Allergic Reaction to Ketamine as Monotherapy for Procedural Sedation.

BACKGROUND: Ketamine is a cyclohexamine derivative that acts as a noncompetitive N-methyl D-aspartate receptor antagonist. Its use for procedural sedation is recommended by national clinical policy. However, its immunogenic potential is not well documented. CASE REPORT: We report a case of allergic reaction associated with the administration of intravenous ketamine for procedural sedation in a 16-year-old male. Minutes after administration, the patient developed a morbilliform, erythematous rash that extended to the upper and lower torso and resolved with intravenous diphenhydramine. It is most likely that this allergic reaction was caused by a ketamine-induced histamine release that has been described in vitro. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This is the first case report in which ketamine was used as monotherapy in the emergency department for the facilitation of procedural sedation that resulted in an allergic reaction. Supportive measures, including advanced airway procedures and hemodynamic support, may be necessary in more severe anaphylactic cases. Providers should be aware of this potential adverse effect when using ketamine for procedural sedation.

Effect of Pharmacy Involvement in Transitions of Care for Children With Medical Complexity.

OBJECTIVE: The purpose of this study is to evaluate the effects of pharmacy integration into care transitions for children with medical complexity. These children are at a higher risk for medication errors and adverse effects because of their complex medication regimens. In addition, care transitions increase the risk for medication errors, especially during hospital-to-home transitions. METHODS: This was a retrospective chart review of patients enrolled in a complex care clinic who were discharged between September 1, 2021, and December 31, 2021, and who had received a discharge medication evaluation. Intervention categories were predetermined (medication reconciliation and clinical interventions) and documented. The primary outcome was to quantify and characterize the types of interventions made by the pharmacist. Descriptive statistics were used for data analysis. Continuous data were analyzed using Wilcoxon rank sum test, and correlation was measured using Spearman correlation values. RESULTS: A total of 92 clinic encounters for 60 patients were included, with a median patient age of 7 years (IQR, 5-12.3), median length of stay of 3.2 days (IQR, 1.2-5.7), and a median number of 18 discharge medications (IQR, 14.8-25). A total of 283 interventions were made, consisting of 192 (68%) clinical interventions and 91 (32%) medication reconciliation interventions. In addition, 82 (89%) of the clinic encounters had at least one pharmacist intervention. CONCLUSIONS: Pharmacist evaluation of a patient's discharge medication regimen clarifies and better optimizes the patient's medication regimen.

Evaluation of a Structured Onboarding Process and Tool for Faculty Members in a School of Pharmacy.

Objective. To develop and assess the usefulness of a structured onboarding process and tool at a school of pharmacy to improve the overall onboarding experience for new faculty members. Methods. An assessment of a previously existing, informal onboarding process was conducted from January 1 to February 28, 2017. A structured onboarding tool was developed based on interviews with nine recently hired faculty members regarding their experiences with this legacy, unstructured onboarding process. Nine faculty members who onboarded while the legacy onboarding process was in place and six faculty members who onboarded after the new, onboarding tool was in place were included in the study. The experience of the pre-tool cohort was compared to that of the post-tool cohort. Results. More positive responses in the post-tool cohort were obtained compared to the pre-tool cohort in regard to timeline, expectations, and mentorship. More negative responses for the post-tool group were observed for communication. Overall utility of the onboarding tool changed from 56% (pre-tool group) to 80% (post-tool group). Free text feedback included recommendations to rearrange tasks throughout the onboarding process; clarifying mentor responsibilities and expectations; and providing an overview of the checklist to new faculty members on day 1. Conclusion. Overall, a structured onboarding process tool improved the onboarding experience for new faculty members. Given the lack of literature regarding a structured onboarding process in the academic setting, further refinement and analysis of the onboarding tool is needed.

Evidence of natural hybridization among homothallic members of the basidiomycete Armillaria mellea sensu stricto.

Populations of Armillaria mellea (Basidiomycota, Agaricales) across much of its range are heterothallic; homothallic populations occur only in Africa (A. mellea ssp. africana), China (China Biological Species CBS G), and Japan (A. mellea ssp. nipponica). Monosporous isolates of heterothallic A. mellea are haploid and their mating behaviour is consistent with the requirement of two different alleles at two mating-type loci (tetrapolar mating system) to create a diploid individual. In contrast, monosporous isolates of homothallic A. mellea are putatively diploid; they bypass the haploid phase by undergoing karyogamy in the basidium (a unique type of secondary homothallism/pseudohomothallism). In order to determine the genetic origin of this homothallism, we analyzed genetic variation of 47 heterothallic isolates from China, Europe, and North America, and 14 homothallic isolates from Africa, China, and Japan. Gene trees and mutational networks were constructed for partial mitochondrial gene ATP synthase subunit 6 (ATP6) and for the following nuclear genes: actin (ACTIN), elongation factor subunit 1-alpha (EFA), glyceraldehyde 3-phosphate dehydrogenase (GPD), and the RNA polymerase subunit II (RPB2). Homothallic isolates from Africa and Japan shared a common mitochondrial ATP6 haplotype with homothallic isolates from China, and are likely introductions. Homothallic isolates from China that shared a common mitochondrial haplotype with all European isolates did not share European nuclear haplotypes, as revealed by median-joining networks, but instead clustered with haplotypes from China or were intermediate between those of China and Europe. Such mitochondrial-nuclear discordance in homothallic isolates from China is indicative of hybridization between lineages originating from China and Europe.