Improving preoperative medication instructions and patient adherence: a collaborative, hospital-based quality improvement project.

The goal of this project was to improve preoperative medication instructions. After baseline data were collected prospectively through standardised patient surveys, preoperative care providers were educated to convey clear, appropriate preoperative medication instructions. After the education period, patient surveys were again completed to assess improvement. Hospital-wide education effectively increased the percentage of medications with written, colour-coded, and medically appropriate instructions. Patients found the instructions clearer and easier to follow.

Interrenal function in larval Ambystoma tigrinum. I. Responses to alterations in external electrolyte concentrations.

Larval Ambystoma tigrinum were acclimated to distilled water, 150 mM NaCl, or 100 mM KCl to alter electrolyte balance. The effects on electrolyte balance and circulating interrenal steroids were observed by analysis of plasma and urine samples. Steroid titers were measured by radioimmunoassay. Acclimation to distilled water decreased plasma and urinary [Na+] and elevated circulating aldosterone (sixfold) and corticosterone (45%) but did not affect cortisol. Larvae acclimated to 150 mM NaCl experienced increases in plasma and urinary [Na+]. In this group aldosterone titer was depressed (47%), corticosterone was elevated (100%), and cortisol was unchanged. Salamanders acclimated to 100 mM KCl increased plasma and urinary [K+] and shifted to net renal K+ secretion. This group elevated aldosterone (150%); however, corticosterone was not significantly affected. Reciprocity between the Na+-loaded and K+-loaded groups was observed. Acclimation to high potassium stimulated fractional renal Na+ reabsorption while Na+ loading stimulated fractional K+ reabsorption. These findings are consistent with aldosterone having opposite effects on renal Na+ and K+ transport, stimulating the reabsorption of the former and the net secretion of the latter.

Interrenal function in larval Ambystoma tigrinum. II. Control of aldosterone secretion and electrolyte balance by ACTH.

Renal clearance techniques were used to assess the role of ACTH on renal electrolyte transport in larval Ambystoma tigrinum. Radioimmunoassay was employed to evaluate changes in circulating aldosterone in these animals. Larvae were hypophysectomized and maintained for 1 week on either ACTH replacement therapy (50 ng/g) or sham injections prior to clearance measurements. Hypophysectomy significantly lowered plasma [Na+] (from 96 to 90 mM), plasma [K+] (from 6 to 4 mM), plasma aldosterone titer (from 157 to 36 pg/ml), fractional Na+ reabsorption (from 97 to 94%), and fractional K+ reabsorption (from 68 to 50%). ACTH replacement restored plasma [Na+] to 96 mM, aldosterone titer to 157 pg/ml, fractional Na+ reabsorption to 96%, and fractional K+ reabsorption to 75%. When steroid synthesis was blocked in a separate set of larvae; ACTH was unable to reverse the sodium depletion which results from adaptation to distilled water. This suggests that ACTH is not acting directly on Na+ transport but acts through a steroid like aldosterone. When larvae were injected intravenously with antialdosterone antibodies their fractional Na+ reabsorption decreased from 95 to 87%. We conclude, therefore, the ACTH works via interrenal steroids, such as aldosterone, to control renal electrolyte transport in this species.