4 - 6 July 2013 Royal College of Physicians, Edinburgh
Around 120
young and senior pharmacologists from 5 continents attended the EACPT Summer School:
half the young clinicians and researchers from the UK and half from continental Europe, from Estonia and Lithuania to Denmark and Spain, 16
from China, others from Australia and elsewhere.
Listen to young pharmacologist delegates discussing the Edinburgh July 2013 EACPT Summer School with EACPT Secretary Professor Donald Singer.
Hear the podcast from delegates at the EACPT Summer School from 6 European countries talking about why they came and how useful they found the EACPT Summer School in Edinburgh: 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.
Hear the podcast from delegates at the EACPT Summer School from 6 European countries talking about why they came and how useful they found the EACPT Summer School in Edinburgh: 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.
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| Delegates on the podcast |
Questions addressed by delegates in the podcast
- How did you
hear about the EACPT Summer School?
- What attracted
you to come to the EACPT Summer School?
- How interesting
and relevant to you did you find the programme?
- What was it
like taking part in the poster sessions?
- How easy was it
to meet other young pharmacologists at the EACPT Summer School?
- How
approachable were the senior clinical pharmacologists at the EACPT Summer School?
- How helpful
were the workshops on
- prescribing skills
- how to use new communications methods to
interact with fellow researchers and the wider public?
Here are some further reflections by delegates.
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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
Prescribing - From Paper to Pixels 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.
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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.
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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.
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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!
The programme included over 30 speakers. Keynote lecturers from around Europe included:
- Ingolf Cascorbi, University of Kiel on the '-omics' revolution and personalised drug therapy.
- Adam Cohen, Centre for Human Drug Research, Leiden on the return of Dream Drug development.
- Munir Pirmohamed, University of Liverpool on advances and challenges to implementing stratified medicine.
- Sir Michael Rawlins, Royal Society of Medicine, former chairman of NICE, London on the first 14 years at NICE.
- Sir Kent Woods, MHRA, London on the role of the regulator in proportionate regulation; innovation in healthcare; addressing financial and regulatory barriers that slow innovations reaching patients; regulation of targeted therapies; sustainability of healthy pipeline of new products; making all stake-holders aware of intended improvements in flexibility in the current regulatory regime.
- Professor Amrita Ahluwalia, London, giving the GSK Clinical Prize Lecture for her work on a 'green' approach to treating cardiovascular disease; advances in understanding of effects of nitrites and the significance of the entero-salivary cycle.
EACPT Summer Schools consist of keynote presentations and workshops on all aspects of clinical pharmacology by invited expert speakers, poster presentations, and social events. There is a strong interactive element and ample opportunity for delegates to network with speakers.
See also information on the 11th
EACPT Congress in Geneva: 28th - 31st August, 2013
