fMRI study uncovers mechanism for drug cravings

This article at Medical Xpress caught my interest because I’ve been reading Physics of the Future: How Science Will Shape Human Destiny and Our Daily Lives by the Year 2100 by Michio Kaku, which spends a fair amount of time talking about fMRI.

“An fMRI machine uses “echoes” created by radio waves to peer inside living tissue. This allows us to pinpoint the location of the various signals, giving us spectacular 3-D images of inside the brain…

The fMRI scans allows scientists to locate the presence of oxygen contained within hemoglobin in the blood. Since oxygenated hemoglobin contains the energy that fuels cell activity, detecting the flow of this oxygen allows one to trace the flow of thoughts in the brain.

…fMRI scans can even detect the motion of thoughts in the living brain to a resolution of .1 millimeter, or smaller than the head of a pin, which corresponds to perhaps a few thousand neurons. An fMRI can thus give three-dimensional pictures of the energy flow inside the thinking brain to astonishing accuracy…”

According to the Medical Xpress article:

“Cues such as the sight of drugs can induce cravings and lead to drug-seeking behaviors and drug use. But cravings are also influenced by other factors, such as drug availability and self-control. To investigate the neural mechanisms involved in cue-induced cravings the researchers studied the brain activity of a group of 10 smokers, following exposure to cigarette cues under two different conditions of cigarette availability. In one experiment cigarettes were available immediately and in the other they were not. The researchers combined a technique called transcranial magnetic stimulation (TMS) with functional magnetic resonance imaging (fMRI).

The results demonstrate that in smokers the orbitofrontal cortex (OFC) tracks the level of craving while the dorsolateral prefrontal cortex (DPFC) is responsible for integrating drug cues and drug availability. Moreover, the DPFC has the ability to suppress activity in the OFC when the cigarette is unavailable. When the DPFC was inactivated using TMS, both craving and craving-related signals in the OFC became independent of drug availability.”

Cool stuff.

Article referenced: Takuya Hayashi, Ji Hyun Ko, Antonio P. Strafella, Alain Dagher; “Dorsolateral prefrontal and orbitofrontal cortex interactions during self-control of cigarette craving.” PNAS, January 2013, DOI:10.1073/pnas.1212185110

Saturday morning coffee [January 26 2013]

Amsterdam Coffee MugSo 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 comes straight from Amsterdam. I stopped there back in November 2011 on my way to Germany on a work trip. It’s a dirty city with a weird vibe to it. Everyone smokes and you better watch your butt or you’re likely to get run down by a bicycle, which appears to be a popular form of transportation. I walked through the Red Light District just to say that I’ve seen it. It was disturbing and depressing. It’s sad to see that kind of thing in my opinion.  Overall I didn’t like Amsterdam. You can have it. By the way, that’s a pretty big coffee mug. It hold a lot of coffee.
Continue reading Saturday morning coffee [January 26 2013]

Accuracy of preparation of i.v. medication syringes for anesthesiology [article]

Here’s an interesting article from the January issue of AJHP that talks about the accuracy of medication syringes used in surgical procedures. Some of the findings are a bit unnerving: “18% of preparations deviated from the declared dose by ±20%, 8% deviated by ±50%, and 4% deviated by ±100%“. Humans, we’re just not all that good at things like this.

Accuracy of preparation of i.v. medication syringes for anesthesiology
Cyril Stucki, Anna-Maria Sautter, Adriana Wolff, Sandrine Fleury-Souverain and Pascal Bonnabry


Purpose: The results of a study of the accuracy of i.v. medication preparation by anesthesiologists are presented.

Methods: The accuracy of syringe preparation was assessed by analyzing the contents of 500 unused syringes collected after adult and pediatric surgery procedures. The collected syringes contained various i.v. medication formulations representative of different preparation techniques: atracurium 1, 2.5, and 5 μg/mL and fentanyl 10, 20, 25, and 50 μg/mL, which required serial dilution after withdrawal of the drugs from ampuls; thiopental 5, 25, and 50 mg/mL, prepared by diluting reconstituted powdered drug from vials; and lidocaine 10-mg/mL solution, which was withdrawn directly from the ampul into a syringe. Variances between actual and labeled drug concentrations were determined via a validated ultraviolet–visible light spectro-photometry method.

Results: Overall, 29% of the evaluated syringes were found to contain drug concentrations outside the designated range of acceptability (±10% of the targeted concentration); 18% of preparations deviated from the declared dose by ±20%, 8% deviated by ±50%, and 4% deviated by ±100%. In one instance, the actual drug concentration was at variance with the labeled concentration by >100%. In 4% of cases ( n = 20), discrepancies exceeded 100%, suggesting not just imprecision but errors in the preparation process, such as incorrect dilution calculations and selection of the wrong medication vial by the syringe preparer.

Conclusion: Analysis of different i.v. formulations of four medications prepared in syringes by anesthesiologists revealed a high rate of discrepancies between ordered and actual drug concentrations, suggesting a need for increased institutional efforts to prevent errors during the preparation process.

Am J Health-Syst Pharm. 2013; 70:137–42


Firefighers in Australia using ingestible capsule to monitor core body temperature

Equivital LifeMonitor CapsuleEngadget: “A new swallowable pill has been trialled with 50 firefighters in Australia, aimed at monitoring body temperatures and other vital readings when working under extreme conditions. Using Equivital’s VitalSense Core Temperature capsules, they transmit readings to the companion EQ02 LifeMonitor, housed on the chest. This then sends data on skin temperature, heart rate and respiration rate to an external computer.”

The ingestible capsule works in conjunction with Hidalgo‘s Equivital belt. According to medGadget the belt is the same one “used by Felix Baumgartner in his brilliant Red Bull Stratos jump”.

I have to admit, this is both creepy and cool all at the same time. The capsule, along with all the tech wizardry is made by Equivital.

Image credit

BMTS Corp goes down for the count and takes Demolizer II with it

Way back in November 2011 I posted about a cool pharmacy technology called the Demolizer II, a sharps waste eliminator system of sorts. That’s not the interesting part though. That particular post has generated more comments than any other post I’ve ever written. As of this moment there are 32 comments attached to it, mostly bad.

Starting last month comments mentioning BMTS going out of business started to appear.

Mike – December 26, 2012 at 5:27 pm
BMTS, a public company appears to be out of business. They have not filed a report with the SEC since the third quarter of 2011.

John – January 22, 2013 at 11:35 am
The IRS has placed locks on the office doors at BMTS due to back taxes. Not sure what the future holds for these guys but its not good at this point.

Sharon Wagner – January 22, 2013 at 11:38 am
I just spoke with the owner of the company, John Bricken, who apologized profusely, told me that the company is in financial dire straits and told me to do whatever I have to do because he has no way of helping me. I point blank asked him if I purchased a very expense piece of equipment that is now useless and his respose was, “yes, I’m afraid so”. I asked if there was any possibility that we would be able to eventually get the containers and use this device again and he told me if he was a betting man, he’d say no. The long and the short of my conversation with Mr. Bricken was that we might as well throw our Demolizers away because the company is going belly up! At least someone was finally honest with me!

Kind of sad really as the Demolizer II was a pretty cool product.

Quick review of things worth reading this week

I missed my regular Saturday morning coffee post yesterday for a couple of reasons. I have a cold that has been kicking my butt all week. Not sure why this cold feels particularly weighty, but it does. Is it that I’m run down or that I’m aging? I pray that it’s the former, but fear that it is the latter. My good friends acetaminophen, antihistamine and decongestant have helped me through the week. Top that off with one of the worst travel weeks I can remember in a while and I’m ready for a day on the couch.

Yesterday was a bit of a reprieve as I found myself in Los Angeles visiting my daughter and watching the UCLA men’s basketball team lose to Oregon in an exciting game. I would have preferred that UCLA won, but at least I had some downtime with my family and the weather in Los Angeles was spectacular.

However, life goes on and there were at least a few things I read this week that are worth sharing:
Continue reading Quick review of things worth reading this week

Cool Pharmacy App – MediSafe Medication Reminder [#android]

MediSafeI came across this app the other day and thought it was pretty interesting. The app, MediSafe Medication Minder, is part of the MediSafe Project. The website isn’t very informative, but it’s worth checking out.

What’s the MediSafe app all about? Well, this pretty much sums it up: “It’s simple. When it’s time for you to take your medication, the app will remind you. You can also update your app manually. Your caretaker is notified if you don’t check in, so they can remind you only if needed.” The application also supports barcode scanning. Pretty cool stuff.

I’m not convinced that these apps work for everyone when it comes to improving medication adherence, but I think they have their place and should be an option for those that are comfortable using mobile technology.

You can grab it for free on Google Play. I think I’ll download it and give it a whirl.

Saturday morning coffee [January 12 2013]

Welcome to my first Saturday morning coffee post of 2013. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The coffee mug below was a Christmas present from my youngest daughter, Mikaela. Apparently she reads my blog; yeah, I’m as surprised by that as anyone. She thought I needed a customized coffee mug to go along with my Saturday morning coffee post. I’m thrilled to be displaying it here today for the first time. I had to move it down because it deserved an image from both sides.

Christmas SMC Mug
Continue reading Saturday morning coffee [January 12 2013]

Pharmacy tabletop unit-dose packager comparison [table]

Tabletop unit-dose packagers don’t get much respect, but have you ever been in a hospital pharmacy servicing more than 100 beds that doesn’t have one? I haven’t. Not to say that every pharmacy out there has one, but they’re certainly prevalent.

The Cadet by Euclid is pretty much synonymous for “tabletop unit-dose packager” in the pharmacy world. It’s akin to how people use the term Xerox to refer to any copy machine, or iPod for any mp3 player. So don’t be surprised if someone refers to your tabletop unit as a “Euclid” regardless of which one you have.

Anyway, I was doing a little research on the subject and thought I’d share my findings with you (table below). The one piece of data I don’t have is price; companies aren’t exactly transparent with that type of thing.
Continue reading Pharmacy tabletop unit-dose packager comparison [table]

The impact of prescription time guarantees on patient safety

I came across an interesting article at the ISMP website this morning. The article details the results of a community pharmacy survey looking at what impact policies and procedures related to guaranteed prescription fill times have on medication errors. The results are predictable and scary.

“Eighty-three percent of pharmacists working at pharmacies with advertised time guarantees reported that the time guarantee was a contributing factor to dispensing errors; almost half of them (49%) felt this contributing factor was significant. In fact, 44% of pharmacists working in pharmacies with time guarantees reported a dispensing error they were personally involved in, which was directly attributed to rushing to fulfill the time guarantee.”

That right there is reason enough to not allow time guarantees when it come to filling a scripts.

Read the rest of the article, especially the table of pharmacists’ perspective on time guarantees. It’s worth a few minutes of your time.

Afterthought: Why do pharmacists continue to work in this environment? Do they like the work most of the time, and only hate it some of the time? I used to know a few pharmacists that worked in the retail sector of pharmacy, but they’ve all moved on. A couple went to work for PBM’s and two abandoned the profession altogether: one left pharmacy to become an accountant – he’s much happier these days – and another one just quit. I don’t know what she’s up to these days, but the last time we spoke she was dabbling in interior design.