Pocket Prescriber Update

@HealthMed Pocket Prescriber 2012 was published on 30th March as a book and in e-format, aimed at providing core information to junior doctors, nurse and pharmacist prescribers and medical students and other health professional students interested in drugs and prescribing.
As in previous editions, there is a listing of ~500 of the most commonly used medicines, informed by advice from  experts in the wide range of therapeutic disciplines reflecting current medical practice. We have also included national guidelines aimed at improving safety and effectiveness in prescribing, and advice on management of medical emergencies, supported by guidelines from national and international professional societies, NICE guidelines and Formulary updates.

Over 100,000 copies of the Pocket Prescriber have entered national and international circulation since the first edition was published in 2004, Since 2010, the Pocket Prescriber has progressed to being an annually updated source of prescribing advice.

Online launch by Elsevier of FPM journal - Health Policy and Technology

@HealthMed Health Policy and Technology was launched online on 14th March by the international publisher Elsevier on behalf of the Fellowship of Postgraduate of Medicine (see Editorial on Launch). The print version of the journal will be published later in March.
The first issue of the journal features editorials, reviews and original research by an international range of contributors from USA, Norway, Holland, UK and India. 
Key themes of papers in the issue include diagnostics, technology for drug discovery, e-Health, and health technology assessment, and health policy.
There is also the first in a series of interviews with senior health service, research and industry professionals, and policy makers, starting with Clinical Pharmacologist Sir Michael Rawlins, Chairman of the UK's National Institute for Health and Clinical Excellence.

Helpful links
Podcast of interview with Sir Michael Rawlins, Chair of NICE
HPT website
Background to FPM and the launch of HPT
Fellowship of Postgraduate of Medicine website

Clinical pharmacology theme for Spring 2012 WMPA conference

@HealthMed Registration is now open for members and guests for the Spring meeting of the West Midlands Physicians Association.
The next meeting of the WMPA has updates on Clinical Pharmacology as its major theme and will be held on Wednesday 16th May 2012 at the Clinical Sciences Building at the University Hospital Campus in Coventry. Key speakers will include Dr Andrew Kicman (King's College London) on drugs in sport, Professor of Psychiatry Femi Oyebode (Birmingham) on medicines in psychiatry, Dr Richard Fitzpatrick (Liverpool) on advances in pharmacogenetics and Dr Paul Newrick (Worcestershire Royal Hospital)on medical advances in managing diabetes mellitus.
In view of the large number of high quality abstracts submitted, an attended poster session will be included in the May 2012 meeting.
Registration is open to members and guests (subject to availability of places).
For further information, contact the WMPA organizers.
See the WMPA blog or the WMPA website for more on the WMPA 2012 Spring conference and on the history of this 62 year old medical society.

Drugs don't work if patients don't take them

@HealthMed A surprisingly common problem: WHO estimates published in 2003 and more recent studies suggest that in the developed world around 50% of patients with chronic medical disorders such as diabetes and asthma do not take their medicines regularly. Indeed, for example, for high blood pressure, around half the patients on drug treatment have stopped taking their tablets within the first year of starting treatment. Despite this evidence that many patients are not benefiting from prescribed medicines, these data may even be underestimates of prevalence of low adherence to medicines, as clinical studies are typically conducted in patients willing to participate, who have less co-morbidity and have fewer prescription medicines than is usual in the general population of patients.
There are multiple potential contributory factors, including costs of paying for medicines, lack of insight into medical conditions or awareness of ways in which medicines may help, perceptions that medicines are not working, and concerns about potential or actual adverse effects of medicines.
Personalising medicines using genetic and other companion diagnostics may help to improve adherence by avoiding drugs more likely to cause adverse effects.
Identifying and improving poor adherence is important to maximise disease control, improve quality of life, and to avoid unnecessary investigation, avoidable treatment escalation and avoidable adverse effects if treatments not normally taken are taken variably by a patient or are dispensed e.g. during acute medical admission.
Poor adherence can be recognized in a number of ways, including direct discussion with the patient, tablet counts, checking timeliness of prescription renewal, and both clinical and laboratory clues from expected biological effects of the medicines.
More studies are needed to identify ways to be more effective in helping patients to be more adherent to their medicines. Meantime the UK'S NICE recommends regular informed discussion with patients to improve adherence to their medicines.

© DRJ Singer

Broadcaster Martha Kearney joins judges for 2012 Hippocrates Awards for Poetry and Medicine

@HealthMed BBC broadcaster and journalist Martha Kearney has joined New York poet and critic Marilyn Hacker and medical scientist Professor Rod Flower FRS to complete the judging panel for the 2012 Hippocrates Awards for Poetry and Medicine.

Martha Kearney, Marilyn Hacker and Rod Flower, FRS.

In its first 2 years, the Hippocrates Prize attracted over 3000 entries from 32 countries, from the Americas to Fiji and Finland to Australasia.

The Hippocrates poetry and medicine initiative was co-founded by a team from the University of Warwick, supported by several external organizations interested in medicine and the arts. 

The Hippocrates initiative was named winner of the Award for Excellence and Innovation in the Arts in the 2011 Times Higher Education awards, announced 24th November 2011 in London. This award aims to recognise the collaborative and interdisciplinary work that is taking place in universities to promote the arts.

Entries are now closed for the 2012 Hippocrates Prize for poetry and medicine, which is for unpublished poems in English.

With a 1st prize for the winning poem in each category of £5,000, the Hippocrates prize is one of the highest value poetry awards in the world for a single poem. In each category there is also a 2^nd prize of £1,000, 3^rd  prize of £500, and 20 commendations each of £50. 

Medicine may be interpreted in the broadest sense. Themes for prize entries may include the nature of the body and anatomy; the history, evolution, current and future state of medical science; the nature and experience of tests; the experience of doctors, nurses and other staff in hospitals and in the community. 

Other topics might include experience of patients, families, friends and carers; experiences of acute and long-term illness, dying, birth, cure and convalescence; the patient journey; the nature and experience of treatment with herbs, chemicals and devices used in medicine.

Awards are in an Open category, which anyone in the world may enter, and an NHS category, which is open to UK National Health Service employees, health students and those working in professional organisations involved in education and training of NHS students and staff.

Awards will be presented in London on Saturday May 12th 2012, at the 3rd International Symposium on Poetry and Medicine, to be held at the Wellcome Collection rooms in London.

Marilyn Hacker's book of poetry Presentation Piece (1974) won the National Book Award. In 2009, she won the PEN Award for Poetry in Translation for King of a Hundred Horsemen by Marie Étienne. In 2010, she received the PEN/Voelcker Award for Poetry.

Rod Flower is Professor of Biochemical Pharmacology at the WIlliam Harvey Research Institute^[21] in London. His main scientific research interests concern inflammation and anti-inflammatory drug mechanisms. He was formerly President of the British Pharmacological Society and is a Fellow of the Academy of Medical Sciences.

Martha Kearney is the main presenter for BBC Radio 4’s lunchtime news programme ‘The World at One’. She previously worked for Channel 4, presented the BBC’s Woman’s Hour, Today and PM and was political editor for Newsnight.  She has been commended for her national and international reporting, including for work on child poverty. She has been a judge for the Webb Essay Prize and the Guardian First Book Award, and has chaired the judging panel for the Orange Prize for Fiction.  

Marilyn Hacker said: ‘The enormous scope and the intense focus provided by this conjunction combine to entice and hold a reader's attention. The poems I read from the 2011 submissions touched basic and utterly complex human issues, with extreme attention and with admirable verbal bravura. I look forward to reading the new ones.’ 

Rod Flower observed that ‘poetry can reconnect us with ourselves, and with the outside world, in a way that promotes a feeling of well-being and acceptance…and in some mysterious way, poetry enables us to gain traction on the conflicting emotions stirred up by the suffering of disease or the triumph of the cure.’

He added that ‘As a professional pharmacologist with a deep interest in the discovery and use of new medicines to mitigate the ravages of disease, I am delighted to be amongst the panel of judges this year and am eagerly anticipating the challenge of enjoying – and assessing – this year’s entries.’  

The 2012 Awards are supported by the Fellowship of Postgraduate Medicine and the Cardiovascular Research Trust.
The Hippocrates initiative for poetry and medicine was co-founded by clinician and medical researcher Professor Donald Singer and poet and translator Michael Hulse. The 2012 awards are co-organized by humanities researcher Sorcha Gunne.

-->

See also 

- Enter online for the 2012 Hippocrates awards for poetry and medicine   

- Register for the 12th May International Symposium on Poetry and Medicine

- Submit a paper for the 12th May International Symposium on Poetry and Medicine 
- Nominate your favourite poem with a medical theme
- View and listen to podcasts from 2010 and 2011 Hippocrates Awards and Symposia 
- Press and media reports on previous Hippocrates Awards 
- Order Anthology for 2010 or 2011 winning entries for the Hippocrates Awards 
- Hippocrates poetry and medicine initiative
- International Hippocrates Research Forum for poetry and medicine. This includes poets, academics and health professionals in the UK, Europe and the USA. 

- Origins of the Hippocrates poetry and medicine initiative  

Notes

Poems entered are to be of no more than 50 lines and submitted online, accompanied by an entry fee (£6 per poem). 
Judging of submissions will be anonymised.
The deadline for submissions is 31^st January 2012.
For more details please visit the website www.hippocrates-poetry.org.

The Fellowship of Postgraduate Medicine is a national medical society founded in 1918 and publisher of the Postgraduate Medical Journal and Health Policy and Technology.

The Cardiovascular Research Trust is a charity founded in 1996, which promotes research and education for the prevention and treatment of disorders of the heart and circulation. The charity founded Healthy Heart Awards for schools and colleges.

Information on health and disease from the patient's perspective

@HealthMed Where can patients and their family, friends and carers go for advice from the patient's perspective about  health-related conditions? And how can health professionals gain insight into patients' perspectives on their health or illnesses. Individual disease-focused charities and patient associations are ever better at providing patient friendly advice.
A further excellent web resource is Health Talk Online, with over 60 serious and common diseases represented, based on the experience of over 2000 patients. Conditions and issues covered range from heart risk and disease to cancer and women's health. This resource was established by the Charity DIPEx, in collaboration with health scientists from the University of Oxford (the Health Experiences Research Group), and is coupled to the website Youth Health Talk, which is about 'young people's real life experiences of health and lifestyle'. Health Talk Online aims to use the real life experience of people to discuss health, health-related conditions and illnesses, including insight into tests and therapies (and their possible adverse effects), what outcomes to expect from treatment with drugs and/or devices, news, and updates on progress in medical research, patients' viewpoints about the impact on their life of the health conditions of interest,  and discussion forums.
It is vital that information sources such as this are reliable. With that in mind it is noteworthy that the charity DIPEx has been selected by the UK's Department of Health to help to pilot an accreditation scheme  using 'kite marking' to indicate reliability of organisations that provide information about health and social care.

Assessing prescribing skills

@HealthMed Doctors and other prescribers internationally find prescribing challenging. To get this right at times of high pressure, including in the emergency medicine setting, it is vital that basic skills are as well developed as possible. Add to that the need for care in calculation, avoiding the distracting effects of multi-tasking, challenges in medicines reconciliation, and risks inherent in shift-working and other complex work patterns. And electronic prescribing systems alone are not a sufficient safeguard. For example, reporting from the USA indicates that error rates may increase following the move from paper to electronic prescribing. The complex range of skills needed for safe and effective prescribing includes sound core knowledge of basic mechanisms of drug action, drug use in the clinical setting, and the impact of patient genetics, age, gender, lifestyle, the disease to be treated as well as co-existing medical conditions and the impact of other drugs and remedies. Many of these principles are easier to put into practice by adopting a personalized approach to therapeutics, with the aim of prescribing the right drug or drugs at the right dose to the right patient for the right disease and at the right time.

To help to increase focus on early training in essential prescribing principles and practice, in the United Kingdom the British Pharmacological Society and the Medical Schools Council supported by a national team of experts, to develop a Prescribing Skills Assessment that will eventually allow all students to rehearse and demonstrate competencies relevant to safe and effective initiation, monitoring, review and, when needed change in route, dose, duration or type of medicines alone and in combination in clinical practice, along with skills in communicating key points about medicines to patients, their carers and to relevant health professional colleagues.

See related blogs on
- Improving prevention of serious adverse drug reactions 
- Personalized medicine for better drug discovery

Advances in treating acute lung syndromes

@HealthMed Although only described as recently as 1967, a range of important contributory factors have been defined for acute respiratory distress syndrome (ARDS), which is now recognized to be at the severe end of a spectrum of acute lung injury, which imposes high risk for patients and which confers a major burden on health services. Outcome of treating the syndrome has been much improved by developments in devices to treat lung and other organ failure, supported by advances in expertise in intensive care. However, other than treatments for underlying causes, there is still important unmet need with regard to effective specific pharmacological treatments.

A timely review of ARDS by Dushianthan and colleagues is the Editor’s choice article in the September issue of the Postgraduate Medical Journal.  These experts from Southampton provide an update on knowledge of risk factors, including genetic biomarkers, for development of ARDS and other acute lung injury variants, and an up-to-date commentary on general and specific treatment options.

The authors note that ‘sepsis, pneumonia, and trauma with multiple transfusions’ account for most episodes. They highlight the importance for recovery of ‘general supportive measures such as appropriate antimicrobial therapy, early enteral nutrition, prophylaxis against venous thrombo-embolism and gastrointestinal ulceration’.

They discuss encouraging experimental evidence from trials of corticosteroids, nitric oxide, prostacyclins, exogenous surfactants, ketoconazole and antioxidants, however note that these findings have not as yet being translated into benefits for patients. They note as further treatment targets of interest, new approaches to modulating inflammation, and use of mesenchymal stem cells.

See the free full article for further details.