bluuebunny/crossref_metadata_2025_split huggingface dataset:
957. Evaluation of Chagas Disease Knowledge Among Providers Caring for At-risk People with HIV
Authors: Hayon Jesica , Weatherhead Jill E , Clark Eva 
Published: December 2021

Abstract

Background
Chagas disease (CD) is underdiagnosed in the United States due to limited healthcare provider awareness of the disease. Improving provider CD knowledge is important because &gt;200,000 people living in the US are estimated to have CD, and 20-30% of those will develop related cardiac or gastrointestinal disease. People with HIV (PWH) and CD additionally are at risk for CD reactivation, which carries a &gt;70% mortality rate.

Methods
The overall objective of this quality improvement project was to improve provider knowledge of CD prior to implementation of a CD screening initiative at a large HIV clinic in Houston, TX where &gt;5,000 PWH are seen annually (~60% Latinx). We administered the survey to providers at this clinic before and after a 1-hour CD educational session, which included information about CD epidemiology, risk factors, transmission, screening, diagnostic strategies, and available treatments.

Results
Of 33 providers who took the pre-survey (16 faculty, 14 fellows, and 3 medical students), 27 (81.8%) completed all questions. Of 21 providers who took the post-survey (12 faculty, 6 fellows, and 3 medical students), 19 (90.5%) completed all questions. We identified the following CD knowledge gaps (i.e., questions initially answered incorrectly by &gt;25% in the pre-educational session survey): CD transmission, regions of CD endemicity, CD risk factors, organ systems impacted by CD in PWH, and CD testing/follow-up procedures. In the post-educational session survey, we observed significant improvement in providers’ knowledge of CD epidemiology (correct selection of estimated number of people living with CD in the US improved from 26.7% to 90.5%, Fisher’s exact p&lt; 0.0001), transmission (correct selection of “mother-to-child” answer improved from 73.3% to 100%, p=0.0150), and selection of correct CD testing answers improved from 51.9% to 85%, p=0.0286.

Conclusion
Improved CD awareness among healthcare providers and reliable systematic screening protocols are important in at-risk populations. Through simple administration of a 1-hour educational session, we identified and improved several CD knowledge gaps. We noted significant improvement in providers’ confidence in their CD knowledge, specifically in epidemiology, transmission, and diagnostic and screening testing.

Disclosures
All Authors: No reported disclosures
959. Online CME Successful at Improving Knowledge, Competence and Confidence on Incorporating mAbs for COVID-19 Among a Global Audience
Authors: Armagan Allison , Bell Elaine , Uravich Maria B , Voorn Shanthi 
Published: December 2021

Abstract

Background
The incorporation of effective treatments is critical to improving patient care for COVID-19. We assessed the educational impact of a series of continuing medical education (CME) activities on knowledge, competence, and confidence changes in US and OUS physicians related to the use of monoclonal antibodies (mAbs) for COVID-19.

Methods
10 online, CME-certified activities were delivered in multiple formats. For individual activities, educational effect was assessed with a repeated pairs pre-/post-assessment study including a 1 to 7-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question. To assess changes in knowledge, competence, and confidence, data were aggregated across activities and stratified by learning theme. McNemar’s test or paired samples t-test (P&lt; .05) assessed educational effect. The activities launched between November 2020 and May 2021; data were collected through May 2021.

Results
To date, the 10 activities have reached over 50,000 clinicians, including 24,627 physicians. Selected improvement/reinforcement in knowledge/competence measured as relative % change in correct responses pre/post education across the learning themes are reported. (i) 89% improvement/reinforcement among US ID specialists in knowledge/competence incorporating mAbs into patient care and 83% improvement among outside the US (OUS) ID specialists (P &lt; .001). (ii) 70% improvement/reinforcement among US PCPs in knowledge/competence incorporating mAbs into patient care and 55% improvement among OUS PCPs (P &lt; .001). (iii) 52% improvement/reinforcement in knowledge/competence among US PCPs regarding clinical data for mAbs and 44% among OUS PCPs (P &lt; .001). (iv) 42% of US ID specialists and 29% of OUS ID specialists had a measurable improvement in confidence in identifying patients who would benefit from mAbs (P &lt; .001).

Conclusion
This series of online, CME-certified educational activities resulted in significant improvements in knowledge, competence, and confidence regarding the appropriate use of mAbs for SARS-CoV-2 in clinical practice. These results demonstrate the effectiveness of global curriculum-based education for clinicians designed to address specific gaps in care.

Disclosures
All Authors: No reported disclosures
960. Creation of an Infection Prevention and Control (IPAC) Elective for Infectious Disease (ID) Fellows
Authors: Kiley John L , Barsoumian Alice E , Thompson Bernadette , Markelz Elizabeth 
Published: December 2021

Abstract

Background
ID specialists often function as leaders of IPAC for healthcare systems, with variable training. Our graduates have noted feeling underprepared for this role despite completion of a computer-based training course on IPAC basics. We developed a 2-4 week IPAC elective (IPACe) rotation to address this gap to increase familiarity with key IPAC concepts, introduce learners to approaches to IPAC investigations, and develop understanding of common IPAC challenges and controversies.

Methods
Methodology followed Kern’s 6-step approach. A reading list focusing on key areas in infection prevention was developed. Instructional methods included flipped classroom, learner led discussions, performing tracers, and integration with the IPAC team. Key hospital processes including High Level Disinfection (HLD) and Sterile Processing Department (SPD) were reviewed in detail with and observed by learners. In addition to an IPACe, periodic required IPAC essay questions on real-world investigations as they arose were delivered to the learners. Learner Assessment: Learners were assessed on elements of IPAC consistent with the ACGME 6 core competencies at the end of their rotation. Program Assessment: Anonymous narrative feedback was solicited post rotation completion and at semi-annual program evaluations. Additionally, learners were asked to rate the elective on a 5 point Likert scale (1 lowest, 5 highest) and specific feedback was solicited for improvement. Finally, feedback was solicited from graduates in IPAC roles.

Results
8 learners participated over from 2017-2021: 2 for 4 weeks, and 6 for 2 weeks. 4 of 8 surveys included a response to the questionnaire, all survey respondents (4/4) rated the elective 5: “rotation should be required of all trainees in the program.” Narrative assessments revealed the elective was highly valuable. Graduates reported feeling well-prepared after the IPACe for their roles as IPAC leaders. Highlights identified were: exposure to interdisciplinary teamwork, participation in tracers in identifying gaps, and using real-world IPAC challenges as cognitive frameworks for outbreak investigation.

Conclusion
An IPACe was highly valued by fellow learners and narrative assessments identified key areas for further focus.

Disclosures
All Authors: No reported disclosures
961. Experience, Lessons, and Strategies in Developing a High-Impact Real-Time Learning Network for Clinicians Caring for Patients with COVID-19 Infection
Authors: Kullar Ravina , Patel Payal K , Connolly Marjorie , Jallah Coran , Levy Gayle , Phadke Varun , Phadke Varun , Weld Ethel , Werbel William , Weddle Andrea , Wollins Dana , Chida Natasha 
Published: December 2021

Abstract

Background
Accurate and rapid dissemination of clinical information is vital during pandemics, particularly with novel pathogens. To respond to the high volume and constantly evolving knowledge during the COVID-19 pandemic, the Infectious Diseases Society of America (IDSA) created an online educational COVID-19 Resource Center for frontline clinicians.

Methods
In February 2020, IDSA launched an online resource center for COVID-19, which housed relevant clinical guidance, institutional protocols, and clinical trials. Then, in September 2020, IDSA leveraged a CDC grant to transform the resource center into the COVID-19 Real Time Learning Network (RTLN), a user-friendly, up-to-date microsite that contains clinically focused original content, guidelines, resources, and multimedia (Figure 1). The RTLN is supported by a team consisting of a Medical Editor, Associate Editors, an Online Editor, and IDSA staff. As of June 2021, the RTLN housed 12 sections, 7 of which are comprised of original content; these 7 sections contain a total of 37 subsections. A Twitter account (@RealTimeCOVID19) was also created in October 2020 to share information from RTLN in real-time.
Figure 1. COVID-19 Real Time Learning Network Microsite

Results
As of June 2021, the most visited page of the RTLN was the Moderna Vaccine page, with 486,969 page views (Figure 2). Peak monthly page views are displayed in Figure 3. Between October 2020 and June 2021, the RTLN Twitter account had 2,911 followers, 2,135,783 impressions, and 41,793 engagements. The account had also hosted 2 Twitter Chats on COVID-19 vaccines; these chats resulted in 19 million and 5.3 million impressions, respectively. Twitter engagements by month are displayed in Figure 4.
Figure 2. Literature Review of Moderna COVID 19 Vaccine on RTLN

Figure 4. RTLN Twitter Engagements By Month

Conclusion
A comprehensive educational microsite housing clinically relevant COVID-19 information had high uptake, and an accompanying Twitter account had significant engagement. Rapid curation is labor-intensive and required expansion of our editorial team. To ensure we continue to serve the needs of our users a qualitative survey is planned. Our experience launching the RTLN can serve as a roadmap for the development of accessible and nimble educational resources during future pandemics.

Disclosures
Varun Phadke, MD, Nothing to disclose
962. Essential Consultants’ Skills and Attitudes (Willing CONSULT): A Cross-Sectional Survey
Authors: Matsuo Takahiro , Hayashi Kuniyoshi , Uehara Yuki , Mori Nobuyoshi 
Published: December 2021

Abstract

Background
There is an increasing number of studies that infectious diseases consultations improve patients’ outcomes, but few studies have investigated the quality of consultations. The aim of this study was to identify important skills and attitudes for consultants to improve the quality of consultations.

Methods
We conducted our research in two phases: a preliminary survey (May 1 to 14, 2020) and the main survey (June 1 to 14, 2020). As a preliminary survey, first-year postgraduate residents at St. Luke’s International Hospital in Tokyo, Japan, were first asked an open-ended question about the types of skills and attitudes that are important for consultants. After eliminating duplicate answers, there were 19 skills and attitudes in total. In the main survey with residents who completed their residency training at our institute, from 2014 to 2018, and current residents (2019–2020), we first asked them about their demographic characteristics (gender, years of postgraduate education, and type of specialty). Then, they answered how important each skill and attitude are for consultants. All 19 items were scored on a seven-point Likert scale that ranged from 0 (completely disagree) to 6 (totally agree) (Figure 1). Cronbach’s alpha confirmed the internal consistency of the questionnaire items. Principal component analysis and exploratory factor analysis were performed.

Figure 1. Skills and attitudes required in consultants according to residents

Results
The survey included 107 individuals (61.1%, 175 potential participants). The median postgraduate years of education were four (interquartile range: 2-5), and 64.5% were men (n = 69). Seven key elements for consultants were identified and termed Willing CONSULT. These included (1) willingness (willingness to accept consultation requests), (2) contact (easy access to consultants), (3) needs (consideration of consulters’ needs), (4) suggestions and support (providing clear recommendations and suggestions, following up on the patients, and supporting the consulters continuously), (5) urgency (considering the situation’s urgency and responding appropriately), (6) learning opportunities (providing teaching points), and (7) text (writing medical records appropriately and quickly) (Figure 2).

Conclusion
We propose Willing CONSULT, which are important skills and attitudes for consultants.

Disclosures
All Authors: No reported disclosures
963. Antibiotic Talk on TikTok: An Opportunity for Patient Education?
Authors: Biehle Lauren R , Evans Emma , O’Kane Aislinn 
Published: December 2021

Abstract

Background
Antimicrobial resistance is increasing at an alarming rate. Patient education is a critical component of stewardship and many patients access resources online. TikTok is a video-sharing social media platform with 700 million monthly users and contains videos that discuss health information. The objective of this study was to evaluate antibiotic-themed TikTok videos for their validity and reliability.

Methods
In March 2021, a search on TikTok using the term “antibiotics” was performed and the top 300 consecutive videos were identified. Data collected included: number of likes, associated disease state, medications, educational aim, mention of COVID-19, and if performed by a healthcare professional (HCP). Non-English videos were excluded. The DISCERN score was used to evaluate all videos for reliability.

Results
The first 300 consecutive videos were assessed using the DISCERN score. Of the 300 videos, most (n=224) were not created by HCPs (non-HCPs). The number of “likes” per video ranged from 1 like to 2 million likes with a mean of 34,949 ± 143,482. Videos produced by HCPs were significantly more valid and reliable (mean DISCERN score of 1.65 vs 1.17, p &lt; .00001) than non-HCPs. They were found to be more relevant (p&lt; .00001), have clearer aims (p&lt; .00001), and were more balanced/unbiased (p=.00188). Videos created by HCPs were more likely to have an educational focus (p&lt; .0001). There was no difference between groups in clarity of sources utilized or risk/benefits discussed of each treatment. Across all videos, the most common disease states mentioned were urinary tract infection, skin and soft tissue infection, and upper respiratory tract infection. Natural products, penicillins, and sulfa antibiotics were the most commonly discussed medications.

Conclusion
Videos created by HCPs were significantly more valid and reliable than those created by non-HCPs. The videos created by HCPs were also more likely to have clear aims and be more relevant. However, the majority of the videos evaluated were created by non-HCPs. It may be beneficial for HCPs to provide TikTok videos that are valid and reliable for patient education.

Disclosures
All Authors: No reported disclosures
116. Characterization of small colony variants from a patient with bloodstream infection of Candida glabrata
Authors: Cheng Shaoji , Hassan Badrane , Liu Guojun , Clancy Cornelius J , Nguyen Minh-Hong 
Published: December 2021

Abstract

Background
Bacterial small colony variants (SCVs) that are tolerant to commonly used antibiotics are well recognized. Clinical SCV Candida have been rarely reported. We describe SCV C. glabrata (CG) strains recovered from within a population causing bloodstream infection (BSI) in a patient (pt), which were not recognized by the micro lab. Pt J developed CG BSI shortly after liver transplant (OLTX), which was treated with voriconazole (VOR). VOR was also used for post-OLTX mold prophylaxis. 67 d after BSI, he developed intra-abdominal infection due to VOR-resistant CG. We hypothesized that BSI might be caused by an unrecognized mixed population of azole-susceptible and –resistant strains.

Methods
Ten colonies from small (SCV) and large colonies (LC) from blood culture (BC) agar plates underwent Illumina NextSeq WGS and phenotype testing.

Results
BCs from pt J harbored a diverse population of genetically distinct CG strains, differing by unique SNPs and indels [Fig. 1]. Gene variants identified were enriched for biological processes involved in mitochondrial processes (2.5e-9), cell adhesion (3.3e-5), and respiration (3.5e-4). Unlike LC, SCVs were fluconazole (FLU) resistant (MIC: 128 µg/mL), and exhibited enhanced CDR1 and PDR1 expression (257 ± 11, 15 ± 4, respectively). Compared to LCs, SCVs grew slowly in YPD, did not grow on media containing glycerol as sole carbon source, and were less adherent to agar. SCVs stained poorly with rhodamine 123 by fluorescence flow cytometry and had fewer mitochrondria by transmission electron microscopy, consistent with WGS findings and respiratory deficiency. SCVs were less susceptible to macrophage (J774) phagocytosis, and they were significantly outgrown by other strains in competitive infections in vitro and during disseminated candidiasis in mice. LCs incubated with FLU in vitro yielded SCVs in concentration-dependent manner. Likewise, LCVs passed through spleens of mice following IV inoculation yielded SCVs in both presence and absence of FLU.
Venn diagram for 5 representative stranis of C.glabrata

Conclusion
Mitochondrial dysfunction and SCVs may be under-recognized determinants of azole resistance in CG, if micro labs select single colonies from BCs for antifungal susceptibility testing, or in absence of prolonged incubation.

Disclosures
Cornelius J. Clancy, MD, Merck (Grant/Research Support) Minh-Hong Nguyen, MD, Merck (Grant/Research Support)
968. Leveraging On-Demand Digital Education to Increase ID Specialists’ Knowledge and Confidence on Appropriate Probiotic Use for CDI Prevention
Authors: Armagan Allison , Hurst Simi Thomas 
Published: December 2021

Abstract

Background
Probiotics are increasingly being used in healthcare. As the number of probiotic options and their potential uses increase, it has become more challenging to make an informed selection for a given disease state. This study assessed the ability of digital education to improve Infectious Disease (ID) specialists’ knowledge regarding the use of probiotics in preventing Clostridioides difficile infection (CDI) and antibiotic-associated diarrhea (AAD).

Methods
A CME/ABIM MOC certified, educational program featuring a panel of 3 expert ID faculty was developed. The program sought to clarify the role of different probiotic strains in the prevention or treatment of different disease states. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values &lt; 0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (&lt; 0.05 modest; 0.06-0.15 noticeable effect; 0.16-0.26 considerable effect; &gt; 0.26 extensive effect). The activity launched on a website dedicated to continuous professional development. Data for this matched-learner analysis were collected through 09/09/20.

Results
To date, 7122 HCPs, including 5068 physicians, have participated in the activity. Data from the subset of ID specialists (n=235) who answered all pre-/post-assessment questions during the initial study period were analyzed. Following activity participation, significant improvements were observed in the proportion of ID specialists who answered assessment questions correctly (47% pre vs 69% post; P &lt; .0001; V=.22). Improvements were also observed in several specific areas of assessment (Table) and confidence in their ability to select a probiotic-based on strain- and disease-specific efficacy (36% increase).

Conclusion
Participation in this online educational program significantly improved ID specialists’ understanding of the interplay between strain- and disease-specificity in the context of probiotics. These findings highlight the potential for well-designed online education to positively impact physicians’ knowledge and confidence

Disclosures
All Authors: No reported disclosures
970. Medical Student Engagement with the COVID-19 Pandemic Is Increased Through Participation in a Preclinical Elective
Authors: Cummins Kaelyn C , Naeger Katherine , Kulkarni Prathit A 
Published: December 2021

Abstract

Background
The medical field’s response to the Coronavirus Disease 2019 (COVID-19) pandemic required a multifaceted approach. Medical students were often excluded from the initial phases of pandemic response, resulting in feelings of disengagement. This study aimed to determine if offering educational experiences on current events related to the COVID-19 pandemic could increase medical students’ understanding of, and engagement with, the pandemic.

Methods
In Fall 2020, an elective course reviewing several aspects of the COVID-19 response was implemented. Preclinical medical students attended a discussion-based seminar series given by expert faculty on a variety of topics including pathophysiology, vaccine development, telemedicine, and others. Upon course completion, students were asked to complete a survey quantifying their understanding of the overall COVID-19 response, understanding of various individual facets of the response, and feelings of personal engagement on a Likert scale from 1-5, with 5 representing the most understanding or engagement. The differences in pre-course and post-course mean scores were compared using a Wilcoxon matched-pairs signed rank test for each question.

Results
A total of 65 students completed the course; 35 (54%) students filled out the final course survey. Results showed significant improvement in students’ perceived holistic understanding of the pandemic response (2.67 pre-course vs. 4.36 post-course; p &lt; 0.001), and their feelings of personal engagement (3.06 pre-course vs. 4.33 post-course; p &lt; 0.001). Students also reported significantly increased feelings of understanding for each individual facet of the pandemic response reviewed during the course (8 questions total, all p-values &lt; 0.001).

Conclusion
Preclinical medical student participation in a course reviewing COVID-19 pandemic response significantly increased feelings of engagement with and understanding of the medical field’s response to the pandemic. Students showed improved understanding of each aspect of the pandemic response that was covered in the elective. Therefore, it appears that seminar- and discussion-based electives can be a useful tool for fostering preclinical student engagement in current events in medicine.

Disclosures
Prathit A. Kulkarni, M.D., Vessel Health, Inc. (Grant/Research Support)