Implementation of a renal pharmacist consultant service: information sharing in paper versus digital form

What is known and objective Renal impairment (RI) and renal drug-related problems (rDRP) often remain unrecognized in the community setting. A “renal pharmacist consultant service” (RPCS) at hospital admission can support patient safety by detecting rDRP. However, the efficient information sharing from pharmacists to physicians is still discussed. The aim of the study was to test the implementation of a RPCS and its effectiveness on prescription changes and to evaluate two ways of written information sharing with physicians. Methods Urological patients with eGFRnon-indexed of 15-59 ml/min and ≥1 drug were reviewed for manifest and potential rDRP at admission by a pharmacist. Written recommendations for dose or drug adaptation were forwarded to physicians comparing two routes: July-September 2017 paper form in handwritten chart; November 2017-January 2018 digital PDF document in the electronic patient information system and e-mail alert. Prescription changes regarding manifest rDRP were evaluated and compared with a previous retrospective study without RPCS. Results and discussion The RPCS detected rDRP in 63 of 234 (26.9%) patients and prepared written recommendations (median 1 rDRP (1-5) per patient) concerning 110 of 538 (20.5%) drugs at admission. For manifest rDRP, acceptance rates of recommendations were 62.5% (paper) vs 42.9% (digital) (P = 0.16). Compared with the retrospective study without RPCS (prescription changes in 21/76 rDRP; 27.6%), correct prescribing concerning manifest rDRP significantly increased by 27.1%. What is new and conclusion A RPCS identifies patients at risk for rDRP and significantly increases appropriate prescribing by physicians. In our hospital (no electronic order entry, electronic chart or ward pharmacists), consultations in paper form seem to be superior to a digital PDF document

Effect of Apheresis for ABO and HLA Desensitization on Anti-Measles Antibody Titers in Renal Transplantation

Desensitization strategies for ABO-incompatible renal transplants with plasma exchange (PE) or specific immunoadsorption (IA) decrease immunoglobulin levels. After recent measles outbreak and decreasing vaccination rates, we studied the impact of apheresis on anti-measles antibodies. Anti-measles antibodies were measured before desensitization, before transplantation and during followup in 12 patients with ABO incompatibility (2x PE only, 8x IA only, and 2x IA and PE) and 3 patients with donor-specific HLA antibodies (all PE). Patients received rituximab, IVIG, and standard immunosuppressive therapy. All patients had detectable anti-measles antibodies before desensitization (mean 3238 mU/l, range 560–8100). After 3–6 PE sessions, titers decreased significantly to 1710 mU/l (P < 0.05), in one patient to nondetectable values, while IA only maintained protective titers. After a median followup of 64 days, anti-measles antibodies returned to baseline in all patients. Immunity against measles was temporarily reduced by apheresis but remained detectable in most patients at time of transplantation. Desensitization maintains long-term protective immunity against measles

Transcatheter Aortic Valve Implantation in Dialysis Patients

Background/Aims: Transcatheter aortic valve implantation (TAVI) has emerged as a new therapeutic option for high-risk patients. However, dialysis patients were excluded from all previous studies. The aim of this study is to compare the outcomes of TAVI for dialysis patients with those for patients with chronic kidney disease (CKD) stages 3 and 4 and to compare TAVI with open surgery in dialysis patients. Methods: Part I: comparison of 10 patients on chronic hemodialysis with 116 patients with non-dialysis-dependent CKD undergoing TAVI. Part II: comparison of transcatheter (n = 15) with open surgical (n = 24) aortic valve replacement in dialysis patients. Results: Part I: dialysis patients were significantly younger (72.3 vs. 82.0 years; p < 0.01). Hospital stay was significantly longer in dialysis patients (21.8 vs. 12.1 days; p = 0.01). Overall 30-day mortality was 3.17%, with no deaths among dialysis patients. Six-month survival rates were similar (log-rank p = 0.935). Part II: patient age was comparable (66.5 vs. 69.5 years; p = 0.42). Patients in the surgical group tended to stay longer in hospital than TAVI patients (29.5 vs. 22.5 days; p = 0.35). Conclusion: TAVI is a safe procedure in patients on chronic hemodialysis. Until new data become available, we find no compelling reason to refuse these patients TAVI. Copyright (C) 2012 S. Karger AG, Base

The COVID-19 pandemic and ANCA-associated vasculitis - reports from the EUVAS meeting and EUVAS education forum.

The Coronavirus Disease 2019 (COVID-19) pandemic influenced the management of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. A paucity of data exists on outcome of patients with vasculitis following COVID-19, but mortality is higher than in the general population and comparable to patients undergoing haemodialysis or kidney transplant recipients (reported mortality rates of 20-25%). Delays in diagnosis have been reported, which are associated with sequelae such as dialysis-dependency. Management of ANCA-associated vasculitis has not changed with the aim to suppress disease activity and reduce burden of disease. The use of rituximab, an important and widely used agent, is associated with a more severe hospital course of COVID-19 and absence of antibodies following severe acute respiratory syndrome (SARS)-CoV-2 infections, which prone patients to re-infection. Reports on vaccine antibody response are scarce at the moment, but preliminary findings point towards an impaired immune response, especially when patients receive rituximab as part of their treatment. Seropositivity was reported in less than 20% of patients when rituximab was administered within the prior six months, and the antibody response correlated with CD19+ B-cell repopulation. A delay in maintenance doses, if disease activity allows, has been suggested using a CD19+ B-cell guided strategy. Other immunosuppressive measures, which are used in ANCA-associated vasculitis, also impair humoral and cellular vaccine responses. Regular measurements of vaccine response or a healthcare-policy time-based strategy are indicated to provide additional doses ("booster") of COVID-19 vaccines. This review summarizes a recent educational forum and a recent virtual meeting of the European Vasculitis Society (EUVAS) focusing on COVID-19

Dispositionen zu denen Potsdamschen Herbst-Manövern

DISPOSITIONEN ZU DENEN POTSDAMSCHEN HERBST-MANÖVERN Dispositionen zu denen Potsdamschen Herbst-Manövern ([1]r) Cover ( - ) Titelseite ([1]r) Text ([2]r) Notata ([1]) 1764. I. Manöver am 10. October ([3]) 1764. II. Manöver am 11. October ([3]) 1765. I. Manöver am 26. September (4) 1765. II. Manöver am 27. September (5) 1765. III. Manöver am 28. September (6) 1766. I. Manöver am 18. September (7) 1766. II. Manöver am 19. September (9) 1766. III. Manöver am 20. September (10) 1767. I. Manöver am 16. September (11) 1767. II. Manöver am 17. September (13) 1767. III. Manöver am 19. September (14) 1768. I. Manöver am 21. September (14) II. Manöver am 22. September (15) 1768. III. Manöver am 24. September (17) 1769. I. Manöver am 21. September (18) 1769. II. Manöver am 22. September (18) 1769. III. Manöver am 23. September (19) 1770. I. Manöver am 21. September (21) 1770. III. Manöver am 23. September (22) 1771. I. Manöver am 21. September (23) 1771. II. Manöver am 22. September (24) 1771. III. Manöver am 23. September (25) 1772. I. Manöver am 21. September (25) 1772. II. Manöver am 22. September (26) 1772. III Manöver am 23. September (27) 1773. I. Manöver am 21. September (28) 1773. II. Manöver am 22. September (29) 1773. III. Manöver am 23. September (30) 1774. I. Manöver am 21. September (31) 1774. II. Manöver am 22. September (32) 1774. III. Manöver am 23. September (33) 1775. I. Manöver am 21. September (33) 1775. II. Manöver am 22. September (35) 1775. III. Manöver am 23. September (36) 1776. I. Manöver am 21. September (37) 1776. II. Manöver am 22. September (38) 1776. III. Manöver am 23. September (39) 1777. I. Manöver am 27. September (40) 1777. II. Manöver am 28. September (41) 1777. III. Manöver am 29. September (42) Anno 1778 waren wegen des Bayerischen Erbfolge-Krieges keine Manövers (42) 1779. I. Manöver am 21. September (43) 1779. II. Manöver am 22. September (43) 1779. III. Manöver am 23. September (44) 1780. I. Manöver am 21. September (45) 1780. II. Manöver am 22. September (45) 1780. III. Manöver am 23. September (46) 1781. I. Manöver am 21. September (47) 1781. II. Manöver am 22. September (48) 1781. III. Manöver am 23. September (49) 1782. I. Manöver am 21. September (49) 1782. II. Manöver am 22. September (50) 1782. III. Manöver am 23. September (51) 1783. I. Manöver am 21. September (51) 1783. II. Manöver am 22. September (53) 1783. III. Manöver am 23. September (54) 1784. I. Manöver am 21. September (54) 1784. II. Manöver am 22. September (55) 1784. III. Manöver am 23. September (56) 1785. I. Manöver am 21. September (57) 1785. II. Manöver am 22. September (58) 1785. III. Manöver am 23. September (58) Original-Text des II. Manövers vom Jahre 1770 (60