BCPS - some flashcards from quizlet

So as promised, I'm sitting here studying (not really) for the BCPS and wanted to share with you some flashcards that I have found online.  I did personally purchase the ACCP study materials in print and I bought last year's audio lectures.  I really don't think I have enough time to devote entirely the amount of time that I need; however, I'm going to just go for it.  If I fail, I will retake in 2013.  Goals.  You need goals in your personal and professional life, ok? Enjoy.  I would like to personally thank the pharmacists that created these.  I've made a few sets, but once I stumbled upon these I realized it is all about studying smarter, correct? So today's set:  GI

Choose a Study ModeScatterLearnFlashcards

This should get you going.  Better yet go to http://www.quizlet.com and search "BCPS."  I promise you'll find a lot of study materials that will help.

There's a study guide online.  Of course we are almost two months out.  (UNREAL):
Jul 23 Amb Care
Outpt Cards
M/W Health
Jul 30 GI
Nephrology
Oncology
Aug 06 Biostats
Policy/Practice
Economics
Aug 13 Pediatrics
Geriatrics
Kinetics
Aug 20 Neurology
Psychiatry
Fluids/Elytes
Aug 27 Ac Care Cards
Crit Care
Sep 03 ID
HIV/ID
Endocrine
Sep 10 Amb Care
Outpt Cards
M/W Health
Sep 17 GI
Nephrology
Oncology
Sep 24 Free Study
Oct 01 Free Study
Oct 06, 2012 BCPS Exam

I am also subscribed to http://www.highyieldmedreviews.com.  We'll see if it helps after October 6th, right?

 

 

 

 

The BCPS and Tackling the Beast

I decided to take the BCPS this October. First of all, I have to admit the first time I even heard of this test, I thought it was a joke. I just figured it was something that wouldn't be recognizable as anything important. Fast forward thirteen years, and I believe this certification should be something most pharmacists should want to attempt. It is pricey though. I have a little over two months and have a ton of information to go through while trying to become a biostats expert. Wish me luck. I figured I could post some posts about recent guidelines in the next few months... Sort of a way to blog and study simultaneously. Genius?

Whooping Cough

So this is the year where the glorious United States reaches the highest levels of pertussis (whooping cough) in 50 years! Is that enough to stop the crazy anti acclimation rhetoric that continues to flow? Sadly, no. So far the CDC has recorded nearly 18,000 cases this year alone. Pertussis is caused by the bacteria Bordetella pertussis. It is highly contagious and spreads from person to person by coughing or sneezing. Young children are the highest at risk and can lead to death as it has with nine children this year.

It is preventable. So,please stop listening to Jenny McCarthy and protect your children!

Health in the News

In short: The FDA approves Truvada to prevent HIV infection.  This is a first.  When taken daily, Truvada (emtricitabine/tenofovir disoproxil fumarate) reduced the risk of HIV infection by 42 percent compared with a placebo. That was in a clinical trial where HIV-negative people had unprotected sex with multiple partners, including some HIV carriers, according to the FDA. Another trial involving heterosexual couples where one partner was infected -- and condoms were used routinely -- found that Truvada reduced the risk of infections by 75 percent.

I'm not sure where you would find people to take part in a study such as this, but Truvada is a treatment for an individual is already infected.  A prevention besides the usual barrier methods (or abstenance) is novel.

Another - Watching TV Causes Larger Waistlines  - no brainer right?

And the unthinkable - Dr. Stephen Stein, Denver Oral Surgeon, May Have Exposed Over 8,000 to HIV, Hepatitis B and Hepatitis C.  The department sent out letters to 8,000 of Dr. Stein's patients Friday, urging them to seek tests for disease if they received intravenous (IV) medications, including sedation, under Stein’s care from September 1999 through June 2011.  Really?  What kind of healthcare professional would do this?  Of course now, he's skipped town.  Seems he may be guilty of prescription fraud and diverting medications.

Interestingly, in Germany, circumcision in the news.  German doctors are seeking an urgent clarification from the government over religious circumcision after a court ruling calling it a criminal act prompted an international outcry.  I know this is a hot button topic with many.

The College of Physicians called on the government to act to prevent clandestine circumcisions and to ensure that "children do not fall into the hands of any butcher or any old health worker".

The Cologne ruling concerned a case brought against a doctor who had circumcised a four-year-old Muslim boy in line with his parents' wishes.

When the boy later suffered heavy bleeding, prosecutors charged the doctor.

Although the doctor was acquitted, the court judged that "the right of a child to keep his physical integrity trumps the rights of parents" to observe their religion, potentially setting a legal precedent.

Want to lose weight?  Don't eat out at lunch, don't skip meals, and log everything you eat in a journal.  So, first thing I'm going to do since I've already started using Fitness Pal is to brown bag it from now on.

LeapFrog vs Consumer Reports

What hospital is the best in your area? Which hospital is the safest? Many times the public uses word-of-mouth from their friends and families to choose. A lot of times our own insurance policies determine which hospital we choose. Consumer Reports just rolled out their own version of safety rankings comparable to another version LeapFrog Group that was released last year.

In June, Leapfrog Group, a Washington D.C.-based hospital safety advocacy group, created its own safety rankings, but unlike Consumer Reports’ numerical scores, Leapfrog used A, B and C letter grades, similar to New York City’s restaurant grading system that only has three grades.

The director of the Consumer Reports Health Ratings Center, John Santa M.D., explained the report as a type of advocacy. “We’re doing this in part because 12 years ago the Institute of Medicine made the same suggestions that we’re making. This kind of information needs to be publicly reported, these problems need to be solved, but the hospitals still haven’t done it,” he said. There are differences in reporting between the two groups. “We each looked at some different measures,” said Leah Binder, CEO of the Leapfrog Group. “Particularly, they [Consumer Reports] looked at patient satisfaction measures and rates of CT scans. We didn’t look at those things. We looked at injuries, errors and accidents only. It’s kind of like having two different book reviews. Different reviewers have different interests.”

This is a good thing in that it helps educate the public about hospital safety. This is a bad thing is that the guidelines for determining safety is different from study to study. Where does your hospital rank?

Oxycontin Reformulation and the Heroin Effect

According to multiple news agencies and a letter published by New England Journal of Medicine, former Oxycontin addicts are moving over to a cheaper readily available illegal substance to get high -- heroin.

Effect of Abuse-Deterrent Formulation of OxyContin

N Engl J Med 2012; 367:187-189July 12, 2012

Article

TO THE EDITOR:

In August 2010, an abuse-deterrent formulation of the widely abused prescription opioid OxyContin was introduced. The intent was to make OxyContin more difficult to solubilize or crush, thus discouraging abuse through injection and inhalation. We examined the effect of the abuse-deterrent formulation on the abuse of OxyContin and other opioids.

Data were collected quarterly from July 1, 2009, through March 31, 2012, with the use of self-administered surveys that were completed anonymously by independent cohorts of 2566 patients with opioid dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders,4th edition, who were entering treatment programs around the United States and for whom a prescription opioid was the primary drug of abuse (i.e., heroin use was acceptable but could not be the patient's primary drug). Of these patients, 103 agreed to online or telephone interviews to gather qualitative information in order to amplify and interpret findings from the structured national survey.

Effect of Abuse-Deterrent OxyContin., the selection of OxyContin as a primary drug of abuse decreased from 35.6% of respondents before the release of the abuse-deterrent formulation to just 12.8% 21 months later (P<0.001). Simultaneously, selection of hydrocodone and other oxycodone agents increased slightly, whereas for other opioids, including high-potency fentanyl and hydromorphone, selection rose markedly, from 20.1% to 32.3% (P=0.005). Of all opioids used to “get high in the past 30 days at least once” OxyContin fell from 47.4% of respondents to 30.0% (P<0.001), whereas heroin use nearly doubled.

Interviews with patients who abused both formulations of OxyContin indicated a unanimous preference for the older version. Although 24% found a way to defeat the tamper-resistant properties of the abuse-deterrent formulation, 66% indicated a switch to another opioid, with “heroin” the most common response. These changes appear to be causally linked, as typified by one response: “Most people that I know don't use OxyContin to get high anymore. They have moved on to heroin [because] it is easier to use, much cheaper, and easily available.” It is important to note that there was no evidence that OxyContin abusers ceased their drug abuse as a result of the abuse-deterrent formulation. Rather, it appears that they simply shifted their drug of choice.

Our data show that an abuse-deterrent formulation successfully reduced abuse of a specific drug but also generated an unanticipated outcome: replacement of the abuse-deterrent formulation with alternative opioid medications and heroin, a drug that may pose a much greater overall risk to public health than OxyContin. Thus, abuse-deterrent formulations may not be the “magic bullets” that many hoped they would be in solving the growing problem of opioid abuse.

Theodore J. Cicero, Ph.D. Matthew S. Ellis, M.P.E. Washington University in St. Louis, St. Louis, MO cicerot@wustl.edu

Hilary L. Surratt, Ph.D. Nova Southeastern University, Coral Gables, FL

Legal Euthanasia: a discussion

I use the term "discussion" lightly when referring to this topic, but in 2002, the Netherlands became the first country to legalize euthanasia as an option for patients who were terminal.  The practice had been taking place since the 1970s, but finally it was signed into law.  There were strict laws and licenses that must be in place for it to take place, and Dutch doctors had a long list to check. Patients must be adults.  There must be suffering.  There must also be no other alternative for the patient.  A second doctor must be consulted to concur with the desires of the patient and the conclusion of suffering and terminal disease.

Christians immediately have thoughts of suicide and how this is a sin.  We classify life as human and it is wonderful that someone took their beloved pet to the vet to end their life humanely.  I did this for my dog, and I can say, it was the most amazing experience to know that he was in my arms and that I did not allow him to suffer as he would have in the last maybe two days of his life.  But wait.  He was a DOG.  We are different, or are we?

I know that personally there was a young lady that I met through one of my jobs years ago.  She was in her twenties, had never been married and had no children.  She had an older boyfriend.  She had been diagnosed with breast cancer and had waited a little too long on having a double mastectomy.  She did not have clean borders of the tumor.  The cancer had spread, and she had gone through many rounds of chemotherapy and radiation.

By the time she became my patient as a home infusion pharmacist, I was intrigued by her case.  Her age (she was four years older than me), her name (we had the same initials), and the thought of how she would probably never marry and definitely never have her own biological children.  I knew she was terminal based on the pain pump I was in charge of filling and keeping running for her so she would be in no pain during the months of her life.

We spoke on the phone weekly, sometimes two to three times a week.  She was always upbeat and positive, and after ten years, I can still hear her voice.  She was going on a trip to Florida with her boyfriend and wanted to jet ski in the ocean. She wanted to take her pain pump with her and jet ski.  We made it happen.

And now years later, The Lancet releases an article basically saying legalizing has not added more cases of euthanasia in  Netherlands.

The introduction of legalised euthanasia in the Netherlands has not led to an increase in the number of cases according to a team of Dutch university researchers, writing in The Lancet magazine.

While there was a slight decrease in the years after euthanasia was made legal in 2002, assisted suicide has now returned to pre-legalisation levels of around 2.8% of all deaths, the researchers from four Dutch teaching hospitals and the national statistics office CBS found.

And while opponents of euthanasia had warned the legislation would lead to a sharp rise in involuntary euthanasia among terminally-ill patients, there has actually been a reduction in this sort of deaths, professor Bregje Onwuteaka-Philipsen from Amsterdam's VU university told the Volkskrant.

Based on interviews with 6,000 doctors and research into 7,000 deaths, the team found just 300 cases of euthanasia where the patient had not given explicit consent in 2010, compared with around 1,000 in the years prior to legalisation.

Openness

'This is probably because there is more openness and doctors talk to their patients at an earlier stage,' Onwuteaka-Philipsen told the paper.

The researchers also found some 600 people forced an end to their own lives in 2010 by stopping eating and drinking. In around half of these cases, euthanasia had been refused.

Euthanasia is legal in the Netherlands under strict conditions. For example, the patient must be 'suffering unbearably' and the doctor must be convinced the patient is making an informed choice. The opinion of a second doctor is also required.

Although it's not legal in the US, believe me, it sort of goes on.  It is an unspoken way to die or at least comfort in the very very end.  I know that my patient "BB" went peacefully.  I know that there were many times she kept urging me to come meet her.  I was leery because I knew that I was already attached. Her pump would beep for whatever reason, she would call me.  I had specific orders from the oncologist that I could basically freely increase her dilaudid based on her pain level.  There was a trust thing between the three of us.

I finally did go meet her.  She was laying in bed at 33 years old with just a little bit of time yet.  Her sweet family brought out pictures of her before the cancer changed her so much.  She was beautiful.  I just hope to see her again, shake her hand (or hug her) and tell her how much of an impact she had on my life.  She missed out on so much yet she impacted others in ways she probably never knew.

What does this have to do with euthanasia?  I believe that it should be legal.  It's humane.  No one should have to suffer today.

Physical Punishment and Mental Disorders

I do not care for statistics.  It's not in my DNA to ENJOY them but this is the perfect example why all pharmacists (and the lay public, for that matter) should understand and interpret study results.  Just the other night, I was watching the news and the anchor states, "Parents should think twice about spanking their children."  Most people would look at the anchor, hear the words, and then turn right around and pass it on as though it was spoken by God Himself. A study was cited:

BACKGROUND: The use of physical punishment is controversial. Few studies have examined the relationship between physical punishment and a wide range of mental disorders in a nationally representative sample. The current research investigated the possible link between harsh physical punishment (ie, pushing, grabbing, shoving, slapping, hitting) in the absence of more severe child maltreatment (ie, physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, exposure to intimate partner violence) and Axis I and II mental disorders.

METHODS: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions collected between 2004 and 2005 (N = 34 653). The survey was conducted with a representative US adult population sample (aged ≥20 years). Statistical methods included logistic regression models and population-attributable fractions.

This is a retrospective study which automatically introduces bias.  Correlation does not imply causation.  That's the biggest issue I see with this study.  For example, the media will pick up a press release about this type of study and report that spankings make children grow into adults with mental disorders, but correlation does not imply causation.  For example, children who were spanked may end up with a mental disorder, but there is no proof that it was the spanking itself that caused the mental illness but perhaps several other factors or combinations of factors.  Even schizophrenia and depression have had genetic components.  What happened to pure genetics?

The next big issue with this study is they looked at many types of mental illnesses since it is not very efficient to run a large study, gather data, and analyze it to look at only one type of mental illness.  Scientific studies, however, rely on statistical analysis to determine whether something is true.  Even if your estimated error is less than one percent, in a study examining thousands of items some will appear to have an effect even though they are just statistical aberrations.  These false positives are then reported, and when a new study fails to confirm them as true, the press reports a scientific “change of mind”.

Finally, when a cohort study is retrospective, the problem is compounded since retrospective studies often rely on memory.  If you developed a mental illness, you may have a different memory recall of punishment and its effect and your perception vs if you did not have a mental disorder.

Be careful with retrospective studies!   As in this case, there are many flaws and biased automatically introduced.

I definitely understand the rationale for wanting to run this study as many parents are probably over the top with physical punishment; however, I don't believe those parents that reserve a spanking for a type of punishment as abusive or that their child will end up with a mental illness due to that one decision.  Too bad the media doesn't know how to interpret studies!

Another critique:

While the new study rules out the most severe cases of physically lashing out at children, "it does nothing to move beyond correlations to figure out what is actually causing the mental health problems," says psychologist Robert Larzelere of Oklahoma State University,. He criticized the study's reliance on memories of events from years earlier, and says it's not clear when punishment occurred.

Afifi acknowledges that it's difficult to change people's mind on this topic, but says "we're confident of the reliability of our data, and the data strongly indicate that physical punishment should not be used on children — at any age. And it's important for parents to be aware of that."

June 27 is National HIV Testing Day

HIV (human immunodeficiency virus) is the virus that causes AIDS. Today, in honor of National HIV Testing Day, the healthcare community encourages you to get tested for HIV. The only way to know if you have HIV is to get tested. Many people with HIV don’t have any symptoms. In the United States, 1 in 5 people living with HIV don't know they have it.

Even if you don’t feel sick, getting early treatment for HIV is important: early treatment can help you live a longer, healthier life.

Am I at risk for HIV?

HIV is spread through some of the body’s fluids, like blood, semen (cum), vaginal fluids, and breast milk. HIV is passed from one person to another by:

  • Having unprotected sex (vaginal, anal, or oral) with a person who has HIV
  • Sharing needles with someone who has HIV
  • Breastfeeding, pregnancy, or childbirth if the mother has HIV
  • Getting a blood transfusion that has HIV (very rare in the U.S.)

HIV testing is covered for many people under the Affordable Care Act, the health care reform law passed in 2010. Depending on your insurance plan, you may be able to get tested at no cost to you. Talk to your insurance provider.

Be the Match!

After years and years of wanting to join the bone marrow registry, I finally discovered that you don't even have to leave your house to join!  At Be the Match, the new name for the bone marrow registry, all you have to do is fill out a questionnaire and then wait for a kit to be delivered by mail within two weeks.  Then, taking a few swabs in your mouth, you send back and wait.  I hope to be able to help someone one day in this aspect. Take a look at the myths and facts of bone marrow donation before dismissing this opportunity to help save a life!