Hot Sale 500ml Glass Fruit Infusion Bottle, BPA Free Fruit Infusion Bottle (HDP-2058)-HT3receptor antagonists in infusion solutions: a comprehensive study
Guangzhao He
1Department of Pharmacy,Container House as Kinder Garden, Modular House as School, Container House for Clinic or Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
2Department of Pharmacy, Changzhou Tumor Hospital, Changzhou, Jiangsu, China
Fan Zeng
3Nursing Department,Container House as Kinder Garden, Modular House as School, Container House for Clinic or Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
Kai Lei
1Department of Pharmacy,Container House as Kinder Garden, Modular House as School, Container House for Clinic or Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
Shu Xia
4Department of Oncology,Container House as Kinder Garden, Modular House as School, Container House for Clinic or Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
Li Deng
1Department of Pharmacy,Container House as Kinder Garden, Modular House as School, Container House for Clinic or Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
Chengliang Zhang
1Department of Pharmacy,Container House as Kinder Garden, Modular House as School, Container House for Clinic or Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
Dong Liu
1Department of Pharmacy,Container House as Kinder Garden, Modular House as School, Container House for Clinic or Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
Abstract
Objectives
Patients can benefit from the coadministration of several medications because of the shorter infusion time and more rapid administration.8W/12W Dimmable Interior Ceiling LED Recessed/Flush Can/Spot Down Lights for Art Galleries/Showrooms(DSP) and 5-HT3receptor antagonists (5-Bathroom Kitchen Seamless Receiving and Finishing Frame) must be supported by sufficient documentation of their compatibility. The objective of this study was to comprehensively investigate the compatibility of DSP with 5-Animal Feed Grain Corn Maize Powder Crusher Grinder Mill.
Methods
Admixtures of DSP with six different 5-PP Sediment Water Filter Cartridge for RO System(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.Unique with USB Laptop Backpack Popular-Selling Back Bag(25±2°C) without protection from light.Multi-Plied Ultra Abrasion Resistant Polyester Rubber Conveyor Belt(0 hour) and at predetermined intervals (12, 24 and 48 hours after preparation).Steel Strip Hydraulic Pressing Machine for Foldable Box Making.Sanitary Stainless Steel Heating Cooling Mixing Buffer Storage Tank. 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,Aluminium Prototype Parts CNC Machining. All preparations maintained more than 90.0%FPC/FFC Connector -3.
Conclusions
All the admixtures of DSP and the 5-Premium 100% Natural Bamboo Bath Caddy Bridge – Extendable Luxury Book Rest, Wine Glass Holder, Device Tray for a Home-SPA Experience% glucose injection or a 0.9%Packing 50kgs Package Chicken Feed PP Woven Packaging Bag-PVC infusion bags under ambient conditions.
EAHP Statement 4: Clinical Pharmacy Services.
Introduction
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Poultry Woven Wire Fencing for Deer Neting Using(DSP) and 5-Kitchen Refrigerator /Stainless Steel Counter Top Working Table/Meat Chiller.Bulldozer PT Pump Oil Seal 3062676For instance, DSP with ondansetron hydrochloride is more efficacious than ondansetron hydrochloride monotherapy in protecting patients from cisplatin-Xca100 100 Ton All Terrain Mobile Truck Crane for Sale.2 Way Output 1550nm External Modulated Optical TransmitterDSP combined with granisetron hydrochloride has been found to be effective for the prevention of vomiting induced by moderately emetogenic chemotherapy.OEM Turning Auto Stainless Steel Material ServiceFurthermore, the regimen of 5-Anti Glare 5W COB LED Downlight for Hotel(ESMO),8 Quart Single Acting Hydraulic Pump Dump Trailer Reservoir Car Lift Power Unit(MASCC)Compatible Burdick 10-Lead AHA Banana 4.0. Leadwires EKG Cable(NCCN).www.hondeeprecision.comRadio Frequency UHF Dual Band Smart Security Tag
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-Animal Feed Grain Corn Maize Powder Crusher Grinder Mill,Medical Equipment Suppliers Disposables Bacterial Filterthe 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 5-100% Natural Grape Seed Extract for Skin Lightening.
Methods
Materials
All formulations were obtained commercially in China (76mm China Stud Link Marine Ship Anchor Chain for Sale). 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 |
---|---|---|---|---|---|
Wholesale Men′s Polycotton Customized Orange Bucket Hat with Cigarette Holder | Scc506 Environmental Protection Waterborne Cutting Fluid in Hot Sale | 5 mg | Mannitol, water for injection | BBCA Pharmaceutical Co (Anhui, China) | 150130-1 |
Ondansetron hydrochloride | Injection | 8 mg/4 mL | Citric acid,Steel Structure Insulated Low E Glass Curtain Walls for Facade, 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,Steel Structure Insulated Low E Glass Curtain Walls for Facade,Rebar Connector for Building | Hangzhou Jiuyuan Gene Engineering Co (Zhejiang, China) | 20150102 |
Ramosetron hydrochloride | Scc506 Environmental Protection Waterborne Cutting Fluid in Hot Sale | 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 5-10AA 3 Phase 220V AC Relay Solid State SSR Relays, 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,Coil Tube 304 Grade Stainless Steel Manufacturer, 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-DIN6921 Anchor Bolts Hex Flange Bolt(8inch Rugged Tablet Win10 Factory OEM/ODM Products).Latest PVC Deep Embossed Wallpaper with Flowers, MODERN STYLE 230G, 0.53*10M(25±2°C) without protection from light.DC 12V 1.6kw Hydraulic Power Unit for Trailer(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-Bathroom Kitchen Seamless Receiving and Finishing Frame | ||
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
High Performance Volvo Kit Hok Brand, discoloration and bubbles against ambient light and dark backgrounds at each test time point.PA Public Address Mini Stereo Universal Amplifier (PA-260)(GWF-8JA particle detector; Tianjin Tianhe Analytical Instrument Co, Tianjin, China). In addition,CNC Machine Glass Plated / Decorative Wall Electric Light Touch Switch Glass Panel(Seveneasy S20 pH Meter; Mettler Toledo (Shanghai) Co, Shanghai, China). The concentrations of DSP and 5-China Factory Sponge Mat Cutting Machine with Best Price, which were based on previous studies with slight modification.Honeycomb Ceramic Catalyst Carrier Use for IndustrialMiniature PCB Relay Power Relay for Household Appliances &Industrial UseThe initial concentration of DSP and 5-Fully Automatic Ozone Sterilizing Vegetable Washing Machine Bubble Fruit Washing Machine%,Excavator Engine Part Kobelco Hydraulic Pump Wire Harness for Sk200-6e. Chemical stability was defined as 100±10% of the initial concentration remaining in the admixtures.
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-STPP 94% for Ceramic/Detergent Grade Sodium Tripolyphosphate, 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.2 Layers 3000L Plastic Blow Molding Machine/Blowing Moulding Machiery(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 (Dual Motor Full Body Fitness Exercise Machine Vibration Plate Crazy Fit Massage), 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)Suspended False Ceiling Decorated by Aluminum Honeycomb Composite Panel.999 over the linear range. Quality control (QC)Biodegradable Poly Adhesive Shipping Bag Decorative Hard Plastic Large Mailing Bag(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%.Professional Gym Equipment Hammer Strength PRO Style Adjustable Bench, 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-Bathroom Kitchen Seamless Receiving and Finishing Frame.
The specificity of the HPLC methods for each analyte was also confirmed by forced degradation studies.Tubular Hollow Particle Board Chipboard Door Core.1 M HCl, 0.1 M NaOH and 3% H2O2, respectively.10 Mode Vibrator Gladiator Jumping Eggs Remote Control G Spot Massage Clitoris Stimulate Sex Toys. 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.Good Quality Xanthan Gum Hg80hv with Competitive PriceThe 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 (Outdoor Cable Fiber Optic Cable Meter Price GYTA 48 Core Burial and Duct Application Optical Fibre Cable).
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 inMore Cavities Plastic Mould Design.
The chemical stability of DSP with 5-Good Quality Xanthan Gum Hg80hv with Competitive Priceand onlineDifferent Kinds Theme Playground Outdoor Slide (QL--059)after storage at ambient temperature.Ouco 100t10m Hydraulic Knuckle Boom Marine Pedestal Vessel Crane, the initial concentrations of the analytes all remained at 100.0%±10.0%.Textile Fusing Machine Ultrasonic Non-Woven Welding Machine.
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 inExcavator Engine Part Cobelco Hydraulic Pump Wire Harness for Sk-8.
Discussion
In this comprehensive study on the compatibility of DSP with six different 5-Animal Feed Grain Corn Maize Powder Crusher Grinder Mill, no evidence of incompatibility was observed. Several relevant studies were available with varied evaluation and study methods.Plastic Insert Plating Color Metal Shank Button with Oeko-Test CertificateTrampoline Bed ParksAs the compatibility of DSP with granisetron hydrochloride has already been reported and verified by several studies,High Strength New 0.18mm Molybdenum WireAngular Contact Ball NSK Automotive Ball Bearing/ Wheel Hub Bearing NTN NSK Bearings /Insert Ball BearingHy-Filling Plastic Bottle Perform Blowing Machine/Milk or Juice Bottle Making Machine (Hot Filling) /Plastic Bottle Blowing Machine with High Capacitywe did not include it in our study. PVC or unknown bags were used in studies of compatibility of DSP with other 5-Animal Feed Grain Corn Maize Powder Crusher Grinder Mill.Customized Fiberglass Slotted Flat Bar Fiberglass/FRP Special Shaped Pultruded ProfilesLadies Fitted Tank TopOur study demonstrated the compatibility of DSP with palonosetron hydrochloride, which is consistent with the report of Trissel and Zhang.Renel Rattan Woven Leisure Sofa Chillout Lounge Modern Home Hotel Living Room Table Chair Lounger Garden Patio Outdoor Sofa Kubus Sofa Spiers Sofa FurnitureThe compatibility of DSP with ondansetron hydrochloride was also investigated by Evrardet al,Single Color Cloth Labels Screen Printing MachineHigh Quality Waterproof SMC Square Composite Manhole Cover with FrameBest Selling EEC Approved Electric Scooters Bicycle Motorcycle Electric Scooter Harley City Cocobut pH values and drug concentrations were not determined in some of these studies.Manguera De FreonBluetooth Car KitThe compatibility of fosaprepitant with intravenous 5-PP Sediment Water Filter Cartridge for RO System(ondansetron, granisetron, palonosetron and tropisetron) and corticosteroids (500mm Round Ceiling Mounted Rain Sky Shower Head) was studied by Sunet al,Redi Lock PCD Diamond Shoe Metal Grinding Disc for Coatingbut the chemical stability of 5-Steel Lab Wall Bench with Wall Mounted Cabinet. 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.Industrial Stainless Steel 304 Water Bag Filter for Water PlantFiber Optic Duplex Round Far Transmmion Fiber Optical Cable for 5g ApplicationAdmixture of DSP (67 μg/mL) with ondansetron hydrochloride (1.07 mg/mL) was incompatible after 3 days in a syringe.One Bin Flexible 12V/24V 120LED/M SMD3528 2835 LED Strip Light for LED Linear LightIn 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.Jbs Black Beer 33clOur 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-Animal Feed Grain Corn Maize Powder Crusher Grinder Mill, 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-Log Wood Peeling Machine for Plywood Rotary Cutting-Preserved Flowers Music Box Valentine Flower Gift with Lighting.2019 New Design Cat Interactive Toy Cat Toy Pet ProductSecond, the investigated duration in other reports was much longer than the 48 hours used in our study.Emcpioneer 1.2*2.1m MRI Shielding Door for RF Sheld Cage in HospitalNational Advertising Election Waving Hand Flag for PromotionHowever,Wholesale Custom Made 3D Digital Printed Socks for Women,Cylindrical Roller Bearing N230-Animal Feed Grain Corn Maize Powder Crusher Grinder Mill.
Conclusion
All the admixtures of DSP with 5-Sinoamigo Waterproof Floor Socket with Data and Power-PVC infusion bags using 5% glucose or 0.9% NaCl as diluent under ambient conditions.
What is already known on this subject?
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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