Penicillin allergy SHACK : Survey of hospital and community knowledge

Aim Penicillin allergy accounts for the majority of all reported adverse drug reactions in adults and children. Foregoing first-line antibiotic therapy due to penicillin allergy label is associated with an increased prevalence of infections by resistant organisms and longer hospitalisation. Clinician awareness of allergy assessment, referral indications, management of allergy and anaphylaxis is therefore vital but globally lacking. We aim to assess the knowledge of penicillin allergy, assessment and management in Western Australian health professionals. Methods An anonymous survey was distributed to pharmacists, nurses and physicians within Western Australian paediatric and adult Hospitals, Community and General Practice. Results In total, 487/611 were completed and included in the statistical analysis. Only 62% (301/487) of respondents routinely assessed for patient medication allergies. Of those who assessed allergy, 9% (28/301) of respondents met the Australian standards for allergy assessment. Only 22% (106/487) of participants correctly cited all indications for management with adrenaline in anaphylaxis to antibiotics and 67% (197/292) of physicians rarely or never referred to an allergy service. Paediatric clinicians had an increased understanding of allergy assessment and anaphylaxis management. Recent penicillin allergy education within a 5-year period led to significant improvements in allergy knowledge. Conclusion Overall, knowledge, assessment and management of penicillin allergies among practitioners in Western Australia are currently inadequate in adults and paediatric clinicians to provide safe and effective clinical care. The implementation of a targeted education program for WA health professionals is urgently required and is expected to improve clinician knowledge and aid standardised penicillin assessment (de-labelling) practices

Geometry of integrable dynamical systems on 2-dimensional surfaces

This paper is devoted to the problem of classification, up to smooth isomorphisms or up to orbital equivalence, of smooth integrable vector fields on 2-dimensional surfaces, under some nondegeneracy conditions. The main continuous invariants involved in this classification are the left equivalence classes of period or monodromy functions, and the cohomology classes of period cocycles, which can be expressed in terms of Puiseux series. We also study the problem of Hamiltonianization of these integrable vector fields by a compatible symplectic or Poisson structure.Comment: 31 pages, 12 figures, submitted to a special issue of Acta Mathematica Vietnamic

Supercoherent States, Super K\"ahler Geometry and Geometric Quantization

Generalized coherent states provide a means of connecting square integrable representations of a semi-simple Lie group with the symplectic geometry of some of its homogeneous spaces. In the first part of the present work this point of view is extended to the supersymmetric context, through the study of the OSp(2/2) coherent states. These are explicitly constructed starting from the known abstract typical and atypical representations of osp(2/2). Their underlying geometries turn out to be those of supersymplectic OSp(2/2) homogeneous spaces. Moment maps identifying the latter with coadjoint orbits of OSp(2/2) are exhibited via Berezin's symbols. When considered within Rothstein's general paradigm, these results lead to a natural general definition of a super K\"ahler supermanifold, the supergeometry of which is determined in terms of the usual geometry of holomorphic Hermitian vector bundles over K\"ahler manifolds. In particular, the supergeometry of the above orbits is interpreted in terms of the geometry of Einstein-Hermitian vector bundles. In the second part, an extension of the full geometric quantization procedure is applied to the same coadjoint orbits. Thanks to the super K\"ahler character of the latter, this procedure leads to explicit super unitary irreducible representations of OSp(2/2) in super Hilbert spaces of $L^2$ superholomorphic sections of prequantum bundles of the Kostant type. This work lays the foundations of a program aimed at classifying Lie supergroups' coadjoint orbits and their associated irreducible representations, ultimately leading to harmonic superanalysis. For this purpose a set of consistent conventions is exhibited.Comment: 53 pages, AMS-LaTeX (or LaTeX+AMSfonts

Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS)trial

Background: In laboratory animals, exposure to most general anaesthetics leads to neurotoxicity manifested by neuronal cell death and abnormal behaviour and cognition. Some large human cohort studies have shown an association between general anaesthesia at a young age and subsequent neurodevelopmental deficits, but these studies are prone to bias. Others have found no evidence for an association. We aimed to establish whether general anaesthesia in early infancy affects neurodevelopmental outcomes. Methods: In this international, assessor-masked, equivalence, randomised, controlled trial conducted at 28 hospitals in Australia, Italy, the USA, the UK, Canada, the Netherlands, and New Zealand, we recruited infants of less than 60 weeks' postmenstrual age who were born at more than 26 weeks

Perioperative management of infant inguinal hernia surgery; a review of the recent literature

OnlinePublInguinal hernia surgery is one of the most common electively performed surgeries in infants. The common nature of inguinal hernia combined with the high-risk population involving a predominance of preterm infants makes this a particular area of interest for those concerned with their perioperative care. Despite a large volume of literature in the area of infant inguinal hernia surgery, there remains much debate amongst anesthetists, surgeons and neonatologists regarding the optimal perioperative management of these patients. The questions asked by clinicians include; when should the surgery occur, how should the surgery be performed (open or laparoscopic), how should the anesthesia be conducted, including regional versus general anesthesia and airway devices used, and what impact does anesthesia choice have on the developing brain? There is a paucity of evidence in the literature on the concerns, priorities or goals of the parents or caregivers but clearly their opinions do and should matter. In this article we review the current clinical surgical and anesthesia practice and evidence for infants undergoing inguinal hernia surgery to help clinicians answer these questions.Fiona Taverner, Prakash Krishnan, Robert Baird, Britta S. von Ungern-Sternber

Allergy alerts - The incidence of parentally reported allergies in children presenting for general anesthesia

Background and aim Pediatric patients increasingly report allergies, including allergies to food and medications. We sought to determine the incidence and, nature of parent‐reported allergies in children presenting for surgery and its significance for anesthetists. Methods We prospectively collected data on admissions through our surgical admission unit over a 2‐month period at a pediatric tertiary care teaching hospital. Data collected included patient demographics, history of atopy, with more comprehensive information collected if an allergy was reported. A clinical immunologist and an anesthetist reviewed the documentation of all patients reporting an allergy. Results We reviewed 1001 pediatric patients, 158 (15.8%) patients with parent‐reported allergies; to medications/drugs (n = 73), food (n = 66), environmental allergens (dust/grasses, n = 35), tapes/dressings (n = 27), latex (n = 4), and venom (eg, bee, wasp, n = 9). Forty‐one patients reported antibiotic allergies, with Beta‐lactam antibiotics being the most common, with the majority presenting with rash alone (57%). Ten patients reported allergies to nonsteroidal anti‐inflammatory drugs and eight to opioids. Twenty‐four patients reported egg and/or peanut allergy. Only 3/1001 (0.3%) patients were deemed to have evidence of likely IgE‐mediated drug allergy. Of the reported allergies, only 60 (38.2%) had been investigated prior, most likely to be followed up were food (53%) and environmental allergies (44.4%). Only 4/73 (5.5%) reported medication allergies had further follow‐up. Just four patients (0.4% of the entire cohort) had drug sensitivities/allergies that were likely to majorly alter anesthesia practice. Conclusion Only the minority of parent‐reported allergies in pediatric surgical patients were specialist confirmed and likely to be clinically relevant. Self‐reported food allergy is commonly specialist verified whereas reactions to medications were generally not. Over‐reporting of allergies is increasingly common and limits clinician choice of medications. Better education of patients and their families and more timely verification or dismissal of parent‐reported reactions is urgently needed