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Pharmaceuticals

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

Epidemiology

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

Treatment

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/
Precautions
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

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

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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Pharmaceuticals

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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Pharmaceuticals

Strong IP protection is vital to healthcare’s AI-encompassing future

Head of Innovation at InnoScot Health, Robert Rea analyses the challenges and opportunities of integrating artificial intelligence into the NHS

Artificial Intelligence (AI) offers huge possibilities for healthcare improvement, and many are already being realised – but it also presents complexities for innovators looking to protect their ideas.

We’ve seen NHS Scotland and its triple helix partners across industry and academia increasingly leveraging AI with the aim of continuously improving patient care while streamlining operations for smarter, more efficient working practices.

Projects already underway include  the use of AI to help detect lung cancer, assess mammograms and skin lesions, and be used to predict or monitor health conditions, to name just a few examples.

Such applications hold the potential to nothing less than revolutionise diagnosis, treatment, and management of patients.

Thanks to a bank of high-quality data-led insights and forward-thinking, innovation-ready staff, NHS Scotland and its partners are well-placed to take a lead on taking advantage of the benefits of AI transformation.

Those benefits should absolutely be explored fully for improved patient outcomes and predictive potentialities. However, in applying the vast possibilities of AI to Scotland’s healthcare system, we also must be cognisant of broader implications; and the recent legal debate over whether AI can be named as an inventor has generated much interest.

It is an area we at InnoScot Health have been closely following – ensuring protection of the intellectual property (IP) inherent in new ideas that involve AI can be complex, particularly depending on how much of the idea sprang from the AI itself.

Patents are used to protect novel aspects of inventions, stopping others from duplicating them – that much is clear cut – but in December, the UK Supreme Court made headlines when it upheld earlier decisions which rejected a bid to allow AI to be named as an inventor in a patent application.

In 2019, US technologist Dr Stephen Thaler had sought to have his AI recognised as the inventor of a food container and a flashing light beacon after claiming the software was sentient and conscious, but the intellectual property office (IPO) rejected this, saying only a person could be named as an inventor.

The decision was backed by both the High Court and Court of Appeal after they supported the view that only ‘persons’ could hold patent rights.

Dr Thaler was not deterred though, and in December, five Supreme Court judges dismissed a bid to reverse those decisions, concluding similarly that “an inventor must be a person” and that AI could not secure patent rights.

One of the judges Lord Kitchin, said the AI was “a machine with no legal personality” and that Dr Thaler had “no independent right to obtain a patent in respect of any such technical advance”.

The judgement, commentators noted nevertheless, did not specifically deal with the issue of whether the AI did in fact invent the food container and light.

While the IPO welcomed the judgement and the clarification it offered – labelling the dispute a “test case, rather than one which is motivated by any pressing need in the real world” – it added interestingly that the government will “keep this area of law under review to ensure that the UK patent system supports AI innovation and the use of AI in the UK”.

So, would the outcome have been different if the AI had come up with the invention, but Dr Thaler had been identified as the inventor and owner of the patent? That remains unclear, though what is certainly clear is that a lot of organisations would find themselves in a predicament going forward if they were not able to own the patent from AI software-led inventions.

It serves to underline the complexities that now stem from AI use and how its growing prominence and advancement could force law changes in future.

Patents are not the only area of intellectual property protection that are being tested by AI – copyright too is being reassessed in light of fresh developments in the likes of AI-generated works.

Does the copyright from the works belong to the original programmer of the AI, for instance, or does it belong to the user who is instructing it to perform the task?

In future, will companies who use autonomous AI have to declare that their employees were the inventors despite them having little to do with the actual creation?

The IPO recently stated that it acknowledges “there are legitimate questions” around how intellectual property looks on AI creations and decides who owns them.

It believes that any future changes would need to be considered on an international level, not just within the UK.

All Scottish healthcare leaders have been very clear on the deployment of AI – that it should supplement human expertise rather than replace it – and there’s no doubting how effective it appears to be in, for example, enabling review and translation of mammograms with high accuracy alongside clinicians’ experience and insight.

Used well, AI can become an important safeguard in such processes while making them faster and more efficient.

For AI innovators working in healthcare though, the securing of patents and copyrights may become increasingly complex.

Under UK patent law, the NHS, as employer, will usually own the intellectual property created by healthcare professionals in the course of their employment or specifically assigned duties.

Comprehensive AI policies must therefore adapt to encompass both current challenges in delivering its benefits in healthcare settings, while precluding issues from likely future advances.

With a robust, horizon scanning policy in place, AI-related innovation can flourish but with the peace of mind which comes through IP protection.  

Protecting the IP rights of the NHS represents one of the cornerstones of InnoScot Health’s service offering and why the organisation was initially set up.

We assist NHS Scotland 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 originator and the health board through a bespoke NHS inventor award scheme as detailed in individual employee contracts and health board IP policies.

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Lifestyle

Ushering in a more personalised healthcare system

Subhro Malik, Senior Vice President & Head Life Science, Infosys

Millions of users across England are using the NHS App to quickly access various digital services such as scheduling doctor appointments, checking their records, referring to repeat prescriptions etc. The UK government wants to extend the app’s usage with ambitious plans to enrich its features over the next couple of years, and eventually accelerate the digital revolution in healthcare. By March 2024, the government hopes to have at least 75% of the adult population relying on the app for a wide array of healthcare services.

These ambitions clearly indicate the growing acceptance of technology as an enabler of healthcare on a massive scale. In the modern context, public healthcare needs to be patient-centric, holistic, anytime and anywhere, and stakeholders are increasingly depending on technology to deliver at scale. Digital interventions can truly transform the way healthcare services are delivered and bring these in line with end-user expectations.

Technologies such as the Internet of things, artificial intelligence, big data analytics, blockchain, and wearables can enable remote monitoring, exchange, and capture of relevant patient information. Studies show that healthcare providers harnessing such technologies and digital solutions are better placed to improve patient outcomes. The use of data enables more accurate diagnoses, better decision-making, self-management, and personalization of care. Medical device companies are also adding value by embedding digital assistants and apps into their products to enable a more personalised user experience.

For example, patients ailing from cardiovascular diseases, diabetes mellitus, chronic pain, or spinal disorders are required to strictly following prescribed medication, exercise, and nutrition regimens to manage their condition. It calls for a high degree of health and nutrition literacy and support in tracking and monitoring regimens, while remaining mindful of ambiguities and consequences. Patients already grappling with chronic conditions often feel overwhelmed by the complexities involved. They tend to lean heavily on professional supervision and interventions, expecting support on-demand.

In such situations, digital health platforms can become their lifelines. By seamlessly integrating real-time data from medical devices, wearables, mobile apps as well as other digital devices, these platforms enable clinicians to remotely monitor each patient’s progress. Digital health platforms also aggregate and analyse data to produce insights tailored to help each patient. They focus on enabling self-management of chronic conditions, and forming positive habits, thus helping them work towards a better quality of life.

A host of digital tools such as virtual coaches and digital diaries are available today that make patient-centred care, a reality. Patients with chronic pain can record, monitor, and access their pain data, closely trace patterns. These insights that can inform and push them towards choosing a better diet, exercise routine, and lifestyle.

Patients want more accessibility to their healthcare provider and may require support anytime. However, this support can be hard to come by, especially at odd hours. On the other hand, one of the biggest advantages of virtual tools is that support is available anytime, anywhere. This makes them an ideal solution for patients with chronic pain to avail on-demand support. In the absence of a consistent in-person supervisor, they can use a virtual coach who remotely monitors and guides them through their medication and exercise regimens that are integral to pain management. They are also able to log their pain patterns, moods, sleep data, and activities and understand whether their coping strategies are effective or need improvement.

Undoubtedly, digital platforms are valuable in the management of patient care with their strong alignment to each patient’s expectation and needs of personalised care. They can play a key role in enabling easy access to reliable information, on-demand support, user-friendly navigation etc. There are challenges, however, that could derail the radical changes, which technology can bring to healthcare systems. For instance, research suggests that patients feel a natural reticence in sharing highly personal/confidential health data on an app or online tool. Patient sensitivities over data privacy and security breaches can override the advantages of any feature or functionality these apps promise.

After all, the success of personalised digital health systems depends on the extent to which patients can trust the healthcare provider with regards to: “Is my confidential data in safe hands? And is my care provider using the most relevant insights to deliver the care I need when it matters the most to me? Health care providers and medical device manufacturers investing in digital solutions need to address these concerns and plug systemic vulnerabilities, on priority. Some of the measures that have proved to be effective include implementing physical and digital access controls, electronic audit trails, and risk analyses. Of course, giving the patient the choice to share their personal information voluntarily and the choice to opt out is important too.

Ensuring the data safety and empowering patients with knowledge and choice will be key in shaping the future of digital healthcare.

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