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Topics for DTB review articles are selected by DTB’s editorial board to provide concise overviews of medicines and other treatments to help patients get the best care. Articles include a summary of key points and a brief overview for patients. Articles may also have a series of multiple choice CME questions.

Early in 2019, the European Medicines Agency (EMA) extended the licence for dapagliflozin 5 mg tablets to include use by people with type 1 diabetes who have a body mass index (BMI) ≥27 kg/m2 when insulin alone does not provide adequate glycaemic control.1 The National Institute of Health and Care Excellence (NICE) subsequently adjudged dapagliflozin to be a cost-effective option for those with type 1 diabetes who require insulin doses of at least 0.5 units/kg of body weight per day.2 Additional requirements from NICE include the need for a structured education programme about diabetic ketoacidosis (DKA), to have treatment started and supervised by a specialist consultant physician and to stop the drug after 6 months if there is not a sustained improvement in glycaemic control. EMA authorisation for type 1 diabetes was based on two placebo-controlled trials …

Dabigatran was the first direct acting oral anticoagulant (DOAC) launched in the UK and has been in clinical use for over 10 years. Since then, ▾rivaroxaban, apixaban and ▾edoxaban have been marketed, and between them the four DOACs account for over 800 000 prescriptions per month in England.1 DOACs provide some advantages over warfarin, including a rapid onset of action, predictable dose–response with fixed doses and limited interactions with food and drugs. Nevertheless, there are still well-recognised problems with bleeding and at present there are only limited therapeutic options available to reverse their anticoagulant effect.2 Since their launch, the Medicines and Healthcare products Regulatory Agency (MHRA) has received more than 4 000 yellow card reports of DOAC-associated haemorrhagic adverse events of which almost 500 were fatal.3 All the DOACs are dependent on …

The London Organising Committee for the Olympic and Paralympic Games was established to plan and deliver the London 2012 Games. Within the Medical Services network, the Pharmacy Planning Committee (PPC) developed and delivered pharmacy services that were among the most advanced and comprehensive of any Games. The PPC designed a pharmacy service according to UK standards, operated through three polyclinics at the Athlete Villages. From these polyclinic pharmacies a system was set up for the supply, storage and management of medicines for use at all competition and training venues. To ensure safe and standardised approaches were used, a comprehensive set of policies and standard operating procedures was developed. Pharmacy guides, including drug formularies, were provided for the medical prescribers both within the polyclinics and as members of the Olympic and Paralympic Teams visiting the Games from around the world. Over 100 pharmacists and pharmacy technicians were recruited as the volunteer workforce for the Games. A training and education programme was developed to prepare this team to work in the unique environment of an Athlete Village polyclinic. A total of 5200 prescriptions (6849 items) were dispensed through the polyclinic pharmacies over the period of the Games. In addition, a Pharmacy Minor Ailments Scheme for non-athletes was introduced for the first time at an Olympics, with 1046 encounters taking place over the period of the Games. Valuable lessons were learnt from developing and delivering these pharmacy services. These have been reported back to the International Olympic Committee to ensure continued development and improvement of pharmacy services at future Games.

Aims the Neonatal and Paediatric Pharmacists Group (NPPG) supported two paediatric pharmacists to work with the online Medusa injectable medicines guide to improve the paediatric content of the website, initially for a 12 month period. The aim of this survey was firstly to understand what resources hospital pharmacists currently use to advise their nursing and medical staff on the administration of injectable medicines for paediatrics. The second aim was to assess current opinions regarding the Medusa website from our paediatric pharmacist colleagues in terms of challenges in using the website and potential solutions to overcoming those challenges. Method An online survey was designed using Survey Monkey and sent to all NPPG pharmacists using the NHS networks message board, as well as all registered users of Medusa. 145 responses (after combining multiple responses from the same centre) were analysed from UK NHS and Irish hospitals. Results Our results showed that almost all centres treat patients under 18 years of age (92%) and 83% of centres had access to Medusa either just for their pharmacists or at ward level. 25% of centres used hard copies of in-house designed IV guides at ward level, hence some centres used both Medusa and in-house guides. The in-house guides were in some cases written by pharmacists at that Trust, in other cases adapted from IV guides written by pharmacists at neighbouring Trusts. District general hospitals were more likely to use Medusa as the sole resource whereas specialist children9s hospitals were more likely to their in-house guide as the sole resource. Other resources used were the BNF for children and Guys and St Thomas9 Hospital formulary. Further resources were only used by centres with designated paediatric medicines information pharmacists. The IV guidance used for children often varied dependEnt on their age. For example, Trusts only treating adolescents and adults would mostly not have separate guidelines for the children. Often also, Trusts used different guidance for neonates on an intensive care unit, compared to neonates on a general ward. 57% respondents provided dosing information as well as administration information to their wards. Medusa does not provide dosing information and this can often be seen as a barrier to its use. Some centres provided dosing information via their in-house guides, but other centres adapted the Medusa monographs by using a function called “local guides” within the website to add information specific to that centre or area within the centre e.g. paediatrics, or intensive care. Respondents recognised that although they produced their own guides, this was becoming an increasingly unsustainable workload and that Medusa was increasingly being used as the main alternative resource. Conclusions The responses were used to create action plans for the NPPG pharmacists working with Medusa: ▸ Review each Medusa monograph for paediatric content ▸ Edit wording to reduce monograph length wherever possible ▸ Include practical information, rather than only information that can be referenced ▸ Review general information within website for paediatric content ▸ Edit wording to produce standardised content for consistency throughout the monographs.

Dense plasmas having uniform and constant density and temperature are generated by passage of a planar shock wave through gas. The opacity of the plasma is accurately measured versus wavelength by recording the risetime of emitted light. This technique is applicable to a wide variety of species and plasma conditions. Initial experiments in argon have produced plasmas with 2 eV temperatures, 0.004–0.04 g/cm3 densities, and coupling parameters Γ∼0.3–0.7. Measurements in visible light are compared with calculations using the HOPE code. An interesting peak in the opacity at 400 nm is observed for the first time and is identified with the 4s‐5p transition in excited neutral argon atoms.

To assess the frequency with which HIV-seropositive patients treated with corticosteroids develop cytomegalovirus (CMV) disease.Retrospective case-controlled study.All 130 patients receiving systemic corticosteroids over a 20-month period at the HIV Unit, Westminster Hospital, London, UK were reviewed for the development of clinical CMV disease within 28 days. The incidence of CMV disease in this group was compared with that in a cohort admitted during the same period, which was matched for admission diagnosis, HIV risk group, antiretroviral therapy and CD4 lymphocyte subset count (+/- 20%) at admission.Eleven of the 130 patients given corticosteroids developed CMV disease within 28 days, compared with two patients in the case-controlled cohort. All patients who developed CMV disease had a CD4 count50 x 10(6)/l on admission.The use of corticosteroids in patients with advanced immunosuppression due to HIV infection should be reviewed carefully in view of the possible increased incidence of CMV disease.

Former consultant obstetrician and gynaecologist Vale of Leven District General Hospital, Alexandria, Dunbartonshire (b 1915; q Glasgow 1937; FRCP Glas, FRCOG), died from pneumonia complicating a stroke on 10 July 2004. Orr became a consultant at Glasgow Royal Maternity Hospital and the Royal Samaritan Hospital for Women before being appointed consultant to Dumbarton County, initially singlehanded and working at a number of small hospitals. In 1953-4 the Vale of Leven Hospital was opened, gynaecology came under one roof, and a second consultant was appointed. In 1970 a maternity unit was opened on the hospital site and a third consultant arrived to complete the team. Orr's main interest, clinically, was radical surgery for cervical cancer. He retired from practice in 1980. Predeceased by his first two wives, he leaves his third wife, Margaret, and a stepdaughter.

During the past few years circumstances have forced a change in the Council's policy towards the retention of original historical material. It should be remembered that, until the formation of the Imperial War Museum in 1919, the R.U.S.I.'s collection in the Banqueting House constituted the sole Service museum (other than the Tower Armouries) in the capital. In 1935 the National Maritime Museum at Greenwich was formed, and since the last war the National Army Museum at Camberley and the Royal Air Force Museum at Hendon have come into being. In 1962 the R.U.S.I.'s collection of uniforms and relics had to be dispersed when the Banqueting House was taken back by the Government, and from that time on the Institution ceased to collect further exhibits. The present position is that there now exists a professionally staffed museum for each of the three Services, and from 1970, when the National Army Museum's new building at Chelsea opens, all four museums dealing with the Services and their histories wi...