ABSTRACT
BACKGROUND: A documented penicillin allergy is associated with increased morbidity including length of hospital stay and an increased incidence of resistant infections attributed to use of broader-spectrum antibiotics. The aim of the systematic review was to identify whether inpatient penicillin allergy testing affected clinical outcomes during hospitalization. METHODS: We performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library over the past 20 years. Inpatients having a documented penicillin allergy that underwent penicillin allergy testing were included. RESULTS: Twenty-four studies met eligibility criteria. Study sample size was between 24 and 252 patients in exclusively inpatient cohorts. Penicillin skin testing (PST) with or without oral amoxicillin challenge was the main intervention described (18 studies). The population-weighted mean for a negative PST was 95.1% [CI 93.8-96.1]. Inpatient penicillin allergy testing led to a change in antibiotic selection that was greater in the intensive care unit (77.97% [CI 72.0-83.1] vs 54.73% [CI 51.2-58.2], P<.01). An increased prescription of penicillin (range 9.9%-49%) and cephalosporin (range 10.7%-48%) antibiotics was reported. Vancomycin and fluoroquinolone use was decreased. Inpatient penicillin allergy testing was associated with decreased healthcare cost in four studies. CONCLUSIONS: Inpatient penicillin allergy testing is safe and effective in ruling out penicillin allergy. The rate of negative tests is comparable to outpatient and perioperative data. Patients with a documented penicillin allergy who require penicillin should be tested during hospitalization given its benefit for individual patient outcomes and antibiotic stewardship.
Subject(s)
Drug Hypersensitivity/diagnosis , Penicillins/adverse effects , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/immunology , Drug Hypersensitivity/epidemiology , Health Care Costs , Humans , Inpatients , Penicillins/economics , Predictive Value of Tests , Treatment OutcomeABSTRACT
We contrasted a sample of children and adolescents with affective disorders and mental retardation with a comparison group on behavioral symptoms, associated diagnoses, and psychopharmacologic treatment. Fifty consecutive patients with both impaired intellectual functioning and at least one affective disorder admitted to a psychiatric inpatient unit for children and adolescents with developmental disabilities and psychiatric disorders were matched to a group of 50 inpatients without depression. Behavioral symptoms such as suicidal ideation or gestures, crying, irritability, sleep problems, agitation, mood lability, and social withdrawal/isolation occurred significantly more often in the affective group than in the comparison group. Aggression, however, was the most frequent behavior concern for both groups, whereas disruption/destruction was identified significantly more often in the comparison group. Regarding Axis I diagnoses, the comparison group was more often identified with externalizing disorders (ADHD, ODD), though there was a high rate of comorbidity in the affective disorder group. The behavioral symptoms used to diagnosis normally developing children and adolescents appear to be applied in making affective disorders diagnoses in this sample of children and adolescents with mental retardation.
Subject(s)
Hospitalization , Intellectual Disability/psychology , Mood Disorders/psychology , Adolescent , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/psychology , Bipolar Disorder/diagnosis , Bipolar Disorder/psychology , Child , Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Comorbidity , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Female , Humans , Intellectual Disability/diagnosis , Internal-External Control , Male , Mood Disorders/diagnosis , Psychiatric Status Rating Scales , Retrospective StudiesABSTRACT
Describes the types of psychiatric and behavioral disturbance present in 169 preschoolers with developmental disabilities admitted to a specialized psychiatric inpatient unit. Differences in the proportion of some diagnoses and behavior problems across cognitive functioning level and across age were found. Seventy-two percent of the sample had one or more medical diagnosis. Similarities and differences with earlier reports in the literature are discussed.
Subject(s)
Child Behavior Disorders/epidemiology , Intellectual Disability/epidemiology , Mental Disorders/epidemiology , Patient Admission/statistics & numerical data , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Attention Deficit Disorder with Hyperactivity/psychology , Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Child, Preschool , Comorbidity , Female , Humans , Intellectual Disability/diagnosis , Intellectual Disability/psychology , Intelligence , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Pennsylvania/epidemiology , Psychiatric Department, HospitalABSTRACT
Using a combination of an alternating treatment and double-blind placebo-controlled drug design, the independent and combined effects of two behavioral interventions and two doses of methylphenidate (MPH) in 3 children with Attention Deficit Hyperactivity Disorder (ADHD) and mental retardation (MR) were assessed. In this single subject design, 2 of the 3 subjects responded positively to medication as measured by increased on-task behavior. The first behavioral intervention, a token economy for on-task behavior, was ineffective for increasing either on-task behavior or work accuracy when combined with placebo. However, improvement in work accuracy was realized with implementation of a second behavioral intervention that specifically targeted accuracy independent of drug conditions. The current findings highlight both the positive effects and limitations of the two commonly used treatment modalities for ADHD. Future studies should continue to extend this area of investigative efforts to produce more data-based knowledge as to the appropriate doses of treatment, both pharmacological and behavioral, with children with both ADHD and mental retardation.
