Search

The evidence pertaining to the effects of asthma on Coronavirus disease 2019 outcomes has been unclear. To improve our understanding of the clinically important association of asthma and Coronavirus disease 2019. A matched cohort study was performed using data from the Mass General Brigham Health Care System (Boston, MA). Adult (age ≥18 years) patients with confirmed Coronavirus disease 2019 and without chronic obstructive pulmonary disease, cystic fibrosis, or interstitial lung disease between March 4, 2020 and July 2, 2020 were analyzed. Up to five non-asthma comparators were matched to each asthma patient based on age (within 5 years), sex, and date of positive test (within 7 days). The primary outcomes were hospitalization, mechanical ventilation, and death, using multivariable Cox-proportional hazards models accounting for competing risk of death, when appropriate. Patients were followed for these outcomes from diagnosis of Coronavirus disease 2019 until July 2, 2020. Among 562 asthma patients, 199 (21%) were hospitalized, 15 (3%) received mechanical ventilation, and 7 (1%) died. Among the 2686 matched comparators, 487 (18%) were hospitalized, 107 (4%) received mechanical ventilation, and 69 (3%) died. The adjusted Hazard Ratios among asthma patients were 0.99 (95% Confidence Internal 0.80, 1.22) for hospitalization, 0.69 (95% Confidence Internal 0.36, 1.29) for mechanical ventilation, and 0.30 (95% Confidence Internal 0.11, 0.80) for death. In this matched cohort study from a large Boston-based healthcare system, asthma was associated with comparable risk of hospitalization and mechanical ventilation but a lower risk of mortality. [ABSTRACT FROM AUTHOR]

The reactions do not appear related to the patient's specific excipient allergy history (e.g., docetaxel HSR patient developed reaction with mRNA vaccine), and in fact, no reactions occurred in paclitaxel HSR patients that received an mRNA COVID-19 vaccine. COVID-19 vaccines tolerated in patients with paclitaxel and docetaxel allergy Keywords: COVID; docetaxel; drug allergy; paclitaxel; PEG; SARS-CoV; vaccine allergy EN COVID docetaxel drug allergy paclitaxel PEG SARS-CoV vaccine allergy 1048 1051 4 03/02/22 20220301 NES 220301 CONFLICT OF INTEREST Dr. Blumenthal receives grant support from the NIH/NIAID K01 AI12563 and the Massachusetts General Hospital Department of Medicine Transformative Scholar Program. [Extracted from the article]

However, as such methods proved too time- and labor-intensive for large-scale allergy safety monitoring, we used a machine learning model to describe the epidemiology of allergic reactions at two academic medical centers (AMCs). Allergic reaction treatment requires prompt identification; future allergic reaction prevention requires appropriate documentation. Although healthcare-related allergic reactions to foods, drugs, and other culprits are increasing, at least a fifth of allergies are inaccurately documented or interpreted.[1] Clinicians do not routinely recognize or appropriately treat allergic reactions; even life-threatening anaphylaxis is often treated with antihistamines or corticosteroids rather than recommended intramuscular epinephrine.[2] Improving allergic reaction recognition, management, and documentation requires improved detection and system-level targeting. [Extracted from the article]

Alternative antibiotics for surgical prophylaxis are associated with increased adverse events and surgical site infection compared to cefazolin. In a sample of perioperative inpatients from 100 hospitals in the United States, cefazolin was 9-fold less likely to be used in patients with a documented β-lactam allergy whereas clindamycin was 45-fold more likely. [ABSTRACT FROM AUTHOR]

Background Having a penicillin allergy label is associated with the use of less appropriate and more expensive antibiotics and increased healthcare utilization. Penicillin allergy testing results in delabeling most allergy claimants and may be cost-saving. This study aimed to project whether penicillin allergy testing in patients reporting a penicillin allergy is cost-saving. Methods In this economic evaluation study, we built decision models to project the economic impact of 2 strategies for a patient with a penicillin allergy label: (1) perform diagnostic testing (drug challenges, with or without skin tests); and (2) do not perform diagnostic testing. The health service perspective was adopted, considering costs with penicillin allergy tests, and with hospital bed-days/outpatient visits, antibiotic use, and diagnostic testing. Twenty-four base case decision models were built, accounting for differences in the diagnostic workup, setting (inpatient vs outpatient) and geographic region. Uncertainty was explored via probabilistic sensitivity analyses. Results Penicillin allergy testing was cost-saving in all decision models built. For models assessing the performance of both skin tests and drug challenges, allergy testing resulted in average savings (in United States [US] dollars) of $657 for inpatients (US: $1444; Europe: $489) and $2746 for outpatients (US: $256; Europe: $6045). 75% of simulations obtained through probabilistic sensitivity analysis identified testing as the less costly option. Conclusions Penicillin allergy testing was projected to be cost-saving across different scenarios. These results are devised to inform guidelines, supporting the adoption of policies promoting widespread testing of patients with a penicillin allergy label. [ABSTRACT FROM AUTHOR]

Objective: To determine the potential association between physician gender and academic advancement among US rheumatologists. Methods: We performed a nationwide, cross‐sectional study of all rheumatologists practicing in the US in 2014 using a comprehensive database of all licensed physicians. Among academic rheumatologists, we estimated gender differences in faculty rank, adjusting for differences in physician age, years since residency graduation, publications, National Institutes of Health (NIH) grants, registered clinical trials, and appointment at a top 20 medical school using a multivariate logistic regression model. We also estimated gender differences in leadership positions (i.e., division director and fellowship program director). Results: Among 6,125 total practicing rheumatologists, 941 (15%) had academic faculty appointments in 2014. Women academic rheumatologists (41.4%) were younger and had completed residency more recently than men. Women had fewer total publications, publications on which they were the first or last author, and NIH grants. In fully adjusted analyses, women were less likely to be full or associate professors than men, with an adjusted odds ratio (OR) of 0.78 (95% confidence interval [95% CI] 0.62–0.99]). Women in rheumatology had similar odds as men of being a fellowship program director or division director (adjusted OR 0.99 [95% CI 0.69–1.43] and adjusted OR 0.96 [95% CI 0.66–1.41], respectively). Conclusion: Among academic rheumatologists, women are less likely than men to be full or associate professors but have similar odds of being fellowship program directors or division directors, when adjusting for several factors known to influence faculty promotion. These differences suggest barriers to academic promotion despite representation in leadership positions within rheumatology divisions. [ABSTRACT FROM AUTHOR]

Having a penicillin allergy label associates with worse healthcare outcomes and increased treatment costs.[[1], [3]] However, whether penicillin allergy testing is cost-saving remains unclear, particularly as there is heterogeneity in the practice of such testing.[4] In the public sector, our cost assessment identified skin tests costs per patient of €95.0 (€73.5 for material costs + €21.5 for personnel costs) and DPT costs of €77.0 (€11.0 for material costs + €66.0 for personnel costs). The estimates reported in this study provide unique contextual information on the need for context-based cost assessments and on when penicillin allergy testing might be cost-saving. [Extracted from the article]