The University of Alberta Hospital (UAH) is a research and teaching hospital in Edmonton, Alberta, Canada. The hospital is affiliated with the University of Alberta and run by Alberta Health Services, the health authority for Alberta. It is one of Canada's leading health sciences centres, providing a comprehensive range of diagnostic and treatment services to inpatients and outpatients. The UAH treats over 700,000 patients annually.The University of Alberta Hospital, Mazankowski Alberta Heart Institute and the Stollery Children's Hospital co-reside within the large Walter C. Mackenzie Health Sciences Centre (WMC) and act as embedded "hospitals within a hospital." With 650, 146 and 89 inpatient beds in the three hospitals, respectively, WMC has an estimated total of 885 beds. Combined, this makes the Walter C. Mackenzie Health Sciences Centre one of the largest hospitals in Western Canada, exceeding the Royal Alexandra Hospital's 869 beds, but behind Calgary's Foothills Medical Centre. The Mazankowski Alberta Heart Institute is located in a new expansion to the WMC that opened on May 1, 2008.Because of UAH, the surrounding area has become part of a healthcare cluster that also includes the Cross Cancer Institute, the Heritage Medical Research Building, the Zeidler Ledcor Center, the Katz Group/Rexall Center for Pharmacy and Health Research, the Kaye Edmonton Clinic, and the Edmonton Clinic Health Academy.The whole complex is served by the Health Sciences/Jubilee light rail transit station and the University station.
The treatment of patients with PNH has been revolutionized by terminal complement C5 inhibitors, which control intravascular hemolysis and thrombosis, reduce morbidity and mortality, and improve life expectancy to that approaching people without PNH. In recent years, approval of proximal inhibitors provides clinicians and patients with additional treatment options such that patients who have residual anemia, ongoing symptoms affecting quality of life, or are intolerant to terminal C5 inhibition now have options to optimize treatment. Here, we provide five questions to guide clinicians involved in the care of patients with PNH in assessing treatment response on terminal inhibitors and identifying patients who might benefit from therapy adjustments. We also provide insights into additional treatment options.
The first-line immunosuppressant mycophenolic acid (MPA) is characterised by complex, variable pharmacokinetics (PK) with high protein binding, where the relationship between total and unbound drug can be difficult to predict early post-transplant. We developed a novel population pharmacokinetic (popPK) model for unbound MPA and its major glucuronide (MPAG) in adult kidney transplant recipients to characterise the pharmacologically relevant unbound drug. This prospective, observational study included de novo adult kidney transplant recipients on steady-state oral mycophenolate mofetil with tacrolimus (±prednisone). The PopPK modelling was performed using stochastic approximation expectation-maximisation, and simulations evaluated the impact of significant covariates on unbound MPA area-under the concentration-time curves (AUC)0–12h. Forty-one participants (aged 48.3±12.1 years, mean±SD) from 63 occasions representing three study visits ( 1, 3, and 6 months post-transplant) were enrolled. A structural model based on first-order absorption (ka=4 h−1, fixed) with lag time (Tlag=0.38 [0.11–0.56] h; estimate [95
Abstract Background Choosing Wisely Canada (CWC) recommends that long-term therapies for Inflammatory Bowel Disease (IBD) should not be initiated or escalated based only on symptoms. Dose escalations of advanced IBD therapies can lead to increased costs, potential safety concerns, and may subject patients to long-term use of higher than necessary advanced therapy doses. This study provides a single-centre examination of advanced IBD therapy dose escalations including what indications were present to inform these management changes. Aims To assess the proportion of advanced IBD therapy changes made between 2021 and 2025 at the University of Alberta IBD Unit which followed current CWC recommendations. Methods This retrospective cohort quality improvement study reviewed advanced IBD therapy dose escalations to determine which reported indications were present at time of escalation. Possible indications included patient symptoms, abnormal biomarkers (i.e., fecal calprotectin [FCP], C-reactive protein), active disease on endoscopy, imaging results (i.e., intestinal ultrasound, CT and/or MR enterography), serum drug and anti-drug antibody levels, and missed doses. Descriptive statistics were calculated for the overall cohort and subgroups for each advanced therapy agent. Results In total, 1334 advanced IBD therapy dose escalations for 1081 patients were reviewed. 384 (28.8%) dose escalations were made based on patient symptoms alone and 701 (52.5%) were made in response to active disease being identified. The remaining 249 (18.7%) escalations were based on serum drug and anti-drug antibodies levels, with or without concurrent symptoms. Anti-TNF agents were the most frequently escalated medication class with 728 (54.6%) escalations, followed by anti-IL12/23 with 358 (26.8%), anti-integrins with 190 (14.2%), JAK inhibitors with 45 (3.4%), and anti-IL23 with 13 (1.0%). Evidence of disease activity was most commonly obtained from FCP levels (48.4%) and endoscopic findings (47.4%). Dose de-escalations were also identified, with 54 de-escalations documented between 2021 and 2025. Conclusions This study demonstrates the need for ongoing improvement in determining active IBD prior to advanced therapy dose escalations. Recommendations regarding the use of serum drug and anti-drug antibody levels to inform dose escalations could potentially minimize the discordance between current CWC recommendations and clinical practice as shown in this study. Further research assessing the clinical outcomes of patients who were dose escalated on the basis of symptoms alone is required. Funding Agencies None
BACKGROUND & AIMS:The efficacy of renal replacement therapy (RRT) in critically ill patients with cirrhosis remains dubious. We aimed to assess the impact of RRT on these patients' outcomes. METHODS:Multicenter retrospective cohort study including adult patients with cirrhosis admitted to intensive care units at University of Alberta Hospital (Edmonton, Canada) and Northwestern Memorial Hospital (Chicago, US) from January 2010 to December 2017. Primary exposure was receipt of RRT on ICU days 1 to 3. Fine and Gray multivariable regression with competing endpoints, in-hospital liver transplant (LT) and mortality, was performed. RESULTS:Among 898 patients, median (IQR) age was 57 (49-64) years and 539 (60.0%) were males. RRT on days 1 to 3 was used in 249 (27.7%) patients. Patients on RRT on days 1 to 3 had higher CLIF-C-ACLF scores on days 1 (61 vs. 55, p < 0.001) and 3 (59 vs. 50; p < 0.001) than others. During the hospital stay, 97 (10.8%) patients were transplanted and 296 (33.0%) died. Following adjustment for aetiology, number of extra-renal organ failures, and year of inclusion, using mortality as competing event, RRT on days 1 to 3 was associated with higher hazard of LT (HR (95% CI) = 1.54 (1.02-2.32); p = 0.039). Conversely, using LT as competing event, RRT on days 1 to 3 was not associated with mortality (HR (95% CI) = 1.15 (0.90-1.47); p = 0.25). CONCLUSIONS:Among critically ill patients with cirrhosis, early RRT, while offered more often to the sickest patients, was associated with a higher likelihood of receiving LT, but not with mortality.
