P16S03: Adverse effects of low molecular
weight heparin on liver
Bottom line: Information on adverse reactions of low molecular weight heparin was used to better understand a specific issue regarding a
patient (long term effects on liver functions). There were no information-related patient health outcomes.
Level 1 outcome (situational relevance): On December 4, 2008, P16 did a search at work, by themselves, and
after an encounter with a patient. They retrieved one information hit on adverse reactions
of low molecular weight heparin, particularly on liver. The reported search objectives were: to address a clinical question, to
look up something they had forgotten, and to share information with a patient. “She [the patient a woman between
sixty and seventy years old] was going in for an ultrasound of her liver.
One of the doctors had told her that her liver function was decreasing and she
was wondering if it had been related to the use of the low molecular weight
heparin. […][So] she had a question about the impact of low
molecular weight heparin on her liver. […] I’m sure I knew this at one point in time, […] [but I had
to look it up because I needed] to provide [that] information for her.” According to P16, e-Therapeutics+ was the only source for information,
and the found information was relevant.
Level 2 outcome (cognitive impact): One hit was associated with a report of positive cognitive impact (see table). Regarding
practice improvement and learning, P16 stated: “I would have more knowledge about this for
her [the current patient] and for future patients. [...][I have
learned] that the elevations of the transaminases had
been reported, but were not associated with the long term effect on the liver.”
Retrieved
information hit:
1) e-Therapeutics+ (CIRT): e-CPS Tab – Keyword: Tinzaparin – Tinzaparin sodium – HEPARINS Low Molecular Weight – Adverse effects(P16S03H01)
Level 3 outcome
(information use): Information on low molecular weight heparin on liver
function test was retrieved, and used to better understand
a specific issue regarding the patient (information used as
presented in e-Therapeutics+). “[I wanted] to understand
the possible impact of the low molecular weight heparin on her liver. [...] She
had already finished her treatment. [At the time of the search] she went for
her ultrasound of liver, and she did not have received results. [Since then,
did anything else happen?] No. Actually her ultrasound of her liver came back
good, clear, and we talked about it again.”
Level 4 outcome (patient health): Not applicable
(conceptual use).
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Look up something forgotten Share information |
Practice improved Learned something Reminded something Confirmed Reassured |
Understand issue |
No outcome |