Clinical Reference Updates – January 2012 Summary for Medscape App for Android™

• 487 diseases & conditions updated
• 114 drug monographs updated
• 4 new drug monographs added

Featured Content of the Month – Heart Failure

This month we bring you an expanded collection of over 30 Heart Failure topics that have been updated with the most recent developments from medical literature and guideline recommendations from the American Heart Association, the New York Heart Association, and the European Society of Cardiology.

Comprehensive coverage on Heart Failure, including:

Heart Failure – includes the latest guidelines from the ACCF/AHA, NYHA, and ESC, as well as a greatly expanded multimedia library of clinical images and videos

Echocardiography – discusses the technical aspects of 2-D and Doppler echocardiography and provides an overview of equipment and patient preparation

Transvenous Cardiac Pacing - provides details on obtaining venous access, a technique for placement of the pacing lead, and complications that may occur

Permanent Pacemaker Insertion – offers information on devices and equipment, details on the implantation technique, and a discussion of technical considerations

New Drug Monographs

azilsartan/chlorthalidone (Edarbyclor)
New drug combination of an angiotensin II receptor blocker and thiazide-like diuretic indicated for treatment of hypertension.

glucarpidase (Voraxaze)
New carboxypeptidase enzyme indicated for toxic plasma methotrexate concentrations in patients with delayed methotrexate clearance due to impaired renal function.

Drug Monograph Updates

brentuximab (Adcetris)
A new black box warning was added that describes cases of progressive multifocal leukoencephalopathy, a rare but serious brain infection that can result in death.

C1 inhibitor human (Berinert)
Expanded indication includes treatment of acute attacks for laryngeal hereditary angioedema.

pneumococcal vaccine 13-valent (Prevnar 13)
New indication for prevention of pneumonia caused by Streptococcus pneumoniae in adults aged 50 years or older.

raltegravir (Isentress)
New pediatric indication for HIV-1 infection in children aged 2 years or older.

Fentanyl transmucosal (Subsys)
New sublingual spray indicated for breakthrough cancer pain.

Practice Changing Updates

Our app is continually being updated with new FDA drug approvals, the latest clinical updates from medical literature and current guidelines to help you stay informed and make the best decisions in the treatment of your patients. Here are this month’s featured updates:

Bacterial Pneumonia – Prevnar 13, a pneumococcal 13-valent conjugate vaccine, has been approved by the U.S. Food and Drug Administration for people aged 50 years and older to prevent pneumonia and invasive disease caused by the bacterium, Streptococcus pneumoniae.

Human Papillomavirus – The CDC now recommends the quadrivalent HPV vaccine (Gardasil) for routine use in boys aged 11 or 12 years. Current recommendations advise vaccination for males aged 13-21 years who have not been vaccinated previously or who have not completed the 3-dose series.

While looking at the table of contents from my favorite journals and reading through the abstracts has value, it falls short of providing the same level of information one gets from digging into an article, looking at the data, viewing the tables and graphs, etc.

In an attempt to improve my access to information I signed up for a service called MedInfoNow.

MedInfoNow touts itself as “A personalized weekly email that quickly summarizes the latest journal article abstracts and citations from Medline® important to you.”

MedInfoNow is easy to use. You simply select topics that interest you, the services searches through those topics, puts them into a simple summary and emails them to you once a week. The service provides obvious value by giving me access to several journals in a single location, but MedInfoNow definitely falls short of my expectations. I was already doing much of what the service provides via RSS feeds, Twitter and frequent visits to my favorite informational websites.

The one thing I really need is access to full-text articles. Unfortunately MedInfoNow doesn’t do that. While it does provide links to some full-text articles, those articles are freely available to anyone and don’t require a paid subscription to the journal or MedInfoNow. Bummer.

Is MedInfoNow worth the $129/year I’m paying? Hardly. My subscription expires in June 2012. I won’t be renewing.

In this case it’s ASHP’s Interactive Handbook on Injectable Drugs: IV Decision Support by Lawrence A. Trissel. Every pharmacist working in a hospital pharmacy knows about this reference. And if they don’t then they have a big problem because it’s only one of the most definitive reference sources for IV compatibility. Over the course of my career it’s simply been know as “the Trissel’s”. (kind of like “the Talyst”…just sayin’ – private joke people)

There’s a link in the ASHP web store leading to a “getting started video”, but I couldn’t get the video to run. Little bit of a fail. Perhaps ASHP’s never heard of YouTube. Who knows.

Link to Android version is here.

Link to iPad version in iTues store is here.

I’ve used Medscape for years. In fact, it was one of the first online reference sources that I signed up for when I became a pharmacist back in 1997. Unlike today, online information was hard to come by back then.

I like the way Medscape has always tailored their content by specialty, i.e. I have my set to Pharmacist so I get mostly information that applies to my profession.

I only spent a little time with Medscape Reference this morning, but it has a nice layout with a good amount of information. Enjoy.

Anyway, I was reading through the MedicalSmarphones.com website and came across the video below demonstrating Epocrates Essentials for Android. It’s pretty cool. I’d love to see it on a Samsung Galaxy Tab or Motorola XOOM. As far as that goes I’d love to see Lexicomp software on a Samsung Galaxy Tab or Motorola XOOM as well.

Medscape Mobile is also available for the iPhone, iPad and BlackBerry, just in case you don’t have an Android device.

From the abstract: “This paper found that a few students demonstrated in-depth knowledge of the Wikipedia editing process, while most had some understanding of how the site functions and a few lacked even such basic knowledge as the fact that anyone can edit the site. Although many study participants had been advised by their instructors not to cite Wikipedia articles in their schoolwork, students nonetheless often use it in their everyday lives.” Kevin also links to the pre-print version of the article here (PDF).

Lately I’ve seen too many references to Wikipedia in the world of healthcare. That’s troubling. I was recently reading a new pharmacy textbook on informatics when I came across a citation that generated some interest in my mind, so I went to the bibliography section of the chapter only to find that the cited reference was Wikipedia. Needless to say I was disgusted. The textbook has received quite a bit of acclaim from many well-respected individuals in the pharmacy informatics community. What’s worse is the author is considered an expert in the field. In my mind the reference to Wikipedia discredits much of what the author had to say. I would have preferred an outright opinion on the subject. Anyway, the book now makes a nice drink coaster on my desk. That’s about all it’s good for.

From The Annals of Pharmacotherpy (Vol. 43, No. 11, pp. 1912-1913): “Approximately 80% of pharmacists use the Internet to obtain drug information. Wikipedia, often found at the top of Internet search results, is a free-access, collaborative, online encyclopedia that can be edited by anyone. Incidents of vandalism have occurred, since the site allows anyone to contribute. For example, an incident occurred in which a fake biography was created as a joke to implicate prominent writer and journalist John Seigenthaler for the assassination of John F Kennedy. It took about 4 months until the fake biography was detected and deleted by Wikipedia. Although Wikipedia does have an internal quality review, the ability of internal editors to find and correct erroneous information may not be timely. As reported by Clauson et al., the information found on Wikipedia may not be complete and accurate, especially in regard to drug information. Published data regarding pharmacists’ use of Wikipedia to obtain drug information is lacking. Therefore, the objective of this study was to measure pharmacists’ use and perception of Wikipedia for obtaining drug information.” – This letter to the editor discusses the results of a questionnaire given to pharmacists regarding the use of Wikipedia for drug information. I was dumbfounded to read that 28% of respondents reported using Wikipedia for drug information. Yikes!

Unfortunately the item above is part of a bigger trend in pharmacy. Many times I’ve heard older pharmacists talk about how new pharmacists are less prepared to enter the workforce than in recent memory. I’ve always blown that off as it’s hard to remember just how ignorant I was when I graduated from pharmacy school. It took me two years to figure out I didn’t know anything and another five years to learn what I really needed to know. However, maybe there’s something to it after all.

With the advent of the non-traditional PharmD, the shortage of pharmacists for the better part of the last decade and the incredible number of new pharmacy schools, I have to wonder if there’s something to the idea that our profession is slowly becoming watered down. I remember being in pharmacy school, and just how rigorous the literature review process was. There were certain things you just didn’t do, and among them were referencing things similar to Wikipedia – as Wikipedia didn’t actually exist at the time. Crud, we weren’t allowed to reference secondary literature, Micromedex or even certain journals that were considered sketchy. When we quoted something of any significance it was expected that we obtained that information from a credible primary literature source. Boy have things changed.

Yesterday I wrote a blog post for another website preaching the bright future of pharmacy secondary to the HITECH Act and the PPMI from ASHP. However, I think we may have a bigger problem if we can’t get ahold of pharmacists at the most basic level of our profession. We are highly trained, intelligent professionals and we should strive to behave in a manner that is above reproach. Using questionable reference material and watering down education because we need more pharmacist certainly isn’t the way to go about it.

Anyway, here’s some other stuff I’ve found interesting over the weekend:

Blood clots made visible by nanoparticles (Gizmag) – I like nanoparticles. Their value appears limitless as batteries, tumor destroying soldiers, robotic surgeons, etc. If I was younger, smarter and research driven this is where I would spend my time; targeted drug delivery is the future.

Medscape Mobile for Android – Medscape mobile isn’t in that upper echelon of medical reference apps, but it’s fairly decent and free.

New Study Identifies Frequent Causes of Analgesic Medication Errors (American Pain Society) – Not surprisingly the article quotes the frequency of analgesic drug errors in hospitals as nearly 3 per 1000 prescriptions. However, it’s important to remember how drug errors are acknowledged; some are harmful, while others hold no clinical significance. The article in The Journal of Pain can be found here.

Smartphone Usage up 60 Percent (paidContent.org) – Of course Apple and Android are the big winners, with Android on top, but expect the numbers to shift again now that the iPhone is available on Verizon.

American Institute of Pharmaceutical Science (AIPS) – “AIPS is a 501c(3) non-profit organization that is focused on advancing healthcare solutions and improving medication safety and health outcomes.” – Interesting site. Thanks to John Poikonen (@poikonen) for bringing it to my attention.

WebMD vs. MayoClinic.com – Reliable Medical Information (eHealth John Sharp) – Very interesting take on medical information and commercial advertising.

Most read posts over the past week on this site:

1. Time to accept pharmacy robotics as our friend and ally
2. Automated unit-dose packagers for acute care pharmacy
3. Cool Technology for Pharmacy (Alaris Smartpumps)
4. Cool Technology for Pharmacy (Capsule machine)
5. Do smaller hospitals get the shaft when it comes to automation and technology?
6. “What’d I miss?” – Week of January 30, 2011
7. The National Drug code (NDC) is a gremlin in the works of pharmacy
8. Moving storage around in the “cloud”
9. Barcodes on patient wristbands
10. Best iPhone / iPod Touch Applications for Pharmacists

• The Chronicles of Narnia: The Voyage of the Dawn Treader was #1 at the box office last weekend. I haven’t seen it yet because my girls have no interest in it. That’s just weird. I thought for sure it would be at the top of their list. Tron Legacy is out and I’m really looking forward to seeing it this weekend.
• It’s unfortunate, but it looks like the RIM BlackBerry PlayBook won’t be making a public appearance until March 2011. RIM is doing some interesting stuff, but is it too little too late? Only time will tell. When I was in San Francisco this week I had the opportunity to interact with some Product Managers from RIM. When I asked them about the PlayBook they wouldn’t even confirm that it existed. Really? C’mon.
• I am, without question, a proponent of cloud computing. The potential of such a platform cannot be ignored. And like it or not the market is demanding that industry move in the direction of the cloud. Security is always a big issue with people and seems to be the battle cry for those that oppose it. Here’s one example at Coputerworld UK where Simon Phipps comments that cloud computing may not be the future platform of choice secondary to circumstances outside the technology, i.e. people, politics and service. He has a valid point, but all technologies suffer from problems. The cloud environment won’t be any different.
• If you’d like to see an alternate view on cloud security take a look at the Practice Fusion Blog. The authors spend a little time talking about some of the security benefits of the cloud.
• There’s a great article at GottaBeMobile that talks about the various technology failures and success of 2010. I don’t agree with everything on the lists, but I do find the list of successes interesting as Android based devices appear as four of the ten items on the list. Android is a disruptive technology that will continue to grow until something bigger comes along. And that could take a while.
• Check out the Laciefloat, a harddrive with trackpad. How cool is that? You can find more information at the Yanko Design site. The QR Code at the right will take you there.
• digitalHealth Summit: “The Digital Health Summit at the 2011 Consumer Electronics Show focuses on the booming market of consumer-based health and wellness innovations that sit at the convergence of technology and healthcare.” – The only questions I have are why haven’t I heard of the digitalHealth Summit before and how do I get it.

• What You’ll See
  • Telehealth Systems
  • Therapeutic & Diagnostic Medical Devices
  • Remote Monitoring Devices
  • Mobile Health Applications
  • Secured Wireless Communication Medical Devices
  • Medication Monitoring Equipment
  • Mobile Health Devices
  • Robotic Prosthetics
  • Personal Health Records
  • Communications Networks
  • Telemedicine Systems

• mobilehealthnews: “Worldwide about 70 percent of people are interested in having access to at least one mHealth application, according to a new research report from Pyramid Research. “ – No surprise as mHealth has become a new buzzword throughout the healthcare industry.
• I recently saw a commercial with a guy sitting on a beach using his smartphone to print a document on a printer halfway around the world. Great concept and it’s available as Web-connected printing through HP. There’s certainly a need for such functionality in a world screaming for instant gratification.
• Medscape for Pharmacists has a list of top 10 Medscape articles in 2010. Unfortunately access to the article requires registration, but the top 10 articles for 2010 were:

1. Is Hookah Harmful?
2. Abbott Withdraws Sibutramine From Market
3. Gemtuzumab Voluntarily Withdrawn From US Market
4. FDA Restricts Rosiglitazone; EMA Pulls the Plug
5. Potential Interaction Between Clopidogrel and Proton Pump Inhibitors
6. FDA Issues Second Warning Against Treating Leg Cramps With Quinine
7. Best Evidence Interview: CINODs — The NSAID Holy Grail?
8. How Can Leg Cramps Be Treated?
9. NDM-1 — Making Resistant Bugs in New Ways
10. DTaP-Tdap Mix-Ups Now Affecting Hundreds of Patients

• ASHP News: “Some pharmacists say the loss of propoxyphene will not be much of an issue for practitioners.Suzanne Nesbit, clinical pharmacy specialist in pain management at the Johns Hopkins Hospital in Baltimore, said the drug is on the formulary but now has a “special alert” about the market withdrawal.” – Propoxyphene is a terrible medication, especially in combination with acetaminophen. I’m glad to see it gone from the market.
• Medical News TODAY: “The release of the AIHW report today that shows more than 80 per cent of all premature deaths are due to chronic disease highlights the importance of a collaborative healthcare model to help deal with the growing pressures of chronic diseases. Pharmacists can play a bigger role in helping to manage chronic conditions as part of a collaborative health-care team. As medicine experts, they are often the first point of contact from patients suffering from chronic conditions.” – Hmm, where have I heard that before. That statement is 20 years old. I think we need to come up with a new one.
• The College Football season is basically over. Now I just have to sit around a wait for the bowl games to arrive. Like every other red-blooded American I will have myself plopped on the couch New Year’s Day watching football and eating myself silly. I can’t wait.
• On the other hand, the NFL season is heating up and everyone is getting ready for a playoff run. I’m in one of those precarious positions again this year as some of the teams I despise are still in the running. I loath some of those teams so much that if they get into the Super Bowl I won’t even watch it. Let’s hope that doesn’t happen.

Have a great weekend everyone.