Drug Informatics

Lecture 3: Effective searching, retrieving and

critically evaluating literature
PHR3100
Naschmil Abdulla
MSc Clinical Pharmacy Practice
naschmil.abdulla@komar.edu.iq

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Learning outcome
• Identify types of resources and use them for searching
• Familiarize with Boolean logic, advanced search keywords and
medical subject heading (MeSH)
• Determine validity of sources
• Critically evaluating literature

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Primary resources
• The most up to date resource available to the clinician and consist of
journal articles reporting original research, new ideas, opinion
• Useful for research, education and current awareness
• Not all articles found in journals are considered primary literature, eg
review articles that summarizes the literature are classified as tertiary
resources

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Secondary resources

• Include indexing and abstracting systems that organize and provide

easy retrieval of primary resources
• Indexing system include the article citation, with or without access to
the abstract; some may include link to a full text
• Eg include databases such as MEDLINE (through PubMed), academic
search premier, Cochrane database of systemic reviews, International
pharmaceutical abstracts, Embase)

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Tertiary resources
• Includes condense and summarized data from the primary literature
• Include textbook, compendia and electronic databases (eg
Micromedex, Lexicomp) and review articles
• Are written by experts in the field and are peer reviewed
• If tertiary resource is not current or comprehensive, a secondary
resource should be consulted to locate primary literature on the topic
• Most questions are answered using tertiary resources

Let’s watch a video on an evidence based resource

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Internet sources of Drug Informatics
• An explosion of information available on the internet for both patient
and healthcare professional
• Patient rely on the internet for health and drug informatics when they
may not have access to a knowledgeable health care professional
• Patient and public may be unable to evaluate the validity of the drug
information available from internet
• Elderly patients: Prefer to talk to an healthcare professional as
primary source for drug information

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Search engines
• When searching for specific words or phases, a search engine (eg
Google, Yahoo!, Bing, AOL Search, Ask) is useful
• Different search engines often produce different results for the same
term; therefore use more than one search engine can improve results
• Internet allows searches retrieve data that still needs expert analysis
and critical eye to evaluate the evidence
• Internet does not replace science of drug informatics retrieval and
evaluation

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Search engines
Reliability of healthcare information on various search engines have been
undertaken:
• 1997 Bonati’s group studies Yahoo! And Excite
• 1999 comparison was made between AltaVista, Excite, Hotbot, Infoseek,
and Lycos (study demonstrated that the use of the general search engines
for health care information, as well as the use of specialized medical and
health websites, had dramatically increased)
• 2005 Forrester Research conducted a Web survey to assess search engines
by evaluating AOL, Google, MSN, and Yahoo! according to 11 parameters in
user experience
• 2009 comScore highlighted the top five search engines on the market
Google, Yahoo!, Microsoft Sites, Ask Network, and AOL LLC

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Search engines
• The 2009 study found that search engines vastly different and
recommended against reliance on a single source
• The study also found that search engines often show Wikipedia results at
the top of the results list (referred to the visible area)
• Wikipedia is not peer reviewed and not always valid and reliable
information present; information to be reviewed with skepticism
• Study also highlighted that most relevant information of value and high
quality references for healthcare professionals is found in the scroll area,
which requires scroll down of the page to find significantly better results
• Study found that patient and healthcare professional don’t tend to scroll
more than two pages

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Boolean Logic
• Used in search engine such Google, StatRef, Medline and
AceesPharmacy
• Use of Boolean operators (and, or, not) narrow down results in search
strategies
• Having two terms tells the engine one or both terms must appear
within the record
• If “not “ is used the engine will look for articles that do not contain
the search term
• Specific search engines may have different terms for not (eg. Google
uses a minus sign)

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Boolean logic
The site offers ways to restrict searches for a particular site or by a
particular author or even by a particular link to another site

Vegan NOT Vegetarian

Using NOT, allow to find resources that only discuss vegan diet

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Advanced search keywords

• Keywords are single terms that appear in the title, abstract and MeSH (medical subject
heading) terms of an article
• Key words are used when MeSH term is available for a specific concept or if MeSH is not
specific enough (eg. new drug released and has no MeSH term assigned a keyword is
best approach to find articles on that drug)
• Metasearch engines (eg. Dogpile, metacrawler.Search.com) allow user to enter terms
and search multiple search engines at one time
Advantages:
• eliminate duplicate results and provide the user with a list ranked by relevancy
• gives information the healthcare professional looks for compared to search engines that
can miss valuable information on the internet
Disadvantage:
• Result in a search strategy that is too broad in scope and identify irrelevant articles
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Advanced search keyword:
Medline Medical subject heading (MeSH) Terms
• MeSH terms are a standardized vocabulary used for indexing articles
in MEDLINE
• MeSH terms are organized within MEDLINE in a fashion referred to as
“tree structure”
• Hierachial system allows for either broad topic search (eg
cardiovascular disease) or more narrow searches (eg cardiac
tamponade)
Advantage of this technique: helps to search specific aspect or facet of
the topic

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Searching strategy
• Efficiency depend on the type of information needed
• Most efficient search for a particular article often uses the article title or
author name
• Searching by journal name can locate a specific article or series of articles
in one journal issue
• When searching by author name, the last name and first initial of the
author is needed
• The limit function in MEDLINE provides a means of filtering unwanted
articles from a set of search result
• Parameters are limited according to criteria the searcher selects; eg.
Include language, human or animal species, gender, age group, review
articles, publication type

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Case I
A MEDLINE search using the MeSH terms for stroke and aspirin is
conducted to find information on whether every woman over the age
of 55 years should take low-dose aspirin for stroke prevention.
In addition to this approach, which search strategy would best
minimize the retrieval of erroneous data?
1.Using the keyword search of “aspirin and stroke”
2.Using the subheading “therapeutics use”
3.Limiting the sex to “female”
4.Restricting publication type to “Review”

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Case 2
A pharmacist is researching MEDLINE for the dose of gabapentin for
treatment of spasticity in a 36-year-old woman newly diagnosed with
multiple sclerosis.
If using the MEDLINE terms “gabapentin” and “spasticity” , which one
of the following limit functions would best help narrow results and limit
erroneous results?
A.Human
B.English only
C.Human and English only
D.Clinical trial

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Clinical Pharmacology/EAACI
• This database offers a product comparison tool that can retrieve a list
of products for a selected allergy or dietary restriction criteria (eg
sugar free, alcohol free, sodium free, dye free)
• Most information is readily referenced with a link to PubMed
citations, although some information, such as the adverse event
reporting not reported
• Also offer a drug comparison tool that easily generates information
on product dosage forms, clinical attributes and adverse events

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Determining validity

• Evaluate the Evidence (Critical Appraisal)

• Assess clinical relevance to determine the scientific validity of conclusions and
facts presented before consideration for use
• Examine the topic to evaluate the methodologic quality and results and
determine its level of evidence
• Represent the best available evidence for the specific content under
consideration
• Have confidence - the more you read and understand, the more you are
becoming an expert in the area and able to critique what you read
• Remember, just because an article is published doesn't mean that it’s perfect -
there will be strengths but also limitations
• You will need a strong understanding of what makes sound or weak research

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Critically evaluate literature
Author
• What are the author's credentials and affiliations?
• Is the publisher or journal known and reputable?
Publisher
• Who is the publisher? Are they reputable? It is an academic press?
Accuracy
• Does the author provide references to support his/her statements?
• Is the source peer-reviewed? (Has the information been verified by
other professionals or researchers in the field?)

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Critically evaluate literature
Currency
• How current does your information need to be?
• What is the publication date?
• Is the information outdated?
• Is it a key historical piece of literature on your topic?
Coverage
• Who is the audience: the general public, professionals, or researchers?
• Is the information general or in-depth?
Point of view
• Is the information balanced and without bias?
• Does the author have a specific goal or objective? (For example: to persuade, to
entertain, to inform?)

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Critically evaluate literature
Questions to ask
• Was the sample size big enough to allow findings to generalize to other
populations?
• Did attrition affect the results?
• Were the inclusion criteria too wide or narrow?
• Were there flaws in the research design?
• Quantitative research: were participants randomly assigned to groups in a
double blinded fashion? Was there a control group?
• Qualitative research: Were interview guides piloted? Were measures taken
to enhance the credibility of data analyses? Do the researchers declare any
personal biases that may have influenced their interpretation of results?
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Critically evaluate literature
• Is the source credible? Is it a peer-reviewed journal or unknown
website?
• When was the article published? Is it recent?
• Does the study explain the results (or simply just describe)?
• Has the author(s) considered how the results apply to wider
populations or practice settings?
• Has the study addressed a ‘gap’ in the literature?
• Are the conclusions final or preliminary? What further research is
required?
• Overall how good do you think the article is?
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References
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799567/#ref19
• Z. Hussain, Sabareesh, K.K. Kumar, S. Kumar. A Magnificent Text Book
Of Pharmacovigillance, Orangebooks Publication, 2019.

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