Kidney transplant recipient perspectives on telehealth during the COVID-19 pandemic

The COVID-19 pandemic has challenged the delivery of health services. Telehealth allows delivery of care without in-person contacts and minimizes the risk of vial transmission. We aimed to describe the perspectives of kidney transplant recipients on the benefits, challenges, and risks of telehealth. We conducted five online focus groups with 34 kidney transplant recipients who had experienced a telehealth appointment. Transcripts were thematically analyzed. We identified five themes: minimizing burden (convenient and easy, efficiency of appointments, reducing exposure to risk, limiting work disruptions, and alleviating financial burden); attuning to individual context (depending on stability of health, respect patient choice of care, and ensuring a conducive environment); protecting personal connection and trust (requires established rapport with clinicians, hampering honest conversations, diminished attentiveness without incidental interactions, reassurance of follow-up, and missed opportunity to share lived experience); empowerment and readiness (increased responsibility for self-management, confidence in physical assessment, mental preparedness, and forced independence); navigating technical challenges (interrupted communication, new and daunting technologies, and cognizant of patient digital literacy). Telehealth is convenient and minimizes time, financial, and overall treatment burden. Telehealth should ideally be available after the pandemic, be provided by a trusted nephrologist and supported with resources to help patients prepare for appointments.Brooke M Huuskes, Nicole Scholes-Robertson, Chandana Guha, Amanda Baumgart, Germaine Wong, John Kanellis ... et al

Residential location and kidney transplant outcomes in indigenous compared with nonindigenous Australians

Poster abstract #271KA Barraclough, SP Mcdonald, BS Grac

Therapeutic monitoring of mycophenolate in transplantation: Is it justified?

Mycophenolate mofetil (MMF) is the preferred antimetabolite in solid organ transplantation. It is a prodrug that undergoes pre-systemic metabolism to mycophenolic acid (MPA), the active drug moiety. MMF is typically administered as a fixed dose without routine monitoring of MPA concentrations. However, a role for therapeutic drug monitoring (TDM) of MPA has been suggested based on the drug's narrow therapeutic window and considerable between-subject variability. Dose-normalized MPA area under the concentration- time curve (AUC) has been observed to vary ≥10-fold. Some of this variability may be accounted for by patient variability in renal and liver function, serum albumin and haemoglobin levels, body mass, concomitant medication exposure and genetic polymorphisms in enzymes responsible for drug metabolism and transport, but much is unexplained. Widespread adoption of MPA TDM has been limited by the impracticality of full 0 to 12 hour AUC measurement (AUC0-12), poor correlation between pre-dose MPA concentration and AUC0- 12, ongoing questions regarding the utility of free versus total MPA measurements and lack of evidence correlating MPA exposure with clinical outcomes. Two recent randomized studies evaluating the role of MPA TDM in renal transplant recipients have reported conflicting results. Promising areas of ongoing study include use of Bayesian forecasting to predict MPA dosage and measurement of inosine monophosphate dehydrogenase activity. This review provides an overview of the pharmacokinetics of MMF in solid organ transplantation, and discusses the benefits and limitations of MPA monitoring. Areas that require additional research are identified

Price Discrimination in the Context of Vertical Differentiation: An Application to Canadian Wheat Exports

The ability of the Canadian Wheat Board (CWB) to price discriminate in wheat exports is examined. The conceptual model shows that the CWB's ability to exploit cost differences in pricing depends on the extent of differentiation between Canadian and U.S. wheat. This model is implemented using monthly confidential price data for exports to four markets from 1982 to 1994. The empirical results support the conclusions that (1) the CWB has market power emerging from product differentiation, (2) the CWB price discriminates across export markets, and (3) Alchian—Allen effects are important in pricing in markets valuing quality such as Japan and the United Kingdom. Copyright 2005, Oxford University Press.

Plasma-Polyplumbagin-Modified Microfiber Probes: A Functional Material Approach to Monitoring Vascular Access Line Contamination

Atmospheric plasma treated carbon fiber filaments (10 micrometer) were used as the base substrate in the design of a probe intended for use within intravascular access devices. The microfiber probe was further functionalized with a polyplumbagin layer through which the line pH could be determined voltammetrically and therein provide the potential for obtaining diagnostic information relating to bacterial colonization of the line. The redox processes attributed to the immobilized polymer are characterized and a methodology developed to enable the acquisition of a redox signal that is selective and sensitive to pH. The applicability of the composite probe was demonstrated through examining the direct response in whole blood.The authors thanks the Royal Society (London, JP100125)), Ministry of Science and Innovation (SAF-2009-10399), and the Engineering and Physical Sciences Research Council (EPSRC, U.K.) for supporting this workPeer Reviewe