RESUMEN
Background: IgA vasculitis (IgAV) is the most common form of childhood vasculitis. Nephritis (IgAVN) occurs in 50% of patients and 1-2% progress to chronic kidney disease stage 5. The pathophysiology of nephritis remains largely unknown, but recent evidence suggests that the complement system may be involved. The aim of this cross-sectional study was to explore whether there is evidence of alternative and/or lectin complement pathway activation in children with IgAVN. Methods: Children with IgAV were recruited and grouped according to proteinuria: IgAVN or IgAV without nephritis (IgAVwoN). Age and sex-matched healthy controls (HCs) were also recruited. Cross-sectional urine and plasma concentrations of complement factor D (CFD), factor B (CFB), and MBL-associated protease 1 (MASP-1) were performed using commercially available enzyme-linked immunoassays. Results: A total of 50 children were included (IgAVN, n = 15; IgAVwoN, n = 20, HCs, n = 15). The mean age was 8.5 ± 3.7 years old, male:female ratio was 1:1. Urinary CFD and CFB concentrations were statistically significantly increased in children with IgAVN (3.5 ± 5.4 µg/mmol; 25.9 ± 26.5 µg/mmol, respectively) compared to both IgAVwoN (0.4 ± 0.4 µg/mmol, P = 0.002; 9.2 ± 11.5 µg/mmol, P = 0.004) and HCs (0.3 ± 0.2 µg/mmol, P < 0.001; 5.1 ± 6.0 µg/mmol, P < 0.001). No statistically significant difference was reported for the plasma concentrations of CFD and CFB. Urinary MASP-1 concentrations were statistically significantly increased in IgAVN (116.9 ± 116.7 ng/mmol) compared to HCs (41.4 ± 56.1 ng/mmol, P = 0.006) and plasma MASP-1 concentrations were increased in IgAVwoN (254.2 ± 23.3 ng/mL) compared to HCs (233.4 ± 6.6 ng/mL, P = 0.046). Conclusion: There is evidence of complement pathway products in the urine of children with IgAVN that warrants further investigation.
RESUMEN
BACKGROUND: The Canadian Hospital Pharmacy Residency Board (CHPRB) first introduced accreditation standards to guide the development and maintenance of pharmacy residency programs in the 1970s. These standards have evolved over the years, including a comprehensive revision in 1998. Ongoing quality assessment of residency training is necessary to identify areas for improvement and to ensure that residency training keeps pace with continual changes in pharmacists' roles. OBJECTIVE: To characterize the practices of graduates of the British Columbia Pharmacy Practice Residency Programs (BCPPRPs), to review the effect of residency training on their careers, and to assess whether the BCPPRPs achieved their educational goals with respect to the 2010 CHPRB accreditation standards. METHODS: An 18-question electronic survey was sent by e-mail to all graduates of the BCPPRPs from inception in 1973 to 2009. Both quantitative and qualitative data were collected, so descriptive, narrative, and formal mixed-methods approaches were used for the analysis. RESULTS: Of the estimated 490 graduates, 144 (29%) completed the survey. About 95% of respondents (125 of 131) agreed that the BCPPRPs had adequately prepared them for a career in hospital pharmacy practice. A majority strongly or somewhat agreed that their respective programs had allowed them to aquire all core competencies. There was less agreement about the achievement of project management and leadership skills. Analysis of these results by eras (specifically, before and after the 1998 revision of the CHPRB accreditation standards) showed statistically significant improvements in achievement for 2 of the educational outcomes, "providing evidence-based direct patient care as a member of an inter-professional team" (p = 0.001) and "adequate training in literature appraisal" (p = 0.005). CONCLUSIONS: A majority of respondents recognized that their residency program had a substantial impact on their hospital pharmacy careers, especially in terms of developing direct patient care skills. The 2010 standards have introduced a specific outcome related to leadership skills. These results indicate that both the CHPRB and specific residency programs would benefit from discussions clarifying outcomes related to project management skills.