Health Info Retrieval and Informatics Exam 1

Step 1 of Modified Systematic Approach

Secure requestor information

Step 2 of Modified Systematic Approach

Obtain background information

Step 3 of Modified Systematic Approach

Determine and categorize the ultimate question

Step 4 of Modified Systematic Approach

Develop strategy and conduct research

Step 5 of Modified Systematic Approach

Perform evaluation, analysis, and synthesis

Step 6 of Modified Systematic Approach

Formulate and provide response

Step 7 of Modified Systematic Approach

Conduct follow-up and documentation

Tertiary Resources

• Filtered and summarized by an author or editor. A quick, concise overview of a topic

• Textbooks, compendia, clinical guidelines, review articles, package inserts, drug databases

Secondary resources

• Searchable databases that index and abstract the literature so you can locate primary (and some tertiary) sources

• PubMed/MEDLINE, Embse, IPA, CINAHL, Cochrane Library, Google Scholar, Trip

Primary Resources

• Original clinical research and reports - published and unpublished. The most detailed information available

• Controlled trials, cohort studies, case series, case reports, meta-analyses

Strengths of tertiary resources

• Fast, convenient, complete-enough overview

• Answers most everyday questions outright

• Orients you to a topic so you can build a smarter search later

• Electronic versions are keyword-searchable

Limitations of tertiary resources

• Lag time: information may be outdated before it is published or printed

• Filtered content: transcription errors, author bias, misinterpretation, gaps

• Databases may disagree with each other on the same topic

• Mobile versions may carry less than online version

Trade-offs for primary resources

• You see the methods, so you can judge validity and applicability yourself

• Requires literature evaluation skill and can be time-intensive

• Hard to search well; easy to end up with the wrong articles

• Reading a few trials out of context can produce misleading conclusions

Gray Literature

Manufacturer medical information department, disease-specific and professional societies, news/media and newswire services, clinicaltrials.gov, content experts, general internet search

Drug Interactions

• Stockley’s

• Hansten and Horn top 100

• Lexi-Drug

• Major compendia

IV compatability and Stability

• ASHP injectable drug information

• Trissel’s 2

• King Guide

• Gahart’s

Dietary and Herbal Supplements

• Natural medicines

• Natural products database

• NIH DSLD

Toxicology and Overdose

• POISINDEX
  Lexi-tox

• Goldfrank’s

• LiverTox

• PubChem

International Products

• Martindale

• Index nominum

• DI handbook with international trade names

Adverse Effects

• Meyler’s

• Side effects of drug annual

• Clin-alert

• Reactions weekly

• FDAble

Pregnancy and Lactation

• Briggs

• LactMed

• Hale’s medications and mothers’ milk

• REPROTOX

Pediatric Dosing

• Harriet Lane

• Pediatric and neonatal dosage handbook

• Neofax

• Nelson

Availability, Pricing, and Shortages

• Red book

• Medi-span price rx

• FDA and ASHP shortage sites

Textbook-focused Tertiary databases

• STAT!Ref

• McGraw hill access

• PharmacyLibrary

STAT!Ref

• books from various publishers, mostly ASHP and APhA for pharmacy

• useful for compounding and formulation, sterile preparation, injectable drug formulation, stability, lab data interpretation, pharmacokinetics, AHFS, and self-care

AccessPharmacy

• McGraw Hill’s pharmacy collection

• useful for pharmacotherapy, pharmacology, toxicology, pharmacokinetics, drug lit evaluation, and pharmacy practice titles

AccessMedicine

• McGraw Hill’s medical collection

• useful for disease pathophysiology, diagnosis, physical findings, and lab interpretation (clinical context around a drug)

PharmacyLibrary

• APhA’s collections and the only one that carries the full Handbook of Nonprescription Drugs rather than a condensed version

• useful for self-care and non-prescription products, compounding, pharmacy calculations, and patient communication and professional practice titles

Evidence-Based Medicine (EBM)

• a systematic approach in clinical problem solving which allows for the integration of the best available research evidence with clinical expertise and patient care

• the conscientious, explicit, and judicious development and use of current best evidence in making decisions about the care of individual patients

• combines best research evidence, clinical expertise, and patient values

MeSH Definition

• Articles about practice guidelines

• works aboit directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances

Systematic Reviews

• summary of previous conducted studies

• research included in the review is identified systematically

• results are not statistically aggregated/combines

• qualitiative review

• considered tertiary literature

Meta-analysis

• aggregates data/results from earlier studies to form a new combined estimate of effect

• conclusions are based on the summarization of results obtained from combining and statistically evaluating data from previously conducted studies

• quantitative review

Cochrane/Cochrane Library

• produces systematic reviews

• publish standards for systematic review methodology

• includes reliable evidence from Cochrane and other systematic reviews, trials, and more

Conclusions changed

older systematic review was updated with new research data and the authors’ final summary or clinical advice has changes

• could be different conclusions or take-away points or new conclusions regarding direction, magnitude, or significance of events

New search

the review authors have re-run their literature search to find newly published studies

Withdrawn

article or protocol has been officially removed from the active database by Cochrane due to serious errors, scientific misconduct, or major policy conflicts. remain accessible in archive with warning to explain

Livin Systematic Review

rapidly changing topic with ongoing updates

Stable Review

older but unchanged

Protocol

planned review

PICO Search

• P - patient/population

• I - intervention

• C - comparison

• O - outcome

Boolean Operators

AND, OR, NOT

Emtree Terms

Embases’s controlled vocabulary which are used to assign subject terms to articles

PubChem

• figuring out what the chemical is

• lists synonyms, trade names, and CAS numbers for compounds

• provides information about structure, physical properties, hazard classifications, and links to toxicity data

LiverTox

• question is about suspected drug-induced liver injury and herbal or dietary supplements are among the possible exposures

• likelihood score for causeing liver injury, typical latency of liver problems, typical pattern of injury, case descriptions

POISINDEX

• standard reference for poison centers

• provides toxic dose range and pediatric thresholds, when symptoms start and how long they last, how long to observe, whether to refer to a hospital, treatment steps

Goldfrank’s Toxilogic Emergencies

• understand toxicology or prepare to teach it, not for managing a patient at point-of-care

PubMed

• questions about evidence

• MeSH terms like drug overdose, toxicology, forensic toxicology, ecotoxicology, pharmacokinetics, toxicity, poisons, poisoning,

Safety Data Sheets

• chronic occupational or environmental exposure

• will tell you what is in the product and provide other information about first-aid and toxicology

• S2 - hazard identification

• S3 - composition and ingredient concentrations

• S4 - first aid

• S11 - toxicological information

Micromedex: Tox and Drug Product Lookup

• identification of a product and its contents

• search by imprint code, color, shape, brand, generic

LexiTox

• questions that require both toxicology management and antidote information

• puts drug monograph together with toxicology management and antidote information

Case Reports

• if a particular exposure is a more recent or rate product and no related trials or large observational studied have been done

• published case reports and case series are often the only human data available

• give an anecdotal account of what can happen, not usually what happens. do not provide statistics

Hazardous Substances Drug Bank

• question is about a chemical, not a drug, and involved chronic, environmental, and occupational exposure

• contains peer reviewd records covering human toxicity, carcinogenicity, absorption and metabolism, environmental fate in air, water, or soil

• exposure standards

• emergency medical treatment

Consumer Product Information Database

• questions about specific branded consumer products

• provides lists of ingredients and health effects, links to manufacturer SDS, reverse lookup tool to search by ingredient and find products containing it

Grey Literature (Erowid, Reddit, etc.)

• some recreational drugs may have informal names that don’t show up in Lexi-Tox or POISINDEX

• confirming a chemical match in PubChem may increase confidence in identification

• Erowid provides many different names for a drug, images of recreational drugs, reported effects, patient reports about how it is used