bluuebunny/crossref_metadata_2025_split huggingface dataset:
1113. A Novel Means of Acquiring High Quality Feedback for Training Programs –The Program Director Ombudsperson
Authors: Riedel David J , Malek Rana 
Published: January 2021

Abstract

Background
Trainees may not always be comfortable providing frank feedback or constructive criticism to their Program Director (PD) due to fears of negative repercussions. PDs likewise may lack the means to obtain high quality feedback from trainees, particularly among smaller training programs, e.g. fellowships. An ombudsperson is defined as an independent appointee whose task is to investigate and attempt to resolve complaints and problems.

Methods
The PDs from Infectious Disease (ID) and Endocrinology fellowships partnered to meet with fellows from the opposite program. Meetings were held with fellows in December and June of the academic year. Each PD started their meeting with 2 questions on a 1-10 scale: How do you rate the fellowship program? How do you rate the job the PD and program leadership are doing? Additional questions covered the fellow evaluation process, faculty feedback, education vs. service balance, and gaps in training. Additional time was allotted for fellow-raised concerns. Meeting notes were summarized anonymously and returned to the PD of the other program. Fellows were asked to complete a brief questionnaire about their experience.

Results
A total of 15 fellows completed the survey (6 Endocrinology, 9 ID; Table). All 15 fellows agreed that the goal of the ombudsperson review meeting (i.e. to address fellow concerns in a more confidential setting) was achieved and were comfortable sharing concerns and feedback to the ombudsperson. The majority of fellows (53%) was more comfortable sharing concerns regarding the fellowship to the ombudsperson than directly to the PD. Thirteen (87%) agreed that concerns raised during the first ombudsperson meeting were addressed by the Program in subsequent months. All fellows (100%) found it helpful that the ombudsperson was another PD and recommended that the ombudsperson review meetings should continue in the fellowship.
Table. Characteristics of participants and outcomes of questions about fellowship ombudsperson program

Conclusion
The fellowship PD ombudsperson meeting is a novel means for soliciting constructive feedback from trainees at small training programs. Fellows were comfortable with the ombudsperson arrangement, felt the meetings achieved their goal, and recommended that the meetings continue in the future.

Disclosures
All Authors: No reported disclosures
1117. An HIV Primary Care Rotation Improved HIV and STI Knowledge, Enhanced Sexual History-Taking Skills, and Increased Interest in a Career in Infectious Diseases among Medical Students and Residents
Authors: Wooten Darcy , Marshall Austin 
Published: January 2021

Abstract

Background
Clinical rotations in HIV primary care provide a unique opportunity to teach trainees about the management of HIV and other sexually transmitted infections (STI), and enhance trainees’ skills in obtaining a culturally-competent sexual history. Positive educational experiences in this setting may also influence trainees’ decisions to pursue a career in HIV Medicine and Infectious Diseases (ID). However, little is known about the impact of an HIV clinic rotation on trainees’ fund of knowledge regarding HIV and STI management, confidence in obtaining a sexual history, or interest in HIV and ID as a career choice.

Methods
Third year medical students and Internal Medicine residents rotate for two to four weeks in UCSD’s HIV primary care clinic. Over a six month period (September, 2019 - February, 2020) trainees were given a pre and post rotation survey to evaluate their fund of knowledge in managing patients with HIV and other STIs, their confidence in taking a sexual history, and their interest in pursuing a career in HIV and ID.

Results
Twenty-one of the 31 trainees completed both the pre- and post-rotation survey. Residents and medical students comprised 57% (12) and 43% (9) of the cohort, respectively. Fund of knowledge regarding antiretroviral management, HIV transmission, and STI diagnosis and treatment improved following the rotation (Figure. 1). Trainees’ confidence in their ability to manage patients with HIV and obtain a sexual history also improved (Figure. 2). Importantly, there was a substantial increase in the proportion of trainees interested in pursuing a career in HIV and ID after the rotation compared to beforehand (Figure. 2).
Fund of Knowledge Pre and Post Rotation

Self-Perceived Competency and Interest in HIV Clinical Care

Conclusion
Clinical rotations in HIV primary care provide valuable learning experiences for trainees by improving their fund of knowledge about HIV and STIs, and their self-efficacy in obtaining a sexual history. These clinical experiences may also be important in recruiting trainees to pursue a career in HIV and ID. Given the importance of these clinical skills and the need to increase the number of trainees entering the field, additional support for educational experiences in HIV primary care clinics is warranted.

Disclosures
All Authors: No reported disclosures
1128. Online Spaced Education to Teach Microbiology to Medical Students in a Threaded Medical School Curriculum
Authors: Sathe Nishad , Bonura Erin 
Published: January 2021

Abstract

Background
A strong foundation in microbiology continues to be essential for physicians-in-training. Little research exists examining pre-clinical microbiology education in undergraduate medical education (UME) curricular structures. Further, no study has evaluated the use of a spaced repetition model for pre-clinical UME students studying microbiology in a threaded curriculum.

Methods
We conducted a prospective cohort design study and enrolled 81 out of 154 (53%) first-year medical students at Oregon Health & Science University from August 2018 through December 2019. The first 18 months of the UME curriculum is organized by organ system blocks with end-of-block exams including retired National Board of Medical Examiner (NBME) questions. Participants were invited to complete 10 microbiology questions using the spaced practice online platform QSTREAM weekly. Performance between participants and non-participants on end of block NBME exams were compared using t-tests for categorical variables.

Results
At the conclusion of the study, 42.5% of participants were “very active” (questions in &lt; 2 days), 7.5% of participants were “active” (questions in 3-7 days), and 50.0% of participants were “inactive” (questions in &gt;7 days). Student performance on second-pass questions improved by 41%, and NBME end-of-block exams demonstrated improved performance in each block compared to non-participants. Specifically, performance in the Skin, Bones, and Musculature end-of-block exam and Developing Human end-of-block exam was significantly (p=0.0001, 0.008, respectively) improved, and study participants outperformed non-participants on topics practiced in the study.

Conclusion
As more medical schools move to a threaded curriculum, with many of these programs proposing fewer contact hours, innovative methods targeting microbiology education should be explored for pre-clinical medical students. Online spaced practice in a threaded curriculum could provide a feasible and acceptable pedagogical technique for UME and add to the discourse around microbiology curriculum development. With initial start-up costs, sustaining such a program across medical school curricula is an inexpensive, innovative, technologically-savvy approach to medical education.

Disclosures
All Authors: No reported disclosures
1138. Works Well Enough? Program Directors’ Perceptions of the Effectiveness and Transparency of Competency-Based Evaluations in Assessing Infectious Diseases Fellow Performance
Authors: Dora Amy V , Vijayan Tara , Graber Christopher J 
Published: January 2021

Abstract

Background
In July 2015, the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Internal Medicine (ABIM) jointly outlined an approach to assessing fellow performance using milestone-based core competencies for incorporation into standardized evaluation templates of trainee performance. Limited data exist regarding the clarity, effectiveness, and reproducibility of competency-based evaluations of infectious diseases fellows.

Methods
From March to May 2019, program directors of ACGME-accredited infectious diseases fellowship programs were invited to complete a Qualtrics-based survey of program characteristics and evaluation methods, including a trainee vignette to gauge evaluation reproducibility. Completed surveys were analyzed with descriptive statistics.

Results
Forty-three program directors initiated the survey, but 29 completed it. Seventeen (59%) were men, 19 (66%) were on a teaching service for over 8 weeks a year, and 19 (66%) had fewer than four first year fellows in their program. Most respondents agreed the competencies lacking the most clarity were systems-based practice (17/29, 58%), and practice based improvement (16/29, 55%). Eighteen (62%) were at least “somewhat satisfied” with their institution’s assessment tool, and 19 (66%) reported it was at least “moderately effective” in identifying academic deficiencies. Responses rating fellow performance from the vignette ranged from 1.5 to 4 on the standard milestone-based competency scale of 1-5 with 0.5 increments (median 3). For the same scenario using a qualitative ordinal scale, 66% (19/29) categorized the fellow as “early first year” and 34% (9/29) as “advanced first year.” Respondents offered a wide range of comments on milestone-based competencies, including “it works well enough” and “the process seems bloated and educratic.”

Conclusion
Clarity is needed on how to evaluate specific core competencies in infectious diseases, particularly systems-based practice and practice-based improvement. Describing anchoring milestones and evaluating fellows in accordance to stage in fellowship (i.e. early first year fellow) can help standardize responses. Further exploration on improving the evaluation process is warranted.

Disclosures
All Authors: No reported disclosures
1139. Adherence to Zika virus-related Pediatric Follow-up Care in Puerto Rico
Authors: Levison Julie H , García-Fragoso Lourdes , García García Ines E , Del Cueto Paola , Gely Leticia , Levis Maria F , Valencia-Prado Miguel , Cortés Dharma E 
Published: January 2021

Abstract

Background
Over three thousand children in Puerto Rico were potentially exposed to Zika virus infection during pregnancy during the 2016 Zika virus epidemic. This congenital exposure is an established risk factor for birth defects and neurodevelopmental abnormalities, which may appear after birth. Puerto Rico guidelines require consistent pediatric monitoring for early identification and intervention of children up to age five.

Methods
Our objective was to assess factors that influence caregiver adherence to Zika-related follow-up pediatric services in Puerto Rico. We conducted qualitative semi-structured focus groups and individual interviews with 57 individuals, including 35 caregivers (aged ≥18 years and a primary caregiver for a child with laboratory evidence of confirmed or possible Zika virus infection during pregnancy) and 22 healthcare providers or service coordinators. We explored participants’ views on barriers to Zika-related pediatric services and suggestions for improving appointment attendance. Interviews were recorded, transcribed, and translated. We developed and applied a coding scheme based on barriers and facilitators from the Andersen Model of Health Care Utilization and Katz Model for Adolescent Vaccine Adherence (a multi-step process influenced by adolescent and caregiver factors). Data were analyzed using thematic analysis.

Results
Three themes influencing adherence to Zika-related pediatric follow-up care were consistently reported throughout the interviews and focus groups discussions: (1) logistics of getting child to appointments based on clinic location, availability and costs associated with transportation, and physical requirements to transport child or multiple children; (2) complexity of requirements for follow-up appointments; and (3) caregiver burden including emotional, social, and time.

Conclusion
Barriers to Zika-related pediatric follow-up care in Puerto Rico are complex and multi-level. Core intervention targets should include caregiver burden, health system navigation, and coaching caregivers in communication with pediatric providers. Use of a caregiver-delivered manualized intervention led by community health workers seems appropriate to achieve these goals.

Disclosures
All Authors: No reported disclosures
1142. Increased Odds of Psychiatric Illness Among Mothers of Infants with Congenital Syphilis
Authors: Thornton Corinne R , Bleasdale Susan C 
Published: January 2021

Abstract

Background
Syphilis can be transmitted mother to child during pregnancy leading to multisystem birth defects if untreated. In Illinois, screening is mandated for pregnant women at first and third trimesters. The University of Illinois Hospital (UIH) serves a vulnerable patient population with a high syphilis prevalence. An understanding of risk factors associated with maternal syphilis infection can guide prevention of congenital syphilis (CS) with early prenatal diagnosis and treatment. The aim of this retrospective case control study is to describe maternal risk factors associated with CS in a clinical setting.

Methods
Using a database used for health department reporting from 2014-2018 at UIH, 106 maternal syphilis diagnoses were identified. Medical records were reviewed for CS infant diagnosis, sociodemographic information, medical history, and potential risk factors, including multiple sex partners, HIV status, drug use, history of incarceration or sex work, and having sex with men who have sex with men (MSM). Cases were matched with controls of pregnant women with syphilis testing that was not indicative of infection.

Results
Of the maternal syphilis diagnoses identified, there were 8 cases in which CS was possible or highly probable, 68 in which CS was less likely or unlikely, and 30 that were lost to follow up. Of the possible and probable infants’ mothers, 38% had a psychiatric illness (6.80 OR, 95% CI 1.06-43.48) and 25% were homeless (12.00 OR, 95% CI 0.94-153.89). Late or scant prenatal care was seen in 75% (4.15 OR, 95% CI 0.72-23.95) and 75% had inadequate syphilis treatment. None were HIV positive or reported incarceration, intravenous drug use, sex work, or having sex with MSM.

Conclusion
Among infants with probable or possible CS, there was a 6.80 increased odds of maternal psychiatric illness compared to those born to mothers not diagnosed with syphilis, which may have complicated prenatal care and delayed diagnosis or treatment. Psychiatric illness outnumbered several other known risk factors; however, these may be less often discussed during clinical encounters. Psychiatric illness history may be a risk factor and means to identify women in the clinical setting who need close follow up and outreach after a prenatal syphilis diagnosis to prevent or mitigate congenital transmission.

Disclosures
All Authors: No reported disclosures
1146. Thrombocytosis in Infants with Congenital Cytomegalovirus Infection Being Treated with Valganciclovir
Authors: Murtagh Kathleen , Toia Jacquie , Scardina Tonya , Rowley Anne H , Mithal Leena B 
Published: January 2021

Abstract

Background
Congenital CMV (cCMV) is associated with sensorineural hearing loss and neurodevelopmental disabilities. Infants with symptomatic cCMV infection benefit from 6 months of oral valganciclovir (vGCV) therapy. Neutropenia, thrombocytopenia, and hepatotoxicity are adverse effects vGCV, for which we monitor. We observed a pattern that cCMV infants treated with vGCV developed an uptrend in platelets and/or thrombocytosis (platelet count &gt;450,000/uL) while on therapy. This observation has not previously been reported.

Methods
Medical records and laboratory results from our multi-disciplinary cCMV clinic led by Infectious Diseases at Lurie Children’s Hospital were reviewed (2017-2020). Data included cCMV signs/symptoms, cCMV treatment prescribed, indication for ganciclovir/vGCV treatment, and complete blood count prior to, during, and post- vGCV therapy.

Results
Of 21 cCMV infants referred to clinic, 14 received &gt;1 month of vGCV for symptomatic disease, 1 discontinued vGCV &lt; 1 month due to perceived fussiness, and 1 was part of a clinical trial. Four infants were initially treated with ganciclovir for ≤1 month and transitioned to vGCV. Of the 14 patients treated with vGCV, 10 (71%) had sensorineural hearing loss (50% unilateral), 12 (86%) had central nervous system abnormalities (including cystic lesions on head ultrasound), 5 (36%) had thrombocytopenia, and 7 (50%) were intrauterine growth restricted [Table 1]. Eleven infants (79%) developed thrombocytosis. Thirteen infants (93%) had an uptrend in platelet count [not including normalization of initial thrombocytopenia (platelets &lt; 150,000/uL)]. Figure 1 shows platelet counts by time with respect to vGCV treatment. Neutropenia (absolute neutrophil count &lt; 500/uL) occurred in 1 patient that required temporary discontinuation of vGCV.
Table 1

Figure 1

Conclusion
We observed an interesting trend of rising platelet count and the development of thrombocytosis in the majority of our cCMV patients on vGCV. Platelet elevation associated with vGCV has not previously been described. This observation is limited by small number of patients and thrombocytosis is not a definitive association/adverse effect. With increasing use of vGCV and interest in its effect on bone marrow function, this observation is notable and warrants further study.

Disclosures
All Authors: No reported disclosures
1165. Epidemiology, management and outcomes of fungal keratitis: A single center study from tertiary hospital in Thailand
Authors: Puttiteerachot Thitiwat , Vanichanan Jakapat , Jutivorakool Kamonwan , Puangsricharern Vilavun , Kasetsuwan Ngamjit , reinprayoon Usanee , Kittipibul Thanachaporn , Satitpitakul Vannarut 
Published: January 2021

Abstract

Background
Fungal keratitis is known as an important cause of sight threatening infection worldwide. Variation of clinical characteristics and treatment have been observed among different geographic regions. Currently, clinical data of fungal keratitis in South East Asia remain scarce.

Methods
A retrospective single study was conducted at King Chulalongkorn Memorial Hospital in Thailand. Medical records of patient with diagnosis of fungal keratitis between January 2016 and December 2018 were reviewed. Cases were identified using ICD-10 code. Data on demographics, clinical presentations, investigations and outcomes were collected. Mycological diagnosis was made in patients who had clinical presentation compatible with fungal keratitis and positive fungal detection in clinical specimen.

Results
During study period, fungal keratitis was diagnosed in 59 pts including 31 by mycological and 28 by clinical diagnosis. KOH preparation of corneal scraping was positive in 19 of 53 pts (35.8%). Culture from cornea, aqueous and vitreous yielded positive result in 18 of 53 (33.9%), 2 of 14 (14.3%), respectively. ITS sequence analysis was positive in 7 of 15 (46.7%) from cornea, 1 of 6 (16.7%) from aqueous and 2 of 2 (100%) from vitreous. Culture and molecular detection from clinical specimens provided additional mycological diagnosis in 8 and 5 cases with negative KOH preparation. Fusarium was the most common pathogen (33%) followed by Paecilomyces (9.7%), Aspergillus (6.4%), Candida (6.4%). Ten patients (32.2%) had only positive KOH preparation. All patients received treatment with topical antifungal agent, while 38 pts (64%) required systemic, 24 pts (40.7%) received intrastromal, 22 pts (37.2%) received intracameral and 3 pts (5.1%) received intravitreal antifungal therapy. Operation was performed in 21 pts (35.6%) which 6 (28.5%) required evisceration. Twenty-three patients (39%) had visual improvement after complete treatment.

Conclusion
Fungal keratitis is not an uncommon disease. Fusarium was the most common etiologic agent similar to study from other region. Unfavorable outcomes were observed in majority of cases. Appropriate fungal culture and molecular detection from clinical specimens can be considered as they may increase diagnostic yield in some patients.

Disclosures
All Authors: No reported disclosures
1166. Evaluating the Impact of the 2016 Candidemia Guidelines on the Incidence of Ocular Complications of Candidemia
Authors: Hillenbrand Molly , Apewokin Senu 
Published: January 2021

Abstract

Background
The incidence of Candida bloodstream infections has risen over the last several decades. Complications of candidemia include endogenous fungal endophthalmitis which can result in devastating outcomes including vision loss. In 2015, the IDSA guidelines were updated to recommend echinocandins as initial therapy for candidemia. Given the poor ocular penetration of echinocandins there has been some concern this change may portend an increased incidence of ocular complications in candidemic patients. We sought to examine whether patients who received empiric echinocandin therapy developed higher rates of ophthalmic complications of candidemia.

Methods
We identified patients in our healthcare system who had blood cultures positive for Candida species and a completed ophthalmology consult between January 1, 2014 and April 30, 2019. Chi-squared analysis was used to compare antifungal prescribing patterns before and after release of the updated IDSA guidelines. We assessed whether the switch to empiric echinocandin therapy as directed by the guidelines was associated with higher rates of abnormal eye exams.

Results
47 patients treated before the guideline change were compared to 57 patients treated after the guideline change. There was no significant difference in age, gender, or comorbid diabetes and hypertension between the groups. Before the guideline change, 24/47 (51%) of patients received eye-penetrating antifungals. This decreased to 21/57 after the updated guideline (37%, p=0.21). The percentage of patients with positive eye exams was nearly equal before and after the updated guidelines, 10/47 (21%) before vs 13/57 (22%) after (p=1). After the guideline change, 7/21 (33%) of the patients treated with penetrating antifungals had positive eye exams vs 6/36 (16%) who received echinocandins (p=0.19).

Conclusion
Echinocandins are known to have poor ocular penetration yet our data demonstrate no change in the incidence of ophthalmic complications of candidemia after the 2016 guideline endorsed echinocandins as empiric therapy. The prevalence of positive eye exams throughout our study period was 22%, suggesting ongoing utility for these exams. Ongoing investigation is necessary to confirm and further study these findings.

Disclosures
All Authors: No reported disclosures