We have shown previously that MH-S cells are not capable

of killing M. pulmonis unless the mycoplasma is first bound by the macrophages. Killing is dependent on phagocytosis (Shaw et al., 2012). Vsa proteins act as a shield that reduces binding to macrophages when the proteins Selleckchem Epacadostat are long with many tandem repeats. We show here that the EPS-I polysaccharide of M. pulmonis is a second shielding factor that inhibits binding to macrophages and hence is antiphagocytic. Both long Vsa protein and EPS-I have a role in protection from complement and inhibit biofilm formation (Bolland & Dybvig, 2012; Bolland et al., 2012). The amount of EPS-I that is associated with the mycoplasma cell is about the same regardless of the length of the Vsa protein being produced (Bolland et al., 2012). It Vorinostat nmr is unknown whether the Vsa proteins and EPS-I interact directly, but it is apparent that full shielding from host defences requires both a long Vsa protein and EPS-I. The shield primarily protects mycoplasmas from macrophages by inhibiting binding, but there are indications that a maximal shield may also inhibit phagocytosis of the bound mycoplasmas. Mycoplasmas bound to MH-S cells are not phagocytosed efficiently when they produce a very long VsaA protein (Shaw et al., 2012). The relative resistance of CTG1701-C

to killing even after being bound by the macrophages (Figs 1b and 2d) suggests that the high level of EPS-I on CTG1701-C has the capability to inhibit phagocytosis. There are several possible explanations for CTG1701-C producing as much as five times more EPS-I than CTG38. CTG1701 was complemented to generate CTG1701-C by inserting the 2-gene operon containing MYPU_7410 and MYPU_7420 along with its native promoter into the mycoplasmal genome using transposon Tn4001C as the vector (Daubenspeck et al., 2009). One possibility for increased production of EPS-I is that sequences upstream of the complementing operon in CTG1701-C have promoter activity that enhances transcription above that of the native promoter alone. Thymidine kinase Alternatively, the complementing operon might be missing

regulatory sequences that are present in the native operon. Another possibility is the position of the complementing operon in the genome might enhance transcription, as has been shown for genes near the origin for DNA replication (Li et al., 2003; Manna et al., 2004). Killing of M. pulmonis by MH-S cells was only modest. Host factors absent in the in vitro assays may be required for efficient phagocytosis. We show that yeast extract enhances killing. We view it likely that the mannosylated proteins from the yeast cell wall are responsible, possibly through interactions with complement receptor 3 or the mannose receptor on the macrophages. Complement receptor 3 contains a lectin domain that is believed to bind polysaccharide and increase killing of iC3b-opsonized microorganisms (Todd, 1996).

We recommend that patients should be entered into clinical trials, if available (GPP). We recommend that first-line treatment of DLBCL in HIV-positive individuals includes chemotherapy regimens used in HIV-negative patients, such as CHOP or infusional JAK inhibitor review therapies such as EPOCH. No randomized studies have been published in the era of ART and hence there is no optimal ‘gold-standard therapy’ (level of evidence

1B). We recommend that chemotherapy regimens should be combined with HAART therapy (level of evidence 1B). We recommend the concomitant administration of rituximab (level of evidence IB). Patients with CD4 cell counts <50 cells/μL may require closer surveillance (GPP). Until recently, patients with HIV-associated BL have been treated similarly to HIV-positive patients with DLBCL. However, in a large retrospective study the

survival of patients with BL was very poor when treated with CHOP or M-BACOD (methotrexate with leucovorin, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone), despite adjunctive HAART [54]. This was corroborated by the results of a Phase II prospective study involving 74 patients with HIV-NHL and HIV-BL treated with rituximab and the CDE infusional regimen (R-CDE). In multivariate analysis, a diagnosis of HIV-BL was significantly associated with a worse outcome in comparison to HIV-NHL patients [50]. In the HIV-negative setting, BL is a highly curable malignancy if intensive chemotherapy regimens of short duration are combined with CNS-penetrating therapy Antiinfection Compound Library [62–64]. In the UK, the most widely used regimen is CODOX-M/IVAC (cyclophosphamide, Lck vincristine, doxorubicin, methotrexate/ifosfamide, etoposide, cytarabine) and the two MRC/NCRI studies (LY6 and LY10) have stratified patients into low-risk and high-risk (Table 4.6). In low-risk disease, patients receive 3 cycles of CODOX-M and those with high-risk disease receive 4 cycles of chemotherapy alternating between CODOX-M and IVAC. Grade

3/4 haematological toxicity is universal with this regimen with a high incidence of neutropenic fever and mucositis. The reported treatment-related death rate is around 8–14% [62,63]. In the LY6 study, the main toxicity was from the use of high-dose methotrexate at a dose of 6.7 g/m2 [63] and thus in the LY10 study, the dose was reduced to 3 g/m2 [62] without compromising outcomes. In the LY10 study, the 2-year PFS and OS for low-risk disease was 85% and 88%, respectively, and for high risk, 49% and 52%, respectively [62]. Two small retrospective studies and one prospective comparative study [65–67] have demonstrated the feasibility of administering more intensive chemotherapy regimens, such as CODOX-M/IVAC [65] and hyperCVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine) to HIV-positive patients with BL [66].

We recommend that patients should be entered into clinical trials, if available (GPP). We recommend that first-line treatment of DLBCL in HIV-positive individuals includes chemotherapy regimens used in HIV-negative patients, such as CHOP or infusional Sunitinib order therapies such as EPOCH. No randomized studies have been published in the era of ART and hence there is no optimal ‘gold-standard therapy’ (level of evidence

1B). We recommend that chemotherapy regimens should be combined with HAART therapy (level of evidence 1B). We recommend the concomitant administration of rituximab (level of evidence IB). Patients with CD4 cell counts <50 cells/μL may require closer surveillance (GPP). Until recently, patients with HIV-associated BL have been treated similarly to HIV-positive patients with DLBCL. However, in a large retrospective study the

survival of patients with BL was very poor when treated with CHOP or M-BACOD (methotrexate with leucovorin, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone), despite adjunctive HAART [54]. This was corroborated by the results of a Phase II prospective study involving 74 patients with HIV-NHL and HIV-BL treated with rituximab and the CDE infusional regimen (R-CDE). In multivariate analysis, a diagnosis of HIV-BL was significantly associated with a worse outcome in comparison to HIV-NHL patients [50]. In the HIV-negative setting, BL is a highly curable malignancy if intensive chemotherapy regimens of short duration are combined with CNS-penetrating therapy http://www.selleckchem.com/products/BAY-73-4506.html [62–64]. In the UK, the most widely used regimen is CODOX-M/IVAC (cyclophosphamide, filipin vincristine, doxorubicin, methotrexate/ifosfamide, etoposide, cytarabine) and the two MRC/NCRI studies (LY6 and LY10) have stratified patients into low-risk and high-risk (Table 4.6). In low-risk disease, patients receive 3 cycles of CODOX-M and those with high-risk disease receive 4 cycles of chemotherapy alternating between CODOX-M and IVAC. Grade

3/4 haematological toxicity is universal with this regimen with a high incidence of neutropenic fever and mucositis. The reported treatment-related death rate is around 8–14% [62,63]. In the LY6 study, the main toxicity was from the use of high-dose methotrexate at a dose of 6.7 g/m2 [63] and thus in the LY10 study, the dose was reduced to 3 g/m2 [62] without compromising outcomes. In the LY10 study, the 2-year PFS and OS for low-risk disease was 85% and 88%, respectively, and for high risk, 49% and 52%, respectively [62]. Two small retrospective studies and one prospective comparative study [65–67] have demonstrated the feasibility of administering more intensive chemotherapy regimens, such as CODOX-M/IVAC [65] and hyperCVAD (cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine) to HIV-positive patients with BL [66].

This antiserum binds to a chitinase at the conidial surface (Boldo et al., 2009), and 86.5% (1972±166.7) of the conidia adhered before RG7422 concentration washing while 106% (1712±177) adhered afterwards. When the wings were treated with the recombinant GAPDH, the adhesion decreased to 31% (697.7±132.4) and 11% (254.3±41.37) (P<0.0001) before and after washing, respectively. Again, to exclude unspecific blocking of the adhesion by the protein

wing treatment, we used BSA as a control. In this case, adhesion was 96% (2205±207.8) and 122% (1974±120.4) before and after washing, respectively (Fig. 6). In order to study the possible participation of GAPDH in adhesion to the host, we isolated and characterized the M. anisopliae GAPDH gene and protein. The deduced amino acid sequence from the cDNA and from the gene was confirmed by MS identification with the major native protein form (36 kDa, pI 7.0) isolated from 2-D gel electrophoresis of mycelial

M. anisopliae protein extract. The other two protein isoforms (36 kDa, pIs 6.6 and 6.8) recognized by immunodetection using the P. brasiliensis anti-GAPDH serum led us to infer GAPDH isoform identity. A multiple isoform pattern could suggest different functions for each isoform, as found in other systems (Barbosa et al., 2004; Benndorf et al., 2008). GAPDH in M. anisopliae revealed regulated transcription and translation patterns in response to different carbon see more sources. In Mucor circinelloides, the orthologous gpdh1 gene was also shown to have a well-defined transcription pattern that is primarily regulated in response to the

carbon source by a mechanism that includes a negative regulator (Larsen et al., 2004). The behavior of gpdh1 gene transcription in M. anisopliae in response to different carbon sources led us to infer that glycerol and ethanol are assimilated directly by the citric acid cycle pathway and the oxidative phosphorylation chain. Because of the lack of glucose in these experiments, the gpdh1 gene transcripts MRIP were strongly repressed. The patterns of gpdh1 transcripts confirm that aerobic metabolism prevails in M. anisopliae as would be expected if aerobic metabolism prevails in M. anisopliae as well as other filamentous fungi such as Trichoderma reesei (Chambergo et al., 2002). A well-known mechanism of carbon-catabolism gene tuning in response to the available substrate is the carbon catabolite repression that was observed in Aspergillus nidulans. When this fungus is grown on complex substrates containing both metabolically favorable carbon sources (such as glucose) and less favorable ones (such as ethanol and glycerol), it is able to repress the genes involved in the utilization of the less favorable carbon. An important regulatory protein controlling carbon repression in A. nidulans is CreA (Mogensen et al., 2006). In M. anisopliae, repression occurs by CRR1 (Screen et al., 1997), the CreA ortholog. A marked decrease in gpdh1 transcript accumulation in total RNA extracted from M.

, 1997). Phylogenetic trees were constructed using the neighbor-joining method (Saitou & Nei, 1987). The robustness of the tree topology was calculated from bootstrap

analysis using 1000 resamplings of the sequences (Felsenstein, 1985). The 16S rRNA gene sequences of the six hmgr gene-positive strains were LDK378 manufacturer submitted to the DNA Data Bank of Japan and were assigned the following accession numbers: SpC080624SC-11 (AB514576), Sp080513SC-18 (AB498736), Se080624GE-07 (AB514578), SpA080624GE-02 (AB514579), SpC080624GE-05 (AB514580), and Sp080513GE-23 (AB498636); the accession numbers for their corresponding hmgr genes are AB514576, AB514577, AB514578, AB514579, AB514580, and AB514581, respectively. The production medium for SpC080624SC-11 and SpA080624GE-02 consisted of 2% glycerol (Nacalai Tesque, Kyoto, Japan), 1% molasses (Dai-Nippon Meiji Sugar, Tokyo, Japan), 0.5% casein (Kanto Chemical, Tokyo, Japan), 0.1% polypeptone (Nihon Pharmaceutical, Tokyo, Japan), 0.4% CaCO3 (Kozaki Pharmaceutical, Tokyo, Japan), 1% HP-20 (Mitsubishi Chemical, Tokyo, Japan), and 1.75% Sealife (pH 7.2 before sterilization). The

production medium for Sp080513GE-23 and SpC080624GE-05 contained 2.5% starch (Kosokagaku, Tokyo, Japan), 1.5% soybean meal (Nisshin Oillio, Tokyo, Japan), 0.2% dry yeast (Mitsubishi Tanabe Pharma, Osaka, Compound Library chemical structure Japan), and 0.4% CaCO3 (Kozaki Pharmaceutical) (pH 6.2 before sterilization). These strains were cultured on a rotary shaker (180 r.p.m.) at 27 °C for 5 days in 500-mL Erlenmeyer flasks containing 100 mL of the production Rho medium. The mycelial extract or the supernatant of the fermentation broth of Actinobacteria was extracted with ethyl acetate, and the organic layer was evaporated to dryness. The dried residue was separated using normal-phase medium-pressure liquid chromatography (LC). The fractions containing isoprenoids were further purified by preparative reversed-phase HPLC. The structures of active compounds were determined on the basis of HPLC-MS and nuclear magnetic resonance spectroscopic data. Human acute myelogenous leukemia HL-60 cells were cultured in Roswell Park Memorial Institute medium

(Nacalai Tesque) supplemented with 10% fetal bovine serum (Invitrogen), penicillin (100 U mL−1), and streptomycin (100 μg mL−1) at 37 °C in a humidified incubator with 5% CO2. The cytotoxic activity was estimated by a WST-8 [2-(2-methoxy-4-nitrophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2H-tetrazolium, monosodium salt] colorimetric assay. HL-60 cells were incubated on 384-well plates at a density of 1 × 103 cells per well in 20 μL of medium overnight, and then treated with compounds at various concentrations for 48 h. Next, 2 μL of WST-8 reagent solution (Cell Counting Kit, Dojindo, Kumamoto, Japan) was added and incubated for an hour at 37 °C in a humidified incubator with 5% CO2. The A450 nm of the formazan dye formed was measured.

1 This research aimed to develop a set of pharmaceutical service quality indicators that could be further refined into a quality improvement tool for use in both CPs and DDs. A mixed-methods study involving three phases was conducted in south-west England: (1) a survey of CPs and DDs (2) 7 case studies in CP and DD sites using interviews, observation and documentary analysis and (3) a two-round Delphi2 to develop the quality indicators derived from the first two phases. This paper focuses on phase 3. The study received NHS ethical approval. Thematic analysis of phase 2

findings (which had been informed by phase 1) led to the development of 22 quality indicators, which were assessed in a two-round Delphi survey with key stakeholders. Thirty-five key stakeholders were invited to take part, including NVP-BEZ235 community pharmacists, dispensing GPs, dispensing assistants/technicians, lay members and board members of CP and DD professional organisations. In round-1, respondents rated the importance for pharmaceutical service quality of selleck chemical each indicator and suggested possible ways for assessing performance against each indicator. In round-2, respondents were provided with median ratings of importance from round-1 and again rated the importance

of each indicator. Of the 35 people approached 30 (86%) agreed to take part with 22 (63%) completing both rounds. The initial indicators covered communication practices, safety and errors, use of space, training, public health engagement and ethos. In round-1 there was widespread agreement that the indicators captured key areas of service quality and no dimensions were deemed unimportant. For this reason all dimensions were retained in round -2 and an additional indicator, suggested by a participant, was added. Median ratings of the indicators varied little between rounds. There Methocarbamol was general agreement of the order of importance

of the four quality themes: safety and dispensing (most important), patient-provider interaction, workplace culture then health promotion. There was disagreement concerning the usefulness of standard operating procedures and the importance of ‘customer service’ issues. Respondents suggested a variety of methods for assessing quality including traditional audits and inspections and more innovative techniques such as mystery shoppers, peer feedback and self-assessment through video playback. A set of 23 quality indicators has been developed for use in CPs and DDs. The indicators highlight certain areas that have received less attention in the past, such as a customer service ethos, as well as re-emphasising the importance of patient safety through safe working practices. Findings suggested a wide variety of ways for assessing service quality, including qualitative and non-traditional methods, which could be used to develop the indicators into a practical resource for practitioners.

There is a paucity of research into the role of community pharmacists in Connected Health and large scale trials have had little or no involvement from pharmacists. The aim of this study was to assess the feasibility of delivering a Connected Health intervention through community pharmacies to patients with hypertension and to determine its effect on adherence to antihypertensive medications and blood pressure control. After ethical approval was obtained, four community pharmacies (A-D) recruited hypertensive

patients who had been regular users of their pharmacy for at least a year and had been taking at least two antihypertensives for at least six months prior to the study. All patients Ku-0059436 in vivo were sent medication

reminders to a mobile phone as either a text message (programmed using Google Calendar) or a video message (programmed using Mobile Phone-based Video Streaming software developed by the Computer Science Research Institute at University of Ulster Jordanstown). Each patient measured their blood pressure and confirmed they had taken their medication daily using a laptop at home. These readings were transmitted via the internet to a monitoring website (DGHome Event Manager, I+, Italy) through which the community pharmacist could view transmitted readings. If the patients failed to transmit a reading or a blood pressure reading fell outside pre-defined parameters, the community pharmacist would follow an algorithm to determine Dichloromethane dehalogenase how to proceed. Blood pressure and adherence scores (using the Medication Adherence Report Scale2) were compared before and after the intervention.

Bleomycin solubility dmso In total, 11 patients were recruited (4 at Pharmacy A, 4 at Pharmacy B, 2 at Pharmacy C and 1 at Pharmacy D). An additional two patients withdrew soon after commencing. To date, 9 patients have completed the study period (the remaining two have still to attend a final meeting with their community pharmacist). Preliminary findings from those who have completed demonstrate that, on average, 83 blood pressure readings and 53 confirmations of adherence were transmitted by each patient during the study period. There was no significant difference in blood pressure (139/87 mmHg vs. 144/83 mmHg) or adherence scores (94.8% vs. 94.4%) before and after the intervention. One focus group consisting of three patients has taken place. Participants responded positively to the involvement of their community pharmacist in Connected Health but with recommendations for improvements such as reduced frequency of blood pressure measurement and improved internet connection. Interviews with three participating community pharmacists have taken place, with recommendations for improvements including less time commitment for patients, overcoming issues with the technology and less recruitment criteria.

Quantitative mass spectrometry-based proteomics has become widely used for examining differences

in global expression level of proteins in various cellular states (Bantscheff et al., 2007; Elliott et al., 2009; Walther & Mann, 2010). In this method, proteins from samples obtained from different experimental conditions can be distinguished by incorporation of unique, stable isotopes with disparate masses in one of the samples. In this way, various samples can be combined and analyzed in a single LC-MS/MS analysis allowing estimation of the relative intensities of the peptides of interest from the labeled and unlabelled samples. Metabolic (Ong et al., 2002) and chemical (Boersema et al., 2009) labeling are two common procedures used for introducing heavy isotopes into cellular proteins. A pre-requisite for metabolic labeling of ATM signaling pathway proteins is that the cells efficiently take up a labeled substrate in culture and incorporate

it into proteins. However, this approach does not always result in a sufficient degree of labeling. Alternatively, as used in the present work, isotopic labeling can be performed by chemical labeling of peptides resulting from post-digestion of the cellular protein fractions. The green sulfur bacterium (GSB) Chlorobaculum (Cba.) tepidum is a strictly RO4929097 cost anaerobic, photosynthetic bacterium that lives in anaerobic aquatic environments, where reduced sulfur compounds, predominantly sulfide and light occur at the same time (Wahlund et al., 1991; Overmann, 2008). Chlorobaculum tepidum oxidizes sulfide, elemental sulfur, and thiosulfate for use as electron donor in its photosynthesis. The 2.15-Mbp genome of Cba. tepidum has been sequenced and revealed about 2245 protein-encoding genes (Eisen et al., 2002). Currently, 15 genome sequences of GSB have been determined (Gregersen et al., 2011). This information has allowed a detailed analysis of the sulfur metabolism of GSB, but many processes are still poorly described Bay 11-7085 (Frigaard & Bryant, 2004, 2008; Frigaard & Dahl, 2009; Sakurai

et al., 2010). Table 1 lists 57 enzymes putatively involved in the oxidative sulfur metabolism of Cba. tepidum, some of which have been functionally investigated. Figure 1 shows a simplified scheme of the pathways and enzymes of the oxidative sulfur metabolism of Cba. tepidum. Sulfide is oxidized by sulfide:quinone oxidoreductases (SQR; Chan et al., 2009); additional unknown enzyme activity contributes to sulfide oxidation (Holkenbrink et al., 2011). Thiosulfate is oxidized exclusively by the sulfur oxidation (SOX) enzyme system in the periplasm (Ogawa et al., 2008, 2010; Azai et al., 2009). Both of these processes give rise to a putative oligosulfide pool, which presumably is in equilibrium with an extracellular pool of sulfur globules that sometimes is referred to as ‘elemental sulfur’ (‘S0’). Oxidation of the oligosulfide pool is dependent on the dissimilatory sulfite reductase (DSR) enzyme system (Holkenbrink et al.

GHSR KO mice, however, did not show these alterations despite having normal glucocorticoid responses to stress. In parallel with these changes, chronic unpredictable Selleckchem PD98059 stress caused changes in norepinephrine, dopamine and serotonin in a number of brain regions. Of these, norepinephrine neurotransmission in the arcuate nucleus and prefrontal cortex was differentially altered

in GHSR KO mice. Within the nucleus acumbens, dopamine utilization was increased in WT mice but not in GHSR KO mice. Finally, there were strain differences in serotonin neurotransmission that may explain interstrain body weight and adiposity differences. These results suggest that the metabolic changes necessary to deal with the energetic challenge presented by repeated exposure to stressors do not occur in GHSR KO mice, and they are discussed within the context of the potential vulnerability to

stress-induced pathology. “
“Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA Brain-derived neurotrophic factor (BDNF) plays a critical role in plasticity at glutamate synapses and in the effects of repeated cocaine exposure. We recently showed that intracranial injection of BDNF into the rat nucleus accumbens (NAc), a key region for cocaine addiction, rapidly increases α-amino-3-hyroxy-5-methyl-4-isoxazole-propionic acid receptor (AMPAR) surface expression. To further characterize OSI-744 purchase BDNF’s role in both rapid AMPAR trafficking and slower, homeostatic changes in AMPAR surface expression, we investigated the effects of acute (30 min) and long-term (24 h) treatment with BDNF on AMPAR distribution in NAc medium spiny neurons from postnatal rats co-cultured with mouse prefrontal cortex neurons to restore excitatory inputs. Immunocytochemical

studies showed that acute BDNF treatment increased cell surface GluA1 and GluA2 levels, as well as their co-localization, on NAc neurons. This effect of BDNF, confirmed MRIP using a protein crosslinking assay, was dependent on ERK but not AKT signaling. In contrast, long-term BDNF treatment decreased AMPAR surface expression on NAc neurons. Based on this latter result, we tested the hypothesis that BDNF plays a role in AMPAR ‘scaling down’ in response to a prolonged increase in neuronal activity produced by bicuculline (24 h). Supporting this hypothesis, decreasing BDNF signaling with the extracellular BDNF scavenger TrkB-Fc prevented the scaling down of GluA1 and GluA2 surface levels in NAc neurons normally produced by bicuculline. In conclusion, BDNF exerts bidirectional effects on NAc AMPAR surface expression, depending on duration of exposure. Furthermore, BDNF’s involvement in synaptic scaling in the NAc differs from its previously described role in the visual cortex.

Anonymous data were gathered from call records by NHSDW staff and collated in an Excel spreadsheet. The sample data included; patient demographics, Alectinib datasheet the question(s) asked and the medicine(s) involved. A NHSDW nurse advisor assigned each question to a category from a pre-determined

list. The British National Formulary (BNF)1 chapter/section classification for each medicine was added to the spreadsheet by a qualified pharmacist. In addition, a computer generated report identified the disposition for all medicines-related calls. The number of calls in each category and BNF section were counted and compared. The local research governance committee advised ethics approval was not required. During 2010/11 NHSDW received 311,343 calls of which 5342 (2%) Inhibitor Library in vivo were medicines related and dealt with by nurse advisors. Within the sample

of 769 calls, 772 medicines listed in the BNF were identified. Medicines used to treat CNS disorders and infections were asked about most frequently, (39% and 16% respectively), followed by cardiovascular (8%), musculoskeletal, (8%), endocrine (7%), gastro-intestinal (6%) and respiratory (6%) medicines. Analgesics (BNF section 4.7) accounted for almost a quarter of questions (23%, 176/772) with the most common question being whether paracetamol/co-codamol could be taken with other medicines (n = 74). Antibacterials (BNF section 5.1) ranked second (15%, 114/772) with callers asking about interactions and clarifying dosing instructions including how long the antibacterial should be taken for. Antidepressants, antiepileptics and antipsychotics accounted for 11% questions (87/772) with dosing queries and questions about how to get further supplies occurring most frequently. Self

PRKD3 care with support from community pharmacy was recommended by NHSDW nurse advisors in 56% calls (3008/5342) compared with contacting the GP in 20% calls (1068/5342). In the context of over 70 million prescription items dispensed in Wales during 2010–11 the number of medicines-related calls to NHSDW is small and therefore these results must be interpreted cautiously. Despite opportunities for the exchange of information with patients during prescribing and dispensing some patients continue to have questions about their medicines. Advanced services have been introduced in England and Wales to support patients for example Medicines Use Reviews and the New Medicine Service 2(England only) however these services predominantly focus on medicines for chronic conditions. This study has highlighted the needs of patients in knowing how to take analgesics and antimicrobials safely and effectively. Pharmacists are well qualified to address the majority of medicines-related calls received by NHSDW and the profession may wish to reflect on why some patients choose to contact NHSDW instead and whether pharmacy could be doing more to support patients. 1.