McKay Dee Hospital

Background: Patients with penicillin allergy have been shown to have suboptimal antibiotics prescribed for infections as well as an increased risk of adverse effects. However, it is currently unknown at what rate patients with penicillin allergy are prescribed antibiotics after hospitalization. Objective: The purpose of this study was to determine the rate at which patients with penicillin allergy are prescribed antibiotics after hospitalization and if this rate differs from that of patients without penicillin allergy. Methods: This was a retrospective case-control study that evaluated subsequent courses of antibiotics after hospitalization in patients with and those without penicillin allergies. Subsequent courses of antibiotics were compared between patients who with penicillin allergy and patients who were not allergic to penicillin for the 15 months after hospitalization by using the incidence rate ratio of new antibiotics prescribed. Results: Patients in the penicillin allergy group received significantly more outpatient antibiotics in the 15 months after hospitalization compared with patients with no penicillin allergy. The incidence rate ratio between the two groups was 1.27 (95% confidence interval, 1.10-1.48); p = 0.0014. There was no difference between the subsequent courses of inpatient antibiotic courses during the same time period. Conclusion: Patients with a penicillin allergy in the current evaluation received significantly more outpatient courses of antibiotics than did the patients without a penicillin allergy. These data provide more evidence for the importance of penicillin allergy de-labeling to provide patients with the most appropriate antibiotics for their respective infections.

Medicine & Science in Sports & Exercise 54(9S):p 183, September 2022. | DOI: 10.1249/01.mss.0000877352.77188.97

The Victoria Hall Theatre was built in 1921 as a lively church in the center of Santa Barbara, California, but matured into a tired theatre in the center of the downtown Arts District. Initial considerations whether to renovate began with a study about minimizing intrusion of loud dance music from a neighboring open-deck club. Thereafter, the renovation took off, with major changes including an entirely new stage house, and replacing a problematic balcony with a continuous floor plan with great sightlines for its 294 seats. Exterior noise isolation is excellent considering its wood construction, and interior finishes promote great clarity and improved intimacy. However, the decision to reuse the six old air handling units in the attic, compounded by some questionable mechanical engineering omissions, undermined the theatre’s potential to make sound system reinforcement essentially unnecessary. This paper will review various renovation decisions, and the several steps to quiet the renovated HVAC to its current moderate levels, plus the follow-up that almost provided authorization to further quiet the system.

BackgroundBacteremia in adult patients has traditionally been treated with extended courses of intravenous antibiotics. Data on the use of (or rapid transition to) oral therapy are limited.MethodsAdult infectious disease physicians participating in the Infectious Diseases Society of America Emerging Infections Network (EIN) were surveyed regarding their use of oral antibiotics in patients with bacteremia. Respondents were asked to assume that patients were hemodynamically stable, recovered bacteria were susceptible to potential antibiotics, adequate source control had been achieved, and patients had adequate gastrointestinal absorption. Variables of specific bacteria, oral agent, and associated infection were included.ResultsA total of 655 (50%) of 1321 EIN participants responded. Under certain conditions, 88% would transition patients with Gram-negative bacteremia to complete a course of therapy with oral antibiotics; 71% would transition patients with Gram-positive bacteremia to oral agents. Only 78 (12%) respondents would not treat any bacteremic patient with oral agents. Most respondents (≥75%) were comfortable treating infections secondary to Enterobacteriaceae, Salmonella, Pseudomonas, Stenotrophomonas, Streptococcus pneumoniae, and β-hemolytic streptococci with oral agents. Fewer than 20% endorsed use of oral antibiotics for Staphylococcus aureus or in cases of endocarditis. Fluoroquinolones and trimethoprim-sulfamethoxazole were the preferred agents in Gram-negative bacteremia; linezolid and β-lactams were the preferred agents in Gram-positive bacteremia.ConclusionsIn select circumstances, the majority of respondents would transition patients to oral antibiotics, in both Gram-negative and Gram-positive bacteremia. Most agreed with the use of oral agents in Gram-negative bacteremia caused by Enterobacteriaceae, but they would not use oral agents for Gram-positive bacteremia caused by S aureus or in endocarditis.

Aims: Infants with fetal exposure to opioids have varying pattern of feeding difficulties mainly manifesting as difficulties with aerodigestive adaptation and disruptive feeding behavior. The reasons are unclear; in a pilot study, we determined basal and adaptive pharyngo-esophageal motility in a group of infants with fetal exposure to opioids and persistent feeding difficulties impeding their discharge.Methods: Six infants with fetal opioid exposure compared to 12 controls who underwent basal and adaptive pharyngo-esophageal manometry to characterize the basis for their symptoms. Spontaneous swallows (N = 180) and pharyngeal stimuli (N = 113)-induced swallowing responses were analyzed.Results: Resting upper esophageal sphincter (UES) pressure was similar in both the groups, but resting lower esophageal sphincter (LES) pressure was significantly high and it relaxed slowly and inadequately in opioid-exposed infants (p < .05). Upon pharyngeal provocation, opioid-exposed infants had higher LES nadir pressure, increased duration of esophageal body contraction at proximal-, mid-, and distal-esophagus, as well as greater area under the curve with distal esophageal waveforms, compared to controls (all p < .05).Conclusions: These pilot observations are suggestive of up-regulation of central vagal effects with heightened cholinergic excitatory responses and inadequate relaxation responses at the foregut, and may form the basis for persistent feeding difficulties in opioid-exposed infants. Abnormality with both sensory and motor aspects of vagal reflexes may be contributory.

The historic Ford Amphitheatre in Hollywood, CA, recently completed an overall renovation and expansion. The centerpiece is the 1,200-seat outdoor amphitheater, which features a dramatic arroyo backdrop. The side walls, rear wall, towers, and house flooring were built of concrete in 1931 after a brush fire destroyed the original 1920 wood structure. Several sound-absorptive treatments had been applied to the walls over the years previous to our involvement, but excessive reverberation and some anomalous reflections remained. The new design features an expanded “sound wall” that helps to mitigate highway noise while providing optimal lighting and control positions, and offering an opportunity to improve the acoustical treatment scheme. The result is a unique installation of decorative perforated-metal panels that tame the reverberation, especially in the low frequencies. Assorted design challenges, apparent arroyo hillside contributions, and the resultant reverberation will be discussed.

# 01.1.1: Surgery versus standardized nonoperative care for the treatment of lumbar disc herniations: a Canadian trial {#article-title-2} The beneficial treatment effect surgery demonstrates over conservative care for radiculopathy secondary to acute lumbar disc herniation (LDH), occurs in the

We agree with the author that promoting collaboration between the adolescent, family, and nurse through the use of motivational interviewing can empower behavior change and lead to a healthier lifestyle. We'd like to add that this method of treatment has the potential to be most effective if performed in the home. Research has shown that a home-based intervention using motivational interviewing can be successful in reducing service attrition and maladaptive behaviors compared with a more traditional intervention.1 Working with the patient in the home allows the nurse to gather objective information about the environment, witness the family dynamic, identify barriers to change, and evaluate progress. This approach is more time consuming and potentially expensive, but it enables the nurse to work with the patient and family in the optimal setting, discovering the source of the problem and suggesting changes and improvements that support self-efficacy. Christine Gillen-McKay Michael Grocki Holly Leahy Milton, MA For more letters from AJN readers, go to https://links.lww.com/AJN/A47.

This is the first guideline describing the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI). This guideline should be used as an adjunct to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) including the ASIA Impairment Scale (AIS), which documents the neurological examination of individuals with SCI. The Autonomic Standards Assessment Form is recommended to be completed during the evaluation of individuals with SCI, but is not a part of the ISNCSCI. A web-based training course (Autonomic Standards Training E Program (ASTeP)) is available to assist clinicians with understanding autonomic dysfunctions following SCI and with completion of the Autonomic Standards Assessment Form (www.ASIAlearningcenter.com).