Drug Information Resources Lecture 5 Kanar Hidayat 2016-2017

Purpose DIR (Drug Information Resources) is a useful drug and health guide for pharmacists and other health care professionals

Different types of DIR To determine different types of sources is depending on the originality of the information and proximity to the source of information. Primary Resources Secondary Resources Tertiary Resources http://hsl.lib.umn.edu

Primary Resources This type of resource is original material/ information which is not changed. Is written by author(s) own words. Which means is a type of literature which other researches are based on the information or the material given from this type of literature. It consists of clinical research studies and reports, both published and unpublished

Primary Resources Original research articles Conference Papers Theses Many kinds of study designs Clinical trials Cohort studies Case series Case reports Conference Papers Theses Patents

Primary Resources Advantages: Current information and original It could be the only source of information for a new drug. Many articles undergo “peer-review process”.

Primary resources Disadvantages Misleading conclusions based on one trial Time needed to evaluate large volume of literature available Limited in capacity Complex, hard to interpret Current information needs time for acceptance throughout medical community

Secondary resources This type of source is indexing (giving bibliographic citation information) or abstracting the primary literature Most of this type are accessible online. Search limitation could be by language, year of publication, type of journal or type of article.

Secondary resources Examples Pubmed Toxline International Pharmacy Abstracts National Cancer Institute Cinahl Cochrane database of systematic reviews Pharmacy letter Embase Google Scholar Medline: National Library of Medicine

Secondary resources Advantages: Quick access to the primary literature Many primary resources consult to write 1 article The journal resources are peer reviewed and of high standard

Secondary Resources Disadvantages Each database is different in the time between publication and addition in to the secondary sources. The number of journals are different in each system depends on the available database Because of the large amount of information, one must be proficient in searching of useful information needed.

Tertiary resources This type of literature include primary and secondary literature information which has been collected and distilled. Drug information is generally well- established information which is accepted and approved by the FDA ( Food and Drug Administration)

Tertiary Resources Examples Textbooks Compendia Encyclopedias Reference books Other general information that might be found on the internet

Tertiary Resources Advantages: Convenience and accessible Fast and Easy to use Citations to primary and secondary sources Information is well accepted in medical practice. ( undergo reviewing)

Tertiary Resources Disadvantages less current information Incomplete information due to space restrictions and incomplete literature search by the author Possible errors in translation, human bias, incorrect interpretation of information or lack of capability of authors.

Clinical Decision Support System (CDSS) Lecture 6 Kanar Fadhil Hidayat MSc 2016-2017

CDSS A (computer) system intended to provide clinical decision support(CDS) to clinicians, caregivers, and healthcare consumers. It could be in the form of an alert, reminder, recommendation, or informational notification regarding a patient. Automated CDSS includes a knowledge base(which contains stored facts and algorithmic logic method), an event monitor(data from a laboratory), and a communication system to the end user.

Computerized Provider Order Entry (CPOE) Automated portion of a clinical information system(e.g. PIS) that enables patient’s care provider to enter an order for a medication, clinical laboratory, radiology test, or procedure directly into the computer.

Types of Clinical Decision Support Systems Patient- Specific CDSS Commercial drug-interaction alerting systems. These are most common is CPOE and pharmacy information systems and provide alerts for drug- allergy, drug-drug, drug-pregnancy, and other kind of alerts.

The possible outcomes from this kind of alerting system True-Positive: produces an alert. Example: an allergy warning appears when penicillin is prescribed for a patient with a beta lactam allergy. Alert is relevant and clinician needs to see it. 2. False-Positive: produces an alert. Example: a duplicate drug warning for a patient appropriately prescribed two antibiotics. Clinician considers this alert an inconvenience and does not need to see it.

The possible outcomes from this kind of alerting system 3. True-Negative: produces no alert. Example: no alert fires when penicillin is ordered on a patient who has no beta lactam allergy. Clinician do not need to see an alert, there is no problem. 4. False-Negative is really a True-Positive, but produces no alert. Example: NO allergy warning for a patient with allergy, because the allergy is undocumented. The alert would be relevant and there is risk of harm.

Types of Clinical Decision Support Systems Non- Patient-Specific CDSS - These require a clinician to adapt general information to an individual patient and clinical situation.

Clinical Rules Clinical Rules is a real-time decision support module, which focuses on medication safety based on an in-depth risk profile of the patient.  Using clinical rules is a possible strategy to improve the CDSS. These rules generate alerts based on all patient characteristics available in the e- health record, e.g. laboratory values, dosage, the use of other drugs, etc.

Clinical Rules The aim of introducing clinical rules is improving patient safety by a better detection of risk situations and optimization of the relevance of alerts.

Clinical Rules

What is the Cognitive Process? Evaluate current therapy Add or discontinue medications Evaluate whether proper monitoring of medication is being done.