Pharmacy Microteaches: Recent Episodes
Dave Abbott
For those who can't even spare 8 minutes, this podcast clocks in just north of 5. How can we explain what the different summary statistics actually mean?
Coming in at nearly 10 minutes, this is the long version of the summary statistics podcast. What are they, why do we like certain ones over others, and how do they behave?
With the world imploding and the climate crisis emerging, what role does pharmacy and medicines have in the area? And more importantly, what can we do as individuals working in the area to make things better and make a difference?
Of all the many conundrums of hospital pharmacy, this is possibly one of the greatest - why are most of them designed with terrible offices and no windows? Just in time for your summer holiday, this is the pharmacy / architecture crossover podcast episode you never knew you needed but now can't live without. Covering Florence Nightingale, germ theory, the birth of the NHS, the Linstead and Noel Hall reports, plus the omnipresent and omni-malevolent Toyota method, this is a whistle stop tour through pharmacy history to try to explain this most puzzling fact.
What's the plural of "Summary of Product Characteristics"? Summaries of Product Characteristics, or Summary of Product Characteristicses? Just one of the many questions this podcasts doesn't answer (because it's only 8 minutes long and about pharmacy stuff so there's loads of stuff outside the bounds of the podcast). But if your question is "how should I think about SPCs, and what are their benefits and limitations," then you've just hit the jackpot by finding this podcast! And if that wasn't your question - why not? Listen anyway, to find out why it should have been. Enjoy!
Just when you thought pharmacy couldn't get more interesting, here we go with a podcast about pharmacokinetics basics. What is a volume of distribution, what does it mean, and why should we care? All this and even more epic stuff! Hold onto your hats, kids - this is going to be a wild one! Give it a listen and see if exceeds your (low) expectations! (We've tried to keep it to under 7 minutes to compensate for the subject matter)
It's a quiz. On a Friday. About pharmacy things. There's almost zero chance you'll get 6/6
We're back into critical appraisal of unpronounceable medicines! Using eptinezumab as an example, how does it work to treat migraines, how well does it work, and most importantly, how did NICE use a network meta-analysis to look at how good it is compared to its equally unpronounceable friends? What is a network meta-analysis, and what are the key points? Enjoy!
It's back! It's a quiz! It's about a minute long! It's on a Friday! That's pretty much all there is to say. Oh, apart from question 5 - you can have a point if you get within 5 of the answer (we're feeling generous as it's the first week back - it won't happen again)
We're back! Asking "what's the point" of more bits of pharmacy. Many thanks to Hannah and Olivia for taking the time to explain the world of radiopharmacy. What exactly is it? Why's everything so heavy to lift? And why do they always seem to be in so early in the mornings? Only 8 minutes out of your day to find out!
Medical gases are medicines, but often relatively neglected by pharmacy - so it's time for a review of what they are and why we should care about them, all provided by our guest expert, Lucy. There's so much stuff we've been slightly flexible (but not that flexible - we are still pharmacy) and given her 10 minutes instead of the normal 8. Loads of content with this one - the only thing you'll not find out is why gases only has 1 "s" in the middle, when all the laws of English would suggest it should have 2. Give it a listen - what have you got to lose?
Never one to miss a bandwagon, with the recent announcement of the withdrawal of pholcodine it seemed an ideal opportunity to look at the study that provided the data to prompt the review. How does pholcodine make you more likely to have an allergic reaction to neuromuscular blocking agents? How do we know? And whilst we answer these questions, we'll also talk about case control studies and odds ratios too. There's not much more fun you can pack into an 8-ish minute podcast!
This week, we're having a look at the fancy new imlifidase, which is used around renal transplant and costs a small fortune (though may be worth it - in the grand scheme of transplants and dialysis, most drugs costs pale into insignificance). What does it do, what do NICE think, and can we play along and see whether we'd get to the same conclusions as NICE - or does commercial confidentiality get in the way and ruin all our fun? Only 8 minutes to find out!
One of the most common questions we get asked about medicines where there isn't a straight forward answer is how to work out whether a medicine is harming someone's liver, or whether someone's liver is affecting a medicine. For kidneys we have eGFR and CrCl. For liver we have LFTs. But why is it not that simple, and how can we start thinking about these sorts of questions to try to make it a bit simpler? This isn't a podcast about what a specific LFT means at specific levels (because - spoiler alert - LFTs don't work like that) but does try to give an overview of what sorts of things to think about and what common pitfalls might be.
A quick 8 minute tour of pharmacy-specific bits of clinical trials and what the point of them is. What do pharmacy clinical trials teams actually do, and why?
In pharmacy, we often bang on about half lives, but what are they actually useful for, and what are the limitations of the values we're given in SPCs? This podcast aims to be a whistle stop tour of half lives, covering some of the interesting things about them and when they might lead us astray (and hardly any maths at all, in case you were worried).
Missing novel Covid treatments and cutting edge pharma tech? Well, don't worry because Evusheld is the newish monoclonal antibody thing that might be useful as a prophylactic treatment for those people for whom vaccines don't work. But how do we know what do we know, what don't we know, and how can we make this all comprehensible if someone asks us about it?
It's a bit niche (or is it?...) but why would a company give away it's shiny new drug for free? Why do these schemes exist? What's in it for the drug company? What's in it for the NHS? What are the risks? Overall - what's the point? Just under 8 minutes of your life needed to get a potted summary and find out!
Finally - they're here! But what exactly is an Integrated Care System or ICS, and why have they been created? Park your cynicism and have a whistle stop tour of ICSs, ICBs, ICPs to meet the saviours of the NHS. Plus bonus material on the previous iterations of SHAs, DHAs, PCGs, PCTs, CCGs, and any number of TLAs in the NHS! It's going to be an excellent way to spend 8 minutes of your life!
To tie in with Medicines Safety Week, we're having a look at the Yellow Card Scheme - what is it, why do we have it, and why is it a really important thing that everyone should make efforts to join in and contribute their adverse event reports.
It's third time out for molnupiravir, with the preliminary results of the Panoramic study. Does molnupiravir work at preventing admission to hospital? Does Panoramic support the findings of Move-Out? How directly linked to our patients are the two trials? What on Earth is a Bayesian credible interval? There's a lot to cover in just over 8 minutes!
In a trial first of a kind, this week we've rented out the podcast to the inestimable Chris Day and Katherine Stirling from Leeds Teaching Hospitals to talk about the practicalities of managing DOACs. Who should get what? What do you need to do when a patient is admitted to hospital? What do patients and GPs need to know when patients leave the hospital taking them? There's a Leeds flavour to things, but useful to all wherever you are. 8 and a bit minutes to do some practical learning!
Back for week 4 of the pharmacy nano-quiz, this time with Charlie "I used to be an MI pharmacist" Daniel
Lecanemab is the shiny new medicine for Alzheimer's that's been in the press - a 27% decrease in progression sounds great, plus it's a 'mab, so it must be cool. But how might it work, what do we actually know from the press release, and what do we need to have a closer look at?
Congratulations for finding your way back for week 3's quiz offering. Only just over a minute to test your pharmacy knowledge!
What's the point of an ePMA pharmacist? What's an ePMA? Why is FHIR cool and interesting? What does DM+D stand for? If acronyms are your thing, this podcast might be right up your street. And we also talk about how electronic prescribing systems are overall a good thing, and what pharmacy can contribute to making them better.
In honour of World Patient Safety Day, we're asking the question - what's the point of Medication Safety Officers? Why do we have them? What do they do? What problems are they trying to solve and how can they make your life better? How are they like Liam Neeson? It's only just over a 7 minute listen to find out!
Back on the "what's the point of..." various bits of pharmacy, today we're asking what's the point of medicines management nurses? What do they do, and why can't pharmacists just do everything?
Keeping on with the "What's The Point Of..." topics, this week we've dared to step outside of a hospital (though not too far) and are having a look at what a virtual ward pharmacist does. What do they actually do, and how is it different to a non-virtual ward pharmacist?
In the break before we get the "What's the point of... Medicines Management Nurses" episode, we're going back for a refresher on evidence based medicine and looking at the hierarchy of evidence triangle thingy. What are the different types of studies? Which ones are better than others? What does better mean? How does any of this link to Matthew Paris's map of Britain, made around 1250? It'll only take 9 minutes to find out! Link to Matthew Paris's map here - https://historiacartarum.org/annotated-claudius-map/
It's finally here! The much anticipated (ok, maybe not anticipated - delayed may be a more accurate description) "what's the point of pharmacy procurement?" Why do we run out of medicines? Why do different areas of the country use different products? Why should this stuff be important to you? Only 8 minutes of your time to spend listening to this podcast to find out!
Welcome back! It's been a couple of weeks, but we're back with a new podcast now we've got a believable excuse to avoid talking about pharmacy procurement again. This time, we're going to talk about alpelisib, how it works, the problems you get into when you try to do indirect comparisons between different trials, and how data being confidential makes looking at stuff for yourself really difficult.
Sticking on the critical appraisal theme, we have a look at tecovirimat, the antiviral suggested as an option for the treatment of monkeypox. How does it work, what does it do, how do we know, and how confident are we in the evidence base? As part of this, we have a think about the directness of evidence, and how far it might be sensible to extrapolate from the data we have to different clinical scenarios.
Going back to critical appraisal (we'll go back to finish the series of "what's the point of..." various different bits of pharmacy next time), we're having a look at the risks around getting your dog vaccinated against kennel cough. Are you going to catch kennel cough from them yourself? When we say "there's a theoretical risk" what do we mean? And if we know what we mean, do the people we're explaining things to take the same meaning from what we say? How do we help people to optimise the risks they might take in a world where we don't have definite numbers to work with?
Following on from last time's "what's the point of Medicines Information services", this time it's the turn of pharmacy QA. What do they actually do, and why might they be good people to know? Thanks to QA Hannah for QA'ing this one.
Following on from last time's podcast, we continue on a theme of having a look at some of the less often seen bits of pharmacy departments and services. This time out, it's Medicines Information (or Medicine Advice) services in the NHS. Back in the 1970s when they started, the world was a different place and information was hard to come by. But now, when you can get millions of guidelines and papers after a quick search of the internet, what function do they serve? With thanks to all those who helped to give me a pharmacy history lesson last year when MI in the UK turned 50!
Going in a slightly different direction with this episode, we're looking at bits of pharmacy and asking "what's the point?". But, you know, in a positive way. This time, what's the point of having a Drug and Therapeutics Group - a group in your organisation who get to decide which new medicines get used. What value does a DTG add, and what benefits does it deliver?
What is methenamine hippurate? Is it as good as prophylactic antibiotics for recurrent UTIs? And most importantly, how come the recent trial could, perfectly legitimately, say it was non-inferior whilst it also looking to the casual observer as being marginally less good? What does non-inferiority mean in clinical trials, and why do people get twitchy about delta values?
Gene therapy - it's here, and it's really expensive! What does onasemnogene abeparvovec do? How does how it works compare to other (also complicated and expensive) medicines? How strong can the evidence be if it's not from a randomised controlled trial? And, probably most importantly, why on earth does it have 10 syllables in its name and how might you go about butchering its pronunciation?
Why does Paxlovid interact with so many other medicines? How can we find out what it interacts with? What approaches can we take to work out what to do with this information? And can we pull out some general learning about how to manage drug-drug interactions, whether it's Paxlovid or something else?
What is sotrovimab, and how does it work against Covid? Why is it called sotrovimab and not sotrolimab? How come it has a risk reduction of 85% and 6% yet these are both true and both mean the same thing? And if you were asked how good it might be for your patient, what would you say?
Often, we get asked about temperature deviations, where medicines get stored by accident outside of what the manufacturers recommend. If something's been stored a couple of degrees warm for a couple of hours, it won't impact on product quality - but when do we need to start worrying? If a manufacturer says they don't have any data, how can you make informed decisions so that you don't waste NHS money throwing away medicines that are perfectly fine to use?
Looking at the new Covid treatment Paxlovid (nirmatrelvir + ritonavir), how does it work and can we work out summary statistics? Then, can we compare them to the ones we worked out for molnupiravir last time? What are the problems with this approach, and why do we need to be cautious comparing outcomes between different trials? (Note: at the time of recording, there wasn't much guidance on how to pronounce nirmatrelvir, so I've gone for NIR-ma-TREL-vir rather than NIR-MAT-rel-vir or any other version. It's a best guess, so sorry if I've gone for the protease inhibitor version of CLO-pi-DOG-rel. Only time will tell)
What do you need to think about when giving medicines via enteral feeding tubes? What are theoretical problems vs real problems, how do you balance the needs of the medicine with the needs of the patient, and how are you going to come to a decision? This podcast isn't going to tell you all the answers, but will hopefully give you pointers on what you might need to consider.
Why do so many medicines taste disgusting, and what do industry try to do to fix this? And more importantly, what can we do to make taking (or giving) medicines less of an ordeal? There's no profound learning in this one, but you might find out why bribing with chocolate is the most successful strategy for getting medicines into children.
Using molnupiravir as an example again, we look at the new data that's been released and the FDA's analysis. Why is the data released showing something different to the interim analysis only a fortnight or so ago? And why does this seem to happen a lot, with early results being more positive than the later full results? And what does this mean for us and how we think about using early data?
We use QALYs to judge how good treatments are and compare them to other treatments, but what are their limitations? Can we use the recent discussions about whether teenagers should be vaccinated against Covid to illustrate these things about QALYs? Listen to find out how successfully we've done this!
Using molnupiravir as an example, and looking at the data from news reports rather than papers, can we work out summary statistics for how well it might work, how can we represent them honestly, and how might we communicate them effectively to others?
What are we trying to do when we do therapeutic drug monitoring? How do we do it, and what can we do if levels aren't taken exactly how we'd like? A pragmatic review of the first principles involved in therapeutic drug monitoring from a pharmacy perspective
A very brief overview of what it means if we say a medicine is unlicensed - what does it mean, and what do we need to do differently compared to if we're using a licensed medicine?
Medicines in secondary care in England are funded in confusing ways. This podcast tries to give a brief overview of why different medicines are funded differently, how you can predict who might pay for different medicines, and how it is kept relatively fair between different providers
How and why do we use summary statistics to explain clinical trials, and why are some statistics better than others for helping us understand what a drug might do? In this podcast, we talk about absolute risks, absolute risk reductions, and number needed to treat, and why they tend to be better statistics to use for understanding compared to odds, odds ratios and relative risk reductions.
In pharmacy, we often change the packaging of medicines - most commonly to put into compliance aids. But what might this do to the medicines, is it important, and how do we balance the pharmaceutical needs of the medicines with the clinical needs of the patient?
Can we do this thing with medicines? Is it within the law? How can you approach these questions without getting bogged down in trying to read legislation (whilst also not just making things up)
Odds and odds ratios are often used to describe the results of clinical trials, but not many people, outside of statisticians, understand what they mean. So what do they mean, how do they behave, and how can we use them in pharmacy, when we're trying to explain how good (or bad) medicines are?
Medicines can interact with each other which may, or may not, cause problems for the person taking them. How can you go about tackling these sorts of questions and work out how best to manage potential interactions for your patients?
How do you make decisions with someone else in pharmacy? Using an awful example (you get called in the middle of the night by the neonatal registrar) we'll work out how we might want to approach shared decision making.
How can you think about tackling questions about IV compatibility, to make it easier for you to manage all the information you get?
How do you go about planning where to look when you're asked a question? Setting yourself up well at the start with a good plan can improve your chances of getting to the right answer - so how do you do that?
What can you do to make sure the questions you get asked in pharmacy make sense? How do you start off on the right foot to give yourself the best chance of getting to the right answer?
A relatively quick run-through about how to think about renal function, and how we use the measures we have to adjust medicines doses
Can you do critical appraisal of published articles, if you've only got access to newspaper coverage and the abstract? It's not ideal, but it's often what you've got, and you can probably do more than you think.