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PPAG Recognizes Local Network

Matthew Helms — Thu, 18 Feb 2010 18:00:00 GMT

PPAG is pleased to announce that the Cleveland-Akron Area Pediatric Pharmacists (CAAPP) has been officially recognized by as a Local Community and Network (LCN).

The purpose of the Cleveland Akron Area Pediatric Pharmacists (CAAPP) is to support local pediatric practitioners by providing an avenue to exchange ideas and practices and provide additional educational opportunities for Continuing Pharmacy Education. CAAPP offers networking opportunities, idea swaps, Journal Club sessions, social events, and volunteer opportunities. The geographical scope of CAAPP includes the Greater Cleveland and Akron/Canton area. JoEllen Hanigosky, PharmD, Clinical Coordinator at Akron's Childre's Hospital, is the Chair of CAAPP.

"We are excited to recognize CAAPP as an official PPAG Local Network," said Michael Christensen, PharmD, Chair of the PPAG Board of Directors. "The Local Network recognition program allows us to acknowledge what our members are doing locally and connects PPAG with those efforts."

The Local Communities and Networks of the Pediatric Pharmacy Advocacy Group help make strong peer-to-peer connections that can make a real different in your career and practice.

Through networking events, local programming, regional news and volunteer opportunities, the Local Networks build a community of peers, advance careers and offer volunteer opportunities within the pediatric pharmacy community.

For more information about the Local Communities and Network (LCN) Recognition Program, click here.

18-Feb-10 12:00 PM

Be a Member Reporter: Submit Your Stories

Matthew Helms — Thu, 18 Feb 2010 14:00:00 GMT

Become a reporter for PPAG! We need to know what you know!

PPAG encourages all members to submit news and stories for the organization's newsletter and website.

Do you have a new job? Have you recently become Board Certified? Is your hospital or institution doing something new or unique? Has a colleague received an award? Do you need to promote something interesting? Let us know! Your stories will appear in the newsletter and/or website.

To sumit your news online, click here.

18-Feb-10 8:00 AM

Member of the Month: Catherine Tom-Revzon, BS, PharmD

Matthew Helms — Mon, 08 Feb 2010 22:00:00 GMT

Catherine Tom-Revzon, BS, PharmD

Catherine Tom-Revzon, BS, PharmD is a former associate professor of pharmacy practice at the Arnold & Marie Schwartz College of Pharmacy and Health Sciences at Long Island University. Her practice site was at the Children's Hospital at Montefiore as a clinical pharmacy manager in pediatrics. She was also adjunct assistant clinical instructor at the Columbia School of Nursing.

Catherine has published manuscripts in such journals as Pediatrics, the Journal of Perinatal and Neonatal Nursing, Clinical Therapeutics, and US Pharmacist.

She advocates for awareness of pediatric pharmacy through interviews with the mass media, such as The New York Times, Parents magazine, NPR, The Today Show, and Reader's Digest.

Catherine is coordinating PPAG's KidsMeds website (www.kidsmeds.info). Catherine and other members of PPAG's Advocacy Committee publish useful medication and health information and tips for parents. Catherine has served PPAG is various capacities throughout the years. She has most recently served as VP of Advocacy.

Catherine also blogs about children's health issues and parenting at http://www.babiesrx.blogspot.com/.

Because of her dedication to PPAG and parent education, we decided to "sit down" with Catherine and ask a few questions.

PPAG: Tell us about your blog, BabiesRx.

CT-R: As a clinical pharmacist, I offered medication education to families. It was such a well-received service that requests were later incorporated into the hospital's CPOE system as a "pharmacy consult." In addition to requests for discharge counseling, there were also times when we would be asked to dispel myths about using opioids, vaccines, stimulants, inhaled steroids, etc. I became a patient advocate and I enjoyed that part of my job tremendously. So when I decided to take time off from working, I needed a medium that would allow me to continue educating the public about the role of pharmacists and keeping parents abreast of current issues related to pediatric medication. The answer was starting a blog. BabiesRx, www.babiesrx.blogspot.com, serves to blend my knowledge and experiences as a pediatric pharmacist, an educator, and a parent. I post my views about relevant topics that pertain to the care of not only babies but older children and adolescents, too. Interesting discoveries are shared with fellow health care practitioners. And I alert caregivers about recalls of medications or side effects to be aware about. I subscribe to multiple listservs generated by the CDC, NIH, FDA, AAP, and other reputable sites, including online newspapers, so I get my topics from them. I also read blogs by fellow pharmacists and other health care professionals to get information. Believe it or not, Twitter is another great source. Personal accounts are also included in my blog as they occur in my life as a mom. It is also a fun blog where I find videos to educate children about topics like the flu.

PPAG: As a mom, do you practice what you preach as a "pharmacist blogger?"
CT-R: I do 99.9% of the time. We’ve occasionally missed doses of medicine.

PPAG: Speaking of social media, what role do you see this playing in the efforts here at PPAG?

CT-R: Social media has an incredible role for PPAG and KidsMeds. Outlets like Twitter, Facebook, and weblogs can help increase our visibility as an organization and enhance our ability to communicate and interact with a broader audience in a more timely manner. With over 700 members of PPAG, many of our members have not yet been able to match faces or voices to other fellow members, let alone share ideas with one another. Establishing groups and fan pages for PPAG and KidsMeds on Facebook has allowed more of our members to interact with PPAG and with colleagues who live in different time zones on a more regular basis. Twitter is not only a great resource for information, it is also a means for PPAG and KidsMeds to build relationships with other organizations who share our passion. While the internet is still how the majority of the PPAG and KidsMeds members access our websites, many of them are using their phones to look up information on the web and disseminate breaking news to their colleagues and friends via email. It's amazing how powerful these gadgets are! In fact, one can access and post Facebook and Twitter entries using these gadgets. Blog posts to raise awareness of pertinent issues can also be made in a matter of minutes. Furthermore, our reputation as the primary source for effective drug therapy in children can be further developed with the use of social media. [Editors Note: Follow PPAG on Twitter at www.twitter.com/theREALppag and KidsMeds at www.twitter.com/KidsMeds.]

PPAG: You are clearly passionate about being a pediatric pharmacist. Why did you choose pediatric pharmacy in the first place?
CT-R: Growing up I found that I connect with children easily. Given that gift and my thirst for challenges, I decided to specialize in pediatric pharmacy. I wanted to help treat children and provide education. I also really like compounding different dosage forms.

PPAG: What do you find most unique about pediatric patients as compared to adult patients?
CT-R: If they are able to express themselves, pediatric patients are more honest about whether something works or not. If the analgesic is not working, you’ll know. Whereas, an adult may want to hide how they really feel because of cultural differences. It’s also more challenging when interacting with children. You really need to get down to their level, engage them with their favorite cartoon characters, and gain their trust before you can start teaching them about their medications.

PPAG: Describe your most significant accomplishment as a pediatric pharmacist.

CT-R: When I first started at the Children's Hospital at Montefiore as a clinical pharmacy manager, I volunteered to help organize the education table for the Pharmacy Department when the Children's Health Fair was reinstated. In addition to educational pamphlets and giveaways, I wanted to leave an impression with the families we were going to encounter. So, I took the medicine vs. Candy poster that the Poison Control Center distributes and brought it to life. I sought colorful pills and matched them to candy look-alikes. Then I glued them on a large poster board and made it into an interactive game. It was such a hit that the CEO of the hospital wanted to see it grow into something bigger. The next few weeks I was meeting with the marketing, Public relations, and health education departments of the hospital to design a more permanent display and a brochure. Although the game board did not become a permanent display in the hospital, it was featured on the John Walsh Show and has been a popular piece for various health fairs, poison prevention events, and departmental functions. It has even traveled to different elementary schools to teach children that medicine is not candy. For this creation and other outreach efforts, I won Pharmacist of the Year and Clinical Practitioner of the Year from local pharmacy organizations and began to get more media requests through the PR department. I was happy to be able to tell the public about pediatric pharmacists and what we’re capable of doing in contributing to their care.

PPAG: Your passion clearly inspired others to take action. What advice would you offer pharmacy students and residents interested in pursuing a career in pediatrics?
CT-R: Let your dream and passion to become a pediatric pharmacist be known to everyone you interview with (advisors, mentors, residency coordinators). Even as a student, your clerkships can be selected to cultivate this interest. When you're looking for a pharmacy practice residency, find out if the program offers pediatric rotations/electives and flexibility; the residency can sometimes be tailored to suit your needs. Finally, don't give up. If you don't match with your dream residency or job the first time, find out what you can do to increase your chances next time and try again. [Editors note: Check out PPAG's Residency Directory: click here.]

PPAG: Why did you join PPAG?
CT-R: I joined PPAG as a resident, though my first interaction with PPAG was as a student at the ASHP Midyear meeting. I remember sitting at the CE program that PPAG was presenting and thinking, “Wow! I want to be a part of this group! I want to make a difference with others who also like pediatric pharmacy.” As a member, I wanted to learn everything I could about pediatric pharmacy and then contribute back to the organization.

PPAG: Now, for some fun questions. If you were a drug, which one would you be and why?
CT-R: I would be a vaccine, because the pieces of knowledge that I share with colleagues, caregivers, and patients provoke a reaction and a memory so that the next time a similar situation is encountered, they will know how to deal with it. There’s sometimes a shortage of me, too.

PPAG: Name one thing your colleagues might not know about you.
CT-R: I own over 500 books (mostly novels) that I haven't read, yet.

PPAG: Thanks, Catherine, for your time. It's been an enjoyable conversation.

CT-R: Thank you. It's been a pleasure.

Editors Note: Each month, PPAG will feature a member doing outstanding things in pediatric pharmacy practice and/or in the community. To nominate someone to be featured, please contact the PPAG office.

8-Feb-10 4:00 PM

Stephen Covey to Give Keynote Address at Specialty Conference

Matthew Helms — Sat, 23 Jan 2010 02:00:00 GMT

Stephen R. Covey, author of The 7 Habits of Highly Effective People will provide the Keynote Address at the Pediatric Chronic Disease Specialty Conference on April 16, 2010 in Salt Lake City, Utah.

In 1996, Stephen R. Covey was recognized as one of Time magazine's 25 most influential Americans and one of Sales and Marketing Management's top 25 power brokers.

Dr. Covey is the author of several acclaimed books, including the international bestseller, The 7 Habits of Highly Effective People. It has sold more than 15 million copies in 38 languages throughout the world. Other bestsellers authored by Dr. Covey include First Things First, Principle-Centered Leadership, with sales exceeding one million, and The 7 Habits of Highly Effective Families.

Dr. Covey's newest book, The 8th Habit: From Effectiveness to Greatness, which was released in November 2004, has risen to the top of several bestseller lists, including New York Times, Wall Street Journal, USA Today Money, Business Week, and Amazon.com and Barnes & Noble. The 8th Habit has sold more than 360,000 copies.

In 2002, Forbes named The 7 Habits of Highly Effective People one of the top 10 most influential management books ever.
A survey by Chief Executive Magazine recognized The 7 Habits of Highly Effective People as one of the two most influential business books of the twentieth century.
The 7 Habits of Highly Effective People audiobook on tape is the best-selling nonfiction audio in history, selling more than 1.5 million copies.
Over two million copies of First Things First have been sold. Simon & Schuster expressed the opinion, "...First Things First is the best-selling time management book ever."
Dr. Covey's book The 7 Habits of Highly Effective Families was released in October 1997 and ranked fourth on the New York Times list within three months of its release date. It is the No. 1 best-selling hardcover book on family.

Dr. Covey is cofounder and vice chairman of FranklinCovey, the leading global professional services firm with offices in 123 countries. FranklinCovey shares Dr. Covey's vision, discipline and passion to inspire, lift and provide tools for change and growth of individuals and organizations throughout the world.

Dr. Covey's organizational legacy to the world is Covey Leadership Center. On May 30, 1997, a merger of Covey Leadership Center with Franklin Quest created FranklinCovey. Dr. Covey's vision of empowering organizations to implement "principle-centered" leadership in their cultures continues to be an important focus of FranklinCovey.

For more information and to register for the Pediatric Chronic Disease Specialty Conference, please click here.

22-Jan-10 8:00 PM

Committee Spotlight: The Advocacy Committee

Matthew Helms — Thu, 07 Jan 2010 15:00:00 GMT

The Advocacy Committee, co-chaired by Kristin Klein, PharmD and Tara Smith, PharmD, accomplished many things in 2009 and is looking forward to a terrific 2010!

The flagship program of the Advocacy Committee is a website for parents called KidsMeds (www.kidsmeds.info). Coordinated by Catherine Tom, PharmD, the websites provides relevant and current information related to children's health. The wesbite continues to grow and expand content. Some new topics that you'll soon see on the site include information regarding tick borne illnesses, use of epi pens, use of insect repleents in children, and information regarding black box warning on medications for children.

KidsMeds also launched a twitter account (www.twitter.com/KidsMeds). This new resource for parents allows parents and practitioners to follow the happenings on KidsMeds. It also provides information from a variety of health information sources, such as the FDA, CDC. It is multidisciplinary in nature, and brings together content from pharmacists, nurses, physicians and other health care providers. Follow KidsMeds on twitter!

The Committee plans to promote KidsMeds to other health care and parent organizations and parent publications throughout the year.

The Advocacy Committee continues to provide position statements and reviews on behalf of PPAG. This past July, the Committee released a position regarding the use of antidepressants in children. The Committee is currently working on positions regarding Heparin use in pediatric patients, as well as, medications for the obese patient.

If you are interested in joining the Advocacy Committee, please contact Kristin Klein at kriklein@umich.edu or Tara Smith at tsmith@shhpens.org.

7-Jan-10 9:00 AM

Accepting 2010 FPPAG Applications

Matthew Helms — Wed, 06 Jan 2010 20:30:00 GMT

Application Deadline: June 1, 2010

PPAG is currently accepting applications from individuals who qualify for Fellowship in the Pediatric Pharmacy Advocacy Group.

In 2008, the Board of Directors approved the Fellowship in Pediatric Pharmacy Advocacy Group Recognition Program. This program is designed to recognize excellence in pediatric pharmacy practice and to publically promote those pharmacists who have distinguished themselves.

The general criteria for FPPAG recognition is as follows:

Candidate must demonstrate sustained practice excellence and professionalism in pediatric pharmacy practice for 10 years or greater.
Candidate shall have contributed to the total body of knowledge in pediatric pharmacy practice.
Candidate must be involved in and committed to educating practitioners in pediatric pharmacy practice and/or pharmacotherapy.
Candidate must demonstrate active involvement and leadership in professional activities, especially the Pediatric Pharmacy Advocacy Group.

To learn more about the criteria for recognition and the application procedures, please go to:

http://www.ppag.org/fppag/.

The application Deadline is June 1, 2010.

6-Jan-10 2:30 PM

Call for Abstracts: Residency Project Showcase

Matthew Helms — Wed, 06 Jan 2010 19:30:00 GMT

The PPAG Board of Directors is pleased to announce an opportunity for Post-doctoral trainees (residents and fellows) to present their projects to pediatric pharmacy practitioners from across North America.

Residents will be able to present their projects at the Pediatric Chronic Diseases Conference in Salt Lake City Utah on Saturday, April 17, 2010.

Presentations will be 10 minutes long.

The format for the presentations will be similar to the format utilized at the regional residency conferences. Presentations can be on any pediatrics-based project and may be a work-in-progress report.

Abstracts must not be more than 500 words and should contain the following sections: Title, Authors, Purpose, Methods, Results (if any), Conclusions/Discussion. The PPAG Research Committee has provided a "How To" document to assist you in writing your abstract. To view the document, please click here.

The abstract submission deadline is March 10, 2010.

Abstacts must be submitted in MSWord format (.doc or .rtf). Please send your abstracts to Julie Clyce at julie.clyce@ppag.org.

The Bruce Parks Memorial Pediatric Pharmacy Residency Showcase was established in 2006. This showcase seeks to stimulate interest in the field of pediatric pharmacy by offering a highly competitive award for the best pediatric pharmacy resident presentation at the PPAG Spring Specialty Meeting each year.

6-Jan-10 1:30 PM

New Fellows Inducted at 18th Annual Meeting

Matthew Helms — Wed, 06 Jan 2010 19:00:00 GMT

The FPPAG designation recognizes individuals who have achieved excellence in pediatric pharmacy through education, research, professional activities, and leadership. The Fellows were introduced at the 18th Pediatric Pharmacy Conference and PPAG Annual Meeting in Cleveland, OH.

2009 Fellows: Helen Fiechtner, Marcia Buck, Kay Kyllonen, and James Dice

Marcia Buck, PharmD, FPPAG

Marcia L. Buck, PharmD, FCCP, is the Clinical Pharmacy Specialist for the University of Virginia Children’s Hospital and a Clinical Associate Professor in the Schools of Medicine and Nursing at the University of Virginia. She also serves as adjunct faculty for Virginia Commonwealth University.

She has excelled as a clinical pharmacist by serving as a caregiver in many different pediatric subspecialties including neonatology, critical care and general pediatrics. She currently has a focus in her practice on working with rehabilitating patients with brain injury, an area where new pediatric pharmacy expertise is needed.

Marcia has contributed greatly to the education of parents and other caregivers on pediatric medication use through her co-authorship of the Pediatric Medication Education Text. This is an important resource for medication counseling in pediatrics.

James Dice, PharmD, FPPAG

Jim is currently the Director of Pharmacy at Children’s Hospital of The King’s Daughters.

Jim is an ultimate professional. He brings professionalism, diligence, and intellect to all he does. He is a hard worker, believes strongly in advancing his field and works non-stop in promoting the interests of Pediatric Pharmacy expertise. He was unwilling to compromise the safety of medication delivery for the sake of maximizing automation through robotics. Total unit dose ready-to-use dispensing was a must.

Jim has a personal commitment to educating other pediatric healthcare providers that I believe can be matched by few others. Whether it is pharmacology or pharmacokinetics, medication safety or informatics, pharmacy administration or dispensing, Jim has used his outgoing personality and talent to educate pharmacists, nurses and physicians about pediatric medication management.

Helen Fiechtner, PharmD, FPPAG

Helen is a full professor with the College of Pharmacy at South Dakota State University and a Pediatric Clinical Pharmacist at Sanford Children’s Hospital in Sioux Falls, SD.

Helen has been involved in Pediatric Pharmacy Practice for over 30 years. Thus, she has a wealth of experience and knowledge. She has remained committed to the pediatric patient population. She demonstrates a passion for the profession.

Her pain management protocol / orders were developed at a time that many physicians under treated children’s pain and used the IM route. This dramatically changed the way pain was / is treated in pediatric patients at her hospital.

She is also willing to challenge decisions made by the hospital administration when that decision is not in the best interest of children.

She enriches our nursing practice and our pediatric patients are safer due to her presence.

Kay Kyllonen, PharmD, FPPAG

Kay has been a Pediatric/Neonatal Clinical Specialist at the Cleveland Clinic since 1995 and residency program director since 2006. Since 1998 she has also been a Course Coordinator and Instructor at the, Ohio College of Pediatric Medicine

Her references talked about the programs and policies that she has developed and implemented to ensure safe and cost-effective therapy in pediatric patients.

Kay has been instrumental in the development of neonatal protocols not only for our institution but in leading a roundtable of regional neonatal pharmacy practitioners to implement best practices.

Kay has trained countless pharmacy students, residents, new pharmacists in the proper and safe care of pediatric patients. Her dedication to the patient population and her vast knowledge in the area allows her to be a fine example to these young practitioners.

For more information about the Fellow in Pediatric Pharmacy Advocacy Group Program, please visit: www.ppag.org/fppag/.

6-Jan-10 1:00 PM

Updated 2009 Red Book/American Academy of Pediatrics Recommendations for Palivizumab Administration

Joy Vreeland, PharmD, BCPS — Tue, 05 Jan 2010 18:00:00 GMT

The American Academy of Pediatrics (AAP) has recently modified its recommendations for use of palivizumab (Synagis^TM) for prevention of RSV infection. The updated AAP recommendations are based on review of the most recent data. They seek to optimize the balance between identifying infants mostly likely to derive benefit and minimizing the cost of palivizumab therapy. The new policy statement, "Modified Recommendations for the Use of Palivizumab for the Prevention of Respiratory Syncytial Virus Infections,” replaces the 2003 policy statement and will be published in an upcoming issue of Pediatrics. The policy statement addresses the following changes:

Modified recommendations for date of initiation and duration of prophylaxis reflecting RSV seasonality by geographic region based on current CDC surveillance data.
Modified recommended number of doses needed for infants 32 to 35 weeks gestation to a maximum of 3 doses, rather than the 5 doses previously recommended.
Redefined risk factors associated with increased hospitalization to require only one of the following two to qualify for prophylaxis: 1) infant attends day care, 2) one or more siblings younger than 5 years old live permanently in the infant’s household. Previous recommendations required 2 of 5 risk factors.

Respiratory Syncytial Virus (RSV) is one of the most common diseases of
childhood. Nearly all children have been infected at least once by their second birthday, most within the first 12 months of life. Infection with RSV usually results in an acute upper airway infection, however RSV can cause severe lower respiratory tract infection with bronchiolitis and respiratory distress. Short and long-term complications of severe RSV disease include recurrent wheezing, reactive airway disease and changes in pulmonary function. Children at highest risk of developing severe RSV lower respiratory tract infections include preterm infants, infants with cyanotic or complex congenital heart disease (CHD), especially those causing pulmonary hypertension, and infants with chronic lung disease (CLD) or immunodeficiency disease.

Each year in the US, there are approximately 57,500 hospitalizations due to RSV in children under 5 years old. Most are healthy, term infants, however high-risk infants have hospitalization rates 4 to5 times greater than those of healthy infants. The monoclonal antibody palivizumab (Synagis^TM) provides passive immunization against RSV. Approved in 1998, it is currently is the only FDA-approved medication available for the prevention of serious lower respiratory RSV infection in high-risk pediatric patients. It is dosed at 15 mg/kg by IM injection once every 30 days. Palivizumab is not effective as treatment of RSV disease and is not approved for use in this indication.

Seasonality

Prevention of RSV disease in high risk patients with use of palivizumab is effective but costly. Cost-efficiency is maximized when the highest-risk infants are prophylaxed during the time when RSV circulation is highest. In North America, RSV seasons range in their start, peak activity, and duration. Based on surveillance of RSV circulation for the majority of the US, the peak activity occurs from November through March. Therefore, doses administered beginning in November and ending March should provide the highest levels of protection at the times of peak virus activity. In the north central and southwest regions of Florida, onset of RSV occurs in late September to early October. Regions of southeast Florida have an onset of RSV in July. The duration of the season remains equal in length despite the earlier onset. Children in these communities should receive palivizumab during the 5 months when they will be most likely to need coverage against peak RSV activity.

Palivizumab prophylaxis for infants and young children with chronic lung disease of prematurity or congenital heart disease varies on geographic location. (RedBook, 2009: p560). The earliest date for initiation of 5 monthly doses of palivizumab is as follows: Southeast Florida, July 1^st; North Central and Southwest Florida, September 15^th; most other areas of the United States, November 1^st.

Infants 32 to 35 weeks gestation / Risk factors

The primary benefit derived from palivizumab is the prevention of hospitalization due to severe RSV disease. Mortality benefits or reduction in recurrent wheezing in infants who have received immunoprophylaxis have not been demonstrated in prospective clinical trials. With the exceptions of CHD, prematurity (less than 32 weeks gestion), and CLD, risk factors for hospitalization from RSV have been inconsistently defined in clinical trials. Several studies have been conducted evaluating infants born from 32-35 weeks gestation which have helped identify the first 3 months of life as the period of highest risk for hospitalization from RSV. In development of their recommendation for 3 doses in this age group, the AAP statement cites these studies along with epidemiological data that point consistently to child care attendance and exposure to children younger than 5 years old as risk factors for hospitalizations from RSV.

Infants who are born 3 months before or during RSV season, at gestation of 32 weeks, 0 days through 34 weeks, 6 days, and who have 1 of the 2 risk factors should receive up to a maximum of 3 doses of palivizumab. These infants may receive less than 3 doses if they are born near the end of the season.

Maximum Number of Monthly Doses of Palivizumab for Respiratory Syncytial Virus Prophylaxis

Infants Eligible for a Maximum of 5 Doses	Infants Eligible for a Maximum of 3 Doses

Infants younger than 24 months of age with chronic lung disease and requiring medical therapy	Preterm infants with gestational age of 32 weeks, 0 days to 34 weeks, 6 days with at least 1 risk factor and born 3 months before or during RSV season.
Infants younger than 24 months of age and requiring medical therapy for congenital heart disease
Preterm infants born at 31 weeks, 6 days of gestation or less
Certain infants with neuromuscular disease or congenital abnormalities of the airways

*Data taken from Table 3.60. Red Book 2009: p.560

Hospitalized Patients

The AAP has also strengthened statements regarding hospitalized infants. Hospitalized infants who qualifiy for prophylaxis should receive their first dose within 48 to 72 hours of discharge, or promptly after discharge from the hospital. Infants who are hospitalized on the day their palivizumab dose is due should receive their dose on that day while they are in the hospital. Palivizumab is not recommended for controlling nosocomial RSV outbreaks in high-risk units.

Some recommendations remain unchanged

Recommendations have not changed for infants born at a gestational age 31 weeks, 6 days or earlier, those infants <24 months of age with CLD, or infants with hemodynamically significant CHD. Infants in these groups should receive a maximum of 5 doses of palivizumab per RSV season. Infants with congenital abnormalities of the airway or neuromuscular disease that compromises the child’s ability to handle respiratory secretions should also receive a maximum of 5 doses during their first year of life. Prophylaxis in immunocompromised children has not been studied in randomized trials. The AAP policy states that these patients may also benefit from prophylaxis, however, more specific recommendations are not made at this time.

References

Reducing RSV hospitalizations: AAP modifies recommendations for use of palivizumab in high-risk infants, young children, H. Cody Meissner, M.D., FAAP, Joseph A. Bocchini, Jr., M.D., FAAP, AAP News Vol. 30 No. 7 July 2009, p.1.

American Academy of Pediatrics. Respiratory Syncytial Virus. In: Pickering LK, ed. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:560-569. Available at: http://aapredbook.aappublications.org/cgi/content/full/2009/1/3.110. Accessed October 20, 2009.

POLICY STATEMENT: Modified Recommendations for Use of Palivizumab for Prevention of Respiratory Syncytial Virus Infections. AMERICAN ACADEMY OF PEDIATRICS Committee on Infectious Diseases. Accessed 10/19/09 at http://aapredbook.aappublications.org/news/RSVPolicy-082409.pdf

Special thanks to Betsy Walters Burkey, PharmD for sharing her slides from the Annual Meeting Hot Topics session.

5-Jan-10 12:00 PM

Influenza Update for 2010

Spencer Durham, PharmD; Sacred Heart Children's Hospital, Pensacola, FL — Tue, 05 Jan 2010 18:00:00 GMT

Influenza is a common infection of the respiratory tract that typically occurs in mid- to late winter and lasts until early spring. Infection with influenza is often self-limited. However, serious complications, such as secondary bacterial infections and even death, can occur. Infection can occur in any age group, but infants and children are particularly susceptible to influenza complications. In fact, children less than 2 years of age are at highest risk for serious illness and death from influenza infection. Annual vaccination against influenza is widely considered to be the most effective method for preventing influenza infections and thus the serious complications associated with infection. Recommendations for specific groups that should receive the influenza vaccine are published each year by the Advisory Committee on Immunization Practices (ACIP) in the Morbidity and Mortality Weekly Report (MMWR). In the United States, approximately 83% of the population has a specific indication for receiving the vaccine. However, during the 2008-2009 influenza season, less than 40% of the population actually received the vaccine. Thus, it is clear that utilization of the vaccine is far from optimal.

In past years, it was recommended that children in certain age groups and with certain medical conditions receive the influenza vaccine. For the 2009-2010 influenza season, however, the ACIP recommends that ALL children, aged 6 months – 18 years, receive the vaccine. The ACIP does note that, although all children should receive the vaccine, certain groups at high-risk for influenza complications should be targeted. These groups include the following:

Aged 6-59 months
Chronic pulmonary conditions (including asthma)
Chronic cardiovascular conditions (excluding hypertension)
Chronic renal, hepatic, and hematologic conditions
Chronic cognitive or neurologic conditions
Chronic metabolic conditions (including diabetes mellitus)
Immunodeficiency
Receiving long-term aspirin therapy and are therefore at risk of Reye syndrome

The influenza vaccine is available as both a trivalent inactivated vaccine (TIV), and a live, attenuated vaccine (LAIV). The TIV may be administered to any person ≥6 months of age, while the LAIV may be used in healthy, nonpregnant patients aged 2-49 years. For the TIV, it is recommended that patients 6 months to 8 years of age who are receiving the vaccine for the first time be administered two doses at least one month apart; it is also recommended that those who received only one dose of the vaccine during their first year of vaccination should receive two doses the following year. Contraindications to receiving the influenza vaccine include: age less than 6 months; severe allergy to chicken eggs; severe reaction to past influenza vaccines; and development of Guillain-Barré syndrome within 6 weeks of receiving the influenza vaccine previously.

The 2009 influenza season has brought about a unique situation in that a novel influenza A (H1N1) virus has caused a worldwide pandemic, beginning in April 2009 and continuing to the present day. The media has popularized this virus as the “swine flu” due to its similarities to influenza viruses identified in pigs. This strain of influenza typically presents with signs and symptoms similar to seasonal influenza, and requires a specific test to distinguish it from seasonal influenza. The current vaccines available for seasonal influenza do not provide adequate protection against this strain of H1N1. As a result, a new monovalent vaccine active against the novel H1N1 was recently released by vaccine manufacturers.

The ACIP has released guidelines on groups of individuals that should be targeted to receive the H1N1 vaccine. Of particular note is the recommendation that all children and young adults aged 6 months to 24 years receive the H1N1 vaccine. Vaccine manufacturers have created both inactivated and live, attenuated vaccines active against H1N1. These vaccines became available to the public in mid-October. Children aged 6 months to 9 years should receive two doses of the new vaccine separated by 4 weeks, while children ≥10 years of age should receive one dose. Like the seasonal LAIV, the live H1N1 vaccine may be used in healthy, nonpregnant patients aged 2-49 years. The most up-to-date information related to both seasonal influenza and the novel H1N1 influenza can be found at the Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov.

References:

Prevention and control of seasonal influenza with vaccines. MMWR 2009:58(RR08);1-52. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5808a1.htm. Accessed October 9, 2009.

Use of influenza A (H1N1) 2009 monovalent vaccine. MMWR 2009:58(RR10);1-8. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5810a1.htm. Accessed October 9, 2009.

Update on influenza A (H1N1) 2009 monovalent vaccines. MMWR 2009:58(39);1100-1101. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5839a3.htm. Accessed October 15, 2009.

5-Jan-10 12:00 PM

Erythromycin Ophthalmic Ointment Shortage

Shannon Rotolo, URMC PGY-1 Resident — Tue, 05 Jan 2010 18:00:00 GMT

Perinatal transmission of sexually transmitted diseases can lead to serious complications in the newborn patient. Neisseria gonorrhoeae and Chlamydia trachomatis are two bacterial species responsible for sexually transmitted disease, and both can pose risk to newborn infants. As they past through the birth canal perinatal transmission occurs in about 30-40% of cases of maternal cervical infection. The result is often ophthalmia neonatorum, a bacterial conjunctivitis. This condition can lead to ulceration of the cornea, scarring, and permanent blindness if left untreated. In fact, at one time it was the number one cause of blindness in the United States. Because prophylactic options have been shown to be both safe and effective in combating these bacteria, in most states it is now a law and a standard clinical practice that every newborn receive prophylactic treatment, regardless of route of delivery.

Historically, a one percent solution of silver nitrate was used to prevent ophthalmia neonatorum in newborns. Two drops would be administered in each eye, and the efficacy of this drug as prophylaxis against Neisseria gonorrhoeae was actually superior to the erythromycin we use today. However, this agent had increased risk of side effects, namely chemical conjunctivitis, and thus fell out of favor. Tetracycline in a one percent ointment has also been used with success, but like silver nitrate solution is no longer commercially available in the United States.

So with these two products off the market, and erythromycin ointment unavailable due to national manufacturer shortage, how can we provide prophylaxis to newborns? Step one, reserve current supplies for neonatal use only. When supply does fall short, one option the Centers for Disease Control (CDC) has recommended is azithromycin 1% ophthalmic solution, marketed by Inspire Pharmaceuticals under the brand name AzaSite®. Although clinical trials have not been completed to confirm the efficacy for this disease state, the CDC has made the recommendation based on current data pertaining to the pharmacology of the drug and the sensitivities of N.gonorrhoeae. One of the challenges of using this product is its formulation. As an eye drop, it is critical that the nurse administering this medication make every effort to ensure that the recommended dose of 1-2 drops reach the conjunctival sac of each eye; no easy task in a newborn. A method that may be helpful in achieving this is using a two nurse approach: one to gently hold the eye lids open, one to administer the drops.

If the manufacturer cannot meet demand for this product, third-line options include gentamicin ophthalmic ointment 0.3% (Gentak®), or tobramycin ophthalmic ointment 0.3% (Tobrex®). Unfortunately, since publication of these recommendations in September the FDA has received numerous reports of lid swelling and dermatitis, some being severe enough to cause blistering of the skin. All reported cases resolved in less than two weeks with no lasting sequelae. To reduce this reaction, it is important for the nurse administering drug to minimize product-to-skin contact.

As a final line of defense, should none of these options be available, ciprofloxacin ophthalmic ointment can be used. However, there is greater antimicrobial resistance to this medication, so it should only be used if none of the other products can be obtained.

5-Jan-10 12:00 PM

Happy Holidays from PPAG

Matthew Helms — Thu, 17 Dec 2009 20:00:00 GMT

17-Dec-09 2:00 PM

Neonatal Small Grant Recipients Announced

Matthew Helms — Tue, 01 Dec 2009 16:00:00 GMT

Emma Tillman, PharmD, Fellow in the Department of Clinical Pharmacy and The University of Tennessee Health Science Center and LeBonheur Children's Medical Center in Memphis receives a 2009 Neonatal Pharmacy Resident/Fellow Research grant for her researchg project, "Parenteral Nutrition Associated Liver Disease: Early Markers and Therapy with Enteral Omega-3 Supplementation." The grant will supplement funding from other sources and will be used to purchase supplies for the research.

Keliana O'Mara, PharmD, BCPS, Neonatal Pharmacology Fellow at Women's Hospital of Greensboro in North Carolina receives a 2009 Neonatal Pharmacy Resident/Fellow grant for her research project, "Impact of Gavsicon on Blood Aluminum Levels in Preterm Neonates Receiving Treatment for Gastroesphageal Reflux." The grant will provide funding for equipment associated with the research.

The Neonatal Pharmacy Resident/Fellow Research Grant supports research in neonatal medication use conducted by pharmacy residents (e.g., PGY-1, PGY-2 pediatric pharmacy resident) and fellows. The primary purpose of the research award is to improve safe and effective use of medications in neonates. Research projects can comprise a wide range of medication-use topics, including but not limited to: technology, safety, and/or pharmacotherapy. A secondary goal of the program is to develop and strengthen the skills of pharmacy residents and fellows by fostering development of mentoring relationships with more experienced senior investigators. For more information about the grants, please go to the following website: http://www.ppag.org/neonatalgrant/.

1-Dec-09 10:00 AM

Membership Survey Insights and Implications

Matthew Helms — Mon, 23 Nov 2009 20:00:00 GMT

Recently, the PPAG Board of Directors conducted a survey which sought input from members regarding two key topics: (1) a possible name change for the association, and (2) the structure of our live continuing education conferences. This article addresses the results of the survey and the subsequent Board response.

Name Change: No Change!

In the late 1970's PPAG was actually known as Pharmacy Directors of Pediatric Hospitals (PDPH). As the name implies, membership was made up of pharmacy directors at children's hospitals. As membership grew to include associate directors and clinical managers, the organization changed its name to the Pediatric Pharmacy Administrative Group or PPAG in 1987. By 1991, PPAG had grown to include pediatric pharmacy clinicians, specialists, academics, and so on, which prompted the Board to change the word "Administrative" to "Advocacy" in PPAG's name.

In more recent years, PPAG has grown to become the largest pediatric pharmacy association in the world. The Board of Directors received feedback from some members suggesting that it might be time for yet another name change to reflect our growth. Some members were concerned that the current name does not adequately reflect our purpose or mission. However, others felt that there was great risk to changing our name and rebranding the organization. As a result of this question and discussion, the Board of Directors felt that it must bring the question to ALL members.

Forty-one percent (41%) of our members participated in the survey. Among those participating, forty-two percent (42%) responded "no" to the question, "Should PPAG change its name?" Thirty-five percent (35%) responded "not sure." Only twenty-three percent (23%) responded "yes."

In the open comment section, one member commented: "While other associations may have 'association' in their name, I like the name PPAG because it makes us unique. Associations ARE advocacy groups!" Other members lamented that PPAG is becoming more well-known and respected, and changing the name may hurt that momentum in the long-term.

In response to these results, the Board of Directors voted to retain the current name of the association, The Pediatric Pharmacy Advocacy Group.

Conferences: Changes Ahead

The Board also received feedback and ideas regarding our live continuing education conferences. In our post-meeting evaluations, we have received feedback that suggests that PPAG should hold its Annual Meeting in the Spring and the Specialty Conference in the Fall. Others have suggested that they cannot attend more than one meeting per year, especially in the current economic climate, although they would like to do so. Again, the Board felt that it must ask the entire membership to give feedback on the issue.

As a result of the question, “Should PPAG hold one or two meetings per year?” Eighty percent (80%) responded, “PPAG should have one Annual Conference, which includes content for different sub-specialties.”

Of the eighty-percent that said they wanted PPAG to have one meeting per year, sixty-one percent (61%) said that this meeting should be held in the Spring.

In response to these survey results, the Board of Directors voted to conduct one live continuing education conference in 2011. This conference will be held in the Spring. We are currently working on a new structure, date, and location for the 2011 Annual Conference. We are committed to providing a variety of tracks which will offer opportunities for junior and senior practitioners in different sub-specialties. The best features from both meetings will be combined into one. For instance, the Residency Project Presentations will continue along with all of the PPAG awards.

If you would like to serve on the 2011 Annual Meeting Planning Committee, please contact the PPAG office for more information.

23-Nov-09 2:00 PM

Updated Pediatric Antiviral Dosing Syringe and Compounding Information for 2009 H1N1 and Seasonal Flu

Matthew Helms — Sat, 10 Oct 2009 13:00:00 GMT

The Center for Diseases Control and Prevention released updated interim recommendations.

Pharmacists and physicians who care for pediatric patients should be aware of two issues: (1) the possible need to compound Tamiflu(r) on site if commercially manufactured pediatric oral suspension formulation is not available, and (2) the need to ensure that the units of measure on the dosing dispenser and the dosing instructions match.

For full information go to: http://www.cdc.gov/h1n1flu/HAN/092509.htm

10-Oct-09 8:00 AM

PPAG is Moving!

Matthew Helms — Wed, 30 Sep 2009 02:00:00 GMT

Please pardon out dust!

We're moving the PPAG office across the street. The move will not effect our online services. However, despite our best planning efforts, we anticipate a temporary outage of phone/fax services. The best way to contact us is via email. We apologize for any inconvenience this may cause you. We will do everything to make sure that we stay connected via the website and email.

As of October 1, 2009, our new mailing address will be:

7953 Stage Hills Boulevard, Suite 101

Memphis, TN 38133

The office phone number and fax number will remain the same (once we are back up and running).

We will keep you posted on the move!

29-Sep-09 9:00 PM

Children's and Infants' Tylenol Oral Suspension Products - Recall

Wed, 30 Sep 2009 02:00:00 GMT

McNeil Consumer Healthcare and FDA notified consumers of a nationwide recall of certain Tylenol products as a precautionary measure because of potential manufacturing problems. The company initiated a recall of certain oral suspension products distributed between March 2008 and May 2008 due to the potential of bacteria in raw materials used to manufacture the finished product. There are no illnesses reported by patients using this product. The full list of recalled product lots can be accessed on the company’s website at http://www.tylenolprofessional.com/assets/TYLENOL_Letter_091809.pdf. McNeil is advising parents and caregivers who have administered affected product to their child or infant and have concerns to contact their healthcare providers. Parents and caregivers can find the lot numbers on the bottom of the box containing the product and also on the sticker that surrounds the product bottle.

Read the complete MedWatch 2009 Safety summary including a link to the FDA news release, at:

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm183924.htm

29-Sep-09 9:00 PM

Annual Meeting Handouts ONLINE!

Matthew Helms — Mon, 21 Sep 2009 22:24:46 GMT

Hello [firstname],

We look forward to seeing you on Thursday!

Easy Meeting Check-In

If you registered early you have received (or will soon receive) your name badge and Conference Agenda in the mail. Upon arrival at the Conference, all you have to do is put on your name tag and go directly to your first session! There is no need to come to the Registration Desk (unless you have a balance due on your account or purchased a Program Booklet).

“Paper-lite” Conference

The 18th Annual PPAG Meeting Program Handouts are available online for Conference registrants. Please direct your web browser to: http://www.ppag.org/18th-conference-eduhandouts/. This site provides you with the Conference Agenda, Schedule, and Program Hand-outs in PDF Format. (You must be a registered participant in the conference to view the Handout website. This is the first time we are using this level of security on our website. Please let us know if you have any problems accessing these files.)

We encourage you to bring your laptop computer to view your handouts during each lecture. "Re-charging" stations will be available through-out the lecture ballroom. We also encourage you to print any materials you may need PRIOR to coming to the Conference.

You will also receive an official PPAG Conference Jump Drive. To pick up your Jump Drive, please come by the PPAG registration desk at any time throughout the Conference.

Again, we look forward to seeing you in Cleveland! Please let us know if you have any questions. We hope you have safe travels to the conference.

Sincerely,

Matt Helms

21-Sep-09 5:24 PM

ISMP Medication Safety Alert

Fri, 14 Aug 2009 15:00:00 GMT

ISMP recently learned about the tragic deaths of two 6-year-old children stemming from severe postoperative hyponatremia. The fatal events occurred at two different hospitals. In at least one of these cases, it is clear that the rapid administration of plain D5W (dextrose 5% in water) postoperatively resulted in acute hyponatremia secondary to free water retention (also called water intoxication, which is described below). Postoperative children are at high risk for developing hyponatremia, and many fatalities from this disorder have been reported in the literature.(1-14) When the serum sodium concentration rapidly falls below 120 mEq/L over 24 to 48 hours—as in the two events described below—the body’s compensatory mechanism is often overwhelmed and severe cerebral edema ensues, resulting in brainstem herniation, mechanical compression of vital midbrain structures, and death.(15)

To see entire Action Alert, please visit the ISMP website at:

http://www.ismp.org/Newsletters/acutecare/articles/20090813.asp.

14-Aug-09 10:00 AM

2009 Board Election Results

Matthew Helms — Tue, 04 Aug 2009 17:00:00 GMT

PPAG is pleased to announce Leslie Briars, William Maish, and Heather VandenBussche have been elected to the Board of Directors. Each will serve on the Board for a three (3) year term.

Leslie A. Briars, PharmD, is an ambulatory care clinical pharmacist at the University of Illinois Medical Center (UIMCC) at Chicago Children and Adolescent Center. She also has an appointment to the College of Pharmacy as a Clinical Assistant Professor. Leslie has served in her current position since July of 1995.

She received her doctor of pharmacy degree from the University of Wisconsin in Madison in 1993 and then completed a one-year pharmacy practice residency at University Medical Center in Jacksonville, Florida in 1994. In 1995, Leslie completed a one-year pediatric pharmacy specialty residency at Children’s Hospital in Columbus, Ohio. Her areas of interest include asthma, attention deficit disorder, adolescent medicine, nephrology and HIV infection.

William (Bill) Maish, PharmD, is an Acute Pediatrics Clinical Pharmacist Specialist at the Arnold Palmer Medical Center in Orlando. He participates in residency training through the PGY2 in Pediatrics at Arnold Palmer Medical Center and the PGY1 at Orlando Healthcare. He also precepts students from the University of Florida College of Pharmacy.

Dr. Maish earned a Bachelor of Science in Pharmacy (Purdue University, 1986) and a Doctor of Pharmacy degree (Medical University of South Carolina, 1991). He completed two fellowships in Oklahoma City; Pediatric Pharmacotherapy (University of Oklahoma Medical Center, 1993) and Clinical Pharmacokinetics and Pharmacotherapeutics (the Veterans Affairs Medical Center, 1994).

Bill has been an active member of PPAG for more than 15 years and has participated on the Membership Services Committee during most of that time. After serving as Member Services Committee Chair, Bill became the Vice-President for Member Services in 2007, where he has worked on projects such as the quarterly PPAG newsletters, PPAG website upgrades, and membership surveys. He has also served as an Abstract Reviewer.

Heather L. VandenBussche, PharmD, is a Professor of Pharmacy Practice at Ferris State University College of Pharmacy in Kalamazoo, MI. She practices in general pediatrics at Bronson Methodist Hospital in Kalamazoo and in the cystic fibrosis clinic at the Kalamazoo Center for Medical Studies. Dr. VandenBussche received her PharmD at the University of Michigan in 1995. She completed an ASHP-accredited pharmacy practice residency at Children’s Hospital in Detroit, MI in 1996 and a pediatric pharmacy specialty residency at the University of Michigan in 1997. Previously, Dr. VandenBussche was a clinical pharmacist in pediatric infectious diseases and assistant clinical professor at the University of Michigan.

Dr. VandenBussche has been a member of PPAG since 1996 and has actively served on the Research Committee since 2003, which she has co-chaired since 2006. She has reviewed scientific research abstracts since 2004 and authored the Guidelines for Abstract Preparation in 2008. She has also served on the Journal Advisory Board for the Journal of Pediatric Pharmacology and Therapeutics since 2006. She has also presented at various annual meetings since 2005.

4-Aug-09 12:00 PM