bluuebunny/crossref_metadata_2025_split huggingface dataset:
2536. Evaluation of Anticipatory Guidance Provided by Internal Medicine Residents for the Care of Patients with Fever
Authors: Rubio Luis , Abdoler Emily , Schwartz Brian , Schwartz Brian 
Published: October 2019

Abstract

Background
Overnight fever is common in hospitalized patients. Past work has analyzed cross-covering resident practices regarding overnight fever, but little is known about how residents provide anticipatory guidance for overnight fever. We aimed to further our understanding of resident sign-out practices for overnight fever by analyzing the specific content of the guidance they provide and evaluating whether the presence of infection impacts the guidance provided.

Methods
We performed a cross-sectional study of resident sign-outs on an inpatient Internal Medicine service between September 2018 and April 2019 using a data collection tool we developed. Data collected included patient’s primary reason for hospitalization, whether fever was an anticipated problem, whether a differential diagnosis for fever was included, evaluation and management instructions for fever, and any rationale provided for the instructions. We analyzed the data using descriptive statistics and chi-squared analysis.

Results
Among 216 sign-outs reviewed, 38% indicated infection was the primary hospital diagnosis. Fever was an anticipated issue in 169 (78%) of sign-outs (Table 1). Of sign-outs recommending fever evaluation, 79% specified at least one diagnostic test but 34% still utilized a nonspecific phrase such as “full fever work-up” (Table 2). Only 62% of fever sign-outs included antibiotic guidance. In addition, rationales were provided for evaluation or management guidance in only 41% and 61% of sign-outs, respectively (Table 3). Chi-squared analysis did not show a statistically significant association between primary hospital problem and the sign-out including fever anticipatory guidance (P = 0.78), recommending in-person assessment (P = 0.11), or providing antibiotic guidance (P = 0.15).

Conclusion
Fever anticipatory guidance is commonly included in resident-written sign-out regardless of primary hospital problem. Specific evaluation instructions for fever are used more commonly than nonspecific fever work-up terms, but rationales for testing are given uncommonly. Future educational interventions around signing-out and evaluating fever overnight may lead to more effective anticipatory guidance and rationale testing and treatment.

Disclosures
All authors: No reported disclosures.
2538. Directed Educational Intervention and Resident Physician Outpatient Antimicrobial Prescribing
Authors: Andrews Shannon L , Beaudoin Amanda , Rothenberger Meghan , Drekonja Dimitri M 
Published: October 2019

Abstract

Background
Antimicrobial stewardship is the coordinated approach to optimal use of antimicrobials. Directed stewardship may benefit resident physicians and improve outpatient antimicrobial prescribing.

Methods
Internal medicine residents as of July 1, 2017 (n = 37) with continuity clinic at the Minneapolis Veterans Affairs Health Care System were eligible. Antimicrobial prescriptions and number of patient visits per month were extracted from the Computerized Patient Record System. Antimicrobial rate was calculated for 9 baseline months (July 1, 2017–March 31, 2018) and 12 intervention months (April 1, 2018–March 31, 2019). Residents were divided into high and low prescribing groups based on baseline antimicrobial rate. The low prescribing group received one email with links to antimicrobial stewardship resources. The high prescribing group received the same email and one in person meeting with an infectious disease fellow to discuss antimicrobial prescribing.

Results
Prescription and visit data were available for 37 residents. The low and high prescribing interventions were administered to 17/17 (100%) and 12/20 (60%) participants, respectively. Remaining high prescribing participants (8, 40%) graduated and did not complete the intervention. During the intervention period, there were a total of 171 prescriptions and 4,018 visits, for an average antimicrobial rate of 43 prescriptions/1,000 visits compared with baseline rate of 51 (P = 0.09). Antimicrobial rate per month is shown in Figure 1.

Conclusion
An educational intervention did not significantly change antimicrobial prescribing rates in a VA resident clinic. Antimicrobial prescribing rates were much lower than expected, suggesting that weekly continuity clinic may not be an optimal setting for learning how to manage outpatient antimicrobials. Our study was small and conducted at a single site without evaluation of antimicrobial appropriateness. Further studies should explore the optimal setting for residents to gain outpatient antimicrobial prescribing experience.

Disclosures
All authors: No reported disclosures.
2539. Characterization of Infectious Diseases Advanced Pharmacy Practice Experiences at United States Colleges of Pharmacy
Authors: Cho Jonathan C , Kufel Wesley D , Jeffres Meghan N , Chahine Elias 
Published: October 2019

Abstract

Background
Antimicrobial resistance is a public health crisis. Experiential education about the appropriate use of antimicrobials is necessary to prevent the post-antibiotic era. The purpose of this study was to describe the learning experiences during infectious diseases (ID) advanced pharmacy practice experiences (APPEs) offered by ID pharmacy faculty.

Methods
A 18-item, cross-sectional, multi-center, electronic survey was distributed via e-mail to ID pharmacy faculty at 124 schools and colleges of pharmacy in the United States. Programs were identified via the Accreditation Council for Pharmacy Education directory. Data related to student learning experiences, preceptor credentials, and teaching opportunities offered to pharmacy students were collected.

Results
Seventy-two (58%) ID faculty responded to the survey and 64 (89%) offered an ID APPE. Forty-three (67%) preceptors completed a PGY-2 ID pharmacy residency and 17 (27%) completed an ID pharmacy fellowship. ID physicians served as co-preceptors for 52% of rotations but only 34% had other ID pharmacists as co-preceptors. Of the 64 APPEs offered, 45% were at an academic medical center. The majority of students participated in antimicrobial stewardship activities (84%) and ID consults (80%) in adults. Greater than 90% of APPEs included learning experiences related to bone and joint, cardiovascular, central nervous system, Clostridioides difficile, fungal, intra-abdominal, lower respiratory, skin and soft-tissue, and urologic infections. Viral hepatitis (39%), travel medicine (13%), ophthalmologic (39%), parasitic (33%), and rickettsial (31%) infections were less commonly offered. Most students were required to present patient cases (92%), lead topic discussions (91%), present journal clubs (89%), conduct medication use evaluations (56%) and work on research projects (53%).

Conclusion
Pharmacy ID APPEs provide students with a broad range of experiences, particularly in adult populations. Students commonly participated in the management of core infectious syndromes. ID APPEs provide students additional training on the appropriate use of antimicrobials.

Disclosures
All authors: No reported disclosures.
2540. Targeting ID Education for Advanced Practice Providers: A Growing Learning Group in Academic Medical Centers
Authors: Lee Matthew S L , Stead Wendy 
Published: October 2019

Abstract

Background
Advanced Practice Providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs), increasingly provide patient care in inpatient settings at academic medical centers. However, little is known about their medical education. We sought to describe current APP educational experiences at our institution and to implement and evaluate an educational intervention aimed at decreasing inappropriate antimicrobial use for asymptomatic bacteriuria (ASB) amongst this group.

Methods
33 inpatient-based APPs participated in the educational intervention consisting of in-person sessions and an online video reviewing diagnosis and management of ASB. Pre- and post-intervention surveys assessed knowledge before and after the intervention. Surveys also assessed APP’s educational background, opportunities, and barriers.

Results
17 APPs completed the pre-intervention survey. 59% estimated less than 10 hours of antimicrobial education during their training. 88% reported that the majority of their current learning is independent. All APPs reported desiring more educational opportunities. 76% felt current opportunities are designed for medical students or housestaff. Commonly reported barriers included patient care, rounding obligations, and lack of protected time. 8 APPs attended the in-person sessions and there were 21 views of the online video. 10 APPs completed the post-intervention survey. All reported interest in similar sessions in the future. 70% planned to prescribe fewer antimicrobials for ASB; however, the same number also reported “Attending or fellow decision” as the main barrier to decreasing prescriptions. Mean knowledge scores significantly increased after the intervention from 2.5 to 4.125 (P < 0.05).

Conclusion
APPs within an academic medical center have unique educational backgrounds and needs. APPs identified current educational opportunities as student/resident directed and incompatible with their work schedules. More APPs utilized the video session than attended in-person lectures. This intervention improved immediate knowledge acquisition; however, retention and impact on clinical outcomes are still being evaluated.

Disclosures
All authors: No reported disclosures.
2551. Optimizing Rounding Efficiency on the Infectious Diseases Inpatient Service: A Multi-Generational Conversation
Authors: Clark Eva , Kulkarni Prathit A , Mohajer Mayar Al , Rose Stacey , Serpa Jose , Singhal Geeta , Giordano Thomas 
Published: October 2019

Abstract

Background
To optimize faculty and trainee wellness without compromising patient care and trainee education, it is important to develop efficient team rounding strategies. This quality improvement project describes rounding practices and suggestions for optimizing rounding efficiency on Infectious Diseases (ID) inpatient consult services at a large academic institution.

Methods
An anonymous survey on rounding strategies was distributed to the ID Section at Baylor College of Medicine in February 2019 as part of a facilitated discussion on optimizing clinical education for fellows.

Results
Twenty-seven members of the ID section completed the survey (17 faculty, 10 fellows). Fellows reported rounding for a median of 4 hours per day (range 3–5), while faculty reported 4.5 hours (range 2–5.5). When asked what time fellows should start their workday, the median response was 7:30 am from both fellows (range 6:30–8 am) and faculty (range 7–8 am). When asked what time fellows should end their work day, the median response was 5:30 pm from both fellows (range 5–6 pm) and faculty (range 5–7 pm). Fellows reported signing their last note at 5:30 pm (range 5–9 pm), vs. 9 pm for faculty (range 6–11 pm). Regarding rounding method, most respondents (100% of fellows and 77% of faculty) preferred a combination of traditional rounding at patient bedside and “table” rounds. Regarding teaching method, most faculty (64%) preferred bedside teaching, while most fellows (60%) preferred teaching presentations in the work room (P = 0.011, Fisher’s exact). Both fellows and faculty had many suggestions for optimizing rounding efficiency; the most common was to avoid having fellows see all patients twice daily (“double rounding,” suggested by 80% of fellows and 30% of faculty).

Conclusion
Overall, the reported behaviors of fellows regarding the structure of their days on inpatient ID services coincided with faculty expectations, although preferences differed between fellows and faculty regarding teaching methods. Avoiding “double rounding” was the most common suggestion to optimize efficiency. Larger studies are needed to better understand rounding behavior and strategies that will optimize the efficiency and effectiveness of inpatient ID consult teams.

Disclosures
All authors: No reported disclosures.
148. Retrospective Evaluation of Acute Cholangitis and Clinical Implication and Management of Secondary Bacteremia
Authors: Hamdi Ahmed , Yetmar Zachary A , Miller Alexander T , Diaz Mark , Fida Madiha , Beam Elena 
Published: October 2019

Abstract

Background
Optimum duration of antimicrobial therapy for acute bacteremic cholangitis is not well established; however, 4–7 days is recommended by the 2018 Tokyo guidelines in those without Gram-positive bacteremia.

Methods
A retrospective study performed at Mayo Clinic - Rochester, Florida and Arizona sites was conducted, reviewing all adult patients with the first episode of acute cholangitis secondary to biliary stone obstruction, between January 1, 2012 and December 31, 2017. We reviewed the duration of prescribed antimicrobials.

Results
Among 331 included cases, 197(60%) were men, 66 (20%) were immuno-compromised. Presenting symptoms included fever in 202 (61.5%), abdominal pain in 289 (87%), jaundice 128(38.7%), and altered mentation in 49 (15%). Among these, 256 (77%) were classified as “definite” and 38 (11.5%) were “suspected” using the 2018 Tokyo guideline classification. Cholangitis grade was grade III in 134 (40.5%); grade II in 115 (34.7%); and grade I in 82 (24.8%). Majority of cases, 321 (97%), underwent source control—most commonly 309 (96%) achieved by endoscopic retrograde cholangiopancreatography (ERCP). Source control occurred within 24 hr of presentation in 197 (61.4%) of the cases. Bacteremia was documented in 131/277 (47%). Majority of bacteremias were due to Gram-negative organisms in 119 (91%). Mean duration of antibiotic therapy following “source control” was 9.6 days (SD 7.0). Cases with bacteremia, resulted in longer treatment duration, mean of 13 days (SD 5.6), regardless of the isolated organism. Overall 30 day mortality was 14/331 (4.2%). No mortality difference was noted in patients who underwent early (within 12 hours) vs. later source control (4.55% Vs. 4.53%), nor in those who received more or less than 6 days of antibiotic therapy after source control (4.7% Vs. 3.9%, P = 0.76). No difference in mortality was observed in those with or without bacteremia.

Conclusion
Our results note the use of longer courses of antimicrobials for management of bacteremic cholangitis, regardless of the organism type. This population could be a prime target for an antimicrobial stewardship intervention, to decrease the duration of prescribed antimicrobials in accordance with recent guidelines.

Disclosures
All authors: No reported disclosures.
2556. Does a Brief Education Intervention Affect Perceptions and Knowledge Regarding HIV Pre-Exposure Prophylaxis Among Medical Trainees?
Authors: Myers Michaela , Weissman Sharon , Tavakoli Abbas , Sanasi-Bhola Kamla 
Published: October 2019

Abstract

Background
HIV Pre-Exposure Prophylaxis (PrEP) has been shown to be 90–92% effective in preventing HIV, but uptake in the South is the lowest in the country. Expanded implementation into clinical practice requires systemic efforts to improve education among providers early in their careers.

Methods
The objectives were to investigate medical trainees’ perceptions, knowledge, and attitudes regarding PrEP and to improve knowledge with a brief interventional education session. Trainees were affiliated with the University Of South Carolina and received a ten-minute, 23-question survey starting June 2018. This was followed by the intervention and then a post intervention survey.

Results
157 trainees (31 residents, 86 medical students and 40 others) responded to survey and attended the intervention. Post intervention survey was completed by 43 trainees. Prior to intervention 83% of trainees (n = 131) had heard about PrEP and 80% (n = 125) knew of PrEP for HIV prevention. Half, mainly medical students and residents, had formal PrEP education as part of their curriculum but only 38% identified the appropriate regimen (n = 60). Trainees’ concerns included non-adherence (n = 96, 61%), side effects (n = 91, 58%), development of resistance (n = 81, 52%) and poor risk reduction practices (n = 55, 35%). 33% (n = 52) felt confident evaluating patient’s eligibility for PrEP and 47% (n = 74) felt comfortable recommending PrEP. Post intervention 91% (n = 39) of trainees who responded identified the appropriate regimen. No statistically significant changes in trainees’ perceptions regarding SE, adherence development of resistance and risk reduction practices were observed. 93% (n = 40) felt confident evaluating patient’s eligibility for PrEP and 98% (n = 42) felt comfortable recommending PrEP (P < 0.0001). 95% (n = 41) felt that the intervention was beneficial and 98% (n = 42) would recommend the education intervention to other trainees.

Conclusion
After a brief intervention medical trainees’ knowledge and comfort with prescribing PrEP improved. Modifications to the intervention are needed to improve perception regarding safety and efficacy. Improving PrEP uptake in the South will need continued formal PrEP education in the curriculum to advance perceptions and knowledge.

Disclosures
All authors: No reported disclosures.
2557. Knowledge, Attitude, and Practices on Vaccination and Occupational Health Among Healthcare Workers in a Teaching Hospital in Mexico City
Authors: Lopez-Enriquez Claudia , Martinez-Hernandez Lucia , Donis-hernandez Jose-Juan , Virgen-Cuevas Margarita 
Published: October 2019

Abstract

Background
Vaccination is one of the most effective ways to prevent the transmission of certain bacterial and viral diseases and it has reduced the associated morbidity and mortality. WHO estimates that all over the world 59 million healthcare workers (HCWs) are exposed every day to multiple occupational hazards.

Methods
Cross-sectional survey of a sample of HCWs from a hospital in Mexico was conducted through an anonymous, self-administered questionnaire between October 2015 and May 2016.

Results
Of 930 HCWs 76% completed the questionnaire. Among responders 64% declared knowing the required vaccines. Specialties associated with greater knowledge in vaccines were: Internal medicine (70%) (P = 0.04) and Pediatrics (63%) (P = 0.003); however, only 31% and 34% respectively were vaccinated against influenza. The mean number of years since influenza vaccination was 1.5 ± 1.8 and only 30% workers reported having been vaccinated in the period 2015–2016; 61.2% referred at least one dose against hepatitis B with a mean of 4.4 ± 4.4 years since the application, 15% reported knowing their immune status for hepatits B. In total 65% have been vaccinated against Tdap/td with an average of 3.7 ± 3.9 years from application. The reasons for not getting vaccinated included: Not having access to vaccines in 34%, cost in 8%, fear of adverse events 8%, belief of not require to be vaccinated in 5%. A total of 82.5% HCWs have worked while been sick. Reasons: Sense of duty in 57%, perception of poor performance in 21%, not disappointing colleagues in 13% and not letting down patients in 8%. Better compliance in vaccination coverage was observed among laboratory personnel: OR 2.0 (95% CI 1.0–4.7; P = 0.04) and nursing staff: OR 1.5 (95% CI 1.0–2.3; P = 0.01). There was no difference in compliance by medical specialty (P = 0.5). In total 17% HCWS reported having some occupational accident in the last 10 ± 5 years. Working in the emergency room: OR 1.6 (IC95% 1.0–2.4, P = 0.01); Unit of Intensive Care OR: 1.5 (IC 95% 10–2.3; P = 0.3) and operating room OR: 1.5 (IC95% 09–2.5; P = 0.05) were risk factors for occupational accidents.

Conclusion
HCWs vaccination coverage and knowledge were poor. Considering the important role of HCWs in preventing diseases, it should be mandatory that all HCWs receive proper advice concerning vaccination at their work place.

Disclosures
All authors: No reported disclosures.
2559. A Novel Approach to Interprofessional Education to Expand HIV Workforce Pipeline
Authors: Leedy Nicole , Porterfield J Zachary , Romanelli Frank , Stover Crystal , Thornton Alice 
Published: October 2019

Abstract

Background
Effective care for persons living with HIV (PLWH) requires a coordinated, multi-disciplinary approach that includes social workers, physicians, advanced practice providers, pharmacists, social workers and community outreach workers. Unfortunately, these individuals often work and train independently of one another without a full sense of the responsibilities and contributions of others. Too often, this results in fragmented or ineffective care.

Methods
In response to the need to improve exposure to both HIV and coordinated interdisciplinary care, the Kentucky AIDS Education and Training Center at the University of Kentucky developed the HIV Interprofessional Education (IPE) Program in 2016. This dynamic IPE links students in multiple professional training programs (including pharmacy, medical, social work, and physician assistant students) to a year-long curriculum designed to acquire advanced skill sets for the treatment of HIV/AIDS. This curriculum includes inpatient and outpatient shadowing opportunities with multiple departments, didactic seminars, flexible mentored learning, and a collaborative capstone project designed to impact the local HIV community.

Results
We report on the development of this program as well as a comprehensive assessment of the quantitative and qualitative experiences of our trainees. Participants reported significant improvements in their understanding of not only the complexities of the continuum of care for PLWH but also on how to improve care by enhancing collaboration between disciplines. They also reported development of critical and generalizable skills including taking a social history, addressing co-morbid mental health and substance abuse issues, cultural competency, screening and prevention strategies for HIV.

Conclusion
As we strive to provide comprehensive and effective care for PLWH aimed at achieving the goals of universal test and treat and retention in care, we must find way to improve crosstalk and understanding of the interdisciplinary nature of modern medical care. Ideally, this begins during training. We present our experience in the development of a novel and highly effective program which has spanned multiple departments and has substantially impacted the approach to HIV care in our trainees.

Disclosures
All authors: No reported disclosures.