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Given the key role of pharmacists as a healthcare resource for patients seeking treatment of headache associated with migraine, this review highlights the burden of migraine, recent advances in preventive migraine therapies, and key takeaways from the most recent migraine management consensus statement. For at least two decades, it has been understood that correct diagnosis of migraine is key to its effective management. Migraine attacks should be treated promptly with acute medications, with preventive treatment for patients with regular, frequent, and/or disabling migraine attacks. Nonetheless, most patients with migraine are still not correctly diagnosed, and do not receive appropriate therapy for acute or preventive treatment of their disease. In addition, patients may be refractory to or unable to tolerate traditional oral preventive treatments, leading to underutilization of preventive treatment and subsequent reliance on acute treatment. Overuse of acute medications is associated with increased risk of progression from episodic to chronic migraine and development of medication overuse headache; therefore, pharmacists should counsel patients receiving over-the-counter or prescription acute migraine medications on when to seek options for preventive treatment to help avoid medication overuse. Pharmacists are well-positioned to identify those patients who would benefit from physician referral for further assessment and treatment with preventive therapy. They also have an important role in educating patients on the benefits of preventive medications, and realistic expectations of treatment outcomes. [ABSTRACT FROM AUTHOR]

An Online First version of this article was made available online at. [ABSTRACT FROM AUTHOR]

The document titled "Guidelines for the specification, implementation and management of IT systems in hospital transfusion laboratories: A British Society for Haematology Guideline" provides guidelines for hospital blood transfusion laboratories on the specification, implementation, and management of Laboratory Information Management Systems (LIMS). The guidelines address the use of IT systems in transfusion medicine, including electronic blood administration systems, recording administration/final fate information, information management, and system management. The document emphasizes the importance of patient identification, stock management, stock ordering, and stock tracking in transfusion laboratories. It also clarifies the use of terms relating to gender in clinical transfusion practice and provides recommendations for compliance with the guidelines. The document provides guidelines for the management of unused units in the transfusion process, as well as the management of patient records and data integrity. It discusses the use of unique patient identifiers, the merging and linking of patient records, and the generation of transfusion requests. The document highlights the benefits of electronic request systems and the use of Order Comms in improving patient safety and the efficiency of the transfusion process. It also addresses sample collection and the handling of samples and requests in the laboratory. The text discusses the importance of accurate patient identification and record-keeping in a laboratory information management system (LIMS) for blood transfusion processes. It emphasizes the need for unique patient identification, barcode labeling of samples, and matching requests to patient records. The LIMS should also support electronic transfer of information, automated testing processes [Extracted from the article]

Objective: To assess cardiovascular (CV) safety of erenumab in clinical trial patients associated with degree of CV risk. Background: Hypertension has been considered a theoretical risk associated with the inhibition of the calcitonin gene‐related peptide pathway in migraine management, particularly in a patient population with pre‐existing CV risk factors. Methods: Data pooled from four double‐blind, randomized trials were used to assess blood pressure (BP) changes and CV safety in patients grouped based on 10‐year risk of cardiac, cerebrovascular, and peripheral artery disease as no‐risk‐factors, low‐risk (>0% to ≤10%), moderate‐risk (>10% to ≤20%), and high‐risk (>20%) categories. CV safety was assessed as ischemic cardiovascular and cerebrovascular adverse events (ICCAE). Results: There was no apparent difference between placebo‐ (N = 1032) and erenumab‐treatment groups (70 mg, N = 885; 140 mg, N = 504) in clinical worsening of BP category from baseline to Months 1–3 (14% [143/1032] placebo vs. 13% [114/885] and 14% [71/504] for erenumab 70 and 140 mg, respectively) regardless of baseline BP category. The adverse event (AE) profile of erenumab was similar across CV risk categories throughout the long‐term analysis. Erenumab‐treated patients with high and moderate 10‐year CV risk (N = 107) did not experience any ICCAEs during the double‐blind treatment period; there was a single ICCAE (a cerebral dural venous sinus thrombosis) observed in the low‐risk erenumab group (N = 273). There were no increases in AEs during the long‐term extensions of up to 5 years (N = 2499; 3482 patient‐years of exposure to erenumab) with exposure‐adjusted incidence rates of cardio/cerebrovascular disorder AEs of 0.4, 0.5, 0.0, and 1.1 (per 100 patient‐years) for no risk factor (N = 1805), low (N = 492), moderate (N = 121), and high (N = 81) 10‐year CV risk groups, respectively. Conclusions: Ischemic CV and cerebrovascular AEs were uncommon and the incidence rates were similar across the 10‐year CV risk categories. This analysis helps provide more detail on the CV safety of erenumab. [ABSTRACT FROM AUTHOR]

Recombinant adeno-associated virus (rAAV) vectors encoding human factor VIII (hFVIII) were systematically evaluated for hemophilia A (HA) gene therapy. A 5.7-kb rAAV-expression cassette (rAAV-HLP-codop-hFVIII-N6) containing a codon-optimized hFVlll cDNA in which a 226 amino acid (aa) B-domain spacer replaced the entire B domain and a hybrid liver-specific promoter (HLP) mediated 10-fold higher hFVIII levels in mice compared with non-codon-optimized variants. A further twofold improvement in potency was achieved by replacing the 226-aa N6 spacer with a novel 17-aa peptide (V3) in which 6 glycosylation triplets from the B domain were juxtaposed. The resulting 5.2-kb rAAV-HLP-codop-hFVlll-V3 cassette was more efficiently packaged within AAV virions and mediated supraphysiologic hFVIII expression (732 ± 162% of normal) in HA knock- out mice following administration of 2 x 1012 vector genomes/kg, a vector dose shown to be safe in subjects with hemophilia B. Stable hFVIII expression at 15 ± 4% of normal was observed at this dose in a nonhuman primate. hFVIII expression above 100% was observed in 3 macaques that received a higher dose of either this vector or the N6 variant. These animals developed neutralizing anti-FVIII antibodies that were abrogated with transient immunosuppression. Therefore, rAAV-HLP-codop-hFVIII-V3 substantially improves the prospects of effective HA gene therapy. [ABSTRACT FROM AUTHOR]

Simple Summary: There is increasing recognition of the role of epigenetics in facilitating the pathogenesis and clinical outcome in patients with a diagnosis of neuroendocrine neoplasia. In this review we outline the different types of epigenetic changes that are observed and their impact. We also highlight novel interventions that can be used to manipulate these epigenetic changes that are being explored in the clinic. Gastroenteropancreatic neuroendocrine neoplasias are a diverse group of neoplasms with different characteristics in terms of site, biological behaviour and metastatic potential. In comparison to other cancers, they are genetically quiet, harbouring relatively few somatic mutations. It is increasingly becoming evident that epigenetic changes are as relevant, if not more so, as somatic mutations in promoting oncogenesis. Despite significant tumour heterogeneity, it is obvious that DNA methylation, histone and chromatin modifications and microRNA expression profiles are distinctive for GEP-NEN subtypes and may correlate with clinical outcome. This review summarises existing knowledge on epigenetic changes, identifying potential contributions to pathogenesis and oncogenesis. In particular, we focus on epigenetic changes pertaining to well-differentiated neuroendocrine tumours, which make up the bulk of NENs. We also highlight both similarities and differences within the subtypes of GEP-NETs and how these relate and compare to other types of cancers. We relate epigenetic understanding to existing treatments and explore how this knowledge may be exploited in the development of novel treatment approaches, such as in theranostics and combining conventional treatment modalities. We consider potential barriers to epigenetic research in GEP-NENs and discuss strategies to optimise research and development of new therapies. [ABSTRACT FROM AUTHOR]

Malignant pleural effusions cause significant morbidity, but there is no gold standard minimally invasive treatment. A new therapeutic approach combines talc pleurodesis and indwelling pleural catheters (IPCs) to enable outpatient management. This case series summarizes the safety and efficacy data of all patients (24) with a symptomatic malignant pleural effusion who underwent talc pleurodeses via IPCs between December 2010 and July 2013. Successful pleurodesis was achieved in 22 procedures (92%). There was one empyema, one hydropneumothorax, one recurrent effusion, and two minor complications: one drain site wound infection and one complaint of chest pain. Twenty-two procedures (92%) were performed in the outpatient setting. This report confirms the safety and efficacy of administering talc slurry through IPCs in an outpatient setting. Studies in a larger cohort are necessary to define the role of this novel approach in the treatment algorithm of patients with this condition. [ABSTRACT FROM AUTHOR]