Process of Determining the Primary Question and the Process in Developing Appropriate Search Strategy Frances Rose L. Alcaraz*Saskin V. Barrera**BS Clinical Pharmacy
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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
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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
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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
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Determining the Primary Question
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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
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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
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Types of Drug Information Questions
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
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Types of Drug Information Questions
INDICATIONS AND THERAPEUTIC USE
• Approved drugs
• Investigational drugs• Unapproved drugs
POISONINGS
• Signs and symptoms
• Treatment
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Types of Drug Information Questions
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
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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...”
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Developing Appropriate Search Strategy
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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
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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
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Micromedex
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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)
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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
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MEDLINE
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MedlinePlus
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PubMed
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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.
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Medical Subject Headings (MeSH)
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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
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Reference
Tietze, K. J. ( 2012). Clinical Skills
for Pharmacists 3rd ed.