p1 _ HPE101 _ cover _ v2 . indd 1 28 / 07 / 2022 10:37
References 1 Lipkind HS . Receipt of COVID-19 Vaccine During Pregnancy and Preterm or Small-for-Gestational-Age at Birth - Eight Integrated Health Care Organizations , United States , December 15 , 2020 – July 22 , 2021 . MMWR Morb Mortal Wkly Rep 2022 ; 71 ( 1 ): 26 – 30 . 2 Halasa NB et al . Effectiveness of Maternal Vaccination with mRNA COVID-19 Vaccine During Pregnancy Against COVID- 19-Associated Hospitalization in Infants Aged < 6 Months - 17 States , July 2021 – January 2022 . MMWR Morb Mortal Wkly Rep 2022 ; 71 ( 7 ): 264 – 70 . 3 Halasa NB et al . Maternal Vaccination and Risk of Hospitalization for Covid-19 among Infants . N Engl J Med 2022 ; June 22 .
8 | Issue 101 | hospitalpharmacyeurope . com hospitalpharmacyeurope . com | Issue 101 | 9
References 1 Soriano JB et al . A clinical case definition of post- COVID-19 condition by a Delphi consensus . Lancet Infect Dis 2022 ; 22 ( 4 ): e102 – e107 . 2 Lopez-Leon S et al . Long-COVID in children and adolescents :
a systematic review and meta-analyses . Sci Rep 2022 ; 12:9950 .
32 | Issue 101 | hospitalpharmacyeurope . com hospitalpharmacyeurope . com | Issue 101 | 33
Re-register to continue receiving Hospital Pharmacy Europe
INSIDE
Issue 101 | 2022 | hospitalpharmacyeurope . com
Optimising physical health in the patient with severe mental illness
P21
EXPERT COMMENT
Normalising cancer associated thrombosis
Professor Simon Noble discusses the importance of normalising cancer associated thrombosis among cancer patients and the steps pharmacists can take to avoid patient distress
The first time I became aware of the association between cancer and thrombosis was as a junior doctor , when I admitted a patient who had developed atrial fibrillation caused by a pulmonary embolism ( PE ). I noticed that the patient had painless jaundice – a tell-tale sign of pancreatic cancer , which a scan confirmed .
As I went on to do some oncology and palliative care , I realised that cancer associated thrombosis ( CAT ) was a massive problem in our population that was not being managed properly . Even today , 20 years later , there is still significant work to do in raising awareness of the condition .
With this in mind , there are two main areas I want to discuss in this piece :
The first is the crucial role that pharmacists can play a role in increasing cancer patients ’ awareness of thrombosis . Pharmacists have an integral role in the administration of anticancer therapies and information giving ahead of cancer treatment . This is the best time to share additional information about the risk and symptoms of thrombosis .
The second is to ensure the safe prescribing of anticoagulants for patients who have been diagnosed with CAT . That is , giving information on how specific drugs should be taken and ensuring that there are no significant drug – drug interactions with anti-cancer therapies .
The risk of CAT for cancer patients Thrombosis is the second leading cause of death in cancer patients , second only to cancer progression . 1 Cancer patients are at very high risk of developing thrombosis for several reasons .
First , the tumours themselves secrete procoagulants , which makes the blood stickier . However , different cancers have different thrombotic effects . For instance , pancreatic cancer , primary brain cancer , and lung cancer can increase the risk of thrombosis twentyfold . 2 Other cancers , such as breast cancer and prostate cancer , are less thrombotic but we see more of these patients with clots because these are such common cancers .
Normalising cancer associated thrombosis P8
Tracking the anticholinergic burden score during admission P25
Neonatal parenteral nutrition and delivery P29
The pharmacy community has an integral role in the management of CAT , starting with the patient who is receiving systemic treatments
Simon Noble MBBS FRCP PGCE DipPalMed Marie Curie Professor in Supportive and Palliative Medicine , Division of Population Medicine , Cardiff University , UK
Disease progression is another factor which makes the cancer patient at greater risk of thrombosis . Patients with metastatic disease will have a twentyfold increase set out to in assess risk of the effectiveness of maternal developing CAT compared vaccination to someone against with hospitalisation for early-stage cancer . 3 COVID-19 among infants under 6 months of
We also have the impact age but of systemic this time , when Omicron was the anti-cancer therapies ( SACT main ). Chemotherapies circulating variant , . To determine the targeted therapies , immunotherapies effectiveness of , and maternal all vaccination , the newer agents increase researchers the risk of compared CAT . A the odds of full patient ’ s risk of developing maternal a blood vaccination clot with ( that is , receipt of two stage one breast cancer doses is 0.2 % of – mRNA only double vaccine ) during pregnancy the risk of a healthy person among developing symptomatic a clot infants . younger than However , if you give that 6 months breast cancer of age patient who were hospitalised for adjuvant chemotherapy COVID-19 , which we ( referred commonly to as case infants ) and do , that risk increases tenfold infants to younger 2 %. 4 Around than 6 months of age who 55,000 women and 370 were men are hospitalised diagnosed
without COVID-19 ( referred with breast cancer every to year as control in the UK infants , so
). The researchers that is a lot of clots .
5 collected information on COVID-19-related
A period of immobility outcomes , dehydration in addition or an to hospitalisation , such infection can increase the as admission thrombotic to risk
an intensive care unit ( ICU ) further . This leaves us with and a life-support patient with interventions an
, for example , underlying high risk of non-invasive cancer and any or illness
invasive mechanical can tip them over the threshold ventilation until . they
develop a clot .
A total of 1049 infants ( 537 case infants )
with a median age of 2 months ( 43.5 % female ) The evidence for prevention were of included clots in the analysis . Among case Despite the prevalence of infants CAT , , the 19 % evidence
had at least one underlying for prevention of clots in health ambulant condition cancer
, which included respiratory patients receiving SACT ( 6 is %), unclear cardiovascular . There are
( 8 %) and other ( not listed ) certain cancers known to chronic be so thrombotic
conditions ( 10 %). In the case infant when treated that we should group be , 84 giving
% of mothers were unvaccinated at prophylaxis . For example the , haematologists time of the study will
. routinely give primary thromboprophylaxis Among the 537 case to infants , 21 % were patients with myeloma admitted receiving to lenalidomide
an ICU and 12 % required and steroids , because we mechanical know up to ventilation 25 % of or vasoactive these patients would get infusions a clot otherwise . However . 6 , the incidence of ICU
There are also strong data admission to recommend and the the need for invasive use of primary thromboprophylaxis procedures was in much lower if the mother had pancreatic cancer patients been receiving vaccinated . For example , ICU admissions chemotherapy . However were , despite much it being lower in ( 23 % vs 13 %, vaccinated vs the National Institute for unvaccinated Health and Care mothers ), as was the need for Excellence ( NICE ) guidelines non-invasive , the uptake mechanical of ventilation ( 8 % vs 6 %, this in clinical practice vaccinated the UK is vs still unvaccinated poor . mothers ).
In terms of risk assessment The tools overall , the vaccine effectiveness of Khorana Score can tell us maternal which patients vaccination are against COVID-related at higher risk of venous thromboembolism hospitalisation among ( VTE ). infants was 52 %; It assesses patients according however to , primary vaccination was only 38 % during the cancer , platelet count , haemoglobin Omicron period , and . The effectiveness was also found to be dependent on the stage of pregnancy . For example , effectiveness was 69 %
when given after 20 weeks of pregnancy but only 38 % when given during the first 20 weeks of pregnancy .
The authors concluded that their data provided additional support for current recommendations to vaccinate pregnant women .
A quarter of children / adolescents experience long COVID
A systemic review and meta-analysis has found that just over 25 % of children and adolescents experienced symptoms that persisted for longer than 4 weeks after an acute COVID-19 infection .
For much of the time during the COVID-19 pandemic , attention focused on the acute phase of infection . However , it has now become clear that many individuals continue to experience ongoing and debilitating symptoms , which have become known as long COVID . Although severe COVID-19 infections are now recognised as being far less common in children than adults , children are known to develop multi-system inflammatory syndrome , in which different parts of the body become inflamed . In addition , long COVID , in which symptoms either persist or where new symptoms appear , has also been identified in children . In 2021 , the World Health Organization proposed a definition of what they termed ‘ post-COVID-19 ’ as a ‘ condition that occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection , usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis .’ 1 However , while research on the prevalence of post-COVID-19 ( that is , long COVID ) has focused on adults , less attention has been paid to the level of this syndrome in children .
For the present study , 2 researchers turned their attention to children , not just to ascertain the prevalence of long COVID but also to gather information on the full spectrum of symptoms experienced . They performed a systematic review and metaanalysis and searched for studies that reported on individuals under 18 years of age and with
GETTY X2
a laboratory-confirmed diagnosis s of COVID-19 . Additional requirements for studies were a minimum of 30 patients , that the study was published in English and that it met the definition of long-COVID proposed by the National Institute for Health and Care Excellence ( NICE ); that is , 4 – 12 weeks or for 12 weeks or longer .
The literature search identified ed 21 eligible studies with the number of participants ranging from 53 to 57,763 . A problem for the researchers was how the definition ion of long COVID varied in the literature . For instance , the terms ‘ persistent COVID ’ ‘ long COVID ’, ‘ post-acute COVID ’ were all used and included in the analysis .
The prevalence of long COVID in children and adolescents , defined by the presence of one or more symptoms persisting for more than 4 weeks , was 25.24 % ( 95 % CI 18.17 – 33.02 ). This prevalence was slightly higher among those who had been hospitalised ( 29.19 %; 95 % CI 17.83 – 41.98 ). In terms of the reported symptoms , the most frequent were mood symptoms , including sadness , tension , anger , depression and anxiety ( 16.5 %), followed by fatigue ( 9.6 %), sleep disorders ( 8.4 %) and headache ( 7.8 %).
In their meta-analysis , which compared symptoms with control patients , children with long COVID had a higher risk of persistent dyspnoea ( odds ratio , OR = 2.69 , 95 % CI 2.20 – 3.14 ), anosmia ( OR = 10.68 ) and or fever ( OR = 2.23 ).
Overall , there was a wide range of symptoms affecting other organs such as the gastrointestinal tract , skin , and musculoskeletal system , l as well as the
FREE TO SUBSCRIBE REGISTER NOW
cardiorespiratory system .
The authors concluded that long COVID represents a significant health concern and that their data support the continued monitoring of the impact on the condition in children and adolescents , to better understand the paediatric burden .
Multivitamin supplements unlikely to benefit either cardiovascular disease or cancer
According to a 2016 survey of over 37,000 adults in the US , 52 % reported use of any supplement , with 31 % reporting the use of a multivitamin , multi-mineral supplement . 1 Supplement use in Europe appears to be more variable , with a 2009 study finding that usage among adults ranged from 2 % ( Greece ) to 51 % ( Denmark ). 2 While prevalence surveys are of interest , what is most revealing is the reason why consumers take dietary vitamin / mineral supplements . One study reported that the most common reasons for supplement use include overall health and wellness ( 58 %), to fill nutrient gaps ( 42 %) and for immune health ( 32 %). 3
Sharing best practice and learning from peers is vital – and Hospital Pharmacy Europe does just this , by providing practical and applicable information that shows what others in this sector are doing across Europe and the UK .
This copy of Hospital Pharmacy Europe is sent to you free of charge and delivers the latest news , clinical articles and research . Re-register today and ensure you don ’ t miss the next issue !
Visit https :// hospitalpharmacyeurope . com / subscribeto-the-journal /