bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

Background
Our Antimicrobial Stewardship Program (ASP) instituted review of patients on antibiotics with procalcitonin (PCT) &lt; 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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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
1135. The PEST Approach to Choosing Antimicrobial Therapy
Authors: Davar Kusha , Vijayan Tara 
Published: January 2021

Abstract

Background
Selecting an empiric antimicrobial regimen can be difficult for early learners and misuse of antibiotics can lead to adverse events and antimicrobial resistance. We describe here an approach to aid internal medicine interns in their clinical decision making, particularly when it comes to diagnosing and empirically treating infections.

Methods
The PEST model was created as a four-step approach to therapeutic reasoning and choosing an appropriate antimicrobial regimen for a given infectious disease syndrome (Figure 1).
In February 2020, we conducted two independent teaching sessions for interns on the PEST approach during noon conference. We assessed pre-and post-teaching responses to five clinical vignette-based questions to assess optimal selection of antibiotics and improvement in the use therapeutic reasoning (Figure 2). Results were presented as a percentage of interns, both pre- and post-intervention, who chose an appropriate antibiotic and a percentage of interns who provided sufficient therapeutic reasoning as defined by using at least three out of the four PEST criteria.
Figure 1 – The PEST Approach Model

Figure 2 – Clinical Vignette Examples

Results
Twenty-seven interns participated in the activity. At baseline, several interns had incorporated aspects of the PEST approach in their pre-teaching responses. While the teaching session improved therapeutic reasoning as defined by the PEST strategy (Figure 3), there was no appreciable difference in antibiotic selection (Figure 4). Ten interns commented on the usefulness of the approach, specifically highlighting the systematic approach to antibiotic selection.
Figure 3 – Differences in Therapeutic Reasoning After PEST Teaching

Figure 4 – Choosing The Correct Antibiotic After PEST Teaching

Conclusion
Our results showed fidelity in using the PEST approach to improve therapeutic reasoning after a teaching session, but the method did little to improve antibiotic selection. Perhaps antibiotic selection requires greater clinical experience in order to provide a narrower or more optimal spectrum of coverage. Interestingly, some interns used select “PEST” concepts prior to the intervention suggesting that the PEST approach may solidify prior knowledge or clinical reasoning skills. Continued incorporation of the PEST approach using a case-based framework may solidify conceptual and practical knowledge of antimicrobial selection.

Disclosures
All Authors: No reported disclosures
1140. Awareness of Cytomegalovirus (CMV) Among Postpartum Mothers: Education Needed!
Authors: Hanlon Cory T , Medoro Alexandra K , Sanchez Pablo J , Beckford Demi R , Schoenbeck Sydney , Purkey Grace 
Published: January 2021

Abstract

Background
Congenital cytomegalovirus (cCMV) infection is the leading cause of non-genetic sensorineural hearing loss and affects approximately 0.5%-1% of all live births in the United States. Despite its substantial burden, maternal awareness of congenital CMV disease is limited. In addition, there is no information on CMV awareness among postpartum women who ultimately would consent for CMV newborn screening. Thus our objective of this study was to determine the proportion and characteristics of postpartum women who had knowledge of CMV in an academic medical center in Columbus, OH.

Methods
From May - December 2019, 276 postpartum women who delivered a newborn at the Ohio State University Wexner Medical Center, Columbus, OH were asked if they had prior knowledge of CMV. Eligible mothers had delivered an infant who was admitted to the Newborn Nursery, were ≥ 35 weeks’ gestational age, and had no signs of congenital CMV infection. These mothers had consented for enrollment of their newborn into the University of Alabama’s Collaborative Antiviral Study Group multicenter study on CMV screening (saliva) of asymptomatic infants. Pertinent demographic and clinical data were collected and subsequently managed using REDCap electronic data capture tools hosted at Nationwide Children’s Hospital, Columbus, OH. Statistical analyses were performed using GraphPad Prism.

Results
505 eligible infants were born during the study period and 276 (55%) of the mothers were asked about their awareness of CMV infection. Of the 276 mothers (62%, white; 24%, Black; 3%, Asian; 0.4%, Native Hawaiian or Pacific Islander; 3%, biracial; 8%, not known), 30 (10%) had prior knowledge of CMV. Mothers who were aware of CMV did not differ from mothers who did not know about CMV in primigravida status (12/30 [40%] vs. 84/246 [34%], P=.55) or age (median, IQR; 33 years [29-35] vs. 31 years [26-34], P=.11). All infants had a normal physical examination, and none had congenital CMV infection.

Conclusion
Among postpartum mothers who consented to saliva screening of their newborns for congenital CMV infection, only 10% were previously aware of CMV. Such a knowledge gap should be addressed to better inform both universal and targeted newborn CMV screening among postpartum mothers.

Disclosures
All Authors: No reported disclosures