In the environment, there are numerous mutagens that may affect m

In the environment, there are numerous mutagens that may affect microorganisms genes. It is well known that mutagens induce mutations in microorganisms and change their susceptibility to bactericidal

drugs (Posnick & Samson, 1999; Takechi et al., 2006). However, bacteria have different susceptibility to the action of mutagens even within a same serotype, such as differences among Salmonella Typhimurium strains, tester strains of Ames test (Levin et al., 1982; Gee et al., 1994; Jemnitz et al., 2004). Therefore, we considered that susceptibilities to mutagens must be investigated in clinically important bacteria as to the emergence of drug resistance. We were unable, however, to find any reports describing whether or how these mutagens induce mutations in clinically important microorganisms, or if the induced mutations might confer resistance to antibacterial agents. Pseudomonas aeruginosa infects STA-9090 in vitro immunosuppressed patients and causes high mortality in hospitalized patients (Stover et al., 2000).

It is unique because it possesses intrinsic resistance to a variety of antimicrobial agents (Chen et al., 2008). Ciprofloxacin (CPFX), a new quinolone antibacterial agent that inhibits type II topoisomerases, has been effective in treating P. aeruginosa infections. The emergence, however, of CPFX-resistant P. aeruginosa with mutations in gyrA/gyrB/parC/parE, PF-562271 in vivo which encode gyrase or topoisomerase IV, has been reported (Jalal & Wretlind, 1998; Akasaka et al., 2001; Mouneimne et al., 1999; Wydmuch et al., 2005). Essential for treating tuberculosis, rifampicin (Rif) is an inhibitor of RNA polymerase (Campbell et al., 2001). In Masitinib (AB1010) recent years, however, Rif-resistant Mycobacterium tuberculosis has become a serious worldwide clinical problem. Resistance to Rif is conferred by mutations in the rpoB gene, which encodes the β-subunit of RNA polymerase (Mariam et al., 2004). How Rif-resistant bacteria acquire mutations in the rpoB gene is not known. We designed this study to clarify whether and how mutagens in the environment and drugs are involved in the evolution of drug-resistant microorganisms. We exposed

P. aeruginosa to environmental mutagens. Then, we calculated the incidence of Rif- and CPFX-resistant P. aeruginosa and analyzed the gene sequences for rpoB and gyrA/gyrB/parC/parE. We found that environmental mutagens and an anticancer drug induce drug resistance in P. aeruginosa, and that the mutation spectra are similar to clinically isolated samples of drug-resistant P. aeruginosa. Ethylmethansulfonate (EMS) and 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) were obtained from Sigma-Aldrich, (St. Louis, MO). N-nitroso-N-methylurea (MNU) and benzopyrene (BP) were obtained from Wako (Kyoto, Japan). N-nitrosonornicotine (NNN) was obtained from Toronto Research Chemicals Inc. (Ontario, Canada) and 1,6-dinitropyrene (1,6-DNP) from AccuStandard (New Haven, CT). MNU, 1,6-DNP, and NNN were each dissolved in DMSO.

This increased risk peaked in the first 6 months after individual

This increased risk peaked in the first 6 months after individuals started ART and then gradually declined. Immune reconstitution inflammatory syndrome (IRIS) is a possible explanation for this observed initial increase in risk. When ART first became available in this cohort, individuals starting ART would have included those with advanced HIV infection and low

CD4 cell count, who were therefore at increased risk of IRIS. Those commencing ART were also seen more frequently Kinase Inhibitor Library mouse in clinical follow-up, especially during the first 6 months, and hence were more likely to have HIV-related illnesses diagnosed in this early period compared with the later periods. Strengths of our study include the long follow-up period, the general population source, the high levels of follow-up (93% in seroconverters), and the availability

of an estimated date of HIV seroconversion. Taken together, these features of the study enabled us to estimate find more rates of WHO stage-defining diseases before and after ART introduction. Most previous studies in developing countries have been limited to cohorts of prevalent HIV cases with no known HIV seroconversion dates. There are also several limitations to our data. Firstly, although the date on which an episode of morbidity commenced was documented, there was no documentation of when it ended. The time ‘not at risk’ of future episodes STK38 while experiencing an episode may

have been under- or overestimated, and may have influenced our incidence rates. However, the same criteria were used in all follow-up periods, and while on or off ART, so this is unlikely to have biased our measures of effect. Secondly, diseases requiring invasive diagnostic procedures and histology such as lymphoma and cytomegalovirus infections were not documented in this cohort, so our overall rate of any WHO stage-defining disease may be an underestimate, as was also observed in an earlier study in Cote d’Ivoire [10]. The use of cotrimoxazole may be an alternative explanation for the reduction in morbid events following the introduction of ART, or may explain the residual trend with calendar time after adjusting for the use of ART. Though cotrimoxazole prophylaxis was prescribed for all HIV-infected participants, we did not adjust for its effect on morbidity in this analysis. The first edition of the National Policy guidelines for cotrimoxazole prophylaxis was issued in 2005 [18], but we did not have a separate code in our database for cotrimoxazole prophylaxis until 2008. The slightly higher response rates for male than female subjects may have resulted in a slight underestimation of our incidence rate, as female subjects had a slightly higher rate of acquiring any WHO stage disease than male subjects (adjusted HR 1.35; 95% CI 0.97–1.9).

(2) Male expatriates reported more frequent intensive sun exposur

(2) Male expatriates reported more frequent intensive sun exposures and more skin exposures during nautical and mountain sports than male nonexpatriates. Ezzedine and colleagues have registered a large cohort of French adults to observe for sun exposure

and protection behaviors in tropical and high UV-index countries for short and prolonged stays, and their results have repeatedly demonstrated that travelers would benefit from more pre-travel advice regarding sun exposures and sun protective behaviors.[20, 21] Observational studies have demonstrated that the public often misuses sunscreens for intentional UV overexposures and knows little about proper sunscreen protection, selection, JAK inhibitor and use. In 2001,

Wright and colleagues evaluated attitudes toward sunscreen effectiveness and found that 47% of study subjects reported staying out longer in the sun after applying sunscreen.[22] Later, Autier defined this behavior as sunscreen abuse or the misuse of sunscreens by sun-sensitive subjects engaging in intentional sun exposure to increase their duration of exposure without decreasing sunburn occurrence.[23] In 2008, Ezzedine and colleagues reported the results of a cross-sectional this website study on artificial and natural tanning behaviors in a French national cohort of 7,200 adults.[24] The investigators determined that indoor tanners were also regular sunbathers unconcerned about the risks of combined indoor and outdoor UV exposures.[24] In a 2009 survey assessment of sunscreen knowledge, Wang observed that only 48.2% of survey

respondents knew that “SPF” was the acronym for “sun protection factor.”[25] The confusing measurement systems for UV protection afforded by sunscreens and photoprotective clothing are compared in Table 1.[18, 26, 27] The quantity and frequency of sunscreen use are the most important factors determining sunscreen efficacy. The international standard quantity of sunscreen application used to determine SPF is 2 mg/cm2.[28, 29] However, Diffey observed that most people apply only 0.5 to 1.5 mg/cm2 Tideglusib of sunscreen and do not reapply sunscreens after swimming or excessive sweating.[29] Drug-induced photosensitivity reactions occur commonly and are characterized by cutaneous eruptions in sun-exposed areas and result from either toxic or allergic reactions between drugs and UV radiation, primarily UVA.[30-33] Phototoxic reactions are more common than photoallergic reactions, which occur when drug haptens combine with skin proteins producing an immune cellular reaction.[31] Chronic therapy with certain photosensitizing drugs has been associated with the subsequent development of skin cancers, such as PUVA therapy for psoriasis which increases risks of SCC and CMM.

(2) Male expatriates reported more frequent intensive sun exposur

(2) Male expatriates reported more frequent intensive sun exposures and more skin exposures during nautical and mountain sports than male nonexpatriates. Ezzedine and colleagues have registered a large cohort of French adults to observe for sun exposure

and protection behaviors in tropical and high UV-index countries for short and prolonged stays, and their results have repeatedly demonstrated that travelers would benefit from more pre-travel advice regarding sun exposures and sun protective behaviors.[20, 21] Observational studies have demonstrated that the public often misuses sunscreens for intentional UV overexposures and knows little about proper sunscreen protection, selection, AZD1208 supplier and use. In 2001,

Wright and colleagues evaluated attitudes toward sunscreen effectiveness and found that 47% of study subjects reported staying out longer in the sun after applying sunscreen.[22] Later, Autier defined this behavior as sunscreen abuse or the misuse of sunscreens by sun-sensitive subjects engaging in intentional sun exposure to increase their duration of exposure without decreasing sunburn occurrence.[23] In 2008, Ezzedine and colleagues reported the results of a cross-sectional BMN-673 study on artificial and natural tanning behaviors in a French national cohort of 7,200 adults.[24] The investigators determined that indoor tanners were also regular sunbathers unconcerned about the risks of combined indoor and outdoor UV exposures.[24] In a 2009 survey assessment of sunscreen knowledge, Wang observed that only 48.2% of survey

respondents knew that “SPF” was the acronym for “sun protection factor.”[25] The confusing measurement systems for UV protection afforded by sunscreens and photoprotective clothing are compared in Table 1.[18, 26, 27] The quantity and frequency of sunscreen use are the most important factors determining sunscreen efficacy. The international standard quantity of sunscreen application used to determine SPF is 2 mg/cm2.[28, 29] However, Diffey observed that most people apply only 0.5 to 1.5 mg/cm2 Tacrolimus (FK506) of sunscreen and do not reapply sunscreens after swimming or excessive sweating.[29] Drug-induced photosensitivity reactions occur commonly and are characterized by cutaneous eruptions in sun-exposed areas and result from either toxic or allergic reactions between drugs and UV radiation, primarily UVA.[30-33] Phototoxic reactions are more common than photoallergic reactions, which occur when drug haptens combine with skin proteins producing an immune cellular reaction.[31] Chronic therapy with certain photosensitizing drugs has been associated with the subsequent development of skin cancers, such as PUVA therapy for psoriasis which increases risks of SCC and CMM.

3 Assessment of liver disease 431 Recommendations  20 We recom

3 Assessment of liver disease 4.3.1 Recommendations  20. We recommend staging of liver disease should be performed

in those with chronic HCV/HIV and HBV/HIV infections (1B).  21. We suggest in patients with chronic hepatitis/HIV infection a non-invasive test as the staging investigation of choice (2B).  22. We suggest hepatic transient elastography (TE) (FibroScan™ or ARFI [Acoustic Radiation Force Impulse]) as the non-invasive investigation of choice (2B) but if unavailable, or when reliable TE readings are not obtained, a blood panel test (APRI, FIB-4, ELF, Fibrometer™, Forns Index, FibroTest™) as an alternative (2C).  23. We recommend in chronically

infected viral hepatitis/HIV patients, TE readings suggestive of BAY 73-4506 in vitro cirrhosis (Metavir >F4) using recommended disease-specific cut-offs (using FibroScan™ these are >11.0 kPa for HBV, >14.5 kPa for HCV), should lead to appropriate monitoring for complications of portal hypertension and HCC screening (1B).  24. We recommend in HCV/HIV viraemic patients, repeated fibrosis assessments using TE, or if unavailable an alternative non-invasive selleck kinase inhibitor blood panel test, should be performed at least annually (1D). 4.3.2 Good practice point  25. We recommend when the aetiology of underlying liver disease is in doubt, or where factors other than viral hepatitis are likely to have influenced liver disease progression and may be important to address, or there is discordance between non-invasive markers or uncertainty as to their interpretation, liver biopsy is the investigation of choice for assessment. 4.3.3 Auditable outcomes Proportion of patients with chronic

HCV/HIV or chronic Endonuclease HBV/HIV with documented staging of liver disease performed at least once before commencing therapy Proportion of HIV-positive patients with chronic viral hepatitis and Metavir stage 4 fibrosis who are monitored for complications of portal hypertension and have HCC screening performed Proportion of HIV-positive patients with chronic viral hepatitis and who are viraemic having at least annual repeated fibrosis assessments 4.4 Immunisation 4.4.1 Recommendations  26. We recommend all non-immune HIV-infected individuals are immunised against HAV and HBV (1A).  27.

Blood

2010; 116 Available at: https://ashconfexcom/ash

Blood

2010; 116. Available at: https://ash.confex.com/ash/2010/webprogram/Paper29716.html (accessed January 2014). 18 Westrop SJ, Lagos D, Boshoff C et al. African ancestry and innate immunity contribute to the incidence of multicentric Castleman’s disease in HIV-1/Kaposi’s sarcoma herpesvirus- coinfected individuals. Future Virology 2012; 7: 729–734. 19 Algada J, Navani N, Taylor M et al. High prevalence of malignancy in HIV infected patients with enlarged mediastinal lymphadenopathy. Thorax 2010; 65: A169–A170. 20 Du MQ, Liu H, Diss TC et al. Kaposi’s sarcoma-associated herpesvirus infects monotypic (IgM lambda) but polyclonal naive B cells in Castleman’s disease and associated lymphoproliferative disorders. Blood 2001; 97: 2130–2136. 21 Oksenhendler E, Boulanger E, Galicier L et al. High incidence of Kaposi’s sarcoma-associated Alvelestat in vitro herpesvirus-related non-Hodgkin lymphoma in patients with HIV infection and multicentric Castleman’s disease. Blood 2002; 99: 2331–2336. 22 Arce J, Huang C, Levin M et al. Human herpes virus 8 viral load in multicentric Castleman’s disease. Lab Invest 2010; 90: 285A. 23 Menke DM, Chadbum A, Cesarman E et al. Analysis of the human herpesvirus 8 (HHV-8) genome and

HHV-8 vIL-6 expression in archival cases of Castleman disease at low risk for HIV infection. Am J Clin Pathol 2002; 117: 268–275. 24 Bacon CM, Miller RF, Noursadeghi M et al. Pathology of bone marrow in human herpes virus-8 (HHV8)-associated multicentric Castleman disease. Br J Haematol 2004; 127: 585–591. 25 Grandadam M, Dupin N, Calvez V et al. Exacerbations Dorsomorphin mw of clinical symptoms in human immunodeficiency virus type 1-infected patients with multicentric Castleman’s disease are associated with a high increase in Kaposi’s Inositol monophosphatase 1 sarcoma herpesvirus DNA load in peripheral blood mononuclear cells. J Infect Dis 1997; 175: 1198–1201. 26 Chilton DN, Raja F, Lee SM et al. HIV-associated Multicentric Castleman’s disease (MCD) may present in the context of immune reconstitution (IR); highly active antiretroviral therapy (HAART) alone can modify clinical response and is associated with radiological

response and suppression of Kaposi Sarcoma Herpes Virus (KSHV) viraemia. HIV Med 2009; 10(Suppl 1): 49 [Abstract P132]. 27 Fish R, Paul J, Hargreves S et al. Can KSHV viral load be used to differentiate multicentric Castleman’s disease from Kaposi’s sarcoma? HIV Med 2010; 11(Suppl 1): 12 [Abstract O32]. 28 Sayer R, Paul J, Tuke PW et al. Can plasma HHV8 viral load be used to differentiate multicentric Castleman disease from Kaposi sarcoma? Int J STD AIDS 2011; 22: 585–589. 29 Polizzotto MN, Uldrick TS, Wang V et al. Distinct human and viral interleukin-6 profiles and other viral and immunologic abnormalities in KSHV-associated multicentric Castleman disease: Relationship with disease activity and individual disease manifestations. Blood (ASH Annual Meeting Abstracts) 2011; 118: Abstract 1573. 30 Stebbing J, Adams C, Sanitt A et al.

stutzeri This is the first report of IS transposition directly l

stutzeri. This is the first report of IS transposition directly leading to an expansion of the effective host range of a plasmid, adding a new dimension to our understanding of the relationship between plasmids and IS elements. “
“Institut Für Molekulare Infektionsbiologie, Würzburg University, Würzburg, Germany Instituto Gulbenkian de Ciência, Oeiras, Portugal Bacterial communication via the secretion of small diffusible compounds allows microorganisms to regulate gene expression in

a coordinated manner. As many virulence BGJ398 nmr traits are regulated in this fashion, disruption of chemical communication has been proposed as novel antimicrobial therapy. Quorum-quenching enzymes have been a promising discovery in this field as they interfere with the communication of Gram-negative

click here bacteria. AHL-lactonases and AHL-acylases have been described in a variety of bacterial strains; however, usually only one of these two groups of enzymes has been described in a single species. We report here the presence of a member of each group of enzymes in the extremophile bacterium Deinococcus radiodurans. Co-occurrence of both enzymes in a single species increases the chance of inactivating foreign AHL signals under different conditions. We demonstrate that both enzymes are able to degrade the quorum-sensing molecules of various pathogens subsequently affecting virulence gene expression. These studies add the quorum-quenching enzymes of D. radiodurans to the list of potent quorum-quenchers and highlight the idea that quorum quenching could have evolved in some bacteria as a strategy to gain a competitive advantage by altering gene expression in other species. “
“Extracytoplasmic function Fluorometholone Acetate (ECF) sigma factors are known

to play an important role in the bacterial response to various environmental stresses and can significantly modulate their pathogenic potential. In the genome of Porphyromonas gingivalis W83, six putative ECF sigma factors were identified. To further evaluate their role in this organism, a PCR-based linear transformation method was used to inactivate five ECF sigma factor genes (PG0162, PG0214, PG0985, PG1660, and PG1827) by allelic exchange mutagenesis. All five isogenic mutants formed black-pigmented colonies on blood agar. Mutants defective in PG0985, PG1660, and PG1827 genes were more sensitive to 0.25 mM of hydrogen peroxide compared with the wild-type strain. Isogenic mutants of PG0162 and PG1660 showed a 50% decrease in gingipain activity. Reverse transcription-PCR analysis showed that there was no alteration in the expression of rgpA, rgpB, and kgp gingipain genes in these mutants. Hemolytic and hemagglutination activities were decreased by more than 50% in the PG0162 mutant compared with the wild type. Taken together, these findings suggest that ECF sigma factors can modulate important virulence factors in P. gingivalis.

stutzeri This is the first report of IS transposition directly l

stutzeri. This is the first report of IS transposition directly leading to an expansion of the effective host range of a plasmid, adding a new dimension to our understanding of the relationship between plasmids and IS elements. “
“Institut Für Molekulare Infektionsbiologie, Würzburg University, Würzburg, Germany Instituto Gulbenkian de Ciência, Oeiras, Portugal Bacterial communication via the secretion of small diffusible compounds allows microorganisms to regulate gene expression in

a coordinated manner. As many virulence CHIR-99021 purchase traits are regulated in this fashion, disruption of chemical communication has been proposed as novel antimicrobial therapy. Quorum-quenching enzymes have been a promising discovery in this field as they interfere with the communication of Gram-negative

this website bacteria. AHL-lactonases and AHL-acylases have been described in a variety of bacterial strains; however, usually only one of these two groups of enzymes has been described in a single species. We report here the presence of a member of each group of enzymes in the extremophile bacterium Deinococcus radiodurans. Co-occurrence of both enzymes in a single species increases the chance of inactivating foreign AHL signals under different conditions. We demonstrate that both enzymes are able to degrade the quorum-sensing molecules of various pathogens subsequently affecting virulence gene expression. These studies add the quorum-quenching enzymes of D. radiodurans to the list of potent quorum-quenchers and highlight the idea that quorum quenching could have evolved in some bacteria as a strategy to gain a competitive advantage by altering gene expression in other species. “
“Extracytoplasmic function Non-specific serine/threonine protein kinase (ECF) sigma factors are known

to play an important role in the bacterial response to various environmental stresses and can significantly modulate their pathogenic potential. In the genome of Porphyromonas gingivalis W83, six putative ECF sigma factors were identified. To further evaluate their role in this organism, a PCR-based linear transformation method was used to inactivate five ECF sigma factor genes (PG0162, PG0214, PG0985, PG1660, and PG1827) by allelic exchange mutagenesis. All five isogenic mutants formed black-pigmented colonies on blood agar. Mutants defective in PG0985, PG1660, and PG1827 genes were more sensitive to 0.25 mM of hydrogen peroxide compared with the wild-type strain. Isogenic mutants of PG0162 and PG1660 showed a 50% decrease in gingipain activity. Reverse transcription-PCR analysis showed that there was no alteration in the expression of rgpA, rgpB, and kgp gingipain genes in these mutants. Hemolytic and hemagglutination activities were decreased by more than 50% in the PG0162 mutant compared with the wild type. Taken together, these findings suggest that ECF sigma factors can modulate important virulence factors in P. gingivalis.

As evident based upon the large cadres of lupus patients and grow

As evident based upon the large cadres of lupus patients and growing

numbers of lupus investigators within these Asian communities, significant advances are being made in the evaluation and care of systemic lupus erythematosus in Asian countries. Additional work in therapeutic, genetic, prognostic and biomarker work is underway and will provide more insights to the unique and common aspects of lupus pathogenesis within and across Asia, as well as the rest of the world. The authors declare no conflicts of interest. “
“To review the clinical profile of patients with plasma cell dyscrasias presenting with inflammatory arthritis. Retrospective analysis was performed on clinical, laboratory and imaging Poziotinib cell line data of patients who presented with

inflammatory arthritis between May 2009 and April 2010 and were subsequently diagnosed as having plasma cell dyscrasias. Six out of 630 patients presenting with inflammatory arthritis were identified. The demographic, clinical and laboratory characteristics of these patients were analyzed. The diagnosis of monoclonal gammopathy was based on protein electrophoresis, immunoelectrophoresis and bone marrow biopsy. The outcomes of the treatments were analyzed. Four patients had monoclonal gammopathy of unknown significance and two patients had multiple myeloma. Mean age of the patients was 65 years (range 59–74). Three patients presented with oligoarticular arthritis, two with symmetrical polyarticular joint pains and one with fleeting periarticular pains. Wrist and shoulder were the most commonly involved joints. Three Doxorubicin concentration patients had carpal tunnel syndrome. Five

patients were seronegative for both rheumatoid factor and anti-cyclic citrullinated peptide antibodies. Mean erythrocyte sedimentation rate (ESR) was high in all patients (range: 82–120 mm/h with a mean of 99.6 mm/h). Arthritis improved with chemotherapy in patients with multiple myeloma. Occurrence of inflammatory arthritis with plasma dyscrasias is more than a chance association. Plasma cell dyscrasias should be ruled out in any elderly patient presenting with atypical arthritis with disproportionately high ESR, high creatinine and hyperglobulinemia. “
“To describe our experience with 16 patients with eosinophilic fasciitis (EF) Montelukast Sodium treated in our clinic over 14 years. We retrospectively reviewed the charts of all patients with biopsy-proven EF. We collected data regarding demographics, clinical presentations, possible triggers, labs, imaging, treatment and response to therapy on follow-up. Eight women and eight men with a mean age of 52 years were included in the study. Three patients related the onset to prior strenuous exercise and one was exposed to vibratory machinery. Fourteen patients had a gradual onset and presented with induration of the skin.

Pharmacists also considered their own personal views This study

Pharmacists also considered their own personal views. This study used hypothetical cases, which may have been handled differently if presented as real scenarios in the pharmacy. This study may have benefitted practice by raising

awareness of the complexity of decision-making, as well as highlighting the impact of personal p38 MAPK inhibitor review beliefs and GP relationships on practice. 1. Cooper RJ, Wingfield J, Bissell P. Ethical, religious and factual beliefs about the supply of emergency hormonal, contraception by UK community pharmacists. Journal of Family Planning and Reproductive Health Care 2008; 34: 47–50. 2. Hanna LA, Hughes CM. ‘First, Do No Harm’: Factors that Influence Pharmacists Making Decisions about Over-the-Counter Medication A Qualitative Study in Northern Ireland. Drug Safety 2010; 33: 245–255. Michael Wilcock, Joanna Lawrence Pharmacy, Royal selleck inhibitor Cornwall Hospitals NHS Trust, Truro, UK Inter-professional collaboration as a means of improving patient care requires that clinical pharmacists have good communication skills. Doctors’ and nurses’ views on how well pharmacists communicate were captured via a brief survey. The results have informed a short tailored training programme on communication

skills for pharmacists and technicians. To ensure that patients receive the optimum level of care it is essential that clinical pharmacists, as members of the healthcare team, can effectively communicate with prescribers and nurses. A recent report acknowledge that the future for pharmacy practice will see the wider

pharmacy team drawing on their individual clinical and communication skills to work with other healthcare professionals and patients to optimise the use of medicines.1 As part of a wider service improvement Venetoclax datasheet project, designed to assess and develop the communication skills of the pharmacist team, we undertook a baseline assessment of how clinical staff perceive the pharmacists’ communication skills. Two 3rd year medical students, attached to the pharmacy department for a two week Special Study Unit, undertook a brief survey of doctors and nurses on a range of hospital wards. The survey instrument consisted of 4 closed questions (3 requiring answers on a 5-point Likert scale and the fourth requiring a simple yes/no response), and a final question seeking free text comments. Staff were advised of the broad purpose of the survey (to ascertain how they perceive the ability of the clinical pharmacists to communicate with clinical staff) and reassured that the survey was anonymous. This was deemed service improvement performed to meet specific local needs and ethics approval was not sought. During April 2013, thirty-eight clinical staff (18 junior doctors, 20 nurses) were approached and agreed to answer the survey.