Hear about what participants of the EACPT Focus Meeting 2013 thought about the meeting and why they attended:
People interviewed: Eglė Svitojūtė, Lithuania; Morten Rix Hansen, Odense, Denmark; Aurelija Noreikaite, Lithuania; Gareth Barnes, London, UK; Alexandra Androu, Romania; Madli Pintson, Tartu, Estonia; Julia Daragrjati, Padua, Italy.
Aurelija Noreikaite, Lithuania
A long first day at the EACPT Summer School, starting early from Lithuania in view of our 2 hour time zone difference, and initially lost in Edinburgh. Now after several hours of lecturing at the EACPT Summer School, a hard but very worthwhile day.
Documentation and drug errors - does it sound an interesting topic? Well, in my opinion it depends on the lecturer. I felt attracted by the passionate speaker Phil Routledge, who started from the Independence Day of the USA, setting the presentation into a historical envelope before discussing prospects is what current health professionals can do to reduce risk.
He described standardization as a process that should involve all hospitals, with all practitioners using the same charts for medicine prescribing, coupled to the medical history of the patients. This sounded as “people be equal”. However, as in political ideologies, this may not work well in practice.
Standardization in a patient’s medication chart should help to “encourage and promote patients safety”. But still leaves traps such as abbreviations that might be understood differently. Despite the minuses that standardization has it also offers solutions. Professor Routledge discussed “All Wales Prescription Writing Standards” and how medical students are trained before starting to prescribe medication. He stressed that knowledge is the best way to avoid errors. Thinking ahead, Routledge also discussed moving medical training from paper to electronical prescribing versions, while using lessons from the past to avoid the mistakes in the near future.
Eglė Svitojūtė, Lithuania
s Nowadays everything around us is getting the E letter before the word. E-shopping, e-learning, even e-relationship. So it’s not a surprise that we are at a time for prescriptions to get the E letter as well. Dr Jamie Coleman’s lecture on e-Prescribing during the first day of the Edinburgh EACPT Summer School was really focused on the main issues and the amount of information he gave in the lecture was optimal. The words that stayed with me were “conceptually” and “realistically”. Unfortunately, only an Alice in Wonderland would say that e-prescribing is a simple process. However, if we look at it realistically, it is a very complex process, which involves various specialists. Even though e-prescribing and Clinical Decision Support system can prevent various errors in prescribing medicines, if the system is not established correctly, if there was no collaboration of the staff, that will have to work with this system, and finally, if the system was not optimized, Dr Coleman was clear that we can’t expect astonishing results. So the main message to take home from this lecture would be that if a country wants to establish an e-prescribing system, a lot of effort has to be made for this process to see the light of day.
Morten Rix Hansen, Odense
Ian Wilkinson gave an interesting lecture about his research within cardiovascular disease and especially arteriosclerosis. First he explained the pathology behind the vascular stiffness developing during arteriosclerosis, and how it correlates to pulse wave velocity (PWV). Wilkinson and his team have shown that PWV predicts the risk of hypertension: even more interestingly there was a clear correlation between mortality and PVW in patients with renal failure. Wilkinson and his team have also reported that PWV predicted stroke death in hypertensive patients. Most important was the essence of an meta-analysis published in JACC which showed a 1.42 RR for all cause mortality related to PWV. A key point was showing that patients with rheumatoid arthritis, which is a known risk factor for CVD, had increased aortic stiffness: the punchline was that anti-TNF alfa therapy reduced that stiffness.
Thanks for a great 10th EACPT Summer School in beautiful Edinburgh.
Madli Pintson, University of Tartu, Tartu University Hospital, Estonia
This was the first clinical pharmacology event I have attended. As clinical pharmacology is very new area in Estonia and we have shortage of trainees, it is necessary to attend international courses to be informed about the latest trends in pharmacology.
I especially enjoyed Amitra Ahluwalia’s GSK Prize Lecture about ‘green’ approaches to cardiovascular disease. She talked about how eating green leaves vegetables can lower your blood pressure because green leaves include nitrates. 25% of nitrates go into enterosalivary circulation where they change into nitrites. Hypoxia and acidosis stimulate nitric oxide (NO) production from nitrites. Nitrite reductase transforms nitrites to NO. NO is a strong vasodilator and has antiplatelet effects; this helps to lower your blood pressure and protect against cardiovascular disease.
Also it was fascinating to know that anaerobic micro-organisms in the saliva transforms nitrates to nitrites. Professor Ahluwalia showed data that antiseptic mouthwash reduces this transformation because it destroys bacteria in the saliva. Moreover it is important that you swallow your saliva not spit it out, or you willl also spit out good nitrates and nitrites. As I am a resident both in internal medicine and in clinical pharmacology it was very practical lecture for me. I can suggest that patients eat more green leaves to help themselves to protect their own health. Green leaves are also good for preventing diabetes. More studies are underway to find out whether more green vegetables or 250 ml of beetroot juice a day should be suggested to every person as a way to reduce cardiovascular risk.
Gareth Barnes, Tim Dawes & Gregory Scott, Imperial College, London
The last talk of the morning on day two of the EACPT Summer School was by Sir Michael Rawlins, on "NICE: the first 12 years". NICE, or the National Institute for Health and Care Excellence in its unabbreviated form (did including the H make it sound too much like Nietzsche?) was chaired by Michael Rawlins for 14 years, from its inception in 1999 through to April 2013.
Rawlins described the evolving responsibilities of NICE during his tenure, and the internal changes which he oversaw as a result. NICE is perhaps best known for its work on "technology appraisal", producing recommendations on the use of new (and existing) medicines, medical devices, and so on. But this role has long since been only one slice of the advisory cake that NICE now serves up for the delectation of health professionals. Rawlins presented a timeline of the organisation's seemingly ever-growing remit. Today, NICE assesses interventional procedures as well as diagnostic tests, it produces extensive evidence-based clinical guidelines, as well as quality standards and performance metrics (like the Quality Outcomes Framework), and a range of information services (like NHS Evidence). As of April 1st 2013, courtesy of the Health and Social Care Act, NICE also has responsibility for producing guidance in social care.
Going by this description, NICE is already a behemoth of guidance. An obvious concern is how clinicians can make the best use of everything NICE has to offer. Outlining an accumulated portfolio of hundreds of NICE publications, Rawlins explained how technology is being used to deliver NICE guidance and to help all users navigate the potentially unwieldy back catalogue. He points to examples such as NICE Pathways, an online interactive tool for navigating and drilling-down into the guidance, and the new NICE Guidance smartphone app (available for iPhone and Android).
"NHS denies patients life-saving treatment!". NICE's judgements on the cost-effectiveness of treatments, particularly some expensive cancer treatments, have been a source of much debate. An illuminating part of the talk was on the decision-making processes that go on inside the NICE machinery, particularly the analysis of efficacy and cost effectiveness of treatments. NICE uses the instrument called a quality-adjusted life year, or QALY, to measure the relative benefits of treatments. When combined with information about the cost of treatments over time, use of QALYs provides a common ground on which different treatments can be compared for their cost effectiveness (cost per QALY). The problem of (what the political philosophers call) "distributive justice" in a publicly funded health care system with limited resources, like the NHS, is that treatments that are insufficiently cost-effective (costing too much per QALY) cannot be funded. Defining the threshold for cost effectiveness, i.e. threshold of cost over which treatments shouldn't be funded, is understandably challenging.
Under the chairmanship of Rawlins, NICE has become an organisation at the heart of the health care system, with wide-ranging responsibilities and influence. The guidance Mothership, if you like. Rawlins has not jumped ship (let us continue the analogy) of course. Rather, he is stepping down, waving goodbye, and moving on (he is now President of the Royal Society of Medicine). NICE looks here to stay, but there will be no more Mr Nice Guy.
Lucia Llanos, Madrid
Since I received the acceptance letter to attend this EACPT Summer School, I have been really looking forward to it, and I have to say it has definitely fulfilled my expectations. I was especially impressed by the Friday morning lecture by Ken Paterson. He gave an excellent overview of the multiple tasks performed by the Scottish Health Technology Assessment body, with the purpose of promoting high quality, evidence-based, and (last but not least in these days) efficient care.
Simon Maxwell’s prescribing assessment workshop made me think that maybe such an evaluation program is not only necessary for medical students but also for practicing health professionals involved in prescribing. And finally, what can I say about new forms of communication outlined by Donald Singer? I admit that I am still not very much into this new world of multiple connections, but the fact that I am writing these lines from my mobile phone at the hotel makes me reflect... I’d better get up-to-date!