The Impact of Hybridisation on the Accuracy of Fluid Balance Documentation: A Retrospective Cross-Sectional Analysis of Intravenous Fluid Order and Administration Documentation Using a Partly-Computerized Medical Record in an Australian Tertiary Teaching Hospital.

Inaccurate intravenous (IV) fluid documentation remains a major cause of fluid-related adverse health outcomes in hospitals. In this study, we characterise the integrity and documentation completeness of a hybrid paper-computer documentation system for IV fluids and explore how inconsistencies within it are associated with adverse patient health outcomes. We highlight key areas of weakness specific to IV fluid documentation that need to be addressed in moving to a fully computerised system in the future.

IgD attenuates the IgM-induced anergy response in transitional and mature B cells.

Self-tolerance by clonal anergy of B cells is marked by an increase in IgD and decrease in IgM antigen receptor surface expression, yet the function of IgD on anergic cells is obscure. Here we define the RNA landscape of the in vivo anergy response, comprising 220 induced sequences including a core set of 97. Failure to co-express IgD with IgM decreases overall expression of receptors for self-antigen, but paradoxically increases the core anergy response, exemplified by increased Sdc1 encoding the cell surface marker syndecan-1. IgD expressed on its own is nevertheless competent to induce calcium signalling and the core anergy mRNA response. Syndecan-1 induction correlates with reduction of surface IgM and is exaggerated without surface IgD in many transitional and mature B cells. These results show that IgD attenuates the response to self-antigen in anergic cells and promotes their accumulation. In this way, IgD minimizes tolerance-induced holes in the pre-immune antibody repertoire.