HPE HPE 90 – November 2018 | Page 43

of the Spanish study was better aligned to the objectives and more likely to yield a definitive answer, said Professor Bouvy. Using evidence The goal of clinical pharmacy services is to optimise medication therapy and to improve safety and clinical outcomes for patients. However, given the rapidly expanding volume of medical and pharmaceutical knowledge, pharmacists need some tools to help them to utilise the available evidence effectively, explained Claudia Langebrake (Head of Research and Education, Pharmacy Department, University Medical Centre Hamburg-Eppendorf, Germany). Both explicit (criterion-based) and implicit (judgement-based) tools are available. Clinical guidelines are generally helpful for decision-making in patient care but there can be inconsistencies. For example, there are seven sets of guidelines for the management of hypertension in diabetes and there are differences in the target blood pressure values and the recommended treatment for first line treatment in the presence of chronic kidney disease. Explicit criteria include the START-STOPP, FORTA and PRISCUS criteria but these need to be adjusted for each country and do not take account of comorbidities or patient preferences, said Dr Langebrake. A new screening tool includes a list of potentially inappropriate medicines (PIMs) compiled by a consensus group for use throughout Europe (‘EU(7) PIM list’). Research has shown that there is only limited overlap between the different PIM identification systems and so an in-house tool has been developed at the University Medical Centre in Hamburg (GERAS – the UKE-PIM Tool) to help clinical pharmacists to minimise the risk of PIM intake amongst elderly patients. Where electronic prescribing has been implemented, clinical decision support systems can also be built in and these often incorporate tools to identify inappropriate medications and interacting drugs. All the tools are helpful support instruments, but should not be seen as a substitute for professional decision-making, concluded Dr Langebrake. Predatory publishers In recent years ‘predatory publishers’ have become a problem for researchers Gerd Antes (Head of the German Cochrane Centre) explained. The pressure on academic researchers to publish has led to a proliferation of open-access journals where the authors pay substantial fees for publications. Many of these publishers are corrupt and exist only to make money from authors – peer review is faked or ignored and much of what is published is fringe or junk science. The result is that much misleading, redundant or even ‘fake’ material is published that could distort the results of systematic reviews. Predatory publishers choose names that are similar to the names of bona fide journals and commonly target academics to offer rapid publication. One member of the audience – an experienced researcher – described her experience of being drawn in by this approach. Faecal microbiota transplant Faecal microbiota transplant is an effective treatment of recurrent Clostridium difficile infection. In France, it is classed as a medicine that requires preparation under pharmaceutical supervision. The procedure has been performed at the St Antoine Hospital in Paris since October 2015. The goal of clinical pharmacy services is to optimise medication therapy and to improve safety and clinical outcomes for patients Pharmacists work closely with the medical team to select and screen potential donors. Donor faeces (45–110g) are collected and prepared for administration by the nasoduodenal route or as an enema. A suspension of the faeces is made with a sterile cryoprotector and frozen at –80°C. After a further check the material is defrosted and prepared for administration. The pharmacy process ensures traceability and efficacy. In a series of 26 patients, all underwent successful transplants with four patients requiring two transplants. “Our patients are so happy – it makes a tremendous difference for them”, says Anne-Christine Joly (Pharmacist, St Antoine Hospital, Paris, France) Melatonin pre-medication Melatonin (MLT) is being used for premedication before diagnostic procedures in a number of French hospitals, according to a survey by Jean-Meidi Alili and colleagues (Pharmaceutical Establishment of Paris Hospitals Group). Pharmacists and clinicians in 18 hospitals were interviewed. Age/body weight- adjusted doses of MLT were administered as immediate-release hard capsules (or, in one case, as oral suspension) to children from pre-term infants to teenagers. MLT was administered 15min –1hour before EEG, auditory brain stem response test or medical imaging. All respondents reported good efficacy and a good safety profile for MLT. A standardised preparation – most probably a hard capsule – is now required. STOPP/START guideline can improve prescribing The STOPP/START criteria were developed to help identify medicines that could be discontinued and those that should be started for an individual, according to the developer, Cristín Ryan (School of Pharmacy, Trinity College, Dublin, Ireland). Originally developed in 2008, an updated version was published in 2014. Studies show that there is a need for this and that the criteria are suitable for routine use (by pharmacists and prescribers). Face-to-face communication with patients appears to be critical. The criteria do not identify all errors and cannot replace clinical judgement, neither can they improve adherence when used alone. A recent study of the use of the criteria in community pharmacy practice looks promising. The 46th ESCP Symposium, Science meets practice: towards evidence- based clinical pharmacy services, was held in Heidelberg, Germany, 9–11 October 2017 Mobile health – future trends So far we have practised ‘imprecision medicine’ dealing with the average patient but in future precision medicine will be the norm – personalised, preventive, proactive and participatory, said Katarzyna Wac (Associate professor, University of Geneva and Stanford University, USA). Developments could include wearable gadgets and devices attached to mobile phones, for example, the AliveCor™ device for monitoring AF. There could also be tattoo-based devices for non-invasive blood glucose monitoring and a swallowable device for ‘colon capsule endoscopy’ (PillCam™). Smart lenses can measure blood glucose levels in eye and lung function can be measured using the microphone of smart phone. “Devices will be all around you”, said Professor Wac. Some 420 wearable devices are now listed, she added. More recent developments include sweat analysis to measure glucose, lactate and alcohol, and ‘smart socks’ that can detect excess fluid as a result of heart failure. Evidence for the impact of all these devices is “emerging”, said Professor Wac. hospitalpharmacyeurope.com | 2018 | Issue 90 | 43