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Penicillin allergy is a significant burden on patient, prescribing and hospital outcomes. There has been increasing interest in the incorporation of penicillin allergy testing (i.e. delabelling) into antimicrobial stewardship (AMS) programmes to reduce the burden of penicillin allergy labels and improve prescribing. In particular, there has been a focus on point‐of‐care penicillin allergy assessment and direct oral challenge for low‐risk phenotypes. The National Antibiotic Allergy Network has provided a guide to assist AMS clinicians with the incorporation of penicillin allergy programmes, in particular direct oral challenge, into Australian hospitals. [ABSTRACT FROM AUTHOR]

Background: Western Australia (WA) serves as a unique global case study on the impact of coronavirus disease 2019 (COVID‐19) on an isolated, prepared and highly vaccinated population. This study builds upon the study performed by House et al. through an extended data set. Aim: To examine the impact of COVID‐19 at the only quaternary hospital in WA following the border opening from 3 March to 17 July 2022. Participants: A total of 257 adults were admitted with COVID‐19 under either respiratory or the intensive care unit (ICU). Outcomes: Admission numbers, disease severity, ICU admission, prevalence of COVID‐19 deterioration risk factors, length of stay and mortality. Results: A total of 257 patients were admitted with COVID‐19, under respiratory (81.7%) and ICU (18.3%). COVID‐19 was the primary reason for admission for 67.7%. Ten patients died during the study, with seven deaths attributed to COVID pneumonitis. COVID‐19 severity was 37.4% mild, 37.0% moderate, 18.3% severe and 7.4% critical. Risk factors for requiring ICU included incomplete immunisation status (P = 0.011), chronic kidney disease (P = 0.008) and Aboriginal and Torres Strait Islander (ATSI) ethnicity. The WA Department of Health predicted that the number of hospitalisations and ICU cases were significantly higher than the actual number of cases. Conclusion: The number of hospitalisations and ICU COVID‐19 cases were significantly less than predicted, likely due to high population vaccination rates prior to border opening. The main risk factors for COVID‐19 severity were incomplete immunisation and ATSI ethnicity. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Ankle fractures are a frequent occurrence, and they carry the potential for syndesmosis injury. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Presently, the gold standard for treating an ankle syndesmosis injury is to insert a metallic screw through the fibula and into the tibia. This technique requires a second intervention to remove the hardware, but also carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope™, has gained popularity in treating ankle syndesmosis injuries. The TightRope™ involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. Clinical Question: In patients suffering from ankle syndesmosis injuries, is the Tightrope™ ankle syndesmosis fixation system more effective than conventional screw fixation at improving return to work, pain, and patient-reported outcome measures? Summary of Key Findings: Five studies were selected to be critically appraised. The PEDro checklist was used to score 2 randomized control trials, and the Downs & Black checklist was used to score the cohort study on methodology and consistency. Two systematic reviews were also appraised. All 5 articles demonstrated support for using the TightRope™ fixation. Clinical Bottom Line: There is moderate evidence to support the use of the TightRope™ syndesmosis fixation system, as it provides both clinician- and patient-reported outcomes that are similar to those using the conventional metallic screw, with a shortened time to recover and return to activity. Strength of Recommendation: Grade A evidence exists in support of using the TightRope™ fixation system in place of the metallic screw following ankle syndesmosis injury. [ABSTRACT FROM AUTHOR]

Background: Western Australia (WA) was in a unique position to experience coronavirus disease 2019 (COVID‐19) in a highly vaccinated and geographically isolated population. Aim: To describe the COVID‐19 Omicron experience at the only quaternary hospital in WA following border opening from 3 March to 11 May 2022. Participants: A total of 158 adults with microbiologically confirmed COVID‐19 were admitted to the respiratory or intensive care unit (ICU). Outcomes: Admission numbers, disease severity, prevalence of COVID‐19 deterioration risk factors, immunisation status, severity of infection, immunosuppression and treatment regimen. Results: One hundred fifty‐eight COVID‐19–positive patients were admitted to the respiratory ward (n = 123) and the ICU (n = 35) during the study period. COVID‐19 infection was the primary admission reason in 32.9% of patients, 51.3% were male and the median age was 62 years. Aboriginal or Torres Strait Islanders (ATSI) were overrepresented (13.3%). Care was predominantly ward based (77.2%). Nearly half of the patients had mild COVID‐19 (49.4%). Dexamethasone was the most common treatment provided to patients (58.2%). The median length of stay was 5.8 days (interquartile range, 5–15). Eight patients died during the study period (5.1%), with three of those deaths attributable to COVID‐19. Conclusions: COVID‐19 case numbers following WA state border opening were of lower care acuity and disease severity than predicted. Two‐thirds of admissions were for other primary diagnoses, with incidental COVID detection. Hospital admissions were overrepresented by partially or unvaccinated patients and by ATSI Australians. An increase in social support along with general and geriatric medicine speciality input were required to treat hospitalised COVID‐19 cases in the WA Omicron wave. [ABSTRACT FROM AUTHOR]