It is that time of the year again when our Society, the Royal Pharmaceutical Society, is asking us to dig deep into our pockets and join or renew our membership. There is no obligation to do so but it is a nice thing to do for what is our leadership body. Then again, nice doesn’t quite cut it as our income is cut and our sources of gainful employment facing a significant axe.
What are the alternatives? This is exactly the time we should be engaging better with our leadership body. We all have our fears and anxieties but being part of that body should offer us the opportunity to put our case in a determined manner to the decision makers. I don’t have much spare cash but I will dig deep this time and renew my membership!
Our Society promises to: (1) To make me confidence in facing down known & unknown professional challenges ; (2) To recognise me through a validated peer review process; (3) Give me the opportunity to influence the future of the profession we all love; (4) To guide me in developing my career.
Updated advice on use of nicorandil as second-line treatment for stable angina – some ulcers may progress to complications unless treatment is stopped.
Advice for healthcare professionals:
Use nicorandil for treatment of stable angina only in patients whose angina is inadequately controlled by first line anti-anginal therapies, or who have a contraindication or intolerance to first line anti-anginal therapies such as beta-blockers or calcium antagonists
Nicorandil can cause serious skin, mucosal, and eye ulceration, including gastrointestinal ulcers which may progress to perforation, haemorrhage, fistula, or abscess
Stop nicorandil treatment if ulceration occurs—consider the need for alternative treatment or specialist advice if angina symptoms worsen
Please continue to report suspected adverse drug reactions to nicorandil or any other medicines on a Yellow Card
In our next installment of the pre-registration project, Prabsimranjeet Rathaur describes his audit project on evaluating the use of patient controlled analgesia (PCA) on surgical and orthopaedic wards.
…this may represent opportunity to review the current guideline with the hope of gaining consensus across all prescribers….I will like to thank both of my supervisors Claire Sheikh & Jennifer Thompson for all their help”
We are always looking at ways to encourage different aspects of quality practice at bookapharmacist.com. To fulfill our audit dissemination agenda, we are encouraging pre-registrations pharmacists – past and present to discuss their audit/pre-reg project in a short time frame. Our first volunteer, Tomisin Adedipe presented his pre-registration project in less than 2 minutes! He has set the bar now!
Economists are a funny lot! They are obsessed with the two P’s of the economy: Performance & Productivity. Productivity is commonly defined as a ratio between output volume and the volume of input (1). As we know from our elementary physics – that the law of conservation of energy holds for any closed system whereby energy can neither be created nor destroyed but can be transformed from one form to another; even in special relativity provided the frame of reference of the observer is unchanged (2) – it will be odd to aspire for a level of productivity greater than unity. Then again, the system we are operating in is not closed and the frame of reference is a moving target. So if an economy achieve a level of productivity greater than 1, then another economy, somewhere will achieve a productivity less than 1 (a zero-sum game). Paul Krugman (3), that renowned and award winning American economist, wrote in his book: Age of Diminishing Expectations (1994):
Productivity isn’t everything, but in the long run it is almost everything. A country’s ability to improve its standard of living over time depends almost entirely on its ability to raise its output per worker.
The Organisation for Economic Co-operation and Development (OECD) is always looking to define a reliable measure of productivity. Let the economist do what they must but as a pharmacist working in the coalface of professional practice, how will I measure my productivity and what target should I set myself? My view on this is clear: we must always start with a level productivity that is unity. If I was using a multi-factor productivity index, I will consider the following:
What are the GPhC minimum requirement to maintain my registration (fitness to practice)? (4)
What are the minimum requirement I set myself in my current professional practice?
What are the minimum requirement I need to achieve my 5-year forward view?
If I can achieve all these minimum requirements, then my productivity is unity. As long as I define these indices in a SMART way, then I can consider myself to be productive.
Performance is another indicator used by economists to describe the achievement of economic objective. I feel performance measures outcome whilst productivity measures activity. Volume of activity in itself does not equate to performance. You can be productive and achieve nothing! That is why I am using this medium to discuss a theory I came across a few years back that led to my writing of the passion article in the PJ (5) and the publication of the work on level of pharmacy engagement of preregistration and final year students (6). The dualistic model of passion proposed by Vallerand and others (7,8) proposes that passion represents a major motivational force that lead one to engage in deliberate practice. Both harmonious and obsessive passion are hypothesised to lead to deliberate practice, which in turn lead to performance attainment. The model is not hypothesised to influence performance directly. Rather, passion sets things in motion by providing people with the energy and goals to engage in deliberate practice, and it is deliberate practice that is hypothesised to have a direct influence on performance (Figure 1).
The profession of pharmacy is now focussed on outcomes for patients and our professional development. Our deliberate practice must therefore be aligned to achieving these outcomes to be able to confidently say we performing effectively. So I was really encouraged that the webinar by Jayne Packham in PharmacyWeb forum was well attended by pharmacist who wanted to explore the option of working in the pharmaceutical industry. Others choose to be members of the professional body and others, still, adopt a range of strategies to improve their performance for their patients. Whatever it is, it should be driven by the right mix of passion drivers, steeped in the fundamental value, that as pharmacists, our aim is to optimise the use of medication in whatever setting we find ourselves.
Today marks another landmark in the battle to combat and defeat the HIV. The theme for World Aids Day 2015 is “Getting to zero – ending AIDS by 2030” (link). This is an aspiration we all share especially with 37 million people living with HIV in 2014.
The following are key messages to get us closer to that target:
All people living with HIV should start antiretroviral treatment as soon as they are diagnosed. Almost 16 million people were receiving antiretroviral therapy in 2015
We need to diagnose more people. Only 54% people with HIV are aware of their infection.
Tap into best practice. Eliminate the risk of vertical transmission.
The latest Intensive Care National Audit and Research Centre (ICNARC) report showed the general intensive care unit (GICU) at Southampton General Hospital had the lowest number of deaths over a three-month period.
Now that is something to be really proud of….Well done to the GICU team at Southampton General Hospital
The Medicines and Healthcare products Regulatory Agency has just issued a Class 4 Drug Safety Alert for Wockhardt UK Ltd – Amoxicillin Sodium 1g, 250mg and 500mg Powder for Solution for Injection.
Drug alert number EL (14)A/09 in connection with the above products was issued on 9 July 2014. In this alert, healthcare professionals treating neonates and infants (below one year old) were asked not to use Wockhardt Amoxicillin Powder for Solution for Injection (all strengths and all batches) in such patients. This was a precautionary measure following receipt of a number of reports of extravasation and injections site reactions.
When in March last year, Kazeem met Adel, it was bound to be another insightful interview and meeting of old mates. Adel featured in my first book: The Doctrine of Universal Truths. From one ‘wacky’ idea to the next, we stumbled along and then MUR….the rest, as they say, is history! It has always been about a drive to make a difference.
Adel said on MUR:
I felt that this was a very good project because this could potentially….make a difference
In this case study interview with Adel it was more respiration than perspiration but really sorry it has taken me the best part of over a year to put it up! As is customary with these interviews, there is an accompanying YouTube video for extra insights. Enjoy.
Pharmacognosy is the branch of knowledge concerned with medicinal drugs obtained from plants or other natural sources. This has been critical to drug development and exemplified by the recent ward of the Nobel prize for medicines to the Chinese scientist Youyou Tu (a pharmaceutical chemist) (link) who is famous for discovering artemisinin used to treat malaria. BBC reported that she found that an extract from the sweet wormwood plant Artemisia annual was sometimes effective – but the results were inconsistent, so she went back to ancient literature, including a recipe from AD350. Derivation of medicinal drug from plants remain relevant today.
The drug that commands my attention today is ingenol mebutate (branded as Picato), which is a substance found in the sap of the plant Euphorbia peplus and an inducer of cell death. It has been formulated as a gel and approved for use in America and Europe for the cutaneous treatment of non-hyperkeratotic, non-hypertrophic actinic keratosis in adults. In the UK, two strengths of Picato exists: 150microgram/g and 500microgram/g. The SPC suggests that:
If an area on the face or scalp and another area on the trunk or extremities are simultaneously treated, then patients should be advised to ensure they use the appropriate strengths.Care should be exercised not to apply the 500 mcg/g gel on the face or scalp as this could lead to a higher incidence of local skin responses. (link)
Picato can cause local skin reaction and are transient and typically occur within 1 day of treatment initiation and peak in intensity up to 1 week following completion of treatment. Localised skin responses typically resolve within 2 weeks of treatment initiation when treating areas on the face and scalp and within 4 weeks of treatment initiation when treating areas on the trunk and extremities. Treatment effect may not be adequately assessed until resolution of local skin responses.
Take home message:
It is important that when we are dispensing both strengths to our patient cohorts, that we take time to explain that the right strength is applied to the right area.
“There is no evidence to show that any oral preparation of mesalazine is more effective than another, however delivery characteristics of oral mesalazine preparations may vary. If it is necessary to switch a patient to a different brand of mesalasine, the patient should be advised to report any changes in symptoms”
How will this affect my practise?
I am free to start a new patient on whatever brand of mesalazine (whatever the local policy) and it will be fine. There shouldn’t be a need to change to another product on efficacy grounds. However, some patient may not get along with the brand prescribed for a number of reasons: big tablets; bad taste etc. If I do change brand, the symptom control may be affected and titration of the new brand may be necessary to get symptom control again…so I will let the patient be my eyes and ears for any changes in symptoms control.
There is an increased risk of venous thromboembolic disease in users of combined hormonal contraceptives, particularly during the first year and possibly after restarting combined hormonal contraceptives following break of four weeks or more. In all cases the risk of venous thromboembolism increases with age & other risk factors, such as obesity, diabetes etc.
Risk is considerably smaller than that associated with pregnancy….but:
Whilst the controversy about statins heat up….my thoughts turn to staying alive. How does one stay alive in the face of controversy amongst experts? First, there is no dispute about whether or not statins save lives…they do. So if you are put on it with no side effects….take it. It will save your life.
To really stay alive, you really need to consider the following:
As the long awaited release 2 of the Electronic Prescription Service rolls out of different GPs (almost certainly in April in Hampshire), we are running a series tagged EPS2 where we will highlight issues and gather your views. So join me in this EPS2 series to inform stakeholders – you & me, alert relevant bodies and ultimately lead to improvement of the way the system works.
For this first post in the series, let me fire a poll at you:
The issue here is that when the GP sends an electronic prescription to a pharmacy, it is not a linear journey. What GP practice is actually doing is sending it into the NHS infrastructure spine; then once all necessary verification are done, the pharmacy can download the prescription into their pharmacy system. Clearly this is no email in that you shouldn’t really expect the prescription instantaneously. The bottlenecks present are determined by the speed of GP connection to the spine (internet & other traffic across the networks); the traffic on the spine; and the connection between the pharmacy and the spine (internet and other traffic) and frequency of download from spine by the pharmacy system. I have heard that in some cases the prescription reach the pharmacy almost instantaneously (within the hour of it being sent). I have also learnt that in some cases, it is taking an average of 6 hours. My experience recently is that a prescription that left the surgery at about 3pm was still not in the pharmacy at close of business at 6:30pm. Resulting in multiple disappointing visits by patient.
I think this calls for the management of expectation at point of issue of prescription. This is no email and we need to let the patient know that when a prescription is sent to the pharmacy, it doesn’t necessarily appear instantaneously at the pharmacy. If the prescription is acute, a prescription token printed at the GP practice maybe the way to go.
The construction of the COPD Pathway fills me with real excitement. I now, more or less know how to navigate my way through the myriad of services and service providers in the NHS: right from symptoms recognition right through to the end of life. This will form the basis for our COPD Series which will run in parallel to our Asthma Series.
If you suffer from COPD or suspect the symptoms of COPD….then visit the pathway to identify where you are on the journey and understand opportunities to get help, if needed.
Go well, Live well
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