Archive for November, 2010

Recall: Hospira Symbiq One-Channel and Two-Channel Infusers

http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm232568.htm

Hospira Symbiq One-Channel and Two-Channel Infusers: Class I Recall – Motor Encoder Failures

[Posted 11/04/2010]

AUDIENCE: Risk Manager, Anesthesiology, Critical Care Medicine

ISSUE: FDA and Hospira notified healthcare professionals of a Class 1 recall of these infusion pump products due to motor encoder failures in the pumping mechanism that causes the infuser to cease operation. Delay or interruption of therapy may result in serious injury or death in: patients receiving critical therapy, pediatric patients, and neonates.

BACKGROUND: Symbiq Infusers are infusion pumps intended for the delivery of fluids by parenteral, enteral, intravenous, intra-arterial, subcutaneous, epidural, or irrigation routes of administration. Hospira mailed an Urgent Device Field Correction to affected customers on February 22, 2010, and a Recall Notification on February 22, 2010. Information regarding additional recall actions was also provided in an update Recall Notification letter on October 4, 2010. The affected units were distributed from December 23, 2006 to January 22, 2010.

RECOMMENDATION: Until Hospira can upgrade all Symbiq pumping mechanisms, corrected loaner pumps will be provided at no cost to customers for critical care areas. Until loaner or corrected pumps are in place in critical care areas, Hospira urges customers to consider an alternate method to administer therapy. All lots affected can be found in the List Number Configurations in the FDA Recall Notice.
 

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:

  • Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
  • Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

 
 
[11/04/2010 - Recall Notice - FDA]

Previous Recalls:

[09/21/2010 - Recall Notice - FDA]
[07/15/2010 - Recall Notice - FDA]

Cymbalta to treat chronic musculoskeletal pain

Link:  http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm232708.htm

FDA Press Release

For Immediate Release: Nov. 4, 2010
Media Inquiries: Shelly Burgess, 301-796-4651, shelly.burgess@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

FDA clears Cymbalta to treat chronic musculoskeletal pain
Indications include osteoarthritis, chronic lower back pain

The U.S. Food and Drug Administration today approved Cymbalta (duloxetine hydrochloride) to treat chronic musculoskeletal pain, including discomfort from osteoarthritis and chronic lower back pain. Cymbalta was first used to treat major depressive disorder in 2004. 

“Up to three quarters of the population experience chronic pain at some time in their lives,” said Janet Woodcock, M.D., director of FDA’s Center for Drug Evaluation and Research. “This approval means that many of those people now have another treatment option.”

Since its initial approval, about 30 million patients in the United States have used Cymbalta. It was approved for the treatment of diabetic peripheral neuropathy in 2004; generalized anxiety disorder and maintenance treatment of major depression in 2007; and fibromyalgia in 2008.

More than 29,000 patients have used Cymbalta in clinical trials, and more than 600 patients were studied in the clinical trials involving osteoarthritis and chronic low back pain. The safety evaluation for Cymbalta included review of data from the clinical trials as well as post-marketing data from the previously approved patient populations.

The FDA assessed the efficacy of Cymbalta in chronic low back pain and osteoarthritis in four double-blind, placebo-controlled, randomized clinical trials. At the end of the study period, patients taking Cymbalta had a significantly greater pain reduction compared with placebo.

The most common side effects reported with Cymbalta include nausea, dry mouth, insomnia, drowsiness, constipation, fatigue, and dizziness. Other serious side effects include liver damage, allergic reactions such as hives, rashes and/or swelling of the face, pneumonia, depressed mood, suicide, suicidal thoughts and behavior.

While these serious side effects have been associated with the use of Cymbalta, they have occurred in less than 1% of treated patients. There are a finite number of drugs available for the treatment of chronic musculoskeletal pain, all of which are associated with rare, serious side effects. There are patients in whom none of the available treatments are effective. 

The recommended dose for Cymbalta is a 60 milligram capsule taken once daily without regard to meals. The capsule should be swallowed whole, and not chewed, crushed or opened; the contents should never be sprinkled on food or mixed with liquids.

Consumers and health care professionals are encouraged to report adverse events to the FDA’s MedWatch program at 800-FDA-1088 or online at www.fda.gov/medwatch/how.htm.

Cymbalta is manufactured by Indianapolis-based Eli Lilly and Co.
 
For more information:

Approved Drugs: Questions and Answers

Malaria & Flight Crews

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5943a5.htm?s_cid=mm5943a5_e

Notes from the Field: Malaria Imported from West Africa by Flight  Crews — Florida and Pennsylvania, 2010

Weekly

November 5, 2010 / 59(43);1412

On September 15, 2010, CDC notified the Florida and Pennsylvania departments of health of four Plasmodium falciparum–associated malaria cases among employees of a single commercial airline. All four employees had traveled to Accra, Ghana, during August 25–September 2, 2010, two of whom were on the same flight. Their duration of stay in Accra ranged from 48 to 80 hours. All had stayed at the same hotel and spent time outdoors near the swimming pool, in restaurants without air conditioning, and in other locations during the evening and night.

Two cases were in female flight attendants aged 20–40 years, and two cases were in male pilots aged 40–60 years. All had fever, headache, nausea, vomiting, and diarrhea approximately 2 weeks after their most recent exposure in Accra. Three of the four received diagnoses of acute P. falciparum–associated malaria on the basis of trophozoites observed on microscopic examination of thin and thick blood films. Malaria was diagnosed for one patient by blood smear, but the species (P. falciparum) was determined by positive polymerase chain reaction. One flight attendant was hospitalized for treatment, recovered uneventfully, and was discharged after 2 days. The two pilots and the other flight attendant were severely ill, were hospitalized, and required intravenous treatment. Both pilots had respiratory distress and required intubation. All recovered and were discharged after 6–15 days with diagnoses of acute malaria infection and acute respiratory failure for the pilots.

None of the four airline workers had used antimalarial chemoprophylaxis, despite company-paid atovaquone-proguanil (Malarone, GlaxoSmithKline) being an element of this airline’s malaria prevention strategy. All reported having used insect repellent most of the time. Accra is recognized as a high-risk area for malaria transmission (1). CDC advises travelers to West Africa, an area of intense transmission, to use chemoprophylaxis as well as to take measures to avoid mosquito bites, because even brief exposure can result in transmission (2). Travelers to malaria-endemic countries, even for brief periods, should be aware of the risk for malaria and of prevention measures that can be taken.

Reported by

D Stanek, DVM, C Blackmore, DVM, PhD, Florida Dept of Health. V Dato, MD, Pennsylvania Dept of Health. B Martin, Delta Air Lines, Atlanta, Georgia. P Arguin, MD, Center for Global Health; P Kozarsky, MD, National Center for Preparedness, Detection, and Control of Infectious Diseases; D Bensyl, PhD, Scientific Education and Professional Development Program Office; M Selent, DVM, VM Beau De Rochars, MD, EIS officers, CDC.

References

  1. CDC. Malaria surveillance—United States, 2008. MMWR 2010;59(No. SS-7).
  2. CDC. Health information for travelers. Atlanta, GA: US Department of Health and Human Services, CDC; 2010. Available at http://wwwnc.cdc.gov/travel. Accessed October 27, 2010.

IV Acetaminophen

http://www.medpagetoday.com/Surgery/GeneralSurgery/23123

IV Acetaminophen Wins Approval

By John Gever, Senior Editor, MedPage Today
Reviewed by
November 02, 2010

“The FDA has approved an intravenous form of acetaminophen for relieving pain and fever after surgery, according to the drug’s manufacturer.

Cadence Pharmaceuticals indicated that it would market the product, with a trade name of Ofirmev, as a treatment for post-surgical pain for patients who would normally receive IV medications.

The company noted that its product is the only nonopioid, non-NSAID medication approved for treating pain and fever currently available in intravenous form….”

Swallowing pens, batteries, knives

http://www.jsonline.com/blogs/news/106553328.html

The high cost of swallowing pens, batteries, knives

By Mark Johnson of the Journal Sentinel

Nov. 2, 2010

“Some people swallow pens. Some swallow batteries. Some swallow knives, or razor blades.

Such cases are highly unusual, but costly for the hospitals that deal with them. Now a new study from Rhode Island Hospital finds that 33 people in an eight-year period were responsible for 305 cases of medical intervention to remove foreign objects that were swallowed intentionally. Total cost of the hospital care: more than $2 million…..”

Neonatal Resuscitation

Neonatal Resuscitation: 2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
John Kattwinkel, Jeffrey M. Perlman, Khalid Aziz, Christopher Colby, Karen
Fairchild, John Gallagher, Mary Fran Hazinski, Louis P. Halamek, Praveen
Kumar, George Little, Jane E. McGowan, Barbara Nightengale, Mildred M.
Ramirez, Steven Ringer, Wendy M. Simon, Gary M. Weiner, Myra Wyckoff, and
Jeanette Zaichkin
Pediatrics 2010;126 e1400-e1413
http://pediatrics.aappublications.org/cgi/content/extract/126/5/e1400?etoc

Pediatric ALS

Pediatric Advanced Life Support: 2010 American Heart Association Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Monica E. Kleinman, Leon Chameides, Stephen M. Schexnayder, Ricardo A.
Samson, Mary Fran Hazinski, Dianne L. Atkins, Marc D. Berg, Allan R. de
Caen, Ericka L. Fink, Eugene B. Freid, Robert W. Hickey, Bradley S. Marino,
Vinay M. Nadkarni, Lester T. Proctor, Faiqa A. Qureshi, Kennith Sartorelli,
Alexis Topjian, Elise W. van der Jagt, and Arno L. Zaritsky
Pediatrics 2010;126 e1361-e1399
http://pediatrics.aappublications.org/cgi/content/extract/126/5/e1361?etoc

Pediatric BLS

Pediatric Basic Life Support: 2010 American Heart Association Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Marc D. Berg, Stephen M. Schexnayder, Leon Chameides, Mark Terry, Aaron
Donoghue, Robert W. Hickey, Robert A. Berg, Robert M. Sutton, and Mary Fran
Hazinski
Pediatrics 2010;126 e1345-e1360
http://pediatrics.aappublications.org/cgi/content/extract/126/5/e1345?etoc

Neonatal Resuscitation

Neonatal Resuscitation: 2010 International Consensus on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care Science With Treatment
Recommendations
Jeffrey M. Perlman, Jonathan Wyllie, John Kattwinkel, Dianne L. Atkins,
Leon Chameides, Jay P. Goldsmith, Ruth Guinsburg, Mary Fran Hazinski, Colin
Morley, Sam Richmond, Wendy M. Simon, Nalini Singhal, Edgardo Szyld,
Masanori Tamura, Sithembiso Velaphi  on behalf of the NEONATAL
RESUSCITATION CHAPTER COLLABORATORS
Pediatrics 2010;126 e1319-e1344
http://pediatrics.aappublications.org/cgi/content/extract/126/5/e1319?etoc

Pediatric Basic and Advanced Life Support

Pediatric Basic and Advanced Life Support: 2010 International Consensus on
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science
With Treatment Recommendations
Monica E. Kleinman, Allan R. de Caen, Leon Chameides, Dianne L. Atkins,
Robert A. Berg, Marc D. Berg, Farhan Bhanji, Dominique Biarent, Robert
Bingham, Ashraf H. Coovadia, Mary Fran Hazinski, Robert W. Hickey, Vinay M.
Nadkarni, Amelia G. Reis, Antonio Rodriguez-Nunez, James Tibballs, Arno L.
Zaritsky, David Zideman, and   on behalf of the PEDIATRIC BASIC AND
ADVANCED LIFE SUPPORT CHAPTER COLLABORATORS
Pediatrics 2010;126 e1261-e1318
http://pediatrics.aappublications.org/cgi/content/extract/126/5/e1261?etoc

Meningitis in Children: Can you tell?

Clinical Features Suggestive of Meningitis in Children: A Systematic Review
of Prospective Data
Sarah Curtis, Kent Stobart, Ben Vandermeer, David L. Simel, and Terry
Klassen
Pediatrics 2010;126 952-960
http://pediatrics.aappublications.org/cgi/content/abstract/126/5/952?etoc

Clinical Examinations for Pediatric Skin and Soft-Tissue Infections

Reliability of Clinical Examinations for Pediatric Skin and Soft-Tissue
Infections
Jennifer R. Marin, Warren Bilker, Ebbing Lautenbach, and Elizabeth R.
Alpern
Pediatrics 2010;126 925-930
http://pediatrics.aappublications.org/cgi/content/abstract/126/5/925?etoc

Referral to the Emergency Department by a PCP

Referral to the Emergency Department by a Primary Care Provider Predicts
Severity of Illness
Andrea S. Rinderknecht, Mona Ho, Pawel Matykiewicz, and Jacqueline M.
Grupp-Phelan
Pediatrics 2010;126 917-924
http://pediatrics.aappublications.org/cgi/content/abstract/126/5/917?etoc

Pain During the Last 2 Years of Life

The Epidemiology of Pain During the Last 2 Years of Life
Alexander K. Smith, Irena Stijacic Cenzer, Sara J. Knight, Kathleen A.
Puntillo, Eric Widera, Brie A. Williams, W. John Boscardin, and Kenneth E.
Covinsky
Ann Intern Med 2010;153 563-569
http://www.annals.org/cgi/content/abstract/153/9/563?etoc

Thigh-Length Versus Below-Knee Stockings for Deep Venous Thrombosis

Thigh-Length Versus Below-Knee Stockings for Deep Venous Thrombosis
Prophylaxis After Stroke: A Randomized Trial
  The CLOTS (Clots in Legs Or sTockings after Stroke) Trial Collaboration
Ann Intern Med 2010;153 553-562
http://www.annals.org/cgi/content/abstract/153/9/553?etoc