Bacteria everywhere run scared as vancomycin gets new life

vancomycinmedGadget: “Scientists from the Scripps Research Institute have successfully reengineered vancomycin. They have reported their findings in the Journal of the American Chemical Society. This research could be a solution in the treatment of patients infected with highly resistant bacteria. Vancomycin is often considered the antiobiotic of last resort, if other antibiotics have failed to do the job. But the emergence of vancomycin-resistant bacteria is becoming a major health problem. Vancomycin works by binding the D-alanyl-D-alanine terminal dipeptide of peptidoglycan precursors, used by bacteria for constructing their cell walls. By binding it, the bacteria can not use the peptidoglycan anymore and they die. But certain bacteria have altered their peptidoglycan by replacing an amide with an ester, resulting in vacomycin resistance.

The reengineered vancomycin can bind the altered peptidoglycan and kill the bacteria once again using the same mechanism as described above. But besides binding the altered peptidoglycan, this new antibiotic can bind the original peptidoglycan as well. It took Dale L. Boger and his team some serious chemical engineering to redesign vancomycin into this new antibiotic. In the article down below you can read the report how they managed to synthesize this altered antibiotic and exchange a single atom in the vancomycin to reinstate its antimicrobial activity.”

Vancomycin is an oldie, but a goodie. It continues to be useful despite its age. Several drugs have been developed over the years to replace it, but for one reason or another the newer agents tend to fall out of favor. With that said, vancomycin won’t last forever as bacteria are slowing finding ways to combat its mechanism of action. So instead of finding a new drug, someone decided to alter the old one. Go figure.

Is the Motion J3500 still the best Win-Slate on the market?

j3500To borrow a phrase from Tommy Lee Jones in The Fugitive, I’ve been doing a “hard-target search” recently for a new tablet PC. Don’t get me wrong, I love my Lenovo x201 Tablet PC, but I really want to try another slate.

In my mind the ASUS Eee Slate EP121 (who comes up with these names?) is currently the best tablet PC slate on the market. I’ve spent quite a bit of time messing around with it at the Microsoft Retail Store at Bellevue Square in Washington. The employees in there must think I’m some kind of stalker.

As far as the EP121 goes the inking is great, the touchscreen responsive, it’s fast, it’s the perfect size and it just “feels right” in my hands. So what’s the problem? The battery life is terrible? The information on the tablet states that the battery life is less than 3 hours. Online reviews have it at about 2 hours. That’s ridiculously bad in this day of hi-tech.

I looked hard at the Motion Computing CL900, but just don’t think it has enough muscle for me. It’s a bit slow and clunky. That’s a bummer as on the surface the CL900 looks like the perfect device.

While rummaging around the Motion Computing website for information on the CL900 I stumbled across an old friend, the Motion J3500. I’ve used it’s predecessor, the J3400 before and it was a great machine. I found the J3400 to be a good mix of functionality, toughness and battery life. With upgrades to the hard drive, processor and display the J3500 may just be the best option currently available, which says something about the tablet market; the J3500 is over a year old.

Not everyone’s opinion should count

Contrary to what your mom told you as a kid, not everyone’s opinion should count.

There are several definitions for the word opinion. The one I like comes from Merriam-Webster and reads “belief stronger than impression and less strong than positive knowledge”. Opinions are beliefs; something you think. They are not rooted in fact – although facts can play a roll in forming an opinion – nor are they required to be acknowledged by anyone other than the one giving the opinion. You have your opinion and I have mine. What if they’re different? No matter because they’re opinions.

Where we get ourselves in trouble is when we start thinking of one’s opinion as fact, or something close enough to fact that is must be acted upon. I frequently see this when someone with “expert” stamped on the end of their name says something like “you should …” or “why don’t you …”. Instead of evaluating statements like these and thinking them through many people will simply accept  them as fact and act on them. This is a bad thing. Why? Because everyone has an opinion and they don’t often line up with each other. This is especially true in healthcare; pharmacy in particular.

crazyknifeWe have a habit of taking an idea, passing it around the table, collecting opinions and making every attempt to act on them all. I see this a lot with automation and technology. Hey, I’m all about functionality, but not at the expense of common sense. When you try to incorporate everyone’s opinion into a product you get the object to the right. I’m sure someone thought this was a good idea; someone must have requested all that functionality, right? Sure. It’s the most functional piece of utility equipment in the history of mankind, but practical it is not. Try putting it in your pocket. This is what many pieces of pharmacy automation and technology turn into once everyone’s opinion is taken into account.

This goes doubly when people start suggesting that something needs to be added secondary to safety; “that should be added because it’s a safety issue”. Ah, the battle cry of those that know their opinion can’t stand up to close scrutiny. I get this one all the time. I suppose walking around in a suite of chainmail armor and driving 25MPH on the freeway would be safer than the way we do things now, but I just don’t see that happening anytime soon. It’s just not practical. And at the most basic level we give up the marginal difference in safety for the efficiency and practicality of wearing jeans and t-shirts while driving 70MPH. It’s a matter of compromise between form, function and usability combined with taking a little responsibility for our actions.

You simply can’t replace human responsibility and accountability with automation and technology. We need people to be responsible for their actions. It’s the only thing that keeps us honest. Without it everyone’s life will be like Phil Connor’s (Bill Murray) in Groundhog Day before he figured it all out.

Why regulatory compliance is killing innovation in healthcare

Anyone that’s worked in healthcare knows about regulatory compliance. If not, then they should because it takes up about 50% of everyone’s time, energy and effort. I understand the theory behind regulations, i.e. protect the patient, but I think most of the time all additional regulations do is is create work for people that are already over burdened.

Ask a nurse how much time they spend documenting and double documenting things to meet some arbitrary rule or regulation. You’ll be surprised by the answer. Now ask a pharmacist or a physician. You’ll get the same ugly responses. I know a lot of my time as a clinician was spent generating documentation to cover my ass rather than helping care for a patient.

Unfortunately the need to comply with government agencies and silly rules inside the walls of healthcare has generated an unwanted side effect – lack of innovation. Why? Because all that innovative energy is spent on regulatory compliance instead of other, more useful things.

I’ve been involved in several conversations over the last month dealing with how to best use pharmacy automation and technology to increase efficiency and solve problems. Would you like to venture a guess as to what most of those conversations centered on? Yep, how to automate some documentation process or create technology to meet some new regulatory compliance. None of the discussions have been about providing better, safer, more complete patient care.

If you don’t think this is a major problem, think again. I was reading a blog by John Halamka last night in which he discusses the ‘Burden of Compliance’. In the blog John states that “[a]s we draft new regulations that impact healthcare IT organizations, we need to keep in mind that every regulation has a cost in dollars, time, and complexity.” Just remember, there is a finite amount of dollars and time floating around in healthcare these days. If a majority of those dollars and time are gobbled up by regulatory compliance, what does that leave for innovation to actually improve medication distribution, safe administration and better patient care? Precious little if you ask me.

Something new from Medscape – Medscape REFERENCE

Received an email this morning touting the benefits of a “new product” from Medscape called Medscape Reference. Medscape Reference offers several databases including one for drugs and diseases. In addition there’s a drug interaction checker to boot. I took the interaction checker for a test drive by putting in amiodarone, warfarin and TMP/SMX. As predicted several serious interactions were found. So on the surface it works.

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.

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Ridiculously random thoughts

– There must be interest in the HP Touchpad because I can’t find one to save my life. I spent the better part of three days chasing down internet leads and visiting all the places in Fresno that used to sell them. HP obviously had the price wrong. Just a few weeks ago I was willing to purchase a 16GB model for $299, but ran into a problem at the Staples I visited. With that said I was never willing to pay $499 for the same model.

– HP used to make awesome calculators. I used to collect HP calculators, and still have several vintage models. I’ll never forgive HP for discontinuing the HP-11C. It’s still my favorite calculator. Mine was stolen from my high school locker in 1987. I’ve never replaced it. My next favorite is the HP 32S. I used it until the day I stopped being a pharmacist.

– In my opinion the Asus Eee Slate EP121 remains the best option for a slate tablet PC available today.  The problem is the battery life; less than 3 hours. That’s a deal breaker for me.

– In my opinion the Samsung Galaxy Tab 10.1 is the premier Android tablet on the market. Still not compelling enough to make me buy it. Hoping the Lenovo ThinkPad Tablet offers more. I’m ready to try another slate.

– Looking for a new phone. Eliminated iPhone and Windows 7 Phone. BlackBerry has nothing exciting enough to compel me in their direction. Looks like I’m sticking with Android. Droid 3 is at the top of my list. It’s not 4G, but I’ve become quite accustomed to a physical keyboard. Hated the physical keyboard when I bought my Droid. Go figure.

– You know, Windows Live Writer is pretty cool. I started using it a couple of months ago. Simply type what I want, wait for an internet connection and publish it. Simple.

– The Oakland Raiders took Terrelle Pryor in the supplemental draft. That’s funny. How could they go wrong given their history of drafting quarterbacks: JaMarcus Russell 2007, Andrew Walter 2005, Ronald Curry 2002. Need I say more?

– Speaking of Terrelle Pryor. The NFL sure taught him a lesson. Let me see if I have this straight. Break the rules in college. Check. Get to play in the bowl game. Check. Decide not to declare yourself eligible for the NFL draft. Check. Get suspended. Check. Enter supplemental NFL draft. Check. NFL says whoa their son, you broke the rules so we have to punish you severely. Check. Pryor has to wait a couple of extra months before earning millions. Check. I don’t see a difference in the outcome. Do you?

Median household income in 2009 in the US was approximately $50K. Median NFL player salary is approximately $770,000. That means the average person in the US has to work about 15 years to earn that. Think about that for minute. Now do the math on these (all rookies by the way): Cowboys signed Tyson Smith to a four-year, $12.5 million deal which is entirely guaranteed. Bengals signed A.J. Green to a four-year, $19.6 million deal, all of which is also guaranteed.Denver signed Von Miller to a four-year, $21-million deal. The players are complaining that these contracts are “low”. Chew on that for a while.

– My girls started back to school on Monday. Bummer. The last place on earth to learn anything is in school. The schools focus too much on testing, instead of focusing on thinking.

– Data is no longer king. What you do with the data is. The more data you collect, the more confused you become. Figure out how to use it and you’re no longer confused.

– Anyone besides me hate the character (Brenda) that Kyra Sedgwick plays in the Closer? She’s a real hypocrite.

– A friend of mine told me today that one of the physicians in the hospital where he works “is out of control”. Would you allow an employee or contractor you hired to get out of control and keep working? Didn’t think so. So why do hospitals?

– Three services worth paying for: Evernote Premium, SugarSync and Google Music. I know, I know, Google Music is in beta and it’s free. When they start charging, I’ll pay for it.

– Decided to sit down and read for pleasure a bit over the weekend. Grabbed Dominant Species by Michael E. Marks for my Kindle DX. Half way through it. So far, so good.

– The Kindle DX is still my favorite reading device. An LCD screen just can’t compete with eInk for that purpose. Period.

– Healthcare has forgotten about the patient. We spend a lot of time working on protocols, evidence based medicine, technology, efficiency, rules, regulations, “safety”, etc. Somewhere along the trail we left the patient behind.

– Healthcare and education are over regulated. The rules and regulations are suffocating everyone in these professions. Who suffers the most? The patients and the students. We’ll all pay for it latter on.

– “Business” is killing innovation. In my opinion “businesses” rely on the sheep effect instead innovating. And we all know what happens to sheep. I’ll give you a hint, it ain’t pretty. So is innovation dead? Not yet, but the days of truly innovative thought may well be over. I think we’re in for incremental changes from here on out.

– Form has overtaken function. Too bad because function is where it’s at.

– The average person is uh, uh, hmm. I’ve met many people in my 41 years and very few look beyond their shadow. “The vast possibilities of our great future will become realities only if we make ourselves responsible for that future.” –Gifford Pinchot. We’re in trouble.

– Trying to find an Arizona Cardinals game to attend this year. Here’s the schedule. The Steelers game looks promising. Seahawks game would be nice – New Years Day.

– Google+ is great, but I find myself going back to Twitter time and time again. Why? Because it’s so easy to post things on Twitter.

– Never got into Facebook. Friends and Family, but nothing “professional”. Don’t care for the games either.

– By the way, photo sharing apps for smartphones are the worst idea ever. I’ve seen about all the photos of food, beer bottles, cats, dogs, mountains, oceans, beaches, etc that I can handle. People should be required to take a class before they’re allowed to use them.

– Saw Conan the Barbarian (2011). Not as good as the original (1982) with Schwarzenegger, but still worth seeing.

– It’s been a dry movie Summer for the Fahrni crew. I’m going to have to double my efforts if I have any chance of seeing 50 movies in the theater this year. Things could definitely be worse.

– Most of the presidents in my time have at least given me a sense of leadership, control. I don’t get that with President Obama. From him I get the feeling he’s pulled off one of the biggest practical jokes in the history of the United States. Funny.

– Just ate my bodyweight in cheesecake. Time for a nap.

HP webOS dies a quick, albeit painful death

hpTP_deathHP decided to discontinue the webOS, which means the TouchPad is no more. I can’t say that I’m totally surprised that it failed, but I am shocked at the speed at which the company pulled the plug. I thought this might happen. I even went as far as to say “the webOS died in 2010” in a post back on December 31, 2010.

I have no idea why HP killed the webOS, but I’m sure we’ll find out more in the weeks to come. The operating system itself was awesome. I personally think it had the best user experience of all the current tablet platforms. I was looking forward to it’s maturation as a mobile computing ecosystem. With that said I think HP failed to offer the smartphone variety necessary to make the HP TouchPad meaningful.

I considered buying a TouchPad, but ultimately decided against it. Like many others I have a host of tablets to chose from these days. Why did I baulk at the TouchPad? Basically it boils down to cost, lack of smartphone choice and the feeling that the TouchPad still had some growing pains to go through. These are the same reasons that lead me to hold off on purchasing many of the early Android tablets.

Good-bye TouchPad. Your death was premature to say the least. Shame on you HP for destroying such a beautiful tablet operating system.

Free registration available for Pediatric Safety Summit September 28, 2011

infant-cuteIn just over a month the first ever Pediatric Medication Safety Summit will be held in Bellevue, Washington. As the name implies, the one day event will focus on pediatric safety in healthcare. The lineup includes some big names like Michelle Mandrack, Director of Consulting Services at ISMP and Mark Neuenschwander, President of The Neuenschwander Company, co-founder of the unSUMMIT and barcoding evangelist. Pharmacy CE is available.

Early Registration for the event is $150 if done by August 30; $200 after that and $300 at-the-door. However, if you contact Casey Cram, Director of Marketing at Talyst by Friday, August 25 she will waive the registration fee. Her contact information is below. Just tell her Jerry sent you.

I will be in attendance. Hope to see you there.

More information can be found at the Pediatric Safety Summit website.

Contact information for free registration:
Casey Cram, MA Director of Marketing
425.289.5726  Direct
1.877.4.Talyst  Toll Free
CCram@talyst.com

Socket announces latest Bluetooth barcode scanner

chs7xscannermobihealthnews: “Socket Mobile announced this week the availability of its latest Socket Bluetooth Cordless Hand Scanner (CHS) Series 7, a barcode scanner with medical applications which has been Apple-certified as a “Made for iPad, iPhone, iPod” accessory.

“This is the best performing barcode scanner for developers who are creating applications incorporating barcode scanning for the Apple iOS,” stated Samantha Chu, data collection product manager at Socket Mobile, in a press release. “There are numerous applications that stand to benefit from barcode scanning in a range of vertical markets, and we believe the CHS 7Xi provides the Apple developer community with a level of control and data integrity that didn’t exist previously.”

I’ve mentioned the CHS Series 7 scanners before. They really are neat little devices; small, quick and accurate.

Another scanner worth mentioning in this category is the Koamtac KDC200. I’ve used the KDC200 and it’s a pretty slick scanner as well.

Ever wonder why forklifts have roll cages?

I’ve driven my share of forklifts. I had several manual labors jobs before deciding to become a pharmacist. In fact, it was those manual labor jobs that helped me decide to go back to school and become a pharmacist in the first place. But that story is for another time.

I was searching for something completely unrelated to forklifts when I came across the video below. I was both horrified and amused.