The primary goal for this section is to familiarize the student with the usefulness and limitations of various sources and types of drug information,as well as develop skills in literature retrieval. This goal coincides with those Lifelong Learning objectives listed in the Experienced Based Curriculum. The skills gained in this section can be utilized throughout the medical school curriculum (i.e. MED 408) and can be applied to other topics besides pharmacology.

SKILLS WORKSHOP:

After studying this syllabus and completing the exercises which are posted on the news group Website for this section of the course, the student should be able to:

1. Define primary literature, secondary literature and tertiary literature.
2. Give one or two examples of primary literature, secondary literature and tertiary literature.
3. Demonstrate the ability to appropriately comprehend and utilize the primary, secondary or tertiary literature to answer a variety of drug information questions.
4. Demonstrate the ability to access Internet applications for drug information purposes.
5. Given a drug related question, indicate an effective search strategy to find the appropriate drug information necessary to answer the question: tablet identification, usual dose, available dosage strengths, adjustment of dose for renal impairment, safety of drug in pregnancy or lactation, drug interactions, accessing drug information in specific journal articles.
6. State five limitations of the Internet for drug information.
7. Define the benefits and limitations of sources of drug information from experts, pharmacists, hospital based treatment plans, and pharmaceutical companies.

The overall amount of medical information is growing at an alarming rate; even the body of knowledge covering only drug information seems to be endless. There are vast amounts of data on drugs that are approved by the Food and Drug Administration (FDA), and on agents undergoing clinical investigation. There are many sources of information available that can help answer drug-related questions. Deciding which one is best for a specific situation is the key. This outline will discuss drug information sources and explain how to effectively utilize them. Exercises posted on the web, and the self-paced news group will assist you in developing the skills to efficiently utilize these resources to better manage your patients' drug related problems.

1. CATEGORIES OF DRUG INFORMATION LITERATURE


1. Primary Literature
   
   
   1. Definition

Primary literature forms the foundation of the literature hierarchy. It is the source of information for the development of the secondary and tertiary literature resources. Primary literature is classified as original publications and consists of research studies, case reports, editorials, and letters to the editor. Most primary literature contains a detailed description of the study design, methodology, and scientific results. The reader is able to critique and analyze the study in order to develop a conclusion. (Examples of excellent primary literature resources include articles and studies presented in the New England Journal of Medicine, Journal of the American Medical Association, Archives of Internal Medicine, Annals of Internal Medicine, Lancet, British Medical Journal, etc.)

2. Advantages of primary literature
   1. Contains current, original and "cutting-edge" information. The journals listed in the definition are quite important as they contain a vast amount of information that pertains to patient-oriented, evidence-based medicine that can be utilized directly to help care for patients. The mnemonic POEMS (Patient Oriented Evidence that Matters) is often utilized to define this information and the journals in which it is contained.
   2. Many articles undergo review by the author's peers before an article is accepted for publication thus incorporating unbiased views and suggestions to improve the quality of the report. (This is the "peer-review process.")


3. Disadvantages of primary literature
   1. With any research report, flaws in study methodology may lead to inaccurate conclusions. [example: utilizing inappropriate statistical analysis may lead one to reach an inappropriate conclusion of the results of a study]
   2. In assessing the primary literature, knowledge of scientific methods and statistics is necessary to properly interpret the information.
   3. Since the information presented in the primary literature is so new, it may take time before wide acceptance occurs throughout the medical community.
      
      
4. Utilizing the primary literature in practice
   1. Be cautious, careful, and conservative when utilizing new information from a primary literature source.
   2. Is the article from a peer-reviewed journal? Articles published in peer-reviewed journals are generally better in quality and objectivity than non-peer reviewed work.
   3. In utilizing data from primary sources be sure that all aspects of the primary source are understood (i.e. patient inclusion or exclusion criteria, study methods and interventions, primary outcome being assessed, statistical and clinical relevance of the reported findings), before applying that information to your patient).
   4. To extrapolate primary literature data to a single patient encounter, make sure the patient population mentioned or utilized in the primary work corresponds to your practice population.
   5. Remember that case reports relate only to one patient not a whole patient population. Be watchful for potential for bias and avoid relying solely on anecdotes.
      
      
2. Secondary Literature
   


1. Definition

The secondary literature is compiled by indexing and abstracting services that can be used to systematically locate various types of published literature. The indexing system usually provides bibliographic information indexed by topic and will allow the user to view a brief description of the information within most citations. (An example is search results from Medline identifying primary literature publications on a disease or drug-intervention. Citations will include author, title of the work, location and date of the publication and generally, an abstract of the manuscript.)

2. Utilization
   1. Different formats of secondary literature are available either on-line or through CD-ROM (Medline, Embase, PubMed, National Library of Medicine Gateway, International Pharmacy Abstracts, Current Contents, Toxline). A microfiche (Iowa Drug Information Service) or hardcopy (Index Medicus and Medline) application may also be available. Each database may have a different scope (i.e. Medline focuses on the biomedical sciences, Toxline focuses on toxicology) Many of these databases are available online from the UMKC Health Sciences Library. Medline is available online in the health sciences library through the OVID database. There are excellent tutorials available online which teach you how to properly utilize the vast resources supplied by the Health Sciences Library. The extensive list of databases incorporated into the UMKC Health Sciences Library can be found online.
   2. The Clinical Medical Librarians (CMLs) are highly proficient in searching the secondary literature, especially if you are not well acquainted with medical subject headings (MeSH), or other terms used to index the information. The medical librarians are extremely helpful. If you have questions you can "ask a librarian."


3. Advantages of secondary literature
   1. Provides quick access to the primary literature
   2. Provides a large scope of and/or concise information on specific topics (The information is usually current but it depends on the abstracting service and the specific type of information for which one is looking.
   3. Generally, the journal sources are peer reviewed and of a high standard
   4. With most resources, updated information can be sent to you periodically (i.e. weekly or monthly).
      
      
4. Disadvantages of secondary literature
1. The time period between publication and inclusion (lag time) into secondary sources can vary for each database (e.g. weeks to months).
2. The number of journals indexed by each system depends upon the scope of the database. (Hopefully they are the journals that you consider important and regularly review.)
3. Because a secondary source can encompass such a large amount of information, one must be proficient at sifting through the sources listed on a particular subject to find the exact information one is looking for.
4. To obtain useful information, one must utilize specific search terms and be proficient with a particular database's search techniques. For example, if one searches for "the use of aspirin" in a particular medical database, hundreds of articles would be reported. However, if one can be specific ("aspirin use in myocardial infarction, secondary prophylaxis"), more exact information can be obtained.
   
   
5. Examples of secondary literature
1. OVID: This extensive network is utilized by many libraries to search a large collection of scientific, medical, and technical databases (currently over 80). For the most part it is extremely easy to work with and use. The UMKC Health Sciences Library uses OVID technology which is available online. The CMLs can demonstrate how to utilize it. For a discussion of the company that created OVID, see the OVID website at http://www.ovid.com.
   
   
2. MEDLINE: Abstracting service produced by the National Library of Medicine; indexes articles from over 4000 journals of international biomedical literature including allied health fields; available on-line through UMKC Health Sciences Library ( via OVID Medline). The UMKC Health Sciences Library has excellent tutorials available on-line that explain how to properly perform a search. Access to MEDLINE is also available online from the National Library of Medicine via the Web through PubMed and NLM Gateway.
   
   
3. The Medical Letter: This is basically an abstracting and evaluating service that reviews recently approved medications, drug classes, and lists current treatment options for various diseases; the reviews (although brief) are excellent and non-biased and offer specific recommendations; published every two weeks. (Ask at the library desk to get this from the "Core Texts" shelf in the Health Sciences Library).
   
   
4. Iowa Drug Information Service: Indexes English articles relevant to drugs and treatment of disease from approximately 200 journals; available access from CD-ROM, hard disk and Internet; updated monthly [http://www.uiowa.edu/~idin/]
   
   
5. International Pharmaceutical Abstracts: Offers an extensive list of indexed information, including information pertaining to international pharmacy and pharmaceutical sciences; index includes all pharmacy periodicals. IPA is by subscription, and you can read about its availability in various online databases through the company Thomson Scientific. The UMKC Miller Nichols Library, Volker Campus, receives the printed version of the IPA Abstracts, located at call no. RS1 .I63
   
   
6. The Cochrane Library (Collaboration): Provides an assessment of the literature on particular health care topics through a very complete and thorough literature review. The UMKC Health Science Library subscribes to the Cochrane collection through the Evidence Based Medicine (EBM) database supplied by Ovid.
   
   
7. Micromedex: Micromedex is an extensive pharmacology database which has a vast array of information dealing with pharmacology, therapeutics, poison information, etc. It is available online in the Health Sciences Library and from all TMC computers through the TMC Intranet.


3. Tertiary Literatures
   
   
   1. Definition and types

The information presented in tertiary literature is core knowledge established via primary literature or accepted as standard of practice within the medical community. Drug information contained in the tertiary literature is generally well-established information that is approved and accepted by the FDA (i.e. a FDA labeled indication) or well founded in the primary care literature (i.e. an unlabeled but well-documented use for an FDA approved drug).

The tertiary reference may consist of textbooks on various drug or disease topics (eg. Pharmacotherapy), compendia (a vast array of information about many drugs such as the Physician's Desk Reference) and full-text databases. Review articles that thoroughly summarize a particular topic can also be considered tertiary literature. Reviews will contain more current information about a specific topic than texts.

2. Advantages of tertiary literature
   1. Tertiary references (textbooks, CD-ROMs) are convenient and in general, fairly accessible.
   2. Drug information references may be divided into specific subjects to make them easier to use. For instance, one text may be devoted only to drug interactions, while another might discuss principles of pharmacotherapy or use of drugs in pregnancy. This way, if a specific subject needs to be queried, a specific reference can be reviewed.
   3. Usually the information contained in tertiary literature is well accepted in medical practice. This is because most forms of tertiary literature are referenced with primary literature sources and should undergo a stringent review process to ensure that the information presented is generally well regarded in the medical community.
      
      
3. Disadvantages of tertiary literature
   1. Because of the lag time between when a text was written and the actual publication date, several months to years may have passed before the information is available; thus, information from tertiary literature may be outdated even in "new" editions.
   2. Space limitations within a text may prevent extensive discussion of a drug or topic.
   3. Authors may emphasize limited information about a topic or drug.
   4. Authors may present information that is based on a less than thorough review of the primary care literature.
   5. The tertiary literature may not be referenced appropriately thus preventing a proper check of the primary care literature.
   6. If the information presented in the tertiary literature is based on flawed primary care literature (i.e. poorly done studies are referenced) then the tertiary information may be suspect.
   7. Any updated or new information cannot be inserted into the printed (hard copy) tertiary literature in a timely fashion. [This has changed over time as more texts have become available on-line or through CD-ROMs.]
      
      
4. Evaluation of Tertiary Literature
   1. The reader should assess the text for timeliness (i.e. when was the last edition published?) and if possible, utilize computer applications of the text if more up-to-date information can be obtained. {Note: Scientific American Online is an excellent example of this. This journal is available online from the UMKC Health Sciences Library and it provides detailed, up-to-date reviews on a variety of topics.)
   2. The reader should assess consistency by comparing information presented in one text to the same information presented in another text.
   3. What credentials do the authors/contributors have?
   4. How many references does each section have and how up-to-date are they?
      
      
5. Review Articles
1. Review articles may have the same inherent limitations as texts. A thorough assessment of the review article must be completed.
   
   
6. Examples of Common Tertiary Sources for Drug Information
   
   
• PHARMACOLOGY AND DRUG INFORMATION RESOURCES

(NOTE: The "Call Number" is the MERLIN catalog reference number which tells you where to find the book on the shelf in the Health Sciences Library. To learn more about the MERLIN catalog system, view the tutorial and instructions provided by the UMKC Health Sciences Library.

Goodman and Gillman's Pharmacological Basis of Therapeutics general principles of action, absorption, distribution and metabolism; "gold standard" pharmacology text as well as some therapeutics; very well referenced (general references and reviews are separated); updated editions published approximately every five years (call#: QV4 .G653p 2006; located on the Core Texts of the Health Sciences Library and online through the Library's Electronic Books website).

American Hospital Formulary Service (AHFS): FDA approved and non-labeled uses; extensive dosage and usage sections; not referenced; published annually with quarterly updates (call# QV740. AA1 A5132; located on the shelf in the Reference collection of the Health Sciences Library and online through STAT!Ref on the Library's Electronic Books website). The 2008 online version is kept current by ongoing electronic updates throughout the year.

Drug Facts and Comparisons: FDA approved drugs and investigational and orphan agents; legend and OTC listings; good quick-source; not referenced; (available as an annual bound edition, call# QV772. F1422; located on the shelf in the Reference collection of the Health Sciences Library.

Handbook on Injectable Drugs: parenteral drug stability and compatibility; updated editions published approximately every two years with an annual supplement (call# WB354. T837h 2003; located in the Reference collection of the Health Sciences Library).

Drug Information Handbook: alphabetical listing of drugs by generic name; many charts algorithms and tables of various information; not referenced; updated editions published annually (2007/2008 edition: call# QV735 .D794 is located in the Reference Collection of the Health Sciences Library).

Handbook of Clinical Drug Data: quick reference to drug information; listing of drugs by class; excellent tables and disease state sections; well referenced and pocket size; soon to be published annually (2002 edition: call# QV55.3 .K72h 2002; located in the circulating collection of the Health Sciences Library).

Martindale:The Complete Drug Reference: foreign drug information including selected US drugs; great resource for obscure information and for names of drugs in other countries; well referenced; published by the Royal Pharmaceutical Society of Great Britain; updated editions published approximately every four years; (call# QV738. FA1; located in the Reference collection of the Health Sciences Library.

Physician's Desk Reference (PDR): FDA approved product information; usage and dosage information only as approved by the FDA; not referenced; does have pictures and tablet and capsule markings for some drugs which can be an aide in drug identification; lists manufacturers of specific drugs and manufacturer contact information; lists FDA pregnancy categories for drugs (categories describe current knowledge of relative safety or harm for a product in pregnancy); not useful for finding critical drug information; updated annually (call# QV772. P579; located in Core Texts section of Health Sciences Library; also available through Micromedex in the Health Sciences Library).

USPDI Volume I: Drug Information for the Health Care Provider: FDA approved and some non-label uses; auxiliary labeling; not referenced; new editions published annually (call# QV738. AA1 P53; located in the Reference collection of the Health Sciences Library; also available through Micromedex in the Health Sciences Library and TMC).

American Drug Index: listing of products available in US and cross-referenced by trade, generic, and chemical names; various pharmacy type information; updated editions published annually (call# QV747. A512; located in the Reference collection of the Health Sciences Library).

Drug Topics Red Book: National Drug Codes (NDC numbers); average wholesale prices (AWP) of legend (prescription) and OTC (over-the-counter) drugs; manufacturer's phone numbers; "do not crush or chew" list; updated editions published annually with monthly updates (call# HD9666.1.D573; located in the Reference collection of the Health Sciences Library).

• DRUG INTERACTION RESOURCES

Drug Interaction Facts: Mechanism of drug/drug and drug/food interaction listed as well as clinical significance; well referenced; updated quarterly for placement binders or available annually in a text version (call# QV38 .D796; located in the Reference collection of the Health Sciences Library).

Hansten and Horn's Drug Interaction Analysis and Management: similar to Drug Interaction Facts; an introductory chapter provides an excellent discussion regarding mechanisms of drug interactions (call# QV39 .H251 (updated quarterly); located in the Reference collection of the Health Sciences Library).

• MEDICAL AND PHARMACY THERAPEUTICS RESOURCES

The Washington Manual of Medical Therapeutics: The 2007 edition is available online through Books@Ovid. It is a quick reference to the treatment of disease states and medical emergencies; numerous charts and tables; updated editions published approximately every two or three years (call# WB300 .319m 2007; located in Core Texts of the Health Sciences Library).

Applied Therapeutics: The Clinical Use of Drugs: pathophysiology and pharmacotherapeutics in a case presentation format (interesting format but sometimes it makes it hard to find the information you are seeking unless it is directly attributable to the case); focus is on drug therapy; well written; updated editions published approximately every four years (call# WB330.A651 2005; located in circulating collection of the Health Sciences Library).

Pharmacotherapy: A Pathophysiologic Approach: pathophysiology and treatment of disease; focuses upon drug therapy; very well written; updated editions published approximately every four years (call# WB330. P5357 2005; located in circulating collection of the Health Sciences Library).

Textbook of Therapeutics: Drug and Disease Management: focus is on drug and disease management; organized by disease groups; an excellent text; updated editions published approximately every four years (call# WB 330.T3555 2000; located in the circulating collection of the Health Sciences Library).

• INFORMATION ON DRUG SIDE EFFECTS

Meyler's Side Effects of Drugs: lists and discusses side effects associated with drug therapy; comprehensive index referenced by drug and adverse drug reaction; updated editions published approximately every four years with yearly updates (also called Side Effects of Drugs Annual) (call# WB 330 .S5681; located in the Reference collection of the Health Sciences Library).

• DRUG INFORMATION RESOURCES FOR SPECIAL PATIENT POPULATIONS

Harriet Lane Handbook: a Manual for Pediatrics House Officers: well known pocket guide to pediatrics, including drug dosing; updated every few years; electronic book version updated annually (call# WS29 .H297 2002; located in the circulating collection of the Health Sciences Library).

Handbook of Commonly Prescribed Pediatric Drugs (Barbieri): excellent reference on pediatric drug therapy; updated every few years (call# QV39 .B236h 1999; located in circulating collection of the Health Sciences Library). (NOTE: This topic is extensively reviewed in the year five Self Paced Learning Module [Medicine 575R])

Handbook of Geriatric Drug Therapy : drug handbook organized alphabetically by drug name (call# WB39 .H23643 2000; located in circulating collection of the Health Sciences Library). (NOTE: This topic is extensively reviewed in the year five Self Paced Learning Module [Medicine 575R])

Drug Prescribing In Renal Failure (Aronoff et al.): discusses all aspects of drug dosing in renal failure including recommended dosages of individual drugs; soft copy pocket guide is an excellent reference and is updated every few years (call# QV16 .D794 1999; located in circulating collection of the Health Sciences Library). (NOTE: This topic is extensively reviewed in the year five Self Paced Learning Module [Medicine 575R])

Drugs in Pregnancy and Lactation: excellent reference that discusses all aspects of drug dosing in pregnancy and lactation; updated every four years
(call# QV772 .D795 2005; located in Reference collection of the Health Sciences Library).(NOTE: This topic is extensively reviewed in the year five Self Paced Learning Module [Medicine 575R])

Cancer Chemotherapy Handbook: by Fischer DS, Knobf MT and Durivage HJ
(call# QZ39 .F533c 2003) and Lippincott's Cancer Chemotherapy Handbook by
Baquiran DC (call# QZ39 .B222L 2001) are both are excellent references relevant to the pharmacology and use of chemotherapeutic agents. (Both titles located in circulating collection of the Health Sciences Library).

The Review of Natural Products: from Facts and Comparisons; monographs include a comprehensive and up-to-date source of referenced, evaluated, factual information about natural products (call# QV 766 .R485; located in the Reference collection of the Health Sciences Library).

Natural Standard Database: is an evidence-based resource that is available online in full text. It contains information on alternative, complementary and integrative medicine, arranged in topic monographs. It is continually updated and international in scope. (http://www.naturalstandard.com.ezproxy.mnl.umkc.edu/index.asp)

• OTHER INFORMATIONAL RESOURCES

Remington: The Science and Practice of Pharmacy: information concerning the practice of pharmacy and pharmaceutical sciences; republished approximately every five years.
(call#QV704 .R38815 2006; located in the Reference collection of the Health Sciences Library)

USPDI Volume II: Advice for the Patient: supplements for patient education; updated editions published annually and updated monthly (call# QV740 .AA1 P54 2007; located in the Reference collection of the Health Sciences Library; also available online as part of theWebsite called MEDLINEplus from the National Library of Medicine at this URL: http://www.nlm.nih.gov/medlineplus/druginformation.html.

USPDI Volume III: Approved Drug Products and Legal Requirements: some pharmacy practice acts and regulations; list of A and B ratings; lists older drugs and discontinued agents; updated editions published annually and updated monthly (call# QA740 .AA1 P55; located in the Reference collection of the Health Sciences Library).

• DRUG INFORMATION and POISON CONTROL CENTERS

UMKC Drug Information Center (ph# 816-235-5490): staffed primarily by pharmacy students and instructors from the UMKC School of Pharmacy; turn around time for response to questions is not always rapid; may want to speak with a pharmacist and not a student (must know the credentials of the person); DI center only open for a limited time period each day.

Poison Control Centers: Kansas-Mid-America Poison Control Center, 1-800-222-1222; Missouri-Regional Poison Control Center, 1-800-222-1222)- usually staffed by well trained individuals (RPh, RN); has very up-to-date information on most products; in case of poisoning or overdose poison control can be extremely helpful.

Cardinal Glennon Children's Hospital Poison Center: Ph# (1-800-222-1222)- utilized by the TMC Emergency Medicine Department for FAX-back information on poisonings and overdose; consultation provided by trained center staff. They provide statewide service 24 hours a day, 7 days a week.

4. DRUG INFORMATION ON THE INTERNET

   The Internet provides a plethora of medicine and drug information sites. Some of these sites are useful, but some can provide inadequate information to health care professionals. Utilizing the Internet correctly is the key. Some issues to consider are:

   1. Necessity
      
      Is it necessary to get online to find information when opening up a particular reference book would be faster and easier?
      
      
   2. Computer comprehension

   Rudimentary skills are necessary to access information on the Internet. This is not a computer class so I won't go into detail here.

   3. Areas where the Internet is very useful
   1. When a reference to the Internet is found (e.g., advertisement, citation), you have an Internet address to quickly access the information described.
   2. When company specific information is necessary (e.g., pharmaceutical companies), Internet information is usually readily available.
   3. Current event topics (items in the news).
   4. Information provided by the United States government. (e.g., Food and Drug Administration or the Centers for Disease Control) The U.S. government places significant amounts of information on the web.
   5. When the information is not likely to be contained in any other available sources of information (e.g., alternative medicine, tropical diseases).
   
   
   4. Internet problems
   1. There are times when accessing and navigating the Internet can be time consuming and restraining. (The CMLs can provide help in correctly navigating the Internet as well as evaluating the utility of various sites.)
   2. Remember, not all information put over the net is useful. Some of it is advertising (e.g., from pharmaceutical companies, support groups, etc). You must be willing to take the time to critically and judiciously review all the information that is presented.
   3. Many useful sites may require a subscription ($$$$) or at least registration, which means your name and Email address could be accessible. You will have to be the judge of whether or not you want give out personal information.
   4. The sheer amount of information that is available on the Internet can be daunting. It can be difficult to sort through all of the clutter to get to what you need.
   5. Finally, some of the Internet drug information sites can give incorrect information since many of the articles, reviews, and citations are not referenced. The accuracy of this information should always be questioned. (Note: Many patients will utilize the Internet as their primary information source. Effective communication with patients can ensure that patients understand their medical conditions and therapies. Patients should understand that not all medical information presented on the Internet is evaluated or presented appropriately, and can potentially be misleading, or not related to a particular patient's condition. The Internet can be useful, though, in teaching a patient about his or her condition, and keeping the patient well informed and educated.)
   
   
5. INTERNET INFORMATION SITES

There are an enormous number of Internet sites devoted to drug information. To list them all would be very time consuming. Some sites are useful and some are designed only for the lay population.

1. Various health science programs maintain lists of sites that provide excellent drug information. Examples include:
• University of Illinois at Chicago, College of Pharmacy (http://www.uic.edu/pharmacy/research/index.php)
• RX List (http://www.rxlist.com/script/main/hp.asp)
• The US Food and Drug Administration (http://www.fda.gov)
• University of California San Francisco Database of Antiviral Drug Interactions is a component of HIV InSite from UCSF. Here you will find interactions among HIV drugs and interactions of some HIV drugs with non-HIV drugs. and get all of its interactions with the antiretrovirals. Or you can pick any of about 20 drug classes and see their interactions with antiretrovirals.(http://hivinsite.ucsf.edu/insite?page=ar-00-02)


2. Evaluation of Internet Drug Information Sites

The Internet can be an effective tool to access drug information quickly and efficiently. Realize, though, that ANYONE, whether professional or non professional, qualified or unqualified, can write information about drugs and post them on a web page. This web page may even look official and professional. Whether or not this medical or drug information is based on well-supported, scientific evidence is left for you, the medical professional, to decide. Just because something appears on a web page does not make it true. You must develop the skills to critically assess and authenticate the information presented to you.

• Is the information based on strong scientific evidence?
• Is it referenced appropriately?
• Is the web page there to bias the practitioner in any way?

Being able to effectively assess medical and drug information will enable you to provide proper care for your patients.You will develop these skills throughout your medical education at UMKC. Two sites which may aid in this development are:

• Nuts and Bolts, created and maintained by the UNC Health Sciences Library
• Johns Hopkins University, Evaluating Information Found on the Internet

The following sites may offer some valuable information.

TABLE 1: POTENTIALLY USEFUL MEDICAL INFORMATION SITES

Available free online or through the Health Sciences Library
MEDLINE through Ovid	HSL - http://library.umkc.edu/online/databases/medline.htm
PubMed	Free - http://www.ncbi.nlm.nih.gov/sites/entrez/
National Library of Medicine Gateway	Free - http://gateway.nlm.nih.gov
EBM Reviews—Cochrane Database of Systematic Reviews	HSL - http://library.umkc.edu/online/databases/ebmcochrdatabase.htm
EBM Reviews—ACP Journal Club (includes the contents of the journals Best Evidence and ACP Journal Club)	HSL - http://library.umkc.edu/online/databases/ebmacpjournal.htm
EBM Reviews—Database of Abstracts of Reviews of Effects	HSL - http://library.umkc.edu/online/databases/ebmeffectiveness.htm
STAT!Ref Electronic Medical Library	HSL - http://library.umkc.edu/online/databases/statref.htm
Goroll's Primary Care Medicine	HSL - http://library.umkc.edu/hsl/books/ebooks.html
Harrison 's Online	HSL - http://library.umkc.edu/online/databases/statref.htm
eMedicine	Free - http://www.emedicine.com/
Online Journals at the Health Sciences Library	HSL - http://pc8ga3qq6a.search.serialssolutions.com/
Clinical Practice Guidelines	Free - http://www.guideline.gov
Evidence-Based On Call	Free - http://www.eboncall.org/
Bandolier Evidence-Based Health Care	Free - http://www.jr2.ox.ac.uk/bandolier/index.html
Medical Matrix	Free - http://www.medmatrix.org/Index.asp
Merck Medicus	Free - http://www.merckmedicus.com/pp/us/hcp/hcp_home.jsp
ScHARR Netting the Evidence Tutorials	Free - http://www.shef.ac.uk/scharr/ir/netting/
UpToDate	HSL - http://library.umkc.edu/hsl/Books/ebooks.html. Available only in the School of Medicine and Truman Medical Centers.
Available online by subscription (for a fee)
Clinical Evidence	http://www.clinicalevidence.com/ceweb/index.jsp
MDConsult	http://www.mdconsult.com/

Other suggested site for the medical student

• Information specifically for the medical student (www.medicalstudent.com ) This may also be a useful site as it provides a large number of links to various medicine sites (including pharmacology). This is such an extensive site with many pages, though, and one could easily get lost.
  
  
6. DRUG INFORMATION FOR PERSONAL DIGITAL ASSISTANTS

For a list of drug information resources suitable for the Palm™ OS or the Microsoft® Windows® Powered Pocket PC, see the Health Sciences Library's PDA Resources website.

6. OTHER DRUG INFORMATION RESOURCES


1. Information From Experts
   • Benefits
     1. The expert may have great wisdom gained through many years of experience.
     2. Important clinical "pearls" can be obtained.


• Detriments
  1. The information may be out of date.
  2. The expert may be biased.
  3. Experience may be favored over good scientific evidence.


• General considerations
  1. Make sure the expert advice makes good medical sense and if possible can be supported by current best evidence or research data. If seeking expert advice, give the expert the full case history.
  2. Make sure that the expert's experience parallels your patient population.


7. OTHER SOURCES
   
   
1. Review articles from non-peer reviewed journals ("throw-aways").

These may offer good information, but you should review it very carefully. (i.e. any drug company sponsored journal such as "Hospital Pharmacy Hotline" or Welcome Trends in Pharmacy").

2. Hospital based treatment plans or clinical pathways

Although some people consider this to be "cook-book" medicine, these plans (if done well) can ensure that patients with certain problems are treated correctly and uniformly. The drug information they contain may be very specific and may be based on cost. Only use them if they conform to what is currently recommended in the medical literature.

3. Pharmacists

This is an excellent drug information source, especially if you can develop a good working relationship with a pharmacy professional. Make sure you know this person's background and skill level. When utilizing pharmacist for information, make sure that only a licensed pharmacist responds to your request, not a technician or student. It is also advisable to inquire which resources the pharmacist utilized to answer your request.

4. Pharmaceutical companies and sales representatives

Although most pharmaceutical companies and their representatives are well meaning, they are in the business of promoting their product so the information that they provide to you may be very biased. Never base a drug treatment plan solely on what is provided to you by a pharmaceutical company. It must always be backed up by sound scientific evidence (e.g. the literature sources described above).

2. CONCLUSION
• Understand what drug information you need.
• Go to the most accessible and convenient source first (generally a textbook or tertiary reference).
• If more information is necessary seek other sources (e.g., the secondary or primary literature).
• If you still cannot answer your question seek help from a qualified pharmacist or possibly a medical librarian.
• Remember, the worst question is the one that is not asked. Continue to ask lots of drug information questions as this can only enhance your experience, expand your knowledge and most importantly, benefit your patients. Never settle for poor or inadequate answers.

THE INFORMATION LADDER

1. Glowniak JV. Medical resources on the Internet. Ann Intern Med 1995; 123: 123-31.
2. Wright SG, Leroy RL, Kendrach MG. A review of the three types of biomedical literature and the systematic approach to answer a drug information request. J Pharm Pract 1998;11: 148-62.
3. Erbele SM, et al. Evaluating internet drug information. Hospital Pharmacy 2002; 37(2): 141-5.
4. Slawson DC, Shaughnessy AF. Obtaining useful information from expert based sources. BMJ 1997; 314: 947-9.
5. Wilson I. Searching the literature: A beginners' guide. Austral Fam Phys 1998: 27: 385-6.
6. Chambliss ML. Choosing the best medications. Am Fam Phys 1996; 53: 2565-70.
7. Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: A guidebook to the medical information jungle. J Fam Pract 1994; 39: 489-99.
8. Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master: Feeling good about not knowing everything. J Fam Pract 1994; 39: 505-13.
9. Hunt DL, et al. Users' guide to the medical literature. JAMA 2000; 283: 1875-79.