bluuebunny/crossref_metadata_2025 huggingface dataset:
1109. Valgancyclovir Dosing for Cytomegalovirus Prophylaxis in Heart Transplant Recipients
Authors: Huang Glen , Davis Matthew R , Beaird Omer E , Carlson Margrit , Gaynor Pryce , Multani Ashrit , Deng Mario , Nsair Ali , Schaenman Joanna M
Published: January 2021

Background

Cytomegalovirus (CMV) is one of the most common infections after transplantation and continues to cause significant morbidity and mortality. Current guidelines recommend 3-6 months of post-transplant prophylaxis with 900mg daily of valganciclovir in heart transplant recipients. At our institution, however, the protocol is to use 450mg daily of valganciclovir for 6-12 months for intermediate risk (R+) patients and 900 mg daily for high risk (D+/R-) patients. In this study we aimed to identify underlying patient characteristics associated with detectable viral load above the quantifiable threshold.

Table 1. Comparison of patients with a CMV viral above and below 137.

Methods

We retrospectively reviewed medical records of adult (≥ 18 years) heart transplant recipients with detectable CMV viremia from 2016-2018 resulted during routine clinical screening.

Results

Ninety-seven heart transplant recipients with a detectable CMV viral load were identified. Of those, 38 (37.2%) had a quantifiable viral load above the 137 IU/mL threshold. When compared to the individuals with a detectable viral load below the threshold (< 137 IU/mL), they had similar age at time of transplant, increased likelihood of donor/recipient CMV IgG mismatch, and were more frequently on 900mg daily of prophylaxis at time of viremia. Of the individuals with CMV DNAemia above the threshold, the median time to viremia was 271.4 days and the median peak viral load was 701 IU/mL. When limiting analysis to only recipients who were CMV IgG positive, patients with viremia had similar age and more likely to be on 900mg daily of valganciclovir as prophylaxis when compared to individuals with CMV viremia < 137 IU/mL. When comparing CMV D+/R- patients, age and rates of 900mg valganciclovir as prophylaxis were similar (Table 1).

Conclusion

We found that despite receipt of CMV prophylaxis, an appreciable number of both R+ and D-/R+ heart transplant recipients developed breakthrough DNAemia despite being on prophylaxis of valganciclovir as recommended by guidelines. Despite receipt of the higher 900 mg daily dose, high risk patients had higher rates of breakthrough DNAemia at our institution compared with R+ intermediate risk patients. More research is needed to evaluate the optimal dose and duration for prophylaxis in heart transplant patients against CMV.

Disclosures

All Authors: No reported disclosures
1110. Very Late Onset Infections Amongst Long Term Survivors of Kidney Transplantation
Authors: Cheung Harry , Azar Marwan M , Gan Geliang , Deng Yanhong , Cohen Elizabeth A , Kulkarni Sanjay , Malinis Maricar F
Published: January 2021

Background

Kidney transplant recipients (KTR) are at increased risk for infections immediately post-transplant due to intense immunosuppression. However, this risk decreases over time as immunosuppression is tapered. The incidence of infection in KTR many years after transplant is not well characterized. The aim of this study was to describe these “very-late onset infections” (VLIs) ≥ 10 years after KT.

Methods

We performed a retrospective chart review of patients age ≥ 18 years who underwent KT between 2003 and 2009 and who survived ≥ 10 years post-KT. VLIs included opportunistic infections (OIs) and non-OIs. Demographics, comorbidities, immunosuppression, and clinical data for VLIs ≥ 10 years from KT were collected. Simple logistic regression was performed to determine characteristics associated with risk for VLIs.

Results

Of 332 KTR that met the inclusion criteria, the majority were male (62.0%), white (59.6%), and the largest proportion was transplanted between the ages of 50-59 (28.3%); 220 (67.9%) were on mycophenolate-based regimens. The mean Charlson Comorbidity Index (CCI) was 4.7 (S.D. 2.0). Of 332, 103 (31.0%) KTR experienced ≥ 1 VLI amounting to 187 episodes. Compared to those without VLI, KTR with VLI were more likely to have diabetes (p=0.005), cardiovascular disease (p=0.004), low ALC (p < 0.001) and require dialysis (p=0.002). Of 103 KTR with VLI, 16 (15.5%) had OIs, while 87 KTR (84.5%) had non-OIs, most commonly urinary tract infection (n=85, 45.5%), pneumonia (n=35, 18.7%) and gastrointestinal infection (n=18, 9.6%). The most commonly isolated pathogens were E. coli (n=30, 16%), K. pneumoniae (n=16, 8.6%), MSSA (n=7, 3.7%), and P. aeruginosa (n=7, 3.7%). Higher CCI, diabetes, dialysis, cerebrovascular, cardiovascular disease and lower ALC were associated with increased risk for VLI (p < 0.05), while living donor KTR was protective (p=0.04). Additionally, every 1 year after transplant was associated with an increased risk of VLI (OR=1.31, p < 0.001).

Table 1: Demographics, comorbidities, immunosuppression, and clinical data for all patients

Conclusion

VLIs were common in long-term survivors of KT and included both conventional and opportunistic pathogens. Every additional year from transplant incurred additional risk for VLI, particularly for those with multiple co-morbidities and lower ALC.

Disclosures

All Authors: No reported disclosures
1112. #EducationInTheTimeofCOVID: Using Twitter to Disseminate Evidence-Based Medicine during a Pandemic
Authors: Coleman Caroline G , Daugherty Timothy T , Chung Yooree G , Xiao Angel X , Sherman Amy C , Axell-House Dierdre B , Weatherhead Jill E , Woc-Colburn Laila , Chida Natasha , Chida Natasha , Jennifer Spicer O
Published: January 2021

Background

The medical community has used Twitter as a learning tool during the COVID-19 pandemic to digest the high volume of rapidly evolving literature. However, Twitter contains educational content of varying quality and accuracy. To address this issue, we created and disseminated visual abstracts of COVID-19 literature on Twitter to educate health professionals.

Methods

Fellows and faculty members from multiple institutions collaborated with Emory University medical students to create visual abstracts of published COVID-19 literature (Figure 1). ID fellows and faculty identified and summarized 10-15 high-impact COVID-19 articles each week. Medical students created visual abstracts for each article, which fellows or faculty reviewed for accuracy. We disseminated them on Twitter (@JenniferSpicer4, 4,373 followers) and our website (Figure 2). We measured engagement with tweets using Twitter Analytics.

Figure 1: COVID-19 Visual Abstract Example

Figure 2: Website hosting COVID-19 weekly literature summaries and visual abstracts (https://med.emory.edu/departments/medicine/divisions/infectious-diseases/covid19-roundup/)

Results

Since March 2020, we have created, reviewed, and disseminated 139 graphics with 116 student authors and 33 fellow/faculty reviewers across three academic institutions (Table 1). Topics included public health & prevention, virology & basic science, epidemiology, transmission & infection control, clinical syndrome, diagnostics, therapeutics, vaccinology, and ethics & policy. Tweets had a median of 9,300 impressions (interquartile range [IQR] 5,432-13,233) with 766 engagements (IQR 432-1,288) and an engagement rate of 8.6% (IQR 7.1%-10.0%) (Table 2). Each tweet had a median of 25 retweets (IQR 17-38) and 55 likes (IQR 34-81). A few tweets had significantly higher metrics; maximum values were 84,257 impressions, 9,758 engagements, 19.0% engagement rate, 239 retweets, and 381 likes. In addition to disseminating graphics on Twitter, we received requests to use them as teaching aids from multiple health professionals worldwide, and the visual abstracts have been translated into Spanish and disseminated on Twitter and Instagram via @MEdSinFrontera.

Table 1: Descriptive Statistics of COVID-19 Visual Series

Table 2: Twitter Metrics for COVID-19 Visual Series (as of 6/10/2020)

Conclusion

Engagement rates with our visual abstracts were high, demonstrating the power of Twitter. ID educators can use visual abstracts to summarize and disseminate accurate information to a large audience on social media, which is especially important in the setting of an emerging infection.

Disclosures

All Authors: No reported disclosures
1114. Identifying and Addressing Knowledge Gaps in Influenza Management with Targeted Continuing Medical Education
Authors: Robinson Katie , Frederick Jennifer , Lester Kevin , Esgro Robert A
Published: January 2021

Background

Influenza represents a year-round disease burden. Despite CDC recommendations, providers do not always effectively test for and treat influenza. To address identified knowledge gaps regarding the care of patients with or at-risk for influenza infection, a series of continuing education (CE) initiatives were implemented for distinct specialty audiences, and the impact of the education on provider knowledge was measured.

Methods

Between July 2018 and June 2020, Vindico Medical Education provided 35 CME programs (19 web, 14 live, and 2 print) targeted primarily to any of 4 specialty audiences – ID specialists, pulmonologists, emergency medicine providers, or primary care providers (PCPs). Baseline knowledge and educational impact were assessed via pre-and post-test, respectively, across 3 primary topics – testing, mechanisms of therapeutic agents, and treatment.

Results

As of June 1, 2020, 39,677 healthcare providers participated in the education and 19,209 had obtained CE credit. Baseline knowledge was lowest regarding testing (44%) and antiviral mechanisms (43%), particularly among all but the pulmonology specialists. Average post-test scores were highest among pulmonology (85%) and primary care (85%) providers. The average relative increase in knowledge across all topics and specialties was 69%. A total of 17,480 providers who see on average 8.5 patients per month presenting with flu-like symptoms committed to practice improvements, resulting in approximately 150,000 patients per month who are more likely to receive the latest evidence-based care. Moreover, three months following the education, 68% of providers reported implementing practice improvements, including applying the latest clinical guidelines and recommendations.

Conclusion

As data regarding new options for the treatment of influenza continues to emerge, CE education on these topics will be needed. This study highlights the efficacy of multimodal CE to address knowledge gaps among providers who see patients with or at-risk for influenza infection.

Disclosures

All Authors: No reported disclosures
1115. A Longitudinal Medical Education Program for Infectious Diseases Fellows
Authors: Steinbrink Julie M , Burns Charles , Seidelman Jessica L , Maziarz Eileen K , Maziarz Eileen K , Criscione-Schreiber Lisa , Alspaugh J Andrew
Published: January 2021

Background

Many Infectious Diseases (ID) fellows express interest in the education of future learners, yet there is little opportunity to develop these skills during training. We designed an immersive program to develop the teaching skills of ID fellows. We report our initial experiences and plans for future directions.

Methods

ID fellows were recruited to participate in the program after their first year. Enrollees had no changes to their clinical/research requirements. Faculty provided initial guidance on teaching techniques and instructed fellows on how to create a curriculum for medical student ID clinical rotations. This curriculum consisted of weekly teaching sessions led by the fellows and formatted to the fellows’ discretion. Teaching session goals were to provide education on high-yield topics at an appropriate level and in a separate environment from where student grading would be assigned. Fellows received faculty feedback on their teaching in real-time by direct observation and learner feedback by anonymous student survey. An annual survey also assessed the fellows’ experiences. Outcomes of interest included an evaluation of baseline teaching skills, experience designing a curriculum, and confidence teaching over time.

Results

Since its inception in 2017, 7 fellows have participated in the program. Teaching sessions consisted of various formats: lecture, roundtable discussion, case-based, and remote virtual conferences. Education sessions were well-received by students (Figure 1).

86% of enrollees reported only occasional lecturing experience prior to fellowship and requested additional training in design of an educational course (Table 1). After participation in the program, 57% rated their experience as better than expected and 100% agreed that fellow-led sessions should remain part of the rotation. After involvement, 57% reported strong interest in a career involving medical education.

Figure1

Table1

Conclusion

We developed a structured, longitudinal medical education program dedicated to improving fellows’ skills as academic teaching physicians. Thus far, it has been well received by ID fellows and students. The program is ongoing and continues to adapt to the fellows’ and learners’ needs as determined by routine quantitative and qualitative assessments.

Disclosures

All Authors: No reported disclosures
1116. AIMS-trained Residents Exhibit Specific Communication Skills in a Standardized Patient Model of Vaccine Hesitancy
Authors: Barton Shanna M , Calhoun Aaron W , Bohnert Carrie A , Multerer Sara , Statler Victoria A , Bryant Kristina A , Marshall Gary S
Published: January 2021

Background

Vaccine hesitancy (VH) is one of the top 10 threats to global public health. While VH is common among parents, there are no accepted best practices for counseling, and training in this area is not required in residency. Strategies are needed to help providers address VH in practice.

Methods

The AIMS (Announce, Inquire, Mirror, Secure) Method for Healthy Conversations is a structured communication strategy that attempts to build trust between provider and patient (or parent), inviting receptivity to healthcare recommendations. To assess whether relatively inexperienced providers exhibit AIMS behaviors after training, blinded pediatric residents were pseudo-randomized to receive either AIMS or control training. Subjects underwent pre- and post-training clinical encounters with blinded standardized patients (SPs) portraying vaccine-hesitant parents; encounters were video-recorded and assessed by 3 blinded raters using the Vaccine Hesitancy Communication Assessment (VHCA) tool, which was developed by an iterative process and validated in pilot testing. Subject confidence was assessed pre- and post-training.

Results

Overall VHCA intraclass correlation was 0.273 for pre and 0.681 for post encounters (2-way mixed averages); reliability varied with AIMS phases. Fifty-eight subjects completed the protocol, and VHCA ratings for 29 subjects were available for this analysis. AIMS behaviors were more commonly detected among AIMS-trained subjects than control (median change in score [scale 0–30]=4.5 versus 0 for control) (Figure 1). Confidence improved in both groups (Figure 2). SPs perceived no differences between groups, nor between pre and post within groups, in aspects of subject performance such as respect, empathy, and promotion of trust (P=0.936 [ANCOVA]; partial eta-squared 0.0).

Figure 1

Figure 2

Conclusion

Pediatric residents can be trained in AIMS behaviors, and an SP model of VH can be used to assess performance. AIMS training results in similar gains in self-confidence compared to control training. SP perceptions may be colored by their script, which in this case was to exhibit adamant vaccine refusal. Testing of AIMS training in longitudinal experimental scenarios and in real-world settings is warranted.

Disclosures

Kristina A. Bryant, MD, Pfizer (Research Grant or Support, Investigator on multi-center clinical trials) Gary S. Marshall, MD, GlaxoSmithKline (Consultant, Scientific Research Study Investigator)Merck (Consultant, Scientific Research Study Investigator)Pfizer (Consultant, Scientific Research Study Investigator)Sanofi Pasteur (Consultant, Grant/Research Support, Scientific Research Study Investigator, Honorarium for conference lecture)Seqirus (Consultant, Scientific Research Study Investigator)
1118. Development of a Curriculum for Internal Medicine Residents on Latent and Active Pulmonary TB: A Targeted Needs Assessment
Authors: Sherwood Kyla , Babik Jennifer M
Published: January 2021

Background

Internal medicine (IM) residents have previously been found to have significant knowledge and practice gaps in tuberculosis (TB) diagnosis, but it is unknown whether these gaps vary based on geography or TB incidence. San Francisco has the highest incidence of TB of any US city. UCSF IM residents encounter TB throughout their clinical training; however, the residency program does not have a dedicated TB curriculum. Following the Kern model of curriculum development, the aim of this project was to conduct a targeted needs assessment of UCSF IM residents regarding the need for and format of a TB curriculum.

Methods

An anonymous survey was sent to residents in February 2020 to assess their confidence in multiple domains in the diagnosis and management of latent and active pulmonary TB and gauge their preferences for the format and timing for delivery of a TB curriculum. All questions used a five-point Likert scale. Chi-squared test was used to compare confidence levels between interns and residents. The study received UCSF IRB approval.

Results

Seventy-five IM residents completed the survey (41% of residency; 32% interns and 68% residents). More than 50% of respondents reported that they were quite or extremely confident in only 1 of 14 domains assessed. Residents demonstrated significantly increased confidence compared to interns in only 4 of 14 domains. IM residents felt that a TB curriculum of a short video series, online videos interspersed with questions, or a house-staff handbook would be most useful, with more than 50% stating that these formats would be quite or extremely useful. While lectures and Powerpoint slides are common teaching methods, residents felt these formats were less useful. IM residents also felt they would be more likely to access a TB curriculum during ID elective or while caring for patients on wards and less likely on own time.

Conclusion

IM residents demonstrated lack of confidence in multiple domains in the diagnosis and management of latent and active pulmonary TB. Confidence did not markedly improve between interns and residents despite increased experience in a high TB incidence clinical setting, highlighting the need for a TB curriculum to address this gap. This curriculum should avoid lecture format and be integrated within relevant clinical time to maximize utility.

Disclosures

All Authors: No reported disclosures
1120. Impact of Training Residents to Improve HIV Screening in a Teaching Hospital in Mexico City
Authors: Guerrero-Torres Lorena , Núñez-Saavedra Isaac , Caro-Vega Yanink , Crabtree-Ramírez Brenda
Published: January 2021

Background

Among 230,000 people living with HIV in Mexico, 24% are unaware of their diagnosis, and half of newly diagnosed individuals are diagnosed with advanced disease. Early diagnosis is the goal to mitigate HIV epidemic. Missed opportunities may reflect a lack of clinicians’ consideration of HIV screening as part of routine medical care. We assessed whether an educational intervention on residents was effective to 1) improve the knowledge on HIV screening; 2) increase the rate of HIV tests requested in the hospitalization floor (HF) and the emergency department (ED); and 3) increase HIV diagnosis in HF and ED.

Methods

Internal Medicine and Surgery residents at a teaching hospital were invited to participate. The intervention occurred in August 2018 and consisted in 2 sessions on HIV screening with an expert. A questionnaire was applied before (BQ) and after (AQ) the intervention, which included HIV screening indications and clinical cases. The Institutional Review Board approved this study. Written informed consent was obtained from all participants. BQ and AQ scores were compared with a paired t-test. To evaluate the effect on HIV test rate in the HF and ED, an interrupted time series analysis was performed. Daily rates of tests were obtained from September 2016 to August 2019 and plotted along time. Restricted cubic splines (RCS) were used to model temporal trends. HIV diagnosis in HF and ED pre- and post-intervention were compared with a Fisher’s exact test. A p< 0.05 was considered significant.

Results

Among 104 residents, 57 participated and completed both questionnaires. BQ score was 79/100 (SD±12) and AQ was 85/100 (SD±8), p< .004. Time series of HIV testing had apparent temporal trends (Fig 1). HIV test rate in the HF increased (7.3 vs 11.1 per 100 episodes) and decreased in the ED (2.6 vs 2.3 per 100 episodes). HIV diagnosis increased in the HF, from 0/1079 (0%) pre-intervention to 5/894 (0.6%) post-intervention (p< .018) (Table 1).

Fig 1. HIV test rates. Gray area represents post-intervention period.

Table 1. Description of episodes, HIV tests and rates pre- and post-intervention in the Emergency Department and Hospitalization Floor.

Conclusion

A feasible educational intervention improved residents’ knowledge on HIV screening, achieved maintenance of a constant rate of HIV testing in the HF and increased the number of HIV diagnosis in the HF. However, these results were not observed in the ED, where administrative barriers and work overload could hinder HIV screening.

Disclosures

All Authors: No reported disclosures
1121. Implementation and Evaluation of a Virtual Microbiology Laboratory for Pharmacy Students
Authors: Gruenberg Katherine , Trinh Trang D , Joyce Elizabeth , MacDougall Conan
Published: January 2021

Background

Health professions students learn microbiology concepts during in-person laboratories (labs). While highly rated by students, labs are extremely resource- and time-intensive. A virtual lab may minimize resource use while maintaining educational value. We report on the implementation and evaluation of a virtual lab designed to teach clinical microbiology to pharmacy students during an infectious diseases course.

Methods

We created a video in our clinical microbiology lab to depict the steps involved in processing and analyzing a patient sample. We also designed 2 web-based, interactive modules for students to practice lab techniques, such as virtually streaking an agar plate. Students viewed the video and completed the modules prior to attending a 2-hour in-person, case-based, small group discussion on higher-order clinical microbiology concepts. All students were invited to complete a post-session evaluation that assessed achievement of session objectives.

Results

Sixty-nine students (65%) completed the survey. Students highly rated the video, modules, and in-class cases (Table 1). Fewer students felt confident explaining the clinical microbiology process, compared to selecting antibiotics, interpreting cultures, explaining Gram stains, and interpreting an antibiogram (Table 2). Student comments highlighted the value of the video, modules, and instructor facilitation during the in-class session. Students also suggested improvements with the module user interface and reinforcement of certain topics (e.g. clinical breakpoints) during the in-class session.

Table 1: Student Ratings of the Quality of Instructional Materials

Table 2: Student Self-Reported Agreement with Achievement of Session Objectives

Conclusion

We demonstrated successful implementation a virtual microbiology lab within a pharmacy course. Overall student ratings of materials were favorable. We plan to refine and re-offer the virtual micro lab next year and measure its association with student performance. To facilitate the adaptation of this virtual lab by other schools, our teaching materials are available for use via https://vimeo.com/390087512 (video) and http://tiny.ucsf.edu/atlas (modules).

Disclosures

All Authors: No reported disclosures
1122. Improving Knowledge of Infectious Disease Fellows Regarding Infection Prevention & Antibiotic Stewardship Using a Multi-Faceted Approach
Authors: Mohajer Mayar Al , Pipkins Takei , Atmar Robert , Barradas Maria Rodriguez- , Young Edward , Giordano Thomas Giordano , Kulkarni Prathit , Serpa Jose
Published: January 2021

Background

Infection prevention and antibiotic stewardship are critical to the safe and effective delivery of patient care. The primary objective of this fellowship rotation is to train infectious diseases fellows to develop key competencies in the fields of infection prevention and antibiotic stewardship.

Methods

We implemented an infection prevention and antibiotic stewardship rotation for the first-year infectious disease fellows starting July 2017. This new one-month rotation included several lectures by infectious diseases physicians, infection preventionists and pharmacists. Fellows rounded with infection preventionists (isolation, device, environmental, and endoscopy rounds) and participated in infection control subcommittees (CLABSI, CAUTI, Clostridioides difficile colitis and surgical site infections). Fellows were required to present infection control data and develop a proposal for a quality improvement project using the Define, Measure, Analyze, Improve and Control (DMAIC) method. Knowledge was evaluated through a 25 item questionnaire administered before (pre) and after (post) rotation. Topics included definitions, surveillance, isolation, preventive methods, outbreak investigation, policies, antibiotic stewardship, healthcare economics, and leadership.

Results

Sixteen fellows have participated in the rotation (2017-2019); all completed the pre- and post- evaluations (same questionnaire). Fellows answered a mean of 11.1/25 questions correctly pre-course (SD 2.3). Scores improved significantly to a mean of 21.2/25 correct answers at the end of the course (SD 2.6, P< 0.001). All fellows presented quality improvement proposals at the end of the rotation, with a mean score of 85.7% (SD 4.6). The fellows were highly satisfied with the course with mean evaluation score 6.2/7 (88.5%).

Conclusion

The one month duration infection control and antibiotic stewardship rotation that provides basic training in the field at the beginning of the fellowship led to significant improvement in the fellows’ knowledge, and was very well received. An additional track has been implemented during the second year to prepare interested fellows for careers in infection control and/or antibiotic stewardship.

Disclosures

All Authors: No reported disclosures
1123. Improving Quality Improvement: Increasing QI Competency in Internal Medicine Subspecialty Fellows
Authors: Subramanian Praveen , Kubat Ryan , Clough Lisa , Newman Jessica
Published: January 2021

Background

Medical errors contribute to 44,000 – 98,000 deaths annually, which can result in total national costs upwards of 17-29 billion dollars. The Institute of Medicine suggests the application of QI as on of its five core competencies for all health care providers. ACGME has recognized the importance of QI curriculum in the training of both residents and fellows. To date, most QI curriculums focus on participation rather than application proficiency. A review performed by ACGME found that participants appeared to have a limited understanding of QI even after partaking in QI curricula. An activity that emphasizes practical application and meets the time constraints of residents and fellows would prove more beneficial than standard approaches.

Methods

This study included 13 ID, Allergy and Immunology, and Endocrine fellows from the University of Kansas Medical Center. Utilizing a QIKAT-R assessment tool, fellows were given 3 cases for which they had to develop a QI project. The assessment was made based on the ability to make an aim, find a measurable outcome or process that could easily be tabulated, and propose a change that could be tested. Following this, a 1-hour power point presentation which included active learning prompts in developing a QI project was given to the fellows. At the conclusion of the presentation, 3 additional cases were given to the fellows. Their ability to develop a QI project was again evaluated using the QIKAT-R assessment tool. At the end of the session a 5-question satisfaction survey was completed. As a group mean, scores prior to the 1-hour presentation were compared to those afterwards. A paired, single-tail, t-test was utilized to obtain a p-value in order to determine significance of change.

Results

In total, there was a 42.2% (p=0.00001) increase in total QIKAT-R score after “QI Power Hour.” 92.3% of participants had a positive perception (Agree/Strongly Agree) of the 1-hour session.

Conclusion

The findings suggest that fellows are able to show a higher proficiency in QI understanding as well as development of future QI projects. Fellows satisfaction of “QI Power Hour” was overall favorable. This study shows that it is possible to easily integrate QI understanding for practical application into the time constraints of a fellowship or residency curriculum.

Disclosures

All Authors: No reported disclosures
86. Use of a Novel Clinical Decision Support Tool for Pharmacist-Led Antimicrobial Stewardship in Patients with Normal Procalcitonin
Authors: Watkins Andrew B , Van Schooneveld Trevor C , Reha Craig , Anderson Jayme , McGinnis Kelley , Bergman Scott
Published: January 2021

Background

Our Antimicrobial Stewardship Program (ASP) instituted review of patients on antibiotics with procalcitonin (PCT) < 0.25 mcg/L in 2012. In 2018, a clinical decision support (CDS) tool was implemented as part of a “daily checklist” for frontline pharmacists to assist in this patient review. We sought to validate the effectiveness of this tool for pharmacist-led PCT-based antibiotic stewardship.

Methods

A retrospective cohort design was used to assess antibiotic de-escalation after PCT alert in patients on antibiotics for lower respiratory tract infections (LRTI). Secondary outcomes included antibiotic use and length of stay (LOS) in patients with PCT interventions vs those without.

Results

From 1/2019 to 11/2019, 652 of 976 (66.8%) PCT alerts were addressed by pharmacists. Of these, 331 were in patients with a respiratory-related diagnosis at discharge and 165 alerts were in patients on antibiotics specifically for LRTI over 119 encounters. Pharmacists made or attempted interventions after 34 (20.6%) of these alerts, with narrowing spectrum or converting to oral therapy being the most common interventions. Antibiotics were completely stopped in 4 of these interventions (11.8%). Patients with pharmacist intervention had 125 fewer antibiotic days of therapy (DOT) in the hospital, and changes were made to an additional 56 DOT (narrower therapy, IV to PO, dose optimization) following the alert. Two cases (5.9%) subsequently had therapy escalated within 48 hours. Vancomycin was the most commonly discontinued antibiotic with an 85.3% use reduction in patients with interventions compared to 27.4% discontinuation in patients with no documented intervention (p=0.0156). Alerts eligible for de-escalation but with no pharmacist intervention represented 140 DOT. LOS was similar in patients from both groups (median 6.4 days vs. 7 days, p=0.81).

Conclusion

Interventions driven by a CDS tool for pharmacist-driven antimicrobial stewardship in patients with normal PCT resulted in fewer DOT and significantly higher rates of vancomycin discontinuation. Additional interventions could have potentially prevented 140 DOT. We feel refinement of this tool can lead to more meaningful CDS, reduce alert fatigue, and likely increase intervention rates.

Disclosures

All Authors: No reported disclosures
1124. Increasing Student Confidence in Antimicrobial Prescribing with a Novel Teaching Framework
Authors: Sheffield Virginia , Abdoler Emily
Published: January 2021

Background

Physicians frequently prescribe antimicrobials inappropriately, increasing rates of resistance and adverse effects. Difficulty with antimicrobial reasoning likely begins during medical school, where many students learn infectious diseases by memorization. Past work has shown that learners benefit from tools such as schema and checklists. We report our experience using an antimicrobial reasoning teaching tool in a pilot medical student workshop.

Figure 1: Antimicrobial Selection Tool

Figure 2: Usefulness of Session and Tool

Methods

We converted a published antimicrobial reasoning framework into a teaching tool (Fig 1). Students enrolled in the 2020 Internal Medicine Residency Preparation Course participated in one of two identical hour-long antimicrobial reasoning workshops. We started with an interactive didactic introducing the tool. Students used the tool to work through a clinical vignette in small groups, followed by a facilitated discussion. Students filled out pre- and post-surveys assessing their identification of factors impacting antimicrobial selection, and their self-efficacy regarding antimicrobial selection. The number of factors identified was analyzed using a t-test, while the change in self-efficacy scores was analyzed using a paired t-test. Students also rated the utility of the session.

Results

87% of students (52/60) completed surveys. Prior to the session, only 59% (n=29) of students felt prepared to prescribe antimicrobials and the majority of students (59%, n=30) felt less confident managing infections than other conditions. After the session, there was a significant increase in students’ perception of their preparation to prescribe antimicrobials (t=2.08, p=0.04) and ability to identify factors important to antimicrobial selection (t=2.13, p=0.036). The majority of students found both the session and tool to be useful for future practice (Fig 2).

Conclusion

At baseline, medical students feel unprepared to prescribe antimicrobials and are less confident managing infections than other conditions. This workshop assessed the feasibility of using an antimicrobial reasoning tool to teach students. Despite its brevity, students felt more prepared to prescribe antimicrobials after the session and rated it as useful for future practice. They felt a simpler tool and longer session would improve future efforts.

Disclosures

All Authors: No reported disclosures
1126. Learner Driven Call Center to increase Convalescent Plasma Donation in COVID-19
Authors: Joyner Nancy M , Deaney Michael , Derrick Caroline , Bouchard Jeannette , Brown Hannah G , Freeman Kennedy J , Drummond Malashia , Harper Madeline , Waddell Alexandria , Albrecht Helmut , Weissman Sharon
Published: January 2021

Background

Convalescent plasma (CP) may be obtained from patients who have recovered from the novel coronavirus disease, COVID-19, caused by the virus SARS-CoV-2. Although not FDA approved, preliminary data suggests patients who receive convalescent plasma from recovered donors may have shortened recovery time and symptom reduction. The purpose of the study is to detail learner recruitment of convalescent plasma donation (CPD) for treating hospitalized COVID-19 patients.

Methods

Prisma Health Midlands formed a multidisciplinary CP donation team, consisting of seven COVID-19-certified pharmacy learner volunteers, two pharmacists, and two providers. Primary eligibility criteria were SARS-CoV-2 polymerase chain reaction (PCR) positivity at least 28 days prior to donation and asymptomatic for a minimum of 14 days. Donors were excluded based on FDA guidelines for CPD, limiting ineligible contact. Team learners were trained on call techniques and subsequently contacted, educated, and requested candidates donate through this program. Willing donors were then linked to The Blood Connection to circulate CP back into the Prisma Health System, creating a self-sustaining and closed-loop donation cycle.

Results

In total, 253 recovered adult patients with positive SARS-CoV-2 PCR test results were evaluated. 195 patients met baseline inclusion criteria for contact. This pre-screen reduced call and travel time for ineligible candidates. 108 patients were successfully reached. Of the 108, n=79 (73.14%) accepted referral to The Blood Connection, and n=29 (26.85%) were no longer candidates primarily due to patient communicated new exclusionary factors, such as active COVID-19 symptoms. The program allowed for rapid, internal access to CP for patients hospitalized with COVID-19 at Prisma Health Midlands.

Conclusion

Interest and awareness in COVID-19 CPD was successfully increased upon direct communication from the team and was felt to represent a personnel intense but successful model for recruiting potential CP donors. This program educated and utilized learners during this pandemic to enhance Prisma Health’s ability to obtain CP for hospitalized patients using a closed system.

Disclosures

All Authors: No reported disclosures
1129. Optimizing Feedback Strategies on the Infectious Diseases Inpatient Service
Authors: Clark Eva , Kulkarni Prathit , Mohajer Mayar Al , Rose Stacey , Serpa Jose , Singhal Geeta , Giordano Thomas Giordano
Published: January 2021

Background

Timely, efficient, and effective feedback strategies are crucial for enhancing faculty-trainee communication and trainee education. Here we describe attitudes, practices, and perceived behaviors regarding giving feedback to medical trainees rotating on Infectious Diseases (ID) inpatient consult services.

Methods

An anonymous survey on feedback strategies was distributed to our adult ID Section in February 2020 as part of a facilitated discussion on optimizing trainee clinical education.

Results

Twenty-six ID Section members completed the survey (18 faculty, 8 trainees). Most trainees (62.5%) and faculty (66.7%) felt that trainees are “sometimes” comfortable voicing concerns to faculty; however, no trainees but 11.1% of faculty indicated that trainees are “always” comfortable voicing concerns to faculty. Most trainees (87.5%) felt that conversations about team expectations occur “sometimes” or “often.” In contrast, most faculty (72.2%) felt that these conversations “always” occur. Although most faculty felt that both informal (94.4%) and formal (83.3%) feedback should be given to trainees, 22.2% of faculty responded that they do not explicitly use the term “feedback” when discussing feedback with a trainee. No trainees and 22.2% of faculty indicated that they utilize a feedback tool. Regarding quantity of feedback trainees perceive they receive from faculty, 37.5% of trainees felt they needed more feedback while 50% felt they received adequate feedback. Most faculty (88.9%) responded that they encourage trainees to give feedback to faculty, although most trainees (62.5%) responded “sometimes” regarding how comfortable they feel doing so.

Conclusion

In summary, we found differences between faculty and trainees regarding two important aspects of medical education: setting expectations and providing feedback. While most faculty feel that conversations regarding these topics occur invariably, trainees do not always share this perception. Trainees felt less comfortable voicing concerns and giving feedback to faculty than faculty perceived them to be. Overall, the data suggest that there is room for improvement to ensure that trainees and faculty are operating from a shared mental model regarding setting team expectations and providing/receiving feedback.

Disclosures

All Authors: No reported disclosures
1130. Optimizing Use of COVID-19 Personal Protective Equipment among Resident Physicians at a Veterans Affairs Hospital
Authors: Beaulieu Ronald M , Kimball Joanna , Bailin Samuel S , Lowry Michael , Werthman Jennifer A , Gettler Erin , Gorsline Chelsea , Lumpkins Kelly , Ni Bin , Volpe Karen , Harris Bryan , Hulgan Todd , Person Anna K , Fiske Christina , Staub Milner
Published: January 2021

Background

Correct personal protective equipment (PPE) use is key to prevent infection. Observations on a single unit at the Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) prior to COVID-19 (October 2019-February 2020) showed low rates of correct PPE use among healthcare workers (HCWs) (Figure 1). In response to the COVID-19 epidemic, the VA implemented new PPE protocols. Based on our initial observations, we were concerned that incorrect use of PPE may increase the risk of COVID-19 exposure among HCWs. Resident physicians, who work at many sites, may be at high-risk for incorrect PPE use due to rapid turnover and limited site-specific PPE training. We aimed to assess and improve COVID-19 PPE use among internal medicine residents rotating at the VA TVHS.

Figure 1: Pre-COVID-19 Observations of Adherence to Contact Precaution Protocols at the Veterans Affairs Tennessee Valley Healthcare System

Methods

We used the plan, do, study, act (PDSA) model. Prior to starting VA rotations, residents were emailed PPE education to review. We implemented a 1-hour video conference PPE protocol review at rotation start followed by in-person PPE use evaluations for residents performed by infectious diseases fellows on day 2 and day 5-6 post-review to provide just-in-time educational intervention. Errors at each PPE don/doff step were tracked. Correct PPE use data from both observations were compared using McNemar’s test. Baseline and post-implementation resident surveys assessed PPE use knowledge and comfort.

Results

Pre-implementation survey response rate was 72% (21/29); 19/21(91%) reported knowing which PPE to use and 16/21(76%) reported knowing how to safely don/doff PPE. Twenty of 29 (69%) residents completed both observations. Errors decreased by 55% (p=0.0045) from 17/20 (85%) to 6/20 (30%) between initial and follow up observations. Errors in hand hygiene, inclusion of all donning/doffing steps, and PPE reuse decreased, but PPE don/doff order errors increased (Figure 2). Post-project survey response rate was 16/29 (55%). All 16 reported knowing which PPE to use and how to safely don/doff PPE, and 11/16 (69%) residents felt both online and in-person interventions were helpful.

Figure 2: COVID-19 PPE Errors and Correction Types by Observation

Conclusion

Correct COVID-19 PPE use is essential to protect HCWs and patients. Just-in-time education intervention for PPE training may yield higher correct use compared to pre-recorded or online training.

Disclosures

All Authors: No reported disclosures
1132. Professional Development Curriculum for Fellows in Infectious Diseases
Authors: Wells jessica B , Luther Vera
Published: January 2021

Background

ID fellowship training demands that fellows must learn a wealth of information to master ID content and become experts in the field. As such, there is often a limited amount of formal curricular time devoted to career development and to the business of medicine. We designed and implemented a professional development educational series for ID fellows.

Methods

Surveys of fellowship graduates indicated an increased need for training on the business aspects of medicine and careers in ID during fellowship. The primary aim of this project was to develop a professional development curriculum to meet identified needs while still being feasible to implement given all the other topic areas about which fellows must learn. WE developed a 6-part series comprised of: careers in ID, physician contracts, compensation models, and job search (table). Each of the 6 educational activities included pre-reading and a 1-hour small group activity. Outside speakers were utilized in 2 of the sessions. Fellows completed surveys pre- and post- curriculum implementation and also provided formative assessments of curricular activities throughout the year.

Results

All (n= 6) ID fellows completed the curriculum. All 6 (100%) reported an increased understanding of careers in ID, physician contracts, and resources for continued learning on career paths. All fellows reported that this was a meaningful addition to the existing curriculum. Strengths of the curriculum as identified by fellows were the general topic areas and the interactive format. Fellows identified areas for improvement for upcoming years: expand the session on compensation models, include more information on careers in industry, and add billing and coding workshops. All fellows strongly agreed that the professional development curriculum should be continued in future years.

Conclusion

The professional development curriculum was a valuable addition to our existing ID fellowship training program. Implementing a professional development curriculum for ID fellows is feasible.

Disclosures

All Authors: No reported disclosures
1133. Qualitative Analysis of Pharmacists’ Therapeutic Reasoning Processes Applied to Antimicrobial Selection and Stewardship Activities
Authors: Gruenberg Katherine , Abdoler Emily , OBrien Bridget C , Schwartz Brian , MacDougall Conan
Published: January 2021

Background

Relative to the study of diagnostic reasoning, less is known about how clinicians make therapeutic decisions. Past work has explored how physicians choose particular antimicrobials in specific cases (antimicrobial therapeutic reasoning - ATR), but how pharmacists make similar determinations has remained unexplored. Understanding ATR by pharmacists could inform pharmacist education and improve antimicrobial stewardship (AS).

Methods

We conducted individual interviews with a purposeful sample of 11 pharmacists (5 ID specialist pharmacists and 6 non-specialists), adapting a protocol for semi-structured interviews utilizing clinical vignettes based on a prior study in physicians. In addition, participants were asked to describe their ATR process generally using a novel notecard exercise. Interviews were transcribed and analyzed with Dedoose, using the prior study’s codebook as an initial framework and adding and adapting codes through an iterative process.

Results

We found that pharmacists generally engage in the same major ATR steps (Naming the Syndrome, Delineating Pathogens, Selecting the Antimicrobial) previously described in physicians (Figure 1). Pharmacists also seemed to incorporate similar patient- and system-factors and to utilize “therapy scripts”. However, specific factors and therapy script categories did not overlap completely, with some new factors and nuances emerging (Table 1). Overall, the antimicrobial reasoning framework described for physicians encompassed pharmacists’ AR, but some pharmacists described “Revisiting the Syndrome” in light of the clinical data and in some cases pharmacists appeared to filter script options (for example, due to allergies) before proceeding.

Figure 1 - Antimicrobial Therapeutic Reasoning Framework

Table 1 - Factors Involved in Pharmacists’ Antimicrobial Reasoning Process

Conclusion

The framework describing pharmacist antimicrobial ATR and is similar to that in a prior study of physicians, with some nuances that may be attributable to the pharmacist’s reviewer role in AS. Application of this framework has potential to aid in teaching learners, identifying where error or bias may occur, improving multidisciplinary AS efforts, and providing a common framework for communication.

Disclosures

All Authors: No reported disclosures