Saturday morning coffee [June 15 2013]: The Purge, Nanopatch, NSA, Adherence, Smartphones, CPOE

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 below is from the Netherlands. Just in case you’ve forgotten, I stopped in Amsterdam back in November 2011 on my way to Germany for work. Amsterdam is the largest city in the Netherlands and serves as the regions capital. It’s also a dirty city with a weird vibe to it. Didn’t care for it. I would return to Germany in a heartbeat, but wouldn’t choose to spend any personal time in Amsterdam. I can’t really say much about the rest of the Netherlands.

What’s the best way to brew a great cup of coffee from home? Well, according to The Wall Street Journal it might just be a “pour-over”. “With a pour-over, the grounds are doused in stages, rather than left to soak as in a French press. That’s partially why a pour-over is lighter: The extraction is gentler. Plus, the paper filter captures particles and oil.” I’m up for giving it a try, but I drink a lot of coffee and doing this 10 times a day would get old. Check the article for detailed instructions.

The Purge was #1 at the box office last weekend pulling in just over $34 million. That’s a respectable number considering the movie had a budget of only $3 million; in comparison Star Trek Into Darkness had a budget of $190 million. Don’t expect The Purge to keep the #1 spot for very long because Man of Steel will likely pull down $100 million plus in its debut weekend. The only question is whether or not it can take the opening weekend record for June away from Toy Story 3 ($110 million). My daughter saw Man of Steel Thursday afternoon; special sneak peak tickets from a friend. Based on her review the rest of the Fahrni crew went to see it yesterday evening.  Good movie, highly recommended. The first 20 minutes pulls you in and the rest of the movie keeps you there.

The top post at jerryfahrni.com over the past 7 days was Why pharmacy continues to fail, again. It’s amazing to me that of all the things I throw up on my blog, this is what gets the most attention. I think that speaks volumes about the status of the profession. I received an email from a pharmacy student this week contemplating what to do as this particular person thinks the profession is in deep trouble based on what’s she’s seen and heard.

TED Blog: “The Nanopatch, a tiny square (smaller than a postage stamp) that can deliver a dose of vaccine. But beyond solving needle-phobia, the Nanopatch could solve many other problems that now keep vaccines from being completely effective. The Nanopatch is designed with thousands of tiny projections dry-coated with vaccine. When the Nanopatch is stuck on the skin, the vaccine is delivered to the right cells, just under the outer layer of skin. Kendall’s research in animals shows that a 450 ng dose of an influenza vaccine was far more effective delivered through the patch than 600 ng of the same vaccine delivered via a needle.” - Needles, I hate needles. This will be a welcome addition.

I’ve been reading quite a bit about medication adherence lately, specifically how technology can help. There’s plenty of data out there to suggest that various types of technology – from text reminders to fully automated med boxes – can have a positive impact on adherence. However, I came across an article in Frontiers in Pharmacology (Front. Pharmacol. 4:69. doi: 10.3389/fphar.2013.00069) that indicates that electronic reminder devices (ERDs) may not work in elderly patients taking lipid-lowering agents. The article reports on a multicenter, community pharmacy-based, randomized controlled trial that was conducted in 24 pharmacies in the Netherlands among patients aged 65 years or older. They measured refill adherence rates using ERDs. The data found that there was no statistically significant improvement in refill adherence. However, women using statins for secondary prevention had improved adherence when using an ERD.

Text Message Smoking Cessation Program Sees Success Among Teens: “The National Cancer Institute’s smartphone-based smoking cessation program, called SmokefreeTXT, has had a higher success rate among teenagers than traditional anti-smoking methods. The application checks in daily with users on their smoking cessation efforts and personalizes text messages based on participants’ responses.” – I’m amazed that anyone would ever pick up a cigarette these days, much less a teenager.

“The world’s foremost thinkers, creators and innovators convene at the OME Summit at UC San Francisco to make precision medicine a reality. Hailing from diverse backgrounds — from government leaders to physicians and tech entrepreneurs — they come together to identify and take action on new approaches and projects that could harness the wealth of information from genetics and health records to transform medicine worldwide.” To join the movement: www.MeForYou.org. More information on the campaign from UCSF can be found here.

I’ve been trying to distance myself from Microsoft Office this week. I just feel like I’d like to use something else. I’ve experimented with Kingsoft Office and Libre Office, and I’m sad to report that the experiment hasn’t gone well. I have been using Microsoft’s Office Suite for a long, long time and have become quite accustomed to the functionality, but more importantly I’ve gotten used to the look and feel. It’s frustrating when I go to make a small formatting change and can’t find the place to do it.

Retail pharmacies are beginning to see the benefits of mobile technology and many are developing applications to help users keep up with their medications. Mobile Health News has a nice summary of what’s available from several of the retail chains. The most progressive of the retail pharmacy chains appears to be Walgreens. “This February, Walgreens introduced an API that allows mobile developers to integrate Walgreens’ prescription refill technology with a different app. While a regular customer at Walgreens might already be content with the store’s mobile app offerings, someone else might prefer the refill technology added to an app he or she is already using.” Having an API is all too rare these days and I applaud Walgreens for being bold enough to offer one.

This is great: Best 5 Android Launchers/ Themes 2013. I currently use Nova Launcher Prime; great launcher. Everything.me Home is also really cool. Different, but cool.

Still using Feedly as my RSS reader of choice. I’m finally starting to feel comfortable with it, and have started making good use of “save for later” and tags. I find that using keyboard shortcuts are more efficient than using a mouse. Interesting side note: my reliance on keyboard shortcuts has generated a bit of a usability problem on my Windows 8 slate tablet, i.e. no physical keyboard. Here are some of the keyboard shortcuts that I use most often:

G A                         Show All
Shift + J                Navigate Next Feed or Category
J                              Inline Next Article
K                             Inline Previous Article
M                            Toggle Mark as Read
S                              Save for Later
Shift + V               Preview

One of the things I really like about Samsung is the variety of products they offer. “An infographic shows the staggering variety of devices that Samsung has brought to market in the UK over the past year.” Part of the infographic is shown below. Taken from British gadget technology site Which?.

Ever heard of the Gallon milk challenge? I came across this concept earlier week while watching cartoons with my daughter. “The rules are simple. The challenger has to drink a gallon of milk (2% or more and no chocolate) in an hour, and then hold it down for another hour. The beauty of it is that it can’t be done, and your friend always ends up yacking all over himself.” It’s unclear to me why the challenge is so difficult, but the most plausible explanation I’ve read has to do with the limited size of your stomach. I believe there is more to it than that. I’ve seen guys drink a gallon of water in about the same amount of time without blowing chunks. I think it’s likely to do with the amount of casein and fat in the milk, and the effect it has on gastric emptying, etc. Anyway, if you feel the need for a little entertainment have a gallon-milk-challenge party and let the fun begin.

Speaking of cartoons, what’s your favorite? I still watch the original Scooby-Doo when I come across them on TV. The ones that ran from 1969 to 1973, before they jacked it up. I wonder what they’d look like if someone redid them with CGI? They could even use the same soundtracks. That’s something I’d like to see.

I am an AC/DC fan. Love their music, as do people all over the world. The epic nature of their popularity can be seen is this video below – Thunderstruc (Live At Donington). The size of the crowd is staggering. I’ve always wanted to see them live, but fear that my window for that has closed.

Computerized Physician Order Entry (CPOE) has been around for a while. According to the most recent ASHP survey (AJHP May 1, 2013 vol. 70 no. 9) “54.4% of hospitals have CPOE systems that include clinical decision support (CDS). During the past nine years, the percentage of hospitals with CPOE systems has slowly increased (just 2.7% of hospitals had such systems in 2003).” Expect the numbers to continue upward as Meaningful Use will continue to drive adoption. I think CPOE is a good thing, but I’m not convinced that it’s the panacea that everyone thinks it is. If you’re interested in getting a quick and dirty summary of the current state of CPOE I’d recommend reading the AHRQ Patient Safety Primer on CPOE.

For those that just like to read about technology I recommend stopping by the Future Tech Report site. You’ll keep yourself busy for hours.

I thought this was brilliant: Dear NSA, let me take care of your slides:

There’s an interesting article in the April edition of Pharmacy Purchasing & Products that talks about the use of barcodes to help with anticoagulation education. Anticoagulation is a hot topic because of TJC’s NPSG 03.05.01; regulatory B.S. “The development and implementation of patient education cards was the crux of our program’s success. Pharmacy produces the cards, which are stored in the medication carousels in the pharmacy and then stocked in the ADCs on nursing units. The cards are bar coded by pharmacy and entered into the PIS as medications. The cards are stocked in separate bins from the corresponding drug and appear on the ADC profile as an active medication; they also appear as a due medication in BCMA. When the nurse enters the patient’s information, the ADC displays the profile and the nurse obtains both the medication and the card. The nurse must remove and scan both at the patient’s bedside; otherwise, the administration will not appear in the bar code administration system as administered. The benefit of this system is that medication and education are delivered simultaneously, and documentation is automatically generated.” Creative use of barcode technology to help keep track of anticoagulation education.

Ever heard of “pullquote”? It’s a pretty cool extension/app. “Use Pullquote to create a link to a paragraph or sentence on a web page. Share the link with just one click, then watch clickthrus rise in your browser’s toolbar. Pullquote is great for tweeting, micro-bookmarking and sharing key ideas.” I’ve been playing with it off and on. Haven’t found where it fits in the whole scheme of things, but it’s pretty slick.

I’ve been looking for a new smartphone. My Samsung Galaxy Nexus is great, but there are just too many awesome phones out there for me to just sit idly by. For the first time in a while I have a lot of great choices: Android, Windows 8 and BlackBerry. I’ve narrowed it down to the Nokia 928, the HTC One and the BlackBerry Q10. I’ve been petting the BB Q10 off and on for a couple of weeks. Love the concept and the physical keyboard, but I’m not sure about the future of BB. The Nokia phones are appealing to me because I like the interoperability with my other Windows machines, not to mention the 928 has a spectacular camera. The HTC One sucked me in. I was looking at the BB Q10 earlier this week and made the mistake of picking up the HTC One. All I can say is that I believe this is the new flagship device for the Android platform.

Geek humor: When life gives you C₆H₈O₇ make H₂O + C₁₂H₂₂O₁₁ + C₆H₈O₇

Only 82 days until the NFL season kicks off. It can’t happen soon enough. I was flipping channels the other night and I think I saw a basketball game on. Can’t be sure as I didn’t stop, but I think it was basketball. I think there’s some baseball on as well. It’s possible that people might be interested in that. Can’t imagine that that’s true, but the world is full of weirdos. No football though.

That’s it folks. Happy Father’s Day everyone.