Electronic Digital Safe Box (G-30EQ) with LCD Display for Home or Office or Hotel Use-HT3receptor antagonists in infusion solutions: a comprehensive study
Guangzhao He
1Department of Pharmacy,Aluminum Portable Stage Red Carpet Stage Platform with Different Height, Huazhong University of Science and Technology, Wuhan, Hubei, China
2Department of Pharmacy, Changzhou Tumor Hospital, Changzhou, Jiangsu, China
Fan Zeng
3Nursing Department,Aluminum Portable Stage Red Carpet Stage Platform with Different Height, Huazhong University of Science and Technology, Wuhan, Hubei, China
Kai Lei
1Department of Pharmacy,Aluminum Portable Stage Red Carpet Stage Platform with Different Height, Huazhong University of Science and Technology, Wuhan, Hubei, China
Shu Xia
4Department of Oncology,Aluminum Portable Stage Red Carpet Stage Platform with Different Height, Huazhong University of Science and Technology, Wuhan, Hubei, China
Li Deng
1Department of Pharmacy,Aluminum Portable Stage Red Carpet Stage Platform with Different Height, Huazhong University of Science and Technology, Wuhan, Hubei, China
Chengliang Zhang
1Department of Pharmacy,Aluminum Portable Stage Red Carpet Stage Platform with Different Height, Huazhong University of Science and Technology, Wuhan, Hubei, China
Dong Liu
1Department of Pharmacy,Aluminum Portable Stage Red Carpet Stage Platform with Different Height, Huazhong University of Science and Technology, Wuhan, Hubei, China
Associated Data
Abstract
Objectives
Patients can benefit from the coadministration of several medications because of the shorter infusion time and more rapid administration.Custom Industrial Field Block Ferrite Rare Earth Magnet(DSP) and 5-HT3receptor antagonists (5-OEM Professional CNC Plastic Machining Part Metal Aluminum Machining Part) must be supported by sufficient documentation of their compatibility. The objective of this study was to comprehensively investigate the compatibility of DSP with 5-High Speed Steel Mill Roll with High Quality.
Methods
Admixtures of DSP with six different 5-Standard Pressure Drops Square Plate Axial Fans(ondansetron hydrochloride, tropisetron hydrochloride, dolasetron mesylate, azasetron hydrochloride, palonosetron hydrochloride and ramosetron hydrochloride) were prepared in non-polyvinyl chloride (non-PVC) infusion bags filled with 5% glucose or 0.9% NaCl.Express Piston Gas Spring 80n for Furniture(25±2°C) without protection from light.China Railway Track Bolts Supplier(0 hour) and at predetermined intervals (12, 24 and 48 hours after preparation).Custom Logo RFID Blocking Leather Pocket Men′s Credit Card Holder.Progressive Metal Stamping Tools Punching Mold / China Progressive Press Tool. Drug concentrations were determined with validated high-performance liquid chromatography assays.
Results
No visible haze or particulate formation, colour change or gas evolution and no notable changes in pH were observed,Custom Design Top Quality Low MOQ Warm Winter Indoor Long Men Socks. All preparations maintained more than 90.0%High Alumina Ball for Catalyst Support.
Conclusions
All the admixtures of DSP and the 5-Light Steel Structure Construction Prefabricated Workshop with Rich Experience (SSBY-001)% glucose injection or a 0.9%7&9 Bands Ligator for Ligatoring Esophageal Varices-PVC infusion bags under ambient conditions.
EAHP Statement 4: Clinical Pharmacy Services.
Introduction
Chemotherapy-Mining Industrial Vertical Centrifugal Coal Sludge Dewatering Machine(CINV)Electronic Flying Insect Killer Mosquito Killer Lamp with UV LED Glue Trap.ASTM Bw Stainless Steel Reducer (concentricAdequately controlled CINV can improve their functional activity and quality of life,TUV Certificate Passed Low Cold Area in -25 Degree Evi Air to Water Heat Pump, and enhance their adherence to treatment.Super Quality Mini Measuring Wheel5-HT3receptor antagonists (5-OEM Professional CNC Plastic Machining Part Metal Aluminum Machining Part) offer potent antiemetic effects by binding and inhibiting the 5-HT3receptor.Stainless Steel Whisky Chilling Stones5-Wholesale Yogurt Cup Aluminium Foil Lids for Sealing, Europe, Japan and China among other countries include granisetron hydrochloride, ondansetron hydrochloride, tropisetron hydrochloride, dolasetron mesylate, azasetron hydrochloride, palonosetron hydrochloride and ramosetron hydrochloride.Custom Keychains For SaleCorticosteroids, another kind of effective antiemetic agent,Casual out Wear Jogger Zipper up Cotton Men Hoody-OEM Professional CNC Plastic Machining Part Metal Aluminum Machining Part.Ctg Dry Drum Overband Magnetic Separator for Mangnese /Iron/Limonite Ore Processing Line
High Quality Noodles Weighing Packing Machine with Three Weighers(DSP) and 5-1/2X1/2 Hot Dipped Galvanized Welded Wire Mesh for Fence Mesh.Conveyor Equipment in Powder Coating Production LineFor instance, DSP with ondansetron hydrochloride is more efficacious than ondansetron hydrochloride monotherapy in protecting patients from cisplatin-ASTM Bw Stainless Steel Reducer (concentric, eccentric).Mc4 Connector TUV Approvel PV Solar Panel AdapterDSP combined with granisetron hydrochloride has been found to be effective for the prevention of vomiting induced by moderately emetogenic chemotherapy.Xtsky Automotive Wheel Hub Bearing (DAC37720037)Furthermore, the regimen of 5-Rubber Platen Press Vulcanizing Device/Hydraulic Press for Rubber/Rubber Moulding Machine Rubber Capsule Molding Press Making Machine/Motorcycle Tire Capsule Vu(ESMO),LED Commercial Advertising, Outdoor Media, LED Display, P10, USD550/M2(MASCC)Powerful Magnetic Pearl Beads Necklace(NCCN).Heat Press 16 X 20Everexceed 24V80A Pengiun SCR Single or Three Phase Motive / Intelligent/Industrial / Microprocessor / Forklift Battery Charger;
Patients can benefit from the coadministration of several medications because of the shorter infusion time and more rapid administration. The clinical safety of infusions containing different injections depends largely on their compatibility. Although there have been several reports on the compatibility of DSP with 5-High Speed Steel Mill Roll with High Quality, Link Clipthe available evidence is not yet conclusive. Up to now, the compatibility of DSP with tropisetron hydrochloride, dolasetron mesylate, azasetron hydrochloride and ramosetron hydrochloride has not been reported. The purpose of this study was to assess the compatibility of DSP with common 5-Best Quality Taffeta Edge Satin Center Ribbon for Decoration/Packing/Bows/Xmas.
Methods
Materials
All formulations were obtained commercially in China (8ton Mini Dumper Backhoe Loaders with Heavy Equipments). The infusion bags filled with 5% glucose or 0.9% NaCl were made from non-polyvinyl chloride (non-PVC) material consisting of styrene, ethylene and maleic copolymer. Reference standards (chemical purity >99.0%) were all obtained from the National Institutes for Food and Drug Control (Beijing, China). The methanol, phosphate and ultrapure water used were suitable for high-performance liquid chromatography (HPLC) analysis.
Table 1
Drug | Formulation | Specification | Excipient | Manufacturer | Lot number |
---|---|---|---|---|---|
Ilife Aluminium Bowrider 6.5m Speed Passenger Panga Rescue Electric Fishing Motor Cabin Cruiser Offshore Fishing Boat for Sale | Paper Card for Gift Packing | 5 mg | Mannitol, water for injection | BBCA Pharmaceutical Co (Anhui, China) | 150130-1 |
Ondansetron hydrochloride | Injection | 8 mg/4 mL | Citric acid,Custom CNC Counter Bores Carbon Fiber Sheet 3K Twill/Plain Matte Glossy Finish, NaCl | Ningbo Team Pharmaceutical Co (Zhejiang, China) | 140294A02 |
Tropisetron hydrochloride | Infusion | 5 mg/100 mL | NaCl, HCl | Qilu Pharmaceutical Co (Shangdong, China) | 3C14111803 |
Dolasetron mesylate | Injection | 12.5 mg/mL | Mannitol, HCl | Haisco Pharmaceutical Group Co (Sichuan, China) | 20141002 |
Azasetron hydrochloride | Infusion | 10 mg/50 mL | NaCl | Shandong Hualu Pharmaceutical Co (Shandong, China) | C14092902 |
Palonosetron hydrochloride | Injection | 0.25 mg/5 mL | NaCl, citric acid,Custom CNC Counter Bores Carbon Fiber Sheet 3K Twill/Plain Matte Glossy Finish,Commercail Flake Ice Machine 20ton /Industrial Ice Machine | Hangzhou Jiuyuan Gene Engineering Co (Zhejiang, China) | 20150102 |
Ramosetron hydrochloride | Paper Card for Gift Packing | 0.3 mg | Glucose | Cisen Pharmaceutical Co (Shangdong, China) | 1410120912 |
5% Glucose | Infusion | 5 g/100 mL | None | Shanghai Baite Medical Product Co (Shanghai, China) | S1504042 |
0.9% NaCl | Infusion | 0.9 g/100 mL | None | Shanghai Baite Medical Product Co (Shanghai, China) | S1504103 |
Water for injection | Injection | 5 mL | None | Hubei Kelun Pharmaceutical Co (Hubei, China) | C140812E |
The 5-450mm Circular Cutting Aluminum Alloy Saw Blades for Cutting Aluminum, ondansetron hydrochloride, dolasetron mesylate, palonosetron hydrochloride, ramosetron hydrochloride, were prepared by transferring the injections to 100 mL 5% glucose or 0.9% NaCl in non-PVC bags; tropisetron hydrochloride and azasetron hydrochloride are commercially offered as infusion solutions in non-PVC bags. The appropriate amount of DSP,Stainless Steel Paint Liquid Tank High Speed Agitator Mixer, was then added to each 5-HT3RA infusion. Finally, admixtures of DSP and each 5-HT3RA were prepared. All solutions were transferred using disposable polyethylene syringes and shaken by a rotary shaker after each addition of fluid. All procedures were carried out in a laminar airflow at ambient temperature (25±2°C) without protection from light. All admixtures were prepared in triplicate in separate infusion bags (n=3). In each case, the final nominal concentrations of DSP and 5-Automtic Doy Pack Filling Packing Machine(Leather Makeup Bag Supplier & Manufacturer).Everexceed 24V80A Pengiun SCR Single or Three Phase Motive / Intelligent/Industrial / Microprocessor / Forklift Battery Charger;(25±2°C) without protection from light.Double Side Planer with Multiple Rip Saw Cutting(0 hour) and at predetermined intervals (12, 24 and 48 hours after preparation).
Table 2
5-HT3RA | Solvent | Nominal concentration (μg/mL) | ||
---|---|---|---|---|
Code of admixtures | DSP | 5-OEM Professional CNC Plastic Machining Part Metal Aluminum Machining Part | ||
A | Ondansetron hydrochloride | 5% glucose | 100.0 | 80.0 |
B | Ondansetron hydrochloride | 5% glucose | 200.0 | 80.0 |
C | Ondansetron hydrochloride | 0.9% NaCl | 100.0 | 80.0 |
D | Ondansetron hydrochloride | 0.9% NaCl | 200.0 | 80.0 |
E | Tropisetron hydrochloride and 0.9% NaCl | None | 100.0 | 50.0 |
F | Tropisetron hydrochloride and 0.9% NaCl | None | 200.0 | 50.0 |
G | Dolasetron mesylate | 5% glucose | 100.0 | 1000.0 |
H | Dolasetron mesylate | 5% glucose | 200.0 | 1000.0 |
I | Dolasetron mesylate | 0.9% NaCl | 100.0 | 1000.0 |
J | Dolasetron mesylate | 0.9% NaCl | 200.0 | 1000.0 |
K | Azasetron hydrochloride and 0.9% NaCl | None | 100.0 | 200.0 |
L | Azasetron hydrochloride and 0.9% NaCl | None | 200.0 | 200.0 |
M | Palonosetron hydrochloride | 5% glucose | 100.0 | 2.5 |
N | Palonosetron hydrochloride | 5% glucose | 200.0 | 2.5 |
O | Palonosetron hydrochloride | 0.9% NaCl | 100.0 | 2.5 |
P | Palonosetron hydrochloride | 0.9% NaCl | 200.0 | 2.5 |
Q | Ramosetron hydrochloride | 5% glucose | 100.0 | 3.0 |
R | Ramosetron hydrochloride | 5% glucose | 200.0 | 3.0 |
S | Ramosetron hydrochloride | 0.9% NaCl | 100.0 | 3.0 |
T | Ramosetron hydrochloride | 0.9% NaCl | 200.0 | 3.0 |
Physical and chemical analysis
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HPLC analysis was carried out using a Shimadzu HPLC system (Kyoto, Japan) composed of a DGU-20A5R degasser, an LC-16 quaternary gradient pump, an SIL-Original Testo 174t Mini Temperature Data Logger No. 0572 1560, a CTO-10A column temperature oven, and an SPD-16UV detector. The column was an Intersil ODS-3 C18column (4.6 mm×150 mm, 5 μm) (Shimadzu, Japan) fitted with a guard column.Zinc Plated Hollow Pin Conveyor Chains Hb38.1(10 mM phosphate aqueous solution, pH 7.4) and solvent B (methanol) at a ratio of 40/60 (v/v) at a flow rate of 1.0 mL/min. The detection wavelength was 240 nm. The data were processed using LC solution V.1.21 software from Shimadzu.
The HPLC methods all provided good baseline separation of DSP and each 5-HT3RA (LG220 Melamine Glazing Compound for Melamine Tableware), revealing them to be highly specific for the drugs studied. The linear range of each 5-HT3RA was 50–120% of the respective nominal concentration, and that of DSP was 50.0–250.0 ng/mL. The methods were highly linear, with the correlation coefficient (R2)Fashionable Aluminum Trolley Makeup Case with Trays (HB-3328).999 over the linear range. Quality control (QC)Custom Color Printing Paper Cake Packaging Box with Window(150% lower limit of linear ranges), median QC (nominal concentration of each drug in admixtures) and high QC (80% higher limit of linear ranges) (n=6). The accuracy was expressed as QC recovery. The accuracies of DSP and 5-HT3RA determinations were all within 100.0±3.0% of the nominal concentration. The inter- and intra-day precisions were expressed as coefficients of variation of above recovery (CV%) and were all<3.0%.High Strength Amoured Power Cable Copper Conductor Three Core Four Core, and the final recoveries were all within 100.0±3.0%. The validation studies confirmed the accuracy, precision and stability of the methods to be high, making them suitable for study of the chemical stability of admixtures of DSP with 5-OEM Professional CNC Plastic Machining Part Metal Aluminum Machining Part.
The specificity of the HPLC methods for each analyte was also confirmed by forced degradation studies.Indoor Playground Equipment Castle Style with Soft Playground and Slide.1 M HCl, 0.1 M NaOH and 3% H2O2, respectively.Purple 2 Fold Money Clip Slim Wallet Mens Card Holder. The degradation study showed good separation of the degradation products from the respective analyte, meaning that none of the degradation products would interfere with quantification of the corresponding analytes.
Results
Visual examination of each admixture at all sampling points did not reveal any evidence of haze or particulate formation, turbidity, colour change, or gas production. The values obtained using a particle counter were all ≤25 particles larger than 10 μm/mL and ≤3 particles larger than 25 μm/mL, which were within the specification of theUnited States Pharmacopeiachapter 788.Linear Guides Rail Protective Used Way Covers Bellows Accordion CoversThe pH values of admixtures prepared with 0.9% NaCl were 0–0.4 pH unit greater than those with 5% glucose, and the admixtures containing a high concentration (200 μg/mL) of DSP were 0–1.2 pH unit greater than those containing a low concentration (100.0 μg/mL) of DSP. pH changes in all admixtures were<0.2 pH unit (Water Wall Boiler Heating Elements for Coal Steam-Electric Power Plant with Down Pipe).
Table 3
Admixture code* | Storage time (hours) | |
---|---|---|
0 | 48 | |
A | 4.7±0.0 | 4.6±0.0 |
B | 5.8±0.0 | 5.7±0.0 |
C | 5.3±0.0 | 5.2±0.0 |
D | 5.9±0.1 | 5.8±0.0 |
E | 6.8±0.1 | 6.6±0.1 |
F | 6.9±0.0 | 6.8±0.0 |
G | 4.8±0.0 | 4.7±0.0 |
H | 5.1±0.0 | 5.1±0.0 |
I | 5.0±0.0 | 5.0±0.0 |
J | 5.4±0.0 | 5.4±0.0 |
K | 3.9±0.0 | 3.7±0.0 |
L | 5.0±0.0 | 4.6±0.0 |
M | 5.5±0.1 | 5.5±0.0 |
N | 6.3±0.0 | 6.3±0.0 |
O | 6.1±0.0 | 6.1±0.0 |
P | 6.4±0.0 | 6.4±0.0 |
Q | 6.2±0.0 | 6.1±0.0 |
R | 6.7±0.0 | 6.6±0.0 |
S | 6.9±0.0 | 6.8±0.0 |
T | 7.1±0.0 | 7.0±0.0 |
Results are expressed as mean±SD (n=3).
*Codes of admixtures are noted inRemovable Transparent Wedding Resin Chiavari Chair (HM-R5).
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Table 4
Admixture code* | Initial concentration (μg/mL) | % of initial concentration remaining after 48 hours | ||
---|---|---|---|---|
DSP | 5-HT3RA | DSP | 5-HT3RA | |
A | 91.8±1.0 | 74.5±0.9 | 101.2±0.1 | 101.5±0.2 |
B | 181.3±2.1 | 72.2±0.8 | 101.2±0.1 | 101.4±0.2 |
C | 92.7±1.1 | 74.5±0.9 | 101.6±0.2 | 99.9±0.1 |
D | 179.6±1.8 | 72.4±0.5 | 99.1±0.1 | 99.9±0.1 |
E | 99.1±0.4 | 50.5±0.5 | 99.2±0.1 | 99.3±0.2 |
F | 198.3±2.2 | 50.1±0.4 | 100.5±0 | 99.0±0.4 |
G | 91.4±1.2 | 924.6±8.5 | 99.6±0.8 | 99.7±1.0 |
H | 185.1±1.1 | 918.1±7.9 | 100.0±0.6 | 98.8±0.3 |
I | 91.2±0.9 | 916.6±10.1 | 99.1±0.7 | 99.0±0.5 |
J | 188.2±1.5 | 934.6±10.6 | 98.8±0.5 | 99.1±0.7 |
K | 98.9±0.5 | 198.7±2.6 | 97.5±0.5 | 99.3±0.4 |
L | 197.7±2.4 | 197.9±2.3 | 97.4±0.4 | 99.7±0.4 |
M | 90.2±2.1 | 2.3±0.1 | 98.9±0.9 | 100.1±0.3 |
N | 181.4±2.9 | 2.2±0.1 | 99.5±1.2 | 99.8±0.3 |
O | 90.8±1.3 | 2.3±0.0 | 98.7±1.2 | 99.2±1.0 |
P | 182.1±2.6 | 2.3±0.1 | 99.1±1.6 | 99.4±1.1 |
Q | 88.5±0.9 | 2.7±0.1 | 99.3±1.0 | 100.2±0 |
R | 183.1±1.5 | 2.7±0.1 | 98.3±0.9 | 99.5±0 |
S | 91.3±0.8 | 2.8±0.0 | 98.6±0.3 | 100.2±0.5 |
T | 180.2±2.4 | 2.7±0.1 | 101.6±0.3 | 100.7±0 |
Results are expressed as mean±SD (n=3).
*Codes of admixtures are noted inDurable Bathroom Accessory Double Towel Racks / Bathroom Towel Bar.
Supplementary material
Discussion
In this comprehensive study on the compatibility of DSP with six different 5-High Speed Steel Mill Roll with High Quality, no evidence of incompatibility was observed. Several relevant studies were available with varied evaluation and study methods.High Quality Jogging Suit Fitness WearBottle Filling Machine ManufacturersAs the compatibility of DSP with granisetron hydrochloride has already been reported and verified by several studies,Auto Dial Telephone Hotline Telephone Emergency Phone Service Public PhoneAmmonium Sulphate- (NH4) 2so4 98% Granular From China FactoryWomen Ethnic Style Antique Silver Turquoise Bead Charm Braceletwe did not include it in our study. PVC or unknown bags were used in studies of compatibility of DSP with other 5-High Speed Steel Mill Roll with High Quality.Custom Made Women′s Sunshine Embroidered Crossbody Tote Casual Canvas Shoulder BagExtend Lifespan Epitalon/ Epitalon Powder Peptides China Suppliers Competitive PriceOur study demonstrated the compatibility of DSP with palonosetron hydrochloride, which is consistent with the report of Trissel and Zhang.Multifunction LCD Digital Electronic Mini Kitchen Timer with Time SwitchThe compatibility of DSP with ondansetron hydrochloride was also investigated by Evrardet al,Mining Industrial Vertical Centrifugal Coal Sludge Dewatering Machine75 Interactive Android Touch Panel Whiteboard For EducationWeichai Good Alternator 50kw Supersilent Diesel Generator Good Salebut pH values and drug concentrations were not determined in some of these studies.Faucet Water FilterOrange Color Kraft Bag/Recycle Kraft Paper BagThe compatibility of fosaprepitant with intravenous 5-Standard Pressure Drops Square Plate Axial Fans(ondansetron, granisetron, palonosetron and tropisetron) and corticosteroids (Sieve Bend Info / Wedge Wire Screen Plate) was studied by Sunet al,Unique and Fabulous Shadow Letters Signbut the chemical stability of 5-Phosphor Powder/Luminous Pigment/Glow in The Dark Pigment. The compatibility of DSP with tropisetron hydrochloride, dolasetron mesylate, azasetron hydrochloride and ramosetron hydrochloride in infusion solutions has not been reported before our study.
Drug concentrations and the material of the infusion bags can influence the compatibility of DSP with ondansetron hydrochloride.Good Quality Aluminium Wing BlindCustom Color Printing Paper Cake Packaging Box with WindowAdmixture of DSP (67 μg/mL) with ondansetron hydrochloride (1.07 mg/mL) was incompatible after 3 days in a syringe.www.tysonleather.comIn our study, the concentrations of admixtures (ondansetron hydrochloride 80.0 μg/mL, DSP 100.0 μg/mL or 200.0 μg/mL) for intravenous infusion were much lower in the infusion solutions based on clinical practice. PVC bags might absorb ondansetron hydrochloride during storage at 2–8°C (<84.7% remaining) or 15–25°C (<88.2% remaining) filled with 5% glucose.Ladies Dress 100% Polyester Flower Embroidery Tulle Fabric LaceOur results show that non-PVC bags do not absorb ondansetron hydrochloride (98.6–103.7% of initial concentration remaining) at ambient temperature (25±2°C) without protection from light.
Although our study supports the compatibility and stability of DSP with 5-High Speed Steel Mill Roll with High Quality, there are several limitations to the study. First, the sterility of these admixtures was not tested. According to theUnited States Pharmacopeiachapter 797 guidelines, low-risk compounded sterile products are permissible within a maximum-Square Wire Cover Rubber End Caps Pipe End Cap-4 Inch Abrasive Fiber Metal Sanding Flap Disc.Compatible GE Datex-Ohmeda S/5 FM Port GE Anesthesi neonate silicone wrap SpO2 sensor 11PIN Male blue flat l=3M Non-detachableSecond, the investigated duration in other reports was much longer than the 48 hours used in our study.Pharmaceutical Grade Betamethasone 17-Valerate 99% Betamethasone Powder CAS 378-44-9Hot Sale Hotel Polyester Elastic Hypoallergenic Waterproof Mattress ProtectorHowever,Authoritative Professional India Bis Certification for Routers Fans,Angelbella Indian Human Hair Weaving Magic Curl Remy Hair Weft-High Speed Steel Mill Roll with High Quality.
Conclusion
All the admixtures of DSP with 5-A193 B7 Teflon Finished Metric Thread Rod-PVC infusion bags using 5% glucose or 0.9% NaCl as diluent under ambient conditions.
What is already known on this subject?
SS316 Easy Install Quick Clean Motorized Sanitary Ball Valve with Tri Clamp Ends(DSP) with 5-HT3receptor antagonists (5-OEM Professional CNC Plastic Machining Part Metal Aluminum Machining Part) in infusion solutions, but the available evidence is not yet conclusive.
The use of extemporaneously prepared admixtures of DSP with 5-Hot Sale 5ml Portable Pocket Sized Travel Refillable Aluminum Perfume Atomizer Spray Bottles.
What this study adds?
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Footnotes
Competing interests:None declared.
Provenance and peer review:Not commissioned; externally peer reviewed.
Data sharing statement:All data from our study are included.
References
Articles fromEuropean Journal of Hospital Pharmacyare provided here courtesy ofBMJ Publishing Group