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Informatics for Pharm D students

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Informatics for Pharm D students

  1. 1. Informatics for Pharm D students Amy Beaith, Pharmacy Liaison Librarian University of Toronto, July 3 rd , 2007
  2. 2. Overview <ul><li>Defining Informatics </li></ul><ul><li>Program objectives </li></ul><ul><li>Roles/Responsibilities  Clinical/ Informatics Skills </li></ul><ul><li>Case of the week </li></ul><ul><li>PubMed vs. MEDLINE </li></ul><ul><li>Limits </li></ul><ul><li>Combining search terms: </li></ul><ul><ul><li>AND, OR, NOT </li></ul></ul><ul><li>Additional resources </li></ul>
  3. 3. Health Informatics -Defined <ul><li>“ Health informatics or medical informatics is the intersection of information science , computer science and health care . It deals with the resources, devices and methods required to optimize the acquisition, storage, retrieval and use of information in health and biomedicine. Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems.” Wikipedia. 2007. http://en.wikipedia.org/wiki/Medical_informatics </li></ul>
  4. 4. Pharmacy Informatics - defined <ul><li>“ Pharmacy informatics (PIX) , also referred to as pharmacoinformatics , is the application of computers to the storage, retrieval and analysis of drug information…within health care with a focus on pharmaceutical care and improved patient safety.” Wikipedia. 2007 http://en.wikipedia.org/wiki/Pharmacy_informatics </li></ul>
  5. 5. Pharm D program <ul><li>“ The primary objective of the Pharm.D. program is to graduate individuals who can provide and promote excellence in patient-focused care based on the philosophy of pharmaceutical care.” ( U of T website) </li></ul><ul><li>This means that by the time you graduate, you will have gained the skills, knowledge, and expertise to become effective: </li></ul><ul><ul><li>Clinical experts (pharmacology, pharmacokinetics, etc.) </li></ul></ul><ul><ul><li>Managers/Directors </li></ul></ul><ul><ul><li>Communicators & Collaborators </li></ul></ul><ul><ul><li>Scholars </li></ul></ul>
  6. 6. Pharm D program cont’d References: Sandra Langlands, “Health Informatics Instruction”, October 2006 & Suzanne Miranda “Information Literacy & CanMED Roles”, June 2007. <ul><li>Work with </li></ul><ul><li>physicians & </li></ul><ul><li>health professionals </li></ul><ul><li>Prescribe meds. </li></ul><ul><li>Write texts, review </li></ul><ul><li>articles </li></ul><ul><li>Director or manager </li></ul>Responsibilities <ul><li>Topic  question </li></ul><ul><li>Access, search, information </li></ul><ul><li>Evaluate, critically appraise information </li></ul><ul><li>Collaboration </li></ul><ul><li>Communication </li></ul><ul><li>Integrate sources of knowledge with specific facts of a case </li></ul><ul><li>Reflect on and document the learning process. Learn to identify your information gaps </li></ul>Informatics skills <ul><li>Knowledge of IPE & </li></ul><ul><li>collaboration </li></ul><ul><li>Communication </li></ul><ul><li>Knowledge of therapeutics, </li></ul><ul><li>pharmacokinetics, etc. </li></ul><ul><li>- Critical appraisal </li></ul><ul><li>Leadership </li></ul><ul><li>Management, health </li></ul><ul><li>systems, health policy, etc. </li></ul><ul><li>Educate/instruct/mentor </li></ul>Clinical Practice Skills <ul><li>Pharmacology </li></ul><ul><li>Expert </li></ul><ul><li>Communicator </li></ul><ul><li>Collaborator </li></ul><ul><li>Director/Manager </li></ul><ul><li>Scholar </li></ul>Roles
  7. 7. Informatics in the workplace Evaluate Find Appraise Apply
  8. 8. Case of the week (Evaluate) <ul><li>Characteristics: 55+ year old female patient, postmenopausal. She was assessed for the presence of osteoporosis. Decision made to begin a therapeutic regimen of a bisphosphonate to prevent onset of osteoporosis. Patient is reluctant to take the medication because a friend of hers was given a drug for her osteoporosis and her jaw became very sore and some of her teeth became loose. </li></ul><ul><li>What do we need to know? </li></ul><ul><ul><li>Medication history of patient? i.e. is she taking any corticosteroids, etc. </li></ul></ul><ul><ul><li>Risk of jaw osteonecrosis for patients on bisphosphonates? Other adverse effects? </li></ul></ul><ul><ul><li>Length of therapy? </li></ul></ul><ul><ul><li>… </li></ul></ul><ul><li>Topic  question </li></ul><ul><ul><li>For a post-menopausal patient taking bisphosphonates for osteoporosis prevention, what is the risk of jaw necrosis? What is the recommended length of therapy of bisphosphonates for osteoporosis prevention? </li></ul></ul>
  9. 9. PICO Model Osteoporosis prevention, assess/eval. risk of jaw necrosis None Bisphosphonates Female, post-menopausal, at risk of osteoporosis Search terms <ul><li>e-books </li></ul><ul><ul><li>e-CPS </li></ul></ul><ul><li>Databases </li></ul><ul><ul><li>PubMed </li></ul></ul><ul><ul><li>MEDLINE </li></ul></ul><ul><ul><li>EMBASE </li></ul></ul><ul><ul><li>MEDLINEplus </li></ul></ul>Information Tools O= Outcome(s) C= Comparison I = Intervention P= Patient, problem, population Elements
  10. 11. Search Tips <ul><li>Before searching information resources: </li></ul><ul><ul><li>Develop a PICO model </li></ul></ul><ul><ul><li>List synonyms for: conditions, drugs, etc. </li></ul></ul><ul><ul><ul><li>Bisphophonates </li></ul></ul></ul><ul><ul><ul><ul><li>Alendronate, Risedonate, Itidronate </li></ul></ul></ul></ul><ul><ul><ul><li>Jaw necrosis </li></ul></ul></ul><ul><ul><ul><ul><li>Osteonecrosis, bone necrosis, osteonecrosis of the jaw/mandible </li></ul></ul></ul></ul><ul><ul><ul><li>Think about: </li></ul></ul></ul><ul><ul><ul><ul><li>What are you using the information for? Patient education, treatment guidelines/policies, clinical education/instruction </li></ul></ul></ul></ul><ul><ul><ul><ul><li>How you want to combine your search terms </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Terminology: Natural vs. controlled language terms (i.e. keyword or MeSH) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Ways you can apply limits to your search results, etc. (pub year, language, type of study) </li></ul></ul></ul></ul>
  11. 12. Searching e-CPS
  12. 13. Searching e-CPS
  13. 14. Searching e-CPS
  14. 15. e-CPS: Bisphosphonates (Find)
  15. 16. MEDLINE vs. PubMed <ul><li>Medline : </li></ul><ul><li>Covers over 3900 biomedical journals, majority English language publications with North American emphasis </li></ul><ul><li>More limit features available through Ovid Medline </li></ul><ul><li>Different interfaces e.g. Ovid, PubMed </li></ul><ul><li>Can search using MeSH headings and/or keywords </li></ul><ul><li>PubMed : </li></ul><ul><li>is more up to date than Ovid </li></ul><ul><li>automatically searches keywords as well as MeSH headings </li></ul><ul><li>Great tools: Clinical queries, related articles, etc. </li></ul><ul><li>Sophisticated searches may be easier to manipulate in OVID MEDLINE </li></ul>
  16. 17. EMBASE <ul><li>Covers 3500+ international journals </li></ul><ul><ul><li>European, UK, Canadian content </li></ul></ul><ul><ul><li>Indexes more drug journals than MEDLINE </li></ul></ul><ul><ul><li>Good coverage of alternative medicine resources </li></ul></ul><ul><ul><li>Part of the OVID databases. (i.e. same search interface as OVID MEDLINE) </li></ul></ul><ul><ul><li>Can search using controlled vocabulary and/or keywords </li></ul></ul>
  17. 18. Searching in PubMed
  18. 19. Searching in PubMed
  19. 20. PubMed – search results
  20. 21. PubMed – details
  21. 22. EBM Pyramid University of Washington, HealthLinks. Accessed July 2 nd , 2007 from: http://healthlinks.washington.edu/ebp/ebptools.html <ul><li>How do you narrow your search results to find the best evidence? </li></ul><ul><li>Apply limits </li></ul>
  22. 23. Applying Limits (Appraise)
  23. 24. Applying limits cont’d
  24. 25. Appraise the evidence
  25. 26. Appraise the evidence cont’d <ul><li>Time to stop and assess. </li></ul><ul><ul><li>Have you found enough evidence? How comprehensive does your search need to be? </li></ul></ul><ul><ul><li>Have you checked more than 1 resource? </li></ul></ul><ul><ul><li>Can you apply the evidence to your patient situation? </li></ul></ul><ul><ul><ul><li>Treatment regimen, patient education, health professional education, etc. </li></ul></ul></ul>
  26. 27. Searching in MEDLINE
  27. 28. Searching in MEDLINE
  28. 29. Searching in MEDLINE
  29. 30. Building a search strategy
  30. 31. Building a search strategy cont’d
  31. 32. Mapping function of OVID
  32. 33. Scope notes in MEDLINE
  33. 34. Building a search strategy cont’d
  34. 35. Combining search terms <ul><li>AND, OR, NOT </li></ul><ul><ul><li>AND : is exclusive. Use this term when you want to retrieve citations that have all the terms in the same record. This narrows your search results </li></ul></ul><ul><ul><li>OR : inclusive. Use this term when you want to retrieve citations that have one or more of the terms in the same record. OR is mORe. This broadens your search </li></ul></ul><ul><ul><li>NOT : is exclusive. Use this term to eliminate a search term (use it sparingly) </li></ul></ul>
  35. 36. Combining search terms
  36. 37. Appraise the evidence
  37. 38. Applying Limits
  38. 39. Applying limits cont’d
  39. 40. Appraise the evidence
  40. 41. Apply the evidence Evaluate Find Appraise Apply
  41. 42. <ul><li>Questions? </li></ul>
  42. 43. Additional resources <ul><li>Databases: (linked on pharmacy e-resources site ) </li></ul><ul><ul><li>HealthSTAR – health policy, health administration, health management </li></ul></ul><ul><ul><li>EMBASE </li></ul></ul><ul><ul><li>International Pharmaceutical Abstracts (IPA) </li></ul></ul><ul><ul><li>Web of Science </li></ul></ul><ul><ul><li>Google Scholar ( http:// scholar.google.com ) </li></ul></ul><ul><li>Clinical Practice Guidelines: </li></ul><ul><ul><li>MEDLINE (apply limits) </li></ul></ul><ul><ul><li>EMBASE (apply limits) </li></ul></ul><ul><ul><li>InfoBase (Canadian CPG database) </li></ul></ul><ul><ul><li>National Guideline Clearinghouse (US, UK, some European content) </li></ul></ul><ul><li>Resource guides: </li></ul><ul><ul><li>Drug Information Comparison chart (Gerstein website) http://www.library.utoronto.ca/gerstein/subjectguides/drug_chart.html </li></ul></ul><ul><ul><li>Article databases by subject: pharmacy (Gerstein website) </li></ul></ul>

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