Summary
A pre‐use check to ensure the correct functioning of anaesthetic equipment is essential to patient safety. The anaesthetist has a primary responsibility to understand the function of the anaesthetic equipment and to check it before use. Anaesthetists must not use equipment unless they have been trained to use it and are competent to do so. A self‐inflating bag must be immediately available in any location where anaesthesia may be given. A two‐bag test should be performed after the breathing system, vaporisers and ventilator have been checked individually. A record should be kept with the anaesthetic machine that these checks have been done. The ‘first user’ check after servicing is especially important and must be recorded.
This article provides an overview of myeloproliferative neoplasms for nurses who do not specialise in haematology. Diagnosis, management and treatment of patients with these conditions is discussed, as well as long-term nursing implications.
This article provides an overview of myeloproliferative neoplasms for nurses who do not specialise in haematology. Diagnosis, management and treatment of patients with these conditions is discussed, as well as long-term nursing implications.
Background
The genetic variation HLADQA1*05 has been reported to be associated with anti-Infliximab antibody in CD. The relevance in UC patients receiving infliximab is uncertain. We aimed to evaluate the association of HLADQA1*05 and infliximab antibody formation, treatment changes and infliximab persistence in a real world setting of single centre cohort
Methods
Infliximab treated UC patients (n=94) were retrospectively screened for HLDqA1*05. The risk of anti-infliximab antibody formation, absent drug levels in presence of antibody, change in therapy from infliximab were assessed in variant carrying patients in comparison to those without the variants. The proportion of patients needing dose optimisation of infliximab also evaluated
Results
Anti-infliximab antibodies were detected in 41.5% of patients in a median follow up of 14.75 (IQR 9–29) months. HLA DQAI*05 was positive in 39.13% of patients. 52.2 % of patients were on concomitant immunomodulators. Higher proportion of patients with HLADQA1*05 developed anti-Infliximab antibodies (59% Vs 24%, p=0.002). Eighty percent of patients who had anti Infliximab antibodies with absent drug levels were positive for HLADQA1*05 with Hazzard Ratio (HR) for development of anti-Infliximab antibodies of 4.54 (95% CI 1.73–11.89) and for antibodies with absent infliximab drug levels 9.86 (95% CI 2.43 -40.01). Higher proportion of HLADQA1*05 patients required dose escalation (78% vs 31%, p=0.001). After adjusting for age, initial infliximab dose and concomitant immunomodulator use, there was no difference anti TNF persistence in patients with HLADQA1*05 variant (HR 2.36, 95% CI 0.89–6.25, p=0.06)
Conclusion
Determination of HLADQA1*05 status may identify patients at higher risk of anti-infliximab antibodies in ulcerative colitis. Early intervention with dose optimisation and concomitant immunomodulation may avoid loss of response and facilitate treatment persistence
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