Evaluation of a pharmacist-led penicillin allergy testing service in a community health system.

BACKGROUND: Roughly 10% of the U.S. population has a documented penicillin (PCN) allergy. Among these individuals, over 95% are able to tolerate PCNs. The inability to use PCNs can result in suboptimal outcomes. In August 2019, Lawrence Memorial Hospital Health System implemented a pharmacist-led PCN allergy testing service to assist with delabeling PCN allergies and increase access to this class of antibiotics. OBJECTIVES: The primary objective was to describe the number of patients who underwent PCN allergy testing and were delabeled from PCN allergy. A secondary objective was to report the number of patients who received and tolerated PCN antibiotics after being delabeled from PCN allergy. METHODS: This retrospective chart review was conducted during the initial 17 months of a pharmacist-led PCN allergy testing service. Eligible patients with a history of an immunoglobulin E (IgE)-mediated reaction underwent a 3-step test that consisted of a scratch test, an intradermal test, and an oral challenge. Eligible patients who did not have a history of IgE-mediated reaction underwent a 2-step graded oral challenge. Descriptive statistics were used for data analysis. RESULTS: Between August 2019 and January 2022, 70 patients underwent testing, and 66 patients were delabeled from PCN allergy. Four patients who underwent the 3-step test developed reactions of mild to moderate severity. All patients who underwent the graded oral challenge were delabeled from PCN allergy. The rate of PCN allergy was 5.7%, whereas the rate of type I IgE-mediated reaction was 1.4%. All 23 patients who received an antibiotic from the PCN class after a negative allergy test tolerated the PCN antibiotic without an incident. CONCLUSION: PCN allergy testing is an effective way to delabel PCN allergies from most patients presenting with a PCN allergy history. Skin testing followed by an oral challenge or a graded oral challenge alone are safe methods for conducting PCN allergy testing in the primary care setting.

The virtual infertility community: a qualitative analysis of patient experiences shared on Instagram.

PURPOSE: To characterize the experiences of patients undergoing in vitro fertilization (IVF) through a qualitative analysis of content shared on Instagram. METHODS: We analyzed Instagram posts from five randomly selected days in February 2020. The hashtag, #ivfcommunity, was selected to identify public posts authored by Instagram's IVF community members from multiple treatment centers. Text, photos, hashtags, and emojis were collected from 452 included posts and entered into a study-specific database. Using thematic coding, a four-member team initially coded the first day in February. Common themes were agreed upon by all team members, and a preliminary codebook was created for further analysis. The remaining posts were coded by two-member teams who reached a consensus on the multiple themes assigned to each individual post. RESULTS: Analysis of posts led to the identification of five major themes: documentation of the medical and physical experience of IVF (76.1%), the emotional spectrum (43.1%), social support (49.2%), coping mechanisms (29.9%), and education (receipt, provision) (11.1%). CONCLUSION: Our findings suggest that women undergoing IVF often utilize social media to document daily experiences, offer and recognize sources of community support, and provide and receive education regarding their treatments. Given the increased prevalence of mental health conditions, medical providers should explore challenges discussed on online platforms and consider harnessing the supportive nature of online communities to supplement care for IVF patients.

Racial differences in hypertensive disorders in pregnancy during the COVID-19 pandemic.

OBJECTIVE: To compare rates of pregnancy induced hypertensive disorders during the period of the COVID-19 pandemic to prior, baseline years. METHODS: We conducted a retrospective study of 17,742 patients on rates for pregnancy induced hypertensive disorders delivering at 2 local hospitals before (Cohort 1; January 2018 to December 2019; n = 8245) and after (Cohort 2; February 2020 to February 2022; n = 9497) the onset of the COVID-19 pandemic. The primary outcomes were rates of gestational hypertension, pre-eclampsia, and chronic hypertension in patients.Wecompared by year (2018-2022), by patient COVID infection status, and by racial demographics. RESULTS: During the pandemic (Cohort 2), there were lower rates of chronic hypertension (7.4 % vs 6.5 %, p =.02), higher rates of gestational hypertension (26.3 % vs 27.8 %, p =.03), and higher rates of preeclampsia (11.3 % vs 13.1 %, p <.001) compared to years prior to the pandemic (Cohort 1). When evaluating by year, rates of chronic hypertension did not statistically change while rates for preeclampsia increased in the first year of the pandemic and remained high, and rates for gestational hypertension did not increase until the second year of the pandemic. When evaluating by COVID infection status, rates for gestational hypertension were significantly higher for individuals with a positive COVID infection status (COVID negative = 27.4 % vs. COVID positive = 32.8 %; p <.004). Rates of preeclampsia did not differ according to COVID infection status (p = 0.15). CONCLUSION: In this study, rates of pregnancy induced hypertensive disorders increased during the COVID pandemic regardless of COVID infection status.

Trends in Social Media Topics During COVID-19 Among Women Undergoing Assisted Reproductive Technology Treatments.

Patients undergoing fertility treatments, such as in-vitro fertilization (IVF), face unique challenges both physically and mentally. With the emergence of the COVID-19 global pandemic, IVF patients began to face additional obstacles as hospitals and clinics shut down in compliance with recommendations for limiting exposure risk. In order to assess the impact of COVID-19 on IVF patients, we conducted a qualitative analysis using 563 public Instagram posts collected from three randomly selected days in March 2020. After the exclusion of 354 posts, thematic coding was used to analyze 209 posts. Five major themes were identified including (1) the medical and physical experience of IVF, (2) emotional spectrum, (3) sources of social support, (4) coping mechanisms, and (5) education on social media. Posts were categorized based on whether COVID-19 was discussed and theme frequencies were compared. The majority of patients impacted by the pandemic discussed setbacks to care, such as clinic closures. In addition, posts authored by those impacted by COVID-19 contained more negative emotions and fewer positive emotions compared to unaffected users. Despite an increase in setbacks and negative emotions, posts offering support nearly tripled in frequency highlighting the resilience of the IVF community. Our thematic analysis supports the need for careful consideration of the psychological and social effects of cycle cancellations on the IVF community. Experiences and sentiments revealed by this study should be considered when a successive pandemic or global emergency threatens IVF treatment protocols.