bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-919. Epidemiology of Cerebral Sinovenous Thrombosis in Children with Acute Bacterial Intracranial Infection: a Single-Institution Retrospective Study
Authors: Mehta Nehali , Swami Sanjeev K , Halverson Mark , Loerinc Leah , Gambrah-Lyles Claudia , McGuire Jennifer 
Published: January 2025

Abstract

Background
Cerebral sinovenous thrombosis (CSVT) is a known complication of acute bacterial intracranial infection. The objective of this study is to determine the annual proportion of, risk factors for, and outcomes in children with CSVT secondary to acute bacterial intracranial infection.Figure 1:Annual proportion of CSVT in children with acute bacterial intracranial infection between Jan 1, 2015 and December 31, 2022

Methods
Retrospective single-center cohort study of children age 1-18 years hospitalized at a tertiary care children’s hospital for acute bacterial intracranial infection between 01/01/2015 and 02/01/2023. Cases were identified by discharge ICD codes for “meningitis,” “meningoencephalitis,” “subdural empyema,” “epidural abscess,” and “brain abscess.” Medical charts were manually screened to ascertain the diagnosis and to abstract relevant clinical data. Multivariate models were built to examine risk factors for CSVT.

Results
One hundred and three patients were included. Median age was 10.2 [5.9,12.7] years. 31/103 (30%) had CSVT. Annual proportion of CSVT did not vary; however, the total number of cases of intracranial infection rose during the study period. Patients with CSVT were no different from those without CSVT by demographics, vaccination status, neurologic signs or symptoms at presentation, or causative organisms. Non-pneumococcal streptococcus species were the most common causative organisms, found in 37/103 (36%) children. Need for neurosurgical intervention (aOR=11.6, p=0.027), need for ENT intervention (aOR=6.1, p=0.013), temporal location of infection (aOR=7.9, p=0.004), and concurrent mastoiditis (aOR=29.5, p=0.004) were associated with CSVT. The sigmoid sinus (55%, 17/31), transverse sinus (42%, 13/31), jugular vein (45%, 14/31), and superior sagittal sinus (45%, 14/31) were the most common locations for CSVT. Two patients (6%) had venous infarction; one (3%) had venous hemorrhage. A higher proportion of children with CSVT had behavioral concerns (p=0.020) and learning concerns (p=0.025) than children without CSVT.

Conclusion
CSVT is common in acute bacterial intracranial infection. Consider empiric surveillance in children with acute bacterial intracranial infection with mastoiditis, temporal location of infection, and/or those who require surgical intervention. Outcomes in this population should be further explored.

Disclosures
All Authors: No reported disclosures
P-922. Intracranial Pressure Phenotypes and Mortality Among People Treated for HIV-Related Cryptococcal Meningitis in Uganda
Authors: Schwartz Elizabeth L , Liu Minda , Kagimu Enock , Nuwagira Edwin , Tugume Lillian , Ssebambulidde Kenneth , Turyasingura Isaac , Kasozi Derrick , Kigozi Enos , Okurut Samuel , Musubire Abdu kisekka , Skipper Caleb , Abassi Mahsa , Fieberg Ann , Muzoora Conrad , Meya David , Boulware David R 
Published: January 2025

Abstract

Background
Cryptococcal meningitis is a leading cause of mortality among people living with HIV, especially among those with advanced HIV disease in Sub-Saharan Africa. Cryptococcosis causes an estimated 19% of HIV-related deaths worldwide. Elevated intracranial pressure (ICP, ≥ 200 mmH2O) is a common complication of cryptococcal meningitis. The causes, phenotypes, and clinical implications of persistently elevated ICP following treatment for cryptococcal meningitis are not well understood, but control of ICP has a survival benefit.

Methods
We prospectively enrolled adults with HIV and cryptococcal meningitis in Kampala and Mbarara, Uganda from 2013 to 2023. Cerebrospinal fluid (CSF) opening pressure (OP) was recorded for each diagnostic and therapeutic lumbar puncture performed during hospitalization. We used the highest OP value in each follow-up time frame (days 2-4, 5-9, 10-16) to categorize participants into distinct ICP phenotypes. We assessed 2-week survival across ICP phenotypes.

Results
We enrolled 1443 participants with cryptococcal meningitis. Analysis of CSF OP revealed five distinct ICP phenotypes (Figure 1). First, 35% of participants had normalizing ICP defined as ICP ≥ 200 mmH2O at diagnosis, followed by ≥ 1 instance of ICP &lt; 200 mmH2O with no subsequent increase. Second, 28% had persistently normal ICP with all OP values &lt; 200 mmH2O. Third, 19% had persistently elevated ICP with all OP values ≥ 200 mmH2O. Fourth, 10% had delayed elevation in ICP defined as normal ICP at diagnosis, followed by ≥ 1 elevated ICP and no subsequent documented normalization. Fifth, 8% had fluctuating ICP that did not fit any other phenotype definition. Among these groups, 2-week mortality varied from 9% to 25% (Table 1). The normalizing, persistently elevated, and persistently normal phenotypes were associated with the poorest prognosis (log-rank test p &lt; 0.001).

Conclusion
This study highlights the heterogeneity of ICP phenotype patterns in cryptococcal meningitis. Further research is needed to investigate the underlying mechanisms and risk factors associated with these ICP phenotype groups and better anticipate clinical management needs.

Disclosures
All Authors: No reported disclosures
P-931. Characterizing Sex-Specific Trends in Opioid Use Disorder-Associated Infective Endocarditis in the United States from 2016-2020
Authors: Kane Cooper D , Smith Stephen W , Schranz Asher J 
Published: January 2025

Abstract

Background
Injection opioid use has emerged as a leading risk factor for infective endocarditis (IE), with incidence of opioid use disorder-associated IE (O-IE) increasing nationwide. Although historically IE has predominantly impacted males, recent studied have shown drug use-associated IE (DUA-IE) may impact males and females to a similar extent. We aimed to characterize sex-specific trends and outcomes in IE across the United States (US).
Demographic Characteristics

Methods
We examined hospitalizations in the unweighted National Inpatient Sample (NIS) from 2016 to 2020. Hospitalizations coded for IE were included and stratified by sex and into O-IE and non-O-IE cohorts based on previously published ICD-10-CM codes. Demographics, clinical factors, and discharge disposition were described. Multivariable logistic regressions assessed the association between 1) sex and O-IE, and 2) sex and inpatient death, among O-IE hospitalizations.

Results
There were 91,377 hospitalizations for IE from 2016 to 2020 comprised of 40,091 (44%) females and 51,286 (56%) males (Table 1). Compared to 2016, hospitalizations for O-IE increased yearly for both sexes, while non-O-IE decreased (Figure 1). There were 14,884 (16%) hospitalizations due to O-IE, 54% of which were females and 46% were males. Among O-IE, females were more commonly White, insured by Medicaid and had concomitant psychiatric diagnoses. Among O-IE hospitalizations, females less commonly underwent valve surgery than males (11% vs 13%), less often died inpatient (5% vs 7%), and more frequently discharged against medical advice (DAMA) (27% vs 22%). In the adjusted models, females demonstrated 43% increased odds of O-IE diagnosis compared to males (aOR: 1.43, 95% CI: 1.32-1.54), while females diagnosed with O-IE demonstrated 21% decreased odds of inpatient mortality compared to males with O-IE (aOR: 0.79, 95% CI: 0.63-0.98).

Conclusion
From 2016 to 2020, most DUA-IE hospitalizations in the US were among females, in stark contrast with IE due to other causes. Females had lower odds of inpatient mortality but higher rates of DAMA. Future work is needed to characterize the social and biological factors driving sex disparities in IE hospitalizations and outcomes, which could serve as vital targets for substance use disorder and harm reduction interventions.

Disclosures
Stephen W. Smith, n/a, Bristol Myers Squibb: Stocks/Bonds (Public Company) Asher J. Schranz, MD, MPH, UpToDate: I receive fees for authorship of an UpToDate article.
P-958. Leveling Up Education Interventions: Antimicrobial Stewardship and Infection Prevention Education Through Gamification
Authors: Hall Nicole M , Ruan Haodi , duncan Mary , Lee Rachael A , Walker Jeremey 
Published: January 2025

Abstract

Background
Kaizen-Education is an app-based, formative question bank infused with gamification for a fun, yet competitive learning environment. This provides an engaging and flexible way to learn new competencies and test retention. Originally developed at University of Alabama at Birmingham (UAB), it has been used in multiple areas of medical education with high learner engagement. Optional participation, team-based competition, leaderboards, and prizes are game elements used to motivate completion of the formative questions. We created two educational games, one for UAB Antimicrobial Stewardship Program (ASP) and another for Infection Prevention (IP), to see if we could engage learners within the hospital system surrounding these topics.

Methods
For the IP game, infection preventionists developed questions for nursing staff. For the ASP game, ID pharmacists developed questions for providers. Both occurred within special weeks: National Nurses Week and U.S. Antibiotic Awareness Week. Recruitment strategies for both games included email invitations and peer-to-peer communication.
Teams for the IP game were nursing units, while the ASP game allowed creation of teams of 4 providers. Winning teams were awarded prizes and were recognized via email, certificate, and highlighted on the institution's website. At the conclusion of the games, participants were invited to provide feedback through a post-game survey.
Participant Survey Results

Results
61 and 156 participants answered at least one question in the ASP and IP games respectively. Retention, defined as completing all questions, was 80% of players in ASP game and 69% in IP game. Across both games, 4,182 questions were answered representing unique teaching moments. Reviewing accuracy based of learning domains (Figure 1), we were able to identify knowledge gaps at our institution. Finally almost all learners who responded to feedback survey agreed the activity increased knowledge in relevant domains (Figure 2).

Conclusion
We found a group of both nurses and providers interested in participating in quality educational activities within Antibiotic Stewardship and Infection Prevention. Retention was high in those that began the activity. Finally, feedback from question performance could be used to identify knowledge gaps for future interventions.

Disclosures
All Authors: No reported disclosures
P-964. Case-Based Learning Outcomes for Pre-Exposure Prophylaxis Education for the Preventative Medicine Plus One Maternal Health Track
Authors: Carr Kristin A , Thomas Alexander , Fleuristal Arshley , Goorhuis Jonathan 
Published: January 2025

Abstract

Background
As HIV prevention methods continue to develop with new agents added for Pre-Exposure Prophylaxis (PrEP). Prep uptake has remained low among US women since its approval in 2012. One major barrier to increasing PrEP uptake remains lack of knowledge of PrEP among patients and providers and lack of access to PrEP care in regions with high HIV prevalence. This study aims to increase PrEP knowledge and medical competence among Maternal Health Track Preventive Medicine residents at a single academic center in Southern California.
Pre-Test and Post-Test Scores and % Improvement
A pre-test was given at the start of each module. The same questions were made into a post-test after the curriculum was completed. Open and closed book portions were offered, and the % improvement was recorded.

Methods
Three Preventative Medicine Fellows from Family Medicine and Obstetrics and Gynecology backgrounds enrolled in multidisciplinary curriculum involving women’s health. A series of twelve case-based lectures were completed from July 2023 through December 2023. Each four-hour session included a pre-test, lecture, and a problem-based learning module. Simultaneous, they provided direct care for women in a combined clinic for PrEP and HIV care weekly for 3-6 months. In March 2024, the pre-test questions were combined into 47 post-test questions.

Results
Two of the three fellows had improvement in the closed book portion of the exam with a mean improvement of 9.5%. However, all of them had significant improvement for the open book exam with an average improvement of 16.2%. This suggests that although the memory retention of the material can wane with time, the ability to use resources to address clinically challenging questions has been strengthened. Of note, the questions were designed to simulate the American Academy of HIV Medicine (AAHIV) certification exam, which is an open-book test.

Conclusion
The combination of lectures, self-assessments, case-based discussions, and clinical experience has enhanced the fellows’ knowledge of PrEP care for women based on the improvement of exam scores after the curriculum. This will enhance their ability to provide multidisciplinary preventative care for women in underserved areas.

Disclosures
Kristin A. Carr, MD, Preventive Medicine Plus One Maternal Health Track: Grant/Research Support
P-980. Film-Based Infectious Diseases(ID) Elective Course
Authors: Lee Su , Ofstad William , Barrameda Maria Cecilia 
Published: January 2025

Abstract

Background
One of innovative educational approaches in enhancing learning outcomes is the integration of cinematic media into educational curricula, to increase student engagement, and motivate students to understand realistic settings to apply their learning (Stone 2010, Karanfil 2016). This research aims to measure qualitative and quantitative assessment of students’ performances in an elective course using movies to introduce various ID in a pharmacy curriculum.

Methods
This study is a systematic analysis of students’ experiences in “PHAR 949 ID in Movies” through assignments and post-course surveys over two years (2023-2024). Students reflected on the course via a post-survey via the CANVAS platform, soliciting feedback on the course experience, including enjoyment, potential areas for improvement, and their knowledge and skills across various ID topics. Students were also asked to indicate how the course had influenced their mindset and future application of learning. Student data were de-identified and thematically analyzed, categorized according to four levels of Kirkpatrick Learning Outcomes.  Quantitative performance assessment for learning was measured with assignments on regarding etiology, transmission, clinical presentation, diagnosis, treatment options, and prophylaxis strategies of each infectious disease topic. All personally identifiable information was removed to ensure confidentiality. IRB#: 05022024_lee_tIDwm.

Results
Ninety-six percent of students were actively engaged in discussions on the films and infectious diseases. Qualitative assessment of post-course survey showed that students had positive responses on Reaction and Learning by 100%, 80% for Behavior, and only 10 % for Results of Kirpatrick Learning Outcomes. In the quantitative assessment, students have achieved the highest average score, 100%, in Cholera (The Painted Veil), followed by COVID-19 (Contagion), 93%, HIV (Philadelphia), 91%, Tuberculosis (Moulin Rouge), 90%, and Syphilis (The English), 89%.

Conclusion
The use of movies to introduce ID in an elective course of a doctoral pharmacy program shows high levels of students’ engagement, reaction, and learning. Students achieved the highest average scores in Cholera (The Painted Veil), followed by COVID-19 (Contagion)

Disclosures
All Authors: No reported disclosures
P-981. Bridging language divides and improving global health education for fellows: Implementation of a real-time closed captioned translation tool for an international case conference
Authors: Peterson Sam , Borgetti Scott , Knodle Ryan D , Roque Yori A , de luna David , Rojas-Fermin Rita A , Mena Lora Alfredo J 
Published: January 2025

Abstract

Background
Delivering a broad curriculum that includes diseases uncommon in the United States (US) such as tropical infections is of interest to program directors. Exposure to global health and tropical medicine is often limited by geographical and language barriers. To address this, our institution established an international case conference within the ID curriculum using Zoom's close-captioned translation technology.
Attitudes and perceptions on automatic caption translation and the educational content of our international case conference

Methods
A monthly conference was established in August 2021 with two US-based academic programs and 4 non-US based academic programs in the Dominican Republic (DR). This conference delivers 30-minute case presentations, with one case from the US and another from a DR site. Cases are chosen to reflect the unique pathologies encountered at respective sites. Conferences are via Zoom with an added automatic close-captioned translation feature. In March, an anonymous online survey was developed and sent to all participants to assess attitudes and perceptions on the educational content of the conference and effectiveness of the translation technology.

Results
A total of 17 individuals participated in the survey, including 11 US faculty, 5 US fellows, and 1 physician assistant. All reported English as their primary language. The translation function showed 65% satisfaction and 77% of participants agreed it improved engagement (Figure 1). Most respondents were very satisfied (53%) or satisfied (41%) with the conference (Figure 2). The diversity of cases was satisfactory (47%) or very satisfactory (29%) by most respondents. Additionally, 94% agreed the conference broadened exposure to cases and management uncommon in the US, 88% agreed it fosters global collaboration, and 82% agreed it improved cultural competency (Figure 1). All participants agreed that the conferences broaden global perspectives.

Conclusion
We report a novel approach to integrating technology into medical education, aiming to enhance the learning by facilitating global collaboration and diversity of case discussions. The conference enables real-time multilingual discussions, enriching the learning experience with a diversity of cases and perspectives. This approach broadens the fellows' exposure and fosters international collaboration.

Disclosures
Scott Borgetti, MD, GSK: Grant/Research Support Rita A. Rojas-Fermin, MD,FIDSA, Gilead: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Honoraria
P-983. Online CME Improves Knowledge, Competence and Confidence in the Management of Hepatitis B among Primary Care Physicians
Authors: Thorpe Sara , Gardner Lindsey , Uravich Maria B 
Published: January 2025

Abstract

Background
Viral hepatitis, affecting diverse populations, is a significant public health concern with 850,000 patients living with hepatitis B virus (HBV). Public policy initiatives, such as the CDC's Division of Viral Hepatitis 2025 Strategic Plan, aim to globally eliminate viral hepatitis through culturally relevant prevention, testing, and treatment services. Healthcare providers need professional education to increase awareness, enhance capacity for reducing infection rates, improve identification and linkage to treatment, and address healthcare disparities. This study examined whether online continuing medical education (CME) could improve the knowledge and competence of primary care physicians in hepatitis B virus (HBV) screening, testing, and vaccination into clinical management.

Methods
The CME intervention comprised of a 30- minute online video-based, three-faculty panel discussion. Response to 3 multiple choice, knowledge questions 1 self-efficacy, 5-point Likert scale confidence question were analyzed using a repeated pairs pre-/post-assessment study design. Pre- to post responses were compared using a McNemar’s test to assess statistical significance (P &lt; .001 level). The activity posted on 6/12/2023; data were collected through 8/24/2023.

Results
The analysis set consisted of responses of primary care physicians (n=193). Analysis demonstrated a significant improvement in knowledge, competence, and confidence.
• 65% relative increase in knowledge regarding ACIP Vaccine guidelines (34% pre vs. 56% post, P&lt; .001)
• 18% relative increase in knowledge of CDC Hepatitis B guidelines (66% pre vs. 78% post, P&lt; .001)
• 17% relative increase in competence related to overcoming barriers to Hepatitis B vaccination (65% pre vs. 76% post, P&lt; .001)
• 35% improved confidence related to recommending HBV screening in primary care settings (P&lt; .001)

Conclusion
This study demonstrated the success of online, video-based round table discussion CME on improving knowledge, competence and confidence related to HBV management in primary care. Education enhanced primary care physicians integration of updated Centers for Disease Control and Prevention (CDC) guidelines for hepatitis B virus (HBV) screening, testing, and vaccination into clinical management.

Disclosures
All Authors: No reported disclosures
P-984. Assessment of Clinical Practice Gaps Negatively Impacting Vaccination Rates for Hepatitis B
Authors: Thorpe Sara , Larkin Amy 
Published: January 2025

Abstract

Background
The World Health Organization (WHO) and the US Department of Health and Human Services (HHS) have set goals for the elimination of viral hepatitis infection as a public health threat by 2030[HHS 2021; WHO 2016]. Barriers to achieving viral hepatitis elimination exist and progress toward hepatitis B (HepB) elimination has stalled. Understanding clinician gaps related to knowledge is critical to improve education and training to improve vaccination rates for HepB.

Methods
A survey instrument of 25 multiple choice, knowledge- and case-based questions allowed participants to assess their clinical knowledge related to HepB vaccination. Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses. Data collection occurred from June 23, 2023 to August 31, 2023.

Results
Topic Gaps Measured with Incorrect Responses to Knowledge and Clinical Decision-Making Questions (%) PCPs (N=158) Pharmacists (N=98) Public Health Specialists (N=36) Knowledge Prevalence of chronic HepB in the US 56% 45% 53% Prevalence of US population vaccinated against HepB 51% 38% 47% Healthy People 2020 goal related to HepB 61% 72% 50% HepB vaccine safety 62% 35% 39% Continuity of care for HepB vaccines series 46% 39% 36% Completion rates for HepB vaccine series 57% 54% 56% Differences in completion rates for different HepB vaccines 74% 78% 64% Seroprotection rates with HepB vaccines 56% 54% 50% Clinical Decision-Making HepB vaccination recommendation in a patient case 42% 50% 31% HepB vaccine selection in a patient case 66% 57% 56% Contraindication for HepB vaccine 54% 59% 50% Most common rationale for not discussing HepB vaccination 82% 84% 94% Assessment of practice HepB vaccine coverage 59% 48% 44% Confidence Self-reported confidence in ability to discuss HepB vaccines with your patients 75% not confident 81% not confident 64% not confident

Conclusion
This assessment yielded important insights into gaps related to HepB vaccination rates. PCPs have lower knowledge related to HepB vaccines in many areas which may be contributing to lower HepB vaccination rates. Pharmacists are the least confident in recommending HepB vaccines to their patients, followed closely by PCPs. Additional education is needed to increase knowledge and confidence to meet elimination goals.

Disclosures
All Authors: No reported disclosures