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This paper is the first report of a P450-electrode in a microfluidic format. A 30 [micro]L microfluidic cell was made in poly(methyl methacrylate) containing the inlet, outlet, and reaction chamber with two electrode strips, one of which contains the human cytochrome P450 3A4 covalently bound to gold via a 6-bexanethiol and 7-mercaptoheptanoic acid (1:1) sell-assembled monolayer. The electrochemical response of the P450-electrode in the microfluidic cell was tested using four drags that are known substrates of P450 3A4: quinidine, nifedipine, alosetron and ondansetron. Titration experiments allowed the electrochemical measurements of KM for the four drugs, with values of 2.9, 29.1, 113.4, and 114.1 mM, respectively. The [K.sub.M] values are found to be in good agreement and correctly ranked with respect to the published literature on human liver microsomes and baculosomes: [ondansetron [approximately equal to] alosetron > nifedipine > quinidine]. The results presented in this paper represent a step forward for a rapid evaluation of the interaction of P450 and drug, requiring small volumes of new chemical entities to be tested. 10.1021/ac102480k

The first electrochemical study of the human flavin-containing monooxygenase 3 (hFMO3) either absorbed or covalently linked to different electrode surfaces is reported. A structural model of the enzyme generated on the basis of reversible electrochemical signals of an active hFMO3 via use of glassy carbon and gold electrodes rationalized the electrochemistry of the enzyme.

Objective: Trastuzumab (T) is a humanized monoclonal antibody used in the treatment of HER2-positive breast cancer and is available as a subcutaneous (SC) formulation thereby allowing short and convenient administration. A lack of trained nurses to administer T at home and/or train patients at home to self-administer, together with challenges in maintaining cold-chain delivery have impeded the uptake of home administration. In order to support patients’ ability to self-administer T at home, we have implemented an educational programme that includes nurse-led training, education material, support apps and follow-up telephone clinics. Home delivery of pre-filled syringes was enabled in collaboration with commercial providers for aseptic and logistic. The aim of this pilot study was to evaluate the utility of this programme from the patients’ perspective and to assess patient satisfaction and its impact on quality of life (QOL). Methods: A previously validated Self-Injection Assessment Questionnaire (SIAQ) was modified to assess patient satisfaction, perceptions and the impact of the programme. Patients, who had agreed to enrol on the ‘self-administration’ scheme, were asked to complete the questionnaire at baseline, at the third training session and at the second self-administered dose. Results: All 14 patients offered the questionnaire responded to all questions. The median age was 58 years old, (age range 43–76): 11(79%) were Caucasian, 2(14%) were Asian and one (7%) was African/ Caribbean. The average distance from their home address to the hospital was 10.1 miles (range 4–19). Following completion of the 1:1 nurse training, there was a significant improvement in patient confidence to self-administer sc. T (p = 0.03). No differences in ‘feeling in control of their treatment’ or ‘satisfaction of attending hospital appointments’ were noted. Of the 11 patients who reached the self-administration stage, 10 pts (91%) reported that they felt ‘very confident’ and 8 pts (82%) reported that it was ‘very easy’ to give themselves the injection. All patients were ‘very satisfied’ with self-administration and felt that the 1:1 nurse training programme helped them to be more confident. 10 pts (91%) found the App and written information useful as well as the pre- and post-administration telephone clinics. All patients reported that the self-administration programme had a positive impact on their QOL by reducing the number of hospital visits. In the first 4 months of self-administration, each patient reduced their hospital attendance by an average of eight appointments (median = 8) equating to 10 h of time that would have been spent at hospital. Conclusion: The subcutaneous T self-administration programme was well received by patients. The nurse training sessions and supportive materials enabled patients to feel more confident about self-administration with no reported incidents or adverse events. This led to fewer hospital visits and improved QOL. This programme was critically dependent on the services of a commercial compounder and homecare provider, emphasizing the importance of joint working between the NHS and the commercial sector. Evaluation of this programme will continue. [ABSTRACT FROM AUTHOR]

Objective: With the rising drug cost, the NHS drug spending soared to £18.2 billion in 2017/2018 and the ‘The Future of Pharmacy Aseptic Services in England’ review found that of the existing 649 installed workstations, 402 will need to be replaced. Utilising ready-to-administer bags of cytotoxic treatment can reduce waste and improve the current chemotherapy supply chains to be more agile, leaner and resilient to drug shortages thereby creating better value for the taxpayers’ money. Implementation of dose banding tables provides an opportunity to move away from bespoke products and enable the use of batch and ready-to-administer chemotherapy drugs. The primary drivers of this are cost reduction in waste and resilience in the chemotherapy supply chain. Methods: A retrospective analysis of gemcitabine and irinotecan procurement and wastage data over a 30-months period was used to compare unlicensed chemotherapy batch versus ready-to-administer doses for cost, waste and patient waiting time in the day units. Results: A total of 1802 dose units of Gemcitabine and 1355 dose units of Irinotecan were administered between January 2019 and June 2021. Ready-to-administer gemcitabine infusion was implemented in October 2019 with a gradual increase from 31% of total doses to an average of 82.5% per month. Irinotecan ready-to-administer infusion was implemented in March 2021 with a gradual increase from 21.5% to 64.3%. Patient waiting times on average shortened by 32 min post-implementation. A reduction of 63.8% and 67% in the value of gemcitabine and irinotecan wasted through the introduction of ready-to-administer products was observed. However, as the products do not cover all dose ranges, batch doses were still in use for 1300 mg and 1500 mg gemcitabine. Additionally, an average monthly saving of £1400 was observed on drug costs of ready-to-administer doses versus batch doses. Conclusion: Aseptic compounding is currently the biggest challenge facing the delivery of chemotherapy treatments and organisations within the NHS need to make the most efficient use of the limited capacity. This study shows that implementation of licensed ready-to-administer doses reduces waste through increased shelf life, reduces costs and improves the availability of doses for patients. [ABSTRACT FROM AUTHOR]

Objective: With significant advances in cancer treatment with multiple lines of treatment, cancer has become a chronic condition. The NHS Long-Term Plan (2020) has set out to improve national screening programmes to accelerate the diagnosis and treatment of cancer. It has been predicted that the gap in the future demand for the specialist oncologist workforce will be widen to 29% by 2025. Skill mix approaches, such as utilising Non-Medical Prescribing (NMP) Pharmacists to bridge the gap are urgently required. Our first studies in 2020 showed that an NMP pharmacist can improve both clinic capacity and service delivery, along with reducing cancer waiting times. In 2021, our NMP pharmacist clinics expanded from one to six tumour sites. Whilst patient satisfaction surveys have shown patients are satisfied with the consultation carried out, at present, there is little published research exploring the perspectives of the healthcare profession (HCP) working with NMP pharmacists. Methods: Implementation of pharmacist NMP clinic provides an opportunity to improve the existing outpatient clinics’ capacity, reduce cancer wait time as well as potentially optimise patients’ understanding of their treatment and improving overall patient experience. To collect the views of the HCP, a semi-structured survey on Microsoft Forms was used. Open-ended questions enabled us to evaluate the positive impact of the NMP pharmacist service as well as areas for improvement. Results: Retrospective data collected between November 2019 and March 2022 showed steady growth in outpatient clinic capacity over a 28-month period with a total of 2585 consultations conducted. A total of 37 healthcare professionals completed the questionnaire: 13 oncologists, three registrars, five SACT-trained nurses, five clinical nurse specialists, six nurses, one pharmacist and four others. The average overall satisfaction with the NMP service was 4.73 out of 5. When asked about how they found the NMP service in comparison to their expectations, 73% (27) found it better than expected and 27% (10) found the service as expected. Four themes were identified when asked about what they like best about the NMP service including being an integral part of the clinical team, utilising expertise and knowledge in drug treatments, being very helpful in providing good support to both patients and staff, streamlining the clinic by reducing clinic waiting time and contributing to smooth running of the clinic. When asked about what could be changed all 37 responses requested the expansion of NMP services to all tumour sites. 92% (34) of respondents would definitely recommend the NMP service to their colleagues. Discussion and conclusion: Post-COVID recovery of NHS services is currently the biggest challenge facing all health systems. This study has shown that the NMP pharmacist can integrate into the clinical team and through their expertise in drug treatments provide good support to both patients and staff. The NMP pharmacist can make a significant contribution towards the challenge of creating the additional clinic capacity required for post-COVID recovery. The NMPs were well-received and accepted by other healthcare professionals making a positive impact by providing great care to our patients. [ABSTRACT FROM AUTHOR]

Introduction: Fluoropyrimidines (5-fluorouracil and capecitabine) are used in the treatment of various cancers. The enzyme dihydropyrimidine dehydrogenase (DPD) plays a key role in their metabolism (Lunenburg 2020). Some patients have reduced DPD activity leading to an increased risk of severe/fatal toxicity (Amstutz et al., 2017). In March 2020, the EMA Pharmacovigilance Risk Assessment Committee recommended DPD deficiency testing prior to starting fluoropyrimidines (UK Chemotherapy Board, 2020). Testing for DPD was introduced at Mount Vernon in March 2021. Aims and objectives: To review if DPD testing meets the standards set by the UKCB and as agreed with the consultant team. To ascertain if: All patients starting fluoropyrimidines are being tested for DPD prior to treatment. All patients being tested for DPD have no delays in treatment. Method: Data was collected retrospectively over 10 months from March 2021 to December 2021. Information from blood test reports, ChemoCare and patient notes were obtained. Results: 348 patients were initiated on fluoropyrimidinebased therapy. Compliance with audit standards is summarised in table 1. 4.7% (n = 15) of patients did not have a DPD test, with reasons unknown. The turnaround time for DPD results varied each month but averaged at 10 days. For some patients, this caused a delay in starting treatment whereas others were delayed due to the DPD test not being ordered on time, chair capacity, and other reasons. Obtaining results from different pathology systems (i.e. Guy’s and St Thomas’, North West London, Watford General, and Royal Marsden) also led to delays. Discussion: This analysis shows that > 95% of patients are being routinely tested for DPD however testing pathway delays are having an impact on patients starting treatment. Overall, 40% of the standards are being adhered to (standards 3 and 4); however, some standards have not been achieved (standards 1, 2 and 5). Recommendation: Create a centralised portal system for which all DPD results are reported and accessible. Due to multiple laboratory sites where DPD testing is conducted, there is difficulty in chasing available results, consequently leading to delays in treatment. Having a central reporting system could also save costs as it prevents patients being re-tested. Interface DPD results into electronic prescribing systems to ensure no prescribing errors. Currently, the results are being manually typed by clinicians onto ChemoCare. Integrated reporting will ensure appropriate patient flow and prevent human errors and delays in treatment. Further investigation on the impact DPD testing has had on reducing fluoropyrimidine toxicity. Present the results of this audit at doctor’s educational meetings and to nursing and pharmacy staff (delivered by the educational lead pharmacist). A collaborative approach can help improve strategies for DPD testing. Re-audit by the end of 2022 to ensure that improvements are sustained after the above recommendations have been implemented. Conclusion: DPD testing is a novel approach to preventing fluoropryimidine toxicity. This audit revealed that not all national standards are being adhered to; consequently leading to treatment delays. However, effective training and a centralised system should increase compliance with the standards set by the UKCB and as agreed with the consultant team. [ABSTRACT FROM AUTHOR]

Objective: At Mount Vernon Cancer centre we have expanded the pharmacy technician role beyond traditional dispensing activities to include advanced or specialised tasks such as medication history taking, counselling, and the day-to-day management of the electronic prescribing system. The objective was to explore the views of pharmacy technicians on their expanding role. Methods: A focus group was held with five pharmacy technicians. The open discussion explored job satisfaction and how the technicians felt about their roles and responsibilities. Information collected from the focus group was analysed according to themes. Results: The main themes identified during the focus group included job satisfaction, job design, communication and education and training. The technicians were motivated by recognition, responsibility, achievement, a stimulating work environment and the possibility of advancement. These factors increased job satisfaction. All technicians were keen to undertake further education and training opportunities, particularly the Medicines Management for Pharmacy Technicians Course. All the rotational pharmacy technicians enjoyed the rotational element of their role. Whilst all rotational technicians enjoyed the variety of their roles, patient facing roles were the most popular. The least popular role was one where training gaps were identified and one where they felt undervalued on occasion. Technicians also wanted increased communication and more recognition. The results of the focus group reflected the Herzberg motivation– hygiene theory. The motivating factors have been listed previously and the hygiene factors identified include company policy/administration, good interpersonal relationships, and quality of supervision and work conditions. Herzberg found that when motivating factors were in place it resulted in a commitment to the job, high satisfaction and high motivation and this was reflected in our focus group discussion. Hygiene factors were less instrumental in increasing job satisfaction but did prevent dissatisfaction. Conclusion: Technicians had higher levels of job satisfaction when they received recognition, responsibility and achievement in a stimulating work environment with the possibility of advancement. The enhanced roles offered a stimulating work environment, empowerment and opportunities for advancement. Recognition and training were identified as areas for improvement. Motivational factors played a big role in job satisfaction and ultimately performance. [ABSTRACT FROM AUTHOR]