September 1st 2020

Looking back on my emails, I see that my first COVID-related message came in on 3rd March. At first, it was impossible to judge the impact the virus was going to have on our healthcare system and hospices. The shocking lack of their inclusion in the two essential components – PPE and testing – soon became apparent. Many of our senior hospice colleagues have described how they had to ‘fight’ for what was needed –on top of caring for very sick patients who may or may not have the virus and staff having to isolate for the statutory period…

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September 1st 2020

Motilin is a naturally occurring hormone secreted by the small intestine. It increases gastro-intestinal motility and peristalsis and accelerates gastric emptying. It functions mainly between meals and in doing so prepares the gut for the next meal. Erythromycin happens to be a motilin agonist – working in the same way as the hormone – so can be used when metoclopramide or other prokinetics are unsuitable. It is effective in about half of cases, and concerns about the development of bacterial resistance…

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September 1st 2020

The MHRA has decided that stimulant laxatives can be inappropriately used by people wanting to lose weight – especially those who may have an eating disorder. In future, products such as Senna and Bisacodyl will sold in small pack sizes only and to people over 18…

Guy’s and St Thomas’ manufacturing unit has now ceased supply of 2% lidocaine in Lutrol gel and it is now distributed by Oxford Health – the NHS specials and wholesale supplier…

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September 1st 2020

For many years the NHS has struggled to fulfil the NHS Out of Hours (OOH) standards that stated ‘patients should be able to access the medicines they need at the time and place of the OOH consultation’. The Drug Tariff, which determines the list of products which can be prescribed on FP10 and their re-imbursement costs, still includes a rather dated ‘Out of Hours national formulary’ which categorises a wide range of medications for emergencies which include palliative care…

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March 30th 2020

We observe that people have a reduced oral intake at the end of life due to their symptoms or general weakness and level of consciousness. There is inconclusive evidence that artificial hydration is beneficial, with arguments against being the chance of it increasing the likelihood of oedema, ascites and death rattle. Arguments for are that it may alleviate feelings of thirst and reduce the risk of agitation.

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March 30th 2020

Presentations at national conferences and courses can have a lasting influence on symptom management. Following a talk at one of the ‘Oxford’ courses(1), an increasing number of prescribers are now using ranitidine to reduce the secretions which make inoperable bowel obstruction such a challenging condition. Treatment in the past would often involve insertion of a nasogastric tube…

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March 30th 2020

In September 2019, the charity Hospices of Hope invited interested supporters on an insight visit to Serbia to see the new hospice building and meet the staff and patients. I have a family connection with Belgrade as my father was a Serbian pharmacist and our family supports the charity with the intention of trying to do something specific to help this particular site. There hasn’t been such an opportunity so far but this visit seemed a great chance to find out more in person…

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October 18th 2019

Articles in medical and pharmacy journals this month are asking us to adopt safer and more rational approaches to prescribing opioids. One comes from experts in chronic pain, notably Cathy Stannard, consultant in complex pain and Clinical Lead for the Pain Transformation Programme at NHS Gloucestershire CCG (1), and her…

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