learning goals to understand the magnitude of drug information available today to understand the...
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Learning GoalsLearning Goals
To understand the magnitude of drug To understand the magnitude of drug information available todayinformation available today
To understand the differences To understand the differences between primary, secondary, and between primary, secondary, and tertiary resourcestertiary resources
To be able to classify questions as To be able to classify questions as background or foregroundbackground or foreground
• There are three categories (types) of drug information resources based upon their proximity to the original source of information:
Resource Types:Resource Types:
Primary Primary
SecondarySecondary
TertiaryTertiary
Primary ResourcesPrimary Resources
Scientific journalsScientific journals
Provide original studies or reportsProvide original studies or reports
E.g. Clinical trial, case series, case reportE.g. Clinical trial, case series, case report
Good for foreground questionsGood for foreground questions
Scope is narrowScope is narrow
Good when topic is new or new data has Good when topic is new or new data has been publishedbeen published
• This type of resource is considered to be the most current source of information and forms the basis for the practice of evidence-based medicine
• evidence-based medicine, which is defined as the conscientious, explicit, and judicious use of current best evidence along with clinical expertise and patients’ values in making clinical decisions about the care of individual patients
Primary ResourcesPrimary ResourcesPros:Pros:
Most current evidenceMost current evidence
Provide data on new drugsProvide data on new drugs
Can personally assess validity of studiesCan personally assess validity of studies
Cons:Cons:May not lead one to best decision because of limited scopeMay not lead one to best decision because of limited scope
Data can be poor or controversialData can be poor or controversial
Every study has limitationsEvery study has limitations
Too complex for patientsToo complex for patients
Secondary ResourcesSecondary Resources
Bibliographic databases that provide abstracts or Bibliographic databases that provide abstracts or full-text of studies full-text of studies
Good for foreground questionsGood for foreground questions
• Secondary resources serve as gateways to primary drug information resources
• These include indexing services, which provide bibliographic citation information, and abstracting services, which—along with the bibliographic citation information—provide a brief synopsis of each article.
• Most of these services are available in an electronic format
Tertiary ResourcesTertiary Resources
Compilations of knowledge in the fieldCompilations of knowledge in the field
E.g. Textbooks, handbooks, online drug compendiaE.g. Textbooks, handbooks, online drug compendia
Good for background questionsGood for background questions
Scope is broadScope is broad
• summarize and interpret the primary literature• the most common types of references
pharmacist will utilize.• good starting point when researching a drug
information question• excellent sources for gaining an
understanding of a new topic.• include textbooks, review articles, and other
general data.
• time associated with publication, which may be as long as one to two years . or some of the information may be outdated, particularly if new guidelines or new material has been released since the time of publication of the reference
• the information provided may be incomplete due to space limitations or because of incomplete literature searches performed by the author(s) of the material.
• consider when utilizing these resources are the expertise of the author, purpose of the book, edition and year of publication, references cited, ease of use, and format in which the information is being obtained.
When trying to answer a clinical question, the best strategy is often to When trying to answer a clinical question, the best strategy is often to consult resources in the following order:consult resources in the following order:
Tertiary, Secondary, PrimaryTertiary, Secondary, Primary
Tertiary resources are good when:Tertiary resources are good when:
The answer to a question is basic factual knowledge in the fieldThe answer to a question is basic factual knowledge in the field
The question was studied extensively and a conclusion was madeThe question was studied extensively and a conclusion was made
Many experts have addressed the question and agree on answerMany experts have addressed the question and agree on answer
Secondary and primary resources are good when:Secondary and primary resources are good when:
A question is new and has never been studiedA question is new and has never been studied
There is no consensus among experts; various opinions aboundThere is no consensus among experts; various opinions abound
There is conflicting evidence and the question needs further studyThere is conflicting evidence and the question needs further study
Resource TableResource Table
Primary
Resources
JAPhA JAMA Pharmacotherapy
New England Journal of Medicine
Annals of Internal Medicine AJHP
Secondary
Resources
PubMed/Ovid MEDLINE
Cochrane Database of Systematic Reviews
Tertiary
Resources Drug Facts and Comparisons
Epocrates Lexi-Comp Micromedex
Clinical Pharmacology
Background v. Foreground QuestionsBackground v. Foreground Questions
Background QuestionsBackground Questions
Question is broad in scopeQuestion is broad in scope
Answer is general knowledge in fieldAnswer is general knowledge in field
Can best be addressed with tertiary resourcesCan best be addressed with tertiary resources
E.g. Is a drug available in the U.S.?E.g. Is a drug available in the U.S.?
What is a drug’s mechanism of What is a drug’s mechanism of action?action?
When is a drug contraindicated?When is a drug contraindicated?
Foreground QuestionsForeground Questions
Question is narrow in scopeQuestion is narrow in scope
Answer may require examining new or conflicting evidenceAnswer may require examining new or conflicting evidence
Can best be addressed with secondary and primary resourcesCan best be addressed with secondary and primary resources
E.g. How effective is a new drug when compared to E.g. How effective is a new drug when compared to
drugs that are already on the market?drugs that are already on the market?
Are there clinical trials supporting an off-label Are there clinical trials supporting an off-label use of a use of a
drug in a specific population?drug in a specific population?
Lab sessionLab session
• Use internet to locate – One primary reference– One secondary reference– One tertiary reference
• Write title and brief description of each one on your logbook.
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