Informatics for Pharm D students

Amy Beaith, Pharmacy Liaison Librarian University of Toronto, July 3rd, 2007

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

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

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

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

Pharm D program cont’d

Roles Responsibilities Clinical Practice Skills

Informatics skills

Pharmacology

ExpertCommunicatorCollaboratorDirector/ManagerScholar

Work with

physicians &

health professionalsPrescribe meds.Write texts, review

articlesDirector or manager

- Knowledge of IPE &

collaboration - Communication- Knowledge of therapeutics,

pharmacokinetics, etc.

- Critical appraisal- Leadership- Management, health

systems, health policy, etc.- Educate/instruct/mentor

1.Topic question

2.Access, search, information

3.Evaluate, critically appraise information

4.Collaboration

5.Communication

6.Integrate sources of knowledge with specific facts of a case

7.Reflect on and document the learning process. Learn to identify your information gaps

References: Sandra Langlands, “Health Informatics Instruction”, October 2006 & Suzanne Miranda “Information Literacy & CanMED Roles”, June 2007.

Informatics in the workplace

Evaluate

Find

Appraise

Apply

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?

PICO Model

Elements Search terms Information ToolsP= Patient, problem, population

Female, post-menopausal, at risk of osteoporosis

• e-books•e-CPS

•Databases•PubMed•MEDLINE•EMBASE•MEDLINEplus

I = Intervention Bisphosphonates

C= Comparison None

O= Outcome(s) Osteoporosis prevention, assess/eval. risk of jaw necrosis

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)

Searching e-CPS

Searching e-CPS

Searching e-CPS

e-CPS: Bisphosphonates

(Find)

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 keywordsPubMed: 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

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

Searching in PubMed

Searching in PubMed

PubMed – search results

PubMed – details

EBM Pyramid

University of Washington, HealthLinks. Accessed July 2nd, 2007 from: http://healthlinks.washington.edu/ebp/ebptools.html

How do you narrow your search results to

find the best evidence?

Apply limits

Applying Limits (Appraise)

Applying limits cont’d

Appraise the evidence

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.

Searching in MEDLINE

Searching in MEDLINE

Searching in MEDLINE

Building a search strategy

Building a search strategy cont’d

Mapping function of OVID

Scope notes in MEDLINE

Building a search strategy cont’d

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)

Combining search terms

Appraise the evidence

Applying Limits

Applying limits cont’d

Appraise the evidence

Apply the evidence

Evaluate

Find

Appraise

Apply

Questions?

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)