Alternatively, exudation by ectomycorrhizal fungi could provide bacterial denitrifiers within the mycorrhizosphere with C and stimulate N2O production. The quality of this C could have

implications on N2O : N2 product ratios (Firestone, 1982; Henry et al., 2008). (2) N availability: bacteria have a higher demand for nutrients due to their lower C : N ratio compared with fungi, but ectomycorrhizal fungi are more efficient at capturing nutrients (Schimel & Bennett, 2004); by competing for available N, ectomycorrhizal fungi could negatively affect N2O production. (3) Moisture content: fungal hyphae can penetrate into and drain water Daporinad order from fine soil pores, thus affecting anaerobic microsites. The mycelial network generally improves soil aeration, which would lower bacterial N2O production. However, at local microsites, N2O production selleck chemicals may be stimulated as a result of O2 limitation due to hyphal respiration or soil wetting from the release of fungal exudates. Thus, bacterial N2O production needs to be evaluated in light of the positive and negative impacts of ectomycorrhizal fungi. As ectomycorrhizal fungi may have both direct and indirect roles to play in forest N2O production, this will have implications for forest management practices seeking

to lower net emissions, particularly as the symbiotic nature of ectomycorrhizal fungi means that N2O production in these soils may be more closely coupled to the plant than previously thought. We thank Hedda Weitz for helpful discussions. This work was funded by the Natural Environment Research Council: a PhD studentship awarded to M.T.P.-M. and Advanced Research Fellowships awarded to E.M.B. and Ibrutinib research buy D.J. “
“Institute of Marine Biochemistry, Vietnam Academy of Science and Technology, Cau Giay, Hanoi, Vietnam The O-demethylases of anaerobes are corrinoid-dependent, ether-cleaving methyltransferase enzyme systems consisting of four components. The interaction of the O-demethylase components of the acetogenic

bacterium Acetobacterium dehalogenans was studied by protein mobility on native PAGE, far-Western blot analysis and yeast two-hybrid screen. Using native PAGE and far-Western blot, the interaction of the activating enzyme (AE) with its substrate, the corrinoid protein (CP), could be observed. The interaction occurred with four different CPs of A. dehalogenans and a CP from Desulfitobacterium hafniense DCB-2, all involved in ether cleavage. In the corrinoid reduction assay, the AE reduced all CPs tested. This result indicates a broad substrate specificity of the AE of A. dehalogenans. In addition, an interaction of the A. dehalogenans CP of the vanillate-O-demethylase with the two methyltransferases of the same enzyme system was observed.

A final limitation is that scores on the screening questionnaire do not translate directly into a cut-off that achieves the ∼80% accuracy rate in the multivariate model. Having

said that post hoc analyses revealed that the average [with standard deviation (SD)] www.selleckchem.com/products/PD-0332991.html score on the proposed screener questions among those who were classified as at risk for TRBs was 11.0 (3.9) compared with an average (SD) of 8.0 (3.4) for those classified as not at risk, and the mean difference was statistically significant [t(253)=6.65, P<0.0005]. This suggests that scores above 8, especially for well-educated, medically engaged, relatively healthy patients, might serve as a reasonable cut-off value. Scores closer to 8 will be less specific but specificity will increase with each additional point and users can adjust according to needs and resources. That

is, the screener (as opposed to the statistical model itself) can be used to whatever degree of specificity is desired and the responses can be handled in a variety of ways. If a provider or a clinic has selleck chemicals sufficient resources, a low cut-off score might be selected for referral to prevention services (more referrals but less specific). Fewer resources might suggest a higher cut-off score for referral (fewer referrals but more specific). Additionally, a quick review of responses could serve as the starting point for a conversation between provider and patient, regardless of score, with the decision about referral being contingent on the outcome of the conversation. Prevention of HIV infection is a formidable public health challenge with great potential benefit. Establishing effective means to identify HIV-positive patients with greater propensity to engage in sexual TRBs is of great benefit, facilitating the focusing of prevention efforts on those in greatest need. This brief screener is being developed as an

effective tool for the medical provider in addressing this public health challenge while meeting the medical needs of HIV-infected patients. Longitudinal follow-up of the initial validation sample is already planned but additional validation in new clinical settings is needed to establish the ultimate clinical utility of the screener. Please Isoconazole choose the response that best reflects whether you agree or disagree with these statements; I am concerned about the risk of being re-infected with HIV. Strongly disagree Disagree Somewhat disagree Neither agree nor disagree Somewhat agree Agree Strongly agree 1 2 3 4 5 6 7 The availability of combination HIV drug treatments makes me less worried about having unprotected sex. Strongly disagree Disagree Somewhat disagree Neither agree nor disagree Somewhat agree Agree Strongly agree 1 2 3 4 5 6 7 I am worried that I could have infected someone else with HIV in the past 6 months.

A final limitation is that scores on the screening questionnaire do not translate directly into a cut-off that achieves the ∼80% accuracy rate in the multivariate model. Having

said that post hoc analyses revealed that the average [with standard deviation (SD)] Osimertinib mouse score on the proposed screener questions among those who were classified as at risk for TRBs was 11.0 (3.9) compared with an average (SD) of 8.0 (3.4) for those classified as not at risk, and the mean difference was statistically significant [t(253)=6.65, P<0.0005]. This suggests that scores above 8, especially for well-educated, medically engaged, relatively healthy patients, might serve as a reasonable cut-off value. Scores closer to 8 will be less specific but specificity will increase with each additional point and users can adjust according to needs and resources. That

is, the screener (as opposed to the statistical model itself) can be used to whatever degree of specificity is desired and the responses can be handled in a variety of ways. If a provider or a clinic has Midostaurin price sufficient resources, a low cut-off score might be selected for referral to prevention services (more referrals but less specific). Fewer resources might suggest a higher cut-off score for referral (fewer referrals but more specific). Additionally, a quick review of responses could serve as the starting point for a conversation between provider and patient, regardless of score, with the decision about referral being contingent on the outcome of the conversation. Prevention of HIV infection is a formidable public health challenge with great potential benefit. Establishing effective means to identify HIV-positive patients with greater propensity to engage in sexual TRBs is of great benefit, facilitating the focusing of prevention efforts on those in greatest need. This brief screener is being developed as an

effective tool for the medical provider in addressing this public health challenge while meeting the medical needs of HIV-infected patients. Longitudinal follow-up of the initial validation sample is already planned but additional validation in new clinical settings is needed to establish the ultimate clinical utility of the screener. Please U0126 research buy choose the response that best reflects whether you agree or disagree with these statements; I am concerned about the risk of being re-infected with HIV. Strongly disagree Disagree Somewhat disagree Neither agree nor disagree Somewhat agree Agree Strongly agree 1 2 3 4 5 6 7 The availability of combination HIV drug treatments makes me less worried about having unprotected sex. Strongly disagree Disagree Somewhat disagree Neither agree nor disagree Somewhat agree Agree Strongly agree 1 2 3 4 5 6 7 I am worried that I could have infected someone else with HIV in the past 6 months.

To identify molecular factors associated with the success and failure of spinal cord axon regeneration, we pharmacologically manipulated thyroid hormone (TH) levels using methimazole or triiodothyronine, to either keep tadpoles in a permanently larval state or induce precocious metamorphosis, respectively.

Following complete spinal cord transection, serotonergic axons crossed the lesion site and tadpole swimming learn more ability was restored when metamorphosis was inhibited, but these events failed to occur when metamorphosis was prematurely induced. Thus, the metamorphic events controlled by TH led directly to the loss of regenerative potential. Microarray analysis identified changes in hindbrain gene expression that accompanied regeneration-permissive and -inhibitory conditions, including many genes in the permissive condition that have been previously associated with axon outgrowth and neuroprotection. These data demonstrate that changes in gene expression occur within regenerating neurons in response to axotomy under regeneration-permissive conditions in which normal development MK-8669 ic50 has been suspended, and they identify candidate genes for future studies of how central nervous

system axons can successfully regenerate in some vertebrates. “
“Pseudomonas is a large and diverse genus of Proteobacteria that was first described in 1894. Members of the genus can be found in virtually every corner of the earth from the Arctic tundra to the tropical rainforests; from arid soils to rain clouds (Morris et al., 2008; Wilhelm et al., 2012). This incredible environmental adaptability is due to Pseudomonas’s extraordinary metabolic versatility. Pseudomonads can grow at temperatures ranging from 0 to 42 °C and can survive even more extreme temperatures. They have few nutritional requirements and can utilize a variety of carbon sources. Although pseudomonads grow optimally in aerobic environments, they can also utilize nitrogen for Sinomenine anaerobic respiration.

Phenotypically, pseudomonads are characterized as Gram-negative, nonsporulating rods that are motile and possess a single polar flagellum. They can live as free-living planktonic cells or as members of a biofilm community and have the exceptional ability to translate microbial signals and environmental cues into niche-specific processes. One example of this exquisite perception is P. putida’s phosphoenolpyruvate phosphotransferase system (PTS), which is reviewed in this thematic issue of FEMS Microbiology Letters by Katharina Pflüger-Grau and Victor de Lorenzo. PTS is a complex multiprotein system that controls the post-translational regulation of proteins involved in metabolism, based on extracellular nutritional information and intracellular biochemical signals received by the bacterium. The ability of pseudomonads to sense and adapt to their environment results in an extraordinary range of activities, such as the secretion of many enzymes and other biomolecules.

Lamivudine

has been extensively used, as has tenofovir and to a lesser extent emtricitabine, for the treatment of HIV mono-infection during pregnancy, and lamivudine and telbivudine have been used in HBV mono-infected pregnant women and all have been JQ1 price found to be safe. There are limited data on adefovir use in pregnancy and it is not recommended. Where it is being used in a woman for management of HBV but who does not require HIV treatment, this should be switched to tenofovir incorporated into her HAART regimen. In the context of coinfection during pregnancy where HAART is indicated, there is unlikely to be a situation where it would be used instead of tenofovir. There is no evidence of any adverse effect on maternal health if women become pregnant while taking tenofovir, lamivudine or emtricitabine: these drugs are recommended as NRTI choices in national [10] and international guidelines [2]. 6.1.6 In all HAV non-immune HBV coinfected women, HAV vaccine is recommended after the first trimester as per the normal schedule (0 and 6–12 months) unless the CD4

cell count is <300 cells/μL, when an additional dose may be indicated. Grading: 1D Immunization for HAV uses inactivated vaccines. Data for HAV vaccine in pregnancy are limited. Nevertheless, several guidelines indicate that pregnancy is not a contraindication for HAV immunization, including in HBV coinfected pregnant women [[11],[12]]. over For HAV vaccines, patients with higher CD4 cell counts and on HAART generally show improved responses to selleck compound vaccination. HIV-positive persons with CD4 cell counts <300 cells/μL should receive three doses of HAV vaccine over 6–12 months instead of the standard two. 6.1.7 Tenofovir and emtricitabine should form the backbone of an ART regimen in naïve patients with wild-type HIV/HBV infection and no contraindication to either drug (Grading: 1B). 6.1.8 If tenofovir is not

currently part of HAART it should be added. Grading: 1B 6.1.9 Lamivudine/emtricitabine may be omitted from the ARV regimen and tenofovir given as the sole anti-HBV agent if there is clinical or genotypic evidence of lamivudine/emtricitabine resistant HBV. Grading: 1C 6.1.10 Lamivudine or emtricitabine should not be used as the only active drug against HBV in HAART because of the likelihood of emergent HBV resistance to these agents. Grading: 1B 6.1.11 Emtricitabine has potential antiviral benefits over lamivudine, is coformulated with tenofovir, and appears to be equally safe during pregnancy and hence is the preferred option to be given with tenofovir in coinfection. Grading: 2D All HBV/HIV coinfected women should receive HAART containing tenofovir with emtricitabine or lamivudine treatment during pregnancy, unless contraindicated.

Only the simultaneous presence of psmrAB, but not the single gene alone, conferred the tolerance of E. coli KNabc to up to 0.6 M NaCl and at alkaline pH. pH-dependent Na+(Li+)/H+ antiport activity was detected from everted membrane vesicles prepared from E. coli KNabc cells carrying Selleckchem Navitoclax psmrAB, which had the highest activity at pH 9.0. However, a detailed

test for antimicrobial drugs showed that E. coli DH5α with psmrAB only exhibited slight resistance to chloramphenicol, but not other representative antimicrobial drugs especially ethidium bromide. Protein sequence alignment showed that neither PsmrA nor PsmrB has homology with known single-gene or multiple-gene Na+/H+ antiporters, or such proteins as TetA(L) and MdfA with Na+/H+ antiport activity. Taken together, PsmrAB should function mainly as a novel two-component Na+/H+ antiporter. This is the first example of a PSMR family member that exhibits Na+/H+ antiporter activity. In bacteria, Na+/H+ antiporters are Nutlin-3 manufacturer ubiquitous secondary transporters that catalyze the efflux of intracellular alkali cations in exchange for external protons, which play a vital role in reducing the cytoplasmic concentration of toxic alkali cations

and supporting Na+(Li+)/K+-dependent intracellular pH homeostasis under alkaline conditions (Ito et al., 1999; Padan et al., 2005). Na+/H+ antiporter genes or the genes with Na+/H+ antiporter activity have been increasingly cloned and functionally identified in Escherichia coli mutants KNabc or EP432 lacking major antiporters (Padan et al., 2004). So far, Na+/H+ antiporters are sorted into two main kinds based on the number of genes: One kind of Na+/H+ antiporters are encoded by a single gene including nhaA (Karpel et al., 1988), nhaB (Pinner et al., 1992), nhaC (Nakamura et al., 1996), nhaD (Ito et al., 1997), napA (Waser et al., 1992), nhaP (Utsugi et al., 1998), nhaG (Gouda et al., 2001) and nhaH (Yang et al., 2006c). The other kind of Na+/H+ antiporters containing multiple subunits are encoded by an operon or a gene cluster such as mrp operon from Bacillus subtilis (Ito et al., 1999), mnh gene cluster from Staphylococcus aureus (Hiramatsu

et al., 1998) and pha2 gene cluster from Sinorhizobium fredii (Jiang et al., 2004; Yang et al., 2006a). ZD1839 datasheet Moreover, an unique tetracycline/H+ antiporter TetA(L) was reported to possess Na+/H+ antiporter activity (Cheng et al., 1994). Another E. coli multidrug resistance (MDR) protein MdfA with a broad-specificity MDR phenotype (Edgar & Bibi, 1997) was also characterized to exhibit Na+(K+)/H+ antiporter activity (Lewinson et al., 2004). In our previous studies, a novel species Halobacillus dabanensis D-8T was isolated and characterized from Daban Salt Lake in Xinjiang Province, China (Liu et al., 2005), and two genes nhaH (Yang et al., 2006c) and nap (Yang et al., 2006b) were cloned from H. dabanensis and found to possess Na+/H+ antiporter activity.

Only the simultaneous presence of psmrAB, but not the single gene alone, conferred the tolerance of E. coli KNabc to up to 0.6 M NaCl and at alkaline pH. pH-dependent Na+(Li+)/H+ antiport activity was detected from everted membrane vesicles prepared from E. coli KNabc cells carrying PARP inhibitor psmrAB, which had the highest activity at pH 9.0. However, a detailed

test for antimicrobial drugs showed that E. coli DH5α with psmrAB only exhibited slight resistance to chloramphenicol, but not other representative antimicrobial drugs especially ethidium bromide. Protein sequence alignment showed that neither PsmrA nor PsmrB has homology with known single-gene or multiple-gene Na+/H+ antiporters, or such proteins as TetA(L) and MdfA with Na+/H+ antiport activity. Taken together, PsmrAB should function mainly as a novel two-component Na+/H+ antiporter. This is the first example of a PSMR family member that exhibits Na+/H+ antiporter activity. In bacteria, Na+/H+ antiporters are www.selleckchem.com/products/azd-1208.html ubiquitous secondary transporters that catalyze the efflux of intracellular alkali cations in exchange for external protons, which play a vital role in reducing the cytoplasmic concentration of toxic alkali cations

and supporting Na+(Li+)/K+-dependent intracellular pH homeostasis under alkaline conditions (Ito et al., 1999; Padan et al., 2005). Na+/H+ antiporter genes or the genes with Na+/H+ antiporter activity have been increasingly cloned and functionally identified in Escherichia coli mutants KNabc or EP432 lacking major antiporters (Padan et al., 2004). So far, Na+/H+ antiporters are sorted into two main kinds based on the number of genes: One kind of Na+/H+ antiporters are encoded by a single gene including nhaA (Karpel et al., 1988), nhaB (Pinner et al., 1992), nhaC (Nakamura et al., 1996), nhaD (Ito et al., 1997), napA (Waser et al., 1992), nhaP (Utsugi et al., 1998), nhaG (Gouda et al., 2001) and nhaH (Yang et al., 2006c). The other kind of Na+/H+ antiporters containing multiple subunits are encoded by an operon or a gene cluster such as mrp operon from Bacillus subtilis (Ito et al., 1999), mnh gene cluster from Staphylococcus aureus (Hiramatsu

et al., 1998) and pha2 gene cluster from Sinorhizobium fredii (Jiang et al., 2004; Yang et al., 2006a). Quinapyramine Moreover, an unique tetracycline/H+ antiporter TetA(L) was reported to possess Na+/H+ antiporter activity (Cheng et al., 1994). Another E. coli multidrug resistance (MDR) protein MdfA with a broad-specificity MDR phenotype (Edgar & Bibi, 1997) was also characterized to exhibit Na+(K+)/H+ antiporter activity (Lewinson et al., 2004). In our previous studies, a novel species Halobacillus dabanensis D-8T was isolated and characterized from Daban Salt Lake in Xinjiang Province, China (Liu et al., 2005), and two genes nhaH (Yang et al., 2006c) and nap (Yang et al., 2006b) were cloned from H. dabanensis and found to possess Na+/H+ antiporter activity.

There were library and study facilities within the hospital sites to support educational development of hospital staff. Organisational support was available for additional care in the form of occupational health where trainees could access, for example, counselling services. In community, training was generally run ‘in-house’ without much support from senior

management (in the case of larger organisations), therefore, the onus for completing training was on the trainee selleck antibody and supervising pharmacist. The relationship between the trainee and supervising pharmacist was, in many cases, considered to be longstanding, with trainees usually having worked as a dispenser in the same branch. The supervising pharmacist appeared to play a central role in the training of trainees through liaising with education providers and answering trainees’ queries. There was variability in the staff working with the trainee: sometimes there was another qualified (senior) technician present, other times there was not. Weekly study time varied, but was generally limited (e.g. 1–2 hours).

Community pharmacies contained necessary learning materials (e.g. BNF); however, studying facilities were often restricted to counselling suites or staff rooms to study or undertake knowledge-based assessments. Training in community would often take trainees more than 2 years and completion rates were not always high. In contrast, trainees in hospital would complete training

in 2 years and completion rates Tanespimycin nmr were often 100%. Findings from this research demonstrate that the delivery of work-based PT training differs between community and hospital settings. This may influence the overall quality and chance of completion of pre-registration PT training; however, the views of other stakeholders need to be considered. Further research to be conducted as part of a larger programme of work, including a census of recently registered PTs in GB, will Phosphoglycerate kinase be able to ascertain how these differences can affect the quality of pre-registration PT training received. 1. General Pharmaceutical Council (2014). UK-Qualified Pharmacy Technicians. http://www.pharmacyregulation.org/registration/registering-pharmacy-technician/uk-qualified-pharmacy-technicians (accessed 28 March 2014). 2. King, N. Using templates in the thematic analysis of texts. In: Symon, G.E. and Cassell, C.E., eds. Qualitative Methods and Analysis in Organizational Research: A Practical Guide. London: SAGE, 2004: 256–270. “
“Discrete choice experiments (DCEs) have been widely used to elicit patient preferences for various healthcare services and interventions. The aim of our study was to conduct an in-depth scoping review of the literature and provide a current overview of the progressive application of DCEs within the field of pharmacy.

At

least half the people living with HIV have serum markers of previous hepatitis B virus (HBV) infection [56]. Occult hepatitis B, in which there is viral replication in Crizotinib price the absence of surface antigen, is well documented in HIV-positive patients [57,58]. Reactivation of HBV and a rise in HBV DNA can occur at low CD4 cell counts, and has been documented in both HIV-positive and HIV-negative patients receiving immunosuppressive chemotherapy [59–66]. In one study of HBV surface antigen, of the HIV-positive patients treated with chemotherapy for lymphoma who did not receive antiviral prophylaxis, 32% experienced HBV reactivation of whom 41% progressed to fatal fulminant hepatitis [67]. The risk of HBV reactivation appears to be particularly high in patients treated with rituximab containing chemotherapy regimens [68]. Sirolimus The use of prophylactic lamivudine in people at risk of HBV reactivation who were treated for lymphoma with chemotherapy reduces the incidence of HBV reactivation, severe hepatitis and the disruptions to chemotherapy compared to historical controls [69]. A meta-analysis of 14 studies involving a total of 275 at-risk patients receiving chemotherapy who were treated with prophylactic lamivudine showed that it reduced the risk of HBV reactivation

and HBV-related hepatitis by 80–100% [70]. Patients with antibodies against hepatitis B core antigen (HBcAb) should be treated with prophylactic antivirals in line with BHIVA hepatitis guidelines (level of evidence 1B) [71] and this should be continued for at least 6 months after completion of anticancer therapy [72]. People living with HIV and malignancies should receive immunizations in line with the BHIVA immunization guidelines [55] and those who have had a splenectomy should receive vaccinations and antibiotic prophylaxis in line with national asplenism

guidelines [73]. We recommend that all patients with AIDS-defining malignancies should start HAART (level of evidence 1B). We suggest that all patients with non-AIDS-defining malignancies who are due to start chemotherapy or radiotherapy should be started on HAART unless contraindicated (level of evidence 2C). We recommend that prophylaxis against Pneumocystis jirovecii pneumonia (PCP) should be started click here for those who have a CD4 cell count less than 200 cells/μL (level of evidence 1A) and should be considered at higher levels in all patients starting chemotherapy or radiotherapy (GPP). We recommend prophylaxis against MAC for individuals with a CD4 cell count less than 50 cells/μL (level of evidence 1B) and in those whose treatment puts their CD4 count at risk of falling below this level. We recommend that systemic azole antifungal prophylaxis should be used in all patients receiving chemotherapy or radiotherapy for HIV-associated malignancy (level of evidence 1D).

74%). PIP was strongly associated with polypharmacy, with those receiving 4 or more medications different

medications www.selleckchem.com/products/MK-2206.html being 17 times more likely to be exposed to PIP compared to those receiving 0–3 medications (Odds Ratio 17.87; 95% Confidence Intervals, 17.66–18.08). There was no association with age and gender. Following application of a subset of the STOPP criteria (28 in total), PIP was lower in the UK (14.87%) compared to NI (34%) and the ROI (36%). Despite this, the most common examples of PIP were similar in each region i.e. use of proton pump inhibitors at maximum therapeutic dose for >8 weeks and use of NSAIDs for >3months. Consistent with other research, the prevalence of PIP in the UK was high and increased with polypharmacy. Whilst PIP was found to be lower in the UK than in NI and ROI, this comparison was based on a limited number of criteria and the most common inappropriate medications were consistently the same in each region. These findings may provide a focus for targeted interventions to reduce PIP. 1. Klarin I, Wimo A, Fastbom J. The association of inappropriate

drug use with hospitalisation and mortality: a population-based study of the very old. Drugs Aging 2005; 22: 69–82. 2. Hanlon JT, Maher R, Lindblad CI Ruby CM, Twersky J, Cohen HJ, Schmader KE. Comparison of methods for detecting potential adverse drug events in frail elderly inpatients and outpatients. Am J Health Syst Pharm 2001; 58: 1622–1626. Yogini Jani1,2, TF Chan3, Sarla RG-7388 mw Drayan4, Wendy Spicer5, Helen Taylor6, Robert Urquhart1 1UCLH NHS Foundation Trust, London, UK, 2UCL School of Pharmacy, London, UK, 3Barnet and Chase Farm Hospital NHS Trust, Hertfordshire, UK, 4North Middlesex University Hospital NHS Trust, London, UK, 5Royal Free London NHS Foundation Trust, London, UK, 6The Whittington Hospital NHS Trust, London, UK Standardisation of inpatient prescription charts has been suggested as a strategy for improving the quality of documentation and reducing prescribing errors. A collaborative approach by 5 acute NHS organisations led to the successful design and trial of a standard inpatient

chart. The new chart resulted in an improvement in the quality of allergy status documentation but a reduction in documentation of patient’s weight. Users reported the Chlormezanone new design had a positive effect in highlighting high risk areas and thus improving patient safety. Prescribing errors in hospitalised patients are common and may occur in up to one in ten prescribed items. In the UK, the General Medical Council (GMC) called for a national prescription chart to reduce errors.1 Implementation of a standard chart in Australia showed a reduction in the frequency of prescribing errors, improved adverse drug reaction documentation and decreased the potential risks associated with warfarin management.2 This quality improvement project was undertaken as a collaborative between five acute NHS organisations.