biostat report.pptx

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Process of Determining the Primary Questionand the Process in Developing Appropriate

Search Strategy

Frances Rose L. Alcaraz*Saskin V. Barrera**BS Clinical Pharmacy



Introduction

Pharmacists:

Provide accurate and timely information about

medications

Answer questions about

Drug dosing, product availability, drug side effects &

drug-related issues

Need good communication skills

Have the knowledge of literature resources and ways to

access them

Have the ability to evaluate published information



Process

The components involved in the provision of drug

information include:

a. Determining the primary question

b. Developing an appropriate search strategy

c. Locating appropriate sources of information if the

question cannot be answered from previously acquired

knowledge

d. Accessing the information

e. Critically appraising the information

f. Providing a verbal or written response to the question



Determining the Primary Question



Determining the Primary Question Most questions arise as the result of a patient-specific

problem

To determine the primary question, ask the person asking

the question several clarifying questions.- Ask whether the question pertains to a specific

patient and, if so, to ask for pertinent background

patient information

- Laboratory and physical examination findings alsomay be important pertinent details

- Questions about therapeutic options may also be

required



Types of Drug Information Questions

ADVERSE DRUG REACTIONS

• Adverse reactions

• Allergies

• Teratogenicity

• Toxicology

DOSING

• Age-specific dosing

• Dosing in patients with altered organ function (liver,

• kidneys)

• Indication-specific dosing




DRUG ADMINISTRATION

• Commercial dosage form alterations (crushing, dissolving)

• Drug administration methods

• Product preparation (reconstitution, admixing,

• compounding)

• Compatibility, stability, and storage

• Timing (with or without food or enteral products)

DRUG INTERACTIONS

• Drug-disease interactions• Drug-drug interactions

• Drug-food interactions

• Drug – laboratory test interactions

• Drug-nutrient interactions




INDICATIONS AND THERAPEUTIC USE

• Approved drugs

• Investigational drugs• Unapproved drugs

POISONINGS

• Signs and symptoms

• Treatment




PRODUCT-SPECIFIC CONCERNS

• Constituents (sugars, dyes, adjuvants, alcohol)

• Formulations

• Identification

• Storage

MISCELLANEOUS

• Drug use during pregnancy and lactation

• Pharmacoeconomics

• Product-specific assays

• Veterinary drug information



Determining the Primary Question After the primary question and patient-specific details

have been identified, rephrase and restate the question

Ask clarifying questions and exchange information

A chart review and/or direct patient interview may benecessary

Determine when the answer is needed and how to contact the

person who asked the question.

“Ask for the person’s telephone or cell number or arrange to

provide information face to face at a certain time and place...”



Developing Appropriate Search Strategy



Developing Appropriate Search Strategy Drug Information Search

Complex process

Needs strategy for locating answer to the question

Appropriate Search Strategy

Think about the question

Match the question with the most appropriate

information sources



Developing Appropriate Search Strategy Questions of fact such as:

Dosage formulations

Usual dosage regimens

Dosage adjustments for patients with renal and hepatic

dysfunction

Pharmacokinetic parameters for drugs that have been marketed

for several years

Spectrum of activity of marketed antibiotics

Are best answered by

Standard drug information handbooks such as that published by

the American Hospital Formulary Service (AHFS)

Standard electronic databases such as Micromedex



Micromedex



Developing Appropriate Search Strategy Questions about :

Investigational drugs

Unapproved indications for currently marketed drugs

Unusual adverse effects

Drug interactions

Are best answered by:

MEDLINE

An online database containing approximately 18 million journalcitations from about 5000 life sciences and biomedical publications

from 1966 to the present

Compiled by the U.S. National Library of Medicine (NLM)

Published on the Internet by the Community of Science (COS)



Developing Appropriate Search Strategy PubMed

Service of the NLM and the National Institutes of

HealthA freely accessible database accessible through the

PubMed interface.

Contains more than 19 million journal citations

published from 1949 to the present



MEDLINE



MedlinePlus



PubMed



Developing Appropriate Search Strategy Key to a successful search of the published literature

Identify appropriate search terms before searching

Terms can be identified by reading about the topic

in a standard medical or pharmacy textbook or published review article or using indexing lists

NLM’s Medical Subject Headings (MeSH)

Used to index key terms for the MEDLINEdatabase

Indexing terms are generally relevant for searches

of any medical or pharmacy-related database.



Medical Subject Headings (MeSH)



Developing Appropriate Search Strategy If a search does not reveal any relevant information

There may be no information to be found

Search strategy is faulty

Literature may not have been searched far enough back in time to locate older information

Search terms were not appropriate

Consider when information about a drug is most

likely to have been published

Try other related indexing terms before deciding that

no information about the topic is available in the

published literature



Reference

Tietze, K. J. ( 2012). Clinical Skills

for Pharmacists 3rd ed.

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