Kieran Reynolds talks to Naz Kanani Alviri about liver cirrhosis. Discussion includes what cirrhosis is, and how it is diagnosed, the difference between compensated and decompensated cirrhosis, complications of decompensated cirrhosis and initiatives being undertaken to improve the earlier diagnosis of liver disease. (19m 16s)

Naz Kanani Alviri - Principal Pharmacist -Hepatology & Liver transplantation, Royal Free Hospital, London

Kieran Reynolds - Advanced Specialist Pharmacist (Medicines Governance), SPS

Useful Links

Calculating and using the Child-Pugh score

https://www.sps.nhs.uk/articles/calculating-and-using-the-child-pugh-score/

Prescribing weight-adjusted oral paracetamol in adults BASL position statement

https://www.basl.org.uk/index.cfm/content/page/cid/20 (available under Resources)

NHS mobile testing scheme finds thousands of new cases of liver damage

https://www.england.nhs.uk/2023/10/nhs-mobile-testing-scheme-finds-thousands-of-new-cases-of-liver-damage/

Kieran Reynolds talks to Sital Shah in our introductory podcast about liver disease. Discussion includes the functions of the liver, difference between liver disease and liver impairment, liver blood tests and how to classify severity of cirrhosis (scarring of the liver) (17m 38s)

Sital Shah - Consultant Hepatology Pharmacist, King’s College Hospital London and Chair of the British Hepatology Pharmacy Group (BHPG)

Kieran Reynolds - Advanced Specialist Pharmacist (Medicines Governance), SPS

Useful Links

Assessing liver function and interpreting liver blood tests

https://www.sps.nhs.uk/articles/assessing-liver-function-and-interpreting-liver-blood-tests/

British Liver Trust - about the liver

https://britishlivertrust.org.uk/information-and-support/liver-health-2/abouttheliver/

NHS conditions - liver disease

https://www.nhs.uk/conditions/liver-disease/

Calculating and using the Child-Pugh score

https://www.sps.nhs.uk/articles/calculating-and-using-the-child-pugh-score/

British Liver Trust - liver blood tests

https://britishlivertrust.org.uk/information-and-support/living-with-a-liver-condition/liver-blood-tests/

Sheetal Ladva, Senior Medicines Advice Pharmacist at SPS, presents a summary of the resources published by SPS between 16th and 22nd November.

To easily find a list of newly published pages go to sps.nhs.uk, select ‘search’, click in the search bar, and press enter.

Quick links to highlighted resources:

Supporting safe use of adrenal crisis emergency management kits

Treatment of adrenal crisis is time critical and relies on timely use of injectable hydrocortisone to prevent harm.

https://www.sps.nhs.uk/articles/supporting-safe-use-of-adrenal-crisis-emergency-management-kits/

We want to hear from you

Safer use of time critical medicines - national scoping review

To share your work or to be involved contact [email protected]

Safe use of insulin

Help us guide our work by answering this short survey: https://forms.office.com/pages/responsepage.aspx?id=slTDN7CF9UeyIge0jXdO45X8LFrmUg1GkTOIj8H5YE5UNVowNVc0MjBVU1lTMkFGU0xNMzNESVRRVi4u&route=shorturl

Next events – forthcoming webinars and conferences

https://www.sps.nhs.uk/home/events/next-events/

Podcast description:

NHS Specialist Pharmacy Service serves healthcare professionals across the NHS who are involved in all aspects of buying, making and using medicines. Our motto is 'do once and share'.

Rakhi talks to Catherine and Kavan about optimising lipid management in patients who have had a haemorrhagic stroke. They discuss the importance of confirming diagnosis, risks of statin use in haemorrhagic stroke, how to use QRISK scores in this patient group, and when to seek specialist advice.

This is a follow up podcast to our 'Primary care discussions: Lipid management' webinar. You can find the webinar recording here: https://www.sps.nhs.uk/articles/primary-care-discussions-lipid-management/

Speakers:

Catherine Tucker, Senior Clinical Pharmacist Lipid Clinic and Integrated Care Team, Northumbria Healthcare NHS Foundation Trust and CVD Medicines Optimisation Pharmacist, CVD Prevention Network, North East and North Cumbria Integrated Care Board

Kavan Nagi, Lead Cardiovascular Pharmacist, Buckinghamshire Healthcare Trust and Lead ICS Lipid Specialist Pharmacist, NHS Frimley Integrated Care Board

Rakhi Aggarwal, Primary Care Lead, Medicines Use and Safety, NHS Specialist Pharmacy Service

Resources discussed by the speakers:

NHSE Summary of National Guidance for Lipid Management for Primary and Secondary Prevention of CVD

https://www.england.nhs.uk/aac/wp-content/uploads/sites/50/2020/04/lipid-management-pathway-v7.pdf

Stroke Association

https://www.stroke.org.uk/

QRISK

https://www.qrisk.org/

SPARCL trial

The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355:549–559 https://www.nejm.org/doi/full/10.1056/NEJMoa061894

Rakhi talks to Catherine and Kavan about optimising lipid management in patients who have had an ischaemic stroke. They discuss the importance of confirming diagnosis, treatment targets, how to prioritise patient for review, and when to seek specialist advice.

This is a follow up podcast to our 'Primary care discussions: Lipid management' webinar. You can find the webinar recording here: https://www.sps.nhs.uk/articles/primary-care-discussions-lipid-management/

Speakers:

Catherine Tucker, Senior Clinical Pharmacist Lipid Clinic and Integrated Care Team, Northumbria Healthcare NHS Foundation Trust and CVD Medicines Optimisation Pharmacist, CVD Prevention Network, North East and North Cumbria Integrated Care Board

Kavan Nagi, Lead Cardiovascular Pharmacist, Buckinghamshire Healthcare Trust and Lead ICS Lipid Specialist Pharmacist, NHS Frimley Integrated Care Board

Rakhi Aggarwal, Primary Care Lead, Medicines Use and Safety, NHS Specialist Pharmacy Service

Resources discussed by the speakers:

NHSE Summary of National Guidance for Lipid Management for Primary and

Secondary Prevention of CVD

https://www.england.nhs.uk/aac/wp-content/uploads/sites/50/2020/04/lipid-management-pathway-v7.pdf

UCL Partners Proactive Care Framework: Lipid Management including

Familial Hypercholesterolaemia

https://uclpartners.com/wp-content/uploads/Lipids-and-FH-Framework_UCLPartners-LTCs-April-2021-v4.1.pdf

Two of our experienced Medicines Advice Pharmacists, John Minshull and Iram Husain, discuss how medicines advice pharmacists answer queries safely.

Quick Links

Swallowing difficulties

https://www.sps.nhs.uk/home/guidance/swallowing-difficulties/

Covert administration of medicines: legal issues

https://www.sps.nhs.uk/articles/covert-administration-of-medicines-legal-issues/

Covert administration of medicines: pharmaceutical issues

https://www.sps.nhs.uk/articles/covert-administration-of-medicines-pharmaceutical-issues/

UKMi Recommended Resource Lists and Tools

https://www.ukmi.nhs.uk/Resources?ContentID=3df605e3-ec43-47b7-99ff-aabc3cd91765

SPS MA contact details

https://www.sps.nhs.uk/home/about-sps/get-in-touch/medicines-information-services-contact-details/

Kieran Reynolds talks to Dr Alicia Demirjian and James Milner about some of the clinical issues you may encounter when providing the new Pharmacy First service to children. Discussion includes practical hints and tips for examining children, how to manage parents’ expectations as well as reassure them about their child’s treatment. (13m 41s)

Dr Alicia Demirjian – Paediatric infectious diseases consultant, Evelina Children’s Hospital

James Milner – ICD Community Pharmacy Clinical Lead, NHS Shropshire, Telford and Wrekin

Kieran Reynolds – Specialist Pharmacist (Medicines Governance), SPS

Useful links:

NHS England Pharmacy First resources

https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-services/pharmacy-first/

Healthier Together guidance (otitis media (earache)) for pharmacists

https://www.what0-18.nhs.uk/professionals/pharmacists/safety-netting-documents-parents/earacheotitis-media-advice-sheet

Medicines for Children – how to give different types of medicines

https://www.medicinesforchildren.org.uk/advice-guides/giving-medicines/

Kieran Reynolds talks to Naomi Fleming and Reena Barai about some of the clinical issues you may encounter when providing the uncomplicated urinary tract infection (UTI) service under Pharmacy First. Discussion includes measures taken to limit the impact of antimicrobial resistance from Pharmacy First and why urine dipsticks aren’t recommended in the uncomplicated UTI service in Pharmacy First. (13m 08s)

Useful links:

NHS England Pharmacy First Resources: https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-services/pharmacy-first/

Community Pharmacy England (CPE) FAQs: https://cpe.org.uk/national-pharmacy-services/advanced-services/pharmacy-first-service/pharmacy-first-service-faqs/

TARGET Treating your infection UTI leaflet: https://elearning.rcgp.org.uk/pluginfile.php/172235/mod_book/chapter/465/TARGET%20TYI-UTI%20leaflet%20V23.5.pdf

Kieran Reynolds talks to Professor Nick Francis and Rahul Sharda about some of the clinical issues you may encounter when providing the otitis media service under Pharmacy First. Discussion includes information to provide patients who don’t require antibiotics, signposting to resources to help with otoscope examination and why the otitis media service is limited to individuals aged 1-17 years. (15m 50s)

Professor Nick Francis – GP & Head of School at School of Primary Care, Population Sciences and Medical Education, University of Southampton

Rahul Sharda - Community pharmacist, Butt Lane Pharmacy

Kieran Reynolds – Advanced Specialist Pharmacist (Medicines Governance), SPS

Useful links:

NHS England Pharmacy First resources

https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-services/pharmacy-first/

Healthier Together guidance (otitis media (earache) for pharmacists

https://www.what0-18.nhs.uk/professionals/pharmacists/safety-netting-documents-parents/earacheotitis-media-advice-sheet

NICE otitis media (acute) antimicrobial prescribing guidance

https://www.nice.org.uk/guidance/ng91

Otoscope examination resources:

CliniSkills: Clinical Examination Skills Training for Community Pharmacists

https://www.cliniskills.com/community-pharmacists/

CPPE: Ear, nose and throat examination – advancing clinical assessment skills workshop

https://www.cppe.ac.uk/programmes/l/ent-w-01/

CPPE: NHS Pharmacy First: Otitis Media e-learning

https://www.cppe.ac.uk/programmes/l/nhsphfrst-e-01/

British Society of Audiology Recommended ear examination procedure

https://www.thebsa.org.uk/wp-content/uploads/2023/10/OD104-54-BSA-Recommended-Procedure-Ear-Examiniation-February-2022.pdf

Kieran Reynolds talks to Professor Paul Little and Simran Sirpal about some of the clinical issues you may encounter when providing the sore throat service under Pharmacy First. Discussion includes the FeverPAIN score, information to provide patients who don’t require antibiotics, strep A antigen tests, and exclusions from the PGDs. (11m 58s)

Professor Paul Little - GP & Professor of Primary Care

Simran Sirpal – Community Pharmacist, Sirchem Pharmacy Group

Kieran Reynolds – Advanced Specialist Pharmacist (Medicines Governance), SPS

Useful links:

NHS England Pharmacy First resources

https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-services/pharmacy-first/

Healthier Together guidance (tonsillitis/sore throat) for pharmacists

https://www.what0-18.nhs.uk/professionals/pharmacists/safety-netting-documents-parents/sore-throat-advice-sheet

NICE sore throat (acute) antimicrobial prescribing guidance

https://www.nice.org.uk/guidance/ng84

Community Pharmacy England Pharmacy First FAQs

https://cpe.org.uk/national-pharmacy-services/advanced-services/pharmacy-first-service/pharmacy-first-service-faqs/

NHS England Direct-to-consumer point-of-care in vitro diagnostic devices for group A streptococcal infections

https://www.england.nhs.uk/long-read/direct-to-consumer-point-of-care-in-vitro-diagnostic-devices-for-group-a-streptococcal-infections/