The Best Health Blogs You Must Read in 2013

1.  Health Beat by Maggie Mahar - Maggie Mahar created HealthBeat in 2007. Earlier this year, she began posting regularly at the healthinsurance.org blog and she’ll continue to write on both websites. The author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006), Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex Gibney.

Before she began writing about health care, Mahar was a financial journalist and wrote for Barron’s, Time Inc., The New York Times and other publications. (Her first book, Bull: A History of the Boom and Bust 1982-2003(Harper Collins, 2003) was recommended by Warren Buffet in Berkshire Hathaway’s annual report. For more on her books, click here.

In an earlier career, Mahar was an English professor at Yale University where she taught 19th and 20th century literature.

2.  HealthBlawg  - David Harlow is a seasoned health care attorney and consultant recognized as an accomplished, innovative and resourceful thought leader in health care law, strategy and policy.  His experience in both the public and private sectors over the past twenty-five years affords him a unique perspective on legal, policy and business issues facing the health care community.

3.  But Doctor I Hate Pink - Breast Cancer? But Doctor, I hate pink is a brutally honest, laugh out loud funny, raw account of navigating life with metastatic breast cancer. Breast cancer is not all pink ribbons and fun runs and survivorship memorabilia, and Ann tells it like it is, what it's like to live life when you know you are going to die.

4.  The Health Care Blog - You can think of us as a little bit like the Huffington Post with a focus on medicine, science and the business of medicine.  Since passage of the Obama administration’s health reform law, we’ve paid close attention to the Affordable Care Act, tracking the implications of the landmark legislation for the industry and consumers, as well as the looming legal battle over the law’s future in Washington.

5.  Health Care Informatics - Mark Hagland's blog about informatics.

6.  Simply Healthy - Marta Montenegro has been inspiring people to live healthy lives by giving them the tools and strength to find one’s inner athlete. Inspired by her father’s last words to her, “Find your victory,” she dedicated herself to living a healthy lifestyle and sharing her personal journey with others. Her personal website MartaMontenegro.com combines health and fitness advice, first-person stories, and tips on nutrition, beauty and fashion.

7.  Runblogger - The best running blog out there (running is health right?) and you can read more about the author.

8.  Wall Street Journal Health Blog - Great resource from the WSJ.

9.  Jay Parkinson + MD + MPH - If I had gone to medical school instead of pharmacy school, THIS is the kind of doctor that I would want to be.  Love this blog.

After completing a residency in pediatrics and one in preventive medicine at Johns Hopkins, I started a practice for my neighborhood of Williamsburg, Brooklyn in September 2007. People would visit my website; see my Google calendar; choose a time and input their symptoms; my iphone would alert me; I would make a house call; they'd pay me via Paypal; and we'd follow up by email, IM, videochat, or in person.

Fast Company calls me The Doctor of the Future. I've got a startup called Sherpaa. Read more about me here.

10.  NPR's Shots - fascinating daily information about health around the world

So there is my top ten list of blogs I enjoy at the moment.  Hope you enjoy!

LeapFrog vs Consumer Reports

What hospital is the best in your area? Which hospital is the safest? Many times the public uses word-of-mouth from their friends and families to choose. A lot of times our own insurance policies determine which hospital we choose. Consumer Reports just rolled out their own version of safety rankings comparable to another version LeapFrog Group that was released last year.

In June, Leapfrog Group, a Washington D.C.-based hospital safety advocacy group, created its own safety rankings, but unlike Consumer Reports’ numerical scores, Leapfrog used A, B and C letter grades, similar to New York City’s restaurant grading system that only has three grades.

The director of the Consumer Reports Health Ratings Center, John Santa M.D., explained the report as a type of advocacy. “We’re doing this in part because 12 years ago the Institute of Medicine made the same suggestions that we’re making. This kind of information needs to be publicly reported, these problems need to be solved, but the hospitals still haven’t done it,” he said. There are differences in reporting between the two groups. “We each looked at some different measures,” said Leah Binder, CEO of the Leapfrog Group. “Particularly, they [Consumer Reports] looked at patient satisfaction measures and rates of CT scans. We didn’t look at those things. We looked at injuries, errors and accidents only. It’s kind of like having two different book reviews. Different reviewers have different interests.”

This is a good thing in that it helps educate the public about hospital safety. This is a bad thing is that the guidelines for determining safety is different from study to study. Where does your hospital rank?

Not By the Hair of My Chinny Chin Chin

Chin implants are the fastest-growing cosmetic procedure according to The America Society of Plastic Surgeons (or called the “chinplant”) in 2011. Of course, as aging happens and things begin to drop, the chin is something that helps hold the face in place. A lack of a chin can make the lower half of a person’s profile look weak and unattractive. And now that everyone’s pictures are being plastered all over the internet with Facebook, twitter, and videos like Facetime, it’s no wonder chinplants are on the rise. The humorous part of this tale to me is that I sort of smugly smile. I have a chin. In fact, I have enough chins for a couple of people. I lovingly refer to my chin as a Jay Leno chin, and on a female, it’s not necessarily something so desired.

I used to not think a thing about my chin. I obsessed over my upper lip which sort of dips down like a cupid’s bow (ever see Little Albert on Little House on the Prairie back in the 1980’s?). I remember kids (oh, aren’t they mean?) who would call me bird lip. Even the husband of a friend I haven’t seen in YEARS remarked at dinner just a couple of years ago, “You don’t even have a top lip.” Stop. Where does that even COME from considering he was carrying around an extra forty pounds, and I would NEVER dare say a word about their weight. It just didn’t seem fair.

What was even less fair was the time when I was at the local orthodontist’s office getting my braces off for the second time. I was thrilled. No more cross bite. My teeth were SO straight! The orthodontist to the local celebrities flashed his over whitened straight smile and brought with him the x-ray of my skull. Creepy. He showed it to me and then said while pointing his golden pen toward my chin, “Now if you would just have a smaller chin HERE, you would have the PERFECT profile.” No. He. Didn’t.

I couldn’t believe he said it, but it sent me into a google searching frenzy at home, “Chin reductions, chin shortening, etc….” I tried them all, but all in all, I’ve never had anything changed about my chin.

So today’s news about chinplasty being the fastest rising surgery of today really makes me smile and stick my chin out even further!

The Top 10 iPad Apps for Pharmacists

Want to know the top 10 apps I use in pharmacy practice?

1. MedCalc Pro - is a medical calculator that gives you easy access to complicated medical formulas, scores, scales and classifications.MedCalc has been available on mobile platforms for more than a decade, so it leverages years of experience in bringing medical equations to physicians in an easy to use, yet very powerful format. The Pro version offers premium features such as native iPad support, a patient database to store results and many ways to export results (email, airprint, copy to clipboard). If you're on a tight budget, you can always check out the cheaper but still amazing MedCalc.

2. Sanford Guide - The Sanford Guide is the essential resource for healthcare professionals who care for patients with infectious diseases. The Sanford Guide to Antimicrobial Therapy 2011 application provides fast, convenient access to critical information on treatment of infectious diseases, for timely, effective decisions at the point of care. Always a pocket guide, still a pocket guide. Portability has been a hallmark of The Sanford Guide for over 40 years. The Sanford Guide to Antimicrobial Therapy 2011 application extends that portability to iOS4 devices: iPhone, iPod Touch and iPad. The most trusted infectious diseases treatment resource in print now presents the same comprehensive, treatment- focused coverage of infectious diseases and clinical conditions, anti-infective drug information, therapeutic adjuncts and comparative spectra of activity in a clean, uncluttered, device-optimized interface. Based on the Sanford Guide Web Edition, the application features expanded coverage of topics compared to the print edition.

3. Medscape - The #1 free medical app in iTunes containing drug reference, daily medical news, CME/CE, drug interaction checker, disease and condition reference, procedure and protocols, and other special features. A must!

4. MedPage - MedPage Today is the only service for physicians that provides a clinical perspective on the breaking medical news that their patients are reading. Co-developed by MedPage Today and The University of Pennsylvania School of Medicine, Office of Continuing Medical Education, each article alerts clinicians to breaking medical news, with summaries and actionable information enabling them to better understand the implications.

5. WebMD - WebMD helps you with your decision-making and health improvement efforts by providing mobile access 24/7 to mobile-optimized health information and decision-support tools including WebMD’s Symptom Checker, Drugs & Treatments, First Aid Information and Local Health Listings. WebMD also gives you access to first aid information without having to be connected wirelessly – critical if you don’t have Internet access in the time of need. Personalize your app by saving drugs, conditions and articles relevant to you — through secure access and easy sign-in.

6. Epocrates - Get quick access to reliable drug, disease, and diagnostic information at the point of care. Epocrates is the #1 mobile drug reference among U.S. physicians. Trusted for accurate content and innovative offerings, 50% of U.S. physicians rely on Epocrates to help improve patient safety and increase practice efficiency.

7. Lexicomp - Committed to improving medication safety with innovative products and technology designed for healthcare professionals, Lexicomp offers a variety of drug information and medical applications for iPhone, iPad and iPod touch. These applications are tailored to meet the point-of-care needs of pharmacists, physicians, nurses, nurse practitioners and dentists by storing content directly on the mobile device. Access to Lexicomp's up-to-date drug information and clinical content is a must for the busy healthcare professional who desires the necessary tools to make important medication and clinical decisions from the palm of their hand! Download your Lexicomp mobile drug information application on the app store.

8. Redi-Reader – the reader I use to read articles, studies, etc…

9. Pharmacy Times – Keeping up with pharmacy news. I choose this app.

10. PACID - Last, but certainly not least, ID Compendium, A Persiflager's Guide by Mark Crislip, MD and programming by Walter Crittenden, PharmD (shout out to the PharmD!). This app is sweet for infectious disease!

p.s. I saved the best for last ;)

Meet Mr. MRSA

I thought I would introduce you to an infectious organism every week!  Today, the lucky "bug" as they are referred to in the medical community is methicillin resistant staphylococcus aureus (MRSA). If I was a common layperson in the field of medicine, I would view this microorganism as a very nasty flesh eating entity.  I thought I would shed some light about MRSA.  Whether you are dealing with a soft tissue infection, pneumonia, central nervous system infection, endocarditis (heart), or bone and joint, the treatment differs.

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It's tougher to treat than most strains of staphylococcus aureus -- or staph -- because it's resistant to some commonly used antibiotics.

The symptoms of MRSA depend on where you're infected. Most often, it causes mild infections on the skin, causing sores or boils. But it can also cause more serious skin infections or infect surgical wounds, the bloodstream, the lungs, or the urinary tract.

Though most MRSA infections aren't serious, some can be life-threatening. Many public health experts are alarmed by the spread of tough strains of MRSA. Because it's hard to treat, MRSA is sometimes called a "super bug."  Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It's tougher to treat than most strains of staphylococcus aureus -- or staph -- because it's resistant to some commonly used antibiotics.

The symptoms of MRSA depend on where you're infected. Most often, it causes mild infections on the skin, causing sores or boils. But it can also cause more serious skin infections or infect surgical wounds, the bloodstream, the lungs, or the urinary tract.

Though most MRSA infections aren't serious, some can be life-threatening.  Many public health experts are alarmed by the spread of tough strains of MRSA.  Because it's hard to treat, MRSA is sometimes called a "super bug." 

Also just news today... an almost instant test in detecting MRSA.

Skin and soft-tissue infections

1.  Abscess  - incision and drainage
2. Purulent cellulitis
   • Clindamycin 300-450 mg PO TID (C diff)
   • Bactrim 1-2 DS tablets BID (pregnancy category C/D)
   • Doxycycline 100 mg BID (pg category D and not recommend for children under 8)
   • Minocycline 200 mg x 1, then 100 mg PO BID
   • Linezolid 600 mg BID (expensive)
3.  Nonpurulent cellultis
   • Beta lactam (cephalexin and dicloxacillin) 500 mg QID
   • Clindamycin 300-450 mg TID
   • Beta lactam and/or Bactrim or a tetracycline – amoxicillin 500 mg TID
   • Linezolid 600 mg BID
4. Complicated SSTI
   • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours
   • Linezolid 600 mg PO/IV BID
   • Daptomycin (cubicin) 4 mg/kg/dse IV QD
   • Telavancin 10 mg/kg/dose IV QD
   • Clindamycin 600 mg PO/IV TID
5. Bacteremia
   • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours
   • Daptomycin 6 mg/kg/dose IV QD
6. Infective endocarditis, native valve – same as bacteremia
7. Infective endocarditis prosthetic valve
   • Vancomycin and gentamicin and rifampin – 15-20 mg/kg/dose IV every 8-12 hrs,                                          i.      1 mg/kg/dose IV every 8 h,  300 mg PO/IV every 8 h
8.  Persistant bacteremia
9. Pneumonia
   • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours        
   • Linezolid 600 mg PO/IV BID
   • Clindamycin 600 mg PO/IV TID
10. Osteomyelitis (Bone and Joint Infections)
    • Vancomycin 15-20 mg/kig/dose IV every 8-12 hours
    • Daptomycin 6 mg/kg/day IV QD
    • Linezolid 600 mg PO/IV BID
    • Clindamycin 600 mg PO/IV TID
    • TMP-SMX and rifampin – 3.5-4.0 mg/kg/dose PO/IV every 8-12 h
11. Septic arthritis
    • Vancomycin 15-20 mg/kg every 8-12 hours
    • Daptomycin 6 mg/kg/day IV QD
    • Linezolid 600 mg PO/IV BID
    • Clindamycin 600 mg PO/IV TID
    • Bactrim 3.5-4.0 mg/kg/dose PO/IV every 8-12 hours
12. Meningitis
    • Vancomycin 15-20 mg/kg/dose IV every 8-12 hours
    • Linezolid 600 mg PO/IV BID
    • Bactrim 5 mg/kg/dose PO/IV every 8-12 hours
13. Brain abscess, subdural empyema, spinal epidural abcess
    • Vancomycin 15-20 mg/kg/dose every 8-12 hours
    • Linezolid 600 mg po/iv BID
    • Bactrim 5 mg/kg/dose PO/IV every 8-12 hours
14. Septic thrombosis of cavernous or dural venous sinus
    • Vanc same
    • Zyvox
    • Bactrim same

Pharmacy Perfection

One of the biggest things I struggle with as a pharmacist is the idea of a profession that requires absolute perfection in everything you do; yet I am human. There is not a lot of room for error because it can detrimentally affect a patient. I remember back when I was as green as the spring grass freshly graduated from pharmacy school in 1999. I landed my first job with K-Mart, not exactly the job that I had dreamed of while I was attending pharmacy school, but they paid for my relocation from one city to another. They also did not do a lot of volume in the particular store where I was assigned. I do not remember the name of the pharmacist that worked there opposite from me initially. What I do remember about her is the words that came out of her mouth almost at her introduction, “I have never made an error while being a pharmacist.” I was too naïve at the time to realize that there was no way she was telling the truth. We are human; we will make mistakes. And at the time K-Mart did not have any mandates in place on flow or any bar-coding scanning to ensure more safety as Walgreens and CVS had. They were way behind the times as far as technological advances go.

I believe one of my first errors was dispensing Adalat CC 30 mg when the prescriptions called for 60 mg. Yes, I felt SICK. But over time I have come to realize that there are things you can do as a pharmacist to be more accurate whether it be hospital, retail, or anything in between.

According to a 2006 report by the Institute of Medicine, medication errors cause harm to roughly 1.5 million patients annually.5 Millions more are caught prior to administration, before they reach the patient. Not only do medication errors adversely impact the patient population, they are estimated to cost billions of dollars in additional treatment costs. Read more: http://www.uspharmacist.com/content/c/31431/

Here are some tips to help you become more accurate

1. Concentrate. Don’t allow distractions to stop your flow of thinking. If a technician comes up to you and needs something right away, go ahead, but realize when you start back on the order, you need to continue the exact same flow from beginning to end. Don’t try to “pick up where you left off.”

2. Do the same thing every single time. Consistency.

3. Do a second double check after you are finished checking. If that means pulling up the profile on the computer screen and holding up the order or pulling it back up electronically, just double check at the very end.

4. Any time you are going outside the usual, there is a higher incidence for errors. For example, if you have to build something from scratch in the computer on a new medication, you can be sure you are more likely to mess up on something else within the order than normal.

5. If you work retail, utilize every program they have to improve accuracy. In the hospital, just do another last review of MAR prior to moving to the next order. If in doubt; ask. It’s always better to phone the office if you work in retail or phone the nurse if you work in hospital to bounce off what you are seeing.

The most important thing is to make sure you have enough staff to safely fill medications and orders.

Management 101

Why is it more important for pharmacy schools to teach pharmacotherapy and kinetics but avoid teaching management? While it is important to understand how a reaction between Bactrim and warfarin will change previous outcome, isn't it equally important that a pharmacist manager knows how to manage? I spent hours memorizing classes of drugs but never once learned the rules of being an employee or a manager. I thought I'd go over those now... 1. A good manager communicates well. He not only communicates thoroughly and succintely in email, he will pick up the phone to schedule the more serious things. Emails and text messages should only be used for short messages. Anything serious in nature should require a phone call.

2. A good manager will not under any circumstances make promises that can't be delivered. Not only does this build distrust, it also gives an employee something to bitch about.

3. A good manager would never ask an employee to write up or monitor their peer. Again, mistrust.

4. A good manager thinks about how decisions affect their employees. If the employee is going to be deeply affected, a personal touch with explanation is probably the way to go.

5. A good manager doesn't keep the riff raff around to use for all the crap jobs.

6. A good manager isn't a manager obsessed with punitive action.

7. Remember positive feedback is more important than you think!

These are just a few of the tips I'd highly recommend a pharmacist manager begin with learning. Be fair, trustworthy, and logical. Care about your employees. Call them rather than blasting off an instant message or email. Don't accuse them for lack of communicating when all of your communications are short sentence fragments via email.

Walk the walk.... don't just talk the talk!