informatics for pharm d students
TRANSCRIPT
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)