Problems and Situations in Searching the Literature

Objectives To be aware of the practical approaches to specific situations and problems in providing drug information services

Use of Textbooks Drug identification Drug availability Pharmaceutical compatibility Poisoning Drug dosing Patient related questions

Use of abstracts 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 A search in the past years is sufficient to provide an adequate response to many questions If a drug or a therapeutic procedure has not been mentioned in the last 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

Use Of The Most Current Literature 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.

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

When Data Cannot be Found in the Literature “There have been no reports in the literature” Extrapolate with closely related drugs in same situations Unpublished data?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 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

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

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)

Investigational Drugs and non-FDA approved indications The pharmacist should present complete information depending on the literature. He should not hesitate in presenting unlabeled use and the final decision must be the physician’s

Formulating A Response Majority of questions are answered verbally Only a small percentage of the questions are prepared in a written responses

Written responses 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 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 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 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

Specific Problems Problems with Synonyms, Indexing and Medical Terminology The news media Teratogenicity