This document provides an overview of informatics for Pharm D students, including defining informatics, the objectives of the Pharm D program, roles and responsibilities, clinical and informatics skills, and using databases like PubMed and MEDLINE to search for information on a case study about the risks of jaw necrosis for a patient taking bisphosphonates to prevent osteoporosis. It demonstrates how to develop a PICO question, search for evidence, apply limits to search results, evaluate the evidence found, and apply it to answer clinical questions.

1. Informatics for Pharm D students Amy Beaith, Pharmacy Liaison Librarian University of Toronto, July 3 rd , 2007

2. Overview Defining Informatics Program objectives Roles/Responsibilities  Clinical/ Informatics Skills Case of the week PubMed vs. MEDLINE Limits Combining search terms: AND, OR, NOT Additional resources

3. Health Informatics -Defined “ 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

4. Pharmacy Informatics - defined “ 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

5. Pharm D program “ 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) This means that by the time you graduate, you will have gained the skills, knowledge, and expertise to become effective: Clinical experts (pharmacology, pharmacokinetics, etc.) Managers/Directors Communicators & Collaborators Scholars

6. Pharm D program cont’d References: Sandra Langlands, “Health Informatics Instruction”, October 2006 & Suzanne Miranda “Information Literacy & CanMED Roles”, June 2007. Work with physicians & health professionals Prescribe meds. Write texts, review articles Director or manager Responsibilities Topic  question Access, search, information Evaluate, critically appraise information Collaboration Communication Integrate sources of knowledge with specific facts of a case Reflect on and document the learning process. Learn to identify your information gaps Informatics skills Knowledge of IPE & collaboration Communication Knowledge of therapeutics, pharmacokinetics, etc. - Critical appraisal Leadership Management, health systems, health policy, etc. Educate/instruct/mentor Clinical Practice Skills Pharmacology Expert Communicator Collaborator Director/Manager Scholar Roles

7. Informatics in the workplace Evaluate Find Appraise Apply

8. Case of the week (Evaluate) 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. What do we need to know? Medication history of patient? i.e. is she taking any corticosteroids, etc. Risk of jaw osteonecrosis for patients on bisphosphonates? Other adverse effects? Length of therapy? … Topic  question 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?

9. PICO Model Osteoporosis prevention, assess/eval. risk of jaw necrosis None Bisphosphonates Female, post-menopausal, at risk of osteoporosis Search terms e-books e-CPS Databases PubMed MEDLINE EMBASE MEDLINEplus Information Tools O= Outcome(s) C= Comparison I = Intervention P= Patient, problem, population Elements

11. Search Tips Before searching information resources: Develop a PICO model List synonyms for: conditions, drugs, etc. Bisphophonates Alendronate, Risedonate, Itidronate Jaw necrosis Osteonecrosis, bone necrosis, osteonecrosis of the jaw/mandible Think about: What are you using the information for? Patient education, treatment guidelines/policies, clinical education/instruction How you want to combine your search terms Terminology: Natural vs. controlled language terms (i.e. keyword or MeSH) Ways you can apply limits to your search results, etc. (pub year, language, type of study)

12. Searching e-CPS

13. Searching e-CPS

14. Searching e-CPS

15. e-CPS: Bisphosphonates (Find)

16. MEDLINE vs. PubMed Medline : Covers over 3900 biomedical journals, majority English language publications with North American emphasis More limit features available through Ovid Medline Different interfaces e.g. Ovid, PubMed Can search using MeSH headings and/or keywords PubMed : is more up to date than Ovid automatically searches keywords as well as MeSH headings Great tools: Clinical queries, related articles, etc. Sophisticated searches may be easier to manipulate in OVID MEDLINE

17. EMBASE Covers 3500+ international journals European, UK, Canadian content Indexes more drug journals than MEDLINE Good coverage of alternative medicine resources Part of the OVID databases. (i.e. same search interface as OVID MEDLINE) Can search using controlled vocabulary and/or keywords

18. Searching in PubMed

19. Searching in PubMed

20. PubMed – search results

21. PubMed – details

22. EBM Pyramid University of Washington, HealthLinks. Accessed July 2 nd , 2007 from: http://healthlinks.washington.edu/ebp/ebptools.html How do you narrow your search results to find the best evidence? Apply limits

23. Applying Limits (Appraise)

24. Applying limits cont’d

25. Appraise the evidence

26. Appraise the evidence cont’d Time to stop and assess. Have you found enough evidence? How comprehensive does your search need to be? Have you checked more than 1 resource? Can you apply the evidence to your patient situation? Treatment regimen, patient education, health professional education, etc.

27. Searching in MEDLINE

28. Searching in MEDLINE

29. Searching in MEDLINE

30. Building a search strategy

31. Building a search strategy cont’d

32. Mapping function of OVID

33. Scope notes in MEDLINE

34. Building a search strategy cont’d

35. Combining search terms AND, OR, NOT 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 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 NOT : is exclusive. Use this term to eliminate a search term (use it sparingly)

36. Combining search terms

37. Appraise the evidence

38. Applying Limits

39. Applying limits cont’d

40. Appraise the evidence

41. Apply the evidence Evaluate Find Appraise Apply

42. Questions?

43. Additional resources Databases: (linked on pharmacy e-resources site ) HealthSTAR – health policy, health administration, health management EMBASE International Pharmaceutical Abstracts (IPA) Web of Science Google Scholar ( http:// scholar.google.com ) Clinical Practice Guidelines: MEDLINE (apply limits) EMBASE (apply limits) InfoBase (Canadian CPG database) National Guideline Clearinghouse (US, UK, some European content) Resource guides: Drug Information Comparison chart (Gerstein website) http://www.library.utoronto.ca/gerstein/subjectguides/drug_chart.html Article databases by subject: pharmacy (Gerstein website)