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Clinical audit methodology was used to compare the treatment of alcohol misusers at risk of Wernicke's encephalopathy in an acute medical setting, and to assess the impact of providing information about best practice to prescribing doctors. All patients prescribed thiamine during an admission to an acute hospital trust over a 6-month period were identified, and data about their treatment episode were collected retrospectively. Hospital pharmacists then provided all prescribers with a flowchart summarising current prescribing guidelines, and prescribing patterns were re-audited 6 months later.
Over two audit periods, half of the patients prescribed thiamine whose case notes we examined had symptoms suggestive of Wernicke's encephalopathy, and another 30% were at high risk. Prescribing adhered to hospital guidelines only in 14% of cases, with the pharmacy-led intervention associated with a small but significant increase in the number of patients receiving adequate treatment for Wernicke's encephalopathy.
Wernicke's encephalopathy is relatively common in alcohol-dependent individuals admitted to hospital, and it is easily and cheaply managed. However, even when potential cases are identified, prescribing guidelines are followed in a minority of cases, even with prompting by a hospital pharmacist. This may be related to the limited research base concerning the optimum dosing schedule of thiamine, or fears about possible anaphylaxis when using parenteral preparations.
George Bentham (1800–84) was one of Britain's most influential botanists, whose own collection of plant specimens numbered more than 100,000. Although he donated his herbarium to the Royal Botanic Gardens, Kew in 1854, he continued to make significant contributions to the field, including this exhaustive, seven-volume work detailing the plant life of Australia, which was published from 1863 to 1878. It was part of a series of works commissioned by the British government to document the flora in its colonies. Using the extensive numbers of specimens at Kew - and with the help of Ferdinand Mueller (1825–96), a German botanist in Australia - Bentham was able to compile descriptions of more than 8,000 species of Australian plants, making these volumes the first completed compendium of the flora of any large continental area. Volume 7, published in 1878, concludes with descriptions of flora in the classes of monocotyledon and cryptogamae.