Are UK pharmacists ready for consultant-level practice? A cross-sectional survey of self-assessed development needs.

OBJECTIVES: The four nations of the United Kingdom (UK) have endorsed a new curriculum and credentialing process for consultant pharmacists. This study aimed to measure the self-reported consultant-level practice development needs of pharmacists across the UK. METHODS: The study was a cross-sectional electronic survey. Inclusion criteria were: pharmacists registered to practice with the General Pharmaceutical Council; working in any professional sector across the UK; and self-identifying as already working at an advanced level of practice or in an advanced pharmacist role. Participants were asked to rate their confidence that their current practice aligns to the level described in the Royal Pharmaceutical Society Consultant Pharmacist curriculum on a 5-point Likert scale. Predictors of overall confidence with the whole curriculum were analysed using binomial regression. KEY FINDINGS: Nine hundred and forty-four pharmacists participated. Median age was 42 years; 72.6% were female. Research skills and strategic leadership skills had low self-reported confidence. Patient-Centred Care and Collaboration was the domain with the highest reported confidence. 10.2% (96/944) of participants self-reported confidence across the whole curriculum. The strongest predictors of overall confidence across the curriculum were advanced clinical practitioner qualification, research qualifications and self-identifying as a specialist. Increasing age and male gender also predicted confidence. White ethnicity and having an independent prescribing qualification negatively predicted confidence. CONCLUSION: A small minority of pharmacists self-reported confidence across the whole curriculum. A planned approach to develop research skills across the career spectrum, coupled with better identification of workplace-based experiential strategic leadership opportunities, may help deliver a larger cohort of 'consultant-ready' pharmacists.

An Eye-Movement Analysis of Overt Visual Attention During Consecutive and Simultaneous Interpreting Modes in a Remotely Interpreted Investigative Interview.

Remote interpreting via video-link is increasingly being employed in investigative interviews chiefly due to its apparent increased accessibility and efficiency. However, risks of miscommunication have been shown to be magnified in remote interpreting and empirical research specifically on video-link remote interpreting is in its infancy which greatly limits the evidence base available to inform and direct evidence-based policy and best practice, particularly in the identification of the optimal mode(s) of interpreting to be used, namely consecutive and simultaneous. Consecutive interpreting refers to a process in which the interpreter transfers short segments of speech from one language into the other as each person speaks in managed turn-taking, while simultaneous interpreting refers to the transfer of natural speech from one language into another in a concurrent manner without the need for speakers to segment their speech. This study provides novel empirical evidence by using eye tracking to compare the overt visual attention of interpreters working in a remote setting in which an English-speaking Interviewer interacts with a non-English-speaking Suspect in person, for whom interpretation is provided via video-link in real time. Using a within-subject design, we analyze eye-movement data from 28 professionally accredited interpreters who interpreted via video-link an investigative interview in which consecutive and simultaneous interpreting modes were counterbalanced. Taking interpreting performance into account, our results showed that, the consecutive mode yielded significantly less gaze time and therefore significantly less on-screen overt visual attention due to off-screen notetaking, an essential component of the consecutive interpreting mode. Relative to gaze time, the consecutive mode also resulted in significantly more and longer fixations and shifts of attention. Participants also allocated significantly more overt visual attention to the Interviewer than the Suspect, particularly in the consecutive mode. Furthermore, we found informative significant correlations between eye tracking measures and interpreting performance: accuracy, verbal rapport, and management. Finally, we found no significant differences between the three language pairs tested. We conclude with a discussion of limitations and the contributions of the study and an outline for future work on this topic of growing importance.

Can omalizumab be used effectively to treat severe conjunctivitis in children with asthma? A case example and review of the literature.

A 14-year-old girl with poorly controlled asthma attended the difficult-to-treat asthma clinic for review. Although she has eosinophilia and significantly raised immunoglobulin E levels, she is not currently a candidate for omalizumab (Xolair). She also suffers from chronic urticaria, eosinophilic eosophagitis and severe conjunctivitis. You wonder if omalizumab would be effective in treating her multiple atopic conditions, in particular her troublesome conjunctivitis. PubMed was searched using the following search terms: (Omalizumab) or (Xolair) and (conjunctivitis). Searches were conducted in November 2020. Abstracts were selected for full text review if the study population identified asthma as a comorbidity. Non-paediatric studies and those that were not written in English were excluded. The use of omalizumab has the potential to be effective in the treatment of conjunctivitis associated with asthma and other atopic conditions. However, research is needed to address the question, in the form of multicenter, double-blind randomized control trials.

Daily stressors as antecedents, correlates, and consequences of alcohol and drug use and cravings in community-based offenders.

Justice-involved individuals with alcohol and drug use problems reoffend at higher rates than their nonusing counterparts, with alcohol and drug use serving as an important vector to recidivism. At the daily level, exposure to stressors may exacerbate problematic alcohol and drug use; at the individual level, prior treatment experiences may mitigate substance use as individuals adapt to and learn new coping mechanisms. We conducted a daily diary study using Interactive Voice Response technology over 14 consecutive days with 117 men on probation or parole participating in a community-based treatment program (n = 860 calls) and referred to medication-assisted treatment. Participants reported daily stressors, craving for alcohol and illegal drugs, and use of alcohol and illegal drugs 1 time each day. Results of multilevel models showed significant day-to-day fluctuation in alcohol and drug craving and use. In concurrent models, increases in daily stressors were associated with increases in cravings and use of illegal drugs. Prior treatment experience modified many of these relationships, and additional lagged models revealed that those with less treatment experience reported an increase in next-day alcohol craving when they experienced increases in stressors on the previous day compared to those with more treatment experience. Collectively, these findings highlight the importance of tailoring treatment as a function of individual differences, including prior treatment experiences, and targeting daily stressors and subsequent cravings among justice-involved adults with alcohol and drug use problems. (PsycINFO Database Record

Medication-Assisted Treatment and Violent Outcomes in Community-Based Offenders with Alcohol and Drug Use Problems.

OBJECTIVE: This study explored medication-assisted treatment (MAT), the combined use of medication and psychosocial treatment, as a strategy for reducing violent outcomes in community-based offenders. The primary aims were to: 1) examine associations between participant characteristics and treatment adherence; 2) examine associations between treatment adherence and substance use; 3) examine associations between treatment adherence and violent outcomes; and 4) determine whether associations between treatment adherence and violent outcomes may be attributable to reductions in substance use. METHOD: Baseline interviews were completed with 129 male offenders in community-based treatment prior to their first MAT appointment. Follow-up interviews (n = 91) were conducted approximately 90 days later. RESULTS: Participant age was associated with medication adherence. Medication nonadherence was associated with at least occasional alcohol use, but not drug use. Conversely, missing several counseling sessions was associated with at least occasional drug use, but not alcohol use. Results of multivariable analyses suggested MAT may be effective in reducing violent outcomes, and victimization specifically, through reductions in alcohol use. CONCLUSION: Findings provide evidence supporting MAT as an intervention for victimization. Continued efforts are needed to explore strategies to promote treatment adherence and reduce violent outcomes in community-based offenders with alcohol and drug use problems.

Optical performance of an ultra-sensitive horn-coupled transition-edge-sensor bolometer with hemispherical backshort in the far infrared.

The next generation of far infrared space observatories will require extremely sensitive detectors that can be realized only by combining extremely low intrinsic noise with high optical efficiency. We have measured the broad-band optical response of ultra-sensitive transtion edge sensor (TES) bolometers (NEP≈2aW/Hz) in the 30-60-µm band where radiation is coupled to the detectors with a few-moded conical feedhorn and a hemispherical backshort. We show that these detectors have an optical efficiency of 60% (the ratio of the power detected by the TES bolometer to the total power propagating through the feedhorn). We find that the measured optical efficiency can be understood in terms of the modes propagating through the feedhorn with the aid of a spatial mode-filtering technique.

Code status documentation in the outpatient electronic medical records of patients with metastatic cancer.

BACKGROUND: Advanced care planning (ACP) is considered an essential component of medical care in the United States, especially in patients with incurable diseases. However, little is known about clinical practices in outpatient oncology settings related to discussing end-of-life care and documenting code status preferences in ambulatory medical records. OBJECTIVE: To assess the rate of documentation of code status in the electronic longitudinal medical records (LMR) of patients with metastatic cancer. DESIGN: Retrospective review of 2,498 patients with metastatic solid tumors at an academic cancer center. An electronic patient database and the LMR were queried to identify demographic information, cancer type, number of clinic visits, and documentation of code status. PARTICIPANTS: The sample consisted of adult patients with metastatic prostate, breast, ovarian, bladder kidney, colorectal, non-colorectal gastrointestinal (GI), and lung cancers. MEASUREMENTS: Primary outcome was the percentage of documented code status in the LMR. MAIN RESULTS: Among the 2,498 patients, 20.3% had a documented code status. Code status was designated most frequently in patients with non-colorectal GI (193/609, 31.7%) and lung (179/583, 30.7%) cancers and least frequently in patients with genitourinary malignancies [bladder/kidney (4/89, 4.5%), ovarian (4/93, 4.3%), and prostate (7/365, 1.9%) cancers]. Independent predictors of having documented code status included religious affiliation, cancer type, and a greater number of visits to the cancer center. Younger patients and black patients were less likely to be designated as DNR/DNI. CONCLUSIONS: Despite the incurable nature of metastatic cancer, only a minority of patients had a code status documented in the electronic medical record.

A poly(propylene glycol-co-fumaric acid) based bone graft extender for lumbar spinal fusion: in vivo assessment in a rabbit model.

STUDY DESIGN: An animal model of posterolateral intertransverse process lumbar spinal fusion compared fusion rates amongst autologous bone (group 1), a porous, bioabsorbable, scaffold based on the biopolymer, poly(propylene glycol-co-fumaric acid) (PPF) (group 2), and a combination of autograft and the bioabsorbable scaffold (group 3). OBJECTIVES: To evaluate the feasibility of augmenting spinal fusion with an osteoconductive and bioabsorbable scaffold as an alternative or as an adjunct, i.e., an extender, to autograft. SUMMARY OF BACKGROUND DATA: There is little preclinical data on applications of bioabsorable bone graft extenders in spinal fusion. METHODS: New Zealand White rabbits underwent single-level lumbar posterolateral intertransverse process fusion. Animals were treated with one of three materials: autologous bone (group 1), a bioabsorable material based on PPF (group 2), and the PPF biopolymer scaffold with autologous bone graft (group 3). Animals were evaluated at 6 weeks, and fusion was evaluated by manual palpation, and radiographic, histologic, and histomorphometric analyses. RESULTS: Radiographic and manual palpation showed evidence of fusion in all three groups. Histomorphometric measurement of bone ingrowth showed the highest quantity of new bone in group 3 (91%), followed by group 1 (72%) and group 2 (53%). CONCLUSIONS: Results of this study suggested that osteoconductive bioabsorbable scaffolds prepared from PPF might be used as an autograft extender when applied as an adjunct to spinal fusion.

Dimensional stability of the alveolar ridge after implantation of a bioabsorbable bone graft substitute: a radiographic and histomorphometric study in rats.

This study evaluated reconstruction of the alveolar ridge after molar extraction in rats with bioabsorbable bone repair scaffolds. The material was prepared from the unsaturated polyester poly(propylene glycol-co-fumaric acid) (PPF), which may be cured in situ to form a porous scaffold. The intention is to use this material either as a stand-alone bone graft substitute or as an extender to autograft harvested from mandibular reconstruction sites. The bioactivity of the graft substitute was investigated in a rat residual ridge resorption model. PPF bone repair material was injected into the defect site, where it cross-linked in situ in the presence of a hydroxyapatite (HA) filler and effervescent agents. The PPF-based material develops porosity during an in situ cure by generating carbon dioxide during the effervescent reaction of citric acid and sodium bicarbonate. The incorporation of HA promotes osteoconduction within the bone repair scaffold. In this study, bioactivity of the porous scaffold was evaluated as a function of HA particle size (micrometer-sized vs nanometer-sized particles). The maxillary or mandibular molars on the right side were extracted from 96 adult Sprague-Dawley rats. A 2-mm round bur was used to create a uniform trench defect measuring 2 mm in diameter, 2 mm in depth, and 4 mm in length at each extraction site. The defect site was (1) treated with PPF bone repair material containing nanometer-sized HA, (2) treated with PPF material containing micrometer-sized HA, (3) treated with demineralized freeze-dried bone allograft, or (4) left untreated. Rats were sacrificed at 2, 4, 7, and 12 weeks postoperative. Resorption of the residual alveolar ridge was assessed by radiographic outcomes. Bone ingrowth through the defect site was measured by histomorphometric outcomes. Mandibular and maxillary ridge heights increased for all treatments used in this study. There were no clinical indications that addition of either of the PPF bone repair materials retarded hard- or soft-tissue healing of the extraction sites. Although not statistically significant, the mandibular defects treated with PPF containing nanometer-sized HA healed at a faster rate as determined by ridge height and new bone formation measurements when compared with the other treatments. These findings suggest the feasibility of using PPF bone graft substitutes for oral-maxillofacial applications.

An injectable porous poly(propylene glycol-co-fumaric acid) bone repair material as an adjunct for intramedullary fixation.

A bioresorbable bone repair material made from the unsaturated polyester poly(propylene glycol-co-fumaric acid), PPF, was investigated for its potential to act as an adjunct to alleviate the disadvantages associated with wire fixation. The PPF bone repair material is an injectable system that can be delivered to the intramedullary site and crosslinked in the presence of a hydroxylapatite filler and effervescent agents. To test the feasibility of using a bioabsorbable material as an adjunct in fracture fixation, femoral osteotomies were created in two groups of 10 Sprague-Dawley rats. Osteotomies were fixed with a threaded Kirschner wire or stabilized with a Kirshner wire augmented with the PPF bone repair material. The quantity of new bone across the osteotomy site was assessed at 4 weeks postoperatively. Histologic analysis of the healing process revealed enhanced osteoconduction across the osteotomy with the PPF bone repair material. These findings were corroborated by histomorphometric analysis of new bone formation. These findings imply suitability of the PPF bone repair material to act as an adjunct to wire fixation, such as techniques used in hand surgery.

Prediction of resorption rates for composite polylactide/hydroxylapatite internal fixation devices based on initial degradation profiles.

Mechanical and physicochemical outcomes were used to predict the resorption rate of polylactide-based internal fixation devices with and without incorporation of an osteoconductive buffer. Devices were degraded in vitro for 1 year. Addition of an osteoconductive buffer to a resorbable polymer internal fixation device controlled the rate of acid generation resulting from polymer hydrolysis. The pH of the physiological buffer remained neutral when it was exposed to the buffered screw, whereas the pH decreased to approximately 3.0 for the polylactide device. Neutralizaton of the acids generated during polymer hydrolysis increased the projected resorption time of the buffered device to 104 weeks in comparison to 71 weeks for a similar screw made from polylactide. In addition, the buffered device retained a higher percentage of its initial flexural strength throughout the course of degradation than the polylactide screw. The flexural strength of the polylactide screw decreased 20% during the first 4 weeks of polymer degradation, whereas the buffered device maintained its initial mechanical properties through 16 weeks of degradation.

Enhanced peripheral nerve regeneration through a poled bioresorbable poly(lactic-co-glycolic acid) guidance channel.

In this study we investigated the effects of materials prepared with electrical poling on neurite outgrowth in vitro and nerve regeneration in vivo. Neuro-2a cells were seeded on poled and unpoled poly(lactic-co-glycolic) (PLGA) films and observed at time periods 24, 48 and 72 h post-seeding. The percentage of cells with neurites and the neurites per cell were quantified using light microscopy. At 48 and 72 h post-seeding, both the number of cells with neurites and the neurites per cell were significantly increased on the poled films compared to those on unpoled films. An established rat sciatic nerve model was used for in vivo studies to assess the effects of PLGA guides, poled for two different periods, on peripheral nerve regeneration. Guides were inserted in rats to bridge a 1.0 cm gap created in the right sciatic nerve. After four weeks, nerves regenerated through poled guides displayed a significant increase in conduction velocity and significantly increased numbers of axons across the guides, as compared to nerves regenerating through an unpoled guidance channel. Electrical poling was shown to promote neurite growth, axon regeneration and the conduction rate of the repaired nerve. We concluded that guides prepared with electrical poling enhance peripheral nerve regeneration.

Mechanical evaluation of a porous bone graft substitute based on poly(propylene glycol-co-fumaric acid).

A porous, resorbable polymer composite based on poly(propylene glycol-co-fumaric acid) (PPF) was mechanically evaluated in vitro for use as a bone graft substitute and fracture fixative. The test material created a dynamic system capable of initially providing mechanical integrity to bony voids and a degradative mechanism for ingrowth by native bone. The unsaturated polymer, PPF, was crosslinked in the presence of effervescent agents to yield a porous microstructure upon curing. An in vitro degradation study first assessed the temporal mechanical properties of the test material. This research was followed by an ex vivo study using a long-bone osteotomy model to characterize the mechanics of fixation. Results showed the initial compressive strength of the cross-linked PPF system was comparable to cancellous bone. The rate of strength loss was commensurate with the predicted mechanical recovery of healing bone with analogous results in a composite that comprised also 25% (by weight) autograft. Mechanical testing in the long-bone model demonstrated that PPF-based bone-graft substitute increased the flexural strength of K-wire stabilized osteotomies. These results suggest that this type of bone graft substitute may have clinical utility in the stabilization of complex tubular bone fractures.