Penicillin allergy reassessment for treatment improvement: A dental office tool to support appropriate penicillin allergy labeling.

BACKGROUND: Dental appointments offer an opportunity to evaluate a documented penicillin (PCN) allergy and determine whether the patient might be a candidate for medical reassessment of their allergy. The authors gathered feedback on the Penicillin Allergy Reassessment for Treatment Improvement (PARTI) tool, designed to enhance dentist-patient communications regarding PCN allergies. METHODS: From January 2022 through May 2023, the authors conducted a mixed-methods study, collecting focus group data from patients with PCN allergies and surveying health care workers (HCWs) regarding the PARTI tool. Feedback focused on reassessment procedures, patient-centered allergy information, and medical records updates. Thematic analysis was used for focus group data. RESULTS: The study included 15 patients in focus groups and 50 HCW survey respondents representing diverse US regions. Patient demographic characteristics included varied races, the mean age was 52 years, and most of the patients were female (53.3%). Most patients had health care interactions within the preceding year, at which 86.6% of patients were asked about drug allergies. HCW respondents primarily consisted of pharmacists (30%) and dentists, dental hygienists, and dental assistants (28%). Feedback on the PARTI tool was constructive, with both patients and HCWs recognizing its potential benefits and providing insights for improvement. Many HCWs (68%) highlighted the importance of step 3 of the PARTI tool, that is, the section on PCN allergy testing. Feedback from participants was incorporated into the final PARTI tool. CONCLUSIONS: Patient and HCW feedback on the PARTI tool was used to finalize a tool for the dental office to provide to patients who are candidates for PCN allergy reassessment. The feedback will also be used to inform an upcoming pilot study in US dental offices, focused on the process for PCN allergy reassessment and health record documentation. PRACTICAL IMPLICATIONS: Deploying the PARTI tool in dental offices is pivotal, as mislabeling patients with PCN allergies could have severe consequences, such as hindering the prescription of lifesaving antibiotics for conditions like endocarditis, in the future. This implementation not only enhances communication between dentists and patients, but it is also crucial for ensuring improved patient safety and maintaining accurate medical records among health care settings.

A Randomized Controlled Trial of a Therapeutic Intervention for Nursing Home Residents With Dementia and Depressive Symptoms.

OBJECTIVE: The purpose of this study was to conduct a randomized controlled trial of a nursing home intervention to reduce depressive symptoms in residents with dementia. METHOD: The multicomponent intervention included group activity sessions, which used question-asking-reading (QAR), reminiscence, and cognitive-behavioral therapy techniques, as well as environmental supports and individualized behavioral activity programs. Fifty-one residents from five nursing homes participated in the study. RESULTS: A significant difference in depressive symptoms was found, with residents in the QAR-Depression condition showing improvement compared with those in the treatment as usual condition. Residents in the treatment group also exhibited significantly higher levels of expressive verbalizations, engagement with materials, and laughter. Few differences in resident behavior occurring outside of the group activities were noted. DISCUSSION: Findings suggest that structured group activities can positively impact a resident's psychological well-being. In addition, the QAR structure may be suitable for older adults with cognitive impairment by distributing group tasks and providing external cognitive supports.

Levofloxacin secretion in breast milk: a case report.

OBJECTIVE: To evaluate levofloxacin secretion in human breast milk. METHODS: Breast milk was collected from a lactating woman during a 23-day period in which she received levofloxacin 500 mg/day and for 5 days after discontinuation of levofloxacin. The levofloxacin concentration was assayed by high-performance liquid chromatography. A two-compartment pharmacokinetic model was used to estimate peak and total levofloxacin exposure. RESULTS: At steady state, peak levofloxacin exposure in breast milk was 8.2 microg/ml at 5 hours after dosing. Elimination pharmacokinetics followed the anticipated pattern. CONCLUSION: Peak levofloxacin concentration in human breast milk is similar to levels attained in plasma. However, breast-feeding mothers who take levofloxacin will expose their infants to levofloxacin in concentrations below those being studied in the pediatric population.