Level III, retrospective comparative series.
BACKGROUND Patients with blood, immune, or metabolic diseases may require a stem cell transplant as part of their treatment. However, 70% of patients do not have a suitable human leukocyte antigen match in their family, and need an unrelated donor. Individuals can register as potential donors at stem cell drives, where they provide consent and a tissue sample for human leukocyte antigen typing. The ideal donors are young, male, and from a diversity of ethnic backgrounds. However, in Canada, non‐Caucasian males ages 17 to 35 years represent only 8.8% of listed donors. STUDY DESIGN AND METHODS The Stem Cell Club is a non‐profit organization founded in 2011 in Canada that aims to augment recruitment of the most needed donors. The initiative published a recruitment toolkit online (http://www.stemcellclub.ca). Currently, there are 12 chapters at universities across Canada. RESULTS To date, the Stem Cell Club has recruited 6585 potential registrants, representing 1.63% of donors on Canada's donor‐database. Of the recruited registrants, 58.3% were male; 60.3% of males self‐reported as non‐Caucasian, and 78.5% were ages 17 to 25 years. From 2015 to 2016, the initiative recruited 13.7% of all ethnically diverse males ages 17 to 35 years listed in Canada's donor database. Data from this initiative demonstrate sustainability and performance on key indicators of stem cell drive quality. CONCLUSION The Stem Cell Club has developed a capacity to recruit 2600 donors annually, with the majority being males with a high degree of ethnic diversity. The initiative enhances the quality of Canada's unrelated donor‐database, improving the chances that patients in need of an unrelated donor will find a match for transplant. The Stem Cell Club is a model relevant to recruitment organizations around the world.
advised that children should attend school as normal, and no child was thought to be sufficiently unwell, as a result of oil fumes, to be unable to attend school (C M Rowlands, personal communication).
these schemes in real-world practice, and propose an optimized approach.Methods: We conducted a retrospective analysis of prospectively collected data from our Vascular Quality Initiative database from 2010 to 2017. Open surgical abdominal aortic aneurysm repairs were queried, and adverse cardiac events (myocardial infarction, myocardial injury after noncardiac surgery), new arrhythmia, new congestive heart failure, or cardiovascular death) along with preoperative cardiac testing results were studied. A selective retrospective chart review was then conducted to investigate details not captured in the Vascular Quality Initiative database.Results:We identified 178 open surgical abdominal aortic aneurysm repairs, including 129 elective cases. The majority of elective patients (62%) had preoperative cardiac stress testing. Of these stress tests, 79% were negative, yet 33% of these patients (vs 48% of those with positive stress tests) experienced an adverse cardiac event. Upon further review, many patients who sustained unanticipated cardiac events had irreversible defects on their stress testing or untreated coronary disease on coronary angiography.Conclusions: Preoperative cardiac risk stratification with stress testing was only modestly protective against adverse cardiac events undergoing open abdominal aortic aneurysm repair. Alternative strategies including biomarker use or coronary angiography warrant further real-world investigation.
Background: In 2015, an Internal Medicine Perioperative Consult Team (IMPCT) was created in our hospital. We sought to determine whether they improve perioperative care without unnecessarily delaying surgery. Objectives:To evaluate the IMPCT service on vascular surgery patient outcomes and course in hospital.Methods: Using a prospectively maintained database, we compared vascular surgery patients who received a preoperative IMPCT consult with age, sex, co-morbidities, and surgical intervention matched patients who received no IMPCT consult. The outcomes of interest were post-operative complications, delays in surgery, and length of stay.Results: From 2015-2017, 71 IMPCT and 129 control patients were identified. The average age (73.7 vs. 74.5 years, p=0.57) and male gender (66% vs.70%, p=0.60) between the two groups were similar. Deaths in the IMPCT and control groups were not different, 4 vs. 5, p=0.57. Post-operative complications occurred in 59% of IMPCT patients compared with 19% of control patients (p<0.01) due to more cardiac, renal and delirium issues, p<0.01. Delays in surgery occurred in 62% of IMPCT and 40% control patients, p<0.01. The need for medical optimization in IMPCT (34%) versus control (6%) patients was the primary reason for delay, p<0.01. However, the average days of delay to OR was not different (4.9 vs. 4.9, p=0.97) between the two groups, nor was the average length of stay for the two groups, (16.2 vs. 9.5 days, p=0.16). Conclusion:More postop complications and delays to surgery were seen in patients who had an IMPCT consult compared with matched controls. In-hospital death, average days of delay to surgery and length of stay was not different.
IntroductionMulti-Drug Resistant Tuberculosis (MDR-TB) is a form of TB that is resistant to the two most powerful first-line anti-tuberculosis antibiotics available, rifampicin and isoniazid. Between 2004 and 2011, the proportion of cases with MDR-TB increased from 1.2% to 1.6%, of which it has remained stable over the past 3 years. Due to the complexity of treatment regimens used for MDR-TB, national monitoring guidelines have been developed to aid monitoring for adverse effects during treatment.1 A previous study identified that prior to the development of these monitoring guidelines the incidence of adverse effects associated with MDR TB medicines was high.2ObjectiveTo establish whether national guidelines for the monitoring of MDR-TB medicines at a tertiary centre are being adhered to.Results9 patients with MDR-TB were included in the audit. The findings (see Table 1) show that baseline monitoring was not undertaken in the majority of patients. Whilst on-going monitoring was predominantly undertaken in over 80% of occasions, the audit standard was not met.Abstract P258 Table 1 DrugNumber of patients taking drug [n = 9]Baseline monitoring carried out (%)On-going monitoring carried out (%)Drug specific monitoring carried out (%)Amikacin658%85%91%Capreomycin181%85%100%Clofazamine371%90%55%Co-amoxiclav338%77%N/A*Cycloserine961%82%91%Ethambutol464%84%52%Linezolid466%82%48%Moxifloxacin672%84%17%PAS453%82%94%Prothionamide860%83%53%Pyrazinamide346%71%N/A*Rifampicin169%72%N/A**Drugs did not require specific monitoring, according to drug monographs.ConclusionsDespite the presence of national guidance to support the monitoring of complex regimens for MDR-TB, this audit shows that monitoring of these in a tertiary centre is below the audit standard. Whilst adherence to on-going monitoring parameters were usually undertaken in over 80% of instances, it is of particular concern that baseline monitoring was significantly below the audit standard. Pharmacists are ideally placed to support the safe and effective monitoring of these often toxic medicines. The development of a pharmacist to support the TB clinics and specifically to support the monitoring of patients with MDR-TB could significantly improve this adherence and reduce the risk of adverse effects as a result of sub-optimal monitoring.References1 Potter JL, Capstick T. A UK based resource to support the monitoring and safe use of anti-tuberculosis drugs and second line treatment of multi-drug resistant tuberculosis. First published May 2014, Latest update January 20152 Keal JL, Khachi H, Hanzaree E, et al. Treatment of multidrug resistant tuberculosis: where are the guidelines for monitoring? Thorax 2011;66(Suppl 4):A91
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