Saturday morning coffee [August 23 2014]

“Talent is God-given. Be humble. Fame is man-given. Be grateful. Conceit is self-given. Be careful.” -John Wooden”

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….

First and foremost, Happy Birthday to my lovely wife Lori. She has no equal.

Teenage Mutant Ninja Turtles was #1 at the box office last weekend bringing its total box office gross to nearly $130 million in the U.S. The movie has done better than I thought it would. I haven’t seen it, and don’t plan to. Instead my wife and I spent our hard earned cash on The Expendables 3, which hasn’t fared well at all. Don’t expect it to hang around at the box office long. I thought the movie was decent, but not as good as the first or second.

“A dark roast is not necessarily “stronger,” it’s just different. It’s like comparing an IPA to a stout – the two are not compared just by their “strength,” but in terms of richness, complexity, and how they’re prepared.” (ILoveCoffee.jp) – I’m not personally a fan of dark roast coffee. I find it bitter. I prefer a smooth, “drinkable” coffee.

On rare occasion I miss working as a pharmacist in a hospital, and this week was one of those times. I found myself reading a lot more about diseases and treatments than I have in months. It was refreshing.

Interesting article in BMJ 2014;349:g4930 on clarithromycin and cardiac risk. After adjusting for certain factors like age, sex, baseline cardiac risk and use of other medication, clarithromycin was associated with a 76% higher risk of cardiac death compared with the use of penicillin V. But don’t panic, the absolute risk difference was 37 cardiac deaths per 1 million courses with clarithromycin. Still, there are lots of options out there so there’s probably no need to even use clarithromycin at this point.

Ever heard of the Zoom out – Pharmacotherapy website? Me neither. Came across it this week while rummaging around the web looking for something on diabetes. “At Zoom out – Pharmacotherapy our aim is to represent diseases in a creative way that provides meaningful learning dedicated to improve clinicians’ practice with a focus on pharmacotherapy and disease management. Our maps will help you understand diseases and pharmacotherapy, memorize and recall information easily, and improve your practice.” Pretty cool concept. The videos aren’t the highest quality, but they’re interesting nonetheless.

Nocardia is an uncommon gram-positive bacilli (bacteria). It’s a nasty bug that typically causes infection (Nocardiosis) in the lungs, skin, or sometimes the brain. It’s not typically found in patients that are immunocompetent, i.e. have healthy immune systems. You used to hear about it in patients with HIV/AIDS, but Nocardiosis can also occur in cancer patients as well as transplant patients. Treatment is tough due to limited susceptibility and length of therapy. Drugs used to treat might include trimethoprim-sulfamethoxazole (TMP-SMX), meropenem/imipenem, amikacin, with a few other possibilities. Therapy can last more than 6 months in some cases. Serious business.

Speaking of trimethoprim-sulfamethoxazole (TMP-SMX), it’s a tricky drug to use intravenously due to dilution requirements and stability. Stability can be as little as two hours after being mixed, depending on concentration. Fluid required for dilution can be quite large depending on dose, which is based on the TMP component. The TMP is diluted at a minimum of 80 mg TMP (5 mL of the commercially available solution) per 75 mL of D5W.  Doses range from 10mg-20mg/kg/day TMP in divided doses depending on the severity of the infection and the bug involved. Do the math for an average adult and you’ll see some interesting numbers.

Did you know that $100 is only worth $81.83 in the San Jose-Sunnyvale-Santa Clara area of California? It’s true according to data presented by the Tax Foundation. There’s a pretty cool interactive map at the site.

Is it just me or does it seem ridiculous that the Little League World Series is getting as much TV coverage as it does? Every time I hear about the Little League World Series I think about The Losing Edge South Park episode. I can’t help myself.

Bought myself a Pilot Metropolitan Fountain Pen with Medium Nib. Filled it with Noodler’s Forest Green Ink; a nice dark color. The Pilot is inexpensive, but it writes nice. You can’t beat it for $15. I think it writes better than my Lamy Safari, and that pen was twice the price of the Metropolitan.

Dumbest quote of the week goes to TelePharm CEO Roby Miller in a MobiHealthNews article: “Instead of just counting pills and dispensing drugs, they are repositioning themselves to become more of a provider of healthcare and I think we’re trying to help them and enable them to become healthcare professionals”. Um, pharmacists have been doing more than just counting pills and dispensing drugs for decades. I believe that goes for being healthcare professionals as well. Where has this guy been? Shameful coming from the CEO of a company touting Telepharmacy services. It’s clear this dude doesn’t have a clue about pharmacy, which bodes poorly for a company peddling pharmacy services. Maybe he’s better at running a company. Let’s hope so for TelePharm.

Here’s a cool way to spend a lazy Saturday, doing tricks with Coca-Cola. I’m a Pepsi drinker myself, but this looks like fun.

I’ve been a little slow to react, but the more and more I read about “The Internet of Things” (IoT) the more interested I become. What is IoT? That’s a valid question. I’ve read a bit about it, and I think one of the most succinct definitions I’ve seen comes from The Huffington Post. “The Internet of Things (IoT) is simply a concept wherein machines and everyday objects are connected via the Internet. Within the IoT, devices are controlled and monitored remotely and usually wirelessly.”

Here’s a great slide deck for IoT from the same Huffington Post article mentioned above:

The Washington Post: “The talk of the NFL through two weeks of preseason games … has been penalty flags, with penalties up nearly 44 percent from last year’s preseason and games taking close to five minutes longer to play. The flags have been flying at a dizzying pace on the heels of the NFL making illegal contact by pass defenders and defensive holding in the secondary major points of officiating emphasis for the upcoming 2014 season.” – This is no joke. I typically don’t watch preseason NFL games because they suck. I decided to watch some games this week as you typically see more of the starters in week 3 than you do in week 1, 2, or 4. Flags were flying everywhere. Really hurts the game.

<sarcasm> Boy, that Johnny Manziel certainly has lived up to all the hype. It’s nice to see that his immature self-centeredness was limited to his college days. Oh, don’t worry about him giving the Redskins bench the bird during their recent preseason game. The NFL fined him $12,000 and told him not to do it again. I’m sure that’s the last we’ll hear of Manziel doing something stupid. </sarcasm> 

What’s the toughest division in the NFL this year? The NFC West, no doubt about it. CBS Sports has three teams from the NFC West ranked in their top 10: Seahawks at #1, 49ers at #3, and my Cardinals at #8. How would you like to play each of these defenses twice a year? Brutal, but fun to watch.  It’s likely that the NFC representative in the Super Bowl will come from this division. How about the weakest division? It has to be the AFC South. The Colts are clearly the best team in that division, but I don’t think they’re ready to compete for a serious Super Bowl run. After the Colts all you have in that division is Houston, Tennessee, and Jacksonville. Need I say more?

Pete Rose was banned from baseball on August 24, 1989. It’s been 25 years. Here are just a few of the records that Rose set during his days in baseball: most career hits, most games played, most at bats, most singles, most total bases by a switch hitter, most seasons with 200 or more hits, only major league player in history to play 500 games at 5 different positions (1B, 2B, 3B, LF, RF), among others. I’m no fan of baseball, but it’s time to let it go and put the man in the Hall of Fame where he belongs.

Feedly made some changes to their layout recently. They moved their preview window to the right. It’s not a major overhaul, but I quite like it.

The Lancet Technology: August, 2014: Brief discussion about UK’s first surgical procedure using Google Glass. “Like many innovators Ahmed’s first attempt reveals both courage “and some naivety”, he admitted. A couple of days after broadcast, the view counter was still rocketing. “I had to pull the feed. I didn’t know who was watching it”, he said. Inviting the public inside theatre was a controversial decision, and yet the popularity of the video points to the public’s interest in engaging with medicine in this way. Perhaps there is a need for an uncensored view to demystify surgery?” – Interesting little article. You should check it out, it’s less than a five minute read.

Lab Soft News: “A recent article reported the results of a study showing wide variation in the cost of lab testing in California hospitals. Below is an excerpt from the article: Researchers studied charges for a variety of tests at 160 to 180 California hospitals in 2011 and found a huge variation in prices. The average charge for a basic metabolic panel, which measures sodium, potassium and glucose levels, among other indicators, was $214. But hospitals charged from $35 to $7,303, depending on the facility.” – I think it’s time for a little transparency in healthcare pricing.

A sick patient asked his doctor, ”Flu?” …. The doctor replied, ”No, I came on my bicycle actually!” Have a great weekend everyone.