668. Restricting Ordering of Multiplex Gastrointestinal Panel Improves Test Utilization

Background The multiplex gastrointestinal pathogen panel (GIP) is a convenient and quick diagnostic test for determining the infectious etiology of diarrhea. It identifies several of the most common pathogens associated with gastroenteritis. However, it is expensive, and test results may not impact care, given that several of the pathogens in the panel are managed expectantly. We describe our experience with a diagnostic stewardship initiative to resolve the overuse of this testing method. Methods We performed a pre/post study of GIPs ordered for inpatients 18 years old and older from December 19, 2018, to December 18, 2020, at Mayo Clinic hospital in Rochester, Minnesota. GIP orders for inpatients were limited to the first 72 hours of hospitalization starting December 19, 2019. Orders after 72 hours were encouraged to be changed to Clostridioides difficile NAAT testing or sent to an infectious disease provider to override on a case-by-case basis. Our hospitals used BioFire® FilmArray® Gastrointestinal Panel (BioFire Diagnostics, Salt Lake City, Utah). Results A total of 2,641 GIPs were performed during the study period. There were 1,568 GIPs (3.3/100 hospitalizations) in the pre-intervention period compared to 1,073 (2.6/100 hospitalizations) post-intervention, representing a drop of 21.2%. The most common pathogen detected was C. difficile (toxin A/B) (48.8%, n=402), followed by norovirus (17.5%, n=144). The overall test positivity rate was 27.9% (n=736). The test positivity rate decreased 1.8% from 28.6% (n=448) to 26.8% (n=288) after the restriction (p=0.33). The proportion of C. difficile among all pathogens detected increased from 48.5% to 49.7% (p=0.67). Table 1. Pre- and Post-Intervention Test Positivity Rate of Specific Pathogens in GIP Conclusion Our study showed that restricting the ordering of GIP to the first 72 hours of hospitalization and directing providers to standalone C. difficile NAAT testing resulted in a reduction of GIPs performed. There were marginal changes in the test positivity rate of GIP. A limitation of our study is that the timing of post-intervention coincided with the COVID-19 pandemic, which had unpredictable effects on hospital practice and patient admissions. Ideally, future quality improvement projects should increase the test positivity of pathogens other than C. difficile while lowering the GIP use in diagnosing C. difficile colitis. Disclosures John C. O'Horo, Sr., MD, MPH, Bates College and Elsevier Inc (Consultant)

Cytological substantiation of application of vacuum therapy in combustiology

The OBJECTIVE was to perform a comparative cytological analysis of the wound exudate in healing wounds during autodermoplasty on a granulating burn wound with and without vacuum therapy.METHODS AND MATERIALS. The article presents the results of the cytological study substantiated the use of vacuum therapy in combustiology. The comparative analysis was performed in 2 groups of patients. The first group consisted of patients with granulating burn wounds, who underwent surgical treatment with vacuum therapy. The second group consisted of patients who underwent surgical treatment without vacuum therapy. In both groups, the complex of surgical treatment included autodermoplasty on a granulating burn wound. All the patients were treated in the Burn Department of the «Scientific research institute – Ochapovsky regional clinic hospital № 1».RESULTS. The application of vacuum-associated dressings in the surgical treatment of patients in burn hospitals helps to reduce the time of graft retention in the plasty of granulating burn wound, decrease the number of dressings and the amount of dressing material, reduce the time of treatment of patients.CONCLUSION. The obtained cytological results allow us to justify the application of vacuum therapy in the surgical treatment of granulating burn wounds.

Difficulty removing dialysis cuff catheter after its adhesion to the right atrium

We describe the case of an elderly Japanese female who had experienced diabetic nephropathy since the year 20xx and had been undergoing dialysis treatment while receiving vascular access interventional therapy (VAIVT) for arteriovenous fistula (AVF) occlusion. The patient visited the clinic/hospital in 20xx+10 with the AVF occlusion; emergency VAIVT was performed but blood flow could not be resumed. The patient was not admitted and was treated as an outpatient, and thus a cuff catheter (Split stream catheter: SST28 cm, Medcomp) was inserted. An infection developed and was successfully treated with antibiotics. The dialysis treatment continued without issue. One year after the cuff catheter’s insertion, the patient was admitted due difficulty breathing. Despite continued dialysis treatment with the catheter, the patient died 15 days post-admission. The removal of the catheter proved to be difficult. An autopsy was approved, and the area around the catheter was examined. The adhesion of the catheter to the right atrium was observed, but no infection was detected in the bloodstream. This case illustrates that dialysis with the use of a cuff catheter can be effective.

Mapeamento das competências de técnicos de enfermagem em um hospital públicoMapping the skills of nursing technicians in a public hospital

RESUMOObjetivo: Realizar o mapeamento das competências de técnicos de enfermagem que atuam em uma unidade de internamento clínico de um hospital público do município de Foz do Iguaçu – Paraná. Método: Pesquisa de caráter qualitativo, realizado em etapas: análise documental das competências requeridas, entrevista semiestruturada e mapeamento de competências. A coleta de dados ocorreu em abril e maio de 2019. Resultados: Foram entrevistados 27 técnicos de enfermagem. A partir de questões norteadoras, emergiram ideias centrais, como: desenvolvimento das técnicas básicas de enfermagem; realização de atividades administrativas e necessidade de busca por aperfeiçoamento profissional. Conclusão: A identificação das competências descritas no perfil profissiográfico divergem com àquelas expressas pelos técnicos de enfermagem; assim como das competências técnicas expressas não foram encontradas como requeridas pela instituição na análise do perfil profissiográficos. Espera-se que o mapeamento de competências possa vir auxiliar as instituições hospitalares a elaborar novas estratégias de desempenho dos profissionais e reestruturar a atuação de cada.Palavras-chave: Competência Clínica; Unidade de Internação; Unidade Hospitalar de Clínica Médica. ABSTRACTObjective: To perform the mapping of the skills of nursing technicians who work in a clinical inpatient unit of a public hospital in the city of Foz do Iguaçu - Paraná. Method: Qualitative research, carried out in stages: documentary analysis of the required skills, semi-structured interview and skills mapping. Data collection took place in April and May 2019. Results: 27 nursing technicians were interviewed. From guiding questions, central ideas emerged, such as: development of basic nursing techniques; carrying out administrative activities and the need to seek professional improvement. Conclusion: The identification of the competencies described in the professional profile differs from those expressed by nursing technicians; as well as the technical skills expressed were not found as required by the institution in the analysis of the professional profile. It is hoped that the mapping of competencies can help hospital institutions to develop new performance strategies for professionals and restructure the performance of each.Keywords: Clinical Competence; Inpatient Unit; Medical Clinic Hospital Unit.

Patient Attitudes Toward Telepsychiatry During the COVID-19 Pandemic: A Nationwide, Multisite Survey

Background The COVID-19 pandemic and its associated movement restrictions forced a rapid and massive transition to telepsychiatry to successfully maintain care continuity. Objective The aim of this study is to examine a large number of patients’ experiences of, use of, and attitudes toward telepsychiatry. Methods An anonymous 11-question survey was delivered electronically to 14,000 patients receiving telepsychiatry care at 18 participating centers across 11 US states between the months of April and June 2020, including questions about their age and length of service use, as well as experience and satisfaction with telepsychiatry on a 5-point Likert scale. Descriptive statistics were used to analyze and report data. Results In total, 3070 patients with different age ranges participated. The overall experience using telepsychiatry was either excellent or good for 1189 (82.2%) participants using video and 2312 (81.5%) using telephone. In addition, 1922 (63.6%) patients either agreed or strongly agreed that remote treatment sessions (telephone or video) have been just as helpful as in-person treatment. Lack of commute (n=1406, 46.1%) and flexible scheduling/rescheduling (n=1389, 45.5%) were frequently reported advantages of telepsychiatry, whereas missing the clinic/hospital (n=936, 30.7%) and not feeling as connected to their doctor/nurse/therapist (n=752, 24.6%) were the most frequently reported challenges. After the current pandemic resolves, 1937 (64.2%) respondents either agreed or strongly agreed that they would consider using remote treatment sessions in the future. Conclusions Telepsychiatry is very well perceived among a large sample of patients. After the current pandemic resolves, some patients may benefit from continued telepsychiatry, but longitudinal studies are needed to assess impact on clinical outcomes and determine whether patients’ perceptions change over time.

Patient Preferences for Maintenance Treatment of Acute Myeloid Leukemia: Results of a Discrete Choice Experiment

Introduction: Standard treatments for older patients (pts) with acute myeloid leukemia (AML) can induce remission; however, responses are often short-lived and survival rates are poor upon relapse (Chen Y, et al. Medicine 2016;95:e4182). To date, no AML maintenance therapies have been approved by the US FDA, but a few have been used 'off-label'. Although some of these maintenance therapies, such as injectable azacitidine (AZA), improved disease-free survival in older pts with AML, overall survival (OS) benefits have been more difficult to achieve. Moreover, injectable therapies are associated with a higher administration burden and infusion reactions, and therefore may not be suitable for long-term maintenance therapy. The randomized, phase 3 QUAZAR AML-001 study (NCT01757535) of CC-486, a novel oral formulation of AZA, was the first maintenance study to demonstrate a significant and clinically meaningful improvement in OS (Wei AH, et al. Blood 2019;134:LBA-3). CC-486 was associated with a 9.9-month increase in OS (vs placebo) with a manageable safety profile and no compromise in health-related quality of life in pts with AML aged ≥ 55 years previously treated with intensive chemotherapy. Although previous research has examined patient preference for induction therapies, very little is known about preferences for AML maintenance therapies. We therefore used an online discrete choice experiment (DCE) survey to determine the relative importance that pts with AML place on key clinical benefits and risks, mode of administration, and out-of-pocket (OOP) costs. Methods: From November 2019 to April 2020, pts aged ≥ 55 years from the USA, Canada, Germany, and Italy who had undergone treatment for AML were invited to participate in an online DCE survey. Attributes in the DCE survey included clinical benefits (time until relapse [6, 12, 24 months] and 2-year survival rate [30%, 50%, 60%]), adverse events (risk of mild-to-moderate stomach problems [40%, 60%, 80%] and risk of serious infection [10%, 20%, 40%]), mode of administration (once-daily oral tablet for 14 or 21 consecutive days/month, subcutaneous [SC] injection in a clinic/hospital for 7 consecutive days/month, or intravenous [IV] infusion in a clinic/hospital for 5 or 7 consecutive days/month), and OOP costs (USD 200, 400, 800). Patient preferences for attribute levels were analyzed using a multinomial logit model and expressed as marginal utilities and maximum acceptable decrease in 2-year survival rate. Results: In total, 170 pts completed DCE surveys (USA, n = 104; Canada, n = 6; Germany, n = 30; and Italy, n = 30). Mean age was 63.0 years, and 54% of pts were male. In all, 73% of pts had achieved remission at any time, 74% had not received prior stem cell transplant, and 79% had been diagnosed with AML in the last 6 months. Based on the DCE survey results, pts valued a 30% increase in the chance of 2-year survival (marginal utility for 60% = 0.84; 95% confidence interval [CI] 0.70-0.99) more than changes in any other attribute. This was followed by a USD 600 decrease in OOP costs (marginal utility for USD 200 = 0.77; 95% CI 0.66-0.89), 18-month increase in time until relapse (marginal utility for 24 months = 0.61, 95% CI 0.48-0.74), an oral tablet for 14 days/month instead of IV infusion 7 days/month (marginal utility = 0.38, 95% CI 0.23-0.54), and a 30% decrease in the risk of serious infection due to injection (marginal utility for 10% = 0.20; 95% CI 0.09-0.32). Risk of mild-to-moderate stomach problems was not important to pts (Figure). Pts preferred an oral tablet taken either 14 or 21 days/month over SC injection 7 days/month (both P = 0.002). In addition, pts were willing to accept a 16% and 14% decrease in the chance of 2-year survival to switch from IV infusion in a clinic/hospital for 7 consecutive days/month to an oral tablet for 14 days/month (95% CI 9.95-22.08) or 21 days/month (95% CI 7.44-20.50), respectively. Conclusions: In this survey of pts with AML, the most important attribute during maintenance therapy was the probability of survival at 2 years. In addition, pts demonstrated a significant preference toward an oral tablet over IV infusions and SC injections in a clinic/hospital, and were willing to accept a significant decrease in treatment efficacy in favor of an oral mode of administration. This study provides valuable insights into patient preferences and may help inform decision-making for AML maintenance therapies. Disclosures Tervonen: Evidera: Current Employment, Current equity holder in publicly-traded company. Seo:Bristol Myers Squibb: Research Funding; Evidera: Current Employment. Nehme:Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. La Torre:Bristol Myers Squibb: Current Employment. Prawitz:Bristol Myers Squibb: Research Funding; Evidera: Current Employment. Chen:Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Beach:Bristol Myers Squibb: Current Employment. Wang:Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company.

Patient Attitudes Toward Telepsychiatry During the COVID-19 Pandemic: A Nationwide, Multisite Survey (Preprint)

BACKGROUND The COVID-19 pandemic and its associated movement restrictions forced a rapid and massive transition to telepsychiatry to successfully maintain care continuity. OBJECTIVE The aim of this study is to examine a large number of patients’ experiences of, use of, and attitudes toward telepsychiatry. METHODS An anonymous 11-question survey was delivered electronically to 14,000 patients receiving telepsychiatry care at 18 participating centers across 11 US states between the months of April and June 2020, including questions about their age and length of service use, as well as experience and satisfaction with telepsychiatry on a 5-point Likert scale. Descriptive statistics were used to analyze and report data. RESULTS In total, 3070 patients with different age ranges participated. The overall experience using telepsychiatry was either excellent or good for 1189 (82.2%) participants using video and 2312 (81.5%) using telephone. In addition, 1922 (63.6%) patients either agreed or strongly agreed that remote treatment sessions (telephone or video) have been just as helpful as in-person treatment. Lack of commute (n=1406, 46.1%) and flexible scheduling/rescheduling (n=1389, 45.5%) were frequently reported advantages of telepsychiatry, whereas missing the clinic/hospital (n=936, 30.7%) and not feeling as connected to their doctor/nurse/therapist (n=752, 24.6%) were the most frequently reported challenges. After the current pandemic resolves, 1937 (64.2%) respondents either agreed or strongly agreed that they would consider using remote treatment sessions in the future. CONCLUSIONS Telepsychiatry is very well perceived among a large sample of patients. After the current pandemic resolves, some patients may benefit from continued telepsychiatry, but longitudinal studies are needed to assess impact on clinical outcomes and determine whether patients’ perceptions change over time.

PATIENT ASSESSMENT OF INTERPERSONAL QUALITY IN OUTPATIENT INSTALLATION CLINIC HOSPITAL EYE UNDAAN

The mission of Undaan Eye Hospital is to provide high quality and affordable eye health service. However, some problems which indicate customer’s dissatisfaction are still found, including the amount of customer complaints which hasn’t reached the target set by hospital which is zero complaint. Based on Customer Complaint Report of Undaan Eye Hospital, most complaints are caused by communication problem. The aim of this study is to analyze the interpersonal quality of Polyclinic of Outpatient Clinic of Undaan Eye Hospital which consists of respect, confidentiality, courtesy, responsiveness, dan empathy. This study is using descriptive and cross-sectional design and conducted to 82 people who are representing the outpatients and proceeded using simple random sampling method. The data were obtained by interviewing respondents using questionnaire. The data is analyzed using quantitative method and presented in tables. The result of the study shows that most of the respondents which includes 63,41% respondents feeling a little satisfied with interpersonal quality in Polyclinic of Outpatient Clinic of Undaan Eye Hospital. The result of the study shows that most of respondents feeling satisfied with respect, courtesy, confidentiality, and empathy of the service, however they are feeling a little satisfied with responsiveness of the service. Therefore, the hospital needs to improve their quality especially in responsiveness aspect by reducing patient wait times, and maintaining the quality of the aspects which have good ratings of patient satisfaction.Keywords: interpersonal quality, outpatient clinic, patient satisfaction