1. Drug Information Resources
Lecture 5
Kanar Hidayat

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

3. 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

4. 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It consists of clinical research studies and reports, both published and unpublished

5. 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

6. 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”.

7. 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

8. 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.

9. 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

10. 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

11. 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.

12. 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)

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

14. 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)

15. 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.

16. Clinical Decision Support System (CDSS)
Lecture 6
Kanar Fadhil Hidayat MSc

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. Clinical Rules

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