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