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zondag 18 maart 2018

DTB: Drugs and their names

Drugs and their names

Over recent years, drug names have become more complex and difficult to pronounce (e.g. axicabtagene ciloleucel, rurioctocog alfa pegol, riociguat ).1,2 Although some rules underpin drug nomenclature, there are several examples of drugs with similar sounding names that are easily confused. In addition, the different levels of nomenclature (chemical, generic and brand names) may cause confusion for patients. Here, we provide an overview of how drugs get their names, the patterns that can be seen in naming conventions and highlight the risk associated with drugs with similar looking or similar sounding names.

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{blacktriangledown}Dupilumab for atopic dermatitis

Dupilumab (Dupixent - Sanofi-Aventis Groupe), a monoclonal antibody for the treatment of moderate-to-severe atopic dermatitis in adults who require systemic therapy, was licensed by the European Medicines Agency in September 2017. It is the first biological drug approved specifically for this condition. Here, we review the evidence for its efficacy and safety and consider its place in therapy.

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ADHD medication use in pregnancy and risk of congenital malformation

Intrauterine exposure to methylphenidate during the first trimester may be associated with a small increase in the risk of cardiac malformation, a cohort study examining the risk of congenital malformations following exposure to stimulants has found.1 The findings identified the potential safety concern in a USA cohort and replicated the analyses in a Nordic validation cohort.

The study was published by the International Pregnancy Safety Study consortium, a collaboration of research groups with access to healthcare databases that are able to study the safety of medicines in pregnancy.1 The initial analysis was conducted using a USA Medicaid cohort consisting of pregnant women aged 12 to 55 years (1,813,894 pregnancies). A pregnancy was considered exposed if, during the first 90 days of pregnancy, a woman had a prescription dispensed for methylphenidate (2,072 pregnancies) or an amphetamine (5,571 pregnancies). The primary outcome was major congenital malformation; a...

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Effectiveness of community screening in reducing fractures in older women

The effectiveness of a community-based screening intervention at reducing fractures in older women has been assessed in a randomised controlled trial.1 In the UK, around 536,000 people have fragility fractures each year, including 79,000 hip fractures, which cost an estimated £3.5 billion in 2010.

The trial included 12,483 women aged 70 to 85 years, randomised to a screening programme using the Fracture Risk Assessment Tool (FRAX) or to usual management. The women were recruited from 100 GP practices in seven regions of the UK. Those currently taking anti-osteoporotic drugs or deemed unsuitable to enter a research study (e.g. known dementia, terminally ill or recently bereaved) were excluded. The primary outcome was the proportion of women who had at least one osteoporosis-related fracture over a 5-year period. In the screening group, treatment was recommended in women identified to be at high risk of hip fracture, according to the...

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E-cigarettes and subsequent cigarette smoking in under-18s

A prospective cohort study in American teenagers has investigated the association between non-cigarette tobacco use and subsequent cigarette smoking initiation.1 Ninety per cent of adult cigarette smokers acquire the habit before the age of 18 years. As non-cigarette tobacco use (e.g. e-cigarettes) increases, there are concerns that use among young people who have not previously smoked could lead to subsequent cigarette smoking.

The study included 10,384 young people aged between 12 and 17 years (mean age 14.3 years), who had never smoked a conventional cigarette. Baseline levels of non-cigarette tobacco use were recorded at the beginning of the study period. They were followed up after 1 year to assess whether they had ever used cigarettes and whether they had smoked a cigarette in the previous 30 days.

At 1-year, 469 (4.6%) of all those who had never smoked at baseline had tried a cigarette and...

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Multiple safety warnings for {blacktriangledown}fingolimod

The Medicines and Healthcare Products Regulatory Agency (MHRA) has published multiple safety warnings for fingolimod, including new contraindications in relation to cardiac risk and updated advice about the risk of cancers and serious infections.1,2

Fingolimod is licensed as single disease modifying therapy in highly active relapsing remitting multiple sclerosis in adults with highly active disease despite treatment with at least one disease modifying therapy, or adults with rapidly evolving severe disease.3 In its assessment of fingolimod, the European Medicines Agency considered that it exhibited a heterogenous and complex safety profile.4,5 Safety concerns included bradycardia, atrioventricular-block, leucopenia, increased frequency and seriousness of infections, lymphoma related to the drug's immunosuppressant effect, neurological effects including posterior reversible encephalopathy syndrome, liver toxicity and strong signals of teratogenicity.

A recent routine EU-wide post-marketing review of cardiac safety data identified 44 reports of serious ventricular...

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Physiotherapy breathing retraining for asthma and quality of life

A randomised controlled trial has assessed the effect on quality of life of digital self-guided breathing retraining exercises for people with asthma.1 The trial included 655 patients aged 16-70 years recruited from 34 UK general practices. Eligibility criteria included asthma diagnosed by a physician, prescription of at least one asthma medication in the previous year, and impaired asthma-related quality of life (Asthma Quality of Life Questionnaire [AQLQ] score of <5.5). The self-guided intervention was delivered as a DVD plus a printed booklet (DVDB). Participants were randomised to receive the DVDB intervention, three face-to-face breathing retraining sessions or standard care, for 12 months. The primary outcome was AQLQ score.

The study found that mean AQLQ scores were higher with DVDB than with standard care (5.40 vs. 5.12; adjusted mean difference [AMD] 0.28, 95% CI 0.11 to 0.44), and with face-to-face retraining compared with standard care (5.33 vs. 5.12;...

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Clinical and cost effectiveness of longer prescriptions for chronic conditions

The evidence on clinical and cost effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care has been assessed in a National Institute for Health Research (NIHR) Health Technology Assessment (HTA).1 The study consisted of three elements:

  • a systematic review comparing 28-day prescriptions with longer prescriptions, assessing relevant clinical outcomes, adherence, costs and cost-effectiveness;

  • a cost analysis of relative medication wastage with prescriptions shorter and longer than 60 days; and

  • a decision model for predicting costs and effects of differing adherence levels associated with 28-day versus 84-day prescriptions in three clinical scenarios.

    The review included 16 studies, the quality of which was assessed as poor, and which yielded no information on health outcomes. Lower adherence was associated with 28-day prescriptions (standardised mean difference -0.45, 95% CI -0.65 to -0.26). The cost analysis found a statistically significant increase...

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    MHRA: confusion over drug names

    Recent examples of medication errors arising from confusion between drug names (generic or brand) that look or sound similar have been highlighted by the Medicines and Healthcare products Regulatory Agency (MHRA).1 In 2010 and 2013, the MHRA issued safety alerts to remind healthcare professionals of the risks associated with confusion over drug names.2,3 The latest alert provides another reminder to be vigilant for potential errors and to take particular care when prescribing or dispensing medicines that could be confused with others.1

    Examples of drugs that have been confused include:1–3

  • amlodipine/nimodipine

  • atenolol/amlodipine

  • clobazam/clonazepam

  • mercaptamine/mercaptopurine

  • propranolol/prednisolone

  • risperidone/ropinirole

  • sulfadiazine/sulfasalazine

  • zuclopenthixol decanoate/zuclopenthixol acetate

    To minimise the risk of error, healthcare professionals are advised to double-check when prescribing, dispensing or administering a medicine that it is the right drug for the...

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    Do hypertension guidelines put the person first?

    High systolic blood pressure (SBP) remains a leading global risk factor for disability and death ahead of smoking and high body-mass index.1 In the UK, high blood pressure is responsible for 75,000 deaths annually, underlies half of all strokes and myocardial infarctions, and is a significant risk factor for heart failure, kidney disease and dementia.2 Data from observational studies suggest that an increase in usual blood pressure above 115/75mmHg is associated with an increased risk of vascular mortality;3 lower than perhaps most people appreciate and lower than the threshold for treatment in current UK hypertension guidelines.

    The latest USA guideline on the management of hypertension, backed by the American Heart Association, the American College of Cardiology and nine other organisations, was published in November 2017.4 Perhaps the most notable changes are the recommendations that the threshold for a diagnosis of hypertension...

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    BBC Health: 'I wish I had the confidence to go out without make-up'

    'I wish I had the confidence to go out without make-up'
    Twenty-nine-year-old Tracy has acne, and worries about what people think of her at work.
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    Worcestershire Royal Hospital's ambulance wait 'catastrophe'
    Ambulance service bosses have warned Worcestershire Royal that patients face "significant risk of harm".
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    TV anchor Andrea McLean: 'Give menopausal women M badges'
    ITV's Andrea McLean, who reached early menopause, tells commuters to cut hot flush sufferers "slack".
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    Hundreds of nurses 'hit by student loan errors'
    Nursing students at a number of universities struggle with student loan overpayments, says the nurses' union.
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    Living healthy in Qatar: Why's it hard?
    In Qatar, over 70% of the population is overweight or obese.
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    zaterdag 17 maart 2018

    Food Standards Agency: FSA board meeting: 14 March 2018

    FSA board meeting: 14 March 2018
    Today's open Board meeting is now live. It is being chaired by the Food Standards Agency Chair Heather Hancock. A link to the webcast is available below.
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    Summary of discussions at FSA Board meeting 14 March 2018
    At its quarterly meeting on Wednesday 14 March, the Food Standards Agency Board discussed the progress on the FSA's science work, a report from the Chair of the FSA Science Council, an update on the raw drinking milk (RDM) programme and the FSA's international strategy.
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    FSA Board meeting now available
    This week's open Board meeting is now available as a video-on-demand. The meeting was chaired by the Food Standards Agency Chair Heather Hancock on 14 March.
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    The Lancet: [Articles] Effect of natalizumab on disease progression in secondary progressive multiple sclerosis (ASCE...

    [Articles] Effect of natalizumab on disease progression in secondary progressive multiple sclerosis (ASCEND): a phase 3, randomised, double-blind, placebo-controlled trial with an open-label extension
    Natalizumab treatment for secondary progressive multiple sclerosis did not reduce progression on the primary multicomponent disability endpoint in part 1, but it did reduce progression on its upper-limb component. Longer-term trials are needed to assess whether treatment of secondary progressive multiple sclerosis might produce benefits on additional disability components.
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    [Comment] Natalizumab in secondary progressive multiple sclerosis
    Although several disease-modifying treatments are available for relapsing types of multiple sclerosis, additional treatment options for progressive types of multiple sclerosis are needed, especially since the available treatments tend to focus on patients who are actively relapsing. In this context, the ASCEND trial by Raju Kapoor and colleagues1 was a two-part study that assessed whether natalizumab slows disease progression unrelated to relapse in patients with secondary progressive multiple sclerosis.
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    [Correspondence] International Classification of Headache Disorders
    The third edition of the International Classification of Headache Disorders (ICHD-3) has now been published.1 This classification and the corresponding diagnostic criteria were initially released as a beta document in 2014; since then, they have been widely accepted and should now form the basis of all diagnosis and management of headache disorders in clinical practice as well as in research. The ICHD-3, like its predecessors, is hierarchical and allows diagnosis in different clinical settings, diagnosing at the first or second level in general practice and at the third, fourth, or fifth level in neurological practice or in headache centres.
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    [In Context] The storm and stress in the adolescent brain
    Sarah-Jayne Blakemore, Professor of Cognitive Neuroscience at University College London (London, UK), is sick of hearing the same joke over and over again. When she informs people that she studies the adolescent brain, she inevitably hears a now familiar refrain: "What? Teenagers have brains?" She's right to take offence, not only on behalf of the young people she works with, but because—as her book, Inventing Ourselves: the Secret Life of the Teenage Brain demonstrates—adolescence is a fascinating and important period of neurological change.
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    [Articles] The effect of APOE and other common genetic variants on the onset of Alzheimer's disease and dementia: a community-based cohort study
    Common variants with small individual effects jointly modify the risk and age at onset of Alzheimer's disease and dementia, particularly in APOE ε4 carriers. These findings highlight the potential of common variants in determining Alzheimer's disease risk.
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    vrijdag 16 maart 2018

    NHS Employers: Making Every Contact Count London

    Making Every Contact Count London
    Take a look at how NHS Employers is supporting Healthy London Partnership to make every contact count in London.
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    Shortlist announced for flu fighter awards 2018
    Find out who has been shortlisted for the 2018 flu fighter awards.
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    HEE Launches report on ARCP review
    Health Education England has published a report summarising the findings from the review of the Annual Review of Competence Progression (ARCP).
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    Non-executive Director, East Cheshire NHS Trust

    Non-executive Director, East Cheshire NHS Trust
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    Provider bulletin: 14 March 2018
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    Bolton NHS Foundation Trust, Non-Executive Director
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    ‘Incredible’ CQC upgrade is endorsement of hospital group model


    Dear Colleague,

    Sir David Dalton says the improvements made at a troubled hospital trust in Greater Manchester have been "incredible", and have come despite it only being offered a "fraction" of the financial support given to struggling trusts in the south east.

    The Care Quality Commission has upgraded Pennine Acute Hospitals Trust to "requires improvement" after being rated "inadequate" in 2016.

    The trust's leadership has been taken over by Salford Royal Foundation Trust as part of its emerging "hospital group" and Sir David is chief executive of both trusts.

    In the previous inspection, the most serious concerns had centred on maternity services at North Manchester General Hospital and Royal Oldham Hospital, as well as urgent and emergency services at NMGH. The CQC previously rated them these services inadequate, but has now found them to be "good".

    The trust's overall leadership has also improved from "inadequate" to "good", and the use of a system to support nurses across the trust was described as outstanding.

    Sir David told HSJ: "It's been a difficult and challenging 18 months and this has meant a lot of hard work, dedication and willingness by staff to implement our improvement plan across our services.

    "Staff can feel a lot of pride in this and heads can be lifted up, it's an incredible result."

    Download the full article for free for further analysis from  HSJ's Lawrence Dunhill.


    Hear from Sir David Dalton at the Patient Safety Congress in July, where he will explain how Pennine Acute Hospitals Trust achieved this incredible turnaround. Book your place today!

    See the full programme and stay up to date here

    For booking enquiries please contact Syed Ali on T: +44 (0) 20 7608 9072, or E: syed.ali@wilmingtonhealthcare.com.

    We look forward to seeing you in Manchester this July.

    The HSJ Patient Safety Congress Team

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