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

Nucleon electromagnetic form factors in two-flavour QCD

We present results for the nucleon electromagnetic form factors, including the momentum transfer dependence and derived quantities (charge radii and magnetic moment). The analysis is performed using O(a) improved Wilson fermions in Nf=2 QCD measured on the CLS ensembles. Particular focus is placed on a systematic evaluation of the influence of excited states in three-point correlation functions, which lead to a biased evaluation, if not accounted for correctly. We argue that the use of summed operator insertions and fit ans\"atze including excited states allow us to suppress and control this effect. We employ a novel method to perform joint chiral and continuum extrapolations, by fitting the form factors directly to the expressions of covariant baryonic chiral effective field theory. The final results for the charge radii and magnetic moment from our lattice calculations include, for the first time, a full error budget. We find that our estimates are compatible with experimental results within their overall uncertainties.Comment: 22 pages, 10 figures, citations modifie

Nucleon axial form factors from two-flavour Lattice QCD

We present preliminary results on the axial form factor $G_A(Q^2)$ and the induced pseudoscalar form factor $G_P(Q^2)$ of the nucleon. A systematic analysis of the excited-state contributions to form factors is performed on the CLS ensemble `N6' with $m_\pi = 340 \ \text{MeV}$ and lattice spacing $a \sim 0.05 \ \text{fm}$. The relevant three-point functions were computed with source-sink separations ranging from $t_s \sim 0.6 \ \text{fm}$ to $t_s \sim \ 1.4 \ \text{fm}$. We observe that the form factors suffer from non-trivial excited-state contributions at the source-sink separations available to us. It is noted that naive plateau fits underestimate the excited-state contributions and that the method of summed operator insertions correctly accounts for these effects.Comment: 7 pages, 12 figures; talk presented at Lattice 2014 -- 32nd International Symposium on Lattice Field Theory, 23-28 June, 2014, Columbia University New York, N

Fission decay of N = Z nuclei at high angular momentum: 60^{60}Zn

Using a unique two-arm detector system for heavy ions (the BRS, binary reaction spectrometer) coincident fission events have been measured from the decay of $^{60}$Zn compound nuclei formed at 88MeV excitation energy in the reactions with $^{36}$Ar beams on a $^{24}$Mg target at $E_{lab}(^{36}$Ar) = 195 MeV. The detectors consisted of two large area position sensitive (x,y) gas telescopes with Bragg-ionization chambers. From the binary coincidences in the two detectors inclusive and exclusive cross sections for fission channels with differing losses of charge were obtained. Narrow out-of-plane correlations corresponding to coplanar decay are observed for two fragments emitted in binary events, and in the data for ternary decay with missing charges from 4 up to 8. After subtraction of broad components these narrow correlations are interpreted as a ternary fission process at high angular momentum through an elongated shape. The lighter mass in the neck region consists dominantly of two or three-particles. Differential cross sections for the different mass splits for binary and ternary fission are presented. The relative yields of the binary and ternary events are explained using the statistical model based on the extended Hauser-Feshbach formalism for compound nucleus decay. The ternary fission process can be described by the decay of hyper-deformed states with angular momentum around 45-52 $hbar$.Comment: 23 pages, 25 figure