Health Information Web Sites by Therapeutic Category for Healthcare Professionals

Objective:

To compile and evaluate health information Web sites to aid healthcare professionals in locating information on select therapeutic categories.

Data Sources:

Therapeutic categories were chosen based on questions that pharmacists may receive in the community and institutional setting for which they might lack adequate resources to answer. Categories included adverse drug reactions, alternative medicine, cardiology, drug dosing in renal failure, drug interactions, foreign drug identification, geriatrics, immunology/vaccines, intravenous stability/compatibility, investigational drugs, oncology, pediatrics, pregnancy/lactation, legal and regulatory, monographs/medication usage evaluations, new drug approvals, shortages, tablet/capsule identification, therapy/therapeutics, and toxicology/poisoning. Web sites were chosen by searching www.google.com , as this search engine currently indexes over 3 billion Web pages.

Data Synthesis:

Resulting Web sites were reviewed, selected, and evaluated using published criteria to assess the quality of each Web site, focusing on the authorship, disclosure, currency, and content.

Conclusions:

The top Web sites in each category are presented, with details on their quality rating, sponsor, content, and special features or directions.

Evaluating the accuracy of health news publications in a drug literature evaluation course

OBJECTIVES

To design an assignment for second-professional year pharmacy students to assess the accuracy and quality of health information published in the news.

DESIGN

Students in a literature evaluation course were assigned a health-related news publication to review and find the original published research article. They then critically evaluated the quality and accuracy of the news publication based on the original research. All students wrote a critique focusing on the quality and accuracy of the news article and potential responses the lay public might have.

ASSESSMENT

Eighty-four percent of students agreed the writing assignment reinforced critical literature evaluation skills, while 90% agreed the assignment contributed to completion of course objectives.

CONCLUSIONS

A writing assignment requiring comparison of a news publication to the original research reinforces critical literature evaluation and communication skills, as well as stimulates thought about the accuracy, quality, and public responses to health information published in the news.

Weekly active-learning activities in a drug information and literature evaluation course

OBJECTIVES

To incorporate learning activities into the weekly 2-hour Drug Information and Literature Evaluation class sessions to improve student ability and confidence in performing course objectives, as well as to assess student perception of the value of these activities.

METHODS

In-class activities that emphasized content and skills taught within class periods were created and implemented. Three different surveys assessing student ability and confidence in completing drug information and literature retrieval and evaluation tasks were administered prior to and following the appropriate class sessions. At the completion of the course, an additional evaluation was administered to assess the students' impressions of the value of the learning activities.

RESULTS

Students reported increased ability and confidence in all course objectives. The teaching activities were also stated to be useful in students' learning of the material.

CONCLUSIONS

Incorporation of weekly learning activities resulted in an improvement in student ability and confidence to perform course objectives. Students considered these activities to be beneficial and to contribute to the completion of course objectives.

Racial comparison of outcomes and costs for inpatient neutropenic patients: a multicenter evaluation

PURPOSE

Racial disparities have been reported in the care and outcome of cancer patients. We evaluated whether race would influence the cost and outcomes of inpatient neutropenic cancer patients in a multicenter study from a large health care system in the southern United States.

METHODS

Data was collected on all cancer inpatients with a diagnosis code for neutropenia in a 16-hospital system between October 1, 2002, and September 30, 2003. Demographics, treatment outcomes, and costs were compared between white and minority patients. A P value less than .05 was considered statistically significant.

RESULTS

Two hundred seventy-nine cancer patients (0.29% of all admits) had a diagnosis of neutropenia. Demographics were similar between white and minority patients. However, minorities were more likely to be younger than whites (P = .002). With regards to outcomes, length of stay (LOS), LOS in the intensive care unit, and discharge status were not statistically different. Total hospital, medication, laboratory, radiation, surgery, and respiratory costs were also similar (P > .05), although minorities were less likely to receive myeloid colony-stimulating factors (P = .032) and more likely to have higher nursing care costs (P = .048).

CONCLUSION

In light of the escalating reports of racial disparities in cancer care, these minimal differences are encouraging.

Evaluation of accuracy of health studies reported in mass media

OBJECTIVE

To evaluate communication of clinical research in the written media for completeness and accuracy.

DESIGN

Observational assessment.

SETTING

United States.

PARTICIPANTS

Not applicable.

INTERVENTIONS

Content of media articles discussing randomized controlled trials was assessed by three reviewers on the basis of the Consolidated Standards of Reporting Trials (CONSORT) criteria modified for the mass media. Reports from October 1 through December 31, 2002, published in the top two U.S. daily newspapers (USA Today and Wall Street Journal), weekly news magazines (Time and Newsweek), and daily news Web sources (CNN.com and MSNBC.com) and the corresponding published RCTs were analyzed.

MAIN OUTCOME MEASURES

Total score and score in 10 specific content areas, leading to classification of coverage as poor, fair, or excellent.

RESULTS

A total of 60 media reports discussing results of 25 RCTs appeared in these media during the study period. All reports were categorized as fair, and no content area was rated excellent. Several content areas received poor rankings in all and/or most media, including reporting of adverse effects, outcomes data, and statistical tests used. Media reports written by newswire services were rated more highly than were those prepared by nonnewswire services, but only 1 of 10 criteria had statistically significant differences.

CONCLUSION

Mass media reports of RCTs are often incomplete. This type of reporting may misinform the lay public and may lead to questions about the applicability of the results to individual patients.

Delayed-onset grade 4 neutropenia associated with rituximab therapy in a patient with lymphoma: case report and literature review

A 53-year-old man developed delayed-onset neutropenia 6 weeks after completing first-line therapy with rituximab, cyclophosphamide, mitoxantrone, vincristine, and prednisone for high-grade B-cell lymphoma. Bone marrow biopsy demonstrated hypercellular marrow with normal maturation. He also developed interstitial pneumonitis, an adverse event associated with rituximab use. Infiltrates of T cells were found in the patient's lungs. For the next 6 months, the patient required subcutaneous granulocyte colony-stimulating factor 300 mug twice/week to maintain a granulocyte count above 1000 cells/mm3. He also received oral antibiotics for mouth sores and thrush. Based on the existing evidence, monitoring blood counts for as long as 8 weeks after rituximab therapy may be advisable, although the literature reports that neutropenia can develop up to 1 year after treatment. The development of a registry and uniform testing may help uncover the cause of this delayed-onset neutropenia.

Technology evaluation: Canvaxin, John Wayne Cancer Institute/CancerVax

CancerVax and the John Wayne Cancer Institute are co-developing Biotechnology Tumor antigen Canvaxin, a vaccine containing over 20 tumor antigens, for the potential treatment of melanoma and colon cancer. Canvaxin is currently undergoing phase III clinical trials for melanoma and a phase II trial for colon cancer.

Trastuzumab for the Treatment of Non—Small-Cell Lung Cancer

OBJECTIVE

To evaluate trastuzumab for the treatment of advanced non-small-cell lung cancer (NSCLC).

DATA SOURCES

Clinical literature was accessed through MEDLINE (1966-January 2003), EMBASE (1974-January 2003), International Pharmaceutical Abstracts (1970-January 2003), Proceedings of the American Society of Clinical Oncology (1995-January 2003), and Genentech. Key search terms included trastuzumab, lung cancer, Herceptin, and NSCLC.

DATA SYNTHESIS

Research has revealed that NSCLC specimens may express the protein HER-2/neu. The monoclonal antibody against HER-2/neu, trastuzumab, could prove valuable for patients. An evaluation of the studies exploring trastuzumab for management of NSCLC was conducted. Phase II clinical trials reveal variable response rates from no improvement to a partial response rate of 42%. Due to a lack of clinical trials and deficiencies in the literature, the ultimate benefit of this agent remains to be proven.

CONCLUSIONS

Clinical data from ongoing trials indicate potential synergy when trastuzumab is added to standard chemotherapy. The ultimate benefit in NSCLC remains to be proven.

Recurring chemotherapy-associated alopecia areata: case report and literature review

A 52-year-old woman with stage IIIC ovarian cancer and stage IA uterine cancer experienced recurring alopecia areata of her eyebrows, eyelashes, arms, legs, and pubic area beginning 5 months after completing chemotherapy with paclitaxel and carboplatin. The condition recurred in a cyclic fashion over the ensuing months. Alopecia is a well-recognized adverse event associated with chemotherapy; however, to our knowledge, this cyclic pattern of alopecia has not been reported in a patient with cancer. Our report of a cancer survivor who experienced cyclic alopecia areata indicates that this condition may be related to autoimmune changes instigated by chemotherapy. Oncology health care practitioners should evaluate unusual clinical cases of alopecia for underlying pathology.