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Clinical Pharmacist's monthly news round-up: the top 10

Clinical Pharmacist

What has been happening in the world of pharmacy? The team at Clinical Pharmacist summarises the month's top 10 clinical pharmacy and NHS stories.

1. Recognition for first RPS Faculty members

Seventy-five pharmacists have become the first members of the Royal Pharmaceutical Society Faculty.

All applicants in the programme’s first wave of assessment — a process for recognition of 10 or more years’ experience — were successful in joining the RPS Faculty. A total of 58 pharmacists were designated fellows of the Faculty (and granted the post-nominal FFRPS), 15 were assessed as being at stage II (MFRPSII) and two were mapped to stage I (MFRPSI).

Hospital pharmacists were the largest group of applicants (49%), followed by academic (17%), community (11%) and education and training (11%). By country, 80% are practising in England, 12% in Scotland and 8% in Wales.

Applicants’ portfolios were assessed throughout September and a credentialing panel met early October to review and ratify the assessors’ findings. The results were approved by the Faculty board at its first meeting on 21 October.

Roll-out of the full assessment process (for RPS members with two to 10 years’ experience) is to be announced in 2014.

Full story

2. Metoclopramide data in pregnancy reassuring

Use of metoclopramide to reduce nausea and vomiting in pregnancy is not associated with increased risk of major congenital malformations, a nationwide cohort study from Denmark indicates (JAMA 2013;310:1601).

National health and prescription registers were examined to assess the safety of metoclopramide use in pregnancy, comparing exposed women and matched unexposed controls.

During the 14-year study, over 1.2 million women in Denmark had a delivery or experienced an abortion and, of these, over 40,000 had taken metoclopramide at some time during their pregnancy.

Around 28,000 women were exposed to the antiemetic in the first trimester. There was no association between metoclopramide use and malformations overall (25.3 cases per 1,000 births in the exposed group and 26.6 per 1,000 births in the unexposed group) or any of the 20 individual malformations analysed, including neural tube defects and cleft palate. There was also no increased risk of spontaneous abortion or stillbirth. 

Full story

3. Cancer drugs funding

Cancer patients in England are to benefit from an extra £400m allocated to the cancer drugs fund, announced by Prime Minister David Cameron last month. The additional funding will see access to medicines paid for through the fund extended until March 2016.

Steve Williamson, consultant cancer pharmacist at Northumbria and North Cumbria NHS Trusts, welcomed the move because it provides stability and reassurance to patients with cancer. However, he expressed concerns that demand for the fund may exceed the money available: “Drugs of less clinical value might have to be removed or reviewed to make room for new medicines.”

Full story

4. Minor ailments in Wales

Wales has introduced a common ailments scheme in 32 pharmacies across two health board areas that will run until September 2015. The service will allow patient data to be transferred between pharmacies.

The plan is eventually to roll out the service to the rest of the country after the Government has undertaken an economic evaluation of the pathfinder sites. The move would make England the only country in Great Britain without such a national scheme.

The “Choose pharmacy” scheme aims to encourage patients to use their community pharmacy for minor conditions.

Full story

5. Antismoking drugs' link with suicide rebutted

People taking varenicline or bupropion for smoking cessation are at no greater risk of suicidal behaviour or depression than those using nicotine replacement therapy (NRT), according to an observational study published online in the BMJ (2013;347:f5704). According to the study researchers, from the University of Bristol, the findings should provide some reassurance for users and prescribers of smoking cessation products.

The researchers recorded cases of treated depression and fatal and non-fatal self-harm within three months of the first prescription for a smoking cessation product. The study included data on 119,546 adults: 81,545 users of NRT, 31,260 users of varenicline and 6,741 users of bupropion.

Overall, there were eight suicides, 84 cases of non-fatal self-harm and 1,094 records of treated depression. There was no evidence of increased risk of fatal or non-fatal self-harm or depression in patients prescribed varenicline or bupropion compared with those prescribed NRT.

The study was funded by the Medicines and Healthcare products Regulatory Agency.

Full story

 

6. Aprotinin licence reinstated in Europe

Aprotinin has had its marketing authorisation reinstated by the European Commission. The medicine will be licensed for prophylactic use to reduce blood loss and the need for transfusions in adult patients who are at high risk of major blood loss undergoing isolated cardiopulmonary bypass graft surgery.

The use of aprotinin was suspended in 2007 following results of the BART study, which revealed an increase in 30-day all-cause mortality among patients receiving aprotinin compared with those given other medicines. A report by the Committee for Medicinal Products for Human Use has since concluded that there were several methodological flaws in this research.

Reanalysis of three other observational studies that had raised concerns over the safety of aprotinin found that two did not draw statistically significant conclusions and the third had methodological issues, according to the committee’s review.

Separately, last month saw the UK launch of lomitapide for homozygous familial hypercholesterolaemia and regorafenib for metastatic colorectal cancer.

Aprotinin full story

Lomitapide full story

Regorafenib full story

7. Pancreatic cancer

Patients with metastatic pancreatic cancer treated with combined gemcitabine and nanoparticle albumin-bound paclitaxel therapy survived longer than patients treated with gemcitabine alone, an international trial has found (New England Journal of Medicine, online 16 October 2013).

Median overall survival was 8.5 months in the combination group and 6.7 months with gemcitabine alone (hazard ratio for death 0.72, 95% confidence interval 0.62–0.83; P<0.001). One-year and two-year survival rates were higher with the combination than with gemcitabine alone: 35% versus 22% and 9% versus 4%.

Full story

8. Asthma services reviewed

The NHS needs to audit asthma services and ensure improvements are continually being made, according to a new report from Asthma UK.

The charity surveyed some 600 people across the UK for its “Compare your care” report and found that only one in four respondents had been given a self-management plan; one in five said that their inhaler technique had been checked; and a quarter had not had a review of their asthma in the past year.

“Plans must be implemented across the UK to ensure that everyone with asthma gets care that meets standards,” the industry-supported report recommends.

Full story

9. Appraisal processes to be revised in Scotland

A major revamp of the processes used for deciding which medicines can be prescribed in NHS Scotland was announced by the Scottish Government last month.

One of the measures announced involves the replacement of the current individual patient treatment request system, which is used for medicines that have not been accepted by the Scottish Medicines Consortium, with a new process. The new peer-approved clinical system will be a single national process that is applied for at a local level using a standard form, said a spokesman for the Scottish Government. Under this system, a clinician will have to make a case for using a medicine for an individual patient to two peers of the same clinical specialism; these peers may include clinical pharmacists.

Other measures include introducing more flexible approaches for SMC evaluations of medicines for end-of-life care and very rare conditions, improving patient engagement in the medicines approval process and developing a value-based approach for SMC assessments of medicines. 

Full story

10. Named pharmacist view backed by RPS

All GP surgeries should have input from a clinical pharmacist, employed by individual practices or working across a number of practices, the Royal Pharmaceutical Society has told the Department of Health.

“Every GP practice should employ a team similar to that in hospitals with the responsibility for the optimisation of medicines within the practice being with the pharmacist,” wrote the RPS last month in its response to the DH consultation “Right care, right place, right time”.

The RPS also said that it supported the concept of patients having a named pharmacist as it was suggested in the consultation. “If a GP is the named clinician responsible for an individual’s care, there should also be a named pharmacist alongside them who is responsible for [his or her] medicines.” The RPS suggests that this responsibility should extend to the appropriateness of the medicine, its effectiveness for the individual patient, considerations around medicines-related risk and helping with correct use of the medicine.

It also said that community pharmacists should have read and write access to the relevant parts of the patient health record.

Full story

STAYING INFORMED

In these pages we summarise the 10 news items from the past month that we believe will be of greatest interest or relevance for your practice. The full stories, accessible on PJ Online (www.pjonline.com), usually contain more detailed information, data and expert comments. 

We work closely with the PJ Online daily news team to get clinical and healthcare news out as soon as possible after the stories break. And so if you want to keep up to date throughout the month, the best way of doing so is to visit our landing page (www.clinicalpharmacist.com) regularly, where you can also sign up to our clinical news RSS feed.

Citation: Clinical Pharmacist DOI: 10.1211/PJ.2013.11129549

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