The Society also will share its vitamin D Clinical Practice Guideline publicly for the first time during a news conference on Monday, June 3. Reporters will have an opportunity to hear directly from members of the guideline development panel.

Other press conferences will feature select abstracts that are being presented at ENDO 2024, the Endocrine Society’s annual meeting taking place this year in Boston, Mass. The news conference slate will wrap up with a panel discussion of the endocrine-disrupting chemicals landscape. The news conferences are being held at the Boston Convention and Exhibition Center. News conferences will be livestreamed for those who are unable to attend in person.

To register for the livestream, visit endomediastream.com. Journalists can register to attend in person and learn more about the meeting on our website.

News Conference Schedule:

Saturday, June 1

Pediatric Health (9 a.m. ET): Researchers will discuss anti-obesity medication prescribing for teenagers, the link between sedentary time during childhood and the risk of metabolic dysfunction-associated steatotic liver disease in adulthood, and the impact of early life stress on the onset of drug and alcohol use.

Diabetes and Obesity (11 a.m. ET): The session will discuss the impact of social vulnerability on blood sugar control in people with diabetes; the association between testosterone, waist size, and diabetes risk in middle aged and older men; prediabetes as a risk factor for mortality in Latin America; and the impact of diabetes and anti-obesity medication semaglutide on taste perception.

Sunday, June 2

Obesity (9 a.m. ET): Featured studies will explore heart disease risk among people who have lived with obesity for a decade as well as predictors of weight gain among breast cancer survivors.

Reproductive health (11 a.m. ET): Researchers will discuss a new clinical trial of a male birth control gel, symptoms experienced by men who stop using anabolic steroids within the first year of cessation, and the association between menopausal symptoms such as hot flashes and metabolic dysfunction-associated steatotic liver disease.

Monday, June 3

Debut of the Society’s Vitamin D Clinical Practice Guideline (8 a.m. ET): Experts will discuss the Society’s recommendations for vitamin D supplementation.

Endocrine-disrupting Chemicals (11 a.m. ET): Society spokespeople Marina Fernandez, Ph.D., Leonardo Trasande, M.D., M.P.P., and Scott Belcher, Ph.D., will share the latest on the United Nations Environmental Assembly’s plastics treaty negotiations and the scientific and regulatory landscape around per-and polyfluoroalkyl substances (PFAS).

Register to attend the news conferences at endomediastream.com. Credentialed journalists will be given priority to attend. Recordings will be available on the Society’s website following the event.

# # #

Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world’s oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions.

The Society has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at @TheEndoSociety and @EndoMedia.

The theme of the 28^th EAHP congress was Sustainable healthcare – opportunities and strategies. Management of antimicrobial resistance (AMR) and good antimicrobial stewardship are two important measures that contribute to the wider sustainability agenda. Two posters illustrated ways in which these issues are being tackled in hospitals.

Pappalardo and colleagues  (Catania, Italy; poster 4CPS-015) described how they had used the World Health Organisation AWaRe tool to evaluate the antibiotic usage patterns in seven suburban hospitals as a way of assessing the performance of local antibiotic stewardship initiatives.

The AWaRe tool classifies antimicrobials into three groups: Access, Watch and Reserve.  WHO guidance recommends treatment for a range of common infections, agents from the first group (‘Access’) in the first instance. In fact, WHO has set a target that at least 60% of overall country-level antibiotic use should be from the Access group by 2023, to contain rising resistance and make antibiotic use safer and more effective.

The researchers in Catania found that the majority (75%) of antimicrobials used in their  Local Health Authority were in the ‘Watch’ category. They concluded that further efforts were required by the Antibiotic Stewardship Team to improve the appropriate use of antibiotics.

Fésüs and colleagues (Debrecen, Hungary; poster 4CPS-036) undertook a retrospective study of antibiotic prescribing for patients hospitalised with urinary tract infections (UTIs). The results showed that of 185 patients who received antibiotics for UTIs 77(42%) did not meet the European Association of Urology (EAU) diagnostic criteria and 46 of these were classified as misdiagnoses. Furthermore, fewer than 50% of the initial empirical therapies were guideline-adherent.  The authors concluded that there was a relatively high rate of non-confirmed UTIs and that written protocols may be crucial in reducing misdiagnosis and in optimising antibiotic use.

The 28^th EAHP Congress took place in Bordeaux, France 20^th-22^nd March 2024. The congress theme was: Sustainable healthcare – opportunities and strategies.

The theme of the 28^th EAHP congress was Sustainable healthcare – opportunities and strategies and several posters addressed different approaches to avoiding or minimising wastage of medicines in hospital pharmacy.

Pousada-Fonseca and colleagues (Móstoles, Spain; poster 6ER-005)  undertook a retrospective study to estimate the costs of wastage due to dose modifications and discontinuation of oral anti-cancer treatment. A total of 1239 prescriptions were identified for enzalutamide, ribociclib, niraparib and lenvatinib. Of these, 63 were interrupted and on 34 occasions patients had tablets remaining.  The total cost of drugs wasted in this way amounted to €56,459 – a sum that would have covered the cost of 17 prescriptions, the authors calculated.  Although only a small number of prescriptions were discontinued, the costs were considerable because of the price of the medicines.  At present Spanish law bans the return of dispensed medicines to the pharmacy services and therefore this represents a hidden cost of cancer care. One option might be for hospital pharmacists to be permitted to decide whether unused medicines could be returned for re-dispensing, they suggest.

Re-dispensing of oral anti-cancer medicines (OAM) is exactly what Akgöl and colleagues (Amsterdam, The Netherlands;) described in their poster.  They calculated that the average monthly expenditure on OAM was €3200 per patient. Approximately 33% pf patients discontinue treatment and 50% pf these have redundant medicines at home.  The authors developed a rigorous procedure to identify and assess the quality of these ‘left over’ OAM. Implementation of this procedure over a one-year period resulted showed that 79% of returned medicines were suitable for re-dispensing and the value of these was €483,301.  The authors concluded that wider implementation of this scheme would result in a significant reduction in financial waste and environmental burden.

Reducing wastage at ward level

Sørensen and colleagues (Central Region, Denmark) described how a mobile phone app had been developed to scan medicine packs on wards and speed up the process of expiry-date checking.  In 2020 a sustainability project had shown that manual expiry-checking was a particularly time-consuming task for pharmacy staff.  Once scanned, packs can be marked as ‘used’, ‘discarded’ or ‘released’.  ‘Released’ medicines are then available for use on other wards in the hospital. Lead author Charlotte Sørensen explained that this is important because many wards hold large stocks of medicines which are delivered from a central (remote) unit.

The app was progressively implemented in four hospitals starting in Spring 2023.  It has given pharmacy staff a useful overview of medicines nearing expiry. So far, medicines to the value of €147,000 have been moved and some 215 packages (value €20,000) have been exchanged between hospitals.  The full potential of the app has yet to be reached but it is expected that for wards ‘to go shopping’ in the app before ordering from the pharmacy will probably reduce medicines’ wastage even further, the authors suggest.

The 28^th EAHP Congress took place in Bordeaux, France 20^th-22^nd March 2024. The congress theme was: Sustainable healthcare – opportunities and strategies.

The theme of the 28^th EAHP congress was Sustainable healthcare – opportunities and strategies and two posters addressed different approaches to sustainability issues in hospital pharmacy.

Anna Harjans and colleagues, Heidelberg, Germany) described a project to reduce the number of metered dose inhalers (MDIs) issued by the hospital pharmacy. The rationale for this was that the propellant norflurane, which is commonly used in MDIs, has a Global Warming Potential 1,430 times greater than carbon dioxide. After a careful analysis of the products in the hospital formulary, one MDI was replaced by an equivalent dry powder inhaler (DPI). The authors calculated that this change enabled the hospital pharmacy to reduce CO₂ emissions by 2,921.9 Kg in the year following the change. 

Another approach to the sustainability issue was the development and testing of environmental criteria for the drug purchasing process.  Outi Lapatto-Reiniluoto and colleagues (Helsinki, Finland) described how this was done with six simple questions requiring yes/no/don’t know answers that were scored 2,1 or 0. An example of a question was: Does the company have a plan to reduce CO₂ emissions caused by itself? Two additional questions were added for companies supplying antibiotics. For example, one question required the company to specify where the active pharmaceutical ingredient (API) was made. The rationale for this being that it was necessary for a company to know this in order to take responsibility for the wastewater treatment of its products.

A total of 172 companies responded with 65 achieving the maximum 12 points and 38 achieving 0 points.  The authors noted wide variations in responses to the questions about antibiotics. Fifteen out of 41 companies were not able to provide acceptable answers. This study showed that the questions could be answered easily and now discussion is needed to determine how they should be used. For example, responsible companies might be rewarded and those who are unable to answer the questions might be excluded, the authors suggested.

The 28^th EAHP Congress took place in Bordeaux, France 20^th-22^nd March 2024. The congress theme was: Sustainable healthcare – opportunities and strategies.

No fewer than 11 posters from Spanish pharmacists dealt with the use of monoclonal antibodies in the management of migraine. Anti-CGRP (calcitonin gene-related peptide) antibodies bind to the receptor (e.g. erenumab) or to the CGRP molecule itself (e.g. eptinezumab, fremanezumab, and galcanezumab). Aspects explored by the Spanish researchers included real-world safety and effectiveness, switching between products and quality of life.

Real-world safety and effectiveness

Garcia-Lastra and colleagues (Aviles, Spain; poster 5PSQ-053) conducted a retrospective study of 32 patients who had received galcanezumab for prevention of migraine. Treatment was considered effective if there was a reduction of at least 50% in the migraine days per month (MDM) or a reduction of more than five points on the Headache Impact Test (HIT-6) score. The median duration of treatment was 19 months. The authors  reported that the MDM fell from 15 to 5 and the HIT-6 score fell from 69 to 57. At the end of the study period on 15.4% of patients had discontinued the drug due to side effects or ineffectiveness.

Estrada and colleagues (Badalona, Spain; poster 4CPS-043) assessed the one-year safety and efficacy of prophylactic anti-CGRP treatment with erenumab, galcanezumab and fremanezumab. A total of 42 patients was included. The authors noted that high response rates (more than 50% reduction in monthly migraine days (MMD)) were achieved with all three agents. Only three discontinued treatments due to adverse effects.

Losa-Lopez and colleagues (Sant Joan Despi, Spain; poster 4 CPS-160) examined the outcomes of long-term (12 months or more) prophylactic treatment of 64 people with chronic and episodic migraine. The mean number of migraine days (before galcanezumab treatment) was 20.46 ± 6.55 days per month for chronic migraine and 12±1.48 for episodic migraine and the mean duration of treatment was 18.4 (1.9 – 34.9) months. It is noteworthy that 20 patients discontinued galcanezumab because of lack of response.

Diaz-Perales and colleagues (Malaga, Spain; poster 5PSQ-072) looked at the real-world safety of galcanezumab in patients with chronic migraine. They reported that 17 of 110 patients discontinued treatment and of these, 29.4% did so because of intolerance. Reactions included weight gain, constipation generalised itching and local reactions. The authors noted that discontinuation due to drug intolerance was lower than reported in the pivotal trials.

Ojeda and colleagues (Barcelona, Spain; poster 4CPS-091) examined real-life persistence with treatment in 207 people who received prophylactic fremanezumab. At three-month and six-month follow-ups, persistence was 92.6% and 80.0%, respectively. The percentages of people who achieved a 50% reduction in monthly migraine days was 56.8% at three months and 54.5% at six months. A total of 27% of people developed side effects, the most common of which were allergic reactions or pruritus.

Therapeutic breaks

Some local guidelines advise a therapeutic break after 12 months treatment with an anti-CGRP agent. Two groups focused on this aspect of anti-CGRP use.

De Castro-Avedillo and colleagues (Leon, Spain; poster 4CPS-144) described the patterns of drug usage in 74 patients treated with erenumab or galcanezumab. They reported that about half the patients had to restart treatment after a therapeutic break of about six months. Of these, about half restarted with the same drug.

Similarly, Gomez and colleagues (Santander, Spain; poster 4CPS-020) described the patterns of drug usage with erenumab and galcanezumab in 273 patients.  They concluded that their results did not demonstrate high effectiveness after 12 months. Moreover, there was no difference between the two drugs.

Switching between monoclonal antibodies

In clinical practice switching between different anti-CGRP monoclonal antibodies occurs but there are no clinical trial data to support the effectiveness of this practice.

Cantudo-Cuenca and colleagues (Granada, Spain; poster 4CPS-018) analysed results from 215 patients who had failed to respond to treatment with a monoclonal antibody for three months and had then switched to another class of monoclonal antibody. They identified 110 patients treated with galcanezumab or fremanezumab (both CGRP-ligands), 24 of whom were switched to the CGRP receptor antibody, erenumab. Of 105 patients treated with erenumab, 30 were switched to a CGRP-ligand. They noted that this appeared to be a promising approach.

Mayo and colleagues (Madrid, Spain; poster 4CPS-202) reviewed a total of 55 treatments in 18 patients who had received, for at least three months, fremanezumab (225mg/month), galcanezumab (120mg/month) and erenumab (140mg/month). The mean number of headache days at baseline was 20.6 (SD 7.8) days.  However, their results showed that only a maximum of 16% of patients could be ‘rescued’, taking a 30% decrease in in the number of headache days per month as the efficacy threshold.

Symptomatic medication overuse

Chronic migraine is associated with the risk of analgesic overuse or abuse. Tudela and colleagues (Cadiz, Spain; poster 4CPS-115) evaluated 54 people suffering from chronic migraine who received at least three months treatment with fremanezumab (225mg monthly injection). The median duration of treatment was 12 months. Forty people were converted to episodic migraineurs with the monthly number of headache days falling from 28.7 (95% CI 27.1 – 30.0) to 4.0  (95% CI 3.9 – 6.4). and episodic migraine. Importantly, the percentage of these people who were classified as ‘symptomatic medication over-users’ decreased from 97.5% to 2.5%.

Quality of life

Velez and colleagues (Leon, Spain; poster 4CPS-010) evaluated quality of life (QoL) using EQ-5D-5L questionnaire in 32 patients receiving erenumab for chronic or episodic, high frequency migraine. The results showed significant reductions in frequency and intensity of migraines for 30 responders and corresponding increases in the quality of life (fewer problems with daily activities, anxiety/depression and mobility). Two patients stopped treatment due to lack of response.

The 28^th EAHP Congress took place in Bordeaux, France 20^th-22^nd March 2024. The congress theme was: Sustainable healthcare – opportunities and strategies.

Antimicrobial resistance (AMR) caused an estimated five million deaths in 2019 and by 2050 this is likely to rise to 10 million as an inevitable consequence of repeated exposure to antimicrobials. This has prompted renewed interest in the use of bacteriophages – naturally-occurring viruses that infect bacteria, Dr Andrew Gainey, a paediatric infectious diseases specialist pharmacist, told the audience.

Phage therapy utilises lytic phages that attach themselves to bacteria, inject their nucleic acids, causing rapid synthesis of viral DNA and proteins so that the bacterial cells burst open releasing many more mature phages. Finding a suitable lytic phage for therapeutic use involves seeding a bacterial lawn (containing bacteria isolated from the patient) with a mixture of phages and looking for the clear areas where phages have lysed (killed) the bacteria, explained Dr Gainey.  Phage banks are now being established but only limited trials have been carried out so far, he added.

By definition, bacteriophages are only suitable for bacterial infections and not for viral, fungal or parasitic infections. They are not suitable for first-line therapy, but they can be used safely in immunocompromised patients. Phages can be used singly or in ‘phage cocktails’. They can also be co-administered with antibiotics and may have synergistic actions. It has been suggested that they could resensitise an organism to antibiotics. Another useful property of phages is that they are able to penetrate biofilms. Some phages produce matrix-degrading enzymes that break down biofilms and it may be this that allows antibiotics to reach the site of action. It is possible to have phage-specific antibodies that neutralise the phages but these take time (7-10 days) to develop. Adverse effects are rarely reported.

When it comes to clinical use, phages are dosed in plaque-forming units (PFUs). It is estimated that about 10 phages are needed for each bacterial cell and that a bacterial load of at least 10⁴ colony-forming units (CFUs) is needed for self-amplification to occur and effective treatment to start. Repeated doses are usually given and the duration of treatment is similar to that for site-specific antibiotic treatment. Thus, for example, when treating recurrent pyelonephritis, a dose of 10⁹ PFUs, intravenously every 12 hours, may be offered. When phage treatment starts improvements can be expected after 7-10 days, said Dr Gainey. The STAMP trial (Standardised Treatment and Monitoring Protocol for Adults and Paediatric Patients) in Australia is evaluating the clinical protocol for administering and monitoring phage therapy, he added.

There are both opportunities and obstacle in the field of phage therapy at present, said Dr Gainey. Major advantages include the fact that phages are self-replicating at the site of infection, have low toxicity and are species specific. On the other hand, most evidence comes from case series rather than RCTs, time-to-treatment can be lengthy and a large bacterial burden is required “to maximise the phage burst size”, he said.  Phage treatment centres are now being established and the Center for Innovative Phage Applications and Therapeutics (IPATH) at the University of California, San Diego is currently the best established.

Phage treatment successes

There have been a number of reports of successful treatments with phages and these have helped researchers to identify the most appropriate situations for phage therapy. One report concerned 16 cases of refractory Pseudomonas infections (including osteomyelitis, bacteraemia and joint infections) treated with a specific phage (PASA16). The authors reported a recovery/remission rate of 86.6 per cent.¹. Ling and colleagues described how more than 30 patients with cystic fibrosis (CF) and chronic pulmonary colonisation had been successfully treated with phage cocktails.² This had resulted in improved lung function, reductions in sputum production and coughing and, in some cases eradication of infection. A multi-centre, randomised, controlled trial of inhaled phage therapy – SWARM-P.a. – for CF was recently completed in the US. Many studies are in preliminary phases. Trials so far report minimal adverse effects associated with phage therapy.

The ideal patients for phage therapy are those with chronic colonisation or recurrent infections and those infected with drug resistant organisms. Dr Gainey described his own experiences with three patients who had received phage therapy. One was a patient with recurrent urosepsis due to infections with extended spectrum beta-lactamase (ESBL) E coli and one had CF with chronic colonisation with pan-drug resistant Achromobacter. Another patient with CF had been colonised with Mycobaterium avium complex (MAC) for six years. In each case, concurrent antibiotic treatment had been given for part of the treatment period and the phage treatment resulted in clinical improvements.

References

1. Onallah H, Hazan R, Nir-Paz Ran et al. Refractory Pseudomonas aeruginosa infections treated with phage PASA16: A compassionate use case series. Med 2023: 4; 600-11 e4
2. Ling K-M, Stick SM, Kicic A. Pulmonary bacteriophage and cystic fibrosis airway mucus: friends or foes? Front Med 2023: 10. https://doi.org/10.3389/fmed.2023.1088494

Dr Andrew B Gainey PharmD, AAHIVP, BCIDP, Prisma Health Children’s Hospital – Midlands; University of South Carolina College of Pharmacy. Dr Gainey gave a presentation entitled, The new age of phage therapy: Utilising viruses to treat antimicrobial resistant infections as part of the ‘Spotlight on Science’ session at the ASHP Midyear Clinical Meeting held in Anaheim, California, USA, December 3-7^th 2023.

In November 2023 The Pharmacy Technician Society (TPTS) was launched under the wing of The American Society for Health System Pharmacists (ASHP). More than 7000 pharmacy technicians had joined the TPTS by December 2023.

TPTS is a new organisation led by pharmacy technicians and supported by the ASHP. It aims to provide critical advocacy and advancement opportunities for the pharmacy technician workforce in all patient care settings. The new organization offers a range of services, including comprehensive continuing education, career development, networking, publications and resources, and standards for the professional practice of pharmacy technicians. TPTS will also advocate for federal and state policies and regulations that promote safe and effective medication use and advanced technician roles.

TPTS builds on the work done by its forerunner, the ASHP Pharmacy Technician Forum, which has existed since  2018.

“The launch of TPTS is a historic moment”, said Hannah K. Vanderpool, PharmD, MA, executive director of TPTS and vice president of ASHP’s office of member relations. “We need to ensure technicians across all practice settings have the support they need to thrive, and are pleased to provide a new professional home solely dedicated to empowering pharmacy technicians as we support advancements in technicians” careers, expansion of technician knowledge and skills, and advocacy and leadership for the technician workforce.”

TPTS is offering pharmacy technicians a free trial membership until June 30, 2024, with all members receiving:

• Access to continuing education, webinars, podcasts, and practice resources such as a monthly newsletter, a comprehensive website, and career development services.
• Opportunities to connect with other pharmacy technician professionals across the country through live and virtual networking forums.
• National and state advocacy on behalf of pharmacy technicians.
• Venues to create and advocate for policies and regulations that promote safe medication use and create advanced practice positions for technicians.
• Toolkits, guidelines, publications, and other resources that support the daily work and advancement of pharmacy technicians.

TPTS will appoint members to its inaugural Board of Directors in 2024, and technicians will vote for TPTS Board members going forward.

Sharon L. Youmans, PharmD, MPH is Professor of Clinical Pharmacy and Executive Vice Dean, University of California San Francisco (UCSF) School of Pharmacy.  She is a respected educator, scholar, and leader with a passion for reducing racial and ethnic disparities in healthcare by fostering a more diverse, equitable, and inclusive healthcare workforce.  The joint leadership award was presented at the Annual Luncheon Meeting of the Association of Black Hospital Pharmacists (ABHP), held during the ASHP Midyear Clinical Meeting in Anaheim, California in December 2023

Presenting the award, ASHP President-elect Leigh Briscoe-Dwyer said:

“For many years, ASHP and ABHP have worked together to implement a shared vision in which pharmacy serves the healthcare needs of our communities. ASHP and ABHP recognize the vital role of pharmacists to improve, advance, and transform healthcare for all patients.

“For these reasons, it is fitting that today we honour Dr. Youmans … with the ASHP-ABHP Joint Leadership Award for her exceptional leadership in addressing racial and ethnic disparities in healthcare and fostering a more diverse and culturally literate healthcare workforce”.

For 15 years, Dr. Youmans has been the UCSF pharmacy school’s representative for the university’s diversity, equity, and inclusion initiatives. In particular, she led the transformation of the pharmacy school admissions process to encourage diversity, ushering in a system that considers candidates’ life experiences along with their academic record and also helped to transform the PharmD program to better support student pharmacists as they progress through their training.

In 2009, Dr. Youmans was named to the Center for Minority Health and Health Disparities Research and Education Advisory Board of the Xavier University of Louisiana College of Pharmacy. She has also served for a decade on the USCF Council on Campus Climate, Culture, and Inclusion, is a member of a UCSF executive council that guides the university’s anti-racism initiative, and is part of the University of California systemwide leadership collaborative that implements training materials and metrics in support of antiracism initiatives in all the university’s health science schools.

Dr. Youmans has been recognized numerous times over the years for her sustained leadership and contributions to the pharmacy profession. Her professional honors include more than a dozen awards from the UCSF School of Pharmacy that recognize her work as an educator, including:

• the UCSF 150th Anniversary Alumni Excellence Award
• the UCSF Founders Champion Award in recognition of her contributions to DEI, and
• the UCSF Chancellor Award for Dr. Martin Luther King, Jr. Leadership in recognition of her outstanding leadership in expanding diversity, equity, and inclusion and advancing anti-racism.

Japanese researchers reported these findings on February 9, 2022 at the American Stroke Association’s International Stroke Conference in New Orleans.

“Our findings confirm that anyone who suffers from stroke should be transferred to a medical facility capable of endovascular therapy as soon as possible. The benefit of endovascular therapy is not limited by the severity or region of a stroke,” said Takeshi Morimoto, M.D., Ph.D., M.P.H., senior author and professor of medicine in the department of clinical epidemiology at Hyogo College of Medicine in Nishinomiya, Japan.

In endovascular therapy, a catheter is threated through a blood vessel in the leg to mechanically remove a clot that blocks a brain vessel.

The researchers enrolled 203 subjects and randomized 101 to endovascular therapy plus standard care and 103 to standard care. Mean age was 76 years (44 % female).

On imaging, the attending clinicians found that all subjects had clots blocking a large artery in the brain, the internal carotid artery, the proximal middle cerebral artery or both. All of the strokes were severe, with a median score of 22 on the National Institutes of Health (NIH) Stroke Scale.

The clinicians also used the Alberta stroke program early CT score (ASPECTS), a 10-point quantitative CT scan score used for patients with middle cerebral artery stroke. A lower ASPECTS score translates to a stroke affecting more core areas of the brain: 8-10=small core, 6-7=moderate core and 0-5=large core.

Current U.S. stroke guidelines recommend endovascular therapy for a score of 6-9. In this new study, the investigators studied blockages with a score of 3-5.

The researchers reported that subjects who had received endovascular therapy were, at 90 days post-intervention, 2.43 times more likely (31% intervention vs. 13% non-intervention) to walk without assistance and to have residual disability rated as none to moderate.

And after 90 days, more subjects (14% intervention vs. 6.9% non-intervention) who had received endovascular therapy were deemed to have achieved functional independence and were able to undertake pre-stroke activities — or to have a slight disability not requiring daily assistance.

At 48 hours after treatment, more of the patients (31% intervention vs. 8.8% non-intervention) who had received endovascular therapy showed improved speech and limb movement.

“These patients may have the chance to more fully recover from stroke and go back to their previous lives and activity levels,” added Morimoto.

In 2016 the UKLCC report, 25 by 25, described the steps required to reach a five-year survival for lung cancer patients of 25% by the year 2025. The NHS Long Term Plan later set an ambition to diagnose 75% of cancer at stages I and II (instead of stages II and IV). This was “a big ask in lung cancer”, said Professor Rintoul. There was also a levelling up agenda to ensure that people with lung cancer had outcomes in line with other cancers.

When the pandemic hit in 2020 there was a big drop in two-week wait referrals and many thousands of people with lung cancer probably died without ever having been recognised as lung cancer patients. At that stage the estimated five-year survival was 17.6% (for patients diagnosed 2014 to 2018) and was “on an upward trajectory”. However, during the pandemic five-year survival fell to about 13%.

The key findings of the NLCA report were:

• In 2020 in England, curative treatment rates for stage I/II with good performance status fell from 81% (in 2019) to 73%.
• The surgical resection rate fell from 20% to 15%
• Overall, there were more emergency presentations, patients had worse performance status and were less likely to have pathological diagnosis.

Moreover, NHS England targeted lung health checks in England were just getting under way when the pandemic struck and had to stop or slow down as a result.  Activity has since picked up and there are now just over 40 lung health check programmes running across England.

The first recommendation in the UKLCC report is that there should be a roll out of a full lung cancer screening programme across all four nations at the earliest opportunity. This “would do more to improve lung cancer survival than any other intervention – that’s probably the biggest winner we could have”, said Professor Rintoul.

Other key recommendations include the funding of twice-yearly public awareness campaigns and a dedicated lung cancer telephone helpline to ensure that people who are worried about signs and symptoms of lung cancer have access to support and can “get advice about what to do next”, he said.  Many clinicians have heard from patients and families who have struggled to find appropriate information and services, he explained.

The full report sets out no fewer than 10 recommendations, all of which are focused on measures to rebuild and recover from the consequences of the pandemic on lung cancer and get back on track to deliver a step change in lung cancer outcomes.

About the UKLCC

The UK Lung Cancer Coalition (UKLCC) is the UK’s largest multi-interest group in lung cancer. It was set up in 2005 with the founding ambition to tackle poor lung cancer survival outcomes and, specifically, to double five-year survival by 2015, which was effectively achieved. It is now looking to redouble five-year survival to 25 percent by 2025. The UKLCC’s membership includes leading lung cancer experts, senior NHS professionals, charities, and healthcare companies with an interest in fighting lung cancer. For more information about our work and members, visit:  www.uklcc.org.uk

Based on a presentation given by Professor Robert Rintoul at the BTOG Annual Conference, 27-28^th January 2022

Pharmacogenomics (PGx) is defined as the study of gene expression and its impact on both pharmacokinetics and pharmacodynamics of drugs. Increasingly it has been realised that many adverse reactions to drugs can be explained by pharmacogenomic variations and a growing number of drug-gene pairs is being identified. PGx testing allows phenotype classifications such as ultrarapid, rapid, intermediate normal and poor metabolisers, depending on gene expression. In turn this allows pharmacists to make recommendations about suitable doses and regimens for specific patients. Dr Manzi emphasised that PGx provides just one more piece of information and it is still important to understand the pharmacology of a drug to understand the implications fully.

Pre-emptive testing is useful in cases where it can prevent morbidity due to adverse drug reactions, for example. However, in Dr Manzi’s experience many children who have already experienced “a laundry list of adverse effects” are referred for pharmacogenomic testing. A number of commonly-encountered drug-gene pairs have been identified. These include   codeine and CYP2D6, ondansetron and CYP2D6, clopidogrel and CYP2C19, voriconazole and CYP2C19, warfarin and CYP2C19/VKORC1 and azathioprine and TPMT/NUDT15.

More than 50% of pharmacogenomic tests result in a clinically significant result, according to Dr Manzi.  Moreover, incidental PGx findings frequently identify important actionable genetic variants. This occurs when a patient is referred for one type of PGx testing but the investigation identifies other variants that may be unrelated to the referral indication but could have implications for the individual in future.

At Boston Children’s Hospital clinical decision support alerts related to PGx testing are only displayed when relevant to medication orders, in order to avoid ‘alert fatigue’. The pop-up alerts are displayed for both prescribers and pharmacists, she said.

Dr Manzi noted that, unlike biochemistry tests, pharmacogenomic test results are permanent. However, the interpretation may change over time as understanding advances and new guidelines are published – as has occurred for NUDT15/thiopurines and CYP2C9/NSAIDs, for example. This can mean that pharmacists have to contact patients years later to explain the implications for them. Pharmacists need to think carefully how they will make contact and how to frame the conversation appropriately, she advised.

Familial implications

There are a number of situations where pharmacogenomic test results for a patient could have important implications for other family members. Examples include genes with dominant expression such as CACNA1/RYR1 (which predisposes to the risk of malignant hyperthermia (MH) if given fluorinated anaesthetics and succinyl choline) and genes with X-linked inheritance such as G6PD.

MH is a potentially fatal inherited disorder involving the genes CACNA1 and RYR1. Because it follows an autosomal dominant inheritance pattern, finding an individual with one high-risk genotype inherited allele means that at least one parent is also susceptible to developing MH.

A case example illustrates how this might play out in practice. CS is a six-year-old boy who undergoes pre-emptive PGx and is found to have a high-risk variant of RYR1. He has three siblings who have not been tested. After the pharmacist explained implications, CS’s parent opted to have whole family tested.  The results showed that his father and one sister also carried the genetic variation and were potentially at risk of developing MH. Dr Haidar explained that it is essential to have the process of family testing in place in advance, before the broader implications of testing are discussed.

Another example of a finding that has implications for other family members is G6PD deficiency. This is an X-linked recessive disorder that affect males more than females. The condition affects about 400 million people worldwide, predominantly in Africa, Asia, the Mediterranean and Middle East. The most common symptom is haemolytic anaemia, triggered by infections, certain drugs, stress or foods. The G6PD gene is found on the X-chromosome, of which males have only one copy.

One important issue in this field is how the results of pharmacogenomic testing are made available to physicians and pharmacists who might care for the patient in adult life. Until a universal health record is available (in the US) health care practitioners will have to rely on the patient to keep a record of pharmacogenetic information and make prescribers aware of it, said Dr Manzi.  The time to mention it is when asked about allergies (not because it is an allergy but because it could be a factor that alters the response to some types of drug therapy), she suggested.

In summary, both speakers emphasised the importance of establishing processes for updating results when new evidence emerges and for discussing the family implications of incidental findings.

The American Society of Health-System Pharmacists Midyear Clinical Meeting is taking place virtually 5 -9th December 2021. See www.ashp.org

These two individuals have demonstrated leadership in different types of acute and ambulatory care settings and exemplify the best of pharmacy practice.

John E. Clark

Dr Clark is an assistant professor in the department of pharmacotherapeutics and clinical research and director of diversity, equity, and inclusion at the University of South Florida (USF) Health Taneja College of Pharmacy in Tampa. He previously served as director of experiential education and pharmacy residency programs.

He is also a clinical pharmacist and faculty preceptor in ambulatory care at the USF Morsani Health Center Building Relationships and Initiatives Dedicated to Gaining Equality (BRIDGE) Healthcare Clinic. The BRIDGE Healthcare Clinic is a student-run, multidisciplinary, non-profit clinic that services uninsured and underinsured patients in the Tampa area. Dr Clark oversees the development and provision of pharmacy services, including medication reconciliation, patient education and counselling, and disease and medication management services.

Before joining the faculty at USF, Dr Clark held several roles at Jackson Memorial Hospital Department of Pharmacy in Miami, Florida, Grand Prairie Community Hospital in Grand Prairie, Texas, and Detroit General Hospital.

Dr Clark is a long-standing champion for racial equity in healthcare and a vocal advocate for the creation of culturally competent systems of care. For several years, he played a key role in the planning and implementation of the Association of Black Health-System Pharmacists’ (ABHP) Minority Health Conference. The conference explored health literacy, medication adherence, use of health information technology, and medication management of conditions such as diabetes, renal disease, prostate cancer, and HIV/AIDS.

A past president of ABHP, Dr Clark played an instrumental role in the organisation’s influence on minority healthcare issues, including creating the ABHP Research and Education Foundation. In 2005, Clark led an effort to increase collaboration between ABHP and ASHP on matters of mutual interest, including reducing health disparities and increasing ethnic and cultural diversity in the workplace. The partnership resulted in a series of educational sessions at ASHP’s Midyear Clinical Meeting and the development of the Joint Leadership Award.

Dr Clark is an active member of ASHP and recently served on the ASHP Task Force on Racial Diversity, Equity, and Inclusion. His ASHP service also includes terms on the ASHP Fellow Review Committee, the Committee on Nominations, Council on Administrative Affairs, Commission on Therapeutics, the Section of Inpatient Care Practitioners Section Advisory Group on Pharmacy Practice Experience, and Florida delegate to the ASHP House of Delegates.

A widely published author and sought-after speaker, Dr Clark’s recent research projects include a historical review of the contributions of African American women in pharmacy and an analysis of the ways early, and now defunct, African American pharmacy schools impacted health disparities.

Dr Clark earned a B.S. in pharmacy from Texas Southern University College of Pharmacy and a Pharm.D. from Florida A&M University. He earned an M.S. in pharmaceutical administration from Wayne State University and completed his residency training at Detroit General Hospital.

M. Lynn Crismon

Dr M. Lynn Crismon is the Behrens Centennial Professor of Pharmacy and professor of psychiatry at The University of Texas at Austin and past dean and James T. Doluisio Regents Chair of the College of Pharmacy.

Before joining the faculty at the University of Texas, Dr Crismon was a commissioned officer and served as deputy chief of pharmacy at the United States Public Health Service (USPHS) Indian Hospital in Winslow, Arizona. He also held pharmacy leadership positions at Austin State Hospital and the Healthcare Rehabilitation Center in Austin, Texas.

Dr Crismon’s research has focused on improving the pharmacotherapy of adults and children with severe mental disorders. He developed and served as director of an ASHP accredited residency in psychiatric pharmacy practice in collaboration with Austin State Hospital, the Texas Department of State Health Services, and Seton Health Network. The program was one of the oldest continuously operating, accredited psychiatric pharmacy residency programs in the country.

He was one of the lead investigators in the Texas Medication Algorithm Project and the Children’s Medication Algorithm Project and helped develop psychotropic prescribing parameters for youth in Texas foster care. He served as a consultant for federal, state, and local government entities, including the Healthcare Financing Administration, the Oklahoma Department of Mental Health, the Texas Attorney General, Texas Department of Mental Health and Mental Retardation, and the Texas Department of Family and Protective Services.

He served as a member of the National Academy of Medicine Committee that developed the 2019 consensus report Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. The report received the American College of Healthcare Executives’ 2021 James A. Hamilton Book Award.

He has published over 260 articles, chapters, or handbooks. He has served as a reviewer for several scholarly journals, including AJHP, The Lancet, Journal of Behavioral Health Services, and Journal of Clinical Psychiatry.

Dr Crismon has a long record of service to the profession, including serving as the current chair of the ASHP Foundation Research Advisory Council. His ASHP service also includes terms as a member of the Commission on Goals and the Deans Advisory Council, Texas delegate in the ASHP House of Delegates, and a chair of the ASHP taskforce to recognize psychiatric pharmacy as a specialty by the Board of Pharmaceutical Specialties (BPS). He is past chair of the American Association of Colleges of Pharmacy (AACP) Council of Deans, a past AACP board member, past member of the American College of Clinical Pharmacy (ACCP) Board of Regents and the ACCP Research Institute Board of Trustees, and the first chair of the BPS Council on Psychiatric Pharmacy.

He earned his B.S. in pharmacy from The University of Oklahoma and his PharmD from a joint program of The University of Texas Austin and University of Texas Health – San Antonio. He completed a pharmacy practice residency at the USPHS Gallup Indian Medical Center and a psychiatric pharmacy residency at The University of Texas.