An educational intervention about the classification of penicillin allergies: effect on the appropriate choice of antibiotic therapy in pregnant women.

BACKGROUND: Most pregnant women who self-report penicillin allergy are not truly penicillin-allergic and this misunderstanding often leads to administration of inappropriate antibiotic therapy. Decision algorithms have been developed to guide antibiotic selection but major discrepancies have been reported between guidelines and clinical practice. We aimed to optimize the prescription of antibiotics for pregnant women who self-reported penicillin allergy, using an educational intervention about the classification of penicillin allergies that targeted gynecologists, anesthesiologists and midwives. METHODS: This quasi-experimental study assessed the effect of an educational intervention about the classification of penicillin allergy. For six months, a combination of two strategies was used, namely dissemination of printed educational materials and group education. The principal study endpoint was the appropriateness of the antibiotic therapy, defined in advance for each level of allergic risk. RESULTS: The pre-intervention phase included 903 women; one year after its conclusion, the post-intervention phase began and included 892 women. The prevalence of self-reported penicillin allergy was stable over the two periods (6.8% before vs 5.4% after, P=0.24). The clinical classification of penicillin allergies was more often used after the educational intervention (68% vs 100%, P<0.001). The appropriateness of the antibiotic therapy prescribed to self-reported penicillin allergic-women increased significantly between the two periods, from 5/29 (17.2%) to 18/27 (66.7%, P<0.001). CONCLUSION: An educational intervention about penicillin allergy classification was associated with an improvement in the choice of appropriate antibiotic therapy among women who had reported penicillin allergy.

Thermo-mechanical analysis of ITER first mirrors and its use for the ITER equatorial visible∕infrared wide angle viewing system optical design.

ITER first mirrors (FMs), as the first components of most ITER optical diagnostics, will be exposed to high plasma radiation flux and neutron load. To reduce the FMs heating and optical surface deformation induced during ITER operation, the use of relevant materials and cooling system are foreseen. The calculations led on different materials and FMs designs and geometries (100 mm and 200 mm) show that the use of CuCrZr and TZM, and a complex integrated cooling system can limit efficiently the FMs heating and reduce their optical surface deformation under plasma radiation flux and neutron load. These investigations were used to evaluate, for the ITER equatorial port visible∕infrared wide angle viewing system, the impact of the FMs properties change during operation on the instrument main optical performances. The results obtained are presented and discussed.

Engineering and manufacturing of ITER first mirror mock-ups.

Most of the ITER optical diagnostics aiming at viewing and monitoring plasma facing components will use in-vessel metallic mirrors. These mirrors will be exposed to a severe plasma environment and lead to an important tradeoff on their design and manufacturing. As a consequence, investigations are carried out on diagnostic mirrors toward the development of optimal and reliable solutions. The goals are to assess the manufacturing feasibility of the mirror coatings, evaluate the manufacturing capability and associated performances for the mirrors cooling and polishing, and finally determine the costs and delivery time of the first prototypes with a diameter of 200 and 500 mm. Three kinds of ITER candidate mock-ups are being designed and manufactured: rhodium films on stainless steel substrate, molybdenum on TZM substrate, and silver films on stainless steel substrate. The status of the project is presented in this paper.