Jerry Fahrni

Author: Jerry Fahrni

  • More on the meningitis outbreak caused by contaminated steroid injection

    Things just keep getting worse: death toll rose to 14 and people affected was up to 172 in 11 states as of this afternoon. It’s difficult to find accurate information on the exact cause of the meningitis, but it appears that most of the cases are related to either Aspergillus or Exserohilum.

    Fungal infections are notoriously difficult to treat, especially when they’re in the central nervous system (CNS). The CNS is designed like a fortress to keep things out, like fungus and bacteria, thus keeping you safe and healthy. Unfortunately it doesn’t discriminate and does a great job of keeping medications out as well. That’s why it’s hard to treat infections in the CNS.

    I’ve been involved with several meningitis cases over the years, but rarely those involving a fungus. The outcome generally depends on several variables including how quickly the infection is discovered, how soon treatment is started, how aggressive the treatment is – you can never be too aggressive when treating meningitis – and the general health of the person you’re treating. A little divine intervention is always desirable as well. However, as I mentioned above, meningitis is difficult to treat and the outcomes associated with fungal meningitis aren’t great.

    The CDC has released treatment recommendations. You can find them at the ASHP Pharmacy News site here.

    “The Centers for Disease Control and Prevention (CDC) recommends i.v. voriconazole and liposomal amphotericin B as initial therapy for patients who meet the current case definition for fungal meningitis.

    According to CDC, the antifungal therapy for patients with meningitis should be administered in addition to routine empirical treatment for potential bacterial pathogens.

    CDC Medical Epidemiologist Tom Chiller said during an October 10 conference call that broad-spectrum antifungal therapy is advisable because it is “unclear as to how many potential fungal pathogens could be involved” in the outbreak.

    For patients who meet CDC’s current case definition for fungal meningitis, the recommended dosage of voriconazole is 6 mg/kg administered every 12 hours. Chiller said the dosage should be maintained “for as long as the patients tolerate it.”

    Liposomal amphotericin B should be administered intravenously at a dosage of 7.5 mg/kg/day, according to CDC. The agency stated that liposomal amphotericin B is preferred over other lipid formulations of the drug.

    The optimal duration of therapy is unknown but is presumed to be lengthy.”

    Emphasis above is mine.

  • Finally! A suitable replacement for my Lenovo x201t convertible tablet PC

    Tablets, love ‘em. But I love having a keyboard, too. The hybrids that I’ve seen have me excited, but I’ve been hard pressed to find a tablet I like more than my trusty Lenovo x201t. The x201t was the first computer I ever ordered from Lenovo and I’ve been hooked since.

    Convertible tablets used to be the norm, and were made by Compaq (had one), and later HP, Motion Computing (had one), Dell (had one) and of course Lenovo (have one). But the convertible tablet has been on a slow descent to extinction for the last couple of years. The explosion of the consumer tablet market brought on by the iPad has pretty much sealed their fate. The hybrid designs are a solid option to be sure, but I’ve always liked the convertible. I still use mine all the time. I wish it was thinner, had newer guts and even better battery life, but I think most people want those things not long after getting a new machine. It’s the evolution of things.
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  • Outsourcing sterile product preparation and the importance of quality assurance

    I’m sure you’ve heard about the recent meningitis outbreak tied to a contaminated batch of preservative-free methylprednisolone acetate. The story has received significant attention as more that 100 people have been sickened and as many as eight have died as a result of receiving an injection of the contaminated steroid (this data is already out of date since I started composing this post yesterday).
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  • Impact of alcohol intake on medication adherence [abstract]

    Does alcohol consumption impact medication adherence? I don’t know, but it’s a fair question. I would assume that it all depends on when you drink, how much, how often, if there’s any correlation between drinking time and medication consumption, age and social status of the patient, and so on. The variables one would have to look at would be quite extensive in my opinion. We’re talking about human behavior here, which is notoriously difficult to quantify and control.
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  • Saturday morning coffee [October 6 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 the historic Cafe Du Monde New Orleans. I picked it up while in New Orleans for ASHP Midyear 2011. Worst ASHP Midyear I’ve ever attended, but that’s another story. You can read more about my trip here. Café Du Monde is a landmark in New Orleans and you can’t call yourself a tourist if you don’t stop in for some of their famous Beignets (French donuts).  The Beignets was good, but the coffee was better.I liked the coffee so much that I brought some home along with the mug you see to the right. While the coffee is still good when I make it here at home, it was much better sitting at Cafe Du Monde eating Beignets with my wife.

    Hotel Transylvania was #1 at the box office last weekend. I haven’t had the opportunity to see it, but it’s on the Fahrni family agenda for this weekend. My wife and I saw Looper last week. Still not sure how I feel about Looper. Typically I know whether I liked a movie or not by the time I leave the theater. Not this time. It was a good movie, but different. I’d recommend you see it given the chance, but if you miss it I won’t hold it against you.
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  • The best inking application for Windows that you’ll never see

    Recently I posted something about Project Austin, a new digital note-taking application designed specifically for Windows 8 by Microsoft.

    Project Austin had me thinking about other cool inking applications. Microsoft OneNote immediately comes to mind, but it’s really not the same. OneNote is overkill for most note taking needs. How about Windows Journal? Journal is cool, but quite limited. I think Project Austin is closer to Journal than OneNote. Nothing wrong with that, just an observation.

    The inking app that I think had the greatest potential of any was an application called InkSeine. InkSeine was developed by Microsoft’s Research Team several years ago, but never made it to the market. It was available as a “beta”, but never went beyond that. I put it on my Dell XT2 back in 2009. It was aging even then, but it was really cool. You can see remnants of InkSeine in the OneNote MX radial menu, but that’s about it.

    I went back to the InkSeine website – still there, but in serious need of attention – and downloaded the app. I tried to install it on my Lenovo x201t tablet PC running Windows 8 a couple of weeks ago. No luck. Bummer.

  • HP ElitePad 900 Windows 8 Tablet. Tah-da!

    Engadget: “…the ElitePad has a premium look, marked by a machined aluminum back cover and 400-nit IPS display coated in Gorilla Glass. Also similar to the EliteBooks, it meets the military’s MIL-spec 810G durability requirements, and can withstand three-foot drops, among other accidents. All told, it weighs 1.5 pounds and measures 9.2mm thick. Going by weight, that’s more along the lines of what you’d expect from a larger, 11-inch tablet, but 1.5 pounds is still manageable, especially considering how armored this thing is.”

    Add to that 10 hours of runtime, a 1,280 x 800 resolution screen, an SSD, and a gaggle of accessories – docking station, “smart jackets” (seriously cool), NFC enabled pen support – and you have one impressive machine. It’s good to see someone going above and beyond and thinking outside the box a little bit.

    The ElitePad 900 is scheduled to be released sometime in January of 2012. I can’t wait to see this thing in person.

  • Hospital called “hotbed for healthcare innovation” with “state-of-the-art NICU” also definition of irony

    According to good ol’ Merriam-Webster irony is defined as “the use of words to express something other than and especially the opposite of the literal meaning”. That’s the first thing that popped into my mind when I read the article referred to in the Tweet below from @ClinicalInnTech.

    The article talks about a state-of-the-art NICU at Women & Infants Hospital of Rhode Island. The article has some great information in it and paints a great picture of some of the cool things that are being done there, but the presentation embedded in the article made me laugh.

    Slide #10 shows “resident pediatrician Carly Guss, MD, [pushing] a workstation on wheels [W.O.W.] through the NICU hallway toward a patient’s room”(image below). How much paper do you think can actually fit on that W.O.W.? It’s a good thing they’re using state-of-the-art technology. I’d hate to see what it would look like if they were using antiquated technology. The full set of slides can be found on SlideShare.

  • Re-evaluating my travel gadgetry

    I enjoy my gadgets. I enjoy them a lot. I take them everywhere I go. I’m not obsessed with them, but I find that they help me pass the time when I’m by myself or during quite periods when my crew is still sleeping.

    Everyone in my family has an “electronics bag” that they carry their stuff in when we travel. During our summer vacation this year I got tickled watching everyone pack their gadget bags. I had everyone lay their stuff out on our coffee table and I snapped a quick photo. The image is below. As you can see it’s quite a bit of stuff.

    I change up my travel gear all the time. I have both a work laptop and a tablet PC. I used to travel with both machines, but it became cumbersome, especially with all the security at airports. So now I only take one machine depending on what I’m doing, i.e. when I travel for work I take my work machine and when I travel for fun I take my tablet PC.

    My other options when I travel include:

    I’ve been trying to pare it down a bit as my bag is getting heavy. I’m considering going in two completely different directions.

    Option 1: Get a Lenovo X1 Carbon to replace both my work laptop and my tablet PC, and add a Samsung Galaxy Note 10.1 to replace my need for note taking on a tablet.

    Option 2: Get a new Windows 8 hybrid tablet like the Samsung ATIV Smart PC to replace my work machine and take the place of my aging Lenovo t201x tablet PC. With this scenario I’d continue to carry my Samsung Tab 7.0 Plus.

    Option 2 is much cheaper, but Option 1 has a pretty solid coolness factor associated with it. I’ll mull this over for a while, at least until the new Windows 8 machines appear on the scene.

  • Project Austin: A new not taking app from Microsoft designed specifically for Windows 8

    Microsoft Blog (Visual C++ Team): “…For the past few months I’ve been working on a Windows 8 app along with a small team of developers from the Visual C++ team, we call it Project Code Name Austin.

    Austin is a digital note-taking app for Windows 8. You can add pages to your notebook, delete them, or move them around. You can use digital ink to write or draw things on those pages. You can add photos from your computer, from SkyDrive, or directly from your computer’s camera. You can share the notes you create to other Windows 8 apps such as e-mail or SkyDrive.”

    When I saw “Project Austin” start showing up on tech blogs over the last couple of days I have to admit I got pretty excited. I’m a tablet PC guy to the core, and one of my favorite things about tablet PCs is their inking ability, i.e. I can use them in place of pen and paper for a great many things. No other tablet OS – iOS, Android, webOS – has been able to give me the same experience; not even close.

    According to the Microsoft blog Project Austin is “a very simple digital replacement to the real paper notebooks people carry around to meetings at work, to school, around the house, where they scribble things and take quick notes.” That’s all I want. That’s what I’ve been waiting for. The blog post goes on to say “Austin doesn’t aspire to be a full-featured note-taking app such as OneNote. It doesn’t give you a way to organize your notes other than by their position in the book, it also doesn’t enable typing or searching.” Perfect.  I have nothing against OneNote. OneNote is fantastic, and I use it all the time, but it’s overkill for most things. And Microsoft Journal, while good for taking quick notes, just doesn’t always cut it.

    Two other things that really made me take notice of Project Austin were: 1) it is supposed to be deeply integrated with Microsoft SkyDrive, which is getting better and better everyday. It’s still not on par with many other cloud based storage/syncing/sharing applications out there, but it’s gaining ground; and 2) “ [Microsoft is] making the majority of the source code available for download here.  We also plan to publish a series of blog posts here in the Visual C++ Team Blog talking about our experience building it, and some of the technologies we used.” I’ve been hammering on my brother, Robert, for a few months to build me a better note-taking app for Windows 8. He and I have talked about it a couple of times and I’ve even gone as far as to start sketching out the design and requirements for “my note-taking app“. Microsoft apparently read my mind. Scary and cool all at the same time.

    What can I say, I’m excited. I’m newly energized about the potential for the host of new Windows 8 tablets hitting the market over the next year. It’s a great time to be a tablet PC guy.