Use and cost analysis of online literature searching in a university-based drug information center

The use of an online literature-retrieval system located within a university-based drug information center over a three-year period is described. The drug information center, which handles 50-100 questions/month, is equipped with a computer terminal and printer, as well as the standard printed reference sources. If a question cannot be answered in 10-15 minutes using general reference sources, a computer search is conducted. For the years 1979-81, the total number of online searches was determined. Data were also collected indicating the database accessed and the time spent for each search. The number of online searches performed for the successive years was 279, 397, and 274. Of these, 69% were conducted on the MEDLINE database. The average time for each search was 10.96 minutes in 1979, 6.40 minutes in 1980, and 8.54 minutes in 1981. The mean annual charge for online searching was $1772.32. Royalty fees and telecommunication charges for the respective years accounted for 23.5%, 32.6%, and 25.4% of the total bill. Online searching provides an efficient method of retrieving information, especially when questions are very complex. Drug information specialists handling many complex questions should consider acquiring the equipment and expertise to do online searches within their drug information center.     

Cost of implementing and maintaining a hospital-pharmacy-based online literature search system

The costs of implementing and maintaining an online literature search system are described. The drug information service component of the department of pharmaceutical services pursued computerization to ensure the availability of timely and comprehensive drug information and to provide hands-on experience in computerized literature retrieval for its undergraduate and graduate students. Three major implementation costs were identified: the cost of purchasing the computer hardware, the expense of a training program for the online search program, and the ongoing user's fee for access to the databases. These implementation expenses were covered through nontraditional sources of funding, and no money was required from the hospital. The system received hospital-wide publicity through a number of prominent communication vehicles when it was implemented. In its first year, there were 448 requests requiring computer searches of a total 4150 requests for drug information. Of these 448, 255 originated from physicians, 138 from pharmacists, and 55 from nurses and drug manufacturers. Medline was the most frequently accessed database, accounting for 62.6% of the charges; Toxline accounted for 32.3% and miscellaneous files 5.1%. The average monthly charge (user's fee) was +238, which was within the initial projection for the yearly expense. Because of the success of this program, the system's costs were added to the operating budget of the drug information service.     

Comparative usefulness of MEDLINE searches performed by a drug information pharmacist and by medical librarians

The usefulness of MEDLINE searches conducted by a drug information pharmacist who had received online training was compared with the usefulness of searches conducted by medical librarians. Searches for literature pertinent to select drug information requests received at a university drug consultation service during a three-month period were conducted independently by the pharmacist and one of three reference librarians. The three librarians had received extensive online search training and were experienced in conducting MEDLINE searches; the pharmacist was trained by a fourth experienced librarian-searcher using National Library of Medicine (NLM) training materials. For each drug information request, the pharmacist and the librarian searched two MEDLINE files on the NLM service. The printouts generated by the two searchers were evaluated by two drug information pharmacists in terms of how useful each list of citations would be in enabling the drug information pharmacists to answer the related question. The majority of printouts in 48 sets of searches were judged to be useful. Of the 96 possible "best search" votes (two votes for each of the 48 sets of printouts), the pharmacist's searches received 34 votes, the librarians' searches received 28 votes, and there were 34 tie votes. The numbers of useful primary and alternate citations were found to be the best predictors of whether a given printout would receive the "best search" rating. MEDLINE searches performed by a drug information pharmacist with online training, in response to drug information requests, were judged by drug information pharmacists to be as useful as searches performed by librarians.     

New drug information resources for pharmacists at the National Library of Medicine

ObjectiveTo provide an overview of selected drug information-related databases of the National Library of Medicine (NLM), with a focus on newer resources that support the professional information needs of pharmacists and other health care providers.SummaryNLM, which is the world's largest medical library, provides an array of bibliographic, factual, and evidence-based drug, herbal remedy, and dietary supplement information resources. Five of the more recently introduced online resources include areas of particular importance to pharmacists, including a repository of current product labeling/package inserts, with automated search links to associated information resources; a portal to drug information that allows pharmacists to search multiple databases simultaneously and link to related medication and health care information resources; authoritative information on the effects of medications, herbal remedies, and dietary supplements in nursing infants and their mothers; comprehensive information, including a case registry, on the potential for liver toxicity due to drugs, herbal remedies, and dietary supplements; and a pill identification system with two intuitive search methodologies.ConclusionNLM provides several clinical–scientific drug information resources that are particularly useful in meeting the professional information needs of pharmacists.     

Online information retrieval in pharmacy and related fields

Online information retrieval in pharmacy and related fields is described. Factors involved in determining whether to conduct an online search are discussed, including characteristics of appropriate and less suitable topics, advantages and limitations of online searching versus manual searching, and possible types of searches. The process of preparing for an online search, involving the determination of search vocabulary, relevant citations, important authors, time frame, special categories (such as language, publication type, and reviews), and the number of citations needed, as well as choosing a database, is explained. Sample search strategies on MEDLINE and IPA are illustrated to demonstrate the basic search commands and to compare file retrievals on the sample subject. Pharmacy-related bibliographic databases, general-interest databases, end-user search services, and full-text and numeric databases are profiled. Online database searching can be a cost-efficient and flexible alternative to manual literature searching for pharmacists. Although most online searching is currently conducted by librarian-search specialists, end-user searching is a growing trend, as is the availability of full-text databases.     

Improving access to computer-based library and drug information services in patient-care areas

A project to increase access to drug and biomedical information through electronic linkage of drug information and library services to three patient-care areas is described. In February 1987, microcomputer work stations were installed in the Bexar County Hospital District's hospital emergency department, medical residents' office, and ambulatory-care clinic, as well as in The University of Texas Health Science Center's library reference area and drug information service office. Drug information was available on compact disk through the Micromedex Computerized Clinical Information System (CCIS) database, which includes DRUGDEX, POISINDEX, EMERGINDEX, and IDENTIDEX. Each work station was also connected to the library's computer via modem, allowing access to the Library Information System, books, journals, audiovisual materials, miniMEDLINE, and an electronic mail system. During the six-month project, the system was used 5487 times by 702 people. The system was successful in providing drug and other information in clinical settings and in introducing clinical staff members to new information technology. To increase access to the system after the project ended, the CD-ROM version was discontinued, and the distributed tape version of CCIS for VAX computers was added to the library's online information system, making drug information more available throughout the campus and teaching hospitals. In 1988-89 an average of 200 people accessed the tape version of CCIS each month. Although it is difficult to replace the convenience of an onsite library, at least some drug and biomedical information needs in the clinical setting can be met through computer networking.     

Computer system for unit dose drug distribution

A computerized unit dose drug distribution system, part of an online hospital information system, is described. Differences between manual and computerized pharmacy distribution, and the advantages and deficiencies of the automated system are discussed. The system seems to improve pharmacy's efficiency, accuracy, control of drugs and capabilities for patient monitoring and drug use review. If mechanical failure occurs, back-up procedures keep the distribution system operational. The computer system is believed to decrease the time spent by pharmacists on routine distribution tasks, leaving time for other necessary pharmacy functions.     

Distributive and clinical activity measurement using spreadsheet software

Documentation of distributive and clinical activities is an important factor in maintaining and expanding pharmacy services. In order to illustrate the impact of pharmacists' efforts on risk management and the reduction of drug costs, the pharmacy must effectively monitor workload. This report describes a method to identify and estimate time required for both distributive and clinical functions. Tabulation of the distributive work units is automated through the hospital billing system. Clinical monitors are dependent on manual documentation by decentralized clinical pharmacists. The clinical coordinator and the pharmacy director review the documented clinical monitors to insure compliance and standardization. Productivity and workload calculations are performed automatically via the spreadsheet software once all the distributive and clinical units are entered. Identifying clinical functions and measuring the associated workload has aided in justifying new positions. Future considerations include calculating the impact of clinical services on revenues, expenses, and staffing.     

Investigational drug information through a hospitalwide computer system.

A hospitalwide computer system that combines protocol-specific information on investigational drugs with order entry is described. A large university teaching hospital had in place a computerized clinical information system. Among other uses, physicians used the system for direct entry of total parenteral nutrient solution orders and associated laboratory tests; labels are produced automatically. Personnel from the pharmacy and information services departments met to discuss how to apply the computer system to investigational drug information. The application they designed has three components: protocol information, order entry, and patient monitoring. Protocol information, including all the standard drug data plus regulatory and investigator information, is displayed as a report on the user's terminal. The order-entry pathway allows the research pharmacist to predesign medication labels that are specific to each study and include all required information. This saves time, ensures accurate labeling, and provides a means for generating patient charges. The patient-monitoring component provides information to the research pharmacist in a daily report to assist in locating subject patients and to monitor compliance with protocols. The system has improved the access of health-care professionals to investigational drug information and decreased the time pharmacists spend dispensing these agents. The system has been well received, although up to three weeks is needed to bring the information online. A hospitalwide information system is effective in disseminating information on investigational drugs and facilitating order entry.     

Comparison of alphabetic and phonetic retrieval of online drug information

Alphabetic, phonetic, and combined alphabetic and phonetic methods of retrieving online drug information were compared. Twenty-four volunteers participated in the study representing four user groups: physicians, nurses, pharmacists, and nonhealth-care hospital staff. Each subject performed 150 searches, 50 by each retrieval method. Using the alphabetic method, drug information was retrievable only if the drug name was spelled correctly. Using the phonetic method, searches were conducted based on the phonetic spelling of requests (e.g., "symetadine" for cimetidine). The combined method used a phonetic search only after an initial alphabetic search was unsuccessful. The elapsed time between the first entry and an indication that the information had been found or could not be found was determined, and the number of drug names not found and the number of excess tries were counted. There were no significant differences in elapsed time among the three methods. Pharmacists had the shortest mean elapsed time and physicians the longest. The average number of excess tries using the phonetic system was a third of the number required using the alphabetic method. The number of drugs not found showed only slight differences among the three methods. The subjects found the desired information on the first try 67% of the time with the alphabetic method, 66% with the combined method, and 90% with the phonetic method. The phonetic method had an average of 75 matches versus 20 for the alphabetic and combined methods. These results support use of a combined alphabetic and phonetic system for retrieving drug information.     

Drug information centers: future trends

The future of drug information centers (DICs) is discussed in light of current problems and future needs. DICs are not being used to their full potential in supplying drug information to health professionals, and the entire system appears to be inefficient. The efficiency of answering nonjudgmental questions in DICs is questionable, especially since community and hospital pharmacists could answer these questions using readily available references. There is no minimum standard of quality for DICs, and DICs do not use computer technology to its fullest extent. Many DICs have had funding problems. In spite of these problems, DICs will continue to perform useful functions, such as providing support for clinical pharmacy services, teaching undergraduate and graduate pharmacy students, and performing reviews for pharmacy and therapeutics committees. Quality assurance guidelines must be instituted for all DICs, as well as standards for facilities, resources, and personnel. The establishment of regional DICs, which are self-supported through fees charged to hospitals, pharmacies, health professionals, consumers, and corporate users, is a possible means of improving the efficiency and providing consistent quality in DICs. Since routine drug information will be readily available online to health practitioners, in the future DICs will provide primarily consultative drug information services.     

Psychological stress and cancer

All the concepts reported in this editorial are based on recent literature data obtained through a PubMed search, using both Medline and manual searches, with particular reference to articles, which could be relevant to clinical practice. This paper contributes to the existing literature on depression and stress and provides important information for the development of effective strategies to manage these conditions among patients with cancer.     

Adolescents' perceptions of the internet as a health information source

The internet offers young people easy and anonymous access to information about health and medicines A series of focus groups with United Kingdom school students explored their perceptions of the internet as a health information source Less than one‐third of the students had looked for health information online; those who did were as likely to look for information about a family member's illness as their own health concerns (including diet/exercise, sexual health) Most health information seekers had used a search engine for their query, and their success was determined by their skill at evaluating the search results that they received There are opportunities for educational interventions through schools and pharmacies to help young adults to optimise their use of the internet for health information     

辽宁省城乡基层医疗卫生机构及居民用药情况调查报告

目的了解基层医疗卫生机构及居民用药情况,发现不合理用药现象,提出针对性建议,保障基层医疗卫生机构和公众安全、有效、经济用药。方法采取多级抽样调查辽宁省内5个城市社区卫生服务中心和5个乡镇卫生院的处方,利用调查表收集就诊患者和居民的基本用药习惯,采用spss13.0对数据进行统计分析。在调查过程中同时采用直接观察法与采访法相结合收集信息。结果基层医疗卫生机构存在比较严重的不合理用药行为,新型农村合作医疗加剧了不合理用药,居民用药仍处于比较低的认知水平。结论应通过多部门共同合作,制定和落实政策,提高基层医疗卫生机构合理用药水平;通过宣传和培训,提高公众的安全用药意识。     

建立区域性审方中心实践探讨与初期效果评价

目的： 介绍广州市天河区区域性审方中心的建设运营经验,评价审方中心的初期实施效果。方法： 建立前置审方信息系统,制定审方规则,规范审方行为与流程,对处方存在的问题进行分级警示,分别采取对应的措施。统计对比先行上线审方系统的3家社区卫生服务机构上线前后处方情况、审方干预情况。2018年7-12月前置审方系统上线前的处方数据为对照组,2019年7-12月审方系统上线后的处方数据为观察组,比较2组数据不合理用药处方数量和比例,统计分析不合理处方情况及审方干预结果,进行初期评价。结果： 经过审方系统前置审核后,处方合格率有较大幅度提升;重复用药或者联合用药不适宜、选药不合理或适应症不适宜占据所有不合理类型前2位;一级/二级/三级警示处方的总趋势逐步减少,四级处方在逐步增加;医生对药师的审方意见接受率总体呈上升趋势。结论： 审方中心确实提高了区域基层医疗机构的处方合格率和合理用药水平,是前置审方集约化模式的尝试,是值得推广的医联体统一药学服务模式。     

"The rock always comes first": drug users' accounts about using formal health care

Illicit drug use remains a significant public health threat. The issues surrounding drug use are recognized by public health professionals as important for several reasons. The incidence and prevalence of drug use persists in spite of the extensive societal, interpersonal, and individual consequences. In addition, the chronic health issues and health care costs associated with drug use continue to spiral. A wide variety of quantitative studies have examined the extent of health care problems, access, cost, and health care satisfaction among illicit drug users. While these studies offer important information through survey formats, fewer studies focus on subjective constructions of health care management from the users' perspective. This article examines the elements of the decision-making process involved in accessing formal health care among chronic and injecting street drug users. Twenty-eight in-depth interviews provide the data for this analysis, which is part of a large quantitative study of 1,479 injecting and chronic drug users and nondrug users in Miami, Florida. By exploring the elements of health care access through the eyes of the drug users, researchers and treatment professionals may gain insights into new ways to improve health care access for this at-risk population.     

Exploration tools for drug discovery and beyond: applying SciFinder to interdisciplinary research

Chemists have long recognized the value of online databases for surveying the literature of their field. Chemical Abstracts Service (CAS) databases covering almost a century's worth of journal articles and patent documents are among the best known and widely used for searching information on compounds. Today's research presents a new challenge, however, as the boundaries of chemistry and biological sciences overlap increasingly. This trend is especially true in the drug discovery field where published findings relating to both chemical and biological entities and their interactions are examined. CAS has expanded its resources to meet the requirements of the new, interdisciplinary challenges faced by today's researchers. This is evident both in the content of CAS databases, which have been expanded to include more biology-related information, and in the technology of the search tools now available to researchers on their desktop. It is the integration of content and search-and-retrieval technology that enables new insights to be made in the vast body of accumulated information. CAS's SciFinder is a widely used research tool for this purpose.