What are the practices and experiences of prescribing practitioners in the United Kingdom? A mixed-methods study

Background Pharmacological treatment is the most common form of healthcare intervention; 1.1billion items were dispensed in the community in England alone in one year. With increasing numbers of prescribers being educated, and a growing number of professions being eligible to undertake the course, it is imperative to understand the reasons why some prescribers do not use their qualification, or why severe constraints are restricting practice for some. The restricted or nonuse of the qualification is wasteful of the expense of education and invested time. Prescribing rights, for healthcare professionals other than doctors, began in the United Kingdom (UK) with nurses and health visitors in 1992. Currently, the UK has more professions eligible to prescribe than any other country: nurses, midwives, podiatrists, pharmacists, physiotherapists, radiographers, dietitians and advanced practice paramedics. Although they all undergo identical education and assessments in the V300 course as all other professions, dietitians and diagnostic radiographers are restricted to supplementary prescribing where everyone else have independent prescribing rights. Study Design This is a mixed methods investigation of the practice and experience of prescribing practitioners in the United Kingdom. An integrative literature review was undertaken and Role Theory, encompassing identity theory, social theory and organisational theory, was used as the theoretical framework. Phase 1 is a quantitative survey with an original questionnaire. There were n409 valid responses. Descriptive statistics were analysed with the use of SPSS. Phase 2 consisted of n11 qualitative semi-structured interviews. Reflexive thematic analysis was used to analyse the data. Findings from both phases were discussed together. Findings The key findings show that the use of supplementary prescribing is increasingly restrictive in the rising use of advanced clinical practice roles. Newly qualified prescribers are in a vulnerable position as confidence is low at this point, and almost half declared they do not have the level of support they need. There are healthcare practitioners who have qualified and never prescribed; lack of support, lack of confidence, lack of need to prescribe in their clinical area are cited as reasons. Colleague support and supervision, along with CPD, are recognised as highly influential to a prescriber flourishing or failing to prescribe. There are still prescribers who experience significant delays due to IT systems that are unable to accommodate their profession. The Competency Framework for All Prescribers became a mandatory part of prescriber education in 2018 and there is currently a wide variation of prescriber awareness of or experience using the Framework. Underpinning all these aspects is how they affect, or are affected by, prescriber confidence. These findings have implications for Higher Education Institutes, practice and further research

Instrumentation for radio astronomy measurements aboard the OGO-5 spacecraft

Design considerations and performance characteristics for radio astronomy instrumentation system aboard OGO-E spacecraf

Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction

<b>Background</b> Meta-analysis of small trials suggests that pharmacist-led collaborative review and revision of medical treatment may improve outcomes in heart failure.<p></p> <b>Methods and results</b> We studied patients with left ventricular systolic dysfunction in a cluster-randomized controlled, event driven, trial in primary care. We allocated 87 practices (1090 patients) to pharmacist intervention and 87 practices (1074 patients) to usual care. The intervention was delivered by non-specialist pharmacists working with family doctors to optimize medical treatment. The primary outcome was a composite of death or hospital admission for worsening heart failure. This trial is registered, number ISRCTN70118765. The median follow-up was 4.7 years. At baseline, 86% of patients in both groups were treated with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. In patients not receiving one or other of these medications, or receiving less than the recommended dose, treatment was started, or the dose increased, in 33.1% of patients in the intervention group and in 18.5% of the usual care group [odds ratio (OR) 2.26, 95% CI 1.64–3.10; P< 0.001]. At baseline, 62% of each group were treated with a β-blocker and the proportions starting or having an increase in the dose were 17.9% in the intervention group and 11.1% in the usual care group (OR 1.76, 95% CI 1.31–2.35; P< 0.001). The primary outcome occurred in 35.8% of patients in the intervention group and 35.4% in the usual care group (hazard ratio 0.97, 95% CI 0.83–1.14; P = 0.72). There was no difference in any secondary outcome.<p></p> <b>Conclusion</b> A low-intensity, pharmacist-led collaborative intervention in primary care resulted in modest improvements in prescribing of disease-modifying medications but did not improve clinical outcomes in a population that was relatively well treated at baseline

Equilibria, kinetics, and boron isotope partitioning in the aqueous boric acid–hydrofluoric acid system

REZ is grateful to Lance Agavulin and Glen Morangie for their spiritual support. JWBR was supported by the European Research Council (ERC Grant 805246) and the Natural Environment Research Council (NERC grant NE/N011716/1).The aqueous boric, hydrofluoric, and fluoroboric acid systems are key to a variety of applications, including boron measurements in marine carbonates for CO2 system reconstructions, chemical analysis and synthesis, polymer science, sandstone acidizing, fluoroborate salt manufacturing, and more. Here we present a comprehensive study of chemical equilibria and boron isotope partitioning in the aqueous boric acid–hydrofluoric acid system. We work out the chemical speciation of the various dissolved compounds over a wide range of pH, total fluorine (FT), and total boron (BT) concentrations. We show that at low pH (0 ≤ pH ≤ 4) and FT ≫ BT, the dominant aqueous species is BF4−, a result relevant to recent advances in high precision measurements of boron concentration and isotopic composition. Using experimental data on kinetic rate constants, we provide estimates for the equilibration time of the slowest reaction in the system as a function of pH and [HF], assuming FT ≫ BT. Furthermore, we present the first quantum-chemical (QC) computations to determine boron isotope fractionation in the fluoroboric acid system. Our calculations suggest that the equilibrium boron isotope fractionation between BF3 and BF4− is slightly smaller than that calculated between B(OH)3 and B(OH)4−. Based on the QC methods X3LYP/6-311+G(d,p) (X3LYP+) and MP2/aug-cc-pVTZ (MP2TZ),  α(BF3−BF4−) ≃ 1.030 and 1.025, respectively. However, BF4− is enriched in 11B relative to B(OH)4−, i.e., α(BF4−−B(OH)4−) ≃ 1.010 (X3LYP+) and 1.020 (MP2TZ), respectively. Selection of the QC method (level of theory and basis set) represents the largest uncertainty in the calculations. The effect of hydration on the calculated boron isotope fractionation turned out to be minor in most cases, except for BF4− and B(OH)3. Finally, we provide suggestions on best practice for boric acid–hydrofluoric acid applications in geochemical boron analyses.PostprintPeer reviewe