Heart Screens for Kids Not Ready for Prime Time

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By Amy Norton

NEW YORK (Reuters Health) Mar 12 - Routine electrocardiography in children could detect some cases of potentially fatal heart problems, but with many false-positives along the way, a new meta-analysis study suggests.

Children and teenagers are at very low risk of potentially fatal heart disorders. But whenever a young person dies suddenly of cardiac arrest, it's a shock -- and often widely publicized, especially deaths among young athletes.

"There's been this debate about whether ECG screening would be practical and effective in preventing these tragic deaths," said Dr. Laurel Leslie of Tufts Medical Center in Boston, the senior researcher on the new study.

Some countries, including Italy and Israel, already have mandatory EKG screening for young athletes. The U.S. is not one of them

There have also been questions about whether EKG screening could be a good idea in kids being prescribed stimulants for attention-deficit hyperactivity disorder -- though that is not currently recommended.

One of the prime arguments against such screening is that heart disorders that are detectable by EKG are so rare in kids that the risk of false-positives outweighs the potential benefits.

For the new study, published March 5th in Pediatrics, Dr. Leslie and her colleagues analyzed the potential effectiveness of routinely screening symptom-free kids for three heart disorders: hypertrophic cardiomyopathy, long QT syndrome and Wolff-Parkinson-White syndrome.

The three conditions, while rare, are the most common EKG-detectable causes of sudden cardiac death in kids, said Dr. Angie Mae Rodday of Tufts, who also worked on the study.

Using data from 30 studies on the heart conditions, the researchers found that EKG screening would have a very low risk of false negatives. But it would carry a high risk of false positives. Even under the best scenario the researchers considered, 59% of kids with a positive EKG screen would, in fact, not have any of the three heart conditions.

"That's related to the fact that these are rare disorders," Dr. Rodday said.

Based on the studies the researchers reviewed, the three heart conditions together occur at a rate of 188 cases for every 100,000 kids.

Sudden death from heart problems is rarer still. In the U.S., estimates range from less than one to about six such deaths for every 100,000 children and teens.

This study is just one step in considering whether routine EKG screening is worthwhile, Dr. Rodday said.

There's also logistics -- like who would do all of that screening? Some pediatricians have EKG devices in their offices. "But some of these disorders are pretty hard to interpret," Dr. Leslie noted.

That means it may take a pediatric cardiologist to interpret the results. And there are only about 1,500 pediatric cardiologists nationwide.

And then there's cost, Dr. Leslie said. "People point out that EKGs are inexpensive," she said, noting that the actual test runs about $10 to $25. But that's a lot when multiplied by millions of kids, and there's also the cost of interpreting those tests -- and then any follow-up that may be needed
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Sudden Cardiac Arrest: Identifying Kids at Risk

An Article from Medscape.com

Victoria L. Vetter, MD, MPH

Posted: 04/09/2012

I am Dr. Victoria Vetter, a pediatric cardiologist at the Children's Hospital in Philadelphia. I'm speaking to you today about a policy statement just published by the American Academy of Pediatrics on pediatric sudden cardiac arrest. This paper identifies the conditions that are associated with sudden cardiac arrest in children. This can include structural functional abnormalities, such as hypertrophic cardiomyopathy and dilated cardiomyopathy; coronary anomalies; electrical conditions, such as long QT syndrome; and acquired conditions, such as commotio cordis, when there is a blow to the chest.

The paper outlines the warning signs and symptoms associated with sudden cardiac arrest. This would include fainting or syncope with exercise, chest pain with exercise, shortness of breath not associated with asthma in response to exercise, a family history of sudden cardiac arrest in someone younger than 50 years of age, or having a member who might be affected with one of the conditions that can cause sudden cardiac arrest.

Unfortunately, many individuals do not know their family history, but this is very important. Pediatric providers should make every attempt to investigate this in all children they are seeing, particularly those who are active, as sudden cardiac arrest is most likely to occur during activity. Of course, this includes most of our children. Providers also should be asking questions that specifically relate to the symptoms that were previously mentioned. Since this is a genetic condition, a molecular or genetic evaluation of affected family members or children who experience sudden cardiac arrest can often identify the cause of the arrest and identify additional individuals.

While we do not have a registry that counts the number of children who experience a sudden cardiac arrest, we are hopeful that the information in this policy statement will encourage people to consider that option, and thus identify the children who are experiencing these conditions. Further, if a school has an automated external defibrillator (AED) and an emergency plan to activate when such an event occurs, the child is much more likely to survive. Currently, the survival rate is 10%. It can be as high as 64% in schools where an emergency response plan is in effect.

Also, we would hope that individuals involved in schools would use this as an opportunity to develop curricula that include cardiopulmonary resuscitation and AED use. Every child who graduates from high school could then become a community bystander who would be available to help resuscitate an individual should they experience a sudden cardiac arrest.

The ways in which children can be identified with this condition include the warning signs and symptoms mentioned above. Unfortunately, symptoms are present in less than 50% of individuals. Thus, there is much discussion in the country at this time about other ways in which we might identify these individuals, including a debate about whether an electrocardiogram, which can identify up to 70%-95% of these conditions, should be used and whether genetic testing should be used in a more proactive fashion.

The paper concludes with a number of recommendations about the ways in which pediatricians may effectively work toward decreasing the tragedy of sudden cardiac arrest in our children.

© 2012 Children's Hospital of Philadelphia and Medscape

MEETING WITH PHARMACY BOARD

To all Assist.Pharmacist of Malaysia,

Pharmacy Board had invited Association to attend a special meeting regarding the new Pharmacy Act and Registration of Assist.Pharmacist of Malaysia. They will also discuss on the Standard of Diploma in Pharmacy and the qualification.
Meeting will be held on 23rd March 2012,  9.00am at Pharmacy Services Division head quaters, Petaling Jaya

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PERUTUSAN TAHUN BARU 2012 - YDP PPFM

Salam sejahtera, salam 1 Malaysia dan salam muhibah kepada semua Penolong Pegawai Farmasi Malaysia.
Tahun 2011 sudahpun berlalu. Kita telah mengorak langkah ke tahun 2012 dan akan bermulalah episod baru dalam kehidupan kita khasnya kepada para Penolong Pegawai Farmasi Malaysia.
Rakan-rakan seperjuangan sekelian, ingin saya mengambil kesempatan untuk mengucapkan Selamat Tahun baru 2012 kepada anda semua semoga anda semua diberkati dengan kesihatan yang baik, bahagia bersama keluarga tersayang, kejayaan dalam karier dan komited dalam tugas harian demi pembangunan negara dan kesejahteraan pelanggan kita.
Saya selaku Yang DiPertua Persatuan Penolong Pegawai Farmasi, ingin menyeru semua Penolong Pegawai Farmasi agar terus cemerlang dan produktif dalam tugas seharian serta menunjukkan kualiti perkhidmatan yang tinggi dan penuh tanggungjawab kepada Jabatan, negara dan masyarakat. Saya juga menyeru kepada semua ahli-ahli agar turut aktif dalam Persatuan dan Kesatuan serta sama-sama berusaha menambah keahlian dalam Persatuan dan Kesatuan. Kejayaan aktiviti serta tuntutan Persatuan dan Kesatuan adalah di tangan anda.
Adalah sangat penting untuk memastikan bilangan ahli yang ramai dan majoriti. Sebarang tuntutan tidak akan di endahkan jika jumlah keahlian kita masih seperti tahun-tahun sebelumnya yang kurang dari 60%.
Seperti yang sedia maklum, skim SBPA akan dikuatkuasaka mulai 1 Jan 2012 walaupun tarikh akhir SBPA diletakkan pada 15 Jan 1011. Saya andaikan sudah pasti ramai yang menandatangani borang opsyen tersebut. Skim tersebut dilihatkan sebagai satu kaedah penjenamaan semula sistem penyampaian perkhidmatan awam yang lebih kualiti, efisien, memenuhi stake holder, Lean Services, tegas mengendalikan aspek disiplin anggota dan yang bermasalah supaya Virus dalam perkhidmatan awam tidak merebak kepada rakan-rakan yang bekerja dengan baik.
Semoga skim baru ini memberi satu motivasi ditempat kerja dan karier. Bagi mereka yang masih tidak berpuashati, haruslah membuat pendirian mengubah sikap dan terus maju ke hadapan (Move Forward).
Rakan-rakan seperjuangan yang di kasihi, baru-baru ini kita digemparkan dengan isu kes kehilangan ubat hampir RM1 juta ringgit di salah sebuah Hospital terkemuka di Malaysia dan didalangi oleh anggota Farmasi sendiri. Walaupun kita telah tahu mereka yang terlibat bukanlah di kalangan Pen.Pegawasi Farmasi, tetapi Persatuan ingin mengambil iktibar dan menyeru kepada semua PPF supaya teruskan sikap Profesionalisma, komitmen tinggi, amanah dan jujur dalam melaksanakan tugas seharian demi masyarakat, pelanggan, Jabatan dan negara tercinta.

Buangkan sikap terlalu berkira dalam tugas seharian, tingkatkan komitmen dan tanamkan kesabaran serta nilai-nilai positif dan juga semangat kerja berpasukan bersama-sama dengan Pegawai Farmasi. Kita harus mencari jalan seiring dengan Pegawai Farmasi demi kemajuan Perkhidmatan Farmasi dan aktiviti-aktiviti yang di rancangkan. Libatkan diri dalam semua aktiviti yang dijalankan dengan penuh ikhlas dan tonjolkan kebolehan anda sebagai PPF yang berkaliber dan efisien.
Akhir sekali, saya bagi pihak Persatuan Penolong Pegawai Farmasi Malaysia ingin mengucapkan syabas kepada semua Penolong Pegawai Farmasi di atas kejayaan sepanjang tahun 2011 baik ditempat kerja mahupun kejayaan dalam keluarga disayangi. Juga saya ingin mengucapkan tahniah kepada PPF yang dinaikkan pangkat Gred U32, U36, U38 dan U40.
SELAMAT MAJU JAYA DAN SELAMAT MENJALANKAN TUGAS 2012 !

GANESAN G.NARAYANAN
YANG DIPERTUA
PERSATUAN PENOLONG PEGAWAI FARMASI MALAYSIA
1 JANUARI 2012

OPSYEN UMUR 60 & FAEDAH PERSARAAN

Taklimat sbpa umum bp 6.12.2011

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HISTORY OF PHARMACY

History of pharmacy

Although people have been using medicinal substances to treat themselves for as far back as there have been people, the pharmacy profession has more recent origins. Nevertheless, its roots can be found over 4000 years ago.

Pharmacy’s roots

The pharmacy profession can be traced back at least as far as the Sumerian population, living in modern day Iraq. From around 4000 BC, they used medicinal plants such as liquorice, mustard, myrrh, and opium. There were separate people who worked to prepare medicines, as a separate role from diagnosis and treatment which was carried out by medics. These precursors to pharmacists also combined their role with that of a priest. The Sumerians wrote the earliest surviving prescriptions from at least 2700 B.C. – so nearly 5000 years ago.

The Ancient Egyptians had specific preparers of medicine, known as Pastophor. Pharmacy was viewed as a high status branch of medicine, and again, like the Sumerians, these pharmacists were also priests who worked and practised in the temples.

From surviving papyrus scrolls, notably the Ebers Papyrus which dates from 1500 BC, we know that the Egyptians made and used infusions, ointments, lozenges, suppositories, lotions, enemas, and pills. The Ebers Papyrus includes 875 prescriptions and 700 drugs.

Meanwhile, in China in about the same era (2000 BC), a man called Shen Nung wrote the first Pen T’sao or native herbal, which contained descriptions of 365 plant-based drugs.

Stalls and shops selling medicinal goods existed around 1900 B.C. in the town of Sippara on the Euphrates river. However, the earliest recorded shop dealing with sales of medicines in London was opened in 1345.

The history of pharmacy in Britain

The word 'pharmacist' was first used in a publication in England in 1834 according to the Oxford English Dictionary in a novel by Lytton called The Last Days of Pompeii.   However, it was certainly in use from the 18th century with the meaning of someone who prepared and dispensed medicines.  Nevertheless, at the beginning of the 19th century most people working in this area would have called themselves chemists and/or druggists. The terms pharmacist and pharmaceutical chemist (now usually shortened to chemist) came later in the 1800s.

The word “pharmacy” has a much longer history in England. Chaucer in The Knight’s Tale (written around 1386) uses the word to describe a medical preparation of plants “farmacies of herbs.”

The term apothecary, often used between the 1600s and 1800s, does not refer to the chemist and druggist, or pharmacist.  It was used for individuals living in London who had passed the examinations of the Worshipful Society of Apothecaries of London, founded in 1617, or to their often less well qualified counterparts in the provinces. The role of the apothecary developed out of the role of the spicer or pepperer – or grocers – someone whose trade included crude drugs and prepared medicines.  The Grocers had their own Guild – professional body in the City of London- from the 13the century. The Apothecaries split from them in 1617 to form their own Society.

Although the apothecary's practice included a strong dispensing element, it was more all encompassing than the handling of drugs and chemicals. Apothecaries were also examining and treating patients, but they did not charge for these services – only for the medicines supplied. 

Following a ruling in the Rose Case (1701-1703/4), apothecaries became legally ratified members of the medical profession, able to prescribe as well as dispense medicines.  

As apothecaries moved into a more advisory role, pharmacists (or chemists and druggists) could develop their own area of preparation and supply of medicines. However, this put them in competition with the apothecaries who were also still involved in the same area.  The apothecaries attempted to control the chemists and druggists' activities in 1748 with a proposed new law to control the supply of medicines. This didn't progress.

In the early 1800s, an Association was formed to put together a proposal to Parliament to set up a body that examined and regulated apothecaries, surgeon-apothecaries, midwives and dispensing chemists. The chemists and druggists took action, arguing that they were best placed to set their own standards, as they were more experienced in making up prescriptions and making medicines than the apothecaries, so they should not be put under their control. The chemists and druggists won their argument, and when the Apothecaries Act of 1815 was finally created, the apothecaries did not have control over making medicines.

Some key dates in pharmacy history

1820		The alkaloid quinine was first extracted from the bark of cinchona trees by two French chemists, Pierre Joseph Pelletier and Joseph Biename Caventou.
1874		Diamorphine or Heroin was first synthesised from morphine.
1883		First edition of The Extra Pharmacopoeia published, edited by William Martindale and Dr Wynn Westcott.
1899		Aspirin, was launched by the German company.
1910		Salvarsan, the first 'magic bullet' drug, effective against syphilis was discovered by Paul Ehrlich and Dr Sahachiro Hata.
1915		Medicine stamp duty was doubled as a wartime fundraiser.
1917		The Venereal Disease Act prohibited the advertising of medicines for VD and selling mixtures containing scheduled substances.  It introduced the concept of 'prescription only' medicines.
1922		The Dangerous Drugs Act regulated the import and sale of potential 'drugs of addiction', including the derivatives of opium, cocaine and cannabis so widely used in proprietary remedies.
1928		Penicillin discovered by Alexander Fleming.
1938		The Food and Drugs Act prohibited the adulteration and mislabeling of drugs.
1939		The Cancer Act restricted the advertisement of products claiming to treat cancer.
1940		Under the Finance (No. 2) Act purchase tax was imposed on a range of goods including most drugs and medicines.
1941		The Pharmacy and Medicines Act repealed the old medicine stamp duty. It forbade the general advertisement of products claiming to treat a number of specific illnesses including Bright's disease, cataract epilepsy and TB, or to be effective in procuring an abortion.  For the first time manufacturers were required to list the active ingredients of products on their packaging.
1948		The National Health Service made prescription medicine available to all. Until the introduction, in the 1950s, and subsequent hefty increasing of prescription charges, proprietary medicines were no longer seen as a cheap alternative to seeing the doctor.
1961		Ibuprofen was first synthesised by a team at the Boots Pure Drug Company in December.
1964		Introduction of Adverse Drug Reaction 'yellow card' scheme in reponse to the thalidomide tragedy of 1961.

- From Royal Pharmaceutical Society of Great Britain