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Management of Idiopathic Pulmonary Fibrosis

Source: pharmacypracticenews

Idiopathic pulmonary fibrosis (IPF) is a progressive, debilitating, and often fatal interstitial lung disease characterized by scarring of the lungs with unknown etiology.1 This scarring causes the alveolar walls to become stiff and thick, preventing inflation, which reduces lung capacity and makes the exchange of oxygen and carbon dioxide more difficult. The decreased lung capacity and oxygen exchange increases breathlessness and decreases mobility and independence.2


Although the precise cause of IPF is unknown, there is evidence that risk factors including age and environmental exposures play a role. The disease tends to affect adults in their sixth or seventh decade of life.3 In addition, there is a strong correlation between smoking and IPF, as well as evidence of a detrimental effect of smoking on survival.4 Environmental exposures to certain types of manufacturing-related dust and genetic factors also are contributors.5

Prognosis and Disease Course

Common symptoms of IPF include dry cough, shortness of breath, fatigue, chest pain, and unintentional weight loss.2 Because these symptoms are nonspecific and are associated with other diseases, such as asthma, chronic obstructive pulmonary disease, emphysema, and heart disease, the diagnosis of IPF often is delayed.1 Thus, significant declines in lung function can occur by the time a patient is correctly diagnosed. It is imperative to start patients on FDA-approved therapies as soon as possible to preserve lung function, reduce the risk for acute exacerbations, and improve outcomes.1

The prognosis of patients with IPF is poor; median survival duration is less than 4 years.1 The clinical course of IPF can vary by patient, with some patients experiencing a slowly progressive course and others rapidly progressing. At diagnosis, there are no distinguishing clinical characteristics to indicate the clinical course a patient is likely to experience. Acute exacerbations with clinically significant worsening of lung function and/or dyspnea can occur at any time during the course of the disease and are associated with a high risk for mortality.1


Historically, the only treatment options available to patients with IPF were focused on symptom relief and not slowing the disease course. In 2014, the FDA approved 2 oral antifibrotic therapies for IPF: nintedanib (Ofev, Boehringer Ingelheim) and pirfenidone (Esbriet, Genentech) (Table).3 Current guidelines from respiratory societies recommend antifibrotic agents as first-line therapy for patients with IPF.6

In addition, patients can benefit from a holistic approach to care that includes pulmonary rehabilitation, education and support, vaccinations, and supplemental oxygen.2,7 Although there is no cure for IPF, medications combined with lifestyle changes can help to slow the decline in lung function, decrease respiratory symptoms, and reduce acute exacerbations.1

Table. Antifibrotic Agents Approved to Treat Idiopathic Pulmonary Fibrosis
MedicationDoseCommon AEsWarnings/
Counseling Notes
Nintedanib (Ofev, Boehringer Ingelheim)Recommended dose: 150 mg twice daily every 12 h with food Mild hepatic impairment (Child-Pugh A): 100 mg twice daily every 12 h with foodDiarrhea Nausea Stomach pain Decreased appetite Headache Weight loss High blood pressureHepatic impairment Elevated liver enzymes GI disorders Embryo-fetal toxicity Arterial thromboembolic events Bleeding events GI perforationIf AEs occur, consider a temporary dose reduction to 100 mg twice daily Pregnancy category D
Pirfenidone (Esbriet, Genentech)Titration dose: Days 1-7: 267 mg 3 times daily (801 mg/d) Days 8-14: 534 mg 3 times daily (1,602 mg/d) Days 15 and beyond: 801 mg 3 times daily (2,403 mg/d)Nausea Rash Abdominal pain Upper RTI Diarrhea FatigueElevated liver enzymes Photosensitivity reaction or rash GI disordersPatients who miss =14 d should restart with 2-wk titration regimen Take with food Pregnancy category C
AEs, adverse events; GI, gastrointestinal; RTI, respiratory tract infectionBased on references 8 and 9.

Antifibrotic Agents


Nintedanib is a tyrosine kinase inhibitor that targets multiple growth receptors involved in the pathogenesis of fibrotic tissue remodeling in interstitial lung disease. The recommended dose is 150 mg orally twice daily with food.8 A dose reduction to 100 mg orally twice daily should be considered for patients with mild hepatic impairment or for the management of adverse events (AEs).8 The most common AEs are diarrhea, nausea, and vomiting. The nintedanib labeling includes warnings and precautions related to hepatic impairment, elevated liver enzymes, gastrointestinal disorders, embryo-fetal toxicity, arterial thromboembolic events, and bleeding events.8

In clinical trials, nintedanib resulted in statistically significant reductions in the annual rate of lung function decline, as measured by forced vital capacity (FVC), preserving lung function, and reduced the risk for acute exacerbations in the first year of therapy.8


Pirfenidone is an antifibrotic medication that is thought to have multiple effects. It has been shown to regulate important profibrotic and pro-inflammatory cytokine cascades in vitro and to reduce fibroblast proliferation and collagen synthesis in animal models.9 The recommended maintenance dose of pirfenidone is 801 mg 3 times daily taken with food, but patients will titrate to the full dosage over a 14-day period.9 The most common AEs are nausea, rash, and abdominal pain. The labeling for pirfenidone includes warnings and precautions about elevated liver enzymes, photosensitivity, rash, and gastrointestinal disorders.9

In clinical trials, pirfenidone was shown to significantly reduce the risk for lung function decline as measured by FVC and to preserve lung function.9

Role of the Specialty Pharmacist

At AllianceRx Walgreens Prime, due to the complex nature of IPF, specialty pharmacists play a critical role educating, counseling and monitoring patients. Educating patients about the disease and the importance of receiving all recommended vaccinations is essential.1 Specialty pharmacists can provide counseling and support related to healthy lifestyle changes, such as smoking cessation, improved nutrition, and increased exercise.1,59 Because the diagnosis of IPF often is delayed due to misdiagnosis, patients likely will have had declining lung function for quite some time. Thus, it is crucial for pharmacists to educate patients about the importance of starting antifibrotic therapy as soon as possible to preserve lung function, slow disease progression, and improve outcomes.1 In addition, specialty pharmacists can educate patients and monitor for AEs associated with antifibrotic therapies. Both medications approved for IPF have warnings and precautions associated with their use. Pharmacists can counsel patients about signs and symptoms to be aware of and when to seek medical attention. Pharmacists also can help ensure patients keep their appointments for laboratory monitoring. By supporting IPF patients in these ways, specialty pharmacists can help optimize outcomes for this population.

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Recognising the value of protecting intellectual property early builds strong foundation for innovators

Innovation Manager at InnoScot Health, Fiona Schaefer analyses an essential facet of developing ideas into innovations

Helping the NHS to innovate remains a key priority during this period of recovery and reform. Even within the current cash-strapped climate, there is the opportunity to maximise the first-hand experience of the healthcare workforce and its knowledge of where new ideas are needed most.

Entrepreneurial-minded, creative staff from any discipline or activity are often best placed to recognise areas for improvement – the reason why a significant number of solutions come from, and are best developed with, health and social care staff.

NHS Scotland is a powerful driver of innovation, but to truly harness the opportunities which new ideas offer for development and commercialisation, the knowledge and intellectual property (IP) underpinning them needs to be protected. That vital know-how and other intangible assets – holding appropriate contracts for example – are key from an early stage.

Medical devices can take years to develop and gain regulatory approval, so from the outset of an idea’s development – and before revenue is generated – filing for IP protection and having confidentiality agreements in place are ways to start creating valuable assets. This is especially important when applying for patent protection because that option is only available when ideas have not been discussed or presented to external parties prior to application.

Without taking that critical initial step to protect IP, anyone – without your permission – could copy the idea, so anything of worth should be protected as soon as possible, making for a clear competitive advantage and ownership in the same sense as possessing physical property.

The common theme is that to be successful – and ultimately support the commercialisation of ideas that will improve patient care and outcomes – the idea must be novel, better, quicker, or more efficient than existing options. Furthermore, to turn it into a sound proposition worth investing in, it must also be technically and financially feasible. It isn’t enough to just be new and novel – the best innovations offer tangible benefits to patient outcomes and staff working practices.

Of course, even more so in the current climate of financial constraints, the key question of ‘Who will pay for your new product or service?’ needs to be considered up front as well.

Whilst development of a strong IP portfolio requires investment and dedicated expertise, when done well and at the appropriate time, then it is resource well spent, offering a level of security whilst developing an asset which can be built upon and traded. There are various ways commercialisation can progress and whilst not all efforts will be successful, intellectual property is an asset which can be licensed or sold to others offering a range of opportunities to secure a good return.

In my experience, however, many organisations including the NHS are still missing the opportunity to recognise and protect their knowledge assets and intellectual property early in the innovation pathway. This is partly due to lack of understanding – sometimes one aspect is carefully protected, whilst another is entirely neglected. In other cases, the desire to accelerate to the next stage of product development means such important foundational steps are not given the attention required for long-term success.

Good IP management goes beyond formally protecting the knowledge assets associated with a project, e.g. by patenting or design registration, however. When considered with other intangible assets such as access to datasets, clinical trial results, standard operating procedures, quality management systems, and regulatory approvals, it is the combination which will be key to success.

Early securing of IP protection or recognition of IP rights in a collaboration agreement, demonstrates foresight and business acumen. Later on, it can significantly boost negotiating power with a licensing partner or build investor confidence.

Conversely, omissions in IP protection or suitable contracts can be damaging, potentially derailing years of product development and exposing organisations to legal challenges and other risks. Failing to protect a promising idea can also mean commercial opportunities are missed, thus leading to your IP being undervalued.

Ideas are evaluated by formal NHS Scotland partner InnoScot Health in the same way whether they are big or small, a product, service, or new, innovative approach to a care pathway.

We encourage and enable all 160,000 NHS Scotland staff, regardless of role or location, to come forward with their ideas, giving them the advice and support they need to maximise their potential benefits.

Protecting the IP rights of the health service is one of the cornerstones of InnoScot Health’s service offering. In fact, to date we have protected over 255 NHS Scotland innovations. Recently these have included design registration and trademarks for the SARUS® hood and trademarks for SCRAM®, building and protecting a recognised range of bags with innovative, intuitive layouts. Spin outs such as Aurum Biosciences meanwhile have patents underpinning their novel therapeutics and diagnostics.

We assist in managing this IP to ensure a return on investment for the health service. Any revenue generated from commercialising ideas and innovations from healthcare professionals is shared with the innovators and the health board through our agreements with them and the revenue sharing scheme detailed in health board IP and innovation policies.

Fundamentally, we believe that it is vital to harness the value of expertise and creativity of staff with a well-considered approach to protecting IP and knowledge input to projects from the start.

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Time is running out: NHS and their digital evolution journey

By Nej Gakenyi, CEO and Founder of GRM Digital

Many businesses have embarked on their digital evolution journey, transforming their technology offerings to upgrade their digital services in an effective and user-friendly way. Whilst this might be very successful for smaller and newer businesses, but for large corporations with long-standing legacy infrastructure, what does this mean? Recently the UK government pledged £6bn of new funding for the NHS, and the impact this funding and investment could have if executed properly, could revolutionise the UK public healthcare sector.

The NHS has always been a leader in terms of technology for medical purposes but where it has fallen down is in the streamlining of patient data, information and needs, which can lead to a breakdown in trust and the faith that the healthcare system is not a robust one. Therefore, the primary objective of additional funding must be to implement advanced data and digital technologies, to improve the digital health of the NHS and the overall health of the UK population, as well as revitalise both management efficiency and working practices.

Providing digital care

Digitalisation falls into two categories when it comes to the NHS – digitising traditionally ‘physical’ services like offering remote appointments and keeping electronic paper records, and a greater reliance on more innovative approaches driven by advances in technology. It is common knowledge that electronic services differ in GP practices across the country; and to have a drastically good or bad experience which is solely dependent on a geographical lottery contradicts the very purpose of offering an overarching healthcare provision to society at large.

By streamlining services and investing in proper infrastructure, a level playing field can be created which is vital when it comes to patients accessing both the care they need and their own personal history of appointments, GP interactions, diagnoses and medications. Through this approach, the NHS focus on creating world-leading care, provision of that care and potentially see waiting lists decrease due to the effective diagnosis and management enabled by slick and efficient technology.

This is especially important when looking at personalisedhealth support and developing a system that enables patients to receive care wherever they are and helps them monitor and manage long-term health conditions independently. This, alongside ensuring that technology and data collection supports improvements in both individual and population-level patient care, can only serve to streamline NHS efforts and create positive outcomes for both the patient and workforce.

Revolutionising patient experiences

A robust level of trust is critical to guaranteeing the success of any business or provision. If technology fails, so does the faith the customer or consumer has in the technology being designed to improve outcomes for them. An individual will always have some semblance of responsibility and ownership over their lives, well-being and health. Still, all of these key pillars can only stand strong when there is infrastructure in place to help drive positive results. Whilst there may be risks of excluding some groups of individuals with a digital-first approach, technology solutions can empower people to take control of their healthcare enabling the patient and NHS to work together. Tandem efforts between humans and technology

Technology must work in tandem with a workforce for it to be effective. This means the NHS workforce must be digitally savvy and have patient-centred care at the front and centre of all operations. Alongside any digital transformation the NHS adopts to improve patient outcomes, comes the need to assess current and future capability and capacity challenges, and build a workforce with the right skills to help shape an NHS that is fit for purpose.

This is just the beginning. With more invtesement and funding being allocated for the NHS this is the starting point, but for NHS decision-makers to ensure real benefits for patients, more still needs to be done. Effective digital evolution holds the key. Once the NHS has fully harnessed the poer of new and evolving technologies to change patient experiences throught the UK, with consistent communication and care, this will set the UK apart and will mark the NHS has a diriving example for accessible, digital healthcare.

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Improving Patient Experience: How To Utilise an Interactive Whiteboard in Hospitals

Hospitals and healthcare facilities face a unique set of challenges every day. Patients comprise most of their daily visitors, and no two cases are alike. Yet it’s crucial that medical staff deliver a stellar patient experience for each individual they see.

Of course, long waiting times, confusing information, and other issues can get in the way of this. And when the patient experience suffers, the hospital’s reputation does as well. Bringing in technology such as interactive whiteboards offers a practical solution, and they’re easier to manage than ever.

How Patient Experience Affects Your Bottom Line

Even in facilities featuring top doctors and services, patients will walk out after just one negative interaction. This might include missed or cancelled appointments, faulty or inaccurate diagnoses, and surly customer service staff. Notice the one thing common with these examples? Often, a negative patient experience comes from a problem with communication—or a complete lack of it.

By nature, the medical practice is busy, and miscommunication can be hard to avoid. But it only takes one highly publicised negative experience to undermine a healthcare company’s reputation. Once word spreads about long wait times, cancelled appointments, unresponsive staff, and misunderstood diagnoses, your bottom line starts sinking.

So, how do healthcare organisations improve their communication systems and deliver a better patient experience? Usually, a communication problem requires a communication solution.

Use Technology To Improve Communication and the Patient Experience

To improve communication between your medical professionals and their patients, don’t reinvent the wheel. There are plenty of existing technologies that help bridge communication gaps and increase engagement levels.

For instance, use monitors to post regular updates in the waiting room and let patients know how long they’ll have to wait. Displaying the order in which patients are being treated offers transparency about how long doctors typically meet with their patients. This way, those in the waiting room know what to expect in terms of when they might be seen.

You can also lean on presentations or videos to help patients better understand their diagnosis and treatment plans. This can free up the doctor’s time and give patients another way to process information.

Among the more popular and easy-to-implement ways to improve communication are interactive whiteboards. Through touchscreen technology, these smart devices help make information more accessible for both patients and medical teams.

4 Ways To Use Interactive Whiteboards for Better Patient Experience

Why digital interactive whiteboards? Previous versions such as dry-erase boards and chalkboards were messy prototypes that relied solely on human handwriting. It takes time to write everything on the board. Plus, chalk and markers are both health and environmental hazards. (Besides, doctors have notoriously bad handwriting.)

Interactive whiteboards are a modern way to communicate with patients. You can use your fingers to write on these devices, and many programs will automatically transform handwriting into readable text. Even better, whiteboards can also serve as digital displays that play presentations, slideshows, videos, and images.

If you need to clarify a point, medical staff can annotate the whiteboard’s content directly. Finally, anything displayed on the interactive whiteboard can be saved into a file and printed. This allows both doctors and patients to keep records of their interactions for future reference.

Let’s review some of the other ways interactive whiteboards can improve the patient experience.

Hospital Branding

An interactive whiteboard in the registration area, waiting rooms, consultation areas, and patient rooms signals a healthcare facility’s commitment to communication. Waiting patients can quickly get updates about the current queue lines and estimated waiting times. In between, staff can display hospital information that can help raise brand awareness.

Whiteboards can also play interactive presentations that share the company’s mission, vision, and goals. Then, patients who want to know more can simply interact with the whiteboard to get additional information.

Personalized Care Planning

During consultations, healthcare professionals can easily share their initial findings and discuss the information with patients. Doctors can also use the interactive whiteboard to gather specific information from patients in order to come up with a more accurate diagnosis. Once a treatment is prescribed, patients can turn to the whiteboard to play videos or presentations that help them better understand the treatment process.

Patient Education

Interactive presentations that are catered to individual patients can help educate patients on the nature and treatment of their conditions. By clicking on the presentation via touchscreen controls, they can get more details of how treatment can reverse their condition. Patients can also view simulations of what can happen to them in the absence of treatment.

In addition, patients can use interactive whiteboards to gather more information about their healthcare facility, including its history, specialisations, and public staff data.

(Hospital) Unit-Specific Information

An interactive whiteboard in a hospital room can give doctors and nurses a quick summary of their patient’s current condition. At the same time, they can add changes or instructions so that attending staff can adjust accordingly. Confined patients or their companions can also access information from whiteboards that show updates on administrative matters such as billing, consumption summaries, and timetables.

For the Best Patient Experience, Interactive Whiteboards Need Reliable Device Managers

Interactive whiteboards can improve the patient experience by providing an always-ready communication medium. Because these smart devices are a substantial investment for any healthcare company, be sure to invest in a reliable device management solution to manage, maintain, and secure them.

The right device manager utilises remote cloud technology to provide over-the-air (OTA) updates to all connected devices. It can also control access levels by assigning authority to users based on need. What’s more, a well-designed device manager can secure devices by shutting down units that report unauthorised access.

Device managers can geolocate missing or stolen devices and start the retrieval process. Finally, admins can remotely wipe private data from the devices if there’s a threat of data theft.

As you can see, your choice of device management software can help you get the most out of your interactive whiteboards. Invest in a reliable device manager to maximise their performance for a more efficient medical staff and a better overall patient experience.

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