One of the benefits of working at a large university is all of the different faculty you get a chance to work with. In this case, I collaborated with a group led by someone I have immense respect for – Dr. Sandra Benavides. She relayed that, “Medication safety and dosing information is often poorly delineated for paediatric patients as 75% of medications demonstrate insufficient labelling for these two purposes.”  So off-label or ‘unlicensed’ use of meds in peds is very common, with accompanying safety problems exacerbated by the more narrow therapeutic window in this population. Since use of clinical decision support tools is one strategy that has demonstrated the ability to help prevent med errors in peds  and the use of mobile devices in clinical practice has expanded substantially – we decided to systematically examine the quality of medicines information in a sample of commercially available tools. The article that came out of the study was recently published in Informatics in Primary Care.
Paediatric-specific tools evaluated included: British National Formulary for Children, Harriet Lane Handbook, and Paediatric Lexi-Drugs. Generalist tools included: A to Z Drug Facts, American Hospital Formulary Service Drug Information, Clinical Pharmacology OnHand, Epocrates Rx Pro, Lexi-Drugs, and Thomson Clinical Xpert. 108 questions (e.g., Can the sudden appearance of extrapyramidal symptoms in an 11-month-old infant be attributed to administration of metoclopramide for injection?) were distributed evenly across infant, children and adolescent subgroups. Answers for the evaluative questions were sourced from established sources and (due to the high rate of off-label prescribing for which no conventional source exists) clinical guidelines.
The verdict? “The best performer [Pediatric Lexi-Drug] provided 75.9% of the answers…Databases generally performed less effectively in providing answers sourced from clinical guidelines compared with more conservative sources such as package inserts”. Obviously the article itself goes into much more detail regarding scope and completeness of the tools and their performance based on several criteria. Hopefully the article adds some useful guidance and identifies both strengths and shortcomings with which these increasingly important tools and their nextgens can be improved upon.
1. Benjamin DK, Smith PB, Murphy MD et al. Peerreviewed publication of clinical trials completed for pediatric exclusivity. Journal of the American Medical Association 2006;296:1266–73.
2. Fortescue EB, Kaushal R, Landrigan CP et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics 2003;111:722–9.
3. Benavides S, Polen HH, Goncz CE, Clauson KA. A systematic evaluation of paediatric medicines information content in clinical decision support tools on smartphones and mobile devices. Informatics in Primary Care 2011;19(1):39-46.
The 45th Annual Meeting of the Florida Society of Health-System Pharmacists (FSHP) was held in Orlando during the weekend. Since it is a state organization conference, it is much smaller than gatherings like the ASHP Midyear Clinical Meeting. This allowed for a streamlined set of programming tracks and a more relaxed atmosphere. There were also some interesting individual sessions (and necessities) on medication errors, pain management, etc. I particularly liked the presentation on “Cyberhealth”, which focused on issues with Internet Pharmacy. Additionally, I had the opportunity to present “Pharmacy: Is there an app for you” at the meeting.
The most recent issue of the American Journal of Pharmaceutical Education featured a Technology in Pharmacy Education section. There is some really interesting reading in this section including, “Use of Twitter to Encourage Interaction in a Multi-campus Pharmacy Management Course” by @Brent_Fox. Brent actually authored several articles including, “Knowledge, Skills, and Resources for Pharmacy Informatics Education“, which he wrote along with the newly installed Chair of the ASHP Informatics Section Allen Flynn, informatics luminary and frontliner Chris Fortier (@FortiPharm), and I. With this article, we tried to summarize the baseline informatics knowledge that pharmacy students should possess upon graduation, framed within med use processes. My hope is that it will be of real practical use to educators and others as specific recommendations are provided regarding activities and resources for class and curricular integration, rather than just observations made from 30,000 feet. Also, as with all articles in AJPE, this one is open access (OA) in that it can be accessed free, full-text by anyone.
Source: Fox BI, Flynn AJ, Fortier CR, Clauson KA. Knowledge, skills, and resources for pharmacy informatics education. Am J Pharm Educ. 2011;75(5):Article 93.
We’ve seen analyses of blogs by physicians & nurses , medical bloggers , etc. However, the excellent article “Analysis of pharmacy-centric blogs: Types, discourse themes, and issues” by Jeff Cain (@jjcain00) is the first analysis of pharmacy-centric blogs. It appears in the the new issue of the Journal of the American Pharmacists Association and presents a balanced view of the pharmacy blogosphere. It found that social media promotes transparency (except for authorship). It also recognized that the degree of disinhibiton in the Web 2.0 world may have contributed to a substantial number of these blogs containing negative content about patients, pharmacy, and other healthcare professionals. Cain and Dillon categorized 136 pharmacy-related blogs into: news, personal views, student oriented, career focused, etc. Blog posts were also scored as positive (e.g. demonstrating empathy, supplying helpful drug information), negative (e.g. complaints, foul language), or neutral. Cain and Dillon asserted that despite three of the top four blog themes being negative, these blogs likely had no real impact on the public perception of pharmacy as their readership “likely does not extend beyond the personal acquaintances of the bloggers and others in the profession”. Overall, they found a variety of blog types with a preponderance of negative and derogatory posts. Some primarily positive ones were identified as well. The authors suggested the personal view blogs may be best used to educate student pharmacists and the profession about issues they will face.
 Lagu T, Kaufman EJ, Asch DA, Armstrong K. Content of weblogs written by health professionals. J Gen Intern Med 2008;23(10):1642-6.
 Kovic I, Lulic I, Brumini G. Examining the medical blogosphere: an online survey of medical bloggers. J Med Internet Res 2008;10(3):e28.
I already miss the sound of the techno music from the Walter E. Washington Convention Center at the 2010 mHealth Summit. Because I’ve seen a number of questions about what mHealth is, here is my preferred definition from lecture courtesy of @mHealthAlliance: “the use of mobile devices and global networks to deliver health services and information”. One reason I like this definition is its emphasis on the ‘network’ piece. It allows for a much broader application. I understand the desire by some for the term uHealth (u=ubiquitous) and others, like one presenter at AMIA 2-3 years ago from Rockefeller, who yearn for everything to eventually just be ‘health’. While recognizing that the types of labels like mHealth can definitely be problematic in the long-run, they also can be really useful in the short term for conveying a basic context, getting people to the table, and creating rallying points…which brings me to my next point. One of the oft-parroted comments of the Summit was that there was too much hype about mHealth. Unfortunately the word ‘hype’ was being used interchangeably with ‘excitement’ in many cases. Of course mHealth isn’t a panacea and there are serious obstacles to navigate. But let’s not lose sight of the fact that it is really hard to motivate people, to excite people, and to generate momentum…and mHealth is accomplishing those things. So please let’s not be so terrified about overpromising and under-delivering that we squash genuine enthusiasm. Of course there are speed bumps and as @joncamfield noted, there are definitely some mobile parlor tricks to be wary of out there (he also had the fantastic idea of an implementer track for next year). In the interest of being fair and balanced, here is an example of a public health/mHealth app featuring augmented reality that may mean well but has questionable execution [EDIT: yes, the video below is for an actual app].
Onto the conference proper…David Aylward, Executive Director of the mHealth Alliance, began with a pseudo-demo of wearable body area networking for basic vitals. Side note: Aylward closed the conference while wearing a Bugs Bunny tie that I speculated was an ode to Ted Turner and his Cartoon Network. This remains unconfirmed. Slightly more relevant, the conference was livestreamed and h/t to @planetrussell who noted that videos from the stream are starting to appear in various YouTube channels.
The first two WOW moments of #mhs10 for me included the announcement of the 2011 NIH Summer Institute on mHealth Research, which will provide specialized training opportunities for 25 researchers.
The second was during a panel presentation by @JoshNesbit in which he shared a word cloud of the tweets from Haiti following the earthquake. The wow moment was when he pointed out that the second most tweeted word was ‘please’. That revelation definitely gave me pause.
End ATF: Part 1
Part 2 may or may not highlight snarky entrepreneurs, bedsore-preventing robots, keynote Star Wars quotes, and actual data.
I recently gave a presentation at the Nova Southeastern University 21st Annual Contemporary Pharmacy Issues program with the above title. I uploaded the deck to Slideshare and it can be accessed by clicking the image or here.
It has been an interesting week. The week started with a short flight down to Caguas, Puerto Rico to attend the International Conference on Health Promotion. It had a pretty impressive lineup of speakers, including representatives from health promotion, public health, and policy hailing from Canada, Chile, Colombia, Ecuador, France, and Spain. I was only able to attend the first day as I traveled the next day to collaborate and consult on a grant cultivating new HIV researchers on the island. However, I was able to see several accounts of what has been done and what is being planned in the area of public health via survey results from Chile, a forward-looking global accounting from PAHO, and a fascinating history of the efforts towards health promotion in Canada.
On the food front - it struck me that this conference, like many others focused on health, offered only decidedly unhealthy options. I can’t really say that *I* would have made a great choice anyway, as later I had my traditional meal of Mofongo & Medalla.
At the conference as well as the visit the following day, there was substantial interest and openness about possibilities with mHealth and SMS patient reminders for public health initiatives as well as among HIV clinicians. Apparently, even though mobile phone penetration there isn’t quite what it is on the mainland, it is significant enough to merit attention.
Upon my return I found a message from a columnist at the Wall Street Journal who was interested in doing an interview about guarana based on an article on energy drinks I wrote a few years ago. The timing was just a little off as another article I helped write on energy drinks, including newer issues like toxic jock identity and anti-energy drinks, will be published next month in The Physician and Sportsmedicine. Anyway, at this point I have done enough interviews to have relative comfort – but it is always an adventure to see what actually shows up in print. I have found it beneficial to speak both with media savvy people in my shoes and others whose business it is like @CreativeFusion (oh Twitterverse, is there anything you can’t help with?). In this case, it was pretty brief and straightforward and I even learned about Perky Jerky.
All in all, an interesting week. I have stayed pretty close to my 2010 plan of hump day posts, but intend to take a ‘no excuses’ approach in the future by planning further ahead as necessary. I’ll close with this delicious piece of proximal irony that I saw on my way home.