Background The Australian Pharmaceutical Advisory Council guidelines for the continuum of quality use of medicines between hospital and community aim to establish a coordinated approach that encourages continuity in all areas of health care and the community. However, the implementation of these guidelines has been problematic. Aim To identify the number and nature of barriers encountered when organising a home medicines review (HMR) for patients at high risk of medication misadventure, after discharge from hospital. Method A liaison pharmacist organised an appointment for eligible patients (around 2 days post‐discharge) for the general practitioner to make an HMR referral. The pharmacist contacted the patient's community pharmacist to engage an accredited pharmacist to undertake the HMR and arranged for the HMR report to be sent to the outpatient clinic, the general practitioner and community pharmacist. Results 38/50 patients consented to have their general practitioner contacted by the liaison pharmacist. General practitioners agreed to order an HMR for 34 patients. Barriers to HMR uptake included: low patient awareness of HMRs, a low level of general practitioner awareness of the HMR process, reluctance of some community pharmacists to participate in HMR delivery and the time taken for HMRs to be performed. Conclusion Once aware of the HMR service, the majority of patients were willing to participate and general practitioners were prepared to refer their patients for such a service. However, time constraints impacted on both general practitioners and community pharmacists, hence, consideration should be given to extending the support from HMR facilitators to include pharmacies as well as general practitioners.

Background: The risk of medication misadventure for patients is greatest during times of change, particularly on discharge from hospital. Patients at high risk of medication misadventure postdischarge should be identified and provided with interventions to ensure the quality use of medicines and positive health outcomes. Home medicines reviews (HMRs) can be used to improve patient health outcomes and reduce the risk of medication misadventure. Aim: To describe the impact of issues raised in post-discharge HMRs, organised via a hospital medication liaison service. Method: HMR reports of participants were evaluated. Issues identified by the accredited pharmacist in each HMR report were classified as either a 'pharmacist intervention' delivered during the HMR or 'information given' that was previously unknown to the medical team. A potential clinical impact of these issues was assigned and the overall clinical significance of all the issues identified in each HMR report was ranked. Results: In 21 HMR reports, 98 issues were identified, with the mean per HMR report of 4.7 ±2.2. Of the 98 issues, 25 were classified as 'pharmacist intervention' and 73 were classified as 'information given'. On 2 occasions, a potential clinical impact of 4 (potentially life-saving) was allocated to an issue identified in the HMR report. 90% of issues identified in the HMR reports were ranked as clinically significant. Conclusion: This pilot demonstrated that a liaison pharmacist was able to implement a hospital medication liaison model for patients at risk of medication misadventure. Evidence suggests that an HMR conducted post-discharge can identify clinically significant medication-related issues.

Background: Treatment for locally recurrent breast cancer poses a significant challenge because the benefits in local control must be weighed against the increased risk of side effects of the treatment. Frequently, patients have been heavily pre-treated with radiation and several types of chemotherapy. Moreover, they often present with large volumes of bulky disease, further complicating management. Hyperthermia can be used to improve the efficacy of radiation, particularly in the setting of recurrent disease. Methods: We reviewed our clinical and dosimetric experience of breast cancer patients who received hyperthermia and radiation for recurrent breast cancer from 2011 to 2017. Thirty-six patients were treated with hyperthermia and radiation. Median follow-up was 11 months. Thirty patients (83.3%) received prior radiotherapy. The most commonly used radiation fraction scheme was 32 Gy in 8 fractions. The median radiation dose at the time of recurrence was 35.5 Gy (range 20-64 Gy). Mild temperature hyperthermia was delivered two times per week. Results: The median repeat radiation volume was 574 cc (range 11-3620 cc). Electrons, conventional photons, and IMRT radiation techniques were used. IMRT was used for large and complex treatment volumes and showed acceptable doses to organs at risk. The overall response rate was 61.1%. Complete response was observed in 17 patients (47.2%), partial response in 5 patients (13.9%), stable disease in 11 patients (30.6%), and progressive disease in 3 patients (8.3%). Twenty-six patients experienced acute grade 1 and 2 toxicities, primarily pain and erythema; and 26 experienced long-term grade 1 and 2 toxicities, mainly hyperpigmentation and lymphedema. Three patients developed new ulcerations that healed with conservative management. One patient developed pulmonary fibrosis resulting in mild dyspnea on exertion. Conclusion: Hyperthermia and radiation provide good local control with a favorable side effect profile. Thermoradiotherapy may be offered to patients with recurrent breast cancer, including those with extensive volumes of disease.

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month follow-up, positive correlation between survival and necrotic volume/lesion volume ratio, and better survival in pts unfit for chemotherapy (CHT) after failure of 1st-line therapy. In this study we aimed to investigate the immunomodulatory effect of EUS-HTP, comparing with the one induced by CHT. Methods: Pts with LA and borderline resectable (BR) PDAC without underlying immune-mediated disorders nor concomitant tumors were randomized to EUS-HTP plus CHT arm (HTP+CHT) or CHT alone arm (randomized controlled trial NCT02336672). HTP (ERBE), combining bipolar radiofrequency ablation with cryogenic CO 2 cooling effect, was used under EUS-guidance. Up to 3 EUS-HTP sessions were performed, 1-month apart. Peripheral blood mononuclear cells were obtained before treatment, at 2-and 4-month follow-up. The following T-cell subsets were evaluated by flow-cytometry: CD4+ T-helper cells (Th1,Th2,Th17), T-follicular helper cells (Tfh1,Tfh2,Tfh17), CD4+ and CD8+ T-cytotoxic lymphocytes (CTLs), T-regulatory cells (Tregs). Age-/ sex-matched healthy donors (HDs) served as controls. Results: In this preliminary analysis, we enrolled 5 pts treated with HTP+CHT (M/FZ2/3, 70.6AE6.3 years, LA/ BRZ4/1), 5 pts treated with CHT (M/FZ3/2, 65.4AE5.4 years, LA/BRZ4/1) and 10 HDs (M/FZ4/6; 65AE7.9 years). Pts underwent Nab-Paclitaxel+Gemcitabine or Folfirinox, without differences between the 2 groups. At baseline, PDAC pts presented higher levels of Th cells, T-effector memory cells (TEMs), Tfh cells, Treg cells, and CD4+ CTLs compared to HDs, although the difference was not statistically significant. Assessing the levels of the different T-cell subsets over time, no statistically significant difference was observed both intra-patient and inter-patient at 2-and 4month follow-up. However, some trends compared to baseline were observed, such as stability up to 4-month of Treg cells in HTP+CHT pts whereas increased in CHT pts, and stability up to 4-month of CD4+ CTLs and TEM cells in HTP+CHT pts whereas decreased in CHT pts. Conclusions: This study is the first assessing the EUS-HTP immunomodulation effect in pts with stage III PDAC. Although a certain degree of T-cell immunomodulation was observed in HTP+CHT pts, this was not significant. These preliminary results are biased by the small number of pts and combination of EUS-HTP with CHT that might have masked some immunomodulatory effects specific to HTP. We cannot exclude that more relevant changes in the immune response occur at tissue level and are not evident in the peripheral blood. Further analyses on other immune cells and plasma cytokines are ongoing to correlate these results with clinical outcome.