Borderline substances

Some elemental metals and many intermetallic compounds are brittle, not malleable or ductile. Borderline substances, showing metallic properties to a decreased extent, are called metalloids or semiconductors. Probably the best criterion for distinguishing a meted and a metalloid or semiconductor is the temperature coefficient of thermal and electrical conductivity. With increase in temperature, the thermal and electrical conductivity of a metal decreases, whereas that of a metalloid or semiconductor increases. 

Medicines Inspectorate GMP/GCP/GLP Defective Medicines Report Centre Product Quality Surveillance Borderline substances Enforcement of the Medicines Act Export Certificates... 

A monthly publication of the NHS listing NHS reimbursement prices for medicines and appliances (devices), borderline substances, dentist and nurse prescribing formularies, and those medicines and other substances which may not be prescribed on the NHS ( blacklisted ). 

This part provides information on those products classified as borderline substances. Further details can be found in Section 2.6.1. 

Details of borderline substances can be found in Part XV of the Drug Tariff for England and Wales (see Section 2.4.1) and Part X of the Northern Ireland Drug Tariff (see Section 2.4.2). Information can also be found in Appendix 7 of the British National Formulary. 

Borderline substances are described by the Drug Tariff for England and Wales as follows ... 

In certain conditions some foods and toilet preparations have characteristics of drugs and the Advisory Committee on Borderline Substances advises as to the circumstances in which such substances may be regarded as drugs. 

The relevant part of the Drug Tariffs is divided into two lists List A and List B. List A gives an alphabetical index of products which the Advisory Committee on Borderline Substances (ACBS) has recommended for the management of the conditions shown under each product. List B is an index cross-linking clinical conditions and the products which the ACBS has approved for the management of those conditions. It is normal to consult List A first. 

It is important that pharmacists are aware of the contents of the relevant part of the Drug Tariffs. Each Drug Tariff is updated on a monthly basis and so is the primary reference source for information on borderline substances. However, the British National Formulary does also indicate whether an item would need to be endorsed ACBS before being supplied by listing the various product in Appendix 7. 

Borderline substances are foods or toiletries that may in certain circumstances be prescribed on an NHS prescription form. For items on the borderline substances list, the prescriber should endorse the prescription ACBS to indicate that the patient is being treated for a listed condition. 

In addition to borderline substances, each Drug Tariff lists those drugs that must only be prescribed on an NHS prescription form in certain circumstances. The drugs and the circumstances in which they may be prescribed can be found in the respective Drug Tariffs. 

Committee on Borderline Substances (ACBS). A list of ACBS approved products and the circumstances under which they can be prescribed, can be found in part XV of the Drug Tariff. Although this is a nonmandatory list, Nurse Independent Prescribers should normally restrict their prescribing of borderline substances to items on the ACBS approved list. 

The first part of this process involves verifying that the item(s) prescribed may be prescribed on an NHS prescription form (i.e. that prescribing the item by any prescriber on an NHS prescription is not prohibited). As discussed earlier in this chapter, certain restrictions have been placed on the prescribing of certain items (e.g. borderline substances - see Section 2.6.1). Further details on these restrictions can be found in Section 2.6. 

Item(sj allowable on the NHS Yes, provided it is prescribed as recommended by the Advisory Committee on Borderline Substances. Although the prescriber does not legally have to add ACBS to the prescription it is good practice and indicates he is prescribing in accordance with the committee s advice. Return the prescription to the doctor to add ACBS in the body of the prescription which will ensure the prescription will be passed for payment without further investigation. 

You may wish to advise the patient of other items that are available on NHS prescription forms for patients with gluten sensitive enteropathies. Where would you find the necessary information Information as to which products can be prescribed on an NHS prescription can be found by consulting the Drug Tariff (see Section 2.4). Specific foods (i.e. borderline substances) can be found in the respective parts of the Drug Tariff for England and Wales (see Section 2.4.1, Part XV) or the Northern Ireland Drug Tariff (see Section 2.4.2, Part X) or in Appendix 7 of the British National Formulary (see Section 2.6.1). 

The aim of this chapter is to describe iodine intakes based on the calculated amounts for standard infant formulas available in the UK, and for all proprietary enteral preparations that can be used as standalone feeds for complete nutrition. The proprietary preparations highlighted in this review are those that are fisted in the British National Formulary, and the corresponding version for Children 2006 (British National Formulary for Children, 2006) mostly in the section Appendix A2 Borderline Substances excluding those which we know have been discontinued (from 2007). Enteral supplements which are not the sole source of nutrition have not been included, as potential iodine intake will be variable and dependent on the proportion of enteral supplement consumed, as well as the amount and iodine content of nonsupplemented food. 

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