Objectives To compare practice pharmacists and community pharmacists based on the use of the General Level Framework (GLF) as a tool to support continuing professional development (CPD). Setting Primary care and community pharmacy in London and the East of England. Method The study pharmacists were self‐selected after distribution of recruitment packs in the study area through local pharmaceutical committees, primary care trusts and two large multiples. Sixty‐nine pharmacists used the framework to support their CPD (42 community pharmacists and 27 with a role in primary care pharmacy). Pharmacists made an initial self‐assessment against the GLF and then used the framework over a 12‐month period to identify learning needs for CPD. Pharmacists identified their desired performance levels for the behaviours in the framework, based on guidance from the project team, and then identified their learning needs by comparing the desired performance level with their self‐assessment. Pharmacists were visited at 4 and 8months by a trained facilitator to support their self‐assessment and progress with CPD. Final self‐assessments were collected at 12months. Assessment ratings for the delivery of patient‐care competencies were compared. Key findings There was no difference in the probability of either group achieving their desired performance level (log rank = 0.023, 1 df, P = 0.878): pharmacists achieved their desired performance level irrespective of their sector of work, demonstrating the applicability of the GLF to the different sectors of practice. Practice pharmacists had a higher aggregated score for the desired performance levels than the community pharmacists (Mann‐Whitney U = 10.500, P < 0.001; median = 133.0 and 119.5 respectively). Conclusion Both groups of pharmacists were able to apply the framework to their practice and use it to support their CPD, resulting in increasing self‐assessed competency scores over time. The higher desired performance level for practice pharmacists compared with community pharmacists conveys a difference, perceived or actual, between the two roles. Irrespective of the difference in desired performance levels, both groups of pharmacists have improved, to meet their level of expectation, over the 12‐month period.

All reviewed treatment options are safe for management of NAFLD in patients with T2DM but long-term histological improvements are minimal. TZDs are efficacious for resolution of NASH and improvements in fibrosis but long-term use is required to maintain these results.

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Metformin and insulin remain the mainstay of treatment for T2DM in pediatric patients. More robust studies are needed to assist in the provision of evidence-based guidance for the treatment of T2DM in youth.

ObjectivesTo survey current prescribing practices of psychotropic drugs by child and adolescent eating disorder (CAED) psychiatrists in the treatment of anorexia nervosa (AN).DesignCross-sectional self-administered survey.SettingAll children and young people eating disorder services (CYP EDS) in England during a national training programme.Participants44 CAED psychiatrists practising in CYP EDS in England.Primary and secondary outcome measuresCAED psychiatrists completed a questionnaire regarding the pattern of psychopharmacological care in AN that they provide and the medication treatment pattern at their CYP EDS. Secondary outcome measures included the process of continuing pharmacotherapy from secondary care to primary care.ResultsOf the 77 CYP EDS representing every team in England, 44 teams represented by a CAED psychiatrist responded, despite 13 having no psychiatrists in post at the time of the study (response rate 69%). Most (40%) respondents estimated that <10% of patients with AN were prescribed psychotropic medications. Olanzapine was reported as the most commonly prescribed medication for AN by 38% of the respondents, followed by fluoxetine (29%) and sertraline (10%). The most common minimum olanzapine initiation dose in this study was at 2.5 mg/day for a duration of 2–4 weeks, reaching a maximum dose of 5 mg/day. Most (68%) reviewed medications every week (30%) or every 2 weeks (38%). Over 50% of the respondents reported continuation of olanzapine prescribing within the CYP EDS teams.ConclusionsThis nationally representative survey showed that despite a lack of evidence, psychotropic medications are commonly prescribed to a minority of patients, most frequently, olanzapine. Further evidence is needed on which patients may potentially benefit from pharmacotherapy as an adjunct to psychological interventions.

Objective The purpose of this study was to explore self-assessed competence of community pharmacists who had completed additional clinical pharmacy training at certificate level and were accredited to provide a clinical medication review service to primary care patients (the 'trained' group). The self-assessed competence of these pharmacists was compared with others who had not undertaken the training (the 'untrained' group). Method A postal questionnaire was sent to 179 community pharmacists in both groups across four primary care trusts in the east of London. The questionnaire comprised two parts: characteristics of the respondents; and 81 behavioural statements divided into four competency clusters. Key findings The response rate was 50% (n = 90). While pharmacists who possessed a postgraduate qualification were more likely to assess themselves to be more competent in the 'Delivery of patient care' competency cluster, there was no difference in self-assessed competence between 'trained' and 'untrained' groups. Conclusion Training and experience in providing clinical medication reviews did not seem to influence the self-assessed competence of community pharmacists: indeed, the 'trained' pharmacists seemed to have become more aware of their competence gaps. As the roles of community pharmacists expand, pharmacists need greater targeted support to face new challenges and to deliver the new services in chronic medicines management.

2511 Background: CD73 is implicated in tumor resistance to checkpoint immunotherapy (CPI) and plays a critical role in adenosine-mediated immune suppression. Uliledlimab, a differentiated CD73 antibody, inhibits the adenosine pathway in a non-competitive and unique intra-dimer binding mode. Uliledlimab suppresses tumor growth when combined with a PD-(L)1 inhibitor in multiple pre-clinical models. Methods: This 3+3 dose-escalation phase 1 study (NCT03835949) evaluated safety, tolerability, PK, PD and preliminary efficacy in cancer patients. Uliledlimab was administered intravenously at doses of 5, 10 or 15 mg/kg weekly (QW) or 15 or 20 mg/kg every 3 weeks (Q3W) alone in the first cycle and in combination with atezolizumab (1,200 mg Q3W) starting on week 4. Soluble CD73 in serum and CD73 receptor occupancy (RO) in circulating CD19+ B cells were measured. Expression of PD-L1, CD73 and A2A receptor was analyzed in baseline tumor specimens (n = 14). Tumor responses were assessed by RECIST/iRECIST. Results: As of 17 January 2021, 20 patients with advanced solid tumors were enrolled (M:F 8:12; mean age = 64; median prior regimens = 3 (range 1-9)). Uliledlimab was well-tolerated with no dose limiting toxicity. The most common treatment-related adverse events were first dose infusion related reactions (65%, n = 13) most commonly comprising chills/rigors, nausea, and vomiting (Grade 1 or 2) that resolved in subsequent infusions. PK appears linear at doses ≥ 10 mg/kg and modelling indicated a mean derived effective half-life of ̃19 days. Soluble CD73 was undetectable and complete RO was achieved in all patients after the first dose at ≥ 10 mg/kg. Anti-drug antibody was detected in 3/20 patients (15%). Among 13 efficacy-evaluable patients dosed at ≥ 10 mg/kg, complete response (CR = 1) and partial response (PR = 2) were observed in 3 patients (ORR = 23%) together with 3 stable disease (SD) patients (DCR = 46%). One PD-(L)1 inhibitor naïve patient with clear cell ovarian cancer achieved CR at 10 mg/kg QW and remains on study after 12 months. Two patients with NSCLC dosed at 15 mg/kg QW and 20 mg/kg Q3W, respectively, achieved PR. One patient failed nivolumab and the other received no prior PD-(L)1 inhibitor treatment. CD73 was expressed on 78% (mean) of malignant cells from archival tumor specimens in responders compared to 23% in non-responders. Conclusions: Uliledlimab is safe and well tolerated up to 20 mg/kg Q3W and 15 mg/kg QW. Full saturation of circulating and cell-bound CD73 was achieved at doses ≥ 10 mg/kg. Uliledlimab exhibited evidence of clinical activity in both PD-(L)1 treatment naïve and refractory cancer patients with high archival tumor expression of CD73. The results of this phase 1 study encourage further clinical investigation to evaluate the efficacy of uliledlimab in the treatment of solid tumors. Clinical trial information: NCT03835949.

Background:The benefits of clinical pharmacy services are established within hospital practice but staff numbers required for service delivery are not well described and staffing levels vary. The need for a consistent, objective method of determining staffing levels was recognised at a UK University Hospital and a Clinical Pharmacy Workforce Calculator (CPWC) was developed.Objective: To develop the Activity Standard (AS) for pharmaceutical care and establish the reliability of the CPWC across acute hospital settings in UK. Setting.Acute hospital in-patient clinical pharmacy services on medical and surgical wards. Method: Using the World Health Organisation's Workload Indicators of Staffing Need (WISN) methodology, a two-round Delphi study was undertaken. This developed the Activity Standard for pharmaceutical care and identified the staff-time unavailable for clinical work. Consenting panel members then tested the CPWC, calculating the staff required for three scenarios to determine whether it could be reliably used by different operators.Results: Thirty-six participants consented to participate. Data were returned from 22 (61%) of whom 20 (56%) supplied analysable data. Consensus was achieved on the tasks required for pharmaceutical care delivery, the mean time each takes, how frequently they should be completed and the time unavailable for clinical work for each grade of staff. The CPWC calculates staffing requirements using these data. Eleven participants (55%) tested the CPWC and analysis of responses demonstrated that 30 of 33 (91%) calculations were accurately completed.Discussion: This study defined the WISN Activity Standard for UK pharmaceutical care delivery to hospital inpatients and showed content validity for the CPWC in acute medical and surgical hospital settings. Different operators used the CPWC reliably and applied it to local sites. Conclusion:The CPWC offers hospital pharmacy managers a useful tool to negotiate adequate staffing to deliver pharmaceutical care. Its development methodology could be applied widely in pharmacy practice.