bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapid streptococcal pharyngitis testing and antibiotic prescribing before and during the COVID-19 pandemic
Authors: Seibert Allan , Stenehjem Eddie , Wallin Anthony , Willis Park , Brunisholz Kim , Kumar Naresh , Stanfield Valoree , Fino Nora , Shapiro Daniel , Hersh Adam 
Published: May 2022

Background: Pharyngitis is 1 of the most common conditions leading to inappropriate antibiotic prescriptions. When personal protective equipment (PPE) was at first constrained during the COVID-19 pandemic, Intermountain Healthcare recommended limiting rapid group A streptococcal pharyngitis (GAS) testing in urgent-care clinics to preserve PPE. Notably, the percentage of pharyngitis encounters prescribed an antibiotic and that underwent GAS testing is a key Healthcare Effectiveness Data and Information Set (HEDIS) measure. We have described our experience with urgent-care pharyngitis encounters and the impact of temporarily reducing GAS testing on antibiotic prescribing before and during the COVID19 pandemic. Method: We identified all urgent care encounters between July 2018 and August 2021 associated with a primary diagnosis of pharyngitis using ICD-10 CM codes and a validated methodology. Pharyngitis encounters were assessed for antibiotic prescriptions ordered through the electronic health record (EHR) and the use of point-of-care rapid GAS tests. Pharyngitis encounters were analyzed monthly. We assessed the percentage of encounters associated with an antibiotic prescription regardless of testing and the percentage of encounters associated with an antibiotic prescription when a GAS test was or was not performed. We examined 3 periods relating to COVID-19 and GAS testing recommendations: the prepandemic period (July 2018–March 2020), the pandemic onset period (April 2020–June 2020), and the pandemic period (July 2020–August 2021). Results: Prior to the pandemic, the monthly percentage of pharyngitis encounters for which rapid GAS testing was performed was nearly 90% (Fig. 1). The average monthly percentage of urgent-care pharyngitis encounters prescribed an antibiotic was 38.9%, and the average percentage of monthly pharyngitis encounters prescribed an antibiotic that also underwent GAS testing was 90.4%. This HEDIS measure declined from 90.4% during the prepandemic period to 29.8% in the pandemic onset period when GAS testing was limited. Following resumption of routine testing practices the monthly percentage of urgent-care pharyngitis encounters for which rapid GAS testing was performed returned to levels ≥80% by July 2020 (Fig. 1). The average percentage of monthly pharyngitis encounters prescribed an antibiotic that also underwent GAS testing rose to 87.3% during this period. Conclusions: Limited PPE in our urgent care centers during the initial months of the COVID-19 pandemic was associated with a mandated substantial decline in rapid GAS testing. As testing volume decreased, we noted a simultaneous relative increase of >30% in antibiotic prescribing for pharyngitis. These findings suggest that rapid streptococcal testing promotes appropriate antibiotic prescribing.Funding: NoneDisclosures: None
Determining the effect of COVID-19 on antibiotic use in long-term care facilities across Tennessee
Authors: Adre Cullen , Ouedraogo Youssoufou , Evans Christopher , Wilson Christopher 
Published: May 2022

Background: Nationally, a decrease in total antibiotic use in nursing homes during the COVID-19 pandemic was observed with an increase in select agents used for respiratory infections. Currently there is minimal data on antibiotic use in long-term care facilities (LTCFs) in Tennessee. To address this issue, the Tennessee Department of Health (TDH) developed a monthly point-prevalence survey of antibiotic use. Utilizing this tool, we sought to determine the effect the pandemic had on antibiotic use in Tennessee LTCFs. Method: We developed a REDCap questionnaire to collect information on selected antibiotics administered in Tennessee LTCFs. Antibiotic use percentage was determined by dividing the number of residents who received an antibiotic on the day of survey by facilities’ average censuses. Data were divided into a prepandemic period (January 2019–February 2020) and a period during the pandemic (March 2020–December 2021). Antibiotic prescriptions were grouped into 4 classes according to their most common uses: Clostridium difficile infections, urinary tract infections, skin and soft-tissue infections (SSTIs), and respiratory infections. Average percentage of residents on antibiotics were compared between study periods. Results: In total, 37 facilities participated in the survey during the prepandemic period and 32 facilities participated during the pandemic period; 14 participated during both periods. The average percentage of residents on antimicrobials before the pandemic was 16.3%, which decreased to 11.5% during the pandemic period (P = .04). During the prepandemic period, 40.2% of antibiotics prescribed were in the common for SSTI category and 38.3% were in the common for respiratory infections category (P = .01); during the pandemic period, 64.3% of antibiotics prescribed were in the common for SSTI category and 45.8% were in the common for respiratory infections category (P = .01). The 3 most prescribed antibiotics in the prepandemic period were amoxicillin (148 prescriptions), doxycycline (140 prescriptions), and levofloxacin (135 prescriptions). The 3 most prescribed antibiotics during the pandemic were doxycycline (141 prescriptions), levofloxacin (125 prescriptions), and trimethoprim–sulfamethoxazole (115 prescriptions). Conclusions: Survey results revealed that antibiotic prescriptions commonly used for respiratory infections increased 7.5% during the pandemic study period. Additionally, the average percentage of residents on antimicrobials fell 4.8% during this period. Both statistics reflect what has been seen nationally with a decrease in antibiotic use with an increase in respiratory antibiotics. This could be due to multiple factors including decreased reporting, a change in healthcare delivery during the pandemic, and facilities seeing an increase of respiratory tract infections. These data will be used to guide future TDH antibiotic stewardship efforts in the long-term care setting.Funding: NoneDisclosures: None
Penicillin allergy reinstatement in a cohort of patients previously delabeled following formal allergy assessment
Authors: Monday Lea , Goteti Ravitej , Michniak Jaclyn , Zoratti Edward , Weinmann Allison 
Published: May 2022

Background: Penicillin allergies are frequently reported and are associated with adverse clinical and antimicrobial stewardship outcomes. Allergy delabeling, either by patient history or skin testing and oral challenge can facilitate removal of penicillin allergy label. However, penicillinallergies are often reinstated in the medical record and data is limited about how and why this occurs. In our center, the departments of allergy and infectious diseases utilize an allergist nurse practitioner for penicillin allergy delabeling. We investigated the prevalence of penicillin allergy reinstatement following removal and associated factors thereof. Methods: We performed a retrospective observational study of patients who previously had penicillin allergy removed by the allergist nurse practitioner between August 2020 and May 2021 (250 days). Patients were followed for a minimum of 8 months and up to 16 months after penicillin allergy removal. We then assessed whether the allergy was reinstated. Clinical characteristics were compared between patients with penicillin allergy reinstated and not reinstated using the χ2 and Mann-Whitney U test. The primary end point was prevalence of penicillin allergy reinstatement following removal. Results: During the study period, 81 patients had penicillin allergy removed, but it was later reinstated in 19 patients (23%) (Fig 1). Median time to reinstatement was 94 days. Allergies were reinstated most frequently by nurses (53%) and medical assistants (37%). Reinstatement occurred in both outpatient (53%) and inpatient (47%) settings. In 18 of 19 cases, there was no acknowledgment that a prior assessment had determined the patient was not allergic to penicillin. Only 1 patient experienced a reaction prompting reinstatement of penicillin allergy. Once the allergy was redocumented, it was subsequently mentioned in a median of 17 notes per patient. Comorbidities did not differ between patients with allergy reinstated versus those without (Table 1). Patients with penicillin allergy reinstated were more often originally delabeled via history rather than skin test followed by oral challenge and were more likely to have been readmitted subsequently. Conclusions: Penicillin allergies were redocumented in almost one-quarter of patients, most frequently by a nonphysician team member and without acknowledgement of prior removal. Patients who undergo skin testing may be less likely to continue to report a penicillin allergy to medical staff compared to those whose allergy is removed based on history. Increased interactions with the healthcare system may have contributed to having the allergy reinstated.Funding: NoneDisclosures: None
Racial and ethnic differences in penicillin allergy reporting and allergist referral
Authors: Bornmann Charles , Ortiz Christina , Guardado Rubeen , Gillis Joseph , Huang Kristin , Blumenthal Kimberly , Doron Shira , Campion Maureen , Wurcel Alysse 
Published: May 2022

Background: Antimicrobial resistance (AMR) is a global public health crisis. A key strategy to combat AMR is to use targeted antibiotics, which is difficult in patients who report an allergy to penicillin. Increased risk for resistant infections, mortality, and healthcare costs are associated with penicillin allergies; however, up to 90% of those with a reported penicillin allergy do not have a true allergy. We investigated racial and ethnic differences related to penicillin allergy delabeling by analyzing rates of penicillin allergy reporting and referral for allergist consultation. Methods: Tufts Medical Center is a teaching medical center in Boston, Massachusetts. This study cohort contains all patients seen in 2019 by clinicians at Primary Care Boston, the main primary care practice at Tufts Medical Center. Demographic data, documented allergies, and referral history were collected from the electronic medical record. We performed univariate and multivariable analyses using logistic regression models. Covariates found to be statistically significant (P < .05) in the univariate analyses were included in the multivariable model. Results:In total, 2,391 (11%) patients reported a penicillin allergy, but only 249 (10%) were referred to an allergist (Table 1). Black patients and Asian patients were less likely to report a penicillin allergy than White patients. We detected no differences related to Hispanic ethnicity. Black patients with penicillin allergy were more likely to be referred to an allergist. Conclusions: There were low rates of allergist referral for penicillin allergy delabeling in this cohort. We identified racial differences in both penicillin allergy reporting and allergist referral. Allergist consultation is an important opportunity to combat AMR and should be considered for all patients reporting a penicillin allergy. Future work should evaluate equitable access to allergy delabeling resources.Funding: NoneDisclosures: None
Recommendations for antimicrobial stewardship during end-of-life patient care
Authors: Balkenende Erin , Goedken Cassie , Livorsi Daniel , Giannitrapani Karleen , McCaa Matthew , Perencevich Eli 
Published: May 2022

Background: Antimicrobials are frequently used during end-of-life care and may be prescribed without a clear clinical indication. Overuse of antimicrobials is a major public health concern because of the development of multidrug resistant organisms (MDROs). Antimicrobial stewardship programs are associated with reductions in antibiotic resistance and antibiotic-associated adverse events. We sought to identify and describe opportunities to successfully incorporate stewardship strategies into end-of-life care. Methods: We completed semistructured interviews with 15 healthcare providers at 2 VA medical centers, 1 inpatient setting and 1 long-term care setting. Interviews were conducted via telephone between November 2020 and June 2021 and covered topics related to antibiotic prescribing for hospice and palliative-care patients, including how to improve antimicrobial stewardship during the end-of-life period. We targeted healthcare providers who are involved in prescribing antibiotics during the end-of-life period, including hospitalists, infectious disease physicians, palliative care and hospice physicians, and pharmacists. All interviews were recorded, transcribed, and analyzed using consensus-based inductive and deductive coding. Results: End-of-life care, particularly hospice care, was described as an underutilized resource for patients, who are often enrolled in their final days of life rather than earlier in the dying process. Even at facilities with established antimicrobial stewardship programs, healthcare providers interviewed believed that opportunities for antimicrobial stewardship in the hospice and palliative care settings were missed. Recommendations for how stewardship should be incorporated in end-of-life care included receiving feedback on antimicrobial prescribing, increasing pharmacist involvement in prescribing decisions, and targeted education for providers on end-of-life care, including the value of shared decision making with patients around antibiotic use. Conclusions: Improved antibiotic prescribing during end-of-life care is critical in the effort to combat antimicrobial resistance. Healthcare providers discussed antimicrobial stewardship activities during end-of-life patient care as a potential avenue to improve appropriate antibiotic prescribing. Future research should evaluate the feasibility and effectiveness of incorporating these strategies into end-of-life patient care.Funding: NoneDisclosures: None
Assessment of antibiotic appropriateness in hospitalized veterans with COVID-19 in the VA MidSouth Healthcare Network (VISN9)
Authors: Forster Derek , Johnson Morgan , Staub Milner , Bennett Jessica , Scheerenberger Hans , Kaucher Angela , Thomas-Gosain Neena , Davis Kelly 
Published: May 2022

Background: Bacterial coinfections with COVID-19 appear to be rare, yet antibiotic use in this population is high. Limited guidance is available regarding the use of antibiotics in these patients. In response, a multidisciplinary group of physicians and pharmacists from 5 VISN9 facilities developed a guideline for the use of antibiotics with COVID-19 in July 2021. This guideline created a network-wide standard for antibiotic use and facilitates the assessment of antibiotic appropriateness in hospitalized veterans with COVID-19. Methods: In this observational, cross-sectional study, we reviewed veterans diagnosed with COVID-19 from August 1 through September 30, 2021, who were admitted to VISN9 facilities. Use of antibiotics was assessed during the first 4 days of admission. If antibiotics were prescribed, their use was determined to be appropriate or inappropriate based on the presence or absence of a finding concerning for bacterial coinfection as outlined in the guideline (Table 1). Additional data including procalcitonin results as well as positive sputum cultures were collected. Results: In total, 377 veterans were admitted for COVID-19 during the study period. Among them, 42 veterans (11%) received antibiotics for nonrespiratory infections and were removed from this analysis. Of the remaining 335 veterans, 229 (68%) received antibiotics and 116 (51%) of those met guideline criteria that were concerning for bacterial coinfection. Additionally, 32 (14%) of the 229 veterans who received antibiotics had >1 finding concerning for bacterial coinfection. Procalcitonin levels were obtained in 97 (42%) of 229. Only 33 veterans (14%) who received antibiotics had an elevated procalcitonin, and only 19 (8%) had a positive sputum culture. Conclusions: Antibiotic use was common in hospitalized veterans with COVID-19 in VISN9 facilities. This results are comparable to findings in the published literature. Among those receiving antibiotics early in their hospitalization, half were considered appropriate based on our guideline. Quality improvement initiatives are needed to improve implementation of the network guideline to reduce the overuse of antibiotics for management of COVID-19. Additionally, procalcitonin may be a helpful tool for hospitalized veterans with COVID-19.Funding: NoneDisclosures: None
Characteristics and Trend of Drug-Resistant Tuberculosis at a Major Specialized Hospital in Chongqing, China: 2016 Versus 2019
Authors: Zhang Huizheng , Zhang Ke , Yang Xin , Luo Ming , Li Chunhua , Wang Xiaoying , Hu Kui 
Published: May 2022

Abstract

Objective:
The epidemic of drug-resistant tuberculosis (DR-TB) has become a major concern in global TB control. This study aimed to investigate the patterns and trend of DR-TB epidemic between different time periods in Chongqing.

Methods:
A total of 985 and 835 culture positive TB patients with drug susceptibility testing (DST) results admitted to the hospital in 2016 and 2019, respectively, were included. Chi-square testing was used to compare the prevalence and trends of DR-TB in 2016 and 2019.

Results:
The proportion of previously treated TB cases with culture positivity was 45.7% in 2019, significantly higher than that in 2016 (39.1%, P = 0.004). The overall rate of drug resistance in 2019 was 43.1%, higher than that in 2016 (40.2%). The rates of multi-drug resistant TB (MDR-TB) and pre-extensively drug resistant TB (pre-XDR-TB) increased significantly from 2016 to 2019 among all TB cases (MDR: 25% vs 33.4%, P < 0.001 and pre-XDR: 7.1% vs 12.8%, P < 0.001, respectively) and previously treated TB cases (MDR: 46.5% vs 56%, P = 0.008 and pre-XDR: 13.2% vs 21.5%, P = 0.003, respectively).

Conclusions:
Our findings indicated that the prevalence of DR-TB remains high in Chongqing. The trend of resistance to anti-TB drugs beccame worse between 2016 and 2019. Moreover, acquired MDR may play a major role in MDR-TB epidemic in Chongqing. Therefore, rapid diagnosis and effective treatment of TB patients will be important to reduce the burden of DR-TB in Chongqing.
Development and Evaluation of Innovative and Practical Table-top Exercises Based on a Real Mass-Casualty Incident
Authors: Liu Jingjing , Huang Yan , Li Bingrui , Gui Li , Zhou Lingjun 
Published: May 2022

Abstract

Purpose:
The aim of this work was to develop a table-top exercise (TTX) program for mass-casualty incident (MCI) response based on a real incident to evaluate the program.

Methods:
The TTX program was developed based on the 8 TTX design steps. Convenience sampling was adopted to recruit recently graduated physicians in China. After the TTX training, the participants completed a self-designed questionnaire, as well as the Simulation Design Scale (SDS) and Educational Practices in Simulation Scale (EPSS).

Results:
In total, 148 valid questionnaires were collected. The difficulty score of the TTX program was 3.69 ± 0.8. The participants evaluated the program highly, with a score of 4.72 ± 0.54 out of 5. Both the SDS and the EPSS had average scores higher than 4.5. Guided reflection/feedback (M = 4.68, SD = 0.41) and fidelity (M =4.66, SD = 0.57) were the 2 highest-rated SDS subscales. For the EPSS, diverse ways of learning and collaboration were the 2 highest-rated subscales. Multivariate stepwise regression analysis showed that the participants’ evaluations of the TTX training course were related to the EPSS score, the difficulty rating, the evaluation of the instructional props, and the degree of participant involvement (F = 24.385, P < 0.001).

Conclusions:
A TTX program for MCIs was developed based on the 2014 Shanghai New Year Crush. The TTX kit is practical and sophisticated, and it provides an effective strategy for MCI training.
Food storage facilitates professional religious specialization in hunter–gatherer societies
Authors: Watts Joseph , Hamerslag Elise M. , Sprules Cassie , Shaver John H. , Dunbar Robin I. M. 
Published: May 2022

Abstract
Professional religious specialists centralised religious authority in early human societies and represented some of the earliest instances of formalised social leadership. These individuals played a central role in the emergence of organised religion and transitions to more stratified human societies. Evolutionary theories highlight a range of environmental, economic and social factors that are potentially causally related to the emergence of professional religious specialists in human history. There remains little consensus over the relative importance of these factors and whether professional religious specialists were the outcome or driver of increased socio-cultural complexity. We built a global dataset of hunter–gatherer societies and developed a novel method of exploratory phylogenetic path analysis. This enabled us to systematically identify the factors associated with the emergence of professional religious specialists and infer the directionality of causal dependencies. We find that environmental predictability, environmental richness, pathogen load, social leadership and food storage systems are all correlated with professional religious specialists. However, only food storage is directly related to the emergence of professional religious specialists. Our findings are most consistent with the claim that the early stages of organised religion were the outcome rather than driver of increased socio-economic complexity.
Gadamer's Historically Effected and Effective Consciousness
Authors: Larrauri Pertierra Iñaki Xavier 
Published: May 2022

AbstractHans-Georg Gadamer argues that consciousness not only historically constrains experience but also allows strangeness to intelligibly speak to it. This historically effected and effective consciousness features in Gadamer's idea that a common language is unearthed for the interpretive horizons of those involved in dialogue with each other through a logic of question and answer. I argue, however, that this reveals a conceptual uncertainty about evaluating progress in interpretive understanding. Gadamer's failure to escape from this uncertainty risks the possibility of a problematic relativism. Effectively, even if sufficient interpretation occurs when horizons are infinitely structured, this does not preclude incoherence between a horizon's elements.
The timing of blueschist-facies metamorphism in the Makrotantalon Unit on Andros Island, Greece: Cretaceous and Eocene high-pressure/low-temperature events?
Authors: Bröcker Michael , Scherer Erik E. , Xypolias Paris , Höhn Melina 
Published: May 2022

AbstractThis study corroborates interpretations suggesting that the Makrotantalon Unit on Andros represents a tectonic slice with Pelagonian affinity in the nappe stack of the Cycladic Blueschist Unit. Previously reported Cretaceous 40Ar–39Ar dates of a garnet-glaucophane schist from the Makrotantalon Unit could not be reproduced by Rb–Sr geochronology, but this is not an indication of contamination with excess Ar. Instead, the newly dated samples record disturbance of the Rb–Sr isotope system by partial recrystallization. Subsets of these phengite populations, representing the smaller grain-size fractions, yielded low-precision dates ranging from c. 21 to c. 15 Ma that document deformation-related resetting and recrystallization of a presumably Cretaceous white mica population. Although these Miocene dates cannot be linked with blueschist-facies metamorphism, they provide time constraints on the formation of shear zones that overprinted the original thrust contact during exhumation. The geological relevance of a Cretaceous high-pressure event is confirmed by a Rb–Sr date of c. 121 Ma for an epidote-glaucophane schist collected further away from the tectonic contact. The occurrence of a second blueschist-facies event in the Eocene is verified by Rb–Sr dates of two epidote-glaucophane schists (c. 40 Ma and c. 44 Ma) that can unambiguously be assigned to the Makrotantalon Unit.