Perioperative cefazolin prescribing rates following suppression of alerts for non-IgE-mediated penicillin allergies.

Background: Cefazolin is the preferred antimicrobial for the prevention of surgical site infections (SSIs) in many procedures. The presence of penicillin allergies can influence prescribing of alternative agents like vancomycin. In April 2022, Nebraska Medicine implemented a suppression of alerts for non-IgE-mediated and nonsevere penicillin allergies in the electronic medical record (EMR) upon cephalosporin prescribing.

Infections including SARS-CoV-2 as triggers for vocal cord dysfunction.

Vocal cord dysfunction (VCD) is often under-recognized and/or misdiagnosed as asthma. Although post-viral syndrome has been suggested as a contributing factor in VCD, there is limited data on infection-associated VCD. The purpose of this study was to assess and describe the proportion of patients who were diagnosed with VCD who did and did not report infection preceding VCD diagnosis.

Expansion of distinct peripheral blood myeloid cell subpopulations in patients with rheumatoid arthritis-associated interstitial lung disease.

Objectives: Interstitial lung disease (ILD) is associated with significant mortality in rheumatoid arthritis (RA) patients with key cellular players remaining largely unknown. This study aimed to characterize inflammatory and myeloid derived suppressor cell (MDSC) subpopulations in RA-ILD as compared to RA, idiopathic pulmonary fibrosis (IPF) without autoimmunity, and controls.

Methods: Peripheral blood was collected from patients with RA, RA-ILD, IPF, and controls (N = 60, 15/cohort).

Use of a beta-lactam graded challenge process for inpatients with self-reported penicillin allergies at an academic medical center.

Background: The Antimicrobial Stewardship Program (ASP) at Nebraska Medicine collaborated with a board-certified allergist to develop a penicillin allergy guidance document for treating inpatients with self-reported allergy. This guidance contains an algorithm for evaluating and safely challenging penicillin-allergic patients with beta-lactams without inpatient allergy consults being available.

Methods: Following multi-disciplinary review, an order set for beta-lactam graded challenges (GC) was implemented in 2018.

Intrapartum antibiotic exposure for group B Streptococcus treatment did not increase penicillin allergy in children.

Background: Group B Streptococcus (GBS) is the leading infectious cause of neonatal morbidity and mortality in the United States. Intrapartum administration of antibiotics to mothers with positivity to GBS is performed for prevention, with penicillin being the drug of choice. Previous studies have noted an increase in atopic diseases other than drug allergy associated with intrapartum antibiotic exposure.

Effects of secondhand smoke exposure on asthma morbidity and health care utilization in children: a systematic review and meta-analysis.

Background: Secondhand smoke (SHS) exposure can trigger asthma exacerbations in children. Different studies have linked increased asthma symptoms, health care use, and deaths in children exposed to SHS, but the risk has not been quantified uniformly across studies.

Objective: To perform a systematic review and meta-analysis to evaluate and quantify asthma severity and health care use from SHS exposure in children.

Asthma-associated comorbidities in children with and without secondhand smoke exposure.

Background: Secondhand smoke (SHS) exposure is known to trigger asthma, but asthma disease severity and comorbidities in children exposed to SHS are not very well quantified.

Objective: To identify comorbidities and understand health care usage in children with asthma exposed to SHS (cases) compared with children with asthma but without SHS exposure (controls).

Methods: A retrospective nested matched case-and-control study was conducted with children 5 to 18 years old who were enrolled in the Pediatric Asthma Management Program.

A Clinical Process Change and Educational Intervention to Reduce the Use of Unnecessary Preoperative Tests.

Background: Internal medicine residents receive limited training on how to be good stewards of health care dollars while preserving high-quality care.

Intervention: We implemented a clinical process change and an educational intervention focused on the appropriate use of preoperative diagnostic testing by residents at a Veterans Administration (VA) medical center.

Methods: The clinical process change consisted of reducing routine ordering of preoperative tests in the absence of specific indications.

Burden of chronic obstructive pulmonary disease: healthcare costs and beyond.

Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating respiratory condition that leads to significant burden, both medically and financially. It affects millions of people worldwide and causes significant morbidity and mortality. Most detailed information related to its prevalence, morbidity, and mortality comes from high-income countries, but 90% of COPD-related deaths occur in low- and middle-income countries.