Disease Specialists Research Articles

Interrater agreement in classifying infections during extracorporeal membrane oxygenation.

Infectious complications are common during extracorporeal membrane oxygenation (ECMO) and may negatively impact outcomes. However, there is considerable variation in the reported rates of incidence, which hampers the use of infections as a quality benchmark for ECMO centers. To assess the contributing role of poor interrater agreement, three independent raters reviewed medical records from all intensive care unit (ICU) patients who received ECMO for >24 h in our tertiary center between October 2019 and October 2021 for suspected episodes of infection, which were rated based on their date of onset and presumed site/diagnosis. To establish a gold standard, any discrepancies were resolved using an expert panel consisting of two intensivists/infectious disease specialists. During 83 ECMO-runs in 77 patients, we observed a total of 62 adjudicated infectious episodes (incidence rate 62, 95% CI: 48-80, per 1000 days at risk). Among 81 episodes suspected by at least one observer, 66 (81%) were identified by two, and only 44 (54%) by all three raters, resulting in Fleiss' kappa of 0.10 (95% CI: 0.00-0.19; slight agreement). However, if raters concurred regarding infection onset, subsequent agreement on infection site was good (concordance 89%; kappa 0.85, 95% CI: 0.72-0.98; near perfect agreement). In conclusion, adjudication of infectious episodes during ECMO is associated with poor interrater agreement regarding occurrence-but not site-of infection. This finding might partially explain the significant disparities observed in reported infection rates during ECMO, emphasizing the need for caution when interpreting infection data in this particular population due to the potential for inherent measurement error.

Implementing a Personalized Antimicrobial Stewardship Program for Women with Gynecological Cancers and Healthcare-Associated Infections.

Healthcare-associated infections (HCAIs) represent a major cause of morbidity and mortality in gynecologic cancer patients, requiring personalized cures. A retrospective study on gynecologic patients with HCAIs, managed through an antimicrobial stewardship program, was performed, focusing on rates of clinical cure, breakthrough/relapse of infections, death, and time of hospital stay (THS). In total, 27 patients (median 60 years, mainly suffering from ovarian, cervical, and uterine cancer) were evaluated by a specialist in infectious diseases and were mainly diagnosed with complicated urinary tract (cUTIs, 12 cases, 44.4%) and bloodstream infections (BSIs, 9 cases, 33.3%). A total of 15 cases (11 cUTIs, 73.3%) were managed with no need for hospitalization and received a median of 11 days of outpatient parenteral antimicrobial therapy (OPAT). In the remaining 12 cases (BSIs in 8 cases, 66.7%), the median THS was 11 days, with 15 days median overall duration of antimicrobial therapy (median 5-day reduction in THS). The management of patients also included source control and wound care. All patients reached clinical cure, with no case of breakthrough infection, one case of relapse, and one death within 30 days (not attributable to the infection). HCAIs in patients with gynecologic tumors can be managed through a patient-centered, multidisciplinary antimicrobial stewardship program.

Detecting Hemileia vastatrix using Vision AI as Supporting to Food Security for Smallholder Coffee Commodities

The loss of food crops during the COVID-19 pandemic threatens food security in Indonesia as one of the world’s top coffee producers. This affects the insecurity of coffee commodities which is influenced by several factors other than the pandemic such as pests, plant diseases, and extreme weather. Plant diseases, such as leaf rust, are a significant factor in the insecurity problem in coffee commodities. The fungus Hemileia vastatrix B et Br causes leaf rust disease, which is a pest that frequently damages coffee plants. This disease not only interferes with plant growth but also causes a decrease in coffee quality and quantity. This initial research aims to carry out early prevention of these diseases as supporting to food security in smallholder coffee commodities. An AI-based visual detection application is the result of this research. We collected 100 images of coffee leaves from various coffee plants. The image is reshaped to 256 x 256 pixels and randomly trimmed to 224 x 224 pixels to fulfill the size requirements of a standard Deep Learning technique. Each image was classified into two classes by a plant pest and disease specialist. The dataset was divided into training, validation, and testing series with a ratio of 60:20:20 for training procedures. The Convolutional Neural Network (CNN) research method used a variation of the ResNet CNN model with 18 layers. The best model validation was 59%.

On the anniversary of Galina A. Melnichenko, Academician of the Russian Academy of Sciences

Galina Afanasyevna Melnichenko is a well-known Russian endocrinologist-researcher, academician of the Russian Academy of Sciences, author and head of fundamental and applied research. G.A. Melnichenko is one of the leaders in creating a methodology for organizing the endocrinological service of the Russian Federation. G.A. Melnichenko made a great contribution to the formation of modern ideas about the role of autoimmune and iodine deficiency states in the development of thyroid pathology. Leading Russian specialist in diseases of the hypothalamic-pituitary system, orphan endocrinopathies, adrenal pathology, multiple endocrine neoplasia syndromes.

The impact of socioeconomic and demographic factors on individuals’ behaviour towards their health and general well-being in rural Sindh, Pakistan

Background: Health and general well-being might sound like a mundane concept for most developed nations; however, it is not perceived similarly in underdeveloped areas of the developing nations. In Pakistan, the concept becomes even more foreign and muddled with certain stubborn biases which needs to be accessed. Therefore, we conducted a study to identify the impact of socioeconomic and demographic factors associated with behaviors regarding health and general well-being.Methods: A cross-sectional study was conducted in rural health centers (RHCs) of five districts of Sindh, Pakistan, from October 2020 to December 2020. A survey questionnaire was designed to collect data on socio-economic and demographic factors and their impacts on behavior towards health and general well-being. Statistical analysis was performed using STATA Version 16.0. Chi-square test and logistic regression analysis were used to determine the extent of association between predictor variables and outcome variables.Results: A total of 969 respondents participated in the study. The mean age of the respondents was 35.70 (±13.17) years. Majority of the participants (82.77%) had limited access to the required health care facility and only (3.61%) of respondents reported that they regularly consult with disease specialists. Multivariable logistic regression revealed the ability to bear disease expenses (OR=0.55, p=0.009), level of education (OR=1.81, p=0.026), female gender (OR=0.30, p=0.048), access to required health facilities (OR=0.58, p=0.012) were significantly associated with positive behavior towards health and general well-being.Conclusions: The study shows that ease of access to healthcare facilities would encourage the population to seek more healthy behaviors. Resources for promoting healthy lifestyle choices in the general population should be more comprehensive for encompassing cognitive beliefs that target psychological and physical health outcomes.

968. Leveraging On-Demand Digital Education to Increase ID Specialists’ Knowledge and Confidence on Appropriate Probiotic Use for CDI Prevention

BackgroundProbiotics are increasingly being used in healthcare. As the number of probiotic options and their potential uses increase, it has become more challenging to make an informed selection for a given disease state. This study assessed the ability of digital education to improve Infectious Disease (ID) specialists’ knowledge regarding the use of probiotics in preventing Clostridioides difficile infection (CDI) and antibiotic-associated diarrhea (AAD). MethodsA CME/ABIM MOC certified, educational program featuring a panel of 3 expert ID faculty was developed. The program sought to clarify the role of different probiotic strains in the prevention or treatment of different disease states. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values < 0.05 are statistically significant. Effect sizes were evaluated using Cramer’s V (< 0.05 modest; 0.06-0.15 noticeable effect; 0.16-0.26 considerable effect; > 0.26 extensive effect). The activity launched on a website dedicated to continuous professional development. Data for this matched-learner analysis were collected through 09/09/20.ResultsTo date, 7122 HCPs, including 5068 physicians, have participated in the activity. Data from the subset of ID specialists (n=235) who answered all pre-/post-assessment questions during the initial study period were analyzed. Following activity participation, significant improvements were observed in the proportion of ID specialists who answered assessment questions correctly (47% pre vs 69% post; P < .0001; V=.22). Improvements were also observed in several specific areas of assessment (Table) and confidence in their ability to select a probiotic-based on strain- and disease-specific efficacy (36% increase). ConclusionParticipation in this online educational program significantly improved ID specialists’ understanding of the interplay between strain- and disease-specificity in the context of probiotics. These findings highlight the potential for well-designed online education to positively impact physicians’ knowledge and confidence Disclosures All Authors: No reported disclosures

213. Assessment of Compliance with Order Set and Bundle for Management of Staphylococcus aureus Bacteremia

Background Staphylococcus aureus (S. aureus) is an aerobic gram-positive coccus that causes a variety of infections. S. aureus bloodstream infections, also known as bacteremias, have significant morbidity and mortality and are difficult to eradicate. A single-center study showed a 9.4% recurrence rate for S. aureus bacteremia, despite adequate treatment. The Infectious Disease Society of America (IDSA) recognizes the seriousness of S. aureus infections, particularly methicillin-resistant S. aureus (MRSA), and has released guidance for treatment of these infections. Guidance for S. aureus bacteremias include identification and removal of the source and early optimization of antibiotics. Serial imaging and laboratory monitoring, including repeat blood cultures, are also necessary to establish the duration of therapy, ensure microbiologic eradication, and reduce the risk of long-term complications. Due to the complexity of S. aureus bacteremia, early involvement of infectious diseases (ID) specialists is strongly recommended. MethodsThis retrospective, single-center study was designed to evaluate the current management of S. aureus bacteremias, including compliance to the elements of the S. aureus order set and bundle. Patients 18 years and older who had a positive blood culture for S. aureus were included in this study. Recurrence of S. aureus infection was assessed at 6 months. Data was analyzed to compare patients with and without ID consults.ResultsEighty-four patients met inclusion criteria. ID consultation resulted in a higher percentage of patients achieving 100% compliance with the bundle elements compared to patients without ID consults (73% vs 25%, respectively; p=0.009). For further breakdown of compliance see Table 1. No statistical difference was detected in recurrence rates (11% vs 33%, respectively; p=0.18) or mortality (8% vs 25%, respectively; p= 0.17) possibly due to the small sample size. Table 1. Outcomes ConclusionID specialist involvement for the treatment of S. aureus bacteremia resulted in greater compliance with the S. aureus bacteremia bundle. No statistical difference in recurrence or mortality rates was detected.Disclosures All Authors: No reported disclosures

1384. Practice Variations in Pre-Hematopoietic Stem Cell Transplantation Infectious Disease Evaluation

BackgroundHematopoietic stem cell transplantation (HCT), and other forms of cellular therapies such as chimeric antigen receptor T cell therapy (CAR-T), while of critical therapeutic value, confers significant, long-term risk of infectious complications. Recipients would benefit from evaluation by infectious disease (ID) specialists. However, amidst many existing guidelines from ID and oncology societies, pre-transplant ID evaluation and management practices vary across US institutions. To better understand these variations and identify targets for standardization, we conducted a survey of ID and oncology providers at transplant centers in the US.MethodsA 38-question, anonymous, voluntary, online survey was distributed via Google Forms to a professional organization e-mail list of ID providers as well as to followers of relevant Twitter accounts. Responses were collected and analyzed.ResultsA total of 51 responses were received, the majority of which (68.6%) came from ID providers. 60.8% of respondents worked at healthcare facilities with over 500 beds. 43 respondents (84.3%) reported that their center performed autologous and allogeneic HCT as well as CAR-T. 56.8% of CAR-T centers use a standardized template, compared to 70.8% of those providing HCT. For allogeneic HCT centers, 8% reported that no ID evaluation is offered; 34% reported that it is offered “sometimes.” Practices varied for treatment of latent tuberculosis infection prior to HCT: 26.5% treat “All the time;” 10.2% treat “Very rarely.” In assessing risk factors, only 63% and 54% identified HIV infection and healthcare occupation, respectively, as epidemiologic risk factors for tuberculosis infection. 59.2% answered that < 10% of patients are screened for Strongyloides. Only 5 respondents reported universal Strongyloides screening prior to transplant. COVID-19 vaccination for family is recommended “Always” by 95.5% of respondents. 25% have offered influenza vaccination to family through the transplant clinic.Table 1 Differences in ID evaluation practices by type of cellular therapy candidate.Table 2 Characteristics of survey respondents.ConclusionPractices around pre-HCT infectious disease evaluation and management are heterogenous among the centers surveyed. The adoption of standardized screening for and management of infectious diseases in this patient population would likely be beneficial.Disclosures All Authors: No reported disclosures

474. Unique Treatment Challenges with Multisystem Inflammatory Syndrome in Children (MIS-C) compared to Kawasaki Disease Shock Syndrome

BackgroundKawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with Coronavirus Disease 2019 present similarly with mucocutaneous symptoms and fever. Both syndromes can progress to shock. Successful treatments for MIS-C are largely based on proven KD management. As more patients with MIS-C are treated, protocols are adjusted. Infectious Diseases (ID) specialists are often early consultants in these cases. Understanding differences in how body systems are affected in MIS-C versus KD is essential for management.Figure 1. Cardiac changes among patients with Kawasaki Disease shock syndrome (KDSS) and Muti-system Inflammatory Syndrome (MIS-C) MethodsThis is a single hospital comparison of 25 cases of MIS-C with mucocutaneous presentation and symptoms of shock and 25 consecutive cases of KD Shock Syndrome (KDSS). Cases were compared for demographics, symptoms, cardiac abnormalities, medical treatments, and cardiac recovery. ResultsPatients with MIS-C develop symptoms of shock including sustained hypotension and tachycardia at 3 times the rate of patients with KD (45% vs 13%; p< 0.001). On echocardiogram, left ventricular myocardial dysfunction, assessed by ejection fraction, is more commonly noted in cases of MIS-C than KDSS (fig 1). About half of patients with MIS-C show left ventricular myocardial dysfunction initially with normalization by 6 months post-presentation in the majority (96%). ConclusionCardiac changes and shock events related to KD and MIS-C are thought to be caused by differing inflammatory mediators. By comparing these two syndromes, we can determine ways to manage each optimally. MIS-C often results in left ventricular myocardial dysfunction, which is rarer in KD cases. Fluid resuscitation with multiple fluid boluses followed by inotropes to treat hypotension in cases of in MIS-C puts increased strain on the already weakened myocardium. Early intravenous immunoglobulin (IVIG) administration, even in the presence of mild hypotension, can simultaneously provide the patient with additional fluid and decrease the underlying inflammatory process. This prompt treatment might reduce the need for pressor support while protecting the myocardium from further damage. As early consultants in MIS-C, ID providers should be educated regarding the unique cardiac challenges of MIS-C and avoid delay in IVIG treatment and cardiologist and intensivist consultation.Disclosures All Authors: No reported disclosures

1130. Impact of a New Pediatric Antibiotic Stewardship Program on Ceftriaxone Use at an Academic Medical Center

BackgroundHoop’s Family Children’s Hospital is a pediatric hospital with 72 beds, nested within Cabell Huntington Hospital. There is an established adult antibiotic stewardship program (ASP), however, since 2014 there has not been a pediatric infectious disease (ID) specialist and no pediatric ASP. With the recent hire of a pediatric ID specialist in Oct 2019 and the formation of a targeted pediatric ASP, we tracked the use of ceftriaxone (CRO) in our facility. MethodsStarting January 2020, education was provided to pediatric providers in regards to appropriate CRO dosing and clinical indications via email communication. The main goals were to limit 100mg/kg/day dosing to severe infections and reduce CRO use in community-acquired pneumonia. This was sustained through intermittent prospective audits and feedback. A retrospective chart review was done from 2019-2021 for the months of January, April and December of each year. Patients ≤18 years of age who received CRO were included. Dosing, interval frequency, indication, and treatment duration were reviewed. Patients who received a single dose of CRO were excluded. ResultsFrom Jan 2019 – April 2021, 391 patient charts were reviewed (189 in the pre-intervention period and 202 in the post intervention period). There were no significant differences in age, race/ethnicity and gender in the two study groups. In the pre-intervention period, 86% of patients were prescribed CRO at severe infection dosing vs 33% in the post intervention period (p< 0.0001) (Figure 1). When dosing was paired with indication, only 20% of patients in the pre intervention period had the appropriate dosing per clinical indication compared to 83% in the post intervention period (p< 0.0001) (Figure 2). We also saw that in the pre-intervention period the most common indication for CRO was pneumonia (66%), which decreased to 57% in 2020 and to 35% in 2021 (p< 0.0001) (Figure 3). Figure 1 describes the percentage of patients receiving ceftriaxone at severe infection dosing. This changed from an average of 86% in the pre-intervention period to 33% in the post-intervention period. Figure 2 describes the percentage of patients receiving ceftriaxone at the appropriate dosing dependent on the clinical indication provided. This changed from 20% in the pre-intervention period to closer to 90% in the post-intervention period.ConclusionPediatric specific ASP efforts and expertise proved to be crucial in appropriate CRO use in our institution. With a feasible education strategy and targeted prospective audit and feedback, there has been a sustained impact in inappropriate CRO use. This underscores the importance of targeted pediatric ASP efforts in pediatric hospitals within larger adult hospitals.Disclosures All Authors: No reported disclosures

Immunobiological Properties and Clinical Applications of Interleukin-38 for Immune-Mediated Disorders: A Systematic Review Study.

Exponential growth in the usage of “cytokines” (as seroimmunobiomarkers) has facilitated more accurate prognosis, early diagnosis, novel, and efficient immunotherapeutics. Numerous studies have reported immunopathophysiological and immunopathological processes of interleukin-38 (IL-38). Therefore, in this systematic review article, the authors aimed to present an updated comprehensive overview on the immunobiological mechanisms, diagnostic, and immune gene-based therapeutic potentials of IL-38. According to our inclusion and exclusion criteria, a total of 216 articles were collected from several search engines and databases from the January 2012 to July 2021 time interval by using six main keywords. Physiologic or pathologic microenvironments, optimal dosage, and involved receptors affect the functionalities of IL-38. Alterations in serum levels of IL-38 play a major role in the immunopathogenesis of a wide array of immune-mediated disorders. IL-38 shows anti-inflammatory activities by reduction or inhibition of pro-inflammatory cytokines, supporting the therapeutic aspects of IL-38 in inflammatory autoimmune diseases. According to the importance of pre-clinical studies, it seems that manipulation of the immune system by immunomodulatory properties of IL-38 can increase the accuracy of diagnosis, and decipher optimal clinical outcomes. To promote our knowledge, more collaboration is highly recommended among laboratory scientists, internal/infectious diseases specialists, oncologists, immunologists, diseases-specific biomarkers scientists, and basic medical researchers.

Perception and clinical decisions from inflammatory bowel diseases’ specialists towards positioning of new therapies in Crohn's disease and ulcerative colitis: A national web-based survey from the Brazilian IBD study group (GEDIIB)

BackgroundIn the last decade, new therapies with different mechanisms of action have been approved for the treatment of moderate to severe Crohn's disease (CD) and ulcerative colitis (UC). Due to the lack of comparative head-to-head trials, the ideal positioning of agents as the most appropriate first- or second-line therapies remains to be defined. ObjectiveThis survey aimed to evaluate the perception and decisions of Brazilian Inflammatory Bowel Diseases (IBD) specialists in positioning of new therapies (vedolizumab [VEDO], ustekinumab [UST] and tofacitinib [TOFA]) in the management of IBD in different clinical scenarios. MethodologyAn anonymous national web-based questionnaire was used to determine the positioning of treatment options in different clinical scenarios (using Google Forms platform), which involved different age ranges, phenotypes, clinical situations and previous exposure to anti-TNF agents (14 scenarios for CD and 10 scenarios for UC). In CD, physicians could choose between UST or VEDO, whilst in UC, between UST, VEDO or TOFA. Six reasons for the specific choice were proposed, such as mechanism of action, safety, method of administration or onset of action. Statistical analysis was carried out with chi-square and t-tests. ResultsA total of 150 out of 672 GEDIIB IBD specialists (22.32%) responded to the survey. In CD scenarios, UST was the most dominant choice (11/14 scenarios), with VEDO dominating only 3 clinical situations. In UC scenarios, VEDO was the dominant choice (8/10), with UST being chosen for scenarios that included extraintestinal manifestations. Among the reasons for specific choices, the most commonly chosen were the higher efficacy due to the intrinsic mechanism of action and safety profile. ConclusionsUST was the dominant choice as compared to VEDO in CD in most scenarios, especially due to its mechanism of action and safety. VEDO was the dominant choice as compared to UST and TOFA in UC scenarios, mainly for reasons also related to its mechanism of action and safety profile. Comparative studies including patient outcomes are needed to better define the positioning of new IBD therapeutic options in our country.

Leven met evenwichtsstoornissen: wetgeving en rol van de (arbeids)arts bij rijgeschiktheid en werkhervatting van werknemers

Legislation and role of the (occupational) physician in the fitness to drive and return to work of employees, in particular with a pathology of the vestibular system It is the responsibility of every driver to verify that he meets the medical standards required to drive a vehicle. For drivers who provide paid passenger transport, a driving fitness certificate is also required in addition to a driving license. This certificate must be drawn up by the occupational physician. Persons with a disorder of the vestibular system can be declared fit to drive if they can provide a favorable report set up by a specialist in nose, throat and ear diseases. Employees confronted with balance disorders should consult with the (occupational) doctor to ascertain for which activities they are suitable and which work adjustments need to be made. This consultation is best done informally before the employee resumes work.

Impact of the COVID-19 pandemic situation on HIV care in Liège, Belgium

Background Background: The COVID-19 pandemic and associated containment measures dramatically affected the health care systems including the screening of human immunodeficiency virus and the management people living with HIV around the world by making the access to preventive care services and specific medical monitoring more difficult. Objective Objective: To study the impact of the COVID-19 pandemic on the holistic care of people living with HIV in Liège (Belgium). Methods Methods: In this retrospective observational study conducted in Liège University Hospital, we compared the out-patient follow-up of HIV-infected individuals as well as the number of new HIV diagnoses between 2019 and 2020 and between the different waves of the COVID-19 pandemic in 2020. Results Results: In 2020, when compared to 2019, we observed a significant decrease in the number of new HIV diagnoses, especially during the first wave of the pandemic, and in the number of consultations undertaken by sexual health services, psychologists and specialists in infectious diseases at our HIV clinic. We also observed a decrease in the number of viral load assays and blood CD4 + T-cells count analyses performed, although we found less patients with HIV plasma viral load above 400 copies per mL in 2020. Finally, we noted a significant reduction in terms of screening of our HIV-infected patients for hepatitis C, syphilis, colorectal and anal cancers and hypercholesterolemia. Conclusions Conclusions: Our experience exhibits the deleterious impact of the COVID-19 pandemic on the HIV care and the need to implement new strategies to guarantee its continuum.

Clinically relevant infections in hematology and oncology: bacterial infections and the role of novel antibiotics in times of multidrug resistance

SummaryMultidrug resistance of bacterial pathogens is an increasing problem wordwide, especially treatment of multidrug resistant (MDR) gramnegative bacteria is challenging. In the recent past, several new antibiotics as well as new betalactamase inhibitors have been introduced. These novel drugs are valuable new tools for the therapy of infectious complications in cancer patients once there is a high risk for infections due to multidrug-resistant pathogens. While it is necessary to start empirical antibiotic therapy immediately, novel antibiotics only provide benefits in certain situations, depending on the underlying pathogens. Thus, these new antibiotics are best used guided by microbiological testing, since the exact mechanism of resistance determines susceptibility or resistance to certain antibiotics. For empirical therapy, previous culture results and/or colonization with MDR pathogens can help to choose from conventional antibiotics or novel drugs. In clinical practice, optimal antibiotic therapy can be achieved by close collaboration of specialists in hematooncology, infectious diseases and microbiology.

SISTEM PAKAR DIAGNOSA PENYAKIT KULIT AKIBAT INFEKSI JAMUR MENGGUNAKAN TEOREMA BAYES

Diagnosa dini penyakit kulit yang disebabkan oleh infeksi jamur diperlukan untuk mengurangi resiko penyakit. Pada artikel ini, diusulkan sistem pakar dengan mengimplementasi teorema Bayes sebagai solusi diagnosa dini penyakit kulit, khususnya yang disebabkan oleh infeksi jamur. Akuisisi pengetahuan dari pakar, dalam hal ini dokter spesialis penyakit kulit dan kelamin, dilakukan untuk memperoleh basis pengetahuan. Sebanyak 31 data yang berasal dari rekam medis digunakan dalam penelitian ini. Jenis penyakit kulit yang dapat dideteksi yaitu tinea korporis, tinea unguium, pitiriasis versikolor, dan kandidosis mukokutan ringan. Teorema Bayes diimplementasikan pada mesin inferensi, sehingga menghasilkan kemungkinan jenis penyakit kulit yang diderita berdasarkan masukan gejala dari pengguna. Hasil dari sistem kemudian divalidasi oleh pakar. Berdasarkan hasil validasi tersebut, maka diperoleh 27 hasil yang sesuai dan 4 hasil yang tidak sesuai, sehingga akurasi kesesuaian sistem berdasarkan hasil tersebut adalah 87,1%.&#x0D;

A Checklist to Assess Childbearing Intentions and Promote Referral to Preconception Care or Contraception: A Multi-Site Study.

This study assesses HIV provider views on the value of a checklist designed to assess patients' preconception care (PCC) needs and guide implementation of PCC. Ninety-two HIV providers in seven U.S. cities provided perspectives via an in-depth phone interview regarding a checklist to facilitate communication and referrals for PCC. A sub-sample of 27 providers shared feedback on a checklist designed for this purpose. Interview audio files were transcribed and uploaded to a web-based program supporting coding and analysis of qualitative data. Content analysis was utilized to identify key themes within the larger, a priori themes of interest. Feedback regarding the checklist was analyzed using a grounded theory approach to examine patterns and emergent themes across transcripts. Providers averaged 11.5years of HIV treatment experience; over 80 percent were physicians (MD) or nurse practitioners (NP) and 76 percent were HIV/infectious disease specialists. The majority of providers were female (70%) and Caucasian (72%). Checklist benefits identified included standardization of care, assisting new/inexperienced providers, educational resource for patients, and aid in normalizing childbearing. Concerns included over-protocolizing care, interfering with patient-provider communication, or requiring providers address non-priority issues during visits. Providers suggested checklists be simple, incorporated into the electronic medical record, and accompanied with appropriate referral systems. Findings support a need for a checklist tool to assist in conversations about reproductive intentions/desires. Additional referral or innovative consultative services will be needed as more persons living with HIV/AIDS are engaged on the topic of childbearing.

The scientific biography of Professor V.N. Klimenko (1868‒1941) – bacteriologist, infectious disease and internal medicine specialist

The scientific biography of Professor V.N. Klimenko (1868‒1941) – bacteriologist, infectious disease and internal medicine specialist

Reciprocal Development and Progressive Responsibility: The History of the Mayo Clinic Neurology Residency.

The first Mayo Clinic neurology resident began training approximately 1 century ago. Over the subsequent 100 years, 639 budding specialists in diseases of the nervous system graduated from the Mayo Clinic Neurology Residency in Rochester, Minnesota. The history of the American residency has been thoroughly covered by Ludmerer in his 2014 book Let Me Heal,1 and a history of the Mayo Clinic Otolaryngology Residency Program was published in 2020.2 Mulder discussed education in the Mayo Clinic Department of Neurology as part of an overview of the history of the department in 1971.

Sistem Pakar dengan Metode Certainty Factor dalam Analisis Penyakit Herpes Zoster pada Manusia

Herpes zoster atau cacar api adalah suatu infeksi yang disebabkan oleh virus varicella zoster. Penyakit Herpes Zoster disebut juga cacar api karena akan muncul lepuhan pada kulit berupa garis atau area kecil disalah satu sisi wajah atau tubuh dan rasanya cukup panas seperti terbakar. Biasanya penderita mengalami keluhan berupa bercak kemerahan dan muncul gelembung-gelembung berisi air. Merancang sistem pakar agar dapat membantu user dalam mengenali gejala awal penyakit Herpes Zoster, serta mengetahui jenis penyakit Herpes Zoster yang mana dideritanya melalui hasil konsultasi secara langsung lewat sistem. Data yang digunakan dalam penelitian ini diperoleh dari hasil wawancara secara langsung dengan pakar yaitu dr.Qaira Anum Sp.KK dirumah sakit RSI. Ibnu Sina Padang selaku dokter spesalis penyakit kulit dan kelamin. Data yang diperoleh berupa data jenis penyakit Herpes Zoster, gejala dari masing-masing jenis penyakit Herpes Zoster, bobot dari masing-masing gejala yang ada, dan solusi atau pencegahan dari masing-masing jenis penyakit Herpes Zoster. Serta dalam penelitian ini dibantu dengan menggunakan metode Certainty Factor agar dapat mempermudah dalam proses penentuan jenis penyakit Herpes Zoster apa yang diderita oleh user yang melakukan konsultasi melalui sistem berdasarkan dari gejala yang dirasakan oleh masing-masing user. Hasil dari pengujian terhadap metode ini adalah terdapat 100% dari 10 data pengujian. Berdasarkan akurasi dari hasil identifikasi terhadap sistem ini, maka penelitian ini sangat tepat dalam tingkat mengidentifikasi tingkat akurasi penyakit Herpes Zoster pada manusia. Sistem pakar pengujian telah dapat mengidentifikasi penyakit Herpes Zoster secara spesifik. Melalui metode Certainty Factor ini, tingkat akurasi yang di dapat cukup akurat dan dapat membantu dokter hewan dalam meningkatkan akurasi untuk mengidentifikasi penyakit Herpes Zoster pada manusia.