What patient assessment skills do pharmacist independent prescribers require to prescribe immunomodulators in myeloma?

Aim To gain consensus on the patient assessment skills (PAS) required by pharmacist independent prescribers (PIPs) prescribing immunomodulators (IMIDs) in myeloma across National Health Service Scotland. Methods This was a two-phase study which used nominal group technique (NGT) to gain local consensus followed by a two-round eDelphi questionnaire to gain national consensus across all cancer networks. Setting This project was conducted across the three cancer networks within NHS Scotland: South East Scotland Cancer Network (SCAN); West of Scotland Cancer Network (WoSCAN) and North Cancer Alliance (NCA). Subjects Participants were invited from each cancer network (SCAN, WoSCAN and NCA) and included haematology consultants, haematology specialist registrars, haematology advanced nurse practitioners and haematology pharmacists. Results There were five participants in the NGT. Twenty-two out of 31 PAS gained local consensus, seven PAS did not gain consensus and two PAS were deemed irrelevant. There were 12 and 14 participants in round one and two of the eDelphi questionnaire, respectively. Twenty-nine PAS were included in the first-round questionnaire and 21 gained consensus. The remaining eight PAS were included in round two where seven did not achieve consensus and one achieved disagreement consensus. Conclusion This research outlines 21 PAS required for PIPs to prescribe IMIDs for myeloma patients according to haematology specialists in Scotland. Discussion on PAS without consensus showed that the PIPs would have a shared responsibility with the consultant. This work should inform the development of a competency framework to allow training of PIPs in Scotland. Some PAS could be transferrable for PIPs prescribing SACT for other haematological malignancies

Near-Earth plasma sheet boundary dynamics during substorm dipolarization.

We report on the large-scale evolution of dipolarization in the near-Earth plasma sheet during an intense (AL ~ -1000 nT) substorm on August 10, 2016, when multiple spacecraft at radial distances between 4 and 15 R E were present in the night-side magnetosphere. This global dipolarization consisted of multiple short-timescale (a couple of minutes) B z disturbances detected by spacecraft distributed over 9 MLT, consistent with the large-scale substorm current wedge observed by ground-based magnetometers. The four spacecraft of the Magnetospheric Multiscale were located in the southern hemisphere plasma sheet and observed fast flow disturbances associated with this dipolarization. The high-time-resolution measurements from MMS enable us to detect the rapid motion of the field structures and flow disturbances separately. A distinct pattern of the flow and field disturbance near the plasma boundaries was found. We suggest that a vortex motion created around the localized flows resulted in another field-aligned current system at the off-equatorial side of the BBF-associated R1/R2 systems, as was predicted by the MHD simulation of a localized reconnection jet. The observations by GOES and Geotail, which were located in the opposite hemisphere and local time, support this view. We demonstrate that the processes of both Earthward flow braking and of accumulated magnetic flux evolving tailward also control the dynamics in the boundary region of the near-Earth plasma sheet.Graphical AbstractMultispacecraft observations of dipolarization (left panel). Magnetic field component normal to the current sheet (BZ) observed in the night side magnetosphere are plotted from post-midnight to premidnight region: a GOES 13, b Van Allen Probe-A, c GOES 14, d GOES 15, e MMS3, g Geotail, h Cluster 1, together with f a combined product of energy spectra of electrons from MMS1 and MMS3 and i auroral electrojet indices. Spacecraft location in the GSM X-Y plane (upper right panel). Colorcoded By disturbances around the reconnection jets from the MHD simulation of the reconnection by Birn and Hesse (1996) (lower right panel). MMS and GOES 14-15 observed disturbances similar to those at the location indicated by arrows

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Characterising the nature of psychotropic medication prescribed in Scottish PICUs

To determine the nature of psychotropic medication routinely prescribed in Scottish PICUs, the medical notes and prescription charts of 75 patients from 10 out of 14 units were consulted. These included 55 males (73%), the majority of whom were detained and had a diagnosis of schizophrenia. There was good conformance with mental health legislation treatment plans (T2/T3 forms) with only five instances of non-conformance identified. Antipsychotics were prescribed to 60 patients (80%) of which olanzapine and zuclopenthixol decanaote were the most common. The average number of regular psychotropic medicines prescribed per patient was two. In total, 14 drugs, encompassing 21 formulations, were prescribed for PRN use. Lorazepam and haloperidol were the most common PRN medicines. 76 PRN prescriptions (32%) had the oral and IM doses written on the same line of the prescription chart and showed no allowance for bioavailability when detailing the maximum dose that could be administered. 16 patients (21%) were prescribed more than one antipsychotic. Seven patients were prescribed high dose therapy, but this increased to 25 when PRN antipsychotics were included. This study provides information about psychotropic medication prescribing in Scottish PICUs and highlights areas where practice is sub-optimal

Determining research priorities for clinician-initiated trials in infectious diseases

To determine research priorities of infectious diseases physicians for clinician-initiated randomised controlled trials (RCTs).Online survey of infectious diseases physicians in Australia and New Zealand.Research priorities for, and perceived barriers to, clinician-initiated RCTs.122/550 infectious diseases physicians (22%) responded to the survey. The five highest ranked proposals for clinician-initiated RCTs were in the areas of prosthetic joint infections, septic arthritis and osteomyelitis of native joints, Staphylococcus aureus bloodstream infections, diabetic foot infections and the treatment of serious multiresistant, gram-negative bacterial infections. Lack of funding was the most important perceived barrier to participation in clinician-initiated RCTs.The research focus of infectious diseases physicians - optimal treatment of commonly encountered serious infections - highlights a lack of well conducted RCTs in this area