bluuebunny/crossref_metadata_2025_split huggingface dataset:
104. Evaluation of a Prep Referral System: From Sexual Health Center to Federally Qualified Health Center Prep Clinic
Authors: Lillis Rebecca A , Beckford Jeremy , Fegley Joshua , Siren Julia , Hinton Bruce , Gomez Samuel J , Taylor Stephanie N , Butler Isolde , Halperin Jason , Clement Meredith E 
Published: January 2021

Abstract

Background
In the United States, less than one-quarter of those who are eligible for pre-exposure prophylaxis (PrEP) have been prescribed the medication. Innovative strategies of PrEP delivery are needed to facilitate access and overcome barriers to care. The objective of this study was to evaluate the referral process from a sexual health center (SHC) to a co-located PrEP clinic as an alternative model of PrEP care.

Methods
An initial report was generated from the electronic health record (EHR) to determine the number of patients seen at the SHC in 2019. Charts were then manually reviewed to determine whether a PrEP clinic referral was made. For those referred, we determined the method of the referral: PrEP clinic navigator met the patient at the SHC (handoff), the navigator was messaged in the EHR to then schedule the appointment (EHR message), or the patient was provided a card with the navigator’s contact information (card). We also determined whether patients had subsequent visits at the PrEP clinic or SHC.

Results
From January to December 2019, there were 3570 unique patients seen at the SHC, and 240 (6.7%) were referred to the PrEP clinic. Of 240 referred patients, median age was 29 years; 95 (40%) were non-Hispanic Black and 25 (11%) were Latinx. The majority (n=198, 83%) were male, 32 (13%) were cisfemale, and 9 (4%) were transfemale. An STI was diagnosed on the day of the clinic visit for 116 (49%) patients. Of those who were MSM, 75 (51%) had been diagnosed with an STI in the previous 6 months. In total, 106 referred patients attended an initial PrEP visit and the proportion attending the visit by method of referral was 81%, 38%, and 22% for handoff, EHR message, and card, respectively (p&lt; .0001). Of the 108 patients who attended an initial PrEP visit, 66 (61%) had a subsequent PrEP visit. Of those who did not attend a PrEP visit, 36 (27%) had a subsequent visit at the SHC.
Figure 1. Method of Referral from SHC to PrEP Clinic

Conclusion
Despite co-location of these two clinics, there are significant drop-offs along the PrEP care continuum for this referral system. Navigator-facilitated handoff was the most effective method of referral from SHC to PrEP Clinic, but further efforts are needed to understand barriers to referral. Implementation of rapid PrEP provided at the SHC may be one possible solution to engaging additional patients in PrEP services.

Disclosures
Meredith E. Clement, MD, FHI360 (Consultant)Gilead (Research Grant or Support)Janssen (Scientific Research Study Investigator)
111. Outcomes Related to COVID-19 Among People Living with HIV: Cohort from a Large Academic Center
Authors: Virata Michael D , Shenoi Sheela , Ladines-Lim Joseph B , Villanueva Merceditas , Aoun-Barakat Lydia 
Published: January 2021

Abstract

Background
The COVID-19 pandemic has resulted in nearly 8 million cases and close to 500,000 deaths globally. Little is known about risk factors for favorable or adverse outcomes from COVID-19 among people living with HIV (PWH). Small case series have described outcomes for hospitalized PWH with COVID19.

Methods
This is a retrospective chart review of PWH with confirmed diagnosis of COVID-19 from 2 HIV ambulatory clinics from March 1 to May 31, 2020 in a large urban academic center that serves a substantial proportion of underserved minorities. Data on demographics, clinical characteristics, and outcomes were abstracted using a standardized data collection tool. Bivariate analysis was performed to identify correlates of hospitalization.

Results
Among the clinic cohort of 1469 PWH, 94 (6.4%) were tested for SARS-CoV-2 and 40 (42.5%) were positive. Fifty-percent were women, 65% were 50 years and older, 65% were black, 65% were former or active smokers, and 40% were active alcohol or substance users. The majority (90%) were on ART and 87.5% had HIV viral suppression (&lt; 50 copies/ml). Among comorbidities, 50% had hypertension, 42.5% chronic lung disease, 42.5% cardiovascular disease (CVD), 40% obesity, 27.5% diabetes (DM), and 20% chronic kidney disease (CKD). Hospitalization occurred in 19 patients (47.5%) and of those, 4 (21%) required escalation of care. The median length of stay was 12 days (IQR5.5–15.5) and there was no inpatient mortality. Among the 12 PWH who had HIV viral load test during hospitalization, 11 (91.7%) maintained viral suppression and none of the 19 patients had ART interruption. Those who were hospitalized were more likely to be &gt;50 years old (p=0.02); have CVD (p=0.003), DM (p=0.01), and CKD (p=0.02); or have multiple comorbidities (p=0.007) compared to those managed as outpatients. Furthermore, incremental numbers of comorbidities were associated with hospitalization (p=0.009). A history of AIDS, black race, obesity, smoking, and substance use disorders were not associated with hospitalization or adverse outcome.

Conclusion
In this initial and to our knowledge largest cohort in an urban academic center, PWH with COVID-19 had favorable short-term outcomes. The risk factors associated with hospitalization were older age and multiple non-HIV related comorbidities.

Disclosures
All Authors: No reported disclosures
117. Adjunctive Daptomycin in the Treatment of staphylococcus Aureus Bacteremia
Authors: Cheng Matthew P , Lawandi Alexander , Butler-Laporte Guillaume , De L’Etoile-Morel Samuel , Paquette Katryn , Lee Todd C 
Published: January 2021

Abstract

Background
Bloodstream infections (BSI) caused by methicillin-susceptible Staphylococcus aureus (MSSA) are associated with significant morbidity and mortality. The objective of our study was to determine whether daptomycin given in combination with an anti-staphylococcal beta-lactam improved outcomes in MSSA BSI.

Methods
A randomized, double blind, placebo-controlled trial was performed at two academic hospitals in Montreal, Canada. Patients ≥ 18 years of age with MSSA BSI receiving either cefazolin or cloxacillin monotherapy were considered for inclusion. In addition to the standard of care treatment, participants received a 5-day course of adjunctive daptomycin or placebo. The primary outcome was the duration of MSSA BSI in days.

Results
Of 318 participants screened, 115 were enrolled and 104 were included in the intention to treat analysis (median age 67 years; 34.5% female). The median duration of bacteremia was 2.04 days among patients who received daptomycin versus 1.65 days in those who received placebo (absolute difference 0.39 days, p=0.40). A modified intention to treat analysis involving participants who remained bacteremic at the time of enrollment found a median duration of bacteremia of 3.06 days among patients who received daptomycin versus 3.0 days in those who received placebo (absolute difference 0.06 days, p=0.77). Ninety-day mortality in the daptomycin arm was 18.9% vs. 17.7% in the placebo arm (p=1.0). There were no significant differences in the proportion of patients who developed renal failure, hepatotoxicity, or rhabdomyolysis between groups.

Conclusion
Among patients with MSSA BSI, the administration of adjunctive daptomycin therapy to standard of care treatment did not shorten the duration of bacteremia.

Disclosures
All Authors: No reported disclosures
122. Dalbavancin Use in Patients with Substance Use Disorders
Authors: Streifel Amber C , Makadia Jina , Luke Strnad , Douglass Alyse , Mayer Heather , Young Kathleen , Lewis James , Sukerman Ellie , Sikka Monica 
Published: January 2021

Abstract

Background
Dalbavancin, a lipoglycopeptide antibiotic, has an extended half-life that allows for weekly dosing and is an alternative to daily intravenous (IV) antibiotics. The dosing interval has the potential to expand treatment options for more severe infections in patients with substance use disorder (SUD), houselessness, and other complex social determinants of health where treatment of severe infections with long courses of IV antibiotics can have a high risk of failure. Questions remain regarding clinical outcomes for this indication and patient population.

Methods
We conducted a retrospective review of dalbavancin use for any patient with documented SUD either by ICD-10 or in chart notes. We identified all patients &gt; 18 years who received &gt; 1 dose of dalbavancin via medication records.

Results
53 patients with documented SUD received dalbavancin as part of their treatment regimen (Table 1). The most common indication was osteomyelitis, including 14 cases of vertebral osteomyelitis (Table 2). The most common causative organism was Staphylococcus aureus, 23 (43%) cases due to MRSA and 10 (18%) due to MSSA.
The majority of patients (41,77%) had a documented history of IV drug use (IDU) and 19% had alcohol use disorder. A structured, RN-lead multi-disciplinary discharge planning conference to discuss antibiotic options, risk factors for outpatient parenteral antibiotic therapy, and PICC safety in the community was held for 17 (32%).
Concern about outpatient PICC safety in patients with history of IDU, unsafe home environment, and prior non-adherence to outpatient antibiotics were common reasons for choosing dalbavancin. Ten (19%) patients were lost to follow-up. The 30 and 90-day readmission rates were 13% and 19% respectively but were due to relapse or recurrence of infection in only 3 (6%) at 30 days and 2 (4%) additional at 90 days. There was only one death at 90 days ant it was unrelated to infection. (Table 3)

Table 2. Dalbavancin Use

Conclusion
Dalbavancin was well tolerated and = a viable alternative for patients with SUD who often have social factors and preferences that make continuation of outpatient IV therapy high risk or impractical. Further data on clinical outcomes in complex infections is needed.

Disclosures
All Authors: No reported disclosures
126. evaluation of Addition of Outpatient Parenteral Antimicrobial Therapy and Orthopedic ID Resources to Transitions-of-care Outcomes
Authors: Young Brett , Bergman Scott , Van Schooneveld Trevor C , Cortes-Penfield Nicolas W , Alexander Bryan 
Published: January 2021

Abstract

Background
Our large academic medical center initiated both an Outpatient Parenteral Antimicrobial Therapy (OPAT) program supported by an infectious disease trained pharmacist, along with an Orthopedic Infectious Disease (OID) consult service to assist in caring for these specialized populations. We measured the impact of these services.

Methods
Patients discharged on parenteral antimicrobial therapy were divided into two groups. The pre-OPAT cohort included all patient receiving OPAT from 4/1/18 - 10/31/18; the post-OPAT cohort included all patients who received OPAT from 4/1/19 - 10/31/19 with OPAT consult (Fig 1). The OID consult service began in September 2018 prior to initiation of the OPAT program. The primary outcome was 30-day hospital readmission. Secondary outcomes included: length of stay (LOS), 90-day readmission, clinical outcomes, and identification of predictors of hospital readmission. Clinical outcomes included: time from final OR visit to discharge for OID patients and optimal treatment (cefazolin, oxacillin, or nafcillin) for MSSA.

Results
Introduction of these programs was associated with a reduction in all-cause 30-day readmission from 39.3% to 22.9%, and a reduction in 30-day readmission for patients on-treatment from 24.6% to 15.6% (p&lt; 0.01 for both). No difference was seen in hospital LOS (8 days in each cohort). In a subgroup analysis (Fig 2), OID patients in the post-OPAT cohort saw a median reduction of 2 days (7 days to 5 days, p=0.002) in time from final OR visit to discharge. Use of optimal treatments for MSSA increased in the post-OPAT cohort compared to pre-OPAT (65.2% to 80.9%; p=0.06). The 90-day hospital readmission rate were higher in the post-OPAT cohort among patients who lived in metro-area zip codes (p=0.03). Having an established primary care physician was associated with lower 90-day hospital readmission in both the pre-and post-OPAT cohorts (p=0.05 and 0.01, respectively).

Conclusion
Thirty-day readmission rates among patients discharged on OPAT significantly lowered following initiation of a combination of both a pharmacist-led OPAT program and OID consult service. OPAT and OID programs accrue additional efficiencies and clinical benefits to both patients and hospitals, which can be further evaluated and used to justify such service additions.

Disclosures
All Authors: No reported disclosures
127. walking to the Virtual Era. Analysis of the Telehealth Experience in the Infectious Diseases Clinic During the COVID Pandemic
Authors: Carvajal Karen L , Pillai Prishanya , Winbush Angelina , mangat Rupinder , Louie Ted 
Published: January 2021

Abstract

Background
The COVID pandemic has changed and will continue changing the way we practice medicine. We sought to investigate the impact of telehealth (TH) in the delivery of healthcare in the general infectious diseases (GID), and HIV clinic during the COVID pandemic.
The University of Rochester Medical Center is a major tertiary care and referral center for ID in upstate New York. From March through May of 2020, the clinics were closed, and nearly all visits were conducted by TH.

Methods
We surveyed (either by telephone or online) a total of 260 patients who participated in TH visits, with a mean age of 56 years in the HIV group and 59 years in the GID group. With a predominance of 62.8 of males v/s 37.2 of females.
We collected information regarding the reason for the TH visits, access to technology, patient satisfaction, and preferences over in-person visits. We obtained the volume and no-show rate from prior years through EPIC. We evaluated compliance between in-person and TH visits using statistical analysis.

Results
We found 93.4% of GID and 84.3% of HIV patients surveyed, either strongly agreed or somewhat agreed that their TH visit was as satisfactory as a clinic visit. 67.5% of GID and 63% of HIV patients agreed that the option of TH would increase their compliance rate in the future. The no-show rate during the TH period in the HIV group decreased from 23% to 5% compared to the previous year, while the no-show rate in GID decreased from 9% to 4%. These results were statistically significant with a P-value &lt; 0.005 in both groups.

Conclusion
GID patients were more likely to have TH for hospital follow-up, follow-up of acute problems, and outpatient antibiotic therapy, compared to HIV patients, who more often had TH for chronic problems. GID patients were more likely to have the capability for televideo visits when compared to the HIV group, although this was not statistically significant. TH was statistically significant in improving patient compliance with appointments in both the HIV and ID clinics. Patients were overall highly satisfied with their TH experience and many patients also reported that continued availability of telemedicine would improve their compliance with appointments.

Disclosures
All Authors: No reported disclosures
129. Beta-lactam vs Fluoroquinolone Monotherapy for pseudomonas Aeruginosa infection: A Systematic Review and Meta-analysis
Authors: Reid Eric C , Walters Ryan , Destache Christopher 
Published: January 2021

Abstract

Background
Pseudomonas aeruginosa (PA) is a leading cause of healthcare-associated infections, including pneumonia, bloodstream infections, and surgical site infections around the world. A variety of antibiotic classes are used in the treatment of PA infections, including beta-lactams (BLs) and fluoroquinolones (FQs), given either together in combination therapy or alone in monotherapy. Here, we report a systematic review and meta-analysis to evaluate the therapeutic efficacy of BL agents versus FQ agents as active, definitive monotherapy in PA infections in adults.

Methods
Comprehensive literature searches of Medline and Scopus electronic databases, alongside hand searches of the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar, were performed in April 2019 without time restriction to identify studies published in English comparing BL and FQ agents given as monotherapy for PA infection in hospitalized adults for which mortality, bacteriological eradication, or clinical response was evaluated. One reviewer screened search results based on pre-defined selection criteria. Two reviewers independently assessed included studies for methodological quality using NIH assessment tools. Two fixed-effects meta-analyses were performed (Figure 1).

Results
A total of 368 articles were screened, and 6 studies were included in the meta-analysis. Upon evaluation of methodological quality, 2 studies were rated good, 3 fair, and 1 poor (Table 1). A meta-analysis of 3 cohort studies demonstrates FQ monotherapy for PA bacteremia is associated with increased survival compared to BL monotherapy (OR, 3.65; 95% CI, 1.27–10.44; p=.02; Figure 2). A meta-analysis of 3 randomized control studies demonstrates FQ monotherapy for PA pneumonia and skin and soft tissue infection is not significantly associated with increased bacteriological eradication compared to BL monotherapy (RD, 0.07; 95% CI, -0.09 to 0.24; p=.39; Figure 3).

Conclusion
The data appear to suggest FQ monotherapy is significantly associated with increased survival in PA bacteremia and associated with similar rates of bacteriological eradication in pneumonia and skin and soft tissue infection caused by PA compared to BL monotherapy. However, more research is needed to make meaningful clinical recommendations.

Disclosures
All Authors: No reported disclosures
137. Applying Gamification to Microbiology Core Curriculum in Undergraduate Medical Education
Authors: Walker Jeremey , Patel Mukesh , Cleveland John D , Heudebert Jose Pablo , Westfall Andrew O , Dempsey Donald , Guzman Alfredo , Long Dustin , Willig James , Lee Rachael A 
Published: January 2021

Abstract

Background
Gamification uses elements of game design to enhance learner engagement. We introduced a microbiology “trivia game” for first year medical students (MS1), leveraging principles of gamification (self-efficacy, points, leaderboards, etc.) to enhance participation. We hypothesized this would engage learners and improve course performance.

Methods
We created a “microbiology trivia game” using Kaizen-Education, a software platform (Kaizen) developed by our Center for Clinical and Translational Science. All MS1 in the Microbiology course at the University of Alabama at Birmingham (Fall 2019) were invited to participate by downloading the smartphone app. We created 56 questions emphasizing high yield concepts and their clinical application. Participation was voluntary during the Microbiology course (3 weeks). We collected app utilization and test performance data in this IRB approved investigation. We completed descriptive analyses of student engagement including a Player Efficiency Rating (PER). The PER is a student-level composite measure of student accuracy, play frequency and question completion. We calculated Spearman rank correlation of mean exam scores and PER. At course completion students received a survey about their experience.

Results
181 (96%) of 189 Microbiology students answered ≥ 1 question. Across those 181 students, 161 (89%) completed all questions (table 1). An average of 67 students answered questions each day. Collectively, students answered 96% of all published questions (n=10,136; 56 questions x 181 students). A total of 49% of questions were answered &lt; 24H from publication. Survey response rate was 34% (n=61), and our teaching innovation was positively received (table 2).
Final exam performance increased from 80% (2018) to 87% (2019) among students in the gamification enhanced Microbiology course. A correlation between higher PER and better exam scores was found (0.34; p≤0.0001).

Conclusion
Our gamification infused Microbiology course was well received. Students appreciated the opportunity to apply core foundational microbiology concepts to clinical medicine scenarios early in training. Novel teaching methods may increase student engagement in Medical Microbiology courses, for many the birthplace of their passion for Infectious Diseases.

Disclosures
All Authors: No reported disclosures
138. Creation of a Clinical Educator Elective for ID Fellows
Authors: Blyth Dana M , Markelz Ana E , surry Luke , Lindholm David , Yun Heather , Barsoumian Alice 
Published: January 2021

Abstract

Background
While fellows are expected to educate residents and students, they often receive limited formal instruction on how to teach. To address this, we developed a 2–4 week Clinical Educator Elective (CEE) for senior ID fellows. Goals were to increase fellow teaching engagement and promote excellence in medical education by improving understanding of adult learning theory and application to medical education.

Methods
Curriculum development: Methodology used Kern’s 6 step approach. A targeted needs assessment was obtained from CEE fellows at the start of the block. A reading list was created from key areas (table). Instructional methods included flipped classroom, learner-led discussions, and exercises in evaluation and feedback of peer and faculty teaching. Fellows completed a required capstone educational project.
Learner Assessment: Standardized peer and faculty feedback surveys of fellow teaching were used.
Program Assessment: CEE narrative assessments were evaluated. Anonymous pre- and post-CEE self-assessment fellow surveys rating their confidence in knowledge and skills in clinical education on a 1–10 scale (1 lowest, 10 highest) were compared. Post-CEE fellows’ medical student (MS3) teaching was compared to a 4-year pre-CEE historical cohort (PCHC).

Results
From 2017–9, 7 of 11 (64%) senior ID fellows completed the CEE. 5 (71%) were male, 3 started fellowship post-residency, 3 were chief residents, and 1 was an internist for 2 years. They had a median of 10 hours of prior faculty development (IQR 1–26). Career goals included GME in 6 of 7 pre-CEE. Narrative assessments revealed fellows highly valued the CEE. 6 available post-rotation surveys showed increased confidence in knowledge of adult learning theory, characteristics of effective educators, and fellows’ ability to teach across a range of settings (table). 5 of 7 CEE fellows precepted MS3s compared to 1 of 8 fellows in the PCHC (p=.04). CEE and PCHC fellows won 7 and 2 teaching awards, respectively.
Fellows’ confidence in knowledge and skills of various aspects of medical education before and after the clinical educator elective

Conclusion
A CEE was highly valued and improved fellow self-assessed knowledge and skills in clinical teaching, even in those with prior teaching experience. It was also associated with more MS3 teaching. Future evaluations of long-term retention in academic medicine and teaching performance can further examine this approach.

Disclosures
All Authors: No reported disclosures