Publication Bias - Antidepressants and Autism

Publication bias: It has long been a problem with medical studies. Studies with outcomes that are positive are more likely to be published than those that are negative.  As a result, the medical literature that establish how diseases and disorders are treated often provides doctors and other healthcare providers a flawed picture of the evidence presented.

Antidepressants are not FDA approved for treating some of autism's symptoms:  hoarding, tapping, head banging and strict adherence to routine.

Read more here.

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Coke Kills Ya'll

A New Zealand inquest has been told a woman's over 2 gallon a day Coca-Cola habit may have contributed to her death, reports said Friday.

A coroner's inquest was told Natasha Harris, a 30-year-old mother of eight from Invercargill in southern New Zealand who died in February 2010, drank huge amounts of the caffeinated beverage, Fairfax Media reported.

It said pathologist Dan Mornin told the inquest that he believed Harris died from cardiac arrhythmia and was also suffering from low potassium levels and caffeine toxicity.

Mornin testified her excessive soft drink consumption probably contributed to her medical condition, along with poor nutrition, Fairfax reported.

Coca-Cola - the real story behind the real thing

Crazy uses for Coca-Cola

Have a Diet Coke addiction?

I can spot a Diet Coke addict from across the room. At the first sip of one freshly poured or popped, there's a barely perceptible sigh and slump; their itch has been scratched. (from Eatocracy)

And yes... Diet Cokes Can Make You Fat

5 Reasons Why You Should Take Up Running

I finished my last half marathon on Saturday at 2:13.  I am still on the quest to break the two hour mark.  I know that if I actually trained for a race, I would probably be a lot faster.  I still show up at the starting line in the early hours of the morning with all the other runners and beat my body into submission.

Why do I run?

I remember one of the first exercises running years and years ago.  Let us flash back to about 1988.  I was in ninth grade and on the basketball team.  We didn't win a single game that season, but I do remember running.  Lots and lots of running and the reason why was because we NEVER won a game.  I loved running.  Back then I was the fastest on the team.  I was small.  Fast.  Couldn't shoot a basket to save my life but I could almost fly.

I remember running with my dad and sprinting.  Freedom.

I did a little jaunt in college with the cross country team.  I was the slowest.

What ended up happening is that running became something more than I ever thought, and when it was almost taken from my life due to chronic back pain (degenerative disc disease and facet arthropathy with spondylosis).  During the time of the most pain, I could not run.  During that time, I was quite depressed about it.

So you can imagine, the joy I feel when I run today.  Radio frequency lesioning (RFL) found me, and I'm back to running again.  It's different though.  Now when I run, there is an elation that I did not experience before.  There was a moment Saturday when I was running through a shaded area.  The trees were shading the road very heavily and there were tiny flowers floating through the air landing in front of me.  Very ethereal.  I'm just saying the appreciating is way above what it could ever have been otherwise.

1.  I run because I can.

2.  I run because I want my heart and lungs to be stronger.

3.  I run because I desperately need ME time.  I can't pull out my iPhone and fill every void moment with texting or tweeting.  It's a time that I completely check out.

4.  I run because I do some of my best thinking while running.  Have a problem at work?  I tend to work through them mentally.

5.  I run because the runner's high exists, and it is truly better than any drug.

I have had runs that absolutely sucked.  Just keep trying.  Just put one foot in front of the other.

It will change your life!

Not By the Hair of My Chinny Chin Chin

Chin implants are the fastest-growing cosmetic procedure according to The America Society of Plastic Surgeons (or called the “chinplant”) in 2011. Of course, as aging happens and things begin to drop, the chin is something that helps hold the face in place. A lack of a chin can make the lower half of a person’s profile look weak and unattractive. And now that everyone’s pictures are being plastered all over the internet with Facebook, twitter, and videos like Facetime, it’s no wonder chinplants are on the rise. The humorous part of this tale to me is that I sort of smugly smile. I have a chin. In fact, I have enough chins for a couple of people. I lovingly refer to my chin as a Jay Leno chin, and on a female, it’s not necessarily something so desired.

I used to not think a thing about my chin. I obsessed over my upper lip which sort of dips down like a cupid’s bow (ever see Little Albert on Little House on the Prairie back in the 1980’s?). I remember kids (oh, aren’t they mean?) who would call me bird lip. Even the husband of a friend I haven’t seen in YEARS remarked at dinner just a couple of years ago, “You don’t even have a top lip.” Stop. Where does that even COME from considering he was carrying around an extra forty pounds, and I would NEVER dare say a word about their weight. It just didn’t seem fair.

What was even less fair was the time when I was at the local orthodontist’s office getting my braces off for the second time. I was thrilled. No more cross bite. My teeth were SO straight! The orthodontist to the local celebrities flashed his over whitened straight smile and brought with him the x-ray of my skull. Creepy. He showed it to me and then said while pointing his golden pen toward my chin, “Now if you would just have a smaller chin HERE, you would have the PERFECT profile.” No. He. Didn’t.

I couldn’t believe he said it, but it sent me into a google searching frenzy at home, “Chin reductions, chin shortening, etc….” I tried them all, but all in all, I’ve never had anything changed about my chin.

So today’s news about chinplasty being the fastest rising surgery of today really makes me smile and stick my chin out even further!

The Top 10 iPad Apps for Pharmacists

Want to know the top 10 apps I use in pharmacy practice?

1. MedCalc Pro - is a medical calculator that gives you easy access to complicated medical formulas, scores, scales and classifications.MedCalc has been available on mobile platforms for more than a decade, so it leverages years of experience in bringing medical equations to physicians in an easy to use, yet very powerful format. The Pro version offers premium features such as native iPad support, a patient database to store results and many ways to export results (email, airprint, copy to clipboard). If you're on a tight budget, you can always check out the cheaper but still amazing MedCalc.

2. Sanford Guide - The Sanford Guide is the essential resource for healthcare professionals who care for patients with infectious diseases. The Sanford Guide to Antimicrobial Therapy 2011 application provides fast, convenient access to critical information on treatment of infectious diseases, for timely, effective decisions at the point of care. Always a pocket guide, still a pocket guide. Portability has been a hallmark of The Sanford Guide for over 40 years. The Sanford Guide to Antimicrobial Therapy 2011 application extends that portability to iOS4 devices: iPhone, iPod Touch and iPad. The most trusted infectious diseases treatment resource in print now presents the same comprehensive, treatment- focused coverage of infectious diseases and clinical conditions, anti-infective drug information, therapeutic adjuncts and comparative spectra of activity in a clean, uncluttered, device-optimized interface. Based on the Sanford Guide Web Edition, the application features expanded coverage of topics compared to the print edition.

3. Medscape - The #1 free medical app in iTunes containing drug reference, daily medical news, CME/CE, drug interaction checker, disease and condition reference, procedure and protocols, and other special features. A must!

4. MedPage - MedPage Today is the only service for physicians that provides a clinical perspective on the breaking medical news that their patients are reading. Co-developed by MedPage Today and The University of Pennsylvania School of Medicine, Office of Continuing Medical Education, each article alerts clinicians to breaking medical news, with summaries and actionable information enabling them to better understand the implications.

5. WebMD - WebMD helps you with your decision-making and health improvement efforts by providing mobile access 24/7 to mobile-optimized health information and decision-support tools including WebMD’s Symptom Checker, Drugs & Treatments, First Aid Information and Local Health Listings. WebMD also gives you access to first aid information without having to be connected wirelessly – critical if you don’t have Internet access in the time of need. Personalize your app by saving drugs, conditions and articles relevant to you — through secure access and easy sign-in.

6. Epocrates - Get quick access to reliable drug, disease, and diagnostic information at the point of care. Epocrates is the #1 mobile drug reference among U.S. physicians. Trusted for accurate content and innovative offerings, 50% of U.S. physicians rely on Epocrates to help improve patient safety and increase practice efficiency.

7. Lexicomp - Committed to improving medication safety with innovative products and technology designed for healthcare professionals, Lexicomp offers a variety of drug information and medical applications for iPhone, iPad and iPod touch. These applications are tailored to meet the point-of-care needs of pharmacists, physicians, nurses, nurse practitioners and dentists by storing content directly on the mobile device. Access to Lexicomp's up-to-date drug information and clinical content is a must for the busy healthcare professional who desires the necessary tools to make important medication and clinical decisions from the palm of their hand! Download your Lexicomp mobile drug information application on the app store.

8. Redi-Reader – the reader I use to read articles, studies, etc…

9. Pharmacy Times – Keeping up with pharmacy news. I choose this app.

10. PACID - Last, but certainly not least, ID Compendium, A Persiflager's Guide by Mark Crislip, MD and programming by Walter Crittenden, PharmD (shout out to the PharmD!). This app is sweet for infectious disease!

p.s. I saved the best for last ;)

Whooping Cough Reaching Record Levels

I remember how I felt about vaccines prior to becoming a mother. They were effective. They were needed. They saved lives. However, my thinking changed the first time I stared at my newborn son seconds after birth, and the reports of the possibility of a link between autism and vaccines and the higher rate in males vs females really challenged my thinking. I ran to the bookstore buying all of Dr. Sears' books, scoured the Internet for information, and joined forums where it was cool to be a home birthing, baby wearing, baby led weaning, crunchy, baby food making, raw milk drinking and cloth diapering momma. I suddenly felt like the worst mother in the world, and all my sense about science left as the prolactin levels rose.

I declined hepatitis B vaccine for my infant. Hell, he was not a IV drug user and wasn't having sex yet.

Over time, he is finally up-to-date, and my daughter received all as scheduled (though I did delay hepatitis B with her as well until she reached three months, I believe. I have definitely been more laid back this time. And I have also seen the stories of the prevalence of diseases previously almost eradicated making a huge comeback. Unfortunately herd immunity is only good if all subscribe. Sporadic cases are becoming more normal... and with that deaths.

Last month, Washington state had 640 confirmed cases of whooping cough (or pertussis) compared to only 94 in the same period last year.

The connection between autism and vaccines have never been confirmed. I cannot think of anything more responsible as a parent than getting your kids vaccinated. I guess you can say my thinking was challenged, but I have reached full circle.

Multilayers

One thing I have noticed about the errors I have made... distraction. I do not mean distraction with other team members or music, but the distraction within the order itself. Take for instance an order written for an IV fluid with no rate written from the ER. Immediately the info missing is the glaring distraction of the true issue: the MD wrote for incompatible fluids. It is easy for me to forget the multilayer dimension of errors. Overlook the error within the error. Those always seem to make me stop and think. Maybe errors come in pairs.

A pharmacist is like a detective trying to solve a case. May your cases always be easy and obvious!

Meet Mr. MRSA

I thought I would introduce you to an infectious organism every week!  Today, the lucky "bug" as they are referred to in the medical community is methicillin resistant staphylococcus aureus (MRSA). If I was a common layperson in the field of medicine, I would view this microorganism as a very nasty flesh eating entity.  I thought I would shed some light about MRSA.  Whether you are dealing with a soft tissue infection, pneumonia, central nervous system infection, endocarditis (heart), or bone and joint, the treatment differs.

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It's tougher to treat than most strains of staphylococcus aureus -- or staph -- because it's resistant to some commonly used antibiotics.

The symptoms of MRSA depend on where you're infected. Most often, it causes mild infections on the skin, causing sores or boils. But it can also cause more serious skin infections or infect surgical wounds, the bloodstream, the lungs, or the urinary tract.

Though most MRSA infections aren't serious, some can be life-threatening. Many public health experts are alarmed by the spread of tough strains of MRSA. Because it's hard to treat, MRSA is sometimes called a "super bug."  Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It's tougher to treat than most strains of staphylococcus aureus -- or staph -- because it's resistant to some commonly used antibiotics.

The symptoms of MRSA depend on where you're infected. Most often, it causes mild infections on the skin, causing sores or boils. But it can also cause more serious skin infections or infect surgical wounds, the bloodstream, the lungs, or the urinary tract.

Though most MRSA infections aren't serious, some can be life-threatening.  Many public health experts are alarmed by the spread of tough strains of MRSA.  Because it's hard to treat, MRSA is sometimes called a "super bug." 

Also just news today... an almost instant test in detecting MRSA.

Skin and soft-tissue infections

1.  Abscess  - incision and drainage
2. Purulent cellulitis
   • Clindamycin 300-450 mg PO TID (C diff)
   • Bactrim 1-2 DS tablets BID (pregnancy category C/D)
   • Doxycycline 100 mg BID (pg category D and not recommend for children under 8)
   • Minocycline 200 mg x 1, then 100 mg PO BID
   • Linezolid 600 mg BID (expensive)
3.  Nonpurulent cellultis
   • Beta lactam (cephalexin and dicloxacillin) 500 mg QID
   • Clindamycin 300-450 mg TID
   • Beta lactam and/or Bactrim or a tetracycline – amoxicillin 500 mg TID
   • Linezolid 600 mg BID
4. Complicated SSTI
   • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours
   • Linezolid 600 mg PO/IV BID
   • Daptomycin (cubicin) 4 mg/kg/dse IV QD
   • Telavancin 10 mg/kg/dose IV QD
   • Clindamycin 600 mg PO/IV TID
5. Bacteremia
   • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours
   • Daptomycin 6 mg/kg/dose IV QD
6. Infective endocarditis, native valve – same as bacteremia
7. Infective endocarditis prosthetic valve
   • Vancomycin and gentamicin and rifampin – 15-20 mg/kg/dose IV every 8-12 hrs,                                          i.      1 mg/kg/dose IV every 8 h,  300 mg PO/IV every 8 h
8.  Persistant bacteremia
9. Pneumonia
   • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours        
   • Linezolid 600 mg PO/IV BID
   • Clindamycin 600 mg PO/IV TID
10. Osteomyelitis (Bone and Joint Infections)
    • Vancomycin 15-20 mg/kig/dose IV every 8-12 hours
    • Daptomycin 6 mg/kg/day IV QD
    • Linezolid 600 mg PO/IV BID
    • Clindamycin 600 mg PO/IV TID
    • TMP-SMX and rifampin – 3.5-4.0 mg/kg/dose PO/IV every 8-12 h
11. Septic arthritis
    • Vancomycin 15-20 mg/kg every 8-12 hours
    • Daptomycin 6 mg/kg/day IV QD
    • Linezolid 600 mg PO/IV BID
    • Clindamycin 600 mg PO/IV TID
    • Bactrim 3.5-4.0 mg/kg/dose PO/IV every 8-12 hours
12. Meningitis
    • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours
    • Linezolid 600 mg PO/IV BID
    • Bactrim 5 mg/kg/dose PO/IV every 8-12 hours
13. Brain abscess, subdural empyema, spinal epidural abcess
    • Vancomycin 15-20 mg/kg/dose every 8-12 hours
    • Linezolid 600 mg po/iv BID
    • Bactrim 5 mg/kg/dose PO/IV every 8-12 hours
14. Septic thrombosis of cavernous or dural venous sinus
    • Vanc same
    • Zyvox
    • Bactrim same

Pharmacy Perfection

One of the biggest things I struggle with as a pharmacist is the idea of a profession that requires absolute perfection in everything you do; yet I am human. There is not a lot of room for error because it can detrimentally affect a patient. I remember back when I was as green as the spring grass freshly graduated from pharmacy school in 1999. I landed my first job with K-Mart, not exactly the job that I had dreamed of while I was attending pharmacy school, but they paid for my relocation from one city to another. They also did not do a lot of volume in the particular store where I was assigned. I do not remember the name of the pharmacist that worked there opposite from me initially. What I do remember about her is the words that came out of her mouth almost at her introduction, “I have never made an error while being a pharmacist.” I was too naïve at the time to realize that there was no way she was telling the truth. We are human; we will make mistakes. And at the time K-Mart did not have any mandates in place on flow or any bar-coding scanning to ensure more safety as Walgreens and CVS had. They were way behind the times as far as technological advances go.

I believe one of my first errors was dispensing Adalat CC 30 mg when the prescriptions called for 60 mg. Yes, I felt SICK. But over time I have come to realize that there are things you can do as a pharmacist to be more accurate whether it be hospital, retail, or anything in between.

According to a 2006 report by the Institute of Medicine, medication errors cause harm to roughly 1.5 million patients annually.5 Millions more are caught prior to administration, before they reach the patient. Not only do medication errors adversely impact the patient population, they are estimated to cost billions of dollars in additional treatment costs. Read more: http://www.uspharmacist.com/content/c/31431/

Here are some tips to help you become more accurate

1. Concentrate. Don’t allow distractions to stop your flow of thinking. If a technician comes up to you and needs something right away, go ahead, but realize when you start back on the order, you need to continue the exact same flow from beginning to end. Don’t try to “pick up where you left off.”

2. Do the same thing every single time. Consistency.

3. Do a second double check after you are finished checking. If that means pulling up the profile on the computer screen and holding up the order or pulling it back up electronically, just double check at the very end.

4. Any time you are going outside the usual, there is a higher incidence for errors. For example, if you have to build something from scratch in the computer on a new medication, you can be sure you are more likely to mess up on something else within the order than normal.

5. If you work retail, utilize every program they have to improve accuracy. In the hospital, just do another last review of MAR prior to moving to the next order. If in doubt; ask. It’s always better to phone the office if you work in retail or phone the nurse if you work in hospital to bounce off what you are seeing.

The most important thing is to make sure you have enough staff to safely fill medications and orders.

Dick Cheney and the Polarizing Heart Transplant

I suppose my first thought at the news that former Vice President Dick Cheney had received a heart transplant paid for by the taxpayers was, "wait… he’s 71? Isn’t that too old for a heart transplant when I am sure there are younger people on the list that could benefit much more in terms of longevity than Cheney would. Then I read that he was on the transplant list for 20 months. That means he was in his sixties when on the list and also on the list longer than average 6-12 months. The most disturbing thing about the whole thing is the comments that have poured in online, online articles and twitter.

Chimed in Tim Viselli of La Canada Flintridge: After many transplants, the body will reject an incompatible heart. This may be the first time where the heart rejects an incompatible body.

Andrew Rubin of Malibu added: Seeing the headline that Cheney had received a heart transplant, I could not help but think, "Better ten years late than never."

Patricia Coelho of South Pasadena echoed several others when she wondered: Does this mean that Dick Cheney will finally have a heart?

Clearly not a fan, Steve Wollenberg of Los Angeles asked: Dick Cheney had a heart transplant? Really? Did anyone toss in a brain? They usually, but not always, come as a set.

And finally, from Phoenix, Ernie Haas emailed a wish: Just heard that ex-Vice President Dick Cheney had a change of heart. Maybe now he'll become a Democrat.

Or Twitter:

I heard a nurse’s hand slipped and touched Cheney’s original heart and she transformed into a spidergoat and ate 2 babies in the maternity ward. -@robdelaney (who is hilarious, by the way)

MUST READ: Cheney Receives Heart Transplant; Bush Still on Waiting List for Brain. @BorowitzReport

@GerryDuggan said “They’re throwing Cheney’s old heart into a volcano, right?

I suppose for me the biggest issue I have with the operation is the age limit of heart transplants. Is there one?

The indication and contraindications for heart transplantation. Indication for heart transplantation - End-stage heart disease not remediable by more conservative measures Contraindications - Irreversible pulmonary hypertension /elevated pulmonary vascular resistance - Active systemic infection - Active malignancy or history of malignancy with probability of recurrence - Inability to comply with complex medical regimen - Severe peripheral or cerebrovascular disease - Irreversible dysfunction of another organ, including diseases that may limit prognosis after heart transplantation

I don’t believe it’s time to place a value on human life based on politics, decisions in the past, age, etc… I’m not surprised that so many negative thoughts are out there regarding Cheney. We have sort of lost the human filter of sympathy for our fellow man.

And, hey, it's easy when you are behind a keyboard ;)