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Human Host Defense Peptide LL-37 Suppresses TNFα-Mediated Matrix Metalloproteinases MMP9 and MMP13 in Human Bronchial Epithelial Cells
(S. Karger AG, 2024-03-12) Altieri, Anthony; Marshall, Courtney Lynn; Ramotar, Padmanie; Lloyd, Dylan; Hemshekhar, Mahadevappa; Spicer, Victor; van der Does, Anne M.; Mookherjee, Neeloffer
Galectin-3 and Soluble CD146 Identify Cardiorenal Injuries in Severe Burn Patients: A Biomarker-Based Approach
(S. Karger AG, 2024-08-12) Boutin, Louis; Soussi, Sabri; Garcia Lavello, Angèle; Masson Fron, Elisabeth; Deniau, Banjamin; Legrand, Matthieu; Blot-Chabaud, Marcel; Muriel Figueroa, Stefanny; Envangelos Chadjichristos, Christos; Azibani, Feriel; Dépret, Fançois
Outcomes In Kidney Transplant Recipients Receiving A Proton Pump Inhibitor For Gastrointestinal Bleeding Prophylaxis At St. Joseph’s Healthcare Hamilton
(2024) Dang, Kim; Wallace, Christine; Burger, Cathy; Saini, Simmi
Background/Objectives: Gastrointestinal complications such as gastrointestinal bleeds can occur in up to 20% of renal transplant recipients, resulting in hospitalizations, graft loss and death. To date, the impact of prescribing proton pump inhibitors (PPIs) for gastrointestinal bleed prophylaxis in the kidney transplant population at St. Joseph’s Healthcare Hamilton (SJHH) has not been evaluated.
Methods: We conducted a retrospective chart review of patients admitted for kidney transplant surgery between November 1st 2019 to November 30th 2023. The electronic health record (EPIC Systems) was reviewed for outcomes related to PPI use in the first 6-month period post-transplant.
Results: 513 transplant patients were analyzed (median age 57 years [IQR 44-66], 63.4% male). 200 patients were prescribed a PPI prior to transplantation, 239 patients were initiated on a PPI during the transplant admission, 22 patients post-discharge, and 52 patients were never prescribed a PPI. A total of 11 patients experienced a gastrointestinal bleed: eight patients from the no PPI group and three patients in the PPI group (15.38% vs 0.65%, p <0.001). The median time to gastrointestinal bleed post-transplant was 16.5 days [IQR 10.75-25.25]. The median dose of prednisone at the time of bleed was 27.5 mg [IQR 20-30]. The odds ratio of experiencing a gastrointestinal bleed without a PPI was 27.8 (95% CI [7.11-108]), p <0.001. Using a PPI resulted in a risk reduction of 1.18 (95% CI [1.05-1.32]), p <0.001. At 6 months post-transplant, 30% of those prescribed a PPI post-transplant discontinued their PPIs. For those previously prescribed a PPI, the discontinuation rate was 9.5%. There were 175 reported incidences of an adverse event in patients prescribed a PPI (e.g. hypomagnesemia, community acquired pneumonia, clostridium difficile infection).
Conclusion: In this cohort of SJHH kidney transplant patients, the routine use of PPIs provided gastroprotection from GI bleeds early in the post-op period.
Development and evaluation of a framework for a pharmacist therapeutic drug monitoring training program at St. Joseph’s Healthcare Hamilton
(2024) Ma, Eulaine; Lee-Yoo, Jean; Wallace, Christine; Wright, Angela
BACKGROUND: Pharmacist-led therapeutic drug monitoring (TDM) programs have demonstrated reduced costs and lengths of hospital stay and is enabled by targeted pharmacist training. St. Joseph’s Healthcare Hamilton (SJHH) does not currently have a formal TDM program for pharmacists. Digoxin is suitable for a pilot TDM training program for pharmacists due to its narrow therapeutic index, potentially fatal toxicity, and many potential drug-drug interactions.
OBJECTIVES: To develop and evaluate a framework for a TDM training program at SJHH using digoxin as an example.
METHODS: A TDM training program framework comprising a training module, knowledge quiz and documentation template was developed and circulated to 13 pharmacists in June 2024. Digoxin TDM interventions were collected for 3-weeks and assessed for compliance. Surveys to evaluate the framework were collected pre and post training completion and following the 3-week data collection period. Quantitative data was analyzed using descriptive statistics and qualitative responses with thematic analysis.
RESULTS: Ten pharmacists (77%) completed the training and 7 (54%) responded to the follow-up survey. Median knowledge quiz scores increased from 8.5/15 (IQR 4) pre-training to 11/15 (IQR 1) post-training (p=0.048). The proportion of pharmacists rating higher confidence across 10 digoxin TDM confidence statements increased from 64% (pre-training, n=12) to 81% post-training (n=10, p=0.006) and 93% at follow-up (n=7, p<0.001). Of 31 digoxin orders and 14 reported digoxin levels, nine interventions were documented, six used the template provided and seven were considered complete. Most participants were satisfied with the training components and overall framework, finding the training program easy to follow, useful, and relevant to practice.
CONCLUSION: Implementation of the TDM framework with digoxin demonstrated improved knowledge scores perceived confidence in digoxin TDM, and standardization of digoxin intervention documentation. Participants were satisfied with the framework and provided suggested improvements that may be implemented for future TDM training at SJHH.
Urban climate change and sustainability planning: an analysis of sustainability and climate change discourses in local government plans in Canada
(Taylor & Francis, 2017-04-11) Laura Tozer
This paper clarifies the competing discourses of sustainability and climate change and examines the manifestation of these discourses in local government planning. Despite the increasingly significant role of sustainability and climate change response in urban governance, it is unclear whether local governments are constructing different discourses that may result in conflicting approaches to policy-making. Using a governmentality approach, this paper dissects the contents of 15 Canadian local governments’ sustainability plans. The findings show that there are synergies and tensions between discourses of sustainability and climate change. Both share discursive space and shape local governance rationalities, though climate change response logics are not necessarily highlighted even where the action could result in greenhouse gas (GHG) emission reductions. In some cases, existing GHG intensive practices are being rebranded as ‘sustainable’. This suggests a tension between discourses of sustainability and climate change that may complicate attempts to address climate change through local sustainability planning.