Two Health Canada Tools Worth Bookmarking

I can't count the number of times I refer to Health Canada's Drug Product Database when I'm researching a project. It's a wonderful source of information. Here is the description from the Website:

The DPD contains product specific information on drugs approved for use in Canada. The database is managed by Health Canada and includes human pharmaceutical and biological drugs, veterinary drugs and disinfectant products. It contains approximately 23,000 products which companies have notified Health Canada as being marketed.

Information available in the database includes the following parameters:
1. Brand Name
2. Drug Identification Number (DIN)
3. Company
4. Active Ingredient(s)
5. Route of Administration
6. Product Monograph (PM)
7. Pharmaceutical Form
8. Package Sizes
9. Therapeutic Classification (AHFS and ATC)
10. Active Ingredient Group (AIG) Number
11. Pharmaceutical Standard
12. Veterinary Species

In addition to the DPD, you can also access a database of NOC listings from the Drugs and Health Products section of the Health Canada Website. This is a great tool if you need to find out what drugs have been approved under a specific therapeutic class. Sometimes, the listing contains a link to a fact sheet and the summary basis of decision for approval, which I've also found helpful for some projects.

Looking It Up

One of the tricks of researching information on topic is to start with a very recent review paper and then to follow the references in the text backward to the original articles. You can then look at the abstracts to see if the article may be useful before purchasing it.

Finding the abstract for an article when you have the citation is easy with the Single Citation Matcher on PubMed. You don't even need to have the full citation for the matcher to work. I have succesfully used the Single Citation Matcher feature when all I've had is an author name and publication year vaguely recalled from the head of a contributing author.

1. From PubMed home page, click on Single Citation Matcher on the left navigation bar. This will take you to the single citation matcher page.
2. Enter whatever information you have about the article that you wish to find in the appropriate search boxes in the form
3. Click 'Go'

It really is that simple.

Finding Formulary Coverage

Quite often I find myself needing to know whether a particular drug is covered on a provincial or private formularies. Usually, finding this information is not difficult, but it is time-consuming. However, I've recently found a database website that is attempting to keep track of just that.

Drugcoverage.ca is maintained by Plasmid Biocommunications, a communications company specialising in prescription drug reimbursement. As such, it isn't quite the official word on drug coverage, and their product list isn't as extensive as I would like, but the information does appear to be accurate. At the very least the website is a place to start your research.

On drugdiscovery.ca you can check to see which provinces cover a drug on their provincial formularies, and you can also check for federal coverage such as with Veterans Affairs Canada. Finally, it will give you an idea to the extent of coverage by private plans, and whether any manufacturer or other special access programs exists for the drug.

Finding Information: Searching the Literature

After I've given myself an overview of the topic, or if it's an area I'm already familiar with, my next step is to find recent review articles, clinical practice guidelines, or possibly original research on the topic.

My search will almost always invariably start with PubMed/Medline. Other databases exist, but PubMed is by far the most accessible and serves well for most searches. You can use PubMed to search specifically for original articles, letters to the editor, clinical practice guidelines, review articles, meta-anlayses, and a whole lot more. The Pubmed website has comprehensive information about the database and how to search it. Their flash tutorials are fantastic and whether you are already familiar with PubMed searching or not, I highly recommend watching the following ones:

• PubMed Overview
• Searching Pub Med Quick Tours (5 tutorials)
• PubMed's MeSH database Quick Tours (3 tutorials)
• Getting Started with My NCBI
• Saving Searches
• Filters

Once you've located articles that look interesting, your next step is to acquire them. Some are available for free, others you may have to pay for.

The PubMed citation usually indicates if an article is available for free by putting a clickable icon on the top right-hand corner that reads something like "Free Fulltext Available." If it doesn't look like full text is available for free, click through to the journal site anyway if PubMed provides a link to it. Sometimes articles become available for free after a set period of time, and PubMed may not ahve the updated information. If it still looks like you have to pay, try going to the journal website and accessing the particulat jounral issue from there. Occasionally that yields different results than the PubMed click-through.

If you still don't get access to the journal article, you still have a few options:

• See if you can get the article through a local library
• Contact one of the authors or the press office at the institution where the article was authored to see if you can get a free copy fo the article
• Order (and pay) for the article online through the journal or its agent
• Order (and pay) for the article through a document delivery service like CISTI

Once again, Dalhousie University has an excellent online article that is worth looking at (Access to Journals) which describes ways to get your hands on actual copies of journal articles

Finding Information: Clinical Practice Guidelines

Clinical practice guidelines inform treating physicians about current best practices in diagnosis and treatment for a medical condition. They often also provide a lot of background disease information and details of clinical trials, so they are very useful documents.

If I'm looking specifically for Canadian clinical practice guidelines, before going to PubMed I will go to Canadian Medical Association (CMA) Infobase, which is a searchable database of guidelines "produced or endorsed in Canada by a national, provincial/territorial or regional medical or health organization, professional society, government agency or expert panel."

If no Canadian guidelines exist, or if I'm looking for USA guidelines, I will visit the National Guideline Clearinghouse or look specifically for a guideline on the approporate professional society website (ie, I will go to the Americal Psychiatric Association website to look for their guidelines on schizophrenia). For British information, I may consult their data base of clinical knowledge summaries. Or for an international approach I may visit the World Health Organization website.

For more information on finding clinical practice guidelines from a Canadian perspective, Dalhousie University has a nice Internet tutorial: Finding Clinical Practice Guidelines.

Finding Information: First Steps

Medical writing, like most science writing, involves knowing how to find the information you need and knowing how to assess the quality of the information that you find. Some medical writers specialise within a specific area of medicine, but most of us are continually taking on projects in medical fields and therapeutic areas that are new to us. This often means getting ourselves 'up to speed' on a topic quickly.

While textbooks, encyclopedias, and print journals were once the the first place to go to understand a medical topic or find information, the Internet is now a common first stop. Not only is a lot of information available online, but so are some databases, like PubMed, and the full-text content of many medical journals

If I'm looking up a disease, my first stop is usually the Merck Manual of Medical Information (home edition), followed by a medical encyclopedia, print or online, with a good medical dictionary by my side. I may also use Wikipedia or Medline Plus, as well as the Merck Manual online. Here are some suggestions for good medical dictionaries and other resources:

• Current Medical Diagnosis and Treatment (available in print and online at most medical libraries)
  
• Dorland's Illustrated Medical Dictionary (available online $$)
  
• Stedman's Medical Dictionary (available online $$)
  
• Harrison’s Principles of Internal Medicine (available online $$)
  
• Mosby's Medical, Nursing, & Allied Health Dictionary (available online $$)

If you're lucky enough to have a medical library where you live, medical textbooks and books are also great sources of more in depth information. Often there are many books published on a medical topic. Make sure to choose the most recent. In medicine, anything older than two years risks being seriously out of date! To help you find the best one, ask the medical librarian.

If am looking up drug information, my first stop is the Compendium of Pharmaceuticals and Specialties (CPS; at least, if my context is Canadian). The CPS is published by the Canadian Pharmacists Association and contains abbreviated Product Monographs for each pharmaceutical product approved for sale in Canada. It is available in print and online. If you don't have access to the CPS, then try getting the Product Monograph or Prescribing Information from the manufacturer's Canadian website.

After the CPS, my next stop is usually Wikipedia or Medline Plus. These sites will usually give me a bigger picture than the Prescribing Information in the CPS. I may also look at the the drug's American (USA) website, under the information for healthcare professionals section. (Don't look for information on Canadian sites, by law they can't provide it. we'll learn more about that in a later module.)

Sometimes you can find textbooks that deal with a specific drug or class of drugs. These can be useful if you're looking for more in depth information and need to get into the pharmacology of a drug.