For the

second data collection, recurrent themes were analysed to investigate negative consequences of VCT. Salient quotations followed by interview (I) numbers and focus group (FG) numbers were chosen as explanatory support for quantitative data. The study was reviewed and accepted by the Committee for Research Ethics of the University of Montreal and by the National Ethics Committee in Guinea in 2005. All participants provided written informed consent to participate in the study. Participating women received financial compensation selleck inhibitor for their transport, the interview time, and blood drawing. Free condoms were distributed to them. Women who tested positive for HIV were referred to a health centre where free ART was available. A total of 421

participants were recruited. Three women declined to participate, yielding a response rate of 99.3% (421 of 424). The characteristics of the participants are described in Table 1. Their age varied between 15 and 49 years [mean 26 years; standard deviation (SD) 6.5 years] (Table 1). Most participants had no education (65.0%) and identified as single (51.0%), although 85.9% of all participants reported at least one regular nonclient sex partner (spouse or boyfriend). The mean duration of sex work was 1.7 years (SD 1.6 years). Almost half of the participants worked in brothels (43.1%) but the majority practised commercial sex in bars or nightclubs (55.5%). Most women believed in the existence of HIV/AIDS (97.4%) and more than a third of all participants (37.5%) knew a person

living with HIV or who had SGI-1776 clinical trial died from the disease. While knowledge about sexual transmission of HIV was excellent (this transmission mode was known by 92.9% of the participants), others modes of viral transmission were less frequently acknowledged (31.4% of the participants). Erroneous ideas about causes of transmission were reported by one-quarter of the participants (Table 1). Despite the fact that 56% of the FSWs reported that they would not buy vegetables from an infected saleswoman, most participants (86.2%) this website stated that they would take care of an infected close relative in their own house (Table 1). Almost all FSWs had contracted at least one STI in the preceding 3 months (95.5%). Most participants (316 of 420; 75.2%) perceived themselves at high risk of HIV infection (Table 1). The baseline prevalence of HIV infection was 38.1% (159 of 417). All women in the study agreed to undergo VCT (421 of 421; 100%). A majority of FSWs accepted VCT to find out their serostatus without any other particular reason (83.4%), while 13.7% of them were anxious because of their sexual behaviour or that of their partners (see Table 2). Only a quarter of FSWs (26.6%) had undergone a previous screening test for HIV, mainly because of a perceived high risk of infection (87.4%) (Table 2). Most participants in our study (362 of 392; 92.

Group A had 24 rats and were fed with commercial rat feed (control); Group B had 30 rats and were fed with commercial rat feed and T2 toxin by intragastric administration; and Group C had 24 rats and were fed with the KBD-affected feed. The histological sections were stained with hematoxylin and eosin (H&E) and Masson dye. Results:  Weight gain was fastest Group A rats and Group C rats had the lowest weight gain (P < 0.05). There were no epiphyseal plate chondrocyte necroses in the control group at the first, second, and fourth weeks. In the T-2 toxin group, two

rats had chondrocyte-focus necroses at the labrocyte cell zone at the second week. At the fourth week, six rats had chondrocyte-focus or lamellar necroses at the labrocyte cell zone. Three rats had focus necrosis at the proliferation cell zone, and there were three rats with penetration necrosis. Epacadostat chemical structure In

the KBD-affected group, one rat had chondrocyte-focus necrosis SRT1720 concentration at the labrocyte cell zone at the second week and seven rats had chondrocyte-focus necrosis at the labrocyte cell zone at the fourth week. And at the same time, two rats had focus necrosis at the proliferation cell zone, three rats had lamellar necrosis at the labrocyte cell zone, four had focus necrosis at the labrocyte cell zone, and two rats had penetration necrosis. The epiphyseal plate Masson dye of the control group showed deep blue collogen coloration and in the KBD-affected group and T-2 toxin group, collogen showed a pale blue enough color, the drum dyeing was uneven, and the collogen was showed an absence of color in the region of the necrosis. Conclusions:  With KBD-affected feed or T-2 toxin intervention, rats had focus necrosis and lamellar necrosis at the epiphyseal plate. KBD-affected

feed rats had less weight gain than T-2 toxin intervention rats, which means there were other etiological factors in KBD-affected feed. “
“Objective:  Patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and ankylosing spondylitis (AS) often require total hip arthroplasties. We present a retrospective review of 32 total hip arthroplasties (THA) performed for patients with SLE, RA or AS from 2003 to 2008 in a tertiary hospital in Singapore. Materials and Methods:  A total of 323 THAs performed between January 2003 to December 2008 were traced and cases of arthroplasties performed for such patients were isolated. Pre- and post-operative range of motion, Harris hip score, limb length discrepancies and complications were studied. Results:  Twenty-six patients aged 24–66 years (mean 47 years) were reviewed, with two AS patients (7.7%), 16 RA patients (61.5%), seven SLE patients (26.9%) and one patient (3.8%) with both RA and SLE. Thirty-two THA operations were conducted with six patients requiring bilateral THAs.

We also demonstrated that H-NS is involved in the expression of T3SS1 genes as a suppressive factor. This suppressive effect of H-NS on the production of T3SS1

proteins was mediated by repression of ExsA expression, suggesting that ExsA is a master regulator of T3SS1 gene expression. As far as we are aware, this is the first report of an association between the H-NS and ExsACDE regulatory systems. The ExsACDE regulatory system is a highly sophisticated transcriptional regulatory system that induces T3SS gene expression when a bacterium establishes contact with host cells OSI-744 cost (Yahr & Wolfgang, 2006). Expression of genes affected by H-NS is typically induced by environmental stimuli such as temperature (Falconi et al., 1998; Prosseda et al., 1998). Therefore, the combination of www.selleckchem.com/products/ldk378.html these two regulatory mechanisms appears to constitute the gene expression system that exerts lethality

in the murine infection model that we recently used as an in vivo phenotype characteristic of T3SS1 (Hiyoshi et al., 2010). Taken together, our findings contribute to the knowledge on how V. parahaemolyticus causes wound septicemia. This work was supported by Grants-in-Aid for Young Scientists and Scientific Research on Priority Areas Applied Genomics and Matrix of Infection Phenomena from the Ministry of Education, Culture, Sports, Science and Technology of Japan. “
“Lancefield group C Streptococcus dysgalactiae is an emerging fish pathogen, which was first isolated in 2002 in Japan. Streptococcus dysgalactiae isolates collected from diseased fish in Japan (n=12), Taiwan (n=12), China (n=2), Malaysia (n=3), and Indonesia (n=1) were characterized using biased sinusoidal field gel electrophoresis (BSFGE), sodA gene sequence analysis, and antimicrobial susceptibility. These isolates exhibited high phenotypic homogeneity irrespective of the countries

from where the strains were collected. Seventeen isolates were found to be resistant to oxytetracycline and carried the tet(M) gene, except for the strains collected in Taiwan and the PP1564 strain mafosfamide collected in China. The sodA gene sequence analysis revealed that 23 isolates were identical, except for one Japanese isolate (KNH07902), in which a single nucleotide differed from that of the other isolates. Based on BSFGE typing by ApaI macrorestriction, the isolates – including the Japanese, Taiwanese, and Chinese isolates – could be grouped into one main cluster at a 70% similarity level. However, the macrorestriction genotypes of some isolates were apparently distinct from those of the main cluster. It has been reported that Streptococcus dysgalactiae belonging to Lancefield group C streptococci (GCS) (Vieira et al., 1998) was responsible for mastitis, subcutaneous cellulitis, and toxic shock-like syndrome in bovine (Aarestrup & Jensen, 1996; Chénier et al., 2008) and other animal infections (Scott, 2000; Lacasta et al., 2008).

An audit of more recent perinatal transmissions occurring in the UK commenced in 2012 and is

expected to report in 2014 [6]. In 2009 the National Screening Committee considered the introduction of a routine repeat screening test in the third trimester to identify seroconversions selleck inhibitor in pregnancy, but concluded that a universal re-offer should not be introduced at that time. However, it was reiterated that women who declined the initial offer should be re-offered screening at around 28 weeks’ gestation, and that repeat tests could be offered to any woman who was thought to be at continuing risk of infection, and to any woman who requested a second or subsequent test [13]. It is the responsibility of clinicians caring for women with HIV and their children to report them prospectively to the NSHPC. Aggregated data tables from the UK and Ireland of antiretroviral exposure and congenital malformations are regularly sent to the Antiretroviral Pregnancy Registry (APR). Individual prospective reports should also be made to the APR antenatally with post-natal follow-up. Antiretroviral

Pregnancy Registry Research Park, 1011 Ashes Drive, Wilmington, NC 28405, USA In UK call Tel: 0800 5913 1359; Fax: 0800 5812 1658; For forms visit: www.apregistry.com This is the UK and Ireland’s surveillance system for obstetric and paediatric HIV, based at the UCL Institute Fulvestrant of Child Health, London. HIV-infected children and children born to HIV-infected women are reported through the British Paediatric Surveillance Unit of the Royal College of Paediatrics and Child Health, or in the case of some units with large caseloads direct to the NSHPC. Diagnosed pregnant women are reported prospectively through a parallel

reporting scheme run under the auspices of the Royal College of Obstetricians and Gynaecologists. Longer-term data on infected children are subsequently collected through the Collaborative HIV Paediatric Study (CHIPS). For further information see the NSHPC website (www.ucl.ac.uk/nshpc), the CHIPS website (www.chipscohort.ac.uk), or email ([email protected]). 4.1.1 Sexual health screening is recommended for pregnant women newly diagnosed with HIV. Grading: 1B 4.1.2 MycoClean Mycoplasma Removal Kit For HIV-positive women already engaged in HIV care who become pregnant sexual health screening is suggested. Grading: 2C 4.1.3 Genital tract infections should be treated according to BASHH guidelines. Grading: 1B There are few data regarding the prevalence of genital infections in HIV-positive women in the UK [15]. At present, the majority of pregnant HIV-positive women in the UK come from, and mostly acquired HIV in, sub-Saharan Africa where the prevalence of genital infections, particularly in the HIV-positive population, can be high [16].

Similar to P176, no significant binding by any rScl protein was detected for fibrinogen, decorin, heparin, collagens type I, and IV (data not shown). In general, the recombinant rScl1 constructs, derived from Scl1 proteins, bound cFn and Lm (Fig. 4a), while the Scl2-protein-based constructs

P163, P177, and P178 were ECM-binding negative. Furthermore, none of the rScl1 proteins tested bound pFn, which is in agreement with our previous reports showing that those rScl1 proteins did not bind pFn from human plasma by affinity chromatography (Han et al., 2006a; Caswell et al., 2008b). All LDL-binding constructs derived from Scl1 proteins BMS-907351 mouse of the M1-, M28-, M41-, M12-, M2-, and M52-type GAS (Han et al., 2006a) showed ECM binding, although to varying degrees. However, the CFH/CFHR-1-binding rScl1s originating from the M6- and M55-type GAS (Caswell et al., 2008b) did not show any significant binding to ECM ligands. In order to determine the region of Scl1 responsible for binding

to ECM proteins, an ELISA was performed using chimeric rScl constructs generated by domain swapping (Fig. 4b). We used two types of chimeric molecules: (1) derived from the ECM-binding positive (+) construct P144 (Scl1.1 of M1-type GAS) and the ECM-binding negative (−) construct P177 (Scl2 of M4-type GAS) and (2) constructs derived from the ECM-binding positive P144 and the ECM-binding negative P179 (Scl1 of M6-type GAS). The rScl1 (+)–rScl2 (−) chimeric construct P183 (P144V/P177CL), but not P184 (P177V/P144CL), bound cFn and Lm. Likewise, the rScl1 (+)–rScl1 (−) chimeric construct P213 (P144V/P179CL), but not P212 (P179V/P144CL), find more bound cFn and Lm. These data strongly indicate that, indeed, the Scl1-V region is responsible for mediating interactions with ECM proteins. The present and previous results underscore the functional diversity of the Scl1-V region. Of particular interest to us is the emergence of two main binding patterns Docetaxel mouse among Scl1 variants. The more common pattern includes binding of plasma LDL and ECM components cFn and Lm, which may represent an intriguing adaptation of Scl1 to either the blood or the tissue environment. Our previous molecular evolutionary genetic analysis

identified an elevated constraint of the Scl1-V region sequence, suggesting that this region responds to selective pressure (Lukomski et al., 2000). Inasmuch as the amino acid sequence in the V-region differs between Scl1 proteins of different M-types, the prediction of two α-helices (Rasmussen et al., 2000; Han et al., 2006a) and the globular structure of the Scl1-V domain (Xu et al., 2002; Han et al., 2006b) seem to be conserved among all Scl1 proteins. The present work provides a platform for future investigations that will determine the Scl1-ECM-binding affinities and identify the specific amino acid sequences or structural motifs of Scl1 variants that constitute the molecular basis for the Scl1-ligand (ECM, LDL, and CFH) recognition. We thank S. Beres for providing plasmid pSB027.

In sum, RT, ACC, P3a, P3b and RON were our main measures for evaluating the group difference MDX-1106 between musicians and non-musicians in

the ability to ignore irrelevant auditory change. Lastly, we wanted to understand to what extent expected advantages in the musicians group can generalize to completely novel sounds by examining ERPs elicited not only by naturally recorded sounds but also by their ROT versions. While ROT sounds retained some of the acoustic properties (such as complexity, pitch, periodicity and temporal envelope) of NAT sounds, their original timbre was completely unrecognizable. We hypothesized that if moderate musical training leads to benefits www.selleckchem.com/products/AZD2281(Olaparib).html that are tightly coupled with the specific timbres to which a musician is exposed, then we should see the expected benefits in the NAT condition but not in the ROT condition. However, if moderate musical training is associated with a more general enhancement of complex sound encoding and cognitive control, musicians may show advantages in both conditions. In addition to the main task described above, all participants were administered the Melody part of the Music Aptitude Profile (Gordon, 2001) to obtain a more

objective measure of their musical ability. They also filled out a detailed questionnaire on their musical training and experience. Electrical activity was recorded from the scalp using Morin Hydrate 32 Ag–Cl electrodes secured in an elastic cap (Quik-cap). Electrodes were positioned over homologous locations across the two hemispheres

according to the criteria of the International 10-20 system (American Electroencephalographic Society, 1994). The specific locations were: midline sites FZ, FCZ, CZ, CPZ, PZ, OZ; mid-lateral sites FP1/FP2, F3/F4, FC3/FC4, C3/C4, CP3/CP4, P3/P4, O1/O2; and lateral sites F7/F8, FT7/FT8, T7/T8, TP7/TP8, P7/P8; and left and right mastoids. Electroencephalographic activity was referenced to the left mastoid and re-referenced offline to the average of the left and right mastoids (Luck, 2005). The electro-oculograms were bipolar recordings via electrodes placed over the right and the left outer canthi (horizontal eye movement) and left inferior and superior orbital ridge (vertical eye movement). The electrical signals were amplified between 0.1 and 100 Hz and digitized online (Neuroscan 4.2) at a rate of 500 samples per second. Individual electroencephalographic records were visually inspected to exclude trials containing excessive muscular and other non-ocular artifacts. Ocular artifacts were corrected by applying a spatial filter (EMSE Data Editor; Source Signal Imaging, Inc., La Mesa, CA, USA). ERPs were epoched starting at 200 ms pre-stimulus and ending at 900 ms post-stimulus onset. The 200 ms prior to the recording onset served as a baseline.

Despite the seemingly clear finding that

CSP duration and surround inhibition were disassociated and a number of experimental controls were employed, the study had limitations and alternative interpretations of the data are possible. For instance, neither measures of spinal excitability nor the spinal component of the CSP (CSP durations < 75 ms) were undertaken and these mechanisms could theoretically contribute to surround inhibition. As cited above, however, a number of the original surround inhibition studies performed control spinal measurements and concluded that surround inhibition was due to supraspinal mechanisms. Therefore, later studies have not deemed it to be necessary to perform spinal

measurements as it seems highly unlikely that spinal mechanisms could be responsible for surround inhibition in healthy subjects or the loss of surround DNA Synthesis inhibitor inhibition in patients. Another alternative explanation for the current findings is that a reduced inhibition of CSP-related Quizartinib chemical structure neurons onto an unknown class of inhibitory interneurons could result in the level of inhibition exerted by these neurons onto surround muscle pyramidal cells increasing, leading to surround inhibition. However, this is highly speculative and unlikely given the known pattern of connections of intracortical neurons mediating the CSP and other forms of intracortical inhibition and facilitation in the motor cortex (Reis et al., 2008). Additionally, this line of reasoning could theoretically apply to almost every other cortical pathway that has been studied and excluded as a possible contributor

to surround inhibition. Although such possibilities cannot be ruled out, they also seem highly unlikely given the known connection patterns in the motor cortex and the conclusions of previous studies. The testing Protein kinase N1 of these possibilities would require complicated experimental procedures and could be an avenue of future research. The presence of surround inhibition in the motor system was confirmed in the current study, but the findings indicated that GABAB receptor-mediated intracortical inhibition, as measured by the duration of the CSP, did not contribute to the generation of surround inhibition. Similar to previous studies (Beck & Hallett, 2011), the results were able to exclude the possible contribution of a specific cortical pathway to surround inhibition, but unable to identify the pathway responsible for the phenomenon. Therefore, future work will examine the remaining candidate cortical inhibitory and excitatory pathways that could be responsible for surround inhibition. This work was supported by the NINDS intramural research program. The authors would like to thank Tianxia Wu for assistance with the statistical analysis.

Bacterial microorganisms, and most specifically the Proteobacteria phylum, are the most studied organisms inside the [Fe–S] cluster biosynthesis machinery field. There are three kinds of [Fe–S] biogenesis machinery described in bacteria, designated NIF, ISC, and SUF. The NIF system, first described in Azotobacter vinelandii, is formed by

structural and regulatory genes involved in the specific task of performing specialized functions in nitrogen fixation and subsequent maturation of the nitrogenase (Jacobson et al., 1989a, b; Rubio & Ludden, 2008). The ISC system, encoded by the iscRSUA-hscBA-fdx gene cluster, is the housekeeping system for the [Fe–S] protein maturation (Zheng et al., 1998) and is highly conserved in Proteobacteria. ISC is probably the most substantial machinery in living organisms, as it can be found in a wide variety selleck screening library of cells, including numerous bacteria, archaea, and plants (Takahashi & Tokumoto, 2002). The SUF system, first described in Escherichia coli, comprises proteins encoded by the sufABCDSE operon, and is expressed under stress growth conditions such as oxidative

stress, NO stress, and iron starvation (Fontecave et al., 2005). Firmicutes are predicted to contain only one kind of biosynthetic machinery for [Fe–S] cluster assembly. This is formed mostly by E. coli SUF homologs (sufC, sufD, sufS, sufB) and is completed by the presence of sufU, an iscU E. coli homolog (Fig. 1), although Sorafenib in vivo Enterococcus faecalis lacks the A-type of scaffold (ATC) sufA and the desulfurase activator sufE (Riboldi et al., 2009). Recently, SufU emerged as a candidate for desulfurase activator in Bacillus subtilis (Selbach et al., 2010; Albrecht et al., 2011). The Firmicutes phyla are a group of bacteria that participate extensively in virulence episodes and pathological

processes in the host organism. Enterococcus spp. comprises commensal microorganisms that colonize the gastrointestinal and vaginal tract and, occasionally, the oral cavity in humans. Enterococcus faecalis is a 3-mercaptopyruvate sulfurtransferase clinically relevant bacterium, responsible for 80–90% of clinical isolates in nosocomial infections (Tendolkar et al., 2003). Pathological processes of these microorganisms include infections of the urinary tract, wounds, bloodstream, and endocardium (Kauffman, 2003). The pathogenic phenotype is mainly due to virulence factors such as cytolysin, aggregation substance, proteases, hyaluronidase, and bacteriocins, which enable the microorganism to adhere to host tissues, facilitating tissue invasion and causing immunomodulation and toxin-mediated damage. A second clinically important characteristic of the Enterococcus spp. is resistance to a wide range of antimicrobial agents (Shepard & Gilmore, 2002). Considering the high conservation of the SUF system among the Firmicutes, and as E.

05). None of the LAB strains stimulated AFB1 accumulation in any of the fungal strains assayed. On the contrary, toxin production of A. flavus RC2053 and A. flavus RC2055 was totally inhibited by L. fermentum L23. It is likely that the low concentration of AFB1 in the presence of Lactobacillus strains could

be due to low mycelial biomass formation. Growth inhibition could directly affect AFB1 production as a result of low synthesis of the enzymes involved. Furthermore, AFB1 is a secondary metabolite that does not occur during primary growth of fungus, so that growth inhibition may reduce its production. In this study we have showed that there could exist a relationship between fungal growth and AFB1 production. In fact, these results showed that minimal yields of toxin coincided with Alectinib minimal mycelial growth. Tukey’s test of the data revealed the influence of L. fermentum L23 and L. rhamnosus L60 on growth parameters (lag phase and growth rate) and AFB1 production. Our results agree with Zinedine Veliparib concentration et al. (2005), who demonstrated the ability of some strains of LAB to reduce the initial concentration of AFB1 in MRS broth.

Similar observations were made by Aryantha & Lunggani (2007), who observed that L. plantarum, L. fermentum and Lactobacillus delbrueckii significantly inhibited fungal growth of A. flavus and AFB1 production. Dalié et al. (2010) established that the main LAB recognized

for their ability to limit mycotoxinogenic mould growth belong to the genera Lactococcus and Lactobacillus, including L. rhamnosus, in agreement with our results. These results reflect a strong ability to inhibit growth rate and AFB1 production by both Lactobacillus strains with a wide spectrum of antimicrobial activity and high probiotic potential. This suggest that the use of LAB with antifungal properties instead of chemical preservatives would enable the food and feed industry to produce organic food without chemical additives. In addition to the known excellent properties of Lactobacillus strains, they could enhance Etofibrate the nutritional value and prolong the conservation of food. These results are important given that these aflatoxicogenic fungi are natural contaminants of raw materials used for food and feed production, which could be effectively controlled by L. rhamnosus L60 and L. fermentum L23, both strains having probiotic properties. It is concluded that, under favourable conditions, the two lactobacilli strains not only inhibited aflatoxicogenic fungal growth, but also inhibited AFB1 biosynthesis. Future studies with L. rhamnosus L60 and L. fermentum L23 may test the application of these lactobacilli as biocontrollers of fungal contaminants and also to extend the self life of food and feed stuffs, approaching in situ their probiotic properties.

Improvements are needed in ordering routine medication during

the working week by the pharmacy team. Automated vending machines should be utilised for stock at the weekend. Ward based teams need to work together to improve discharge planning Monday to Friday. Use of the OOH Policy should be encouraged for discharges not requiring pharmacy input. Interventions demonstrated the important role played Pirfenidone by pharmacy in minimising patient harm. It was encouraging to see how the role of pharmacy was considered pivotal for patient safety and in maintaining clinical governance by SU. To optimise use of the current service, SU need to be re-educated, allowing the weekend service to be utilised for emergency items only, releasing current staff to attend wards at the weekend. An increased clinical ward service provided by pharmacy at the weekend would improve patient safety. 1. Dr Foster Health. Hospital Guide 2011. November 28 2011 [accessed 10 Feb 2013]. Available from: http://drfosterintelligence.co.uk/wp-content/uploads/2011/11/Hospital_Guide_2011.pdf. 2. Welsh Assembly Government. Achieving Excellence. The Quality Delivery Inhibitor Library high throughput Plan for the NHS in Wales- 2012–2016. NHS Wales; 2012. 3. Dornan T, Ashcroft D, Heathfield H, Lewis P. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their

medical education. EQUIP study. 2009 [accessed Available from: http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf. 4. Karnon J, Campbell F, Czoski-Murray C. Model-based cost-effectiveness analysis of interventions

aimed at preventing medication error at hospital admission (medicines reconciliation). J Eval Clin Pract. 2009 Apr;15(2):299–306. H. Rajput, C. Faulkner, J. Carruthers Pharmacy Department, Oxford University Hospitals NHS Trust, Oxford, UK The aim of this improvement project is to evaluate http://www.selleck.co.jp/products/AG-014699.html the impact that an introduction of a ‘pre-pack TTO’ discharges in September 2013 has had on cost, efficiency and speed of patient discharge. Products available for use as pre-packed TTO’s have been selected based on those most commonly prescribed on discharge prescriptions in this specialist area. Patients suitable to be discharged in this manner have their medication ready and can be discharged approximately 2 h faster than if their prescription was processed in pharmacy. Discharging patients from hospital needs to be safe, effective and efficient. Pharmacy services have a significant input in ensuring this happens. Standard practice for preparing discharge prescriptions involves a clinical pharmacist screening the prescription and the items being dispensed by Pharmacy. This service improvement project was designed to facilitate patient discharge by the nurse led supply of ‘TTO pre-packs’; for simple or standard discharge prescriptions. These were medicines commonly used in this surgical specialty.