bluuebunny/crossref_metadata_2025_split huggingface dataset:
1152. Leveraging Human Factors Engineering to Optimize Low-level Disinfection of Bedside Medical Tools
Authors: Handy Lori , Bezpalko Orysia , Hei Hillary , Ehritz Carly , Townsend Sara , Sammons Julia Shaklee 
Published: November 2018

Abstract

Background
Inadequate cleaning and disinfection of shared medical equipment can lead to healthcare-associated infections and outbreaks. Stethoscopes were identified as the most commonly used piece of shared equipment at our institution, but cleaning practices were inconsistent among providers. We aimed to assess provider attitudes and practices around stethoscope disinfection and to subsequently implement a test of change (TOC) supported by human factors observations to improve cleaning consistency and frequency.

Methods
We conducted an anonymous electronic survey via SurveyMonkey paired with human factors observations in a free-standing children’s hospital. We surveyed physicians, nurses, and advanced practice providers to identify barriers to regular stethoscope cleaning. Quantitative results, human factors observations, and workflow simulations on a single unit were used to design an intervention to standardize low-level disinfection. Small mesh baskets holding alcohol prep pads labeled with brightly colored signage were installed by the exit of each patient room on one trial unit. Following implementation, a postsurvey and direct observations on the unit were conducted.

Results
Of those surveyed healthcare providers who completed the pre-survey (n = 383), 92% believed stethoscopes pose an infection risk to patients. However, only 38% of respondents reported cleaning their stethoscope between patient encounters. The most cited barrier to cleaning was a lack of easily accessible cleaning product (49%). After the unit-based TOC, alcohol from baskets were utilized by 80% of the 25 surveyed providers; 74% reported increased frequency of cleaning due to accessibility. Additionally, the brightly colored signage was a visual cue to disinfect equipment. Increased satisfaction of families reinforced the behavior. Direct observations revealed an increased frequency of cleaning while qualitative interviews elicited increased awareness from staff.

Conclusion
Leveraging human factors engineering to inform the placement and design of easily accessible disinfection supplies correlated with increased frequency of stethoscope cleaning by healthcare providers. Future steps include implementation in all inpatient care areas.

Disclosures
All authors: No reported disclosures.
1158. Needlestick Injuries and Other Potential Exposures to Bloodborne Pathogens Among Police Officers in a City Police Department, 2011–2016
Authors: De Perio Marie , Victory Kerton , Groenewold Matthew 
Published: November 2018

Abstract

Background
The approximately 850,000 police officers nationwide are at risk of bloodborne diseases through needlestick injuries and other exposure incidents because of the nature of their work. In response to a request for a health hazard evaluation, we determined the incidence and circumstances of needlestick injuries and other potential exposures to bloodborne pathogens among police officers at a city department from 2011 to 2016.

Methods
We analyzed data extracted from the city’s centralized human resource database on all needlestick injuries and other potential exposure incidents from January 1, 2011 to December 31, 2016 and characterized their circumstances. We calculated the annual incidence of needlestick injuries using two methods. We ran a Poisson regression model to determine the trend in the annual incidence over time using SAS 9.4.

Results
We identified 13 needlestick injuries and 37 additional potential exposure incidents. Needlestick injuries most commonly occurred during pat-down searches of a suspect and during search of a suspect’s property or vehicle. Nine of 11 source persons with documented test results after a needlestick injury were found to have hepatitis C infection. The annual incidence of needlestick injuries ranged from 0 to 5.07 per 1,000 police officers and from 0 to 2.45 per 10,000 reactive calls for service and did not appear to have a significant trend. Most exposure incidents consisted of spitting incidents, human bites, and other contact with blood. Of 22 source persons with blood drawn, four had hepatitis C infection, two have HIV infection, and one had both. None of the incidents reportedly led to transmission of hepatitis B, hepatitis C, or HIV.

Conclusion
Police officers in this department are at risk for needlestick injuries and other exposures to bloodborne pathogens. We recommended improvements to engineering, administrative, and personal protective equipment controls, including training on safe searching techniques and sharps evidence collection and provision of nitrile gloves.

Disclosures
All authors: No reported disclosures.
1165. Comparing Patient Risk Factors, Sequence Type, and Resistance Loci Identification Approaches for Predicting Antibiotic Resistance in Escherichia coli Bloodstream Infections
Authors: MacFadden Derek , Melano Roberto , Tijet Nathalie , Hanage William P , Daneman Nick 
Published: November 2018

Abstract

Background
To improve the adequacy of empiric antibiotic therapy, an important predictor of clinical outcome, rapid diagnostic tests of antibiotic resistance are increasingly being developed that identify the presence or absence of antibiotic resistance genes/Loci. Few approaches have utilized other sources of predictive information, which could be identified in shorter time periods, including patient epidemiologic risk factors for antibiotic resistance and markers of lineage (e.g., sequence type).

Methods
Using a dataset of 414 Escherichia coli isolated from separate episodes of bacteremia at a single academic institution in Toronto, Canada between 2010 and 2015, we compared the potential predictive ability of three approaches (epidemiologic, sequence type, and gene identification) for classifying antibiotic resistance to three commonly used classes of broad-spectrum antibiotic therapy (third-generation cephalosporins, fluoroquinolones, and aminoglycosides). We used logistic regression models with binary predictor variables to generate model receiver operating characteristic curves. Predictive discrimination was measured using apparent and corrected (bootstrapped) area under the curves (AUCs).

Results
Using two simple epidemiologic risk factors (prior antibiotic exposure and recent prior Gram-negative susceptibility), modest predictive discrimination was achieved (AUCs 0.65–0.74). Sequence type demonstrated strong discrimination (AUCs 0.84–0.94) across all three antibiotic classes. Epidemiologic risk factors significantly improved sequence-type prediction for cephalosporins and aminoglycosides (P &lt; 0.05). Gene identification approaches provided the highest degree of discrimination (AUCs 0.73–0.99), with no statistically significant benefit of adding epidemiologic predictors.

Conclusion
Rapid identification of sequence type, or other lineage-based classification, could produce excellent discrimination of antibiotic resistance, and may be improved by incorporating readily available epidemiologic predictors.

Disclosures
All authors: No reported disclosures.
LB5. Safety of In Utero Antiretroviral (ARV) Exposure: Neurologic Outcomes in HIV-Exposed, Uninfected Children
Authors: Crowell Claudia S , Williams Paige , Yildirim Cenk , Van Dyke Russell , Smith Renee , Chadwick Ellen G , Seage George , Hazra Rohan 
Published: November 2018

Abstract

Background
Antiretroviral therapy for pregnant women with HIV has dramatically decreased perinatal transmission of HIV, but concerns remain regarding adverse neurologic outcomes from possible mitochondrial dysfunction or other mechanisms in children exposed in utero to antiretroviral (ARV) medications.

Method
We evaluated HIV-exposed uninfected (HEU) children enrolled in the Surveillance Monitoring for ART Toxicities (SMARTT) study, a longitudinal observational cohort study conducted by the Pediatric HIV/AIDS Cohort Study (PHACS) network. The primary outcome of interest was a “neurologic case” (microcephaly, febrile seizures, seizure disorders, ophthalmologic disorders, other neurologic conditions) as determined by clinical review blinded to ARV exposure. Log-binomial regression analysis was used to obtain adjusted relative risks (aRRs) for associations between in utero ARV exposure and neurologic case status, accounting for potential confounders including Hispanic ethnicity, tobacco use during pregnancy, and birth cohort (2011–2014 and 2015–2017 vs. &lt;2011). To account for variable person-time follow-up within the cohort, Poisson regression models for adjusted incidence rate ratios (aIRRs) were also fitted.

Result
Among 3,747 eligible HEU children enrolled in SMARTT (52% male, 68% Black and 31% Hispanic), 237 were diagnosed with neurologic conditions, yielding an event rate of 6.3% (95% CI: 5.6%, 7.2%). Tobacco and alcohol use during pregnancy were common (17% and 8%, respectively). The majority of children had in utero ARV exposure (87%); 60% to PI-based regimens, 16% to NNRTI-based regimens and 7% to PI + NNRTI-based regimens. In adjusted models, there was a trend towards an association between efavirenz exposure (EFV) and neurologic case status (aRR: 1.60, 95% CI: 0.99, 2.58). This association was statistically significant in sensitivity analyses restricted to children enrolled prior to or shortly after birth (aRR: 1.80, 95% CI: 1.06, 3.05), excluding children with confirmed congenital anomalies (aRR: 1.66, 95% CI: 1.02, 2.64), and accounting for person-time follow-up (aIRR: 1.55, 95% CI: 1.00, 2.76).

Conclusion
EFV exposure during pregnancy was associated with a higher risk of neurologic abnormalities in infancy and childhood.

Disclosures
R. Van Dyke, Giliad Sciences: Grant Investigator, Research grant. E. G. Chadwick, Abbott Labs: Shareholder, stock dividends. AbbVie: Shareholder, stock dividends.
LB8. Outbreak of Enterovirus A71 Neurologic Disease in Children—Colorado, 2018
Authors: Messacar Kevin , Burakoff Alexis , Nix William A , Rogers Shannon , Lopez Adriana S , Oberste M Steve , Gerber Susan I , Spence-Davizon Emily , Herlihy Rachel , Dominguez Samuel 
Published: November 2018

Abstract

Background
In May 2018, an outbreak of enterovirus A71 (EV-A71) neurologic disease was detected at Children’s Hospital Colorado (CHCO) prompting a public health investigation. We characterized clinical, laboratory, and radiologic findings during this outbreak.

Methods
A case was defined as meningitis, encephalitis, or acute flaccid myelitis with EV-A71 identified from a biologic specimen in a child examined at CHCO after March 1, 2018. Biologic specimens from children with neurologic disease and EV identified by clinical reverse-transcription polymerase chain reaction (RT-PCR) were typed by VP1 sequencing at CDC.

Results
As of July 20, 2018, 28 cases of EV-A71 neurologic disease were identified. This report describes the clinical, laboratory, and radiologic findings for the first 13 children identified with EV-A71 neurologic disease, for whom complete information is available. The median age was 13 months (range = 10 days–35 months) and 11 (85%) were male. Neurologic presentations included 12 (92%) with meningitis, 9 (69%) with encephalitis, and 3 (23%) with acute flaccid myelitis (AFM). All 13 children had fever and irritability; 3 (23%) had hand, foot, and mouth disease. Neurologic signs included encephalopathy (n = 7, 54%), ataxia (n = 7, 54%), myoclonus (n = 6, 46%), limb weakness (n = 4, 31%), cranial nerve deficits (n = 2, 15%), and seizures (n = 1, 8%). Nine (90%) of 10 children with cerebrospinal fluid (CSF) specimen analyzed had a pleocytosis (&gt;5 white blood cells/uL); 6 of 8 (75%) children who had brain imaging showed abnormalities, with 5 (63%) in the brainstem, 3 (38%) in the cerebellum, and 3 (38%) in the spinal cord. All 13 children had EV-A71 identified in nasopharyngeal, pharyngeal, or fecal specimens; only 2 of 11 (18%) tested had EV identified in CSF. All 13 children were hospitalized and 4 (31%) required intensive care. The 3 (23%) children with AFM had residual limb weakness at time of discharge. All children survived.

Conclusion
EV-A71 should be considered when children present with myoclonus, ataxia, or limb weakness in the setting of a febrile illness. Testing of nonsterile sites (respiratory, pharyngeal, or fecal) should be considered when CNS disease associated with EV is suspected and initial CSF testing is negative.

Disclosures
All authors: No reported disclosures.
LB10. Changing Epidemiology of Hepatitis A Virus Infections–– United States, 2007–2017
Authors: Foster Monique , Hofmeister Megan , Yin Shaoman , Weidle Paul 
Published: November 2018

Abstract

Background
Hepatitis A virus (HAV) is primarily spread fecal-orally and causes acute illness including fever, jaundice, and diarrhea. After introduction and widespread use of the hepatitis A vaccine in the United States, infection with HAV decreased and outbreaks typically associated with a common-source were uncommon.

Method
CDC receives reports of hepatitis A infections from states through the National Notifiable Disease Surveillance System (NNDSS) and/or directly to the viral hepatitis outbreak response team. We analyzed NNDSS hepatitis A data for 2007–2016, and a combination of NNDSS data and cases directly reported to the CDC hepatitis A outbreak response team during 2017; excluding 2017 NNDSS data from the four states that directly reported outbreaks to the outbreak response team to eliminate the potential for double-counting cases.

Result
During 2007–2011, a total of 10,619 hepatitis A cases were reported; 521 (5%) were associated with outbreaks. Of the 274 outbreak-associated cases for whom clinical data were reported, 102 (37%) were hospitalized and one (0.3%) died. Of the 407 outbreak-associated cases for whom risk exposure data were reported, 210 (52%) were associated with a common source. Comparatively, during 2012–2017, a total of 11,483 hepatitis A cases were reported; 2,323 (20%) were associated with outbreaks. Of the outbreak-associated cases for whom clinical data were reported, 1,306/2,162 (60%) were hospitalized and 43/2,178 (2%) died. Of the outbreak-associated cases for whom risk exposure data were reported, 379/2,188 (17%) were associated with a common source.

Conclusion
In the United States, outbreaks of hepatitis A infections in the decade prior to 2017 were infrequent and typically associated with a common source. Reported cases associated with hepatitis A outbreaks are increasing, along with concurrent increases in hospitalizations and deaths among persons with outbreak-associated infections. Recent outbreaks indicate a decrease in cases associated with a common-source exposure. Decreasing the susceptible population through adherence to childhood vaccination recommendations and targeted vaccination of recommended at-risk groups can prevent future hepatitis A outbreaks of any transmission pattern.

Disclosures
All authors: No reported disclosures.
First-in-Man Clinical Experience Using a High-Definition 3-Dimensional Exoscope System for Microneurosurgery
Authors: Khalessi Alexander A , Rahme Ralph , Rennert Robert C , Borgas Pia , Steinberg Jeffrey A , White Timothy G , Santiago-Dieppa David R , Boockvar John A , Hatefi Dustin , Pannell J Scott , Levy Michael , Langer David J 
Published: November 2018

ABSTRACT

BACKGROUND
During its development and preclinical assessment, a novel, 3-dimensional (3D), high-definition (4K-HD) exoscope system was formerly shown to provide an immersive surgical experience, while maintaining a portable, low-profile design.

OBJECTIVE
To assess the clinical applicability of this 3D 4K-HD exoscope via first-in-man surgical use.

METHODS
The operative workflow, functionality, and visual haptics of the 3D 4K-HD exoscope were assessed in a variety of microneurosurgical cases at 2 US centers.

RESULTS
Nineteen microneurosurgical procedures in 18 patients were performed exclusively using the 3D 4K-HD exoscope. Pathologies treated included 4 aneurysms, 3 cavernous malformations (1 with intraoperative electrocorticography), 2 arteriovenous malformations, 1 foramen magnum meningioma, 1 convexity meningioma, 1 glioma, 1 occipital cyst, 1 chiari malformation, 1 carotid endarterectomy, 1 subdural hematoma, 1 anterior cervical discectomy and fusion, and 2 lumbar laminectomies. All patients experienced good surgical and clinical outcomes. Similar to preclinical assessments, the 3D 4K-HD exoscope provided an immersive 3D surgical experience for the primary surgeon, assistants, and trainees. The small exoscope frame, large depth of field, and hand/foot pedal controls improved exoscope mobility, decreased need to re-focus, and provided unobstructed operative corridors. Flexible positioning of the camera allows the surgeon's posture to be kept in a neutral position with uncompromised viewing angles.

CONCLUSION
The first-in-man clinical experience with the 3D 4K-HD exoscope confirms its excellent optics and ergonomics for the entire operative team, with high workflow adaptability for a variety of microneurosurgical cases. Expanded clinical use of the 3D 4K-HD exoscope is justified.
Dynamic Stress Fluoroscopy for Evaluation of the Femoral Neck After Intramedullary Nails: Improved Sensitivity for Identifying Occult Fractures
Authors: Avilucea Frank R. , Joyce David , Mir Hassan R. 
Published: November 2018

Objectives:
To report on the use of dynamic stress fluoroscopy (DSF) for detection of occult fractures of the femoral neck associated with femoral shaft fractures. To compare DSF with a fully static imaging protocol in detecting occult femoral neck fractures.

Design:
Multicenter retrospective cohort study.

Setting:
Two urban level I trauma centers.

Participants/Intervention:
A consecutive series of 1273 femoral shaft fractures were included. Inclusion criteria were patients treated with an intramedullary rod (antegrade/retrograde), age ≥18 years, a fine-cut (2 mm) preoperative computed tomography and hip radiographs, intraoperative anteroposterior (AP)/lateral fluoroscopic view of the femoral neck before femoral nailing, and a minimum follow-up of 3 months. Patients were divided into 2 groups based on the technique used to identify the presence of a femoral neck fracture after intramedullary fixation of the femoral shaft: DSF or static intraoperative radiographs.

Main Outcome Measures:
Sensitivity, specificity, positive predictive value, and negative predictive value.

Results:
Both the static imaging protocol and DSF had high specificity (100%; 100%), positive predictive value (100%; 100%), and negative predictive value (99.5%; 99.6%). Sensitivity was poor (73.7%) for the static protocol group versus high (92.3%) for the DSF group.

Conclusions:
Compared with a fully static imaging protocol, DSF is a more sensitive and highly specific technique, enabling intraoperative detection of occult fractures of the femoral neck.

Level of Evidence:
Diagnostic Level III. See Instructions for Authors for complete description of levels of evidence.
Follicle-stimulating hormone, but not cardiorespiratory fitness, is associated with flow-mediated dilation with advancing menopausal stage
Authors: Serviente Corinna , Witkowski Sarah 
Published: November 2018

Abstract

Objective:
The aim of the study was to evaluate if there are differences in endothelial function before and after acute exercise in women at different menopausal stages with high and low cardiorespiratory fitness.

Methods:
Participants were healthy high-fit premenopausal (n = 11), perimenopausal (n = 12), and postmenopausal women (n = 13) and low-fit perimenopausal (n = 7) and postmenopausal women (n = 8). Brachial artery flow-mediated dilation (FMD) was measured before and after acute moderate intensity exercise. FMD was calculated as (Diameterpeak−Diameterbaseline)/ Diameterbaseline) × 100. Differences between high-fit women and between high- and low-fit perimenopausal and postmenopausal women were assessed with repeated-measure ANOVAs. Relations with FMD were assessed with Pearson correlations.

Results:
FMD was reduced with progressive menopausal stage in high-fit women (P = 0.005) and was lower in perimenopausal compared to postmenopausal women (P = 0.047). FMD was lower in high-fit compared to low-fit women (P = 0.006) and there was no relation between FMD and VO2peak (P > 0.05). There was an inverse relation between FMD and follicle-stimulating hormone (P < 0.05), but not estradiol (P > 0.05).

Conclusions:
These data suggest that endothelial function is lower with progressive menopausal stage in women with high cardiorespiratory fitness; that FMD is lower in women with higher cardiorespiratory fitness; and that FSH, but not estradiol, is associated with FMD.
ICD-10 Coding Will Challenge Researchers
Authors: Mainor Alexander J. , Morden Nancy E. , Smith Jeremy , Tomlin Stephanie , Skinner Jonathan 
Published: November 2018

Background:
The October 1, 2015 US health care diagnosis and procedure codes update, from the 9th to 10th version of the International Classification of Diseases (ICD), abruptly changed the structure, number, and diversity of codes in health care administrative data. Translation from ICD-9 to ICD-10 risks introducing artificial changes in claims-based measures of health and health services.

Objective:
Using published ICD-9 and ICD-10 definitions and translation software, we explored discontinuity in common diagnoses to quantify measurement changes introduced by the upgrade.

Design:
Using 100% Medicare inpatient data, 2012–2015, we calculated the quarterly frequency of condition-specific diagnoses on hospital discharge records. Years 2012–2014 provided baseline frequencies and historic, annual fourth-quarter changes. We compared these to fourth quarter of 2015, the first months after ICD-10 adoption, using Centers for Medicare and Medicaid Services Chronic Conditions Data Warehouse (CCW) ICD-9 and ICD-10 definitions and other commonly used definitions sets.

Results:
Discontinuities of recorded CCW-defined conditions in fourth quarter of 2015 varied widely. For example, compared with diagnosis appearance in 2014 fourth quarter, in 2015 we saw a sudden 3.2% increase in chronic lung disease and a 1.8% decrease in depression; frequency of acute myocardial infarction was stable. Using published software to translate Charlson-Deyo and Elixhauser conditions yielded discontinuities ranging from −8.9% to +10.9%.

Conclusions:
ICD-9 to ICD-10 translations do not always align, producing discontinuity over time. This may compromise ICD-based measurements and risk-adjustment. To address the challenge, we propose a public resource for researchers to share discovered discontinuities introduced by ICD-10 adoption and the solutions they develop.