Rev Med Interne

The pharmacokinetics of drugs, such as immunosuppressants, justify the need of measuring their blood concentrations in order to adjust their dosage. Therapeutic Drug Monitoring (TDM) of ciclosporin, tacrolimus and mycophenolate mofetil has shown its benefit particularly in the management of renal transplantees, in order to prevent graft rejection. When prescribed in autoimmune diseases, their pharmacokinetic variability and the variability of clinical response would justify TDM in practice. TDM may be useful in systemic lupus, for hydroxychloroquine, in order to monitor patient compliance. Despite insufficient data in the literature, for mycophenolate mofetil, TDM would permit to maintain clinical remission in adults and children with lupus nephritis, as well as in mucosal pemphigoid and idiopathic nephrotic syndrome in children. Studies are still necessary to validate the thresholds and TDM conditions. For azathioprine, TPMT phenotyping is recommended before prescription. For methotrexate, tacrolimus and ciclosporin, data are still sparse on the benefit of TDM, although it may improve tolerance to tacrolimus in lupus. Finally, for infliximab, in case of loss of response in maintenance, TDM may be proposed in parallel with detection of anti-drug antibodies

Stories of feelings and things: intangible heritage from within the built heritage paradigm in the UK

The changing nature of heritage over recent decades has stimulated a focus on intangible heritage – the understanding of which specifically from within the UK built heritage paradigm remains inconclusive. This is problematic when considering developments in policy and practice that demonstrate a steady dismantling of a material focus. To gain sector-specific insight into how the intangible heritage of buildings is conceptualised, a series of 16 semi-structured interviews were conducted with built heritage professionals. Data were collated into eight themes (stories; history; events; memory; use; discord; craft; emotion) and an explanatory model developed, revealing the understanding of intangible heritage as a collection of ‘narratives’ that contribute towards an overarching building ‘story’. Both ‘buildings’ and ‘people’ were acknowledged as co-authors of this story; however, professionals did not acknowledge their own role within the storytelling process. This downplays their role as curator of heritage, as well as their personal experiences that inevitably shape the storytelling process. Findings suggest built heritage practice should be reconceptualised as a storytelling activity. This will offer greater opportunities for intangible heritage to be consolidated within the built heritage paradigm, by encouraging professionals to see themselves as narrators of intangible heritage as well as custodians of physical heritage