Self-perceived role and knowledge of community pharmacists in organ donation.

BACKGROUND: Although a majority of North Americans is in favor of organ donation, registration remains challenging. Community pharmacists are highly accessible frontline health care professionals that could contribute to a new common registration donation consent system. AIM: The objective of the study was to assess self-perceived professional role and organ donation knowledge of community pharmacists in Quebec. METHOD: We designed a telephone interview survey using a three round modified Delphi process. Following questionnaires testing, we randomly sampled 329 community pharmacists in Quebec. Following administration, we validated the questionnaire by conducting an exploratory factorial analysis using principal component followed by a varimax rotation and rearranging domains and items accordingly. RESULTS: A total of 443 pharmacists were contacted, 329 provided answers to the self-perception role and 216 of them completed the knowledge questionnaire. Overall, community pharmacists of Quebec had a positive view on organ donation and demonstrated interest in acquiring knowledge. Respondents have identified lack of time and high pharmacy attendance as non-limiting barriers to implementing the intervention. The average score on the knowledge questionnaire was 61.2%. CONCLUSION: With the implementation of an appropriate education program to address this knowledge gap, we believe that community pharmacists could be key players in registered organ donation consent.

Refractory Dabigatran-Induced Hemorrhage Despite Multiple Idarucizumab Administration and Renal Replacement Therapy.

PURPOSE: This case report describes a patient with dabigatran accumulation due to acute kidney injury on chronic kidney disease, requiring multiple administration of idarucizumab along with renal replacement therapy because of rebound effect causing numerous episodes of bleeding. SUMMARY: An 86-year-old man on dabigatran etexilate 110 mg twice daily for stroke prevention with atrial fibrillation was admitted to the hospital for bowel obstruction and severe acute kidney injury on chronic kidney disease. The patient had an abnormal coagulation profile and no history of bleeding. Initial laboratory values revealed a hemoglobin concentration of 10.7 g/dL, a platelet count of 115 × 103 platelets/µL, an activated partial thromboplastin time of 150.4 seconds, an international normalized ratio of 10.28, a thrombin time greater than 100 seconds and a serum creatinine of 5.54 mg/dL (490 µmol/L). An initial dose of idarucizumab was administered 1 hour prior to surgery to prevent bleeding. Significant bleeding and hemodynamic instability occurred following surgery. Three additional doses of idarucizumab, 2 sessions of intermittent hemodialysis, continuous venovenous hemofiltration and blood products were required to achieve normalization of coagulation parameters and hemodynamic stability due to rebound coagulopathy after each dose of idarucizumab. CONCLUSION: Acute kidney injury on chronic kidney disease and third-space redistribution could have led to important dabigatran accumulation and favored rebound coagulopathy. Multiple therapeutic approaches may be required in the management of complex dabigatran intoxication.

Publisher Correction: Melting conditions in the modern Tibetan crust since the Miocene.

The original PDF version of this Article contained an error in which Fig. 3 and its legend were omitted and Equations 5 and 6 contained errors.This has been corrected in the PDF version of the Article. The HTML version was correct from the time of publication.

Melting conditions in the modern Tibetan crust since the Miocene.

Abundant granitic rocks exposed in ancient mountain belts suggest that crustal melting plays a major role in orogenic processes. However, complex field relations and superposition of multiple tectonic events make it difficult to determine the role of melting in orogenesis. In contrast, geophysical measurements image present-day crustal conditions but cannot discriminate between partial melt and aqueous fluids. Here we connect pressure-temperature paths of Himalayan Miocene crustal rocks to the present-day conditions beneath the Tibetan plateau imaged with geophysical data. We use measurements of electrical conductivity to show that 4-16% water-rich melt is required to explain the crustal conductivity in the north-western Himalaya. In southern Tibet, higher melt fractions >30% reflect a crust that is either fluid-enriched (+1% H2O) or hotter (+100 °C) compared to the Miocene crust. These melt fractions are high enough for the partially molten rocks to be significantly weaker than the solid crust.