* 5. Freely Available, Professional-level, Internet Resources

Start by reviewing the drug information resources we’ve covered thus far.

Use the letters corresponding to the resources in the list below to answer the review questions.

Objectives:

1.  Identify when an internet search is better than a literature database search:
   • When is a Google Scholar search the best place to start?
   • When is a general Google web search or other internet search the best place to start?
2. Effective strategies for searching the internet
3.  List criteria used to evaluate information found on the internet
4. Review websites commonly used by pharmacists (“Internet Assignment”)

Objective 1.  Identify when an internet search is better than a literature database search:

a.  When is a Google Scholar search the best place to start?

⭐ Answer:  When the topics of interest are unlikely to be mentioned in the abstract or title.

Both Google Scholar and standard literature databases focus on scholarly literature.  Google Scholar can search full-text.  Standard literature databases like PubMed only contain brief records for journal articles.  These records include:  authors names, authors’ affiliations, journal title, article title, author-applied keywords and indexer-applied subject heading.  The rest of the article is not available for searching in standard literature databases.

Example:

Let’s pretend you are designing a clinical trial protocol.  You will be testing a drug for congestive heart failure (CHF).  Body weight  gain is one measure used to follow water weight gain when CHF is worsening.   You want to know what time of day people with congestive heart failure are usually weighed when enrolled in clinical trials.  There’s a good chance this will be mentioned in the “Methods” section of articles about CHF trials, but the time of weight measurement is very unlikely to appear in the title or abstract.  A Google Scholar search will be more helpful than a traditional literature database search.

b. When is a general Google web search or other internet search the best place to start?

Answer:

When you need:

• News reports
• Patient-oriented material
• material more likely to be published on an association/university website than in a journal article.  Examples of things more likely to be published on an association/university website include:
  • hospital-specific or state-specific practice guidelines
  • hospital-specific, standard order sets  (e.g. standard orders used when a child with fever of unknown origin is admitted to the hospital)
  • tables that provide upper limits for vitamin and mineral dosing

Objective 2.  Effective strategies for searching the internet

Example:  You want to find a table that lists all the vitamins and minerals, their toxic doses and toxicity symptoms

(A  pharmacy student asked me to find such a table several years ago.  She was working in a community pharmacy and she and her coworkers were frequently asked about toxic doses of vitamins and minerals and symptoms of toxicity.)

Start by creating a search using standard search techniques

1) Outline concepts. ⭐

(The outline should include a “table” concept, a bunch of “vitamin” and “mineral” concepts (vitamins and minerals you think would be present in such a table), a “toxicity” concept, a “dose” concept)

• • • table
    • vitamin a
    • vitamin c
    • vitamin e
    • iron
    • calcium
    • Toxic
    • Dose

Notes: 

• • One of the great things about a full-text search (like an internet search) is that you can search for a “table” or a “figure” concept.  These concepts are not included in standard literature database records.   
  • List the concepts that distinguish relevant from irrelevant results first.  In this case, the search requester really wants a table rather than a narrative description of the toxicities. 

2) list alternate words/phrases for concepts ⭐

• • • table
    • vitamin a
    • vitamin c
    • vitamin e
    • iron
    • calcium
    • Toxic, toxicity
    • Dose, mg, IU

Note:  Internet searches are limited to a certain number of words.  You may not be able to include all the synonyms that you would like to include.

3) joining terms with OR ⭐

• • • table
    • vitamin a
    • vitamin c
    • vitamin e
    • iron
    • calcium
    • Toxic OR toxicity
    • Dose OR mg OR IU

Note:  Wildcards (asterisks) will not work in internet searches!  Don’t use toxic* ⭐

4) Use quotes to define phrases and multi-word search terms ⭐

• • • table
    • “vitamin a”
    • “vitamin c”
    • “vitamin e”
    • iron
    • calcium
    • Toxic OR toxicity
    • Dose OR mg OR IU

Step 5 is optional.  If you copy the list above and paste it into the Google search box, it will turn into the following —

table “vitamin a” “vitamin c” “vitamin e” iron calcium Toxic OR toxicity Dose OR mg OR IU

— and you will get a list of helpful search results.  You may want to compare the results of this search to the results of the search when the optional parentheses and AND’s are added.

5) Optionally

a) use parentheses to define sets of alternate terms

• • • • table
      • “vitamin a”
      • “vitamin c”
      • “vitamin e”
      • iron
      • calcium
      • (Toxic OR toxicity)
      • (Dose OR mg OR IU)

 Note:  You do not have to use parentheses around OR’d terms when searching the internet. ⭐  Internet search engines will assume you want the search treated as though parentheses are present.

b) AND together terms for disparate concepts and remove extra spaces.

table AND “Vitamin a” AND “vitamin c” AND “vitamin e”  AND iron AND calcium AND (toxic OR toxicity OR toxicities) AND (dose OR mg OR IU)

 Note:  You can just leave a space between terms for disparate concepts. ⭐  However, the search results will be a bit different if use AND’s 

Exercise 1:

• Copy one of the red-font search strategies (You can use the strategies with or without the optional parentheses and optional AND’s)
• Open Google (not Google Scholar)  in a separate tab/window.
• Paste the search strategy in the search box and hit the “Enter” or “Return” key on your keyboard.
• What does the top result say about search terms that are not missing from that result?  If the term/s is/are essential for your search (as the word “table” is for this search), click the “Must include: _____” link.

• Scan the results for those discussing a large number of vitamins and minerals (skipping those that are focused on single vitamins and minerals)

• Hopefully, you see a “Vitamins and Minerals | The Nutrition Source” article.  This item is on the Harvard University website (harvard.edu).  It could be a good source.  Click the link.
• Look around the top of the webpage to see which part of Harvard has published the article.

• Scroll quickly through the webpage to find the table/s.
• The table that is present contains many of the needed columns, but does not include a column listing the types of toxicity that can be seen with each nutrient.    If your search hasn’t identified a better table from another source, you could copy this table, paste it into a Word document, add a column and paste in a list of toxicities copied from another source.

• Each of the nutrient names in the table is a link.  Perhaps the linked information includes a nice list of toxicities that you could add to the new column?  Click the “Vitamin A” link to find out.
• Scroll quickly through the page to see if a toxicity section is present.
• Hopefully, you found the toxicity section and think you could use this information and the similar information on the other nutrients to create the toxicity column if no better table is located.
• Now that you know this website’s information might be useful, it’s worth looking at the reference list/s to see if the information is well-referenced and up to date.   Click the “References” link.

• Hopefully, you found that the “References” lists on the “Vitamin A” page includes recent references.
• If you return to the page with the large table and check its references, you may find that the most recent reference cited is rather dated. This was true when this chapter was last updated in August of 2023.  At that point, the references cited in support of this page and table were published between 2010 and 2012.  Don’t immediately discount a page with dated references.  It’s possible that  the dated reference is the best reference available.  In the case of this search,  I (Cindy) can tell you that institutions that release recommendations for all nutrients do not publish new blanket recommendations frequently.  One way for the non-expert to attempt to determine whether a dated reference is still considered current is to go through other  webpages or recently published journal articles identified by a Google search, check the references cited in support of similar tables .  If the  same reference/s is/are cited in many other webpages and journal articles; it’s very likely that the cited reference is still considered current or considered the most current source of guidelines/standards.  I will not ask you to take the time to do this today.
• The only table that I have found that includes columns for recommended doses, highest safe doses, and lists of toxic effects is included in the lists of your Google search.  If you return to the list of Google search results and use the browser’s find on page feature (Ctl-f on Windows and Command-f on Macs) and type in —

unl

— you will find this result quickly.

Google-specific techniques

You can usually find what you need using standard search methods as described above.  Sometimes Google-specific tags/operators/punctuation can make your life easier.

intitle:

⭐ If you only want to see results with a certain word in the title, place the intitle: tag directly in front of the word.  You can OR together terms preceded by this tag.

Ex.  A search for article’s about pharmacists management skills would probably have a “pharmacist” word in the title.  

intitle:pharmacist OR intitle:pharmacists “management skills”

– (minus sign)

The NOT operator doesn’t work in internet searches.  If you want to exclude a word simply add that term preceded by a minus sign to your search.

Example 1. 

If you want to see articles about kava kava on websites that don’t sell the kava kava supplement, try:

-cart -$ “kava kava”

Example 2.

If you want to see articles about pharmacist’s management skills but find you are retrieving unwanted articles about self-management, try:

intitle:pharmacist OR intitle:pharmacists “management skills” -self-management

Site:

The site: tag is useful if you only want results from a specific website or top-level domain (TLD, ex. .com, .net, .org, .gov, etc.) or want to exclude a website or TLD.

Example 1.

If you want to see lists of routine vaccinations published by government agencies or published by the CDC, try:

Site:.gov  “routine vaccinations”

Site:cdc.gov  “routine vaccinations”

Example 2.

If you want to see articles about “kava kava” that are not on commercial websites.,  try:

-site:.com “kava kava”

..     (double dot) 

The double dot can be used like a hyphen to indicate that you are interested in any number between two numbers.

Example:

If you want to see articles that mention aspirin doses between 25 and 80 mg, try:

aspirin 25..80 mg

“___” (Quotation marks)

Quotation marks are part of the standard search punctuation.  However, when you’re searching the internet, you can search for much longer phrases!  Also you’re searching full-text.  You can find the sources of long direct quotes.

Example:

If you want to find the source for a quotation including the phrase –– are still not affected at the LOAEL supplemented Met — simply search for:

“are still not affected at the LOAEL supplemented Met”

Google Scholar Settings to optimize access

Exercise 2.    Set-up Google Scholar for best full-text access and find the source for the quote “are still not affected at the LOAEL supplemented Met” (a quote from a journal article)

• Go to scholar.google.com
• Click on the “Menu” icon

• Click on the “Settings” option.

• There are two things of interest on the settings homepage:(a) a link to “Library links”  and  (b) a drop-down that allows you to select RefMan (RefMan RIS is the export format for Zotero, a tool you will use later this semester). Right now the “Library Links” option is most important.

• Search for  — UNMC

• Select the “GetIt!@UNMC” option

• Click the “Save” button.
• Search for  —

“are still not affected at the LOAEL supplemented Met”

• The links to the right of the “hit” include freely available forms and forms available through UNMC.    Click the “GetIt@UNMC” link.

• A page containing links to the sources for the content that are licensed by UNMC will appear.  Click one of the sources (ignore the “Available Online” link).

• Clicking on one of these links usually opens a page containing the article’s abstract.  If you just end up on a journal webpage with a search feature rather than on a page for the article you wanted, use that search feature to search for the article’s title.  In this case, the article’s title is — Tolerance to increased supplemented dietary intakes of methionine in healthy older adults
• When you reach the webpage for the article of interest, find and click the pdf or other full-text link.
• After opening the article’s pdf file, use the PDF’s search feature or Ctl-f(Window) or Command-f (Mac) to find  the page containing the quote.  You probably will not be able to find the full quote this way (it’s probably split between two lines of the text).  You may want to find searching for a few words.  You could try–  affected at the LOAEL
• You will have to complete a similar exercise to finish your “Internet Assignment”

Objective 3. List criteria used to evaluate information found on the internet

Criteria for Evaluating a Website

• What are the credentials of author or editor or organization?
• Does the site include the date posted or last update?
• Does it contain a bibliography or reference list? Are the important statements referenced?
• Does it contain testimonials? (usually a bad sign if this is the only type of evidence provided)
• Is the information in the website readily and easily accessible and free from bias? If different treatments are available, are all discussed?
• Who sponsors the site?
• Does the information appear accurate based on your knowledge of the subject matter or your research.

Objective 4.  Review websites commonly used by pharmacists (“Internet Assignment”)

•  During the remainder of this session, you will follow the guidance provided in the Internet Assignment ” (click the link to download the assignment) to  look for information in the sources listed below:
  • FDA website’s Orange Book — therapeutic equivalence information. ⭐
  • CDC website’s Yellow Book — health, vaccination, prophylaxis information for travelers. ⭐
  • LactMed — lactation and breastfeeding ⭐
  • DailyMed — PPIs ⭐
  • ClinicalTrials.gov — registered clinical trial information ⭐
  • Hazardous Substances Database (HSDB) — LD50  (lethal dose 50%, animals), human (antidotes, treatment, toxicity) ⭐
  • PubChem  — drug structures, formulas, some properties ⭐
  • Drugs@FDA — approval history, letters, reviews, supporting documents ⭐
• Add your answers to the assignment document.
• Save your document with answers.
• Submit the document through Canvas “Internet Assignment“

For the drug information resources quiz, you should know⭐ :

1. The FDAs website provides access to the Orange Book, the source for information on therapeutic equivalence.

4. The CDCs website provides access to the Yellow Book, the source for health, vaccination, prophylaxis information for travelers

6. LactMed provides information on drug intake/exposure during lactation and breastfeeding

7. DailyMed provides PPIs which include inactive ingredient information

8. ClinicalTrials.gov provides access to information on registered Clinical Trials. That information may include contact information for the participating institutions, and study results,

9. Hazardous Substances Database (HSDB) includes animal (e.g. LD50) and human (e.g. antidotes, treatment, toxic effects) toxicity information

10. PubChem provides access to drug structures and formulas.  In most cases, you can obtain a 3D, rotatable structural diagram.

11. Drugs@FDA provides access to a drugs approval history, letters, reviews, supporting documents, etc.

For the Midterm Exam, you should know the above and also⭐ :

1. Internet searching is especially useful in locating journal articles when the concepts of interest are likely to be discussed in full-text only (and not in abstracts or titles available in PubMed and other literature databases)

2. How to improve your Google searches by using:

• • quotes
  • double dots (..)
  • intitle:
  • site:
  • a minus sign (-)

3. Criteria that may be used to evaluate internet websites

Questions, Problems, Text Errors?

Before you leave, …

• Do you have any questions or do you feel that clarification of some aspect of the materials would be helpful?
• Have you noticed any errors or problems with course materials that you’d like to report?
• Do you have any other comments?

If so, you can submit questions, comments, corrections, and concerns anonymously — or with your e-mail (your choice) — through this online form .  Alternatively, you’re always welcome to contact Cindy Schmidt directly 402-650-5056, cmschmidt@unmc.edu, or by making an appointment to meet with Cindy via Zoom.

Answers to questions or requests for clarification that are submitted anonymously will be answered in Canvas on the “Discussions” page for this course.