LIBR534 Class V Drug information sources in Canada
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LIBR534 (Module 1: Health information questions Part III)
Drug information sources; complementary and alternative medicine (CAM)
Introduce basic concepts in answering drug/CAM related questions Core issues; common issues in drug-related information
Using print resources &/or electronic equivalents Create opportunities to encounter questions, develop search strategies
Reading:
DISCUSS – REPORT BACK: Yanicke J. A suggested book list for hospital libraries. J Hosp Librarianship. 2013;13(3).
On the wiki:
COMPLEMENTARY & ALTERNATIVE MEDICINEhttp://hlwiki.slais.ubc.ca/index.php/Complementary_%26_alternative_medicine_%28CAM%29
LIBR534 Health information sources and services, Sept 2014Dean Giustini, UBC Biomedical Branch Librarian
Complementary & alternative medicine AND drug information for health librarians
“…[drug] spending in Canada is estimated to reach $35 billion dollars in 2014. Cross-Canada per capita costs average $355 per person (private spending = ~$410 per person). Non-prescribed drug costs includes OTC drugs, personal health supplies & complementary &
alternative medicine products…” ~ Canadian Institute for Health Information (CIHI)
LIBR534 Health information sources and services, 2014
Caduceus, based on the spire of Aesclapius
Bowl of Hygeia, symbol of pharmacy
Goals tonight
• Start to examine CAM & drug-related questions
• Identify main / major sources of credible information
• Assess each as a starting point
• Discuss the drug approval process in Canada
• Select appropriate sources of scientific evidence
• Begin to understand how to approach questions
LIBR534 Health information sources and services, 2014
Minerva, goddess of medicine
Complementary & alternative medicine
• Based on the wiki entry, what is complementary and alternative medicine?
• Name some types of CAM therapies?
• What do health librarians need to consider in providing info re: CAM?
https://www.youtube.com/watch?v=zPgUiBPp9mY
NCCAM YouTube Channel https://www.youtube.com/channel/UC3Y8xLrGG7Lh7smbkPZcCGQ
• In CAM, it can be difficult to distinguish between what is meant to be information & what is advertising
• Prescription drugs interact with herbal remedies; may cause adverse reactions
• Regulation of CAM products in Canada is strict(er)
• In 2014, is quackery a problem? http://quackwatch.com
Complementary (CAM) information
Health Fraud Scams (US FDA) http://youtu.be/KsPlwKbGxE8?list=PLVaOpweBregW3JGZ81r3StdH1eyjA4cpN
https://www.youtube.com/watch?v=4pXsm3qaFIk
Integrative medicine
"...Imagine a world in which medicine was oriented towards healing rather than disease; where doctors
emphasized prevention above treatment." — Andrew Weil, MD
Complementary and alternative medicine (CAM)• Any medical system, practice, or product that is not thought of as standard care
Complementary medicine• A CAM therapy used along with standard medicine
Alternative medicine• A CAM therapy used in place of standard treatments
Integrative medicine• An approach that combines treatments from conventional medicine and CAM, and for
which there is high-quality evidence of safety and effectiveness
CAM Definitions
Sources of information in CAM
Herbs at a Glance via NCCAM website
Natural Standard via naturalstandard.com
BC Cancer Agency - Complementary and Alternative Cancer Therapies (no image)
Tyler's honest herbal : a sensible guide to the use of herbs
Rakel: Integrative Medicine via MD Consult
National Center for Complementary & Alternative MedicineNCCAM Health Topics
CAM in PubMed
• Echinacea• Colds, flu
• Gingko biloba• Memory, cerebral
blood flow• Ephedra
• Stimulates heart • St. John’s Wort
• Depression
• Chamomile• Relaxant, anti-anxiety
Most popular herbal supplements
Do you have your own favourite?
10
• British Columbia Naturopathic Associationhttp://www.bcna.ca/
• Boucher Institute Of Naturopathic Medicine http://www.binm.org
• BC Government – Naturopathy Regulationshttp://www.healthplanning.gov.bc.ca/leg/notice/naturopathy.html
• Health Canada – Natural Health Branchhttp://www.hc-sc.gc.ca/dhp-mps/prodnatur/index_e.html
CAM in BC and Canada
Drug use & evaluation process
• Each country has regulatory body to govern approval process
• Each drug must be safe & effective
• Pre-clinical testing (laboratory & animals)
• Clinical testing (clinical trials in humans)
• Drug approval can take ~10-15 yrs
Clinical trials process
• Administer new drug to subjects & assess outcome (uncontrolled)
• Administer new drug to one group & a control to second group (controlled clinical trial)
• What happens to the drug in the body? • What happens to the body when given the drug? • Is the drug clinically-effective? • Is drug clinically-safe / tolerable? • How should the new drug be taken?
http://www.merck.com/clinical-trials/about-clinical-trials.html
Reference interview re: drugs / herbals
• Background information
• Let user state the research question
• Classify it (“THE” question)
• Ask appropriate background questions
• Gather extra information to determine “true” question
• Determine urgency & format needed
Classify drug question• Availability of drug• Identification of drug• Drug interactions• Dosage • Adverse drug reactions• Side effects • IV administration / compatibility • Poisoning / toxicity• Pregnancy & lactation issues• Natural products • Patient-oriented information • Therapeutics
General drug questions
• Background information
• Dosing
• Side effects, drug interactions
• Contraindications & precautions
• Pharmacokinetics & pharmacology
• How medications are supplied (tablet, injection, etc.)
• How medications are taken
• How medications should be stored Basic & Clinical Pharmacology
on AccessMedicine
Sources of drug information are tertiary sources
• Drug monograph, handbook, textbook• Background or fundamental knowledge• By prescription, OTC, herbal, foreign, cosmetics, household
product, and so on
• Organization: how is source organized?• Alphabetical, classified, faceted, by side effect?• What kind of information does it present?
• Generic, trade, chemical, investigational, formula, therapeutic class, pharmacological class
• Authority: is it referenced?• Is it regularly updated?• What is unique about source?• What types of questions might the source answer?
General drug information sources
Martindale : the complete drug referencePrint ONLY
via MedicinesComplete
American Hospital Formulary Service (AHFS) Drug Information
PDR Physicians Desk Reference
http://resources.library.ubc.ca/1147
…also via MedicinesComplete
Drug interactions – sources of information
Martindale : the complete drug referencePrint ONLY
via MedicinesComplete
Stockley’s Drug Interactions via MedicinesComplete
PDR Physicians Desk ReferencePrint ONLY
Adverse Reaction Reportinghttp://www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/index-eng.php
http://www.hc-sc.gc.ca/dhp-mps/medeff/bulletin/index_e.html
Drug portals – sources of information
Licensed Natural Health Products Database Health Canada
Canadian Agency for Drugs & Technologies in Health http://www.cadth.ca
National Library of Medicine Drug Information Portal http://druginfo.nlm.nih.gov/drugportal/drugportal.jsp
Drug & poison information sources
Olson’s Poisoning & Drug Overdose
Goldfrank’s Toxicologic emergencies
http://www.grupopamilt.com/cassarett.pdf
Casarett and Doull's toxicology: the basic science of poisons
Drugs in pregnancy – sources of information
http://toxnet.nlm.nih.gov/help/lactmedapp.htmBrigg’s drugs in Pregnancy and Lactation on Books@Ovid
Disease control & immunization sources
Canadian Immunization Guide http://www.phac-aspc.gc.ca/publicat/cig-gci/
Public Health Agency of CanadaInfection Control Guidelines
http://www.bccdc.ca/default.htm
LIBR534 Health information sources and services, 2014
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