Sticking on the critical appraisal theme, we have a look at tecovirimat, the antiviral suggested as an option for the treatment of monkeypox. How does it work, what does it do, how do we know, and how confident are we in the evidence base? As part of this, we have a think about the directness of evidence, and how far it might be sensible to extrapolate from the data we have to different clinical scenarios.

Tecovirimat for monkeypox and directness of evidence 

Going back to critical appraisal (we'll go back to finish the series of "what's the point of..." various different bits of pharmacy next time), we're having a look at the risks around getting your dog vaccinated against kennel cough. Are you going to catch kennel cough from them yourself? When we say "there's a theoretical risk" what do we mean? And if we know what we mean, do the people we're explaining things to take the same meaning from what we say? How do we help people to optimise the risks they might take in a world where we don't have definite numbers to work with?

Kennel cough vaccines and managing theoretical risks

Following on from last time's "what's the point of Medicines Information services", this time it's the turn of pharmacy QA. What do they actually do, and why might they be good people to know? Thanks to QA Hannah for QA'ing this one.

What's The Point Of... Pharmacy QA?

Following on from last time's podcast, we continue on a theme of having a look at some of the less often seen bits of pharmacy departments and services. This time out, it's Medicines Information (or Medicine Advice) services in the NHS. Back in the 1970s when they started, the world was a different place and information was hard to come by. But now, when you can get millions of guidelines and papers after a quick search of the internet, what function do they serve? With thanks to all those who helped to give me a pharmacy history lesson last year when MI in the UK turned 50!

What's The Point Of... A Medicines Information Service?

Going in a slightly different direction with this episode, we're looking at bits of pharmacy and asking "what's the point?". But, you know, in a positive way. This time, what's the point of having a Drug and Therapeutics Group - a group in your organisation who get to decide which new medicines get used. What value does a DTG add, and what benefits does it deliver?

What's The Point Of... A Drug and Therapeutics Group?

What is methenamine hippurate? Is it as good as prophylactic antibiotics for recurrent UTIs? And most importantly, how come the recent trial could, perfectly legitimately, say it was non-inferior whilst it also looking to the casual observer as being marginally less good? What does non-inferiority mean in clinical trials, and why do people get twitchy about delta values?

Methenamine hippurate and non-inferiority studies

Gene therapy - it's here, and it's really expensive! What does onasemnogene abeparvovec do? How does how it works compare to other (also complicated and expensive) medicines? How strong can the evidence be if it's not from a randomised controlled trial? And, probably most importantly, why on earth does it have 10 syllables in its name and how might you go about butchering its pronunciation?

Onasemnogene abeparvovec, gene therapy, and the hierarchy of evidence

Why does Paxlovid interact with so many other medicines? How can we find out what it interacts with? What approaches can we take to work out what to do with this information? And can we pull out some general learning about how to manage drug-drug interactions, whether it's Paxlovid or something else?

Paxlovid and drug interactions

What is sotrovimab, and how does it work against Covid? Why is it called sotrovimab and not sotrolimab? How come it has a risk reduction of 85% and 6% yet these are both true and both mean the same thing? And if you were asked how good it might be for your patient, what would you say?

Sotrovimab: summary stats and relative risk reduction

Often, we get asked about temperature deviations, where medicines get stored by accident outside of what the manufacturers recommend. If something's been stored a couple of degrees warm for a couple of hours, it won't impact on product quality - but when do we need to start worrying? If a manufacturer says they don't have any data, how can you make informed decisions so that you don't waste NHS money throwing away medicines that are perfectly fine to use?

So you switched your fridge off...

Run-throughs of core concepts in pharmacy, approached pragmatically

Looking at the new Covid treatment Paxlovid (nirmatrelvir + ritonavir), how does it work and can we work out summary statistics? Then, can we compare them to the ones we worked out for molnupiravir last time? What are the problems with this approach, and why do we need to be cautious comparing outcomes between different trials? (Note: at the time of recording, there wasn't much guidance on how to pronounce nirmatrelvir, so I've gone for NIR-ma-TREL-vir rather than NIR-MAT-rel-vir or any other version. It's a best guess, so sorry if I've gone for the protease inhibitor version of CLO-pi-DOG-rel. Only time will tell)

Nirmatrelvir (Paxlovid) - summary stats and comparing between trials

What do you need to think about when giving medicines via enteral feeding tubes? What are theoretical problems vs real problems, how do you balance the needs of the medicine with the needs of the patient, and how are you going to come to a decision? This podcast isn't going to tell you all the answers, but will hopefully give you pointers on what you might need to consider.

How to think about giving medicines via enteral feeding tubes

Why do so many medicines taste disgusting, and what do industry try to do to fix this? And more importantly, what can we do to make taking (or giving) medicines less of an ordeal? There's no profound learning in this one, but you might find out why bribing with chocolate is the most successful strategy for getting medicines into children.

So your medicine tastes disgusting...

Using molnupiravir as an example again, we look at the new data that's been released and the FDA's analysis. Why is the data released showing something different to the interim analysis only a fortnight or so ago? And why does this seem to happen a lot, with early results being more positive than the later full results? And what does this mean for us and how we think about using early data?

Molnupiravir (again) and interim analyses

We use QALYs to judge how good treatments are and compare them to other treatments, but what are their limitations? Can we use the recent discussions about whether teenagers should be vaccinated against Covid to illustrate these things about QALYs? Listen to find out how successfully we've done this!

QALYs (using Covid vaccines as an analogy)

Using molnupiravir as an example, and looking at the data from news reports rather than papers, can we work out summary statistics for how well it might work, how can we represent them honestly, and how might we communicate them effectively to others?

Summary statistics with molnupiravir

What are we trying to do when we do therapeutic drug monitoring? How do we do it, and what can we do if levels aren't taken exactly how we'd like? A pragmatic review of the first principles involved in therapeutic drug monitoring from a pharmacy perspective

How to think about therapeutic drug monitoring

A very brief overview of what it means if we say a medicine is unlicensed - what does it mean, and what do we need to do differently compared to if we're using a licensed medicine?

Unlicensed medicines - what are they?

Medicines in secondary care in England are funded in confusing ways. This podcast tries to give a brief overview of why different medicines are funded differently, how you can predict who might pay for different medicines, and how it is kept relatively fair between different providers

How are medicines funded in the NHS in England?

How and why do we use summary statistics to explain clinical trials, and why are some statistics better than others for helping us understand what a drug might do? In this podcast, we talk about absolute risks, absolute risk reductions, and number needed to treat, and why they tend to be better statistics to use for understanding compared to odds, odds ratios and relative risk reductions.

Summary statistics - absolute risk reduction and number needed to treat

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