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Consultation on a new benchmark on pain

23rd July 2009

The UK Department of Health (DH) has issued a consultation on a new benchmark in pain in their "Essence of care" system of benchmarking. The closing date for responses is 2009-10-12. The consultation document and the questionnaire can be downloaded from the DH website link below.

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Updated SIGN/BTS guidance on the management of asthma

23rd July 2009

The British guideline on the management of asthma published by the Scottish Intercollegiate Guidelines Network (SIGN) and the British Thoracic Society (BTS) has been updated. The updated guideline can be downloaded from the link below. It contains updates in the following sections: pharmacological management (section 4), management of acute asthma (section 6), and asthma in pregnancy (section 7.3).

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NICE guidance on lenalidomide for multiple myeloma

23rd July 2009

The UK National Institute for Health and Clinical Excellence (NICE) has published guidance on the treatment of multiple myeloma in patients who have received at least one prior therapy. NICE have also issued a costing template. Both documents can be downloaded from the links below.
NICE has recommended that lenalidomide in combination with dexamethasone is used, within its licensed indication, as an option for the treatment of multiple myeloma only in people who have received two or more prior therapies, with the condition that the drug cost of lenalidomide (excluding any related costs) for people who remain on treatment for more than 26 cycles (each of 28 days; normally a period of 2 years) will be met by the manufacturer. People currently on lenalidomide for this condition, who have not received two or more prior therapies, should have the option to continue therapy until they and their clinicians consider it appropriate to stop.

NICE guidance on lenalidomide for multiple myeloma
NICE costing template for lenalidomide

Oxycodone injection 50mg/mL now available in UK

16th July 2009

Oxycodone 50mg/mL solution for injection or infusion (OxyNorm, Napp 01223 424444) has been launched in the UK. It should be diluted and used for SC or IV injection or infusion for moderate to severe pain in patients with cancer and post-operative pain. The SPC contains information regarding mixing oxycodone 50mg/mL with the following drugs; hyoscine butylbromide, hyoscine hydrobromide, dexamethasone sodium phosphate, haloperidol, midazolam, metoclopramide, levomepromazine, glycopyrronium and ketamine. We understand that this is extra compatibility data generated specifically for the 50mg/mL product and is awaiting publication. There is also additional information on mixing with cyclizine at concentrations >3mg/mL. The cost of a pack of 5 ampoules is £70.10.

SPC OxyNorm injection 50mg/mL

End of Life Care strategy annual report

15th July 2009

The Uk Department of Health (DH) has published the first annual report of the End of Life Care strategy.

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MLX 356: MHRA allows mixing of medicines

7th July 2009

The UK Medicines and Healthcare products Regulatory Agency (MHRA) has confirmed that the outcome of the MLX 356 consultation about amendments to medicines legislation to allow mixing in palliative care has now been published and will shortly be available on the MHRA website.

"We have published the outcome of the consultation on proposals to regularise the position of those involved in the mixing of medicines, including in palliative care. We have also included a summary of the Commission on Human Medicines' (CHM) consideration of the proposals and recommendations since they extend to other clinical areas where mixing of medicines is undertaken and is established practice. The Chief Nursing Officer and Chief Pharmaceutical Officer for England endorse the CHM's recommendations, which will help to support clinical care. Ministers have accepted these recommendations and agreed to amend medicines legislation accordingly. We plan to implement the changes later this year."

In summary the MHRA and CHM have agreed the following, which covers all areas of clinical practice where mixing is currently undertaken including palliative care:
• Doctors and dentists (who can already mix medicines themselves) should be able to direct others to mix
• Non-medical prescribers should be able to mix medicines themselves and should be able to direct others to mix
• Nurse and Pharmacist Independent Prescribers are to be allowed to prescribe unlicensed medicines for their patients on the same basis as doctors and supplementary prescribers
• The MHRA should approach the Home Office and the Advisory Council for the Misuse of Drugs (ACMD) with CHM's recommendations that corresponding amendments are made to the Misuse of Drugs Regulations for controlled drugs.
Until the medicines legislation has been changed, the MHRA has issued a revised statement on mixing of medicines in clinical practice to allow current practice to continue in all clinical areas where the mixing of medicines is accepted practice.
The full outcome of consultation and the revised statement on mixing of medicines in clinical practice can be downloaded below.

MHRA outcome of consultation MLX356:
MHRA revised statement on mixing of medicines in clinical practice

Symptom Management in Advanced Cancer 4th edition

2nd July 2009

We are delighted to announce that the new edition will be available in 2 months time. Buy now to take advantage of the special prepublication price of £30 (normal price £40). Purchasing this book will help to keep a free access resource.
It will be available only from our website bookshop which can be accessed via the home page).
Symptom Management in Advanced Cancer is an established text which provides a framework of knowledge to enable clinicians to develop a systematic and scientific approach to treatment. It offers practical information and advice on the wide range of symptoms encountered in patients with advanced cancer. This edition has been extensively revised and expanded, and has a new chapter on Last days.

A masterly work: clear, concise and practical: Age and Ageing

A essential book: Geriatric Medicine

Without doubt the best of the numerous offerings on this subject. It is up to date, the information flows logically and the reader acquires concrete information in a few minutes. I have no reservations about recommending it: Oncology in Practice

Should be within reach of all clinicians involved in the management of patients with advanced cancer: Palliative Medicine

Every general practitioner, hospital doctor (medical and surgical) and especially oncologist and palliative care physicians should have this book on their shelf: British Journal of Hospital Medicine.

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MHRA multiple drug recalls

2nd July 2009

The UK Medicines and Healthcare products Regulatory Agency has recalled several products, all of which are distributed by Karib Kemi Pharm, due to serious Good Manufacturing Practice (GMP) deficiencies found during an inspection of their contract manufacturer. Three separate alerts have been issued. The products involved are co-amilozide tablets, doxazosin tablets, fluoxetine capsules, metformin tablets and naproxen tablets. Full details of the batch numbers concerned are in the alerts below.

2009-07-02 pm An additional fourth alert from Sandoz has been issued regarding baclofen tablets, fluoxetine capsules and metformin tablets.

MHRA alert fluoxetine
MHRA alert doxazosin and fluoxetine
MHRA alert co-amilozide, metformin and naproxen
MHRA alert baclofen, fluoxetine and metformin

End of life care strategy: quality markers and measures publication

2nd July 2009

The end of life care strategy, published in July 2008, included a commitment to publish quality markers for end of life care. This has now been published and is available on the UK Department of Health (DH) website (see below).

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Guide on core competences for end of life care published

2nd July 2009

The national end of life care programme has published a document on common core competences and principles for health and social care workers working with adults at the end of life. It can be downloaded from the link below.

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