Metal hypersensitivity screening among frontline healthcare workers-A descriptive study.

AIMS AND OBJECTIVES: The study aims were to (a) assess allergy screening practices, (b) determine the awareness of metal hypersensitivity among frontline healthcare workers and (c) examine perceived barriers to implementing metal hypersensitivity screening into clinical practice. BACKGROUND: Adverse device-related events, such as hypersensitivity to metals, are well documented in the literature. Hypersensitivity to metal is a type IV T-cell-mediated reaction that can occur after cardiac, orthopaedic, dental, gynaecological and neurosurgical procedures where a device with metal components is implanted into the body. Patients with hypersensitivity to metal are likely to experience delayed healing, implant failure and stent restenosis. Identifying patients with a history of metal hypersensitivity reaction could mitigate the risk of poor outcomes following device implant. Yet in clinical practice, healthcare workers do not routinely ask about the history of metal hypersensitivity when documenting allergies. The existing literature does not report why this is not included in allergy assessment. DESIGN: Following the STROBE checklist, a cross-sectional, descriptive study was conducted. METHODS: Frontline healthcare workers were recruited using professional contacts and social online media to complete an online questionnaire. Quantitative data were summarised descriptively while thematic analysis was used to examine barriers to implementation. RESULTS: Three hundred forty-five participants from 14 countries completed the questionnaire, with the majority (187/54%) practicing in Canada, in general medicine and intensive care units. Ninety per cent of the participants did not routinely ask about metal hypersensitivity when evaluating allergy history. Of the respondents, 86% were unaware of the association between metal hypersensitivity and poor patient outcomes. After presented with the evidence, 81% indicated they were likely or very likely to incorporate the evidence into their clinical practice. Common themes about barriers to implementing were 'Standards of Practice', 'Knowledge' and 'Futility of Screening'. CONCLUSION: The findings suggest lack of awareness as the main reason for not including metal in routine allergy assessment.

Living with a Severe Allergy: Lived Perspectives from Swedish Adolescents and their Parents.

BACKGROUND: During adolescence, the young person should gradually develop independence from his or her parents. However, having a chronic disease like a severe allergy may add stress and challenges beyond normal development and involves a struggle between adapting socially, feeling healthy, and managing the disease. OBJECTIVE: To describe experiences of living with a severe allergy from the perspective of adolescents and their parents. METHOD: A qualitative study with six focus group interviews were performed, two with adolescents and four with their parents (10 adolescents, 10-16 years old and 21 parents). The transcribed data were analyzed using systematic text condensation. RESULT: Four themes emerged: Feeling different (adolescents and parents), shift in responsibility (adolescents and parents), the importance of parents (only adolescents) and the importance of healthcare providers (only parents). The adolescents relied on their parents, while also taking responsibility for managing their disease. The parents expressed a need to protect their children; but they did not seem to be aware of the responsibility their children took. The parents highlighted the importance of support from healthcare providers but this was not mentioned by the adolescents. CONCLUSION: This study showed that both the adolescents and their parents stated that they took responsibility for managing the disease, but in different ways. For healthcare providers, this needs to be taken into account in order to support both adolescents and parents for self-management and shift in responsibilities which begins during adolescents.

Venous Flare Reactions: A Case Report of Reactions Following Etoposide Infusion.

Venous flare reaction, a localized allergic response associated with the administration of an irritant, is one of the most common chemotherapy infusion-related reactions. Etoposide, a drug commonly used in patients with lung cancer, has been reported to be an irritant with vesicant properties depending on the volume administered. This article presents the case of a patient who has a venous flare reaction immediately following the administration of etoposide for the treatment of diffuse large B-cell lymphoma. Managing such complications is crucial to maintaining patient safety. Proper training and education should be incorporated into nursing practice when identifying, preventing, and managing such reactions.

RELIABLE ALLERGY RESOURCES.

Allergic conditions now affect 20% of the Australian population (Mullins et al. 2015). This means that nurses in different clinical practice fields will be involved in involved in caring for patients who may also have an allergic condition.

A Universal Anaphylaxis Emergency Care Plan: Introducing the New Allergy and Anaphylaxis Care Plan From the American Academy of Pediatrics.

Anaphylaxis is a life-threatening emergency. In the school setting, school nurses prepare plans to prevent an emergency, educating staff and students on life-threatening allergies. A critical component of any emergency plan is a plan of care in the event of accidental ingestion or exposure to an antigen to prevent the sequelae of untreated anaphylaxis. A universal anaphylaxis emergency care plan developed by the American Academy of Pediatrics and reviewed by NASN offers an opportunity for schools, family, and health care providers to use one standard plan and avoid confusion. The plan and benefits of use are described in this article.

'A voice for young people'.

What does your role involve? I run nurse-led asthma and allergy clinics as well as leading and developing clinical practice, and undertaking clinical research. My strategic work involves supporting and implementing the children and young person priorities and prevention agenda.

Living ordinary family life with an allergic child-the mother's perspective.

Ecocultural theory considering family as an entity may serve as a new point of view instead of "impact of disease"-perspective. Aims were to reveal ecocultural themes and activities of daily routines in the treatment of a child's food allergy and eczema. Interviews (N=24) were held with mothers with allergic children aged 12 months and mothers repeat interviews at 24 months. The theme; "living an ordinary family life", was implemented across the family activities of routines essential for treating the child's allergy. New or altered treatment regimens can be tailored to families on the basis of existing activities.

Effects of Leukoreduction and Premedication With Acetaminophen and Diphenhydramine in Minimizing Febrile Nonhemolytic Transfusion Reactions and Allergic Transfusion Reactions During and After Blood Product Administration: A Literature Review With Recommendations for Practice.

Transfusion-related reactions cause unwanted interruptions in blood-product administration and potential complications for patients. The most common reactions are febrile nonhemolytic transfusion reactions (FNHTRs) and allergic transfusion reactions (ATRs). The presence of leukocytes in blood products has been associated with these reactions, and efficacy of leukoreduction in minimizing FNHTRs and ATRs has recently been investigated. In addition, premedication with acetaminophen and diphenhydramine is the most widely used practice in minimizing FNHTRs and ATRs, yet the benefit of this is not supported by research. The aim of this systematic literature review was to evaluate the potential benefits of both of these interventions in minimizing FNHTRs and ATRs and provide recommendations for practice. We found moderate quality evidence with strong recommendations for the practice of leukoreduction in minimizing FNHTRs but not ATRs. We did not find evidence to support the use of premedications in minimizing transfusion-related reactions, and we question the need for this practice in settings where leukoreduction is used.

Description of a school nurse visit syndromic surveillance system and comparison to emergency department visits, New York City.

OBJECTIVES: We compared school nurse visit syndromic surveillance system data to emergency department (ED) visit data for monitoring illness in New York City schoolchildren. METHODS: School nurse visit data recorded in an electronic health record system are used to conduct daily surveillance of influenza-like illness, fever-flu, allergy, asthma, diarrhea, and vomiting syndromes. We calculated correlation coefficients to compare the percentage of syndrome visits to the school nurse and ED for children aged 5 to 14 years, from September 2006 to June 2011. RESULTS: Trends in influenza-like illness correlated significantly (correlation coefficient = 0.89; P < .001) and 72% of school signals occurred on days that ED signaled. Trends in allergy (correlation coefficient = 0.73; P < .001) and asthma (correlation coefficient = 0.56; P < .001) also correlated and school signals overlapped with ED signals on 95% and 51% of days, respectively. Substantial daily variation in diarrhea and vomiting visits limited our ability to make comparisons. CONCLUSIONS: Compared with ED syndromic surveillance, the school nurse system identified similar trends in influenza-like illness, allergy, and asthma syndromes. Public health practitioners without school-based surveillance may be able to use age-specific analyses of ED syndromic surveillance data to monitor illness in schoolchildren.

For your information. Management in the school setting: position statement.

It is the position of the National Association of School Nurses (NASN) that the safe and effective management of allergies and anaphylaxis in schools requires a collaborative, multidisciplinary team approach. The registered professional school nurse (hereinafter referred to as the school nurse) is the leader in a comprehensive management approach that includes planning and coordination of care, educating staff, providing a safe environment, and ensuring prompt emergency response should exposure to a life-threatening allergen occur. Furthermore, NASN supports, in states where laws and regulations allow, the maintenance of stock nonpatient-specific epinephrine and physician-standing orders for school nurses to administer epinephrine in life-threatening situations in the school setting. School districts must have a clear, concise, all-inclusive policy in place to address the management of allergies in the school setting that should be reviewed annually (National School Boards Association [NSBA], 2012). This policy shall be consistent with federal and state laws, nursing practice standards, and established safe practices in accordance with evidence-based information and include development of a developmentally appropriate Individualized Healthcare Plan (IHP) and Emergency Care Plan (ECP).

Recognising and managing allergic disease in the community.

Allergic disease and its symptoms, whether seasonal or perennial, can have a significant impact on individuals' quality of life. Asthma, allergic rhinitis, eczema, urticaria and food allergy are among the common allergies that nurses may encounter in the community. This article discusses the causes of allergic disease, the importance of considering allergen avoidance, and the alternative treatment options available.

"I want to meet other kids like me": support needs of children with asthma and allergies.

CONTEXT: Asthma is the most common chronic illness of childhood and the leading cause of hospitalization in young children. Asthma negatively impacts physical health, psychosocial wellbeing, and quality of life for affected children but the psychosocial support needs of children with asthma and severe have not been studied from their point of view. OBJECTIVE: The objective of this study was to assess the support and education needs and preferred interventions of allergic children with asthma and/or severe allergies. METHODS: Qualitative constant comparative content analysis was used to identify major themes from semi-structured individual interviews with 20 children with asthma and allergies and 35 parents. FINDINGS: Children expressed frustration with the limitations imposed by asthma and allergies on their regular activities and normal lives. Parents believed that peer support--someone to whom their child could relate as a role model--could improve both their children's and their own coping. CONCLUSIONS: Parents and children preferred a combination of in-person meetings and Internet support to enhance the capacity of children, reduce children's anxiety, increase their self-care skills, and self-confidence. In addition they believed a support intervention was a stepping stone to developing a community of support for children with asthma, allergies, and anaphylaxis.