Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5995_Библиотеки_им_академика_М_И_Перельмана.pdf
93
Drug Information Services
iii. Skillisrequiredtofindouttheexactrelevantinformationfromthesecondary
source.
iv.Useofspecificterminologyrelatedtogetexactinformationisneeded.Onemust
beproficientwithaparticulardatabase'ssearchtechniques.Medicaldatabases
includetheliteratureusingMedicalSubjectHeadings(MeSH).Forexample,if
youwanttheinformationrelatedto“heartattack”throughMeSH,thesystem
willguideforthearticle“myocardialinfarction,”whichistheMeSHheading.
Theterminologyusedinthesearchinfluencethelistofarticles.Ifyousearchfor
“theuseofaspirin”inaparticularmedicaldatabase,severalarticleswouldbe
reported.However,ifyouspecify“aspirinuseinmyocardialinfarction,”number
ofarticleswillbelessened.Hence,useoftheexactterminologyisrequiredfor
morefocusedfindings.
3. Tertiary sources includethesummarizedinformationtogetquickaccess.Tertiary
sourcesof informationare compilationof a primary and secondarysources.
Examplesoftertiarysourcesinclude:
• Textbooks(sometimescategorizedassecondarysources).
• Glossaries,pharmacopeias,drugcompendiaandencyclopedias.
• Handbooks,referencebooks,instructionbooks,records.
• Abstract,catalogues.
These are compiled by individuals or groups, often developed by subject experts.
These condensed sources are widely peer reviewed. It is recommended to consult the
most current edition available for using secondary or tertiary sources. List of most
respected tertiary resources is illustrated in Table 12.2.
Advantages of Tertiary Literature
i. Tertiaryreferencesarequickandeasilyaccessible.
ii. Druginformationreferencesmaybecategorizedintospecificsubjectstomakethem
easiertouse.For instance, one textcategorymayonly include the textfordrug
interactions,whileanothermightdiscusstheconceptofpharmacotherapyoruse
ofdrugsinpregnancy.
iii. Usually,tertiarysources arereferencedin theprimary literaturesources, so the
informationcontainedintertiaryliteratureiswellrecognizedinmedicalpractice.
Disadvantages of Tertiary Literature
i. Theremaybelonglagtimebetweenthedateoftextsubmittedorwrittenand/or
publisheddateintertiaryliterature.Hence,informationavailableinthetertiary
sourcemaynotbeupdatedincomparisontoavailableinprimarysource.
Table 12.2: List of most respected tertiary resources
Formularies listing the essential drugs lists and therapeutics.
BNF(British National Formulary), which is updated every six months.
NFI (National Formulary of India), published by IPC, Ministry of Health and Family Welfare, Govt. of India.
WHO Model Lists of Essential Drugs, compiled by the Expert Committee based on Selection and Use
of Essential Medicines, revised every two years.
To provide model prescribing information for essential drugs used in the treatment of bacterial infections,
WHO published book in 2001, entitled ’WHO Model Prescribing Information’.
94
Textbook of Pharmacy Practice
ii. Comprehensivediscussionaboutthesubjectmaynotbeavailableduetospace
limitationswithinatextbook.
iii. Onlylimitedinformationrelevanttotheauthorinterestmaybehighlighted.
iv.Informationrelatedtothesubjectarepresentedbyauthorsinthetextbookare
basedontheprimaryliterature.
v.Access of primary literatureis possible, if tertiary literatureis referenced
appropriately.
vi. Tertiary informationmaynotbe reliable, if the informationpresentedinit is
basedonerroneousprimaryliteraturesource.
vii. Inthecaseofprintresources,consideredastertiaryliterature,itisdifficultto
insertupdatedornewinformationinto the printed copyinatimelyfashion.
Ifpossible,itistimeconsuming.
Conclusive comparison of primary, secondary, and tertiary resources is illustrated
in Table 12.3.
Other Sources
Manufacturers' Promotional Information
Manufacturers only provide either secondary or tertiary information to promote their
products. Information provided by manufacturers depend on Government’s regulations as
well as ability to implement them. It is noticeable that pharmaceutical manufacturers, only
provide favourable views of their products, and they may not give adequate information
required for encouraging the rational use of drug. Medical representatives may also
provide only limited information, required for promotion of their products. Product inserts
and instruction printed on label, provided by drug manufacturers do not necessarily
reflect complete current information related to accepted uses of a drug. In many instances,
the indications mentioned on a product's labelling do not match with the method of use,
associated with drug. It is observed that subsequent clinical trials may suggest the use in
other indication for the drug, which was already approved for one indication. Labelling
to provide this new information need the approval from drug regulatory authority. Often,
this information is come after several years in the medical literature. In some cases, new
information is never included in a product's labelling because it is not favourable for the
pharmaceutical company due to economical reason to go through the approval process.
Generally, the drug information specialist or healthcare professional has to rely on the
medical literature for making judgment to use the drug for patient care.
Table 12.3: Overview of primary, secondary, and tertiary sources
Source Advantages Disadvantages
Primary sources Recent information
Impartial information
Skill is required
Time consuming
Secondary sources Guide to access primary source
Provide the updated
Search
There is a lag time
Skill is required
Can be expensive
Tertiary sources Easy approach
Quick information
Relatively cheaper
There is a lag time; may be outdated
May be incorrect
Interpretation
95
Drug Information Services
Internet
In the present scenario, internet is a convenient method to get updated drug information,
provided it is properly used. It is quick and easily accessible method for healthcare
professionals as well as patient to get the information, helpful in the diagnosis of health
conditions or the development of suitable treatment approach. Information related to
ADRs, interaction with another drug or OTC product or food can be easily obtained
from internet facility.
Electronic communications between patients and physician, typically in the form of
electronic mail (e-mail) is also facilitated through internet facility. Clinicians can access
patient lab test results as well as place orders electronically in health care systems with
integrated electronic medical records.
Internet provides quick access to numerous sources on the drugs. It is especially
advantageous, when cost of journal is very high and almost unaffordable.
Much of information on the internet are unregulated; therefore, caution is necessary
prior to make decisions based on information, obtained through internet.
There are various websites which can be used to get information about the drugs.
Some of the websites available free of cost are given as follows.
General
1. https://www.cancer.org,ItisrelatedtoAmericanCancerSociety,whoarededicated
tohelpthepeople,sufferingfromcancerdisease.
2.www.cdc.gov,related to the nationalservice organization(Centre for Disease
ControlandPrevention),dedicatedtoprotectsthepublic'shealth.
3. www.drugs.com,relatedtoDrugs&MedicationsAtoZ,whichprovideaccurate
informationonover24,000prescriptionandover-the-countermedicinesforboth
consumersandhealthcareprofessionals.
4.www.hhs.gov, relatedto US department of human and healthservices, who is
promotingthehealthofUScitizen.
5. www.everydayhealth.com,relatedtoeverydayhealth,whoprovideexperthealth
adviceoncommonchronicconditions.
6. www.mayoclinic.com,relatedtoMayoClinic,whichisanon-profitAmericanAcademic
MedicalCentre,focusedonintegratedhealthcare,education,andresearch.
7. www.medilexicon.com,relatedtoMediLexicon,whichisadictionaryofover200,000
medicalterms,ICD-9codes,hospitals,andmore.
8. www.medscape.com,relatedtoMedscape,whichisonestopresourceformedical
news,clinicalreference,andeducation.
9. www.medicalstudent.com,relatedtomedicalstudent,whichislinkedtoauthoritative
medicalinformationforstudentsofmedicine.
10.www.medicinenet.com,relatedto MedicineNet, whichislinked toauthoritative
medicalinformationforconsumers.
11. www.nlm.nih.gov/medlineplus,relatedtoMedlinePlus,whoprovideonlinehealth
informationresourceforpatientsandtheirfamiliesandfriends.
12.www.merckmanuals.com,related toMerck Manuals,which is the world's most
widelyusedonlineavailablemedicalguides.
13.www.nih.gov, relatedtoNational Institutesof Health, whofocusses onmedical
researchintheUnitedStates.
96
Textbook of Pharmacy Practice
14.www.rxlist.com,relatedtoRxList,whoprovidedruginformation forconsumers
andmedicalhealthprofessionals.
15.www. uptodate.com, relatedto UpToDate, who acts as evidence-based clinical
decisionsupportresourceforhealthcareproviders.
16.www.webmd.com,relatedtoWebMD,whohasthousandsofmedicalentriesfrom
abdomentozygote.
Doctor Reviews
17.www.caredash.com,relatedtoCareDash,whoisaproviderandratingsofpatient
reviews.
18.www.castleconnolly.com, relatedto CastleConnoly, which is a publishing
organizationdealingwithhealthcareresearchandinformationservicesintheUS.
19. www.healthgrades.com,relatedtoHealthGrades,withwhoprovidescomprehensive
informationaboutphysiciansandhospitals.
Medical Journals
20.www.biomedcentral.com,relatedtoBioMedCentral,whoprovidesopenaccessto
hundredsofpeer-reviewedmedicaljournals.
21.www.freemedicaljournals.com,relatedtoFreeMedicalJournals,sitethatpromotes
andlinkstofreefull-textmedicaljournalsandresources.
22.www.jamanetwork.com, related toJAMNA, the most widely circulatedpeer-
reviewedmedicaljournalintheworld.
23.www.nejm.org,relatedtoNewEnglandJournalofMedicine,whichpublishesnew
medicalresearchfindings,reviewarticles,andeditorialopinion.
24.www.ncbi.nlm.nih.gov/pmc/,relatedtoPubMedCentral,whichisafreedigital
archiveofbiomedicalandlifesciencesjournalliterature.
25.www.nice.org.uk,relatedtoNationalInstituteforHealthandClinicalExcellence,
UK,which isan executive non-departmental public body of theDepartment of
HealthandSocialCareinEnglandthatpublishesguidelines.
26.www.webarchive.org.uk,related to National prescribingcentre,UK, which
providessupportandpromoteevidence-basedprescribingpracticeandmedicines
managementacrosstheNHS.
27.www.cadth.ca,relatedtoCanadianAgencyforDrugsandTechnologiesinHealth,
whichprovidesresearchandanalysistohealthcaredecision-makers
28.www.pharmainfo.net,relatedtoPharmainfo,whichgivesquickresultaboutarticle
regardingpharmaceuticalsciences.
Mobile Service
Mobile platform is becoming more users friendly, computationally powerful, and
easily accessible. Many aspects of clinical practice in healthcare system have been
transformed with the use of mobile devices since last few years. Commonly used
mobile technology is responsible for rapid development of several medical software
applications (apps) in healthcare settings. Healthcare professionals can take the guidance
from these newly developed softwares in several important tasks, such as: Information
and time management, keeping and access of patient health record, communications
and consultation; collection of information and getting reference, patient monitoring
system, making clinical decision, education & training purposes, etc.
97
Drug Information Services
Computerized Drug Information Services, Storage and Retrieval of information
In the present scenario, pharmacy department at multidisciplinary specialty hospital
include a drug Information Service (DIS) as one of its parts in the developing countries.
Several requests from nurses, pharmacists, physicians, and other health professionals
are received in a month. To answer these queries, pharmacist need the complete search
database of drug information about the pharmacological action, drug interaction, adverse
drug reactions, toxicology, etc. All the requests, answers, references, and demographic
information were stored in loose hard files, arranged in chronological order. But now
manual system has become inadequate due to the increased number of queries from
various categories of healthcare professionals, hence it is outdated now. It has become
overly time consuming to reply the increased numbers of queries on the basis of manual
system. Hence, there is need for the development of method for the rapid storage and
retrieval of data, which has become possible with the help of computer technology.
In comparison to manual system, computerized information retrieval system is time
saving and attractive with the additional advantage of quick search.
Some Important Related Definition
1. Adatabaseisanycollectionofdataorganizedforstorage,accessibility,andretrieval.
2. Information retrieval is theprocessofsearching,collecting,and interpretingthe
informationfromstoreddataasdictionaryofscienceandtechnology.Itisagain
definedasrecoveryofinformation,especiallyfromthestoreddatabaseincomputer
asperBritannicaConciseEncyclopedia.
It is desirable to have international database for retrieval of medical related
information. To fulfil this requirement, centralized database for health sciences
bibliographic information has been developed. The US National Library of Medicine
(NLM), which is a part of the US National Institute of Health (NIH), has been doing
the task of indexing and abstracting medical literature since decades. The MEDLARS
(Medical Literature Analysis and Retrieval System) database has been developed at
NLM, which is a bibliographic database, having more than 29 million references to
include journal articles in life sciences with a main focus on biomedicine. MEDLINE
is the online counterpart to the MEDLARS, originated in 1964. It is also referred to as
MEDLAR online. A typical feature of MEDLARS is the indexing of records with Medical
Subject Headings (MeSH). Records include bibliographic information for articles from
academic journals which cover the field of medicine, nursing, pharmacy, dentistry,
veterinary medicine, and healthcare.
Historical development: Thefirstdirectorofthelibrary,John Shaw Billingscompiledthe
vastnumbersofmedicalbooks,journals,andindexedthemasinternationalindex(Index
Medicus)in1865.Intheearly1960sIndexMedicusproductionwascomputerized;which
ledtothedevelopmentoftheelectronicallysearchableMEDLINE
®
andacomprehensive
MedicalLiteratureAnalysisandRetrievalSystem:MEDLARS
®
.Beginninginthelate
1960sandupuntilthemid-1990s,bilateralagreementswithInternationalMEDLARS
CentresresultedinlicensedanddistributedMEDLINEtapesandalsoprovidedonline
accesstoMEDLINEandotherdatabasestocitizensinselectedcountries.Itwasexpanded
toincludecentresin20countriesThesearrangements providedNLMwithvaluable
assistancein indexing non-English literature and assigned database searching fees.
In1997,PubMedWebsiteprovidedinternetconnectivitytoeveryonetoaccessanduses
alloftheNLMdatabasesforfreeofcost.
98
Textbook of Pharmacy Practice
In May 2022, the database contained more than 34 million records from 5,639 selected
publications covering biomedicine and healthcare. The database is freely accessible
on the Internet via the PubMed website. New citations are added Tuesday through
Saturday.
Vocabulary for Searching
Since the 1960s, with the use of controlled, domain-specific vocabulary (referred to as
MeSH or Medical Subject Headings), online search about the subject can be done via
developed computer technology. In recent years, the information retrieval system has
been advanced to include semantic search techniques, which means finding information
based on concepts and not just accurate matches against search criteria.
NLM provides a MeSH Browser for finding descriptors, qualifiers, and other concepts
of interest because the vocabulary is extensive. Descriptors in MeSH are organized in
categories like A, B, C, D, ... so on, in which ‘A for anatomic terms, ‘B’ for organisms,
‘C’ for diseases, ‘D’ for drugs and chemicals, etc. Each category is further divided into
subcategories. Within each subcategory, there is hierarchical arrangement of descriptors
from most general to most specific in up to thirteen hierarchical levels. These lists are
sometimes referred to as “trees” due to the branching structure. Each MeSH descriptor
appears in at least one place in the trees, and may appear in as many additional places if
appropriate. Those, who use MeSH should find the most specific MeSH descriptor that
is available to represent each concept of interest. Some of tree structures are illustrated
here:
• ‘A’meansanatomy
• 'B'meansorganisms
• ‘C’meansdiseases
• ‘D’meanschemicalsanddrugs
• ‘E’meansanalytical,diagnostic,andtherapeutictechniquesandequipment
• ‘F’meanspsychiatryandpsychology
Using the MeSH browser, searching or surfing can be entered to browse the tree
structure. If the term “heart” is entered, there will be an extensive list of related subjects.
If, for example, the term “heart failure” is clicked, it will indicate a number of entry
terms related to heart failure, including cardiac arrest, congestive heart failure, left-sided
heart failure, myocardial failure, and so on. If you search for the word ‘swelling’, results
are automatically retrieved for edema.
LikeMEDLAR,thereissomeotherdatabase:
EMBASE (Excerpta Medica Database) is a world comprehensive biomedical and
pharmacological database. It is developed by Elsevier BV. It consists of more than
32 million records, from more than 8,500 journals published worldwide from 1947.
It encompasses bibliographic records along with citations, abstracts and indexing
derived from biomedical articles published in peer reviewed journals. It is particularly
significant in the coverage of topics related to drug and pharmaceutical research,
pharmacology and toxicology.
DIALOG isalargestonlineinformation service, owned byProQuest,whoacquiredit
fromThomsonReutersinmid-2008.Dialog,comprisingofacademic,scientificandtechnical
databases,hasamuchwiderrangeofsubjectcoverageincomparedtootherdatabases.
99
Drug Information Services
DRUG AND POISONS INFORMATION CENTRE
Poisons Information Centre (PIC) is a specialized unit, which specifies information
on prevention, early diagnosis and treatment of poisoning and risk management.
Most of the developed countries have well-established poison control centres, who
provide poisons information service, patient management facility and analytical testing
laboratory. National Poisons Information Centre (NPIC) was set up in February, 1995 in
the Department of Pharmacology, AIIMS (All India Institute of Medical Sciences), New
Delhi in India. Poison information centre (PIC) was also established by Department of
Clinical Pharmacy, JSS College of Pharmacy, JSS University, Mysore, Karnataka, India.
The poison information centre is primarily tasked to improve the healthcare of
public as well as hospital staff by minimizing or preventing the illness and death due to
poisoning. Appropriate information regarding management and treatment of poisoning
is provided in emergency by well-trained staff. The services are available round the
clock at free of cost. Queries regarding poisoning treatment may be answered through
phone, e-mail, fax and in person depending on enquirer’s request.
EXERCISE
Multiple ChoiCe Questions
Tick mark the appropriate choice
1. EMBASE stands for ____________
(a) Excerpta Medica Database (c) Excerpta Medical Dictionary
(b) Efficient medica base (d) None of the above
2. MEDLARS database is developed at
(a) NLM, US (c) NLM, Geneva
(b) NLM, France (d) NLM, Germany
3. Pharmacopoeia is an example of ____________ source.
(a) Primary (c) Secondary
(b) Tertiary (d) Primary and secondary
short Questions
4. Write a note on drugs and poisons information centre.
5. What are the objectives of drug information services.
6. What are advantages and disadvantages of primary sources of drug information.
long Questions
7. What are drug information sources? Classify them. Discuss each class.
8. What are computerized drug information services? How the retrieval of information is done?
9. Give a comparative account of primary, secondary and tertiary sources for drug information.
Answer to MCQs
1. (a) 2. (a) 3. (b)
100
Chapter
Patient Counseling
INTRODUCTION
Patient counseling is an interactive process to give the direction to the patient or care-
taker related to use of drugs. verbally or in written form. It also includes the directions for
management of side effects, precautions, storage, diet and lifestyle changes. Generally,
pharmacist is the better person in doing the patient counseling. He has knowledge to
consider all of the domains to guide the patient or his caretaker to understand about
disease, medications and lifestyle modification, if required.
What to Counsel?
The Standards Practice, offered by the pharmacist or other healthcare professional, for
counseling involves:
a. Implementationofeasymethodtomonitortheprogressoftreatmentisdesiredfor
therapeuticoutcomes.
b. Implementationofmethodstoinspirepatientstohavesufficientknowledgeabout
theirtreatmentplans.
c. Identificationoflevelofeducation,whichpatientmayrequiretosolvetheirdrug/
diseaserelatedproblems.
d. Levelofmonitoringrequiredbyapatienttojudgethehealthrisks,whichmayoccur
duetothepatient’smedication,drugrelatedproblems,orillness.
e. Effective consideration for counseling toascertain the patients or caretakerfor
gettingclearandcompleteinformationregardingtheuseoftheprescriptionand
non-prescriptiondrugs,anddischargemedications(foradmittedpatients).Italso
includestheadviceorsuggestionstosolvetheproblemsrelatedtocomplications
causedbypatientmedicationsordiseaselike:
• Drug
What is the name and class ((e.g. antibiotic, pain reliever) of the medication?
What is the strength and dosage form?
What is the intention of the medication?
• Direction
How the medication is taken (including duration, frequency and route of
administration)?
What to do in the case of missed doses?
13
101
Patient Counseling
It also includes the guidance about use of medical devices, if recommended by
physician.
• Storage condition
Where to store the medication? Specify special storage requirement, if any.
• Precautions
What are potential adverse drug effects?
What are risk for various potential food/drug interactions?
What are the drug contraindications?
• Monitoring
What are the desired outcomes of therapy?
How to monitor to judge the safety and effectiveness of treatment?
What to do if the treatment resulted in undesired outcomes?
When to look for medical attention?
Whether there is a need to restock?
Format for Counseling
Counseling should be verbal, and accompanied by written instructions for the patient
to refer at home.
Patient is often distressed and upset due to their disease, that is further augmented,
when he has to wait for their prescription. He may not be able to focus on what the
pharmacist is discussing with them. Written instruction note, however, reinforces the
direction given by the pharmacist. It also helps the patient to recall, what was guided
by the pharmacist. If the patient is unsure of what the pharmacist said, the written
instruction may provide the answer, or guide the patient to call the pharmacist on the
given mobile number in instruction note. This further gives a chance to pharmacist to
reinforce key points about the medication and assess the patient compliance. The written
instruction may provide basic information only, or sometimes detailed depending on the
understanding level of patient or caretaker. Use of pictograms for inpatient counselling
service also support the proper use of medicines. For example, illustration in pictograms,
such as how to administer eye drops, are much straightforward to guide the patient,
which increases the adherence to the therapy. Use of pictograms is more effective, when
combined with written and/or verbal information.
Counseling Area
Counseling to patient should be provided in a semi-private, or private, far-off from
other people and free from interruptions. Selection of counseling area also depends on
types of medicines. The patient should sense the counseling area as confidential, secure
and favorable for suggestion. Confidential and secured area minimizes interruptions
and obstructions. This will provide satisfaction to both patient and pharmacist. In
confidential area, patient has good opportunity to ask questions, in comparison to busy
area where patient may be hesitant.
Documentation
The counseling session should be documented. This may be as simple as a check list
or as detailed as recorded notes in the patients’ medication profile. Any follow-up
102
Textbook of Pharmacy Practice
required should be noted. It should also be recorded if the patient does not wish
to be counseled.
Outcome of Patient Counseling
1. Patientrecognizestheimportanceofmedicationforhiswell-being.
2. Aworkingrelationshipandafoundationforcontinuousinteractionandconsultation
withthepharmacistorhealthcarepersonareestablished.
3. Patient’sunderstandingofstrategiestodealwithmedicationsideeffectsanddrug
interactionsisimproved.
4. Patientcompliancefortakingmedicinesinaprescribedwayisincreased.
5. Patientbecomesaninformed,efficientandactiveparticipantindiseasetreatment
andself-caremanagement.
6. Thepharmacistactsasaprofessionalwhoofferspharmaceuticalcare.Thereisajob
satisfactionforpharmacist.
7. Druginteractionsandadversedrugreactionsareprevented.
Steps Involved in Patient Counseling
Patient counseling consists of three steps:
1. Introduction
2. Processcontentandissuesregardingmedication
3. Conclusion
1. Introduction
• Reviewthepatient’srecordcomprehensively
• Introduceyourselfinafriendlyandgreetingway
• Trytoestablishtrust
• Explainpurposeofinteractionforcounseling
• Obtaindrugrelatedinformationsuchasallergies,useofherbals,etc.
• Assessthepatientsunderstandingpowerfortherapy
• Assessanyactualand/orpotentialconcernsorproblemsofimportancetothepatient.
2. Process Content and Issues Regarding Medications
• Thenameanddescriptionofthemedication(genericandbrandnameofthedrug).
• Howithelpsthepatient?
• Whatwillbehis/herfeeling?
• Howmuchtimedrugactionwilltaketobegin?
• Howmuchquantityshouldbetakenatonetime?
• Howoftentotakethemedicine?
• Howlongitwillbenecessarytotakethemedicine?
• Whentotakeit:Before,during,aftermeals?Atbedtime?Atanyotherspecialtimes?
• Howtotakeit?Withwater?Withfruitjuice?Withmilk?Howmuch?
• Actiontobetakenintheeventofamisseddose
• Foods,drinks,orothermedicinesthatyoushouldnottakewhiletakingthemedicines.
• Restrictionsonactivitieswhiletakingthemedicine
• Possiblesideeffects.Whattodoiftheyappear?Howtominimizethesideeffects?
Howsoontheywillgoaway?