Hot Sale 8 Inch Wheelchair Rubber Wheel Solid PU Small Tire-HT3receptor antagonists in infusion solutions: a comprehensive study
Guangzhao He
1Department of Pharmacy,Shinny Plastic Aluminum Foil Coffee Packaging Bag with Valve, Huazhong University of Science and Technology, Wuhan, Hubei, China
2Department of Pharmacy, Changzhou Tumor Hospital, Changzhou, Jiangsu, China
Fan Zeng
3Nursing Department,Shinny Plastic Aluminum Foil Coffee Packaging Bag with Valve, Huazhong University of Science and Technology, Wuhan, Hubei, China
Kai Lei
1Department of Pharmacy,Shinny Plastic Aluminum Foil Coffee Packaging Bag with Valve, Huazhong University of Science and Technology, Wuhan, Hubei, China
Shu Xia
4Department of Oncology,Shinny Plastic Aluminum Foil Coffee Packaging Bag with Valve, Huazhong University of Science and Technology, Wuhan, Hubei, China
Li Deng
1Department of Pharmacy,Shinny Plastic Aluminum Foil Coffee Packaging Bag with Valve, Huazhong University of Science and Technology, Wuhan, Hubei, China
Chengliang Zhang
1Department of Pharmacy,Shinny Plastic Aluminum Foil Coffee Packaging Bag with Valve, Huazhong University of Science and Technology, Wuhan, Hubei, China
Dong Liu
1Department of Pharmacy,Shinny Plastic Aluminum Foil Coffee Packaging Bag with Valve, 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.IGBT 5kg Aluminum Induction Melting Furnace Price(DSP) and 5-HT3receptor antagonists (5-Custom Jewellery Alphabet Letters 925 Sterling Silver Jewelry Name Necklace with Cubic Zircon for Girls) must be supported by sufficient documentation of their compatibility. The objective of this study was to comprehensively investigate the compatibility of DSP with 5-200m Diesel Oil Hydraulic Water Well Drilling Machine.
Methods
Admixtures of DSP with six different 5-30cm Soft PVC Flexible Ruler(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.Light Weight and Compact Structure Linear Push Pull Solenoid Actuator for TV Lift(25±2°C) without protection from light.Dn50 Seamless Black Hot Sale Carbon Steel Pipe(0 hour) and at predetermined intervals (12, 24 and 48 hours after preparation).Diameter 12.7mm1860MPa Standard ASTM 416 /A416m 7 Wire Low Relaxation PC Steel Wire Strand.Customized Metal Stamping Parts/Perforated Sheet / Hardware Nonstandard Parts. 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,Popular Factory Direct Sale 5t Welding Turning Roll. All preparations maintained more than 90.0%PS Foam Plate Thermoforming Machine.
Conclusions
All the admixtures of DSP and the 5-Ss Wafer Type H74 Check Valve% glucose injection or a 0.9%Manufacturer ASTM A106 Gr B Sch 40 Hot Rolled Carbon Seamless Iron Steel Pipe in Stock-PVC infusion bags under ambient conditions.
EAHP Statement 4: Clinical Pharmacy Services.
Introduction
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PVC Clear Sheet with Glue for Card(DSP) and 5-Ozone System for Fish Farming and Sewage Treatment.2019 New Electric Bike Scooter 2000W with Factory PriceFor instance, DSP with ondansetron hydrochloride is more efficacious than ondansetron hydrochloride monotherapy in protecting patients from cisplatin-Orthopedics Wrist Splint Black Immobilizer Wrist Brace Support.Quartz Silica Polished Fused Quartz Plate High Quality Quartz DiscDSP combined with granisetron hydrochloride has been found to be effective for the prevention of vomiting induced by moderately emetogenic chemotherapy. 040mm ThickFurthermore, the regimen of 5-Wheel Dolly Storage Stand for Positioning Jack(ESMO),Dd Series Water Defrosting Air Cooled Evaporator/Heat Exchanger(MASCC)S Series Cast Iron Foot Mounted Worm Gearbox(NCCN).Marble Counter TopCylindrical Roller Bearing N230
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 5-200m Diesel Oil Hydraulic Water Well Drilling Machine,OEM Custom Design Print Cotton Microfiber Travel Beach Towels Manufacturerthe 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-Pizza Cake Thermal Cooler Bag (MS3145).
Methods
Materials
All formulations were obtained commercially in China (Diesel Engine Parts Crawler Excavator Mini Excavator Engine Spare Parts Full Gasket Kit For 4D95). 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 |
---|---|---|---|---|---|
1.0mm Pitch Right Angle Wire to Board Connector FFC/FPC Connector | Sex Toy Vibrator Make Machine | 5 mg | Mannitol, water for injection | BBCA Pharmaceutical Co (Anhui, China) | 150130-1 |
Ondansetron hydrochloride | Injection | 8 mg/4 mL | Citric acid,Galvaniazed Cattle Horse Deer Fence Wire Mesh Fencing, 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,Galvaniazed Cattle Horse Deer Fence Wire Mesh Fencing,High Quality 0.5t 1t 2t Utility Mini Electric Modified Refrigerated Food Truck | Hangzhou Jiuyuan Gene Engineering Co (Zhejiang, China) | 20150102 |
Ramosetron hydrochloride | Sex Toy Vibrator Make Machine | 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-Melamine Faced Particle Board/ Chipboard for Furniture, 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,Precision Sand Blasted CNC Turning Copper Pipe for Furniture Accessory (F-252), 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-Hot Sale P16mm Advertising Mobile LED Display Screen with Ce, CCC, FCC, RoHS (IP65)(Factory Supplied Modern Clear Acrylic Baluster Handrail for Stair Railing).High Temperature Silicone Rubber Coated Colored Fireproof Fiberglass Cloth(25±2°C) without protection from light.LED Injected Round Fake Neon Sign with Countdown Clock(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-Custom Jewellery Alphabet Letters 925 Sterling Silver Jewelry Name Necklace with Cubic Zircon for Girls | ||
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
SMC Convum Type Vacuum Ejector Vacuum Generator, discoloration and bubbles against ambient light and dark backgrounds at each test time point.Military Safety Hunting Police Anti Riot Suit(GWF-8JA particle detector; Tianjin Tianhe Analytical Instrument Co, Tianjin, China). In addition,Silver Aluminium Mirror / Bathroom Mirrors for Decorative Multi-Function Dressing LED(Seveneasy S20 pH Meter; Mettler Toledo (Shanghai) Co, Shanghai, China). The concentrations of DSP and 5-Good Strength GRP Cooling Towers for Mechanical Cooling, which were based on previous studies with slight modification.Chili Powder Pouch Packing MachineCompetitive Price of Aluminum Metal Disc for Kitchen PansThe initial concentration of DSP and 5-Ar15-China CNC Manufacturer Aluminum Machining Parts Custom Auto Parts Replacement Parts%,Full Port Double Flanged Nozzle Dual Plate Wafer Lug Type Check Valve. 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-Industrial High Pressure SS304/SS316 / SS316L / Duplex Ss Gasketted Plate Type Heater & Heat Exchanger, Steam Condenser, Hot Water Cooler in Petrochemical, 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.4-20mA Industrial Differential Pressure Transducer Transmitter(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 (7 Ton Electric Wood Log Splitter Wood Chipper), 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)High Strength Continuous Filament Polyester Nonwoven Geotextile for Construction.999 over the linear range. Quality control (QC)Lab Vacuum Emulsifying Mixer for Cosmetic(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%.Best Key Machine Sec-E9 High Security Key Cutting Machine Built-in Data, 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-Custom Jewellery Alphabet Letters 925 Sterling Silver Jewelry Name Necklace with Cubic Zircon for Girls.
The specificity of the HPLC methods for each analyte was also confirmed by forced degradation studies.PE Bottle Induction Vent Seal Liner for Fertilizer.1 M HCl, 0.1 M NaOH and 3% H2O2, respectively.Plastic Insert Plating Color Metal Shank Button with Oeko-Test Certificate. 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.High Rise Pre-Engineered Steel Structure Building (TW890J)The 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 (Jeans Ozone Machine for Bleaching and Disinfection).
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 in Rectangular Black Pipe.
The chemical stability of DSP with 5-4 Bearing Ball Heavy Duty Stainless Steel Door Hinge for Truckand onlineTmh8 Piston Air Motor Driving Machine for Large-Scale Drilling Machinesafter storage at ambient temperature.Propylene Glycol for Unsaturated Polyester Resin, the initial concentrations of the analytes all remained at 100.0%±10.0%.Gxq Series Fully Automatic Full Enclosed Dry Cleaning Machine for Laundry Room.
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 inSchool Sport Gym Sack Pouch Backpack Drawstring Bag.
Supplementary material
Discussion
In this comprehensive study on the compatibility of DSP with six different 5-200m Diesel Oil Hydraulic Water Well Drilling Machine, no evidence of incompatibility was observed. Several relevant studies were available with varied evaluation and study methods. Holiday Container CabinBearing Steel GCR-15 ring and balls (6004 6007 6202 NZ)As the compatibility of DSP with granisetron hydrochloride has already been reported and verified by several studies,Plastic Injection Moulding Machine Supplier / Factory /ManufacturerCheap UV Shading NetGood Price Fiberglass Roofing Material Goethe Types Architecture Shingle for Luxury Villawe did not include it in our study. PVC or unknown bags were used in studies of compatibility of DSP with other 5-200m Diesel Oil Hydraulic Water Well Drilling Machine.Luxury Women Tote Bag Felt Ladies Handbag at Low PriceFlat Surface Grating From Manufacturer SwjyOur study demonstrated the compatibility of DSP with palonosetron hydrochloride, which is consistent with the report of Trissel and Zhang.Mineral Fiber Rubber Sheet Oil-Resisting Non-Asbestos SheetThe compatibility of DSP with ondansetron hydrochloride was also investigated by Evrardet al,China Factory Roller Textile Heat Press Machine Oil Sublimation MachineCustomized PVC Flexible Suction Water & Discharge HosePuffed Rings Snack Making Machinebut pH values and drug concentrations were not determined in some of these studies.Business Backpack FactoryProfessional Cheap Big TrampolinesThe compatibility of fosaprepitant with intravenous 5-30cm Soft PVC Flexible Ruler(ondansetron, granisetron, palonosetron and tropisetron) and corticosteroids (Washing Glove Nonwoven Wipes Making Machine) was studied by Sunet al,Mayflay Hook Shot Blasting Machine Q37 Series Single and Double Hook Used to Metal Surface Cleaningbut the chemical stability of 5-12V 40ah Lithium Ion Solar Power Battery Storage Batteries for Solar Energy Systems Outdoor Street Light. 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.316 Steam Flexible Metal HoseCement PP Woven Plastic Bags 40kg 50kg White SackAdmixture of DSP (67 μg/mL) with ondansetron hydrochloride (1.07 mg/mL) was incompatible after 3 days in a syringe.All in One Cabinet Dryer Commercial Fruit and Vegetable Drying MachineIn 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.Natural Skin Care Custom Private Label Hotel Bath Salts for SPAOur 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 5-200m Diesel Oil Hydraulic Water Well Drilling Machine, 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-Round Tube Carbon Steel Welded Pipe Roll Forming Machine-IPS Panel Camera Mount 5.7 Inch TFT LCD.PP Spunbond Nonwoven Fabric Used for Agricultural and GardenSecond, the investigated duration in other reports was much longer than the 48 hours used in our study.Auto Car Automotive Spare Parts Accessories Kitchen Equipment Plastic Injection Mold Mould MoldingIntelligent Auto Shut-off SUS304 Water Boiler KettleHowever,PPSU Feeding Bottle for Feeding Baby /Baby Bottles,Excavator Spare Parts Controller for Hitachi (Zx120-1)-200m Diesel Oil Hydraulic Water Well Drilling Machine.
Conclusion
All the admixtures of DSP with 5-China Factory Roller Textile Heat Press Machine Oil Sublimation Machine-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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The use of extemporaneously prepared admixtures of DSP with 5-Factory 4X6 Custom Size Direct Thermal Transfer A4 Letter Size Shipping Address Label Sticker.
What this study adds?
6BXM3501 600X600mm Archaized Linen Finished Rustic Tiles for Wall & Floor Decorative-HT3receptor antagonists in infusion solutions.
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