Beta-Lactam Allergy De-labeling in a Pediatric Hospital.

OBJECTIVE: To assess the ability to de-label pediatric patients of their beta-lactam allergy by using a newly implemented institutional protocol and to identify potential barriers to the de-labeling process. METHODS: All patients with reported allergies to prespecified beta-lactam antibiotics were eligible for a -beta-lactam allergy interview. Following the interview, patients were grouped into 4 risk categories-no risk, low risk, moderate risk, and high risk-and assessed for intervention eligibility. Potential interventions included de-labeling based on the interview alone or proceeding to an oral amoxicillin challenge with or without penicillin allergy skin testing. RESULTS: Of the 62 patients eligible for beta-lactam allergy interviews, 40% (n = 25) were de-labeled. Among de-labeled patients, 60% (n = 15) were de-labeled on the basis of the interview alone. Additionally, no failures were documented in patients who underwent an oral amoxicillin challenge or penicillin skin testing. Barriers to performing oral amoxicillin challenges or penicillin skin testing included concomitant systemic steroid or antihistamine use, refusal of intervention, and insufficient resources to perform penicillin skin testing. CONCLUSIONS: There was a high frequency of patients de-labeled of their beta-lactam allergies in this study. Increased education to patients, parents, and providers on the de-labeling process, as well as increased personnel available to coordinate and perform de-labeling interventions, may result in more beta-lactam allergy de-labeling.

American Indian Perspectives on Culturally Aligning a Digital Smoking Cessation Resource.

INTRODUCTION: Innovative smoking cessation approaches that overcome barriers such as traveling to program site or that require the staff and infrastructure for sustaining are likely needed to improve smoking quit rates among American Indian (AI) peoples in the United States. In this study, qualitative methods identified recommendations from AI peoples to guide alignment of an evidence-based smoking cessation smartphone app (i.e., QuitGuide) to the culture and needs of AI persons. METHODS: Semi-structured interviews were conducted with AI adults who smoke (n = 40) and with public health professionals (n = 6). Questions included: "The app asks if something triggered you to slip and lists several options. What options were you expecting to see on this list?" as well as how to make the app more engaging such as "What would make the app more helpful for AI peoples, like you, who want to quit smoking?." Constant comparative techniques were used to develop codes and themes. RESULTS: Loss, grief, and not accessing traditional tobacco were put forward as smoking triggers to be addressed in the app. Features that help users connect with and learn about AI cultures and promote healing, such as encouraging traditional tobacco use, being in community, embracing Native spirituality, and participating in cultural crafting were recommended. Some noted the need to motivate AI peoples to think about legacy and ability to care for younger generations and Indigenizing the app with Native imagery. CONCLUSIONS: Themes pointed towards promotion of strengths-based factors, such as healing, cultural connectedness and traditional tobacco use, in the app. IMPLICATIONS: Results will be used to culturally align a smartphone app for smoking cessation among AI peoples and may be insightful for other tribal, federal, and state public health efforts aimed at advancing health equity for AI peoples.

Implementation of a pharmacy residency wellness program: Impact on burnout and mindfulness and lessons learned.

BACKGROUND AND PURPOSE: Attention to wellness in the pharmacy workplace is occurring. To maintain accreditation, pharmacy residency programs must incorporate wellness and resilience initiatives. EDUCATIONAL ACTIVITY AND SETTING: Orlando Health created a pharmacy residency wellness program for post-graduate year one (PGY-1) and post-graduate year two (PGY-2) pharmacy residents to address wellness and burnout. The wellness program included assignment of a mentor, development of a personal wellness plan, completion of monthly reflections, and wellness and resiliency training. FINDINGS: Pharmacy residents anonymously completed the Oldenburg Burnout Inventory (OLBI) and Mindful Attention Awareness Scale (MAAS) at the beginning and end of the residency year. A total of nine pharmacy residents were eligible to participate in the wellness program. Eight residents completed the pre-survey, and seven residents completed the post-survey. No change was observed in the overall median OLBI score (pre-program = 35 [IQR 31.5-37.3] and post-program = 36 [IQR 31-37.5]; P = .683). Similar results were found on the OLBI for disengagement and exhaustion, correlating with low burnout risk. There was no change in the overall median MAAS score (pre-program = 3.7 [IQR 3.6-4.1] and post-program = 3.8 [IQR 3.5-3.9]; P = 1.000). Overall, feedback from the pharmacy residents after program completion was positive. SUMMARY: Pharmacy residents participating in the wellness program at our institution had low risk for burnout and a high level of mindfulness pre- and post-program completion. Pharmacy residents enjoyed participating in the wellness program and found the program to be valuable, supporting its continued implementation.

Escaping the Prison of Mind: Meditation as Violence Prevention for the Incarcerated.

People in prison are disproportionately affected by health problems, some of which lead to imprisonment and some of which are caused by imprisonment. Mental illness and substance use disorders fall into both of these categories, but they are not the only ailments affiliated with incarceration. Prior to their incarceration, many people in prison did not have safe housing or stable employment and job security, and institutional policies and/or budgetary concerns prevent many inmates from receiving adequate health care while in prison. Prison inmates in the United States are both victims and perpetrators of violence while incarcerated. In all cases, acts of violence have negative psychological consequences for the victim, including depression and shame. Mindfulness meditation training for prison inmates might be among the most effective of interventions, helping to prevent violence, improve quality of life, and reduce recidivism. Research and evaluation of data suggest that mindfulness-based nonviolence programs are transferable to other inmate populations, and the author recommends that both the private and public prison systems implement such programs nationwide, with the support of state and federal governments.