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*
The closed position. A person standing with their
arms folded would illustrate this. This is seen as a
rather negative posture and is unlikely to encourage
communication
*
Feet position. It is often found that a person’s
feet will be pointing in the direction in which he
wants t o go. This can be used to check whether
the patient is interested or wou ld rather be
elsewhere
*
Positive body posture. Leaning towards the person
who is talking or sitting in a relaxed fashion are both
examples of non-verbal language which can
encourage good communication.
Physical contact
This is an important aspect of any communication
process and can be used to enhance verbal communication. A sympathetic touch on an arm can often say
far more than any number of words. However, physical contact is governed by broad social rules which
vary greatly between cultures. The British are identified as one of the least ‘touching’ nations, while in
many cultures touching between the sexes is unacceptable. An awareness of this is important for pharmacists who will come into contact with people from
a wide variety of social and cultural backgrounds.
What is considered acceptable behaviour in one culture could be unacceptable in another.
Prescribing for minor ailments CHAPTER 22
Sociable area
This is approximately 1–3 m and is the type of distance used when communicating with people we do
not know very well.
Personal area
This is approximately 0.5–1 m. This is the space we
would normally feel comfortable with when at a business or social meeting with people we know reasonably well. It is sufficiently close to allow friendly and
meaningful communication without any individuals
feeling threatened by having their intimate zone invaded.
Intimate area
This is usually 0–50 cm. This space is reserved for
people we know very well. Husbands, wives, children,
close friends and family are examples of the kind of
people with whom we would be comfortable at these
distances. If anybody else enters this so-called ‘intimate zone’ we feel threatened and will generally
withdraw into ourselves. However, this is the space
that pharmacists must enter if they are to perform
physical examinations. This is why it is essential that
pharmacists, if performing an examination, must
gauge the level of acceptance by the patient by asking
permission to perform the procedure and explaining
what is involved.
Personal space
We all have our own space in which we feel comfortable. Personal space varies between cultures and
its extent depends on the situation. An awareness of
personal space is important for pharm acists as it can
play an important role in the success or otherwise of
communication. If you carry on a conversation with
someone at too great a distance it may be difficult to
build up any rapport. However, if you are so close to
people that they feel uncomfortable and threatened,
no meaningful dialogue will occur. The different
space z ones are generally divided into four main
areas.
General area
This is approximately 3 m or more. This is the space
we would normally prefer to have around us if we are
addressing a group of people or are working alone.
Vocal communication
Vocal communication, sometimes called paralanguage, concerns the vocal characteristics, the quality
and fluency of the voice. The quality of the voice
refers to the tone, pitch, volume and speed. Tone in
particular can convey more meaning than actual
words. ‘Thank you for asking the question’ said in
a harsh voice contradicts the words and indicates
that it is not meant. The same words in a warm tone
showsincerity.Thevolumemustbeadjustedto
the circumstances and can emphasize key words.
The speed of speaki ng must enable the listener to
understand. Varying the speed and pitch can make
the words more interesting and hold the listener’s
attention. Effective use of vocal communication
requires that we become proficient at speaking with
a warm confident tone of voice at an appropriate
speed and volume and without interruptions or
vocal mannerisms.
229
SECTION THREE Pharmacy prescribing and selection of medicines
Outcomes from the consultation
The final step in prescribingfor minor ailmentsis telling
the patient what course of action you feel is most appropriate. This could be a combination of referral to
another healthcare professional, giving advice or supplying a product. It is important that you give the patient as much information as they want or need and
this draws on your skills of counselling (see Ch. 44).
Timescales
One of the key things a patient needs to know is what is
the best course of action to take. Obviously this will
depend on a number of factors including the patient
themselves, the differential diagnosis and the severity
of the condition. As a general rule, all patients should
beadvisedonatimescalewhentheyneedtoconsult
further medical help, whether they return to the pharmacist or see another healthcare practitioner. This
allows the patient to understand the nature of the
problem and know when they should seek further
help. This will have to be gauged on a person-to-person
basis. For example, take three patients all presenting
with viral cough.Althoughthe condition is self-limiting
the timescales given to each patientcan vary. If the first
person presents after 7–10 days then you might tell
them to see the doctor in the next 5–7daysifsymptoms do not improve. The second patient has only had
symptoms for 2 days, in which case you would give
them a longer timescale. The third person might have
had symptoms for 5 days but compared to the firsttwo
patients they have severesymptoms whichwould warrant automatic referral for a second opinion. This process is known as a conditional referral.
Treatment and advice
Once a full assessment of the symptoms has been made,
and a decision made that the patient does not require
immediate referral, appropriate recommendations
should be made. Selection of an appropriate treatment
for a condition involves application of pharmacology,
therapeutics and pharmaceutics knowledge. The first
step will be to choose an appropriate therapeutic group
to recommend. The next step would be to assist the
patient in the choice of product within the therapeutic
group. For many therapeutic groups there is a wide
variety of products available, often in various combinations. The pharmacist should take into account the
efficacy, potential side-effects, interactions, cautions
and contraindications. With regard to efficacy, pharmacists should be aware that many OTC medicines have
little or no evidence base. This does not necessarily
mean they are not effective, but in today’sclimateof
evidence-based health care then products with proven
efficacy should constitute first-line treatment.
The difficulty in establishing efficacy has many
explanations and includes: products that are available
OTC predating clinical trials, a general lack of trial data
or poorly conducted trials, the placebo effect seenwith
some OTC medicines and the nature of self-limiting
conditions – is it the medicine working or the symptoms resolving on their own? Despite this, patient demand for a medicine to treat their symptoms is strong.
Recommending an OTC medicine despite inadequate
evidence of its efficacy is justifiable because many
patients have a desire to try something to give them
symptomatic relief. A negative or dismissive response
by the pharmacist to a request from a patient can
be harmful in that such patients may lose faith in the
pharmacist and exercise self-care elsewhere where
there is no qualified person to assess their symptoms.
When selecting a product, the patient’sneedsshould
be borne in mind. Factors such as prior use, formulation and dosage regimens should be considered. For
example, antacids are available in both tablets and
liquid form. Liquids tend to have a quicker onset of
action than tablets but can be inconvenient for a patient to carry around with them or take to work.
Non-drug treatment should also be offered where
appropriate. For example, providing medication for
motion sickness can be supplemented with advice on
how to reduce symptoms, for example focusing on
distant objects, not overeating before travel or sitting
in the front seat in car journeys will help to reduce
symptoms. Advice on increasing dietary fibre and
fluids is an essential part of the management of conditions such as constipation and haemorrhoids. Certain
situations where pharmacists are being consulted by
patients for advice on symptoms are ideal opportunities to promote health education (see Ch. 5). For
example, someone who is asking for advice about a
cough could be asked about their smoking habits.
Children and the elderly
These two patient groups have the highest usage
of medicines per person compared with anyone else.
Care is needed in assessing the severity of their symptoms as both groups can suffer from complications.
For example, the risk of dehydration is greater in
230
Prescribing for minor ailments CHAPTER 22
children with fever or the elderly with diarrhoea.
Invariably, lower doses are used in children, and because the elderly suffer from liver and renal impairment they frequently require lower doses than
younger adults. Children should be offered sugar-free
formulations to minimize dental decay and elderly
people often have difficulty in swallowing solid dose
formulations. It is also likely that the majority of elderly patients will be taking other medication for
chronic disease and the possibility of OTC–POM
interactions should be considered.
Table 22.2 Medicines to avoid during pregnancy
Pregnancy
The potential for OTC medicines to cause teratogenetic effects is real. The safest option is to avoid taking
medication during pregnancy, especially in the first
trimester. Many OTC medicines are not licensed for
use in pregnancy and breastfeeding because the manufacturer has no safety data or it is a restriction on
their availability OTC. Table 22.2 highlights those
medicines where restrictions apply.
Medicine Advice in pregnancy
Antihistamines – sedating Some manufacturers advise avoidance, although chlorphenamine and
triprolidine are classed by Briggs et al
Antihistamines – non-sedating Manufacturers advise avoidance as limited human trial data, but animal data
suggest low risk
Anaesthetics – local (benzocaine, lidocaine) Avoid in third trimester – possible respiratory depression
Bismuth Manufacturers advise avoidance
Crotamiton (e.g. Eurax) Manufacturers advise avoidance
1
as being compatible
Fluconazole Avoid
Formaldehyde (e.g. Veracur) Manufacturers advise avoidance
Ocular lubricants (e.g. hypromellose, carbomer) Manufacturers advise avoidance as safety has not been established
antagonists Avoid
H
2
Hyoscine Manufacturers advise avoidance as possible risk of minor malformations
Migraleve (opioid component) Avoid in third trimester
Iodine preparations Avoid
Midrid Avoid
Minoxidil (e.g. Regaine) Avoid
Monphytol paint Manufacturers advise avoidance
Posafilin Avoid
Selenium (e.g. Selsun) Manufacturers advise avoidance
Systemic sympathomimetics Avoid in first trimester as mild fetal malformations have been reported
1
Briggs GG, Freeman RK, Yaffe SJ 2008 Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk, 8th edn. Lippincott Williams &
Wilkins, Philadelphia. (This is one of the standard reference texts used by medicine information centres in answering medicine suitability during
pregnancy.)
231
SECTION THREE Pharmacy prescribing and selection of medicines
Table 22.3 Interactions of OTC medicines with POMs that can be significant
Medicine Possible interactions Outcome
Antihistamines – sedating Opioid analgesics, anxiolytics, hypnotics and
Increased sedation
antidepressants
Antacids (containing calcium, magnesium
and aluminium)
Tetracyclines, quinolones, imidazoles,
phenytoin, penicillamine, bisphosphonates,
Decreased absorption
ACE inhibitors, angiotensin II
Aspirin NSAIDs and anticoagulants Increased risk of GI bleeds
Methotrexate Reduced methotrexate excretion, toxicity
Bismuth Quinolone antibiotics Reduced plasma quinolone concentration
Chloroquine Amiodarone, sotolol, antipsychotics Increased risk of arrhythmias
Fluconazole Anticoagulants Enhanced anticoagulant effect
Ciclosporin Increased ciclosporin levels
Carbamazepine and phenytoin Increased levels of both antiepileptics
Rifampicin Decreases fluconazole levels
Atorvastatin Increased atorvastatin levels that can
lead to muscle pain/myopathy
NB: Seriousness of the possible outcome
would mean it is good practice to avoid
all statins with fluconazole
Hyoscine TCAs, and other medicines with
Anticholinergic side-effects increased
anticholinergic effects
Ibuprofen Anticoagulants Enhanced anticoagulant effect
Lithium Reduced lithium excretion
Methotrexate Reduced methotrexate
Opioid-containing products Alcohol, opioid analgesics, anxiolytics,
Increased sedation
hypnotics and antidepressants
Prochlorperazine Alcohol, opioid analgesics, anxiolytics,
Increased sedation
hypnotics and antidepressants
St John’s wort Anticoagulants Reduced anticoagulant effect
SSRIs Potential serotonin syndrome
Phenytoin, phenobarbital, carbamazepine Reduced antiepileptic serum level
Oral contraceptives Reduced efficacy of contraceptive
Antivirals, ciclosporin, digoxin Reduced plasma concentrations
Systemic sympathomimetics, including
isometheptene (ingredient in Midrid)
Topical (nasal or ocular)
MAOIs and moclobemide Risk of hypertensive crisis
Beta-blockers and TCAs Antagonism of antihypertensive effect
MAOIs and moclobemide Risk of hypertensive crisis
sympathomimetics
Iron salts Tetracyclines, quinolones, penicillamine Reduced absorption if taken at same time
ACE, angiotensin converting enzyme; GI, gastrointestinal; MAOI, monoamine oxidase inhibitor; NSAID, non-steroidal anti-inflammatory drug; SSRI,
selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.
232
Prescribing for minor ailments CHAPTER 22
Interactions of OTC medicines
with other drugs
Medicines that are available for sale to the public are
relatively safe. However, there are some important
drug–drug interactions to be aware of when recommending OTC medicines. These are listed in
Table 22.3.
Providing advice (patient
counselling)
The service specifications of the pharmacists’ Code of
Ethics provides some guidance on the content of the
counselling role of pharmacists. The specification on
the supply of dispensed medicines states ‘Pharmacists
must ensure that the patient receives sufficient information and advice to enable the safe and effective use
of the medicine’. The sale of OTC pharmacy medicines is similarly covered by the service specifications
and the pharmacist is required to provide ‘advice relevant to the product and the intended customer’.
Counselling should take place in a thoughtful,
structured way. Pharmacists must have the ability to
explain information clearly and unambiguously and in
language the patient can understand. The counselling
process should not be a monologue by the pharmacist
giving a long list of information points. To be successful, it must be a two-way process. There should be
ample opportunity for the patient to ask questions.
Rapport is built up between the pharmacist and the
patient and a much more meaningful dialogue can take
place. What information to give to the patient will vary
from case to case and will depend on a number of
factors such as prior use and knowledge, the age of
the patient and their comprehension level. However,
as a general summary, patients should know:
*
How to take or use the medicine
*
When to take or use the medicine
*
How much to take or use
*
How long to continue to take or use
*
What to expect, e.g. immediate relief, no effect for
several days
*
What to do if something goes wrong, e.g. if a dose is
missed
*
How to recognize side-effects and minimize their
incidence
*
Lifestyle or dietary changes which need to be
made, if appropriate.
Aids to counselling
Patient information leaflets, warning cards and placebo devices are all useful aids when giving advice to
patients. Most OTC medicines provide product information, often as a patient information leaflet (PIL).
These PILs, where appropriate, can be used during
counselling and important points highlighted. Placebo
devices, e.g. inhalers, drops, patches, etc. can be used
to demonstrate a particular administration technique
and also to check a patient’s ability to use the product.
Leaflets on how to use ear drops, eye drops, eye
ointment, pessaries, suppositories, etc. are available.
Having given the information, it is then of major importance to check if the counselling has been successful. What does the patient understand, and do they
have any problems? Watching the patient’ s body language and maintaining eye contact can give useful
clues as to whether the message is being understood
and whether compliance is likely.
Conclusion
In conclusion, the pharmacist plays a pivotal role in
helping patients exercise self-care and provides an
effective screening mechanism for doctors. The continued deregulation of medicines to pharmacy control
will mean that pharmacists over the coming years will
be able to prescribe more medicines from more therapeutic classes. This necessitates that all pharmacists
have up-to-date clinical knowledge and can competently perform the role. This might require many to
acquire new skills (e.g. physical examinations) and
take a much more active role in monitoring and following up the patient after advice and products have
been given.
KEY POINTS
*
Pharmacists have a traditional role in assisting
patients with self-care
*
Recent increases in patient self-care are
government driven, consumer fuelled and
professionally supported
*
It is estimated that 20–40% of GP consultations are
for conditions which are suitable for self-care
*
Since 1983 there has been a policy of re-regulation
of medicines, mainly POM to P, providing the
public with access to a wider range of medicines
*
Minor ailment schemes, linked to PGDs, enable
pharmacists to prescribe a range of medicines on
the NHS
233
SECTION THREE Pharmacy prescribing and selection of medicines
*
While public opinion supports pharmacists
supplying medicines for self-care, there is
resistance to being questioned by pharmacy staff
*
Pharmacists require effective communication skills
in order to be effective in advising patients
*
The first impression of the patient and by the
pharmacist can be vital
*
Medicine recognizes three inputs in reaching a
diagnosis – patient history, physical examination
and test results. Only the first, and occasionally the
second are available to pharmacists
*
Using open and closed questions, the relevant
medical history of the patient can be obtained, but
the pharmacist must be sensitive to the patient’ s
wishes
*
Various techniques can be used to improve the
efficiency of the process, including the use of
acronyms, the funnelling technique, clinical
reasoning and pattern recognition
*
Non-verbal cues are often more important than the
words used
*
Important parts of body language include gestures,
eye contact, body position, personal space and
physical contact
*
Vocal communication is important for
understanding and rapport
*
When prescribing, first-line treatment should have
proven efficacy
*
Non-drug advice is also appropriate
*
Special considerations apply to children, the
elderly and women who are pregnant or
breastfeeding
*
Patient counselling is a requirement and aims at
ensuring the patient knows how, when and how
much medicine to take, how long to take it for, what
to expect, and what actions to take if something is
wrong
234
Chapter Twenty-Three
Information retrieval
Parastou Donyai
23
STUDY POINTS
*
How to categorize health- and medicine-related
information
*
Relevant search and retrieval processes including
essential preparatory and analytical elements
*
Organizations that can help with information
retrieval
*
How practically to apply the suggestions in this
chapter to enable you to practise and perfect the
art of information retrieval
Introduction
Thecurrenteraischaracterizedbyman’s ability to
store, r etrieve and transmit large volumes of information using computer technology. Albert Einstein
proposed that the secret of success is ‘to know where
to find the information and how to use it’. Most
pharmacists would probably agree. This chapter
aims to provide the reader with a theoretical understanding of how to source health- and medicinesrelated information in the present information age.
While the quality of retrieved information is also
considered, guidance on the detailed evaluation of
what is known broadly as ‘ clinical evidence’ is found
elsewhere (see Ch. 19).
The new Code of Ethics and Standards for pharmacists and pharmacy technicians lists seven principles with supporting explanations that together
define what it means to be a registered pharmacy
professional. For example, pharmacists must have
the appropriate knowledge and competence for their
work and they must also adhere to types of action and
behaviour that uphold the reputation of the pharmacy
profession. In the Code of Ethics and Standards, the
knowledge and provision of health- and medicinesrelated information specifically is considered in the
following manner. In relation to their own knowledge
and competence, pharmacists must develop their
skills in line with their area of expertise, keeping up
to date with relevant progress through continuing
professional development (CPD). In some instances,
for example with pharmacist prescribers, pharmacists
must also have access to a wide range of medicinesrelated information, and their practice, wherever possible, must be evidence based and in accordance with
relevant national and local guidance. Decisions must
be based on clinical and cost-effectiveness and pharmacists must recognize and avoid potentially biased
information. In relation to the provision of medicinesrelated information to those who want or need it,
pharmacists are expected to be able to provide accurate, reliable, impartial, relevant and up-to-date information on a wide range of issues in a manner which
recipients can easily understand.
Yet with thousands of medicinal products, dressings and appliances on the UK market, pharmacists
are highly unlikely to hold in-depth knowledge of all
health- and medicines-related issues at all times. Periodically all pharmacists will need to supplement
their knowledge either proactively or reactively, for
CPD purposes or to address practice-related queries.
Therefore, the ability to retrieve relevant health- and
medicines-related information in a timely and efficient manner becomes central to the practice of all
pharmacy professionals (Box 23.1). One particular
group that benefits specifically from a good working
knowledge of information retrieval is pharmacists involved in research, be it in academia or in practice.
SECTION THREE Pharmacy prescribing and selection of medicines
Box 23.1
Pharmacy activities that might involve
information retrieval
*
Solving patient-specific clinical problems
*
Critical evaluation/appraisal of the literature
*
Preparation of a scientific paper
*
Effective provision of verbal and written
information to the public
*
Clinical guideline development
*
Drug policy management (e.g. formulary
management, drug use evaluation or audit)
*
Preparation of bulletins and newsletters
*
Managing the entry of new drugs into health care
*
Adverse drug reaction/event management
*
Continuing professional development
Where does information exist and how can it be retrieved?
Information retrieval is the tracing and recovery of
stored information. Health- and medicines-related
information can range from patient information to
drug monographs to more sophisticated health technology assessments. It can exist in many forms from
the archives of a drug company to the World Wide
Web (the web). To acquire the art of information
retrieval one must ultimately appreciate the range of
relevant information that exists, where it exists and
how it might be sourced.
Some years ago traditional scholars would have
discounted the web as an appropriate first topic for
discussion. Not so today. Most present-day pharmacists sourcing health- and medicines-related information are likely to use the Internet (the net) at some
point during their search, if not to begin with. The
expanse of information posted on the web and its
apparent accessibility has integrated the Internet into
most work routines. While on the whole the seemingly endless material may not suit most pharmacists’
information needs, there are specific online resources
that pharmacists can browse in order to look for
health- and medicines-related information. These include official websites operated by governments, professional, practice, regulatory or academic bodies as
well as websites belonging to patient groups and the
pharmaceutical industry. We will deal with some of
the well established sites. However, the fluid nature
of the Internet, the vast array of information available,
plus the variable nature of each query will probably
also involve the information-seeking pharmacist in
some degree of Internet searching. This necessitates
a fuller discussion of search engines and search strategies. A myriad of specialized scientific databases and
other portals are also accessible via the net. Some
databases are also available on CD-ROM. These act
as directories for scientific papers and other publications and as such can be used to search for available
material. Searching databases and the material they
contain is considered separately.
Before widespread use of the Internet, the principal source of health- and medicines-related information was the printed book. Books still contain a vast
array of indispensable information and, arguably, reputable ones play a vital role in information management. Although individual pharmacies may not keep
the full range of essential books, specialist centres will
have access to these and to other resources. The topic
of books and that of organizations that help with
health- and medicines-related queries are covered in
the later parts of this chapter.
The Internet
The World Wide Web is less than 20 years old at the
time of writing this book. Yet it contains several billion
pages and has become woven into the fabric of everyday life, especially in the developed world. The Internet in its current form came into being in 1983. The
web took form around 1989/90, was launched in
1991 and came into widespread use from 1993 onwards. From the beginning it acted as a place where
large numbers of files and documents could be stored
for download, circulation, discussion and communication. These days many thousands of documents and
other items are added to the web every hour. Consequently it is not possible to categorize all available
websites in order to create a comprehensive directory
of the web. Most people create their own directory of
useful websites or search the Internet for the information they need.
The web address
The term website is used to denote a set of themed,
linked web pages, usually accessed via a ‘homepage’.
Web pages are written in hypertext mark-up language
(htm). A web page is a collection of text, graphics,
sound and/or video that corresponds to a single window of scrollable material. Web pages are stored on a
236
Information retrieval CHAPTER 23
web server, a program that hosts the website and
‘dispenses’ the pages in response to a web browser.
The web browser displays web pages after communicating with the server. There are a large number of
browsers in existence, although currently the majority
of users in the western world employ either Internet
Explorer
Ò
or Netscape NavigatorÒ.
Each page on the web has a distinct web address
known as the uniform resource locator (URL), sometimes referred to as the uniform resource identifier
(URI). The URL can be a good clue as to the quality of
the information found on a website; this is covered in
detail, below. The ‘locator’ in URL can also give an
indication of where one is within a website; for example, on the homepage or further in. The locator can
also indicate the source of the information being
viewed; for example, whether it is from the Department of Health or a pharmaceutical company.
A web address or website name appears on the
address bar. All website names are part of the domain
name system (DNS) and look similar to this: http://
www.dh.gov.uk/.
Box 23.2 breaks down this address and examines
the individual parts. In summary, the web address
http://www.dh.gov.uk/Publicationsandstatistics/index.
htm is showing: protocol://server.name.domain.
country/pathname/document name.file extension.
Directory of useful websites
This section provides a list of some of the more
established health- and medicines-related websites
with the proviso that any printed list can become
quickly outdated (Table 23.1). Web addresses or
pathnames can change or more useful sites can be
created. Each record in the catalogue of websites in
Table 23.1 represents an electronic resource that can
be browsed or searched for relevant information by
pharmacy professionals. To help order the directory,
a classification scheme has been followed with subheadings to group similar websites together. A short
description of each site is provided and, where applicable, tips on some useful sections have been included. The list is not exhaustive and it should be
used as a starting point by readers to create a personalized catalogue of essential health- and medicinesrelated information websites.
Box 23.2
Individual components of a typical domain name system
The web address http://www.dh.gov.uk/Publicationsandstatistics/index.htm
PROTOCOL. http:// shows us that we are looking at a website with http meaning ‘hypertext transfer protocol’, the set
of rules used by the computer to access and deliver web pages. The variation https:// indicates a secure
connection (secure http) to the site in question
ERVER AND ORGANIZATION’S NAME. www.dh informs us that we are viewing a website held on a computer or a web
S
server known as www belonging to an organization called ‘dh’, in this instance the Department of Health. Although
quite often a web server computer is called www, some websites have dispensed with www and some use
different server names such as ‘news’ or ‘staff’ or ‘students’
D
OMAIN AND COUNTRY. .gov.uk tells us that we are looking at the website of a governmental institution in the UK. This
part of the web address is the ‘domain’, other examples of which are
company);
followed by a country code that indicates the location of the computer holding the website, for example
some websites, especially those originating in North America, omit this information
ATHNAME AND DOCUMENT NAME. Beyond the homepage of an organization’s website, other pages are ordered in a
P
hierarchy of folders in which the various information can be found. In this example,
indicates we are looking at a folder in which we will find an index page
ILE EXTENSION. The file extension usually identifies the type of data found in the file. For example, the extension .htm
F
.html) indicates a file that contains code expressed in the hypertext mark-up language used to develop pages
(or
that are to be placed on the web. There are countless other examples; the extension
textual data; the extension
official documents because it allows exact reproduction of printed text
.ac (academic); .org (non-governmental, non-profit making organizations). Sometimes domains are
.pdf indicates a file in portable document format, widely used for Internet publication of
.edu (educational); .com (commercial); .co (a
.uk, but
Publicationsandstatistics
.index.htm, stored as a htm file
.txt indicates a file containing
237
SECTION THREE Pharmacy prescribing and selection of medicines
Table 23.1 Directory of ‘established’ websites that can be accessed via the Internet for health- and medicines-related information. Each
subsection is arranged in alphabetical order. These websites should form the basis of an individual’s database of useful websites
Name of website and web address Brief description of content and tips on useful subsections
Governmental and regulatory bodies
Department of Health http://www.dh.
gov.uk/
Contains material produced by and for the Department of Health, of relevance to health
professionals. Visit and bookmark letters and circulars: http://www.dh.gov.uk/en/
Publicationsandstatistics/Lettersandcirculars/index.htm
Visit and bookmark the Orange Guide on Drug Misuse and Dependence – Guidelines on
Clinical Management: http://www.dh.gov.uk/assetRoot/04/07/81/98/04078198.pdf
European Medicines Agency http://
www.emea.europa.eu/
Medicines and Healthcare products
Regulatory Agency http://www.mhra.
gov.uk/
Website of the European Union body responsible for issuing European marketing authorization
and for regulating the safety, quality and efficacy of medicinal products
Information about the regulatory processes for medicines and medical devices in the UK,
including news about initiatives in Europe and beyond. Allows online reporting of safety
problems. Visit and bookmark drug safety updates: http://www.mhra.gov.uk/mhra/
drugsafetyupdate
Find and bookmark news on Safety of Herbal Medicines, and Drug Analysis Prints (DAPs) – a
complete listing of the suspected adverse drug reactions (ADRs) through the Yellow Card
scheme
United States Food and Drug
Administration http://www.fda.gov/
American counterpart to the MHRA, the FDA is responsible for ensuring safety, quality and
efficacy of medicines and medical devices as well as other items such as foods, cosmetics
and radiation-emitting devices in the US
NHS bodies, evidence-based medicine and guidelines
AHFS Drug Information Drug information provided by the American Society of Health-System Pharmacists; electronic
access available via Medscape: http://www.medscape.com
Search the Drug Reference section. Visit http://www.medscape.com/druginfo/
All Wales Medicines Strategy Group
http://www.wales.nhs.uk/sites3/
home.cfm?OrgID=371
Provides advice on strategic medicines management and prescribing, a conduit through
which consensus is reached on medicines management issues, especially those affecting
both primary and secondary care in Wales. Click on ‘AWMSG finalized documents’
Bandolier http://www.medicine.ox.ac.
uk/bandolier/
British National Formulary http://www.
bnf.org/bnf/
Centre for Reviews and Dissemination
http://www.york.ac.uk/inst/crd/index.
htm
Clinical Management Plan Library
Online http://
www.cmponline.info/
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Academic department providing collection of abstracted evidence (systematic reviews of
treatments, of evidence about diagnosis, epidemiology or health economics) under various
subheadings. Visit and bookmark the learning zone: http://www.medicine.ox.ac.uk/
Bandolier/learnzone.html
The BNF provides UK healthcare professionals with authoritative and practical information on
the selection and clinical use of medicines in a clear, concise and accessible manner. Visit
BNF Extra for access to various ‘calculators’
Academic department that undertakes systematic reviews related to health and social care
interventions and delivery and organization of health care. Produces three databases: NHS
Economic Evaluation Database (NHS EED); Database of Abstracts of Reviews of Effects
(DARE); Health Technology Assessment (HTA) Database. Visit the databases: http://www.crd.
york.ac.uk/inst/crd/crdweb
Relatively recent repository of clinical management plans for use by supplementary
prescribers
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