Penicillin allergies are associated with inferior patient and antimicrobial stewardship outcomes. We implemented a whole-of-hospital program to assess the efficacy of inpatient delabeling for ...low-risk penicillin allergies in hospitalized inpatients.
Patients ≥ 18 years of age with a low-risk penicillin allergy were offered a single-dose oral penicillin challenge or direct label removal based on history (direct delabeling). The primary endpoint was the proportion of patients delabeled. Key secondary endpoints were antibiotic utilization pre- (index admission) and post-delabeling (index admission and 90 days).
Between 21 January 2019 and 31 August 2019, we assessed 1791 patients reporting 2315 antibiotic allergies, 1225 with a penicillin allergy. Three hundred fifty-five patients were delabeled: 161 by direct delabeling and 194 via oral penicillin challenge. Ninety-seven percent (194/200) of patients were negative upon oral penicillin challenge. In the delabeled patients, we observed an increase in narrow-spectrum penicillin usage (adjusted odds ratio OR, 10.51 95% confidence interval {CI}, 5.39-20.48), improved appropriate antibiotic prescribing (adjusted OR, 2.13 95% CI, 1.45-3.13), and a reduction in restricted antibiotic usage (adjusted OR, 0.38 95% CI, .27-.54). In the propensity score analysis, there was an increase in narrow-spectrum penicillins (OR, 10.89 95% CI, 5.09-23.31) and β-lactam/β-lactamase inhibitors (OR, 6.68 95% CI, 3.94-11.35) and a reduction in restricted antibiotic use (OR, 0.52 95% CI, .36-.74) and inappropriate prescriptions (relative risk ratio, 0.43 95% CI, .26-.72) in the delabeled group compared with the group who retained their allergy label.
This health services program using a combination of direct delabeling and oral penicillin challenge resulted in significant impacts on the use of preferred antibiotics and appropriate prescribing.
Background. Despite the high prevalence of patient-reported antibiotic allergy (so-called antibiotic allergy labels AALs) and their impact on antibiotic prescribing, incorporation of antibiotic ...allergy testing (AAT) into antimicrobial stewardship (AMS) programs (AAT-AMS) is not widespread. We aimed to evaluate the impact of an AAT-AMS program on AAL prevalence, antibiotic usage, and appropriateness of prescribing. Methods. AAT-AMS was implemented at two large Australian hospitals during a 14-month period beginning May 2015. Baseline demographics, AAL history, age-adjusted Charlson comorbidity index, infection history, and antibiotic usage for 12 months prior to testing (pre–AAT-AMS) and 3 months following testing (post–AAT-AMS) were recorded for each participant. Study outcomes included the proportion of patients who were "de-labeled" of their AAL, spectrum of antibiotic courses pre– and post–AAT-AMS, and antibiotic appropriateness (using standard definitions). Results. From the 118 antibiotic allergy—tested patients, 226 AALs were reported (mean, 1.91/patient), with 53.6% involving 1 or more penicillin class drug. AAT-AMS allowed AAL de-labeling in 98 (83%) patients–56% (55/98) with all AALs removed. Post– AAT, prescribing of narrow-spectrum penicillins was more likely (adjusted odds ratio aOR, 2.81, 95% confidence interval CI, 1.45–5.42), as was narrow-spectrum β-lactams (aOR, 3.54; 95% CI, 1.98–6.33), and appropriate antibiotics (aOR, 12.27; 95% CI, 5.00–30.09); and less likely for restricted antibiotics (aOR, 0.16; 95% CI, 09–.29), after adjusting for indication, Charlson comorbidity index, and care setting. Conclusions. An integrated AAT-AMS program was effective in both de-labeling of AALs and promotion of improved antibiotic usage and appropriateness, supporting the routine incorporation of AAT into AMS programs.
Suite Uist Stevenson, Anna-Wendy
Angles (Société des Anglicistes de l'Enseignement Supérieur),
05/2024, Letnik:
17
Journal Article
Recenzirano
Odprti dostop
1. Caismeachd Bho Bhlàr Chàirinis – March from the Battle of Carinish2. Baleshare Rowing Song3. Se Saoghal Beag A Th’ann – it’s a Small World4. Ruidhle Do Steàrnan Beag5. A’ Fàgail Na Dachaigh – ...Leaving Home6. Udal Waulking song7. Fàiltesound:suite-uistTwenty five minutes of new traditional music written and arranged for 3 violins, viola, flute, accordion, guitar, piano, Scottish small pipes, vocals. Written in traditional Gaelic music forms including: March, Slow air, Waulking song, poetr...
Although little detailed consideration has been given to the Treaty of Northampton of 1290 by Scottish historians, it seems to have been implicitly accepted as the sort of treaty which might have ...been expected in connection with the marriage of two independent rulers at that time. This is in spite of the fact that throughout the twelfth, thirteenth and fourteenth centuries the traditional practice of the rulers of the Angevin and Plantagenet dominions was to rule each constituent part according to its own law and customs. This article examines the reasons why the Scots were not prepared to rely on tradition but insisted on a written promise from Edward I that Scotland would remain independent of England. It also suggests that the treaty is more than a written expression of traditional practice. It has a number of specific clauses which, it is argued, give the treaty the character of a charter of liberties. These were intended to prevent the imposition on the Scots of particular aspects of Plantagenet rule in England which burdened its subjects much more severely than the rule of Scottish kings had burdened the Scots. The Scots' wish to remain independent after the proposed union of the crowns and their struggle to maintain that independence after the death of the Maid are generally seen as manifestations of a sense of community or regnal solidarity. The terms of the Treaty of 1290 suggest that it was not just from a desire to be a separate political entity per se that the Scots fought during the so-called Wars of Independence but also because the Scots were anxious to avoid the more oppressive aspects of Plantagenet rule even before they had experience of this after Edward I's conquest of 1296.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, ZRSKP
Epidemic thunderstorm asthma (ETSA) severely affected Melbourne, Australia in November 2016. There is scant literature on the natural history of individuals affected by ETSA.
A multicentre 12-month ...prospective observational study was conducted assessing symptomatology and behaviors of ETSA-affected individuals.
We used a structured phone questionnaire to assess asthma symptom frequency, inhaled preventer use, asthma action plan ownership and healthcare utilization over 12 months since the ETSA. Analysis of results included subgroup analyses of the "current," "past," "probable," and "no asthma" subgroups defined according to their original 2016 survey responses.
Four hundred forty-two questionnaires were analyzed. Eighty percent of individuals reported ongoing asthma symptoms at follow-up, of which 28% were affected by asthma symptoms at least once a week. Risk of persistent asthma symptoms was significantly higher in those with prior asthma diagnosis, current asthma, and probable undiagnosed asthma (all
< 0.01). Of 442 respondents, 53% were prescribed inhaled preventers, of which 51% were adherent at least 5 days a week. Forty-two percent had a written asthma action plan and 16% had sought urgent medical attention for asthma in the preceding year.
Following an episode of ETSA, patients experience a pivotal change in asthma trajectory with both loss of asthma control and persistence of
asthma. Suboptimal rates of inhaled preventer adherence and asthma action plan ownership may contribute to asthma exacerbation risk and susceptibility to future ETSA episodes. Longer-term follow-up is needed to determine the extent and severity of this apparent change.
Although little detailed consideration has been given to the Treaty of Northampton of 1290 by Scottish historians, it seems to have been implicitly accepted as the sort of treaty which might have ...been expected in connection with the marriage of two independent rulers at that time. This is in spite of the fact that throughout the twelfth, thirteenth and fourteenth centuries the traditional practice of the rulers of the Angevin and Plantagenet dominions was to rule each constituent part according to its own law and customs. This article examines the reasons why the Scots were not prepared to rely on tradition but insisted on a written promise from Edward I that Scotland would remain independent of England. It also suggests that the treaty is more than a written expression of traditional practice. It has a number of specific clauses which, it is argued, give the treaty the character of a charter of liberties. These were intended to prevent the imposition on the Scots of particular aspects of Plantagenet rule in England which burdened its subjects much more severely than the rule of Scottish kings had burdened the Scots. The Scots' wish to remain independent after the proposed union of the crowns and their struggle to maintain that independence after the death of the Maid are generally seen as manifestations of a sense of community or regnal solidarity. The terms of the Treaty of 1290 suggest that it was not just from a desire to be a separate political entity per se that the Scots fought during the so-called Wars of Independence but also because the Scots were anxious to avoid the more oppressive aspects of Plantagenet rule even before they had experience of this after Edward I's conquest of 1296.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, ZRSKP
Raman spectra of the hydrogen-deuterium exchange reaction occurring in the HCOO
−-D
2O system at elevated temperatures and pressures are reported. The rate constants at four temperatures have been ...measured and from these an activation energy of around 170 kJ mol
−1 has been calculated. Exchange also takes place in the DCOO
−-H
2O system. The rate constants at four temperatures indicate an activation energy of 93 kJ mol
−1.
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