used for the pharmacy residents 2013

Statistics

Views

Total Views
26,880
Views on SlideShare
25,315
Embed Views
1,565

Actions

Likes
0
Downloads
6
Comments
0

5 Embeds 1,565

http://blogs.ubc.ca 797
http://hlwiki.slais.ubc.ca 752
http://cloud.feedly.com 14
https://www.google.com.au 1
http://webcache.googleusercontent.com 1

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

CC Attribution-NonCommercial-ShareAlike LicenseCC Attribution-NonCommercial-ShareAlike LicenseCC Attribution-NonCommercial-ShareAlike License

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • P = Patient, Problem, Population  (How would you describe a group of patients similar to you? What are the most important characteristics of the patient?) I = Intervention, Prognostic Factor, Exposure  (What main intervention are you considering? What do you want to do with this patient? What is the main alternative being considered?) C = Comparison (Can be None or placebo.)  (What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests?) O= Outcome  (What are you trying to accomplish, measure, improve or affect? Outcomes may be disease-oriented or patient-oriented.)
  • No longer has Merck Index

UBC Pharmacy Residents 2013 Presentation Transcript

  • 1. Using the UBC Library & finding drug information Dean Giustini, UBC Library Kathy McInnes, DPIC July 2013
  • 2. Systematic approach to drug information 1. Obtain demographics of requestor 2. Obtain background information for the situation 3. Determine and categorize the ultimate question 4. Develop strategy, conduct search 5. Critically evaluate information 6. Formulate and provide response 7. Follow-up, document http://hlwiki.slais.ubc.ca/index.php/UBC_Pharmacy_Handout_2013
  • 3. Systematic approach to drug information 1. Obtain demographics of requestor 2. Obtain background information 3. Determine and categorize the ultimate question 4. Develop strategy, conduct search 5. Critically evaluate information 6. Formulate and provide response 7. Follow-up, document
  • 4. Drug Information Categories • Therapeutics • Dosage/route • Adverse Drug Reaction • Pregnancy • Lactation • Identification • Availability • Compatability • Pharmacology • Pharmacokinetics • Ingredients • Alternative/complementary therapies Can I use diltiazem to manage focal atrial tachycardia?
  • 5. Drug Information Categories • Therapeutics • Dosage/route • Adverse Drug Reaction • Pregnancy • Lactation • Identification • Availability • Compatibility • Pharmacology • Pharmacokinetics • Ingredients • Alternative/complementary therapies Which of this patient’s medications can exacerbate ulcerative colitis?
  • 6. Drug Information Categories • Therapeutics • Dosage/route • Adverse Drug Reaction • Pregnancy • Lactation • Identification • Availability • Compatibility • Pharmacology • Pharmacokinetics • Ingredients • Alternative/complementary therapies What are the risks to the fetus from accidental exposure to MMR vaccine in the first trimester?
  • 7. Drug Information Categories • Therapeutics • Dosage/route • Adverse Drug Reaction • Pregnancy • Lactation • Identification • Availability • Compatibility • Pharmacology • Pharmacokinetics • Ingredients • Alternative/complementary therapies Can Arnica tablets cause bradycardia?
  • 8. Systematic approach to drug information 1. Obtain demographics of requestor 2. Obtain background information 3. Determine and categorize the ultimate question 4. Develop strategy, conduct search 5. Critically evaluate information 6. Formulate and provide response 7. Follow-up, document
  • 9. PICOP - Patient problem I – Intervention C – Comparator or control O - Outcome • The PICO framework was developed for intervention/therapy questions. • Helps clearly define the clinical question and guides selecting terms for searching. • A clinical question is more likely to be answered if at least the Intervention and the Outcome are specified. • Not all questions fit neatly into the PICO framework… not necessary for “background” questions.
  • 10. Where do you begin? • General  specific • Background knowledge  foreground knowledge • Tertiary  primary Textbooks/e- books Point-of-care tools Consult secondary sources (Medline, Embase, Cochrane) to get to primary literature General knowledge about illness or disease General knowledge about illness or disease Specific knowledge to inform clinical decisions Specific knowledge to inform clinical decisions
  • 11. E-Books @ UBC Library
  • 12. Access Medicine 40 titles (e-Books) • G&G Pharmacologic Basis of Therapeutics • Katzung Basic & Clinical Pharmacology • Olson’s Poisoning & Drug Overdose • Harrison’s Principles of Internal Medicine
  • 13. Books@OVID 15 titles • Briggs Drugs in Pregnancy & Lactation (8th ) • Wallach Interpretation of Diagnostic Tests • Oski’s Pediatrics • Marino The ICU Book
  • 14. MD Consult Core Collection 40 texts, 78 journals, practice guidelines etc. • Haddad & Winchester Clinical Management of Poisoning & Drug Overdose • Palliative Medicine • Mandell Principles & Practice of Infectious Disease • Pediatrics – Harriet Lane Handbook; Nelson textbook of pediatrics
  • 15. Medicines Complete Three excellent texts • AHFS Drug Information • References included in electronic version • Monthly updates • Martindale: The Complete Drug Reference • Quarterly updates • Stockley’s Drug Interactions • Quarterly updates Sorted by class Sorted by therapeutic use or alphabetically Sorted by class or alphabetically
  • 16. Other ebooks • STAT!Ref platform has changed (May 2013) • ACP Medicine (American College of Physicians) • Various medical topics • Red Book: Report of Committee on Infectious Diseases (Pediatric Resource) • Vaccine information; care of children in special circumstances • Summary of Infectious Diseases
  • 17. Natural Standard • Covers herbal medications • International research collaboration • Has evidence grades • Peer-reviewed • References included • Updated daily
  • 18. E-therapeutics • Therapeutic Choices • e-CPS • Clin Info • Clinical monitoring tools • Drug interactions with food • Drug use guides (dentistry, pregnancy, lactation) • Info on latex and nonmedicinal ingredients • Drug Interactions (Lexi-Interact)
  • 19. Don’t forget print!
  • 20. Mobile apps • Available for smart phones and tablets • Micromedex (PHSA has this) • Differs from online 2.0 version. DI is free. • Dosing, MOA, available strengths, kinetics, IV compatibility, toxicology • Lexicomp (LMPS – not sure about others) • Same info as online product. Not free. • Drugs, infectious diseases, patient education information • Interactions, iv compatibility, toxicology • Medscape • Same as online version. Both are free. • Drug monographs (not detailed), drug interaction checker, medical conditions, procedures • News – can subscribe to daily news
  • 21. Limitations • Lag time • Check frequency of editions, updates, most recent references cited • Incomplete information • Consider depth and scope • Authorship • Qualifications and expertise
  • 22. Clinical Practice Guidelines • British Columbia- guidelines from MOH and BCMA • www.bcguidelines.ca • Can download all or access via computer or mobile device (iPod/iPhone app no longer being supported) • Provides guidelines via topics as well as patient information guides, flow sheets and summaries • “GPAC has engaged practicing physicians in B.C. - including general practitioners and specialists - to evaluate clinical evidence, and publish clinical practice guidelines on numerous conditions, with particular focus on circumstances in British Columbia.”
  • 23. Clinical Practice Guidelines • CMA Infobase: Clinical Practice Guidelines • http://www.cma.ca/cpgs • Canadian Medical Association • 1200 publicly accessible evidence based CPG developed by medical or health organizations in Canada • Developers are national or provincial agencies • Can search by conditions, specialties
  • 24. Clinical Practice Guidelines • National Guidelines Clearinghouse • http://www.guideline.gov • US based • TOPIC: disease/condition; treatment/intervention; health services administration • Organization • May be useful when local or national guidelines are not available • NICE Guidance (National Institute for Health and Clinical Excellence) • http://www.nice.org.uk/guidance/index.jsp?action=find • NICE Pathways (http://pathways.nice.org.uk) • Interactive. Brings all related NICE products on a topic in a single interface
  • 25. Clinical Practice Guidelines • SIGN (Scottish Intercollegiate Guidelines Network) • http://www.sign.ac.uk • Search by topic or assigned guideline number • Easy to see if current, out of date or withdrawn • Levels of evidence provided • Apps available for smart phones; iPad • TRIP Database (Turning Evidence into Practice) • http://www.tripdatabase.com • Clinical search engine to find high-quality research evidence to support practice • Meta database – combs through all guidelines • Guidelines from around the world • PICO search; Advanced search
  • 26. Point of Care Tools
  • 27. Point of Care Tools (Subcription needed for full access) (free but need login) In UBC Library In UBC Library In UBC Library
  • 28. • From BMJ • Subscription based • App is $49.99 (Clinical Evidence Unbound) • 2000 treatments for over 200 medical conditions “Clinical Evidence comprises an international database of high-quality, rigorously developed systematic overviews assessing the benefits and harms of treatments, and a suite of EBM resources and training materials.”
  • 29. • Clinical reference database with more than 3100 evidence based clinical summaries update daily • App for smart phones, tablets
  • 30. • AKA Medscape • http://emedicine.medscape.com • Free but need to register • “Medscape from WebMD offers specialists, primary care physicians, and other health professionals the Web's most robust and integrated medical information and educational tools. After a simple, 1-time, free registration, Medscape from WebMD automatically delivers to you a personalized specialty site that best fits your registration profile.”
  • 31. • Access via UBC Library • “Evidence is summarized where possible from systematic reviews of primary research. The main source of evidence has been from the Cochrane Collaboration, which provides highly structured systematic reviews, with evidence included or excluded based on explicit quality-related criteria, and often using meta-analyses to increase the power of the findings of numerous studies.” • “In the absence of such aggregated trial data, where appropriate, there may be inclusion of individual research papers retrieved from Medline and Embase in order to identify the highest quality evidence for specific medical therapies in
  • 32. • www.uptodate.com • Subscription required • Free area (but need to register: www.freeuptodate.com) • “The knowledge contained in UpToDate is evidence-based and continuously updated, but it is not merely an aggregation and report of the latest research; UpToDate presents a comprehensive synthesis of the evidence, followed by recommendations that can be acted on at the point of care.”
  • 33. Point-of-Care tools Ketchum AM, et al. Type of evidence behind point-of-care clinical information products: a bibliometric analysis. J Med Internet Res. 2011; 13(1):e21. “… summary products, such as POC products, vary in content as determined by differences in literature cited for the same topics in different products, quality regarding types of evidence cited, and currency. There are no standards for guidance on developing content for these products. Users should be aware of this and judiciously appraise POC product information content when using resources to obtain information for applying evidence-based practice principles.”
  • 34. Clinical trial registries Why? •Need to consider all the available evidence in decision making •Publication bias and selective reporting are barriers •Avoid unnecessary duplication of studies and identify gaps in research •Increase awareness of ongoing research – Facilitate recruitment and collaboration •Data checking as part of the registration process may improve quality WHO International Clinical Trials Registry Platform (ICTRP) http://www.who.int/ictrp/trial_reg/en/index.html
  • 35. Clinical trials registries Primary registries Meta registries *
  • 36. Clinical trials registries WHO 20-item minimum data set Some registries offer more information and bonus features, e.g. links to publications, added annotations; pediatric, geographical and active/complete/resulted filters; international language searching
  • 37. Clinical trials registries Limitations • Less than ½ of trials registered at ClinicalTrials.gov are published in peer-reviewed journals within 30 months of completion. Median time to publication for those trials that were published: 23 months. ~1/3 of registered trials remain unpublished after median of 51 months after completion. • Despite guidelines, details on therapy and info on outcomes sometimes or often missing. •Other examples… Viability of some registries… e.g. Current Controlled Trials Ross JS et al. BMJ. 2012; 344:d7292. Viergever & Ghersi. PLoS ONE. 2011; 6(2): e14701. doi:10.1371/journal.pone.0014701
  • 38. International Pharmaceutical Abstracts (IPA) • Who: Thomson Scientific and American Society of Health- System Pharmacists • What: 300,000+ records from around the world incl. all 50 State pharmacy journals • Why: Pharmacy practice and admin, compounding and stability, herbal and alternative therapy; conference coverage • Where: OvidSP • How: keyword searching
  • 39. Grey literature • Adverse drug reactions/pharmacovigilance • National pharmacovigilance programs • search Reactions Weekly (via IngentaConnect) • Health Technology Assessments • CADTH, FDA, EMA, UK • Scientific discussion papers – insider look at unpublished data made available to regulators For more information: http://hlwiki.slais.ubc.ca/index.php/Grey_literature