Saturday morning coffee [November 24 2012]

So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee mug to the right is from Denver, Colorado. I have been in Denver twice now, once in the summertime and once in the late fall/early winter. It’s a nice place, but not what you’d expect. Well, at least it’s not what I expected. With a nickname like “Mile High” I expected to be going up and down mountainous roads all the time. Not the case. It is much more flat than I expected. The downtown area has a small town feel to it, and the the 16th Street outdoor mall area was very nice. I found a lot of cool things to do down there in the evening. I also found the Mellow Mushroom pizza joint. Dude, that was some seriously good pizza. One thing is for sure, the views were spectacular. I ended up on the 9^th floor of one of the hotels I was in. Outside my window was a picturesque view of show capped mountains and green trees. Overall it’s a nice place to visit. Word of caution though about the airport, it’s a mess at times. I’ve only been through there a dozen or so times and have gotten burned on a few occasions. Consider yourself warned.

The Twilight Saga: Breaking Dawn: Part 2 was #1 at the box office last weekend bringing in just over $140 Million. No surprise there as the Twilight series has pulled in over $1 Billion (yes, 9 zeros) domestically and nearly $3 Billion worldwide. My wife took my youngest daughter to see it. Both thought it was pretty good. Skyfall continues to do well as it came in second for the weekend with a cool $40 Million, bringing its total to about $160 Million to date. Not too shabby. A movie that I’d really like to see is Lincoln. I’ve heard nothing but good things about it.

– Did you know that coffee starts out as a yellow berry that changes to red before being hand-picked at harvest? It’s true. The red berry is then soaked in water as part of the de-shelling process, exposing the green coffee bean. The bean is dried in the sun for 3-5 days and packed for sale.

– Thanksgiving was Thursday. Two thoughts on Thanksgiving. First, what a great holiday. My family and I spent it with my brother and his family at his home on the coast. We had a wonderful time. The food was great and the company even better. Second, driving around Thanksgiving time sucks. I’d like to be introduced to the guy  that decided that tearing up every road in the country was a great way to stimulate the economy so I could punch him in the throat. I drove a little over 800 miles in a two day span. The roadways are inhospitable due to massive construction everywhere I went. What a flippin’ disaster.

– Top posts for this week on my site are listed below. I find the one about the Demolizer II interesting. The post has been receiving a lot of attention for all the wrong reasons. Apparently the company hasn’t been making their customers happy. Read the comments if you have a minute.

1. Cool Pharmacy Technology–Demolizer II
2. RFID tracking of refrigerated meds in the pharmacy
3. Why pharmacy continues to fail
4. All good things must come to an end, and so goes the pharmacist shortage
5. Automated unit-dose packagers for acute care pharmacy

– I like chemistry. It was (is?) my first true love, and I’ve always had a soft spot for things that have to do with this particular science. I am especially fond of molecular drawings, shapes, models, and the like. While an undergrad I used to carry around a 3.5-inch floppy disk with a molecular modeling program on it. Times have certainly changed, but my interests haven’t. I found the video below cool because it shows how powerful ChemDraw can be in the hands of someone that knows how to use it.

– Sound-Alike, Look-Alike Drugs (SALAD) have been a thorn in the side of pharmacy for a long, long time. I wrote about it back in January 2011. There’s an article in the December 2012 issue of the International Journal of Pharmacy Practice (IJPP). The article reviews “current literature with the objective of developing strategies and recommendations to enhance patient safety and minimise clinical issues with look-alike, sound-alike medication names.” The conclusions are predictable: “There are many existing medications which can potentially cause clinical issues due to mix-ups because of similar sounding or looking medication names… A multifaceted, integrated approach involving all aspects of the medication use process…is suggested to minimise this issue for medication safety.” Unfortunately I can’t read the details of the article because the journal requires a subscription to access more than just the abstract. Don’t you think this is something everyone should have access to? I do.

– My boss sent me the video below. The video introduces the AutoStore robot from Swisslog. It’s an interesting way to approach the problem of storing lots of stuff in a limited space. There are some things that I would do differently, but overall I was impressed by the concept and design.

– Raise your hand if you think the new range of form factors for tablet PCs and ultrabooks is impressive (my hand is up); convertibles, hybrids, sliders, flip-screens, double-screens, and so on. It’s an exciting time for the tablet/ultrabook market. I can’t help but feel that they’re on the edge of something truly innovative. Just a feeling, nothing concrete, but I can’t shake it. GottaBeMobile has a nice summary of some of the cooler machines that you’ll see on the market if you’re interested. For the first time in my tablet PC career I’m stumped by which machine(s) I’d like to have. In all honesty I’d like to try them all, but that’s not practical from a financial standpoint. I’m continually evaluating machines that come out, and it’s causing me to bounce back and forth on which one I’d like to have most. It’s a good problem to have.

– Vancomycin has been around for a long time. Several drugs have come down the pipeline during my career in an attempt to replace it, but try as the pharmaceutical industry might they have yet to do it. Vancomycin remains the go-to antibiotic for certain infections. And as such, research on the drug remains fairly active. That’s why I wasn’t surprised when I ran across an article in the most recent issue of the American Journal of Health-System Pharmacy (AJHP) about vancomycin. The article discusses the use of continuous-infusion vancomycin therapy in pediatric patients with pneumonia or osteomyelitis. We were doing this over 10 years ago in the pediatric facility I was working in at the time. Interesting how things continue to loop back around. We found that phlebitis was the limiting factor most of the time. The article makes no mention of it. The interest in continuous infusion – versus intermittent infusion – vancomycin is brought on by the pharmacokinetics/pharmacodynamics of the drug. It’s one of a group of drugs that does its best work when its AUC/MIC ration is maximized. Hence the interest in keeping its level above a certain threshold for extended periods of time.

– Google Now received some serious props from Popular Science this week by receiving the Innovation of The Year nod. Cool.

– There is a great article the September 2012 issue of The New England Journal of Medicine titled What Business Are We In? The Emergence of Health as the Business of Health Care. “The analogous situation [to the failure of railroads]  in health care is that whereas doctors and hospitals focus on producing health care, what people really want is health. Health care is just a means to that end — and an increasingly expensive one. If we could get better health some other way, just as we can now produce images without film and transport people and freight without railroads, then maybe we wouldn’t have to rely so much on health care.” It’s a very interesting article. It really makes one think about where we’re headed in healthcare. I think our biggest problem is that we’ve forgotten about the patient.

– Speaking of The New England Journal of Medicine, the November 22, 2012 issue contains more commentary on Regulating Compounding Pharmacies after NECC. I have a feeling this is going to get worse before it gets better.

– GigaOM – “Moo, the online printing company that offers business cards, greeting cards and more, recently demonstrated the ability to use wireless technology in the paper industry. The company showed off a business card with an embedded NFC, or near-field communications tag…after using the test card, I realized that a dedicated card eliminates all the button presses needed to beam data between phones.” – I dig NFC-enabled stuff and can see a lot of potential for uses in pharmacy. It’s cool stuff.

– VistaA EHR preferred over Epic? That’s the word from a 2012 Medscape survey. According to an article at HIT Consultant “Two recent surveys clearly show that, when it comes to enterprise EHRs, physicians prefer VistA. According to the results of the Medscape survey, the VA’s Computerized Patient Record System (VistA CPRS, the clinical application in the VistA EHR system) is the third most preferred enterprise health IT solution in American medicine, ahead of Epic (6), Cerner(11), Meditech(14) and McKesson(15).” – And here’s the best part, the VistaA system is public domain software and is available through the Freedom of Information Act via the VA website. Funny.

– There are several definitions for ‘character’ in the Merriam-Webster dictionary. The one I prefer is “moral excellence and firmness <a man of sound character>”. I’ve always found that people’s real character is defined during two distinctive times: 1) how they behave when they are alone and think no one else it watching. Let’s face it, it’s easier to do the right thing when others are around; 2) when they’re given ultimate power to use or abuse as they see fit. It’s easy to be a jerk when you have all the power. The person with character won’t. Think about it.

– Medgadget: “Scientists at the University of Akron have developed a new polymer system that can do everything from stopping bleeding to filtering water. In addition to the polymer’s impressive adaptability, the researchers say its preparation is amazingly simple: just open a package and mix two ingredients together.” – Polymers are cool.

– Microsoft’s Surface RT tablet has received a lot of attention lately. Some good, some bad.  Pocketables has a pretty solid review of the tablet. It’s long, but worth reading. The more I read about Surface RT the more I begin to wonder what Microsoft is up to. Most people I speak to are waiting for the Pro version of the tablet and have no desire to own the RT version. I’m in that group. Many view Windows RT as being crippled due to its lack of ability to run legacy Windows apps. I see the logic in that thought process, but Surface RT is a very solid consumer tablet if you let it be what it was designed to be. When you consider the price it makes for a compelling device, especially if you’re looking for Office compatible, email, internet surfing, and social media. Microsoft really should have called Windows RT something else to prevent people from constantly comparing it to the full-blown OS, or better yet, don’t even give the OS a name. Just a thought.

– Want to see something really strange? I went to the Microsoft online store to look at tablets and found a couple of real oddities. First, I couldn’t find the Samsung ATIV Smart PC Pro anywhere on the site. I know Microsoft has the tablet in their stores because I was playing with one Wednesday afternoon in the Microsoft Store down in Westfield Century City Mall. Second, and significantly more strange, when I click on ‘Tablets and Convertibles’ in the menu on the Microsoft site the Surface Tablet is nowhere to be found. Only 7 tablets are listed and none is the Surface. What the heck is that all about?

– Need to learn how to properly shave? Check out this article at Greatist on “The Total Guide to Men’s Shaving Health This #Movember”. Apparently I’ve been doing it all wrong for years. The article includes a quick little blurb on the history of the moustache. Interesting.

– I like eggs. In fact I eat more than a dozen a week, easy. I eat them fried, hard-boiled, and of course scrambled. According to Gordon Ramsay I’ve been scrambling my eggs incorrectly my entire life. Check out his video below on how to scramble the perfect egg. Awesome.

– There are three big games in the Pac-12 today: USC vs. #1 ND, #5 Oregon vs. #15 Oregon St, and #8 Stanford vs. #17 UCLA. I’ve been a Notre Dame fan for a long time. When I was a kid I liked their uniforms and that’s carried over to a lifetime of following them. I fully expect them to beat USC. Even though the Civil War game can be a tough one I believe Oregon will dispose of Oregon State. I’d love to see Oregon go down, but I just don’t see that happening, especially after coming off the loss to Stanford. The Stanford – UCLA game is a bit tougher to call. I hate Stanford now, remember? Stanford matches up well against UCLA because they’re well coached and disciplined; they play solid football. UCLA makes mistakes here and there and Stanford is the type of team to take advantage of those mistakes. I’m pulling for UCLA, but I think Stanford wins this one.

– From the no-duh category of the week, it appears that head injury leads to problems. Really? Medscape today: “Compared with normal controls, patients with post-traumatic symptoms soon after mild TBI [traumatic brain injury] showed reduced connectivity in some regions, and increased connectivity in others within the network that the brain uses during inactivity for information processing and maintenance. These abnormalities were associated with cognitive dysfunction, depression, anxiety, fatigue, and post-concussion syndrome.” The study referred to in the article is from Zhou Y, et al “Default-mode network disruption in mild traumatic brain injury” Radiology 2012; 265: 882-892. Just a question, is there a non-traumatic brain injury? Just sayin’.

– I’m headed for Las Vegas this coming Friday, November 30 for the 2012 ASHP Midyear Meeting & Exhibition. Not nearly as excited as I’ve been in previous years as I’m going for reasons other than pharmacy. But I will be connecting with some old friends and that’s pretty cool. It’s one of those rare times when many of my pharmacy friends and colleagues are all collected in one spot, which makes catching up easier to do. If you’re going to be around let me know, I’d love to get together and have a cup of coffee or two.

And with that I bid you adieu. Have a great weekend everyone.