bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sustained Improvement in Hand Hygiene Compliance Using a Decentralized, Technology-Based Approach
Authors: Landon Emily , Pacholek Gretchen , Runjo Demetria , Garcia-Houchins Sylvia , Ridgway Jessica P , Weber Stephen G , Chu Vera , Marrs Rachel , Bartlett Allison H 
Published: October 2017

Abstract

Background
We aimed to use weekly PI calls in conjunction with 24/7 hand hygiene monitoring technology (HHMT) to engage front-line Intensive Care Unit (ICUs) clinicians in improving Hand Hygiene (HH) compliance

Methods
HHMT is used to monitor aggregate, unit-based HH compliance in real time and displayed on monitors at the nursing stations at our academic medical center. After installation and validation were completed, unit-based teams of nursing and physician leadership joined weekly 15-minute HH PI calls to discuss their previous week’s compliance rate, next steps in their own PI plan, and share successes and failures. Calls were suspended for 6 months and restarted in early 2017.

Results
Graph representation of weekly HH compliance rates for the ICUs are shown in figure 1. Units AandB underwent physical moves during the break, Unit C had no change, and Unit D moved and consolidated with other ICUs constituting a major change in personnel and patient population. Each ICU participated in 84 calls and recorded approx. 50,000–100,000 HH opportunities during each month resulting in over 8 million opportunities for HH compliance recorded during the call-in periods. Unit A had an average compliance of 39% for the first 4 weeks of calls and 64% during the same 4 week period one year later (P &lt; 0.0001). After 6 months without the calls, HH compliance was 48% (P &lt; 0.0001 compared with baseline compliance) and unit A implemented 20 separate PI interventions over the course of the calls. Compliance was also significantly improved (P &lt; 0.0001 for all comparison to baseline) for units B, C, and D (Unit B: 42% baseline, 71% at 1 year, 67% after the break, 23 interventions; Unit C: 54% baseline, 58% at 1 year, 59% after the break, 19 interventions; Unit D: 41% at baseline, 56% after 1 year, 49% after the break, 19 interventions). Attendance was &gt;90% for nursing leadership and &lt;25% for physician leadership.

Conclusion
Weekly 15-minute calls were successful in engaging local nursing leadership to undertake performance improvement interventions and significantly improved HH compliance that was sustained over 18 months of calls and did not drop back to baseline even after a 6 month break.

Disclosures
E. Landon, GOJO: Speaker, travel expenses for speaking; &#x2028; J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; A. H. Bartlett, CVS Caremark: Consultant, Consulting fee
The Use of Instructional Technology to Increase Independent Patient Hand Hygiene Practice of Hospitalized Adults in an Acute Care Setting
Authors: Knighton Shanina 
Published: October 2017

Abstract

Background
Despite recognition that hospitalized patients carry pathogens on their hands and demonstrate poor hand hygiene practice, little attention has been given to interventions that increase hand hygiene practices. Studies that have attempted to improve patient hand hygiene practice lack sustainability due to dependability on healthcare staff, and no prior studies have tested ways to improve independent patient hand hygiene practice. One such approach is using a patient-centered multi-modal educational intervention and electronic voice-recorded reminder cue to promote self- management of hand hygiene.

Methods
This comparative effectiveness study tested two educationally-based approaches to improve patient hand hygiene in older adults hospitalized for 4 days for elective lower extremity orthopedic or podiatry surgery at a veterans’ hospital. Group 1 (n = 41) received an educational video, an educational handout and a voice-recorded electronic audio reminder (EAR) an active cue, which verbally reminded the participant to clean their hands 3 times a day (7am, 12 pm, 5pm). Group 2 (n = 34) received the educational video and handout without the EAR. There were no significant differences between the two randomly assigned groups in terms of age, ethnicity and sex.

Results
Figure 1 shows the daily difference in product consumption Day 0 to Day 3. The average product consumption of ABHR (alcohol-based hand rub) in Group 1 (EAR) was 29.97 grams (SD 17.13). Group 2 (No EAR) averaged 10.88 grams (9.27) (P &lt; 0.0001). Comparing post-operative day (POD) 0 to POD 3, and controlling for covariates (Disability of Arm, Shoulder, and Hand [QuickDASH], Hand Grip Strength, Surgical Pain, MRSA in Nares, and Education), multivariate analyses indicated that the electronic audio reminder was a significant predictor (β=.468) of ABHR consumption, R2 = .39, R2adj. = .34, F (6, 68) = 7.265, P &lt; .001.

Conclusion
This study demonstrated that a short educational intervention that included a video, a handout, and a verbal audio reminder has the potential to increase patient-centered infection prevention in the acute care settings without increasing the workload of healthcare workers. Findings can be used for future infection prevention studies in institutionalized patients to improve self-managed care.

Disclosures
All authors: No reported disclosures.
Effectiveness of Live Zoster Vaccine in Preventing Herpes Zoster Ophthalmicus (HZO)
Authors: Aukes Laurie , Bartlett Joan , Fireman Bruce , Hansen John , Lewis Edwin , Earley Elizabeth , Marks Morgan , Saddier Patricia , Klein Nicola P 
Published: October 2017

Abstract

Background
Herpes zoster ophthalmicus (HZO), caused by reactivation of varicella-zoster virus in or around the eye, can be severe and often results in care-seeking that may be less discretionary than for uncomplicated herpes zoster (HZ). We compared the vaccine effectiveness (VE) of live zoster vaccine against HZO with the VE against HZ overall.

Methods
Kaiser Permanente Northern California (KPNC) members enter the ongoing cohort study when age-eligible for zoster vaccine starting in 2007. Incident HZ was defined as a new diagnosis of HZ with an antiviral prescription or a positive varicella viral test. Among those, an HZO case was defined as having an HZO diagnosis during an ophthalmology visit within 30 days of the initial HZ diagnosis. VE by age at vaccination and time since vaccination was estimated using Cox regression adjusted for age, race, sex and time-varying measures of healthcare use, comorbidities and immunocompromise status. Average VE over the first 5 years following vaccination was calculated as a weighted average of annual VE estimates.

Results
During 2007–2014, ~1.3 million individuals ≥50 years of age entered the study population and 29% were vaccinated. Among 48,889 incident HZ cases, 2,858 (6%) had HZO, 87% of whom were unvaccinated. For all ages combined, VE against HZO was 72% (95% CI, 64%-79%) in year 1, similar to 68% (95% CI, 65%-70%) against HZ. VE fell in years 2, 3, 4, and 5 to 47%, 45%, 42% and 27% for HZO and to 47%, 39%, 41% and 37% for HZ. For age groups 60 – 69 and 70 – 79, where we have the most data, initial VE and waning were similar for HZO and HZ. Numbers of HZO cases for 50–59 year olds were too small to evaluate at this time. Average VE against HZO over the first 5 years following vaccination was 52% (95% CI, 42%–60%) for ages 60–69, 51% (95% CI, 39%–61%) for ages 70-79, and 39% (95% CI, 14%-57%) for ages 80+; similarly, 5-year average VE against HZ was 49%, 46%, and 44% for these 3 age groups.

Conclusion
VE against HZO was similar to VE against HZ regardless of age at vaccination or time since vaccination. Effectiveness of live zoster vaccine in preventing HZO was highest in year one with subsequent waning.

Disclosures
E. Earley, Merck & Co.: Research Contractor, Salary; M. Marks, Merck and Co. Inc.: Employee, Restricted Stock and Salary; P. Saddier, Merck & Co., Inc.: Employee, Salary; N. P. Klein, GSK: Investigator, Grant recipient; sanofi pasteur: Investigator, Grant recipient; Merck & Co.: Investigator, Grant recipient; MedImmune: Investigator, Grant recipient; Protein Science: Investigator, Grant recipient Pfizer: Investigator, Grant recipient
How Acceptable Is A Wireless Pill Bottle That Monitors and Texts In Response To Missed Doses: Focus Groups With Young African American MSM Living With HIV
Authors: Dworkin Mark , Panchal Palak , Jimenez Antonio , Garofalo Robert , Haberer Jessica E , Wiebel Wayne 
Published: October 2017

Abstract

Background
African American MSM (AAMSM) living with HIV are less likely to have viral suppression than other racial groups. Wisepill, a wireless pill bottle, transmits a cellular signal to a server when opened and is designed to measure antiretroviral therapy (ART) adherence. The objective of this study was to explore the acceptability of a proposed intervention in these young AAMSM using the Wisepill device opening data to trigger a real-time text alert that ART may not have been taken during a planned time to either the user, a trusted social contact, or a healthcare worker, depending on the duration of consecutively missed doses (1 dose, 3 doses, 7 doses, respectively).

Methods
From December 2016 – May 2017, AAMSM living with HIV age 18–34 years (N = 25) participated in a study that included five focus groups (n = 23) and one on one interviews (n = 2). We performed theory-based discussion grounded in the Technology Acceptance Model. Specifically, we explored usefulness, convenience, concerns, and intention to use.

Results
Fifty-two percent missed at least one dose in the 4 days prior to the focus group meeting. Almost all participants (94%) favored the idea of a wireless pill bottle monitor and linked text message notification that ART may have been missed. The device was considered convenient for use at home or in a backpack, but too large for a pocket. Stigma and privacy were common concerns. For example, participants did not want to carry the device with them if the pills would “sound like a walking pharmacy” and did not want a text message that said, “You missed your HIV meds.” They preferred text message notifications that ranged from emoji icons to cryptic short texts and wanted to receive an email as a backup plan. Most believed that the device appearance would not gain unwanted attention. Thirty percent of the participants identified a partner as a social contact to whom the 3-day missed dose reminders would be sent whereas others designated their mother, aunt, brother, friend, pastor, and case-manager.

Conclusion
An adherence intervention using a wireless pill bottle monitoring device linked to text notifications was acceptable to most of the young AAMSM in this study. Acceptability may be enhanced by personalization of the responsive text messages and a backup email option.

Disclosures
J. E. Haberer, Merck: Consultant, Consulting fee; Natera: Shareholder, Stock ownership
Late Presentation among Patients Diagnosed with HIV in an Inpatient Setting
Authors: Leonard Michael , Figueroa-Sierra Marielys , Kindlick Dianne 
Published: October 2017

Abstract

Background
Despite improved morbidity and mortality with the advent of highly active antiretroviral therapy (HAART), late presentation, CD4&lt; 200 and/or an opportunistic infection or malignancy, remains a major public health concern. Although mortality causes are more diverse in the HAART era, HIV associated deaths continue to be a result of late presentation.

Methods
Carolinas HealthCare System (CHS) is a nonprofit, vertically integrated healthcare system with approximately 12 million patient encounters per year. We identified new HIV positive patients from an institutional database within our multi-hospital healthcare system and retrospectively extracted clinical patient data. Patients with HIV, admitted to one of our eight acute care facilities were identified (n = 1,632) from medical records, of these, 93 were diagnosed during admission.

Results
We identified all newly diagnosed with HIV in the inpatient setting between July 2014 and March 2017 (n = 93). 70% of the newly diagnosed were male, 67% identified as Non-Hispanic black and had a median age of 42 years. The median CD4 count was 156 and 76% presented with a CD4&lt;200. Only 50% of patients were insured prior to hospitalization. Although not statistically significant in this study, we noted that those who were insured prior to hospital discharge were more likely to follow-up and have continuity of care compared with the uninsured. 42% were prescribed HAART prior to discharge. Opportunistic infections or AIDS defining malignancies were present in 38%. An OI was present in 29% with PCP being the most common and an AIDs defining malignancy was present in 9% with NHL being the most common diagnosis.. Inpatient mortality was 10% in newly diagnosed HIV patients and of those the median CD4 was 45. All of those died of AIDS-related complications.

Conclusion
Patients in our study period presented too late in their illness with &gt;75% presenting with a CD4&lt;200. Our findings are limited by our small sample size and further prospective studies are needed to better identify effective strategies to prevent late diagnosis of HIV.

Disclosures
All authors: No reported disclosures.
Reviewing Clinical Outcomes of Patients with the E157Q Mutation in Detroit
Authors: Pavkovich David , Richmond Deborah , Veltman Jennifer 
Published: October 2017

Abstract

Background
Integrase Strand Transfer Inhibitor (INSTIs) transmitted resistance has remained uncommon, estimated at 0.04%, with E157Q being the mutation most commonly identified. E157Q is thought to cause low-level resistance to raltegravir and elvitegravir but has also been the only mutation implicated in a recent case of dolutegravir treatment failure. INSTI resistance testing is not currently recommended and little data is available on clinical outcomes on INSTI therapy in the presence of E157Q, therefore we reviewed all the patients in an urban clinic in Detroit with E157Q seen on genotype to determine its clinical impact.

Methods
We reviewed the records of all Wayne State University Adult HIV clinic attendees in Detroit, Michigan who had an INSTI genotype performed between February 2014 and February 2016 to identify those with an E157Q mutation. We reviewed demographics, HIV risk factors, treatment and clinical outcomes.

Results
292 patients had INSTI resistance testing during our study period. 24 patients (8.2%) had an E157Q mutation. These patients had a median age of 27.5 years. They were predominately male (87.5%), black (87.5%), and MSM (70.8%). Four patients had an additional mutation (N155H, T97S, L74V, and V151I). Eleven patients were treatment-naïve, consistent with transmitted E157Q drug resistance. One treatment-naïve patient had both the E157Q mutation and the T97S mutations. Of the 24 patients with E157Q, 15 were placed on an INSTI-based regimen and 6 (40%) achieved viral suppression at 12 months. 7 patients were lost to follow up at and 2 had stopped treatment at 12 months. Amongst patients adherent to INSTI based ART, there were no cases of treatment failure.

Conclusion
While our sample size was relatively small, our data suggests that E157Q is not an infrequent mutation and patients with E157Q who were started on INSTI based regimens and were adherent achieved viral suppression. This is reassuring for rapid ART start at time of HIV diagnosis with INSTI based ART without genotype data. Loss to follow up and poor adherence were seen frequently, limiting our ability to determine clinical outcomes on ART. In short, patients with E157Q mutation have good clinical outcomes on INSTI based ART.

Disclosures
All authors: No reported disclosures.
Pharmacokinetics of Temsavir, the Active Moiety of the Prodrug Fostemsavir, in Subjects with Hepatic Impairment
Authors: Sevinsky Heather , Magee Mindy , Ackerman Peter , Adamczyk Robert , Karkas Jennifer , Lubin Susan , Ravindran Palanikumar , Llamoso Cyril , Eley Timothy , Moore Katy 
Published: October 2017

Abstract

Background
Fostemsavir (FTR) is a prodrug of temsavir (TMR), a first-in-class attachment inhibitor that binds directly to HIV-1 gp120, preventing initial viral attachment and entry into host CD4+ T cells. TMR is primarily metabolized via hydrolytic and oxidative pathways; impaired hepatic function may alter TMR pharmacokinetics (PK).

Methods
AI438053 (NCT02467335) was an open-label, nonrandomized study in healthy subjects (HS) and subjects with hepatic impairment (HI), defined by Child-Pugh (CP) score: mild (CPA), moderate (CPB), or severe (CPC). HS were matched for age, body weight, and sex. Subjects received a single oral dose of FTR 600 mg fasted and serial PK samples for TMR were collected up to 96 hours post-dose. Unbound TMR at 1 and 3 hours post-dose was determined. Total and unbound PK parameters were derived by noncompartmental methods. Geometric mean ratios (GMR) and 90% confidence intervals (CI) for HI vs.. HS were derived using linear mixed-effects models. Subjects were monitored for adverse events (AEs).

Results
18 subjects with HI (N = 6/CP group) and 12 HS received FTR and completed the study. Total and unbound TMR exposures increased with increasing HI severity (see Table). Total and unbound TMR CLT/F decreased with increasing HI severity. Mean % protein binding of TMR was 81.0% in HS and 79.9%, 81.9%, and 76.5% in CPA, CPB, and CPC HI, respectively, and was independent of TMR concentration. There were no deaths, serious AEs, or discontinuations during the treatment period.

Conclusion
TMR exposures increase with increasing severity of HI. The increase in TMR exposures in patients with mild or moderate HI is not expected to alter the safety profile of FTR. The risk/benefit of higher TMR exposures in severe HI is under evaluation.

Disclosures
H. Sevinsky, ViiV Healthcare: Employee, Salary; M. Magee, GlaxoSmithKline: Employee and Shareholder, Salary; P. Ackerman, ViiV Healthcare/GSK: Employee and Shareholder, Salary and Stock; R. Adamczyk, Bristol-Myers Squibb: Employee, Salary; J. Karkas, Bristol Myers Squibb: Employee and Shareholder, Salary; S. Lubin, Bristol-Myers Squibb: Employee, Salary; P. Ravindran, Bristol-Myers Squibb: Employee, Salary; C. Llamoso, ViiV Healthcare: Employee, Salary; T. Eley, Bristol-Myers Squibb: Former Employee during study conduct, Salary; K. Moore, ViiV Healthcare: Employee, Salary
Avoiding Inpatient Delays in Antiretroviral Therapy via Low Cost Formulary Management
Authors: Sundquist Hannah , Kassamali Zahra 
Published: October 2017

Abstract

Background
Of 8 formulary HIV medications at our institution, 3 are no longer first line treatments. Agents unavailable on formulary are administered from a patient’s own supply. We examined the impact of availability of antiretroviral therapy (ART) on time to appropriate therapy among HIV positive inpatients.

Methods
Adult inpatients who received ART from 11/2015 – 10/2016 were included in this single-center review. Data were evaluated by encounter; individuals with multiple admissions were counted per admit. Descriptive statistics were used to evaluate the time from admission to ART order and administration. We noted discrepancies between ordered and home ART regimen, and any administration of partial therapy. Patients not taking ART prior to admission or without documentation of a home ART regimen were excluded from the outcomes analysis. A cost analysis was conducted to describe the financial impact of any recommended formulary changes.

Results
36 patients with 55 inpatient encounters were evaluated; 46 (84%) had a documented home ART regimen. Mean age was 47.8 years, 67% were male, 36% met criteria for AIDS by CD4 cell count. Creatinine clearance was &lt; 60 ml/minute in 33% of subjects, 25% were admitted for an infectious issue. Median length of stay was 5 days. Half (49%) were taking nucleoside reverse transcriptase inhibitors, 22% integrase inhibitors, 19% protease inhibitors, 3% non-nucleoside reverse transcriptase inhibitors. In the 7 encounters (15%) with all ART on formulary, 100% received their full ART regimens as inpatients vs. 69% of those with partial or no ART on formulary. Median time to therapy doubled in patients who had partial or no home ART on formulary: 25 hours (median of 1 missed dose) vs.. 12 hours (median of 0 missed doses). Anticipated annual cost of formulary revisions, including addition of 4 agents, was $6016.37.

Conclusion
Having a complete ART regimen on formulary substantially increased likelihood of complete ART administration without delay. Adding an NRTI alternative to tenofovir was needed due to high rates of renal dysfunction; adding agents with higher barriers to resistance, dolutegravir and darunavir, were important as genotypes and viral loads are not always known at admit. Expanding the ART formulary provides a significant improvement in quality of care at a reasonable cost.

Disclosures
All authors: No reported disclosures.
Knowledge, Attitude and Practice of Pre-exposure prophylaxis (PrEP) against HIV infection of medical providers at an academic center
Authors: Maude Rapeephan , Volpe Gretchen , Stone David 
Published: October 2017

Abstract

Background
Pre-exposure prophylaxis (PrEP) against HIV infection is available for people at risk of acquiring HIV infection and who are not positive for HIV infection. It is proven to be effective at preventing HIV infection in many studies in various populations. However, due to lack of knowledge or due to attitudes towards PrEP, this mode of prevention may be underutilized by people at risk and their providers. Our aim is to assess the baseline knowledge of, attitudes towards and practice of medical providers at Tufts Medical Center.

Methods
survey of 80 medical providers at Tufts Medical Center with a short questionnaire.

Results
The median age of the participants were 31 years old (IQR 28–34.5, range 22–71). 38.75% were male. Ethnicity were White (60%), Asian (20%), and others (20%). Fifty-five percent were Doctor of Medicine or Doctor of Osteopathic (MD/DO), 20% Physician assistant (PA), 8.75% Registered nurse (RN) and 7.5% were medical students. Other groups included Nurse practicioner (NP), medical assistant, research coordinator and PA student.
Knowledge. Approximately two-third (67.5%) of study participants heard of PREP. In MD/DO group, 81.81% (36/44) heard about PREp. 46.26% responded correctly that PREP should be given daily. 68.75% answered correctly that Tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC; Truvada) is the standard regimen.
Attitude. 31.81% of the MD/DO group were not comfortable prescribing PREP. Top three barriers perceived for prescribing PREP were “Not enough knowledge” 72.5%; “Lack of experience” 56.25% and “Not covered by insurance” 17.5%.
Practice. Of 61 participants who are eligible to prescribe medications (MD/DO, PA, NP), 15.27% prescribed PREP prior to the survey. Over 75% would refer patients to infectious diseases or other providers to prescribe PREP.

Conclusion
There are some knowledge and practice gap of PREP. Most are not comfortable prescribing PREP thus will refer patients to infectious diseases. It is essential to promote knowledge and attitude about PREP in medical providers who have an important role in advising at-risk patients about PrEP which will lead to a better practice.

Disclosures
All authors: No reported disclosures.