Letter Warns About Tricky Dosing With Liquid Tamiflu for Kids
Published: Friday, September 25, 2009 | 6:45 AM ET
Canadian Press
(HealthDay News) - Doctors warn that parents across the country could give the wrong dose of Tamiflu to their children as treatment for the H1N1 swine flu because the dosing instructions don't always coincide with the measurement markings on the syringe that comes with the liquid medication.
The warning letter, penned by scientists from Northwestern University Feinberg School of Medicine in Chicago, Emory University in Atlanta and Weill Cornell School of Medicine in New York City and published online Wednesday in the New England Journal of Medicine, also urges doctors and pharmacists to be on the lookout for this potential dosing mismatch and to help parents figure out exactly how much Tamiflu to give their child.
The authors cite a case that they say is probably happening all over the United States: The parents of a 6-year-old girl diagnosed with the H1N1 virus received a prescription for Tamiflu Oral Suspension that told them to give her three-fourths of a teaspoon of the medicine two times a day. However, the dosing syringe inside the box was marked in milligrams. The confused parents, both of whom are health professionals, had to figure out how to convert the measurement, something most parents would find too daunting to do.
"It's an egregious error that there is a conflict in the prescription labeling instructions and the dosage device that comes in the exact same box. It's incredibly confusing to parents," letter co-author Michael Wolf, an associate professor of medicine and learning sciences at Northwestern University Feinberg School of Medicine, said in a news release from the university. "Tamiflu is one of the main courses of treatment right now for H1N1, and it is being widely used among children, even infants."
The letter's authors recommend that all pharmacies and physicians be instructed to ensure that the prescription label instructions for use are in the same dosing units as those on the measurement device.
"Parents being prescribed Tamiflu for their children need to make sure they understand exactly how to take it at the time they pick it up at the pharmacy," lead letter author Dr. Ruth Parker, a professor of medicine at Emory, said in the release.
Wolf warned that an overdose could be toxic, and an underdose could be ineffective.
And even more complex calculations might be necessary now that the U.S. Food and Drug Administration has approved Tamiflu for off-label use among children under the age of 1, because the syringe doesn't include small enough measuring increments for these youngest patients.
"We need to have a better system for ensuring there are standardized directions for administering drugs to children," letter co-author Dr. Alastair Wood, a professor of medicine and pharmacology at the Weill Cornell School of Medicine in New York City, said in the news release. "We need to move to a system where all doses are given in the same units, preferably milliliters."
Meanwhile, a report released Thursday supports recent U.S. Centers for Disease Control and Prevention recommendations not to use negative rapid test results for management of patients that may be infected with the pandemic swine flu virus.
Researchers in Connecticut assessed the performance of the rapid influenza diagnostic test (RIDT) used during outbreaks of pandemic influenza A (H1N1) at two schools in Greenwich in May 2009. Of the 63 people tested at Greenwich Hospital, infection was confirmed in 49 patients.
The results of the RIDT were compared with the reverse transcription-polymerase chain reaction assay. A low sensitivity of 47 per cent was found for the rapid test. This poor performance couldn't be explained by the clinical features of the patients or by the timing of the specimen collection, said Dr. James R. Sabetta, of the Greenwich Department of Health and the Connecticut Department of Public Health, and colleagues.
While a positive rapid test for influenza is helpful, a negative test doesn't rule out pandemic swine flu, the researchers said.
The report appears in the Sept. 25 issue of the Morbidity and Mortality Weekly Report, published by the CDC.
More information
The CDC has more about http://www.cdc.gov/h1n1flu/ H1N1 flu.
SOURCES: U.S. Centers for Disease Control and Prevention, news release, Sept. 24, 2009; Northwestern University, news release, Sept. 23, 2009
Copyright 2009 ScoutNews, LLC. All rights reserved.
Friday, September 25, 2009
Wednesday, September 23, 2009
Seasonal flu shot may increase H1N1 risk: early data
Seasonal flu shot may increase H1N1 risk: early data
Last Updated: Wednesday, September 23, 2009 | 4:01 PM ET Comments0Recommend1
CBC News
Preliminary research suggests the seasonal flu shot may put people at greater risk for getting swine flu, CBC News has learned.
"This is some evidence that has been floated; it hasn't been validated yet, it's very preliminary," cautioned Dr. Don Low, microbiologist in chief at Mount Sinai Hospital in Toronto.
"This is obviously important data to help guide policy decision. How can we best protect people against influenza?"
It's important to validate the information to make sure it's not just a fluke, and that the observation is confirmed elsewhere such as in the Southern Hemisphere, which just completed its seasonal flu season, Low added.
The four Canadian studies involved about 2,000 Canadians in Ontario, Quebec, British Columbia and Alberta, sources told CBC News. Researchers found people who had received the seasonal flu vaccine in the past were more likely to get sick with the H1N1 virus.
Researchers know that theoretically when people are exposed to bacteria or a virus, it can stimulate the immune system to create antibodies that facilitate the entry of another strain of the virus. Dengue fever is one example, Low said.
No seasonal flu shot?
The latest finding raises questions about the order in which to get flu shots.
Across Canada, public health authorities are fiercely debating the idea of shortening, delaying or scrapping their seasonal flu vaccination campaign in favour of mass inoculation against H1N1.
The main reason is because the H1N1 may be dominant strain of influenza circulating when the fall flu season hits, meaning it could be a waste of time and resources to mount a seasonal flu vaccine campaign.
Health authorities in Quebec say they might scrap or delay seasonal flu shots and carry out mass vaccinations against just the H1N1 swine flu virus instead. In the meantime, the province has paused the launch of its seasonal flu shots.
"For the moment, it's on hold," Karine White, a media relations liaison with Quebec's Ministry of Health and Social Services, told The Canadian Press.
"You can imagine the people over the age 65 who are relatively protected against H1N1, it may make perfect sense for them to get the seasonal vaccine. People who are younger than that, if we don't see a lot of seasonal flu, probably the pandemic vaccine's the way to go. But we're going to make that crystal clear to people," said Dr. Michael Gardam, director of infectious diseases prevention and control at the Ontario Agency for Health Protection and Promotion.
Seasonal flu could appear after Christmas, said Dr. David Scheifele, director of the vaccine evaluation centre at B.C. Children's Hospital in Vancouver.
Last Updated: Wednesday, September 23, 2009 | 4:01 PM ET Comments0Recommend1
CBC News
Preliminary research suggests the seasonal flu shot may put people at greater risk for getting swine flu, CBC News has learned.
"This is some evidence that has been floated; it hasn't been validated yet, it's very preliminary," cautioned Dr. Don Low, microbiologist in chief at Mount Sinai Hospital in Toronto.
"This is obviously important data to help guide policy decision. How can we best protect people against influenza?"
It's important to validate the information to make sure it's not just a fluke, and that the observation is confirmed elsewhere such as in the Southern Hemisphere, which just completed its seasonal flu season, Low added.
The four Canadian studies involved about 2,000 Canadians in Ontario, Quebec, British Columbia and Alberta, sources told CBC News. Researchers found people who had received the seasonal flu vaccine in the past were more likely to get sick with the H1N1 virus.
Researchers know that theoretically when people are exposed to bacteria or a virus, it can stimulate the immune system to create antibodies that facilitate the entry of another strain of the virus. Dengue fever is one example, Low said.
No seasonal flu shot?
The latest finding raises questions about the order in which to get flu shots.
Across Canada, public health authorities are fiercely debating the idea of shortening, delaying or scrapping their seasonal flu vaccination campaign in favour of mass inoculation against H1N1.
The main reason is because the H1N1 may be dominant strain of influenza circulating when the fall flu season hits, meaning it could be a waste of time and resources to mount a seasonal flu vaccine campaign.
Health authorities in Quebec say they might scrap or delay seasonal flu shots and carry out mass vaccinations against just the H1N1 swine flu virus instead. In the meantime, the province has paused the launch of its seasonal flu shots.
"For the moment, it's on hold," Karine White, a media relations liaison with Quebec's Ministry of Health and Social Services, told The Canadian Press.
"You can imagine the people over the age 65 who are relatively protected against H1N1, it may make perfect sense for them to get the seasonal vaccine. People who are younger than that, if we don't see a lot of seasonal flu, probably the pandemic vaccine's the way to go. But we're going to make that crystal clear to people," said Dr. Michael Gardam, director of infectious diseases prevention and control at the Ontario Agency for Health Protection and Promotion.
Seasonal flu could appear after Christmas, said Dr. David Scheifele, director of the vaccine evaluation centre at B.C. Children's Hospital in Vancouver.
'39 Pounds of Love' star dies at 41
Click to Print
The Jerusalem Post Internet Edition
'39 Pounds of Love' star dies at 41
Sep. 22, 2009
Brian Blondy , THE JERUSALEM POST
Ami Ankilewitz, the subject of an award-winning documentary who braved a debilitating illness for 41 years, finally succumbed to it on Sunday.
Ankilewitz was born with Spinal Muscular Atrophy - an extremely rare and often fatal condition that limits physical growth and movement.
Despite a prediction from a doctor that he would live for only six years, Ankilewitz continued to survive and succeed. Due to his medical condition, he weighed only 39 pounds (17.7 kg.) as an adult and had use of only one finger during his life.
In 2005, Dani Menkin directed the documentary about Ankilewitz titled 39 Pounds of Love.
The documentary centers on Ankilewitz's quest across America to make peace with his brother and confront the doctor who predicted his early death. Along the way, he visits the Grand Canyon and rode a Harley-Davidson motorcycle, one of his life's dreams and passions.
The film won the Best Documentary category at the Ophir Awards given out by the Israeli Academy of Film, and at the Palm Beach International Film Festival. It was also screened in the United States to critical praise.
Ankilewitz continuously strived to live an active, normal lifestyle despite his immobility. In recent years, he drove an Alfa Spider convertible, became an outstanding handgun target shooter and even tried to join the IDF. He enjoyed going to bars and clubs, travelling and having "the time of his life" with his friends.
"I think a person like me would have much more motivation... for the simple reason that it would be much more important for me to prove that I could be as efficient as everyone else," Ankilewitz wrote on his personal Web site.
With his index finger, he was also an avid 3D animator, creating computer animation to tell his personal stories of love.
And it was love that was at the center of Ankilewitz's life.
"For me it [love] is more than just a word. It is the essence of our existence," he once said.
Throughout his life, Ankilewitz viewed his disability as an advantage.
"I'm lucky that I am what I am," he said. "I rephrase to myself as a 'what' for the simple reason that science hasn't yet found a definition for me that would be suitable in my mind. It could have been worse. I could have been 'normal.' I have the freedom to be whoever I want. I do not think people should look at me as a hero. Instead, they should think of themselves and put themselves in my position and think what other options do I have. It's either live or die, and I chose not to die."
In remembrance of his life, 39 Pounds of Love was shown in Tel Aviv on Tuesday night. His funeral was held at Kibbutz Givat Hashlosha, east of Petah Tikva, on Sunday night.
The Jerusalem Post Internet Edition
'39 Pounds of Love' star dies at 41
Sep. 22, 2009
Brian Blondy , THE JERUSALEM POST
Ami Ankilewitz, the subject of an award-winning documentary who braved a debilitating illness for 41 years, finally succumbed to it on Sunday.
Ankilewitz was born with Spinal Muscular Atrophy - an extremely rare and often fatal condition that limits physical growth and movement.
Despite a prediction from a doctor that he would live for only six years, Ankilewitz continued to survive and succeed. Due to his medical condition, he weighed only 39 pounds (17.7 kg.) as an adult and had use of only one finger during his life.
In 2005, Dani Menkin directed the documentary about Ankilewitz titled 39 Pounds of Love.
The documentary centers on Ankilewitz's quest across America to make peace with his brother and confront the doctor who predicted his early death. Along the way, he visits the Grand Canyon and rode a Harley-Davidson motorcycle, one of his life's dreams and passions.
The film won the Best Documentary category at the Ophir Awards given out by the Israeli Academy of Film, and at the Palm Beach International Film Festival. It was also screened in the United States to critical praise.
Ankilewitz continuously strived to live an active, normal lifestyle despite his immobility. In recent years, he drove an Alfa Spider convertible, became an outstanding handgun target shooter and even tried to join the IDF. He enjoyed going to bars and clubs, travelling and having "the time of his life" with his friends.
"I think a person like me would have much more motivation... for the simple reason that it would be much more important for me to prove that I could be as efficient as everyone else," Ankilewitz wrote on his personal Web site.
With his index finger, he was also an avid 3D animator, creating computer animation to tell his personal stories of love.
And it was love that was at the center of Ankilewitz's life.
"For me it [love] is more than just a word. It is the essence of our existence," he once said.
Throughout his life, Ankilewitz viewed his disability as an advantage.
"I'm lucky that I am what I am," he said. "I rephrase to myself as a 'what' for the simple reason that science hasn't yet found a definition for me that would be suitable in my mind. It could have been worse. I could have been 'normal.' I have the freedom to be whoever I want. I do not think people should look at me as a hero. Instead, they should think of themselves and put themselves in my position and think what other options do I have. It's either live or die, and I chose not to die."
In remembrance of his life, 39 Pounds of Love was shown in Tel Aviv on Tuesday night. His funeral was held at Kibbutz Givat Hashlosha, east of Petah Tikva, on Sunday night.
Sunday, September 20, 2009
Shira Goes Riding For Her First Time
Shira was turned down as a good candidate by the Cowichan and Vancouver Island Riding For The Disabled Associations. Their policies and candidate requirements are very limited here and don't serve the majority of disabled people. Upon further investigation I interviewed more people turned down by the Associations than those that get to ride. Purely psychological reasons for riding and the joy of riding are not criteria to be accepted into the program. Sometimes these programs are more of an ego boost for the people that run them than they are programs for the disabled and what it can mean for the person riding. Luckily I can ride and have researched enough so that my wife and I could take Shira riding and give her the joy and experience of riding horses. During Shira's ride she didn't stop saying, "Yeehaw, Yahoo" and when the ride was finished she exclaimed, "I Win!" You win Shira you munchkin and Sammy you are a great big brother and good rider!!
Friday, September 18, 2009
Monday, August 17, 2009
Our Beautiful Day
Lately we have all been having a really great time. Shira is changing in leaps and bounds developmentally. Our days are filled with walks, therapy, play dates, beach time, walks in the woods and up the mountain, watching videos, taking walks in the stander. Today was an especially wonderful day. Have you experienced those days when you do a wide variety of activities, unplanned and it was totally effortless? Today was one of those days a day of total synchronicity. After caring for Shira all night and getting little sleep I was surprisingly full of energy this morning. Shira was in a great mood and Sammy was full of beans not wanting to do his home work. It’s not that Sammy is behind in his studies it’s just that we want to keep his mind engaged so that when he returns to school everything will be second nature rather than relearning what he learned last year. Every day Sammy surprises us with what he figures out on his own on the computer or around the house by reading and following directions. I have to say that the only struggle of the day was getting Sammy to sit down and do his math, reading and writing exercises but he did it and the day moved on from there. Sammy attended gymnastics camp today from 1-4pm and he’ll be there all week. Shira and I hung around the house playing, practicing letters and pre reading, singing songs and playing. Maxine was out in the morning working at an assisted living home doing her music therapy with a group of seniors. So it was Sammy, Shira and I at home which can sometimes be challenging but today was a joy. We interviewed a potential employee for nights and tomorrow we will be training her and trying her out for a couple of days to see if she can care for Shira. Our help is really here to support me in shira’s care and I don’t expect any of them to perform any emergency procedures on Shira or even put her on bipap or suction her at night. I have found that while its easy to teach someone how to perform most of Shira’s care I can’t teach them what to do when Shira crashes and this is why I am always close at hand!
The afternoon was wonderful. Maxine spent a few hours with Sammy and Shira singing and playing and then Sam went over to the neighbours behind us to play with their son. I had a nap and Maxine and Shira sang and danced. Shira has really taken to her stander lately more than her power chair. Shira loves to stand up and walk around the neighbourhood in her stander. I’m used to seeing Shira in the device but I’m sure she looks like quite the site coming down the road. I had better wheels and handles put on our stander so we can get out and about in it. It is a little awkward so smooth roads work best with it. Shira loves to be spun in it! We went out for about an hour and a half walk in the stander tonight which is a feat for Shira. Us regular people take standing up for granted but SMA kids have to be braced to stand up and their bodies compress with gravity because of their lack of muscle.
We walked by one of Sam’s friends grandmother’s house from school. The grandmother always takes her grandson to school so Sammy knows her. We rang the door bell and she came out and I told her Sammy wanted to come by and say hello. She held out her arms and Sammy walked up and gave her a great big hug! Then Sammy introduces Shira saying, “this is my sister Shira.” He is so proud to have a sister! I’m so proud of my son. Sammy is such a collected centered person with so much confidence! He has such a big soul. So tomorrow Sammy is going over to her house for a play date with her grandson from 10-12 before he goes to camp.
We then walked over to the park and played there for about 20 minutes because it was getting late. On the way back home from the park Sammy starting begging to be carried on my shoulders but I can’t carry him that way when pushing Shira in her stander because it’s a two handed job. You would think the poor guy was severely injured the way he was walking and begging to be carried and a woman I didn’t know was walking up behind him going I don’t know you and I’m going to chase you which got him moving. She was saying watch out for the crazy lady in the big floppy hat. She seemed decent enough and Sam caught up to me quickly!
About a block from our house a neighbour we met while picking blackberries the other day runs over to us and hands us a plate of home made blackberry tarts which were fantastic! It was late when we got home and I removed Shira from her stander we went into the living room to watch Maxine and Sammy dance free form to some beautiful Israeli singer. Sammy can really move and Maxine and Sammy were taking turns mirroring each other. Maxine has had a lot of training in Dance and it was really beautiful and moving watching her and Sammy dance together. Sammy takes it very seriously and has no inhibitions what so ever. Sam is really into Michael Jackson and the Lion King which he just saw on Broadway in NY a couple of weeks ago. The boy is seriously artistic! After the show we performed Shira’s chest physio, Maxine gave Shira a bath, then bipap and bed and that was our day.
Thursday, August 13, 2009
Ventilation After Breathing Tube Removal May Alter Outcomes
Ventilation After Breathing Tube Removal May Alter Outcomes
Published: Thursday, August 13, 2009 | 7:15 AM ET
Canadian Press
(HealthDay News) - People with chronic respiratory disorders who receive early non-invasive ventilation after a breathing tube has been removed are less likely to suffer respiratory failure or die, a Spanish study has found.
The study included 106 people on mechanical ventilation. All of them had high levels of carbon dioxide in their blood, a condition known as hypercapnia. After their internal breathing tubes were removed, in a procedure called extubation, 54 people received non-invasive ventilation for 24 hours and 52 were given conventional oxygen treatment, the according to the study.
Respiratory failure after extubation occurred in 15 per cent of those who received non-invasive ventilation and in 48 per cent of people given conventional oxygen therapy. Non-invasive ventilation was associated with an 83 per cent decreased risk for respiratory failure after extubation, the researchers found.
They also found that the death rate after 90 days was much lower among people in the non-invasive ventilation group (11 per cent) than among those who received conventional oxygen therapy (31 per cent).
"Early non-invasive ventilation after extubation diminished risk of respiratory failure and lowered 90-day mortality in patients with hypercapnia during a spontaneous breathing trial," concluded Dr. Miquel Ferrer, of the Hospital Clinic of Barcelona, and his research colleagues. "Routine implementation of this strategy for management of mechanically ventilated patients with chronic respiratory disorders is advisable."
The study appears online this week and in an upcoming print issue of The Lancet.
More information
The U.S. National Women's Health Information Center has more about http://womenshealth.gov/faq/lung-disease.cfm lung disease.
SOURCES: Kathryn Schmitz, Ph.D., M.P.H., associate professor, epidemiology, University of Pennsylvania, Philadelphia; Wendy Demark-Wahnefried, Ph.D., R.D., professor, department of behavioral science, University of Texas MD Anderson Cancer Center, Houston; Aug. 13, 2009, New England Journal of Medicine
Published: Thursday, August 13, 2009 | 7:15 AM ET
Canadian Press
(HealthDay News) - People with chronic respiratory disorders who receive early non-invasive ventilation after a breathing tube has been removed are less likely to suffer respiratory failure or die, a Spanish study has found.
The study included 106 people on mechanical ventilation. All of them had high levels of carbon dioxide in their blood, a condition known as hypercapnia. After their internal breathing tubes were removed, in a procedure called extubation, 54 people received non-invasive ventilation for 24 hours and 52 were given conventional oxygen treatment, the according to the study.
Respiratory failure after extubation occurred in 15 per cent of those who received non-invasive ventilation and in 48 per cent of people given conventional oxygen therapy. Non-invasive ventilation was associated with an 83 per cent decreased risk for respiratory failure after extubation, the researchers found.
They also found that the death rate after 90 days was much lower among people in the non-invasive ventilation group (11 per cent) than among those who received conventional oxygen therapy (31 per cent).
"Early non-invasive ventilation after extubation diminished risk of respiratory failure and lowered 90-day mortality in patients with hypercapnia during a spontaneous breathing trial," concluded Dr. Miquel Ferrer, of the Hospital Clinic of Barcelona, and his research colleagues. "Routine implementation of this strategy for management of mechanically ventilated patients with chronic respiratory disorders is advisable."
The study appears online this week and in an upcoming print issue of The Lancet.
More information
The U.S. National Women's Health Information Center has more about http://womenshealth.gov/faq/lung-disease.cfm lung disease.
SOURCES: Kathryn Schmitz, Ph.D., M.P.H., associate professor, epidemiology, University of Pennsylvania, Philadelphia; Wendy Demark-Wahnefried, Ph.D., R.D., professor, department of behavioral science, University of Texas MD Anderson Cancer Center, Houston; Aug. 13, 2009, New England Journal of Medicine
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