bluuebunny/crossref_metadata_2025_split huggingface dataset:
778. PrEParing Medical Students For Their Transition to Residency: The Benefit of Early Education on HIV Prevention
Authors: Pavia Jonathan E , Hornak Joseph P 
Published: November 2023

Abstract

Background
Pre-exposure prophylaxis (PrEP) is a cornerstone of broad efforts to end the HIV epidemic, but uptake by primary care providers (PCP) has been demonstrated as suboptimal. Knowledge gaps have been linked to decreased PrEP uptake among PCPs. This report demonstrates the effectiveness of early career PrEP education aimed at the graduating 4th year medical student (MS4) as they transition to residency.

Methods
Anonymous, online, optional, pre- and post-intervention surveys were administered to MS4s at our institution to assess awareness, knowledge, and perceived comfort around prescribing PrEP as future resident physicians. Students attended a comprehensive, interactive, case-based lecture (“intervention”) about HIV prevention, with particular focus around PrEP availability, identification of potential candidates, and patient monitoring. Results from the two surveys were measured and compared. Fisher's exact test was used for nominal statistics.

Results
Thirty-one pre-intervention and 19 post-intervention surveys were completed. At baseline, a majority of respondents were aware of PrEP (94%), but a minority were comfortable prescribing PrEP (39%). Prior knowledge regarding PrEP (67%) and concerns for cost (16%) were the two highest reported factors contributing to perceived comfort with prescribing PrEP. Post-intervention, MS4s reported significantly increased comfort prescribing PrEP (100% vs. 39%, P = &lt; 0.0001) and no significant decrease in attributing knowledge as a barrier to providing PrEP (52% vs. 67%, P = 0.37). Participants reported very high satisfaction in the material presented during the lecture (100%).

Conclusion
These results indicate the benefit of early career education on the topic of HIV PrEP aimed at senior medical students. If efforts to significantly reduce HIV transmission are to be successful, PrEP use must be greatly expanded across medical disciplines including primary care, pediatrics, infectious diseases, women’s health, and others. Bolstering PrEP education within medical school curricula may assist with accomplishing these goals. Further research should explore other modalities for delivering HIV prevention education to medical students.

Disclosures
All Authors: No reported disclosures
786. Online CME Improves Adoption of Clinical Practice related to Incorporating long-acting Injectables into HIV Clinics
Authors: Thorpe Sara , Blatherwick Donald , Uravich Maria B 
Published: November 2023

Abstract

Background
Recently, the first long-acting injectable (LAI) for the treatment of HIV was approved by the FDA. Although this advancement in therapeutics offers many potential advantages, including eliminating the needs for daily medications, the successful uptake into clinical settings will require navigating systems-level challenges such as clinic or hospital infrastructure. This study examined whether online continuing medical education (CME) focused on evidence-based best for incorporating long-acting injectables into clinical care would result in the adoption of new clinical practices.

Methods
Performance in the real world was assessed 30-60 days post-education for learners in the target audience(s). Email invitations were sent for the first 3 months of learners. Each respondent reported for each possible practice whether they were implementing for the first time or had modified it due to education, they were already doing it prior to education; or they were not doing it before or after education. They also indicated barriers they experience at least “some” of the time for each practice. The activity posted on 4/15/2022. Data was collection ended on 2/1/2023.

Results
There were a total of 39 learners consisting of PCPs, OB/GYNS, Nurses and NPs. Analysis showed that 80% of learners made a practice change or had practices reinforced due to education. Top 3 practice changes included:• 59% of learners are now educating eligible patients about the availability of LAI ART• 57% are staying abreast of current data from clinical trials, evaluating LAI ART for HIV• 56% are implementing LAI ART in clinical practice
Survey results evidence persistent barriers to incorporating long-acting injectables into HIV Clinics. Top barriers included:• 38% Lack understanding of guidance about patient eligibility• 24% Lack knowledge of about best practices for getting started with LAI ART15% lack expertise in counseling patients on LAI ART

Conclusion
The clinical practice changes identified in this assessment provide compelling evidence that participation in online CME/CE prompts adoption of changes in practice related to incorporating LAI ART in the care of people with HIV. Future education is needed to address the barriers identified in this assessment.

Disclosures
All Authors: No reported disclosures
787. Next Steps: Teaching Future Generations an Interdisciplinary Approach to Diabetic Foot Ulcer Care
Authors: Parikh Shalvi B , LaMantia Jamie N , Brennan Meghan B , Tischendorf Jessica S 
Published: November 2023

Abstract

Background
Interdisciplinary care of diabetic foot ulcers (DFUs) is associated with nearly 40% reduction in major (above ankle) amputations. We developed a curriculum emphasizing interprofessional collaboration (IPC) between Infectious Disease (ID) fellows and Podiatry residents in the care of veterans with DFUs.

Methods
The curriculum was delivered in two one-hour in-person sessions. The first session provided background on principles of IPC and perspective sharing of other professions through case discussions. The second session, co-facilitated by an ID physician and a podiatrist, allowed ID fellows and podiatry residents to work through DFU cases. We used a quasi-experimental design (Figure 1) and a multipronged assessment designed by applying Miller's pyramid (Figure 2). We used a modified Jefferson Scale of Attitudes toward IPC (Likert scale 1-5, 5 = strongly positive) to measure fellow attitudes, with items subcategorized by themes of shared learning and diversity & ethics. Fellows reported on the frequency of communication with the primary and podiatry team weekly, and charts of veterans with DFUs were reviewed for documentation of ID-specific content (organism and antibiotic plan), as well as non-ID specific plans (glycemic control, vascular status, and biomechanical considerations). Two-sided t-test was used to compare pre-post performance.

Results
Five ID fellows participated. Post-session evaluations suggest the curriculum was viewed favorably. Fellows had strongly positive baseline attitudes toward IPC. Attitudes toward shared learning improved (4.13 vs 4.44, p &lt; 0.01), but diversity & ethics did not (4.86 vs 4.82, p = 0.61). Hospitalizations of seven veterans with DFUs were analyzed pre-intervention and four analyzed post-intervention. ID-specific content and communication with the primary team remained 100% over the study period. Non-ID-specific content documentation remained low (20% vs 11%, p = 0.30). Frequency of communication with podiatry did not change significantly (57% vs 25%, p = 0.35).

Conclusion
Interdisciplinary didactic sessions were well-received and may improve attitudes toward shared learning, but likely need to be augmented with interprofessional clinical experiences to achieve practice improvements in the care of veterans with DFUs.

Disclosures
All Authors: No reported disclosures
788. Social media as a powerful tool for expanding infectious disease-related medical knowledge: A Twitter account perspective
Authors: Torres Mario A , Zuckerman Richard A , Mazurkiewicz Rebecca 
Published: November 2023

Abstract

Background
The influence of social media on medical education has been demonstrated by multiple meta-analyses, highlighting the important role of this medium in the medical community. Within the realm of available platforms, Twitter plays a major role. The goal of this project was to create an account to propagate medical content and attract learners to the field of Infectious Disease.

Methods
In 2021 @theIDtrivia was founded, an account dedicated to sharing Infectious Disease-related content, creating trivia (Figure 1-A) and “board-style” questions based on the American Board of Internal Medicine Infectious Disease Certification Exam Blueprint. After posting questions in a poll-type format, users have 3-7 days to select an answer before the correct one is posted along with an infographic (Figure 1-B). All tweets and infographics are well-researched, and the references are shared with links embedded with the intent of developing a reliable social media resource.

Results
The first tweet was posted on September 2021, and the account had just one follower at the time. Over the next 18 months, 881 tweets have been posted and the account has gained over 7500 followers (Graph 1-A) - 35% are active accounts from the United States (Figure 2). The number of impressions (times a user is served a tweet in their timeline or search results, Graph 1-B) has increased concomitantly with engagement with the account (total number of times a user interacts with a tweet, including retweets, replies, likes). Based on responses, people at multiple stages of their careers, practitioners of other areas such as pharmacy and microbiology, and institutional accounts from different parts of the world have actively engaged with the content of @theIDtrivia.

Conclusion
We have shown that infectious disease-based trivia via social media engages a wide and varied population interested in exchanging knowledge and ideas. While this is positive in and of itself, one limitation is that we are unable to show that those who follow the account and/or participate in its content, feel that it results in improved test performance or in clinical practice. This opens an opportunity for continued exploration of the role of social media in medical education and how it can be integrated into clinical decision-making.

Disclosures
All Authors: No reported disclosures
813. Characteristics and Outcomes of Hospitalized Patients with Newly Diagnosed Histoplasmosis
Authors: Dalton Liam , Miceli Marisa H 
Published: November 2023

Abstract

Background
Histoplasmosis (histo), is the most common cause of hospitalization and death among the endemic mycoses in the US. Clinical presentation varies from asymptomatic to severe, disseminated illness indistinguishable from other infections, which may result in misdiagnosis. Physicians must remain vigilant for histo given the potentially devastating consequences of disseminated infection. We sought to determine the characteristics and outcomes of admitted patients (pt) newly diagnosed with histo at our institution.

Methods
We performed a retrospective evaluation of hospitalized adult pt newly diagnosed with histo via culture, histopathology, or antigen testing (Ag) at the University of Michigan from 1/1/2015-12/31/2022. Demographic, clinical, treatment, & outcome data were collected. We compared the characteristics and outcomes of immunocompromised (IC) pt with those of non-immunocompromised (NIC) pt.

Results
62 pt were included, 51 IC (76%) & 16 NIC (24%). The IC group included pt with solid organ transplants (19), autoimmune disorders treated with immunosuppressive drugs (22), hematologic (4) or solid malignancies & AIDS (1 each). Mean age of IC was 46.13+17.4 yr vs 58.1+16.4 yr among NIC, p=0.02; 74% IC were men vs 80% NIC. Mean BMI in IC pt was 26.8+6.2 vs 24.1+5.2 among NIC, p=0.13. Disseminated histo was more common in IC pt (74.5% vs 46.7%, p=0.048). ICU admission occurred in 46.8% IC vs 40% NIC, p=0.75. All-cause 6-month (m) mortality was 24%: 25.5% IC vs 20% NIC; 3 pt died before diagnosis was made (2 IC; 1 NIC). The initial treatment for most IC pt was amphotericin B (76.6%, p&lt; 0.01). Fifty-two pt were diagnosed using Ag testing (40 IC; 12 NIC); Ag titers above the limit of quantification occurred in 15 IC pt; 14 had disseminated disease. Histo was diagnosed year-round in our pt cohort, but the most pt presented in winter (39%; p=0.02). December was the m with the most cases (27.4%, p&lt; 0.001). There was no statistical difference in diagnostic seasonality between hospitalized IC & NIC pt.

Conclusion
Hospitalized IC pt diagnosed with histo were younger and more frequently had disseminated disease than NIC pt, but morbidity and mortality did not differ. Unlike other reports, at our institution, the most pt with histo were diagnosed during the winter months.

Disclosures
Marisa H. Miceli, MD, Astellas: Advisor/Consultant|F2G: Grant/Research Support|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support
816. Fatal Coccidioidomycosis Cases in an Endemic Area
Authors: D’Assumpcao Carlos M , Kooner Lovedip , Dhillon Amritpal , Valdez Michael , Kuran Rasha , Johnson Royce H , Heidari Arash 
Published: November 2023

Abstract

Background
While a majority of Coccidioides infections are asymptomatic, it is estimated that 1% develop severe disease and can be fatal. Prior retrospective reviews that attempt to identify risk factors for fatal disease have been limited to public health data hampered by reporting challenges and accuracies. Morbidity review of fatal cases identified by clinical criteria rather than ICD-9/ICD-10 reporting may improve accuracy of conclusions.

Methods
At an academic center in an endemic area, medical records from three sequential electronic medical record systems were reviewed from approximately January 2000 to January 2023. Patients with coccidioidomycosis were identified by microbiological, pathological, serological, or skin testing criteria. Deaths were determined by in hospital records, insurance reporting, review of death certificate if available, or public record. Demographics, clinical course, outcomes and causes of death are compared. Incomplete medical records to make comparison were excluded. Retrospective root cause analysis was performed.

Results
To date, at least 50 patients met clinical criteria for having coccidioidomycosis at one point in their life and died. ICD coding was wrong in about half of the cases. Data integrity has been a challenge when extracting data across three electronic medical record systems. New risk factors found by root cause analysis not previously identified.

Conclusion
Patients were found to have died either with coccidioidomycosis or from coccidioidomycosis. ICD coding was inconsistent. Precise and accurate description of coccidioidomycosis staging is important when trying to determine risk factors for fatal disease.

Disclosures
All Authors: No reported disclosures
826. Decision to Treat Pneumocystis Jirovecii Pneumonia by Combining Molecular Diagnostics and Patient Specific Factors
Authors: Maro Anna W , Cuellar-Rodriguez Jennifer , Kline Ahnika , Das Sanchita , Hunsberger Sally 
Published: November 2023

Abstract

Background
Pneumocystis jirovecii pneumonia (PJP) diagnosis on immunocompromised patients with or without HIV has changed over time. Molecular methods have substituted microscopic methods that can be subjective, labor intensive, and require expertise. Additionally, they can be falsely negative in patients with lower fungal burden, such as transplant recipients and other immunocompromised hosts. Due to optimization of resources, our laboratory has now opted to offer only PCR based testing. We reviewed the clinical and laboratory data at our center, for PJP diagnosis prior to this change, given that we have concurrent results from a direct fluorescent antibody (DFA) assay and PCR test on samples for 16 years.

Methods
We utilized data from retrospective chart review of 402 patients with a positive PJP PCR and a simultaneous DFA assay. Complete medical records were available for 302 patients. We included baseline characteristics by age, sex, race/ethnicity, and comorbid condition such as hematological malignancy diagnosis of PJP, solid malignancy, HIV, primary immunodeficiencies, and other chronic illnesses. Samples were collected by BAL or induced sputum. Concordance of the two tests was recorded; proportions of underlying comorbidities, use of prophylaxis and having received treatment was also recorded in relation to the concordance of both tests. Mortality within 30 and 90 days of sample collection was compared with corresponding Ct values, and DFA factors.

Results
302 patients were included in the analysis (see table 1); 72% had a discordant result. 69% of patients with a discordant result were treated, compared to 99% of those with a concordant result. Patients with hematological malignancy were more represented and were more likely to have received treatment when discordant, than PLWH or other groups. The 30 and 90-day mortality was numerically similar among both groups.Table 1.Clinical and laboratory characteristics of patients with a positive PJP PCR and a simultaneous DFA assay. Variables are expressed as proportions, unless otherwise specified.

Conclusion
PCR is a very sensitive tool to detect PJP, and in the era of decreased availability microscopy studies, clinical data evaluation such as patient population, and net state of immunosuppression, in addition to a positive test, will need to be considered when deciding who requires treatment.

Disclosures
All Authors: No reported disclosures
835. Histoplasmosis in Western India: Shedding Light on a Potentially Underdiagnosed Disease – A Prospective Study from a Tertiary care centre
Authors: Ravindra Akshatha , Kumar Deepak , Naguthevar Santhanam , Bohra Gopal Krishana , Khatod Yash , T R Neetha , Sharma Shivang , Kaur Navneet , Meena Durga Shankar , Midha Naresh Kumar , Garg M K 
Published: November 2023

Abstract

Background
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, can range from pulmonary to disseminated infections. While it is endemic in certain regions of the world, including North and South America, Africa, and parts of Asia, it is considered rare in India. However, recent reports suggest an increasing incidence of histoplasmosis in India. This project aims to evaluate the prevalence of histoplasmosis in the non-endemic western part of India and to study its clinical profile.

Methods
This was a prospective cross-sectional study which was conducted between January 2022 – February 2023 in Medicine department, AIIMS Jodhpur after obtaining approval from Ethics Committee. Patients aged more than 18 years with clinically suspected disseminated histoplasmosis (PUO, pancytopenia etc.) was screened using a rapid lateral flow test – OIDx Histoplasma Capsulatum LFA Kit. Urine samples were collected from all participants. Additional samples such as Blood, cerebrospinal fluid (CSF), biopsies etc, were collected for further confirmatory tests from patients with positive urine Histoplasma test as part of routine clinical care.

Results
A total of 45 patients (29 males, 64.4%) with a mean age of 48.8 years (range, 20-78) were included. Urinary histoplasma was found to be positive in 15 patients (33.33%), 8 of whom were confirmed with histopathology. The most common risk factor among the patients was HIV (35.5%). The common symptoms observed were fever and weight loss (73.3%), followed by cough (53.3%). Disseminated histoplasmosis with hepatosplenomegaly was seen in nearly 46.6% of the cases, while adrenal involvement was seen in 33.3%. Skin lesions were observed in only one-third of the patients. All patients were treated with Inj Amphotericin B, followed by itraconazole based on their weight. Most patients responded well to the treatment, with only one mortality.
Table 1
Clinical features of Disseminated Histoplasmosis in our study

Conclusion
The prevalence of histoplasmosis was found to be significant, particularly among HIV-positive patients. These findings emphasize the importance of considering histoplasmosis in the differential diagnosis of patients with compatible symptoms, especially in HIV-positive patients, and the need for further studies to determine the true burden of this disease in India.

Disclosures
All Authors: No reported disclosures
836. Coccidioidomycosis in the Central U.S. – A Retrospective Case Series
Authors: Scott Brian M , Gordon Olivia , Sassine Joseph , Sahra Syeda , Bowman Deidra J , Higuita Nelson I Agudelo 
Published: November 2023

Abstract

Background
Known as Valley fever, coccidioidomycosis is a disease endemic to arid regions of the Western Hemisphere. In the Southwestern US, Coccidioides spp. may account for up to 20-25% of cases of community acquired pneumonia. Clinical manifestations vary widely, from asymptomatic infection to life-threatening disease, especially in immunocompromised hosts. Management can prove to be challenging, especially in disseminated disease; however, the overall mortality rate remains low. We describe the results of a single-center, retrospective case series over the last 20 years.

Methods
A list of patients was identified from medical records, pathology, and microbiology, utilizing diagnosis codes and the key words ‘coccidioidomycosis’ and ‘valley fever’. Chart review was conducted on each of these cases. Variables included patient demographics, comorbidities, travel to an endemic area, site of infection, diagnosis, treatment, and outcomes.

Results
A total of 33 patients were identified using the methods above; however, only 26 patients were included in our study. 7 patients were excluded due to limited medical records. Most patients identified were male, middle-aged, and Caucasian (table 1). The most common comorbidity was diabetes, and the most common site of infection was pulmonary, followed by central nervous system (table 1, table 2). Nearly all patients received systemic antifungals, and about half underwent surgery for treatment (table 2).

Conclusion
To our knowledge, this is the largest single-center case series of coccidioidomycosis from a non-endemic area. Although most of our patients had visited an endemic area, several cases may be native to Oklahoma, considered a non-endemic region, based on available information in the medical record. Diabetes mellitus was the most frequent comorbidity exhibited by our patient population supporting surveillance data of its association with severe disease. Compared to other case series of coccidioidomycosis, our patient population had higher rates of immunocompromise and had both a higher overall mortality and rate of disseminated disease.

Disclosures
All Authors: No reported disclosures