Updated Guidelines Research Articles

Systematic Review to Inform the Developmental Coordination Disorder Clinical Practice Guideline Update: Physical Therapy Intervention.

Systematically review current evidence on physical therapy (PT) intervention for developmental coordination disorder (DCD) to inform the update to the 2020 DCD Clinical Practice Guideline (CPG). Eight databases were searched for qualitative studies, randomized controlled trials (RCTs) and systematic reviews (SRs) that informed PT management of DCD. Risk of bias and certainty of evidence were assessed. Sixteen studies were included. Three SRs, 3 RCTs, and 1 qualitative study supported task-oriented interventions, the first-choice intervention recommended by the 2020 DCD CPG. One SR and 7 RCTs supported supplemental activities, including a meta-analysis of 2 studies on active video gaming. One qualitative study informed how physical therapists adapt motor learning strategies for children with DCD. Newer evidence reaffirms 3 of the 5 recommendations on intervention of the 2020 DCD CPG and adds low to very low-quality evidence on new evidence-informed supplemental activities.

Correction of the effect of direct oral and parenteral anticoagulants in hemorrhagic stroke

Hemorrhagic stroke is associated with high risk of adverse outcome and follows intake of anticoagulants and antiplatelet agents in 25% of cases. The latest clinical guidelines of the Neurocritical Care Society for correction (reversal) of the effect of anticoagulants and antiplatelet agents in hemorrhagic stroke were published in 2016. In accordance with PRISMA recommendations, we reviewed the PubMed, eLibrary and UpToDate databases to a depth of 5 years and selected 48 articles. Direct oral anticoagulants are currently common. To reverse their effect, one can use specific antidotes (idarucizumab is recommended for dabigatran, andexanet alfa (not yet registered In Russia) for factor Xa inhibitors (rivaroxaban, apixaban)) and combination of prothrombin complex concentrate and tranexamic acid. Protamine sulfate is antidote for unfractionated and low molecular weight heparins. Protamine sulfate completely inactivates unfractionated heparin, but it is less effective against low molecular weight heparin. It is characterized by high probability of anaphylactic reactions, especially after repeated administrations. The effectiveness of andexanet alpha and activated factor VII for reversing the effect of low molecular weight heparin is being studied. Fondaparinux sodium is used for heparin-induced thrombocytopenia. Protamine sulfate is ineffective for reversing the effect of fondaparinux. One can use prothrombin complex concentrate and andexanet alpha, but their effectiveness is unclear. Ciraparantag is being studied in clinical trials. Apparently, ciraparantag is highly effective as an antidote for various anticoagulants. Early hemostatic therapy and reversal of anticoagulant effects in patients with hemorrhagic stroke significantly reduce the risk of adverse outcomes. This problem is being studied. Regular literature review with creation of updated clinical guidelines is needed.

Impact of Consensus Guidelines, Clinical Trials, and COVID-19 on Fractionation Practices for Node-negative Intact Breast Cancer.

To evaluate whether hypofractionated radiotherapy (HF-RT) in node-negative intact breast cancer significantly increased after guideline updates, trial publications, and COVID-19. Patients with node-negative breast cancer undergoing lumpectomy and adjuvant RT were identified in the National Cancer Database. Receiving ≥25 and <50 Gy in 5-20 fractions defined HF-RT. Receiving 50 to 66 Gy in >20 fractions defined conventional RT (CF-RT). Patient characteristics were compared with X2 testing. Joinpoint analysis identified when fractionation significantly changed. Variables associated with HF-RT were identified by univariate and multivariate (MVA) logistic regression. Two-sided P-value <0.05 was significant. Patients meeting criteria totaled 236,336; 54.8% received CF-RT and 45.2% HF-RT. HF-RT and 5-fraction RT significantly increased after 2015 and 2019, respectively (P<0.05). On MVA, HF-RT was positively associated with: age older than or equal to 65 years (OR 2.14, P<0.001); private insurance (OR 1.27, P=0.03); treatment in Midwest (OR 1.66, P<0.001) or Western United States (US) (OR 3.77, P<0.001); distance ≥50 miles (OR 1.16, P=0.001); later year of diagnosis (OR 1.44, P<0.001); and partial breast irradiation (OR 2.08, P<0.001). HF-RT was negatively associated with: community (OR 0.49, P<0.001) or integrated network (0.55, P<0.001) centers; grade 2 (OR 0.83, P<0.001) or 3 (OR 0.49, P<0.001), hormone receptor negative (OR 0.66, P<0.001), and HER2+ (OR 0.74, P<0.001) disease; positive surgical margins (OR 0.61, P<0.001); and presence of lympho-vascular invasion (OR 0.86, P<0.001). HF-RT in node-negative intact breast cancer increased after 2015, coinciding with US and European guideline updates. Five-fraction RT increased after 2019, coinciding with COVID-19 and FAST-Forward trial results.

A Qualitative Exploration of Moderating Factors Shaping Implementation Fidelity to Post-Abortion Care Guidelines in Chibombo District, Zambia

Abstract We sought to identify and describe modifying factors influencing adherence to the post-abortion care guidelines, as well as potential strategies to address them in rural health facilities of Chibombo District, Zambia. We used a qualitative descriptive approach, drawing on key informant interviews with program managers (n = 4) and in-depth interviews with post abortion care providers (n = 22). We adopted Carroll et al.‘s Framework for Implementation Fidelity which prescribes four categories of potential moderating factors that may shape adherence to post abortion care guidelines including comprehensiveness of policy description, facilitative implementation strategies, patient responsiveness, and quality of delivery. We analyzed the interview data using deductive thematic analysis. The study revealed shortcomings in the comprehensive description and dissemination of post abortion care guidelines, underscored by limited provider understanding and reference to them during practice, and delayed dissemination of any guideline changes or updates. Facilitative implementation strategies encompassed monitoring and supervision, technical and administrative support, documentation and audit, and community engagement. Inadequate provider training, inconsistent post abortion care drug supply, weak referral mechanisms and funding gaps affected the quality of delivery of post abortion care services. Lastly, patient responsiveness was affected by non-compliance to the guidelines and community reliance on self-treatment. There is a critical need for comprehensive training, supply chain improvements, and stronger health system support to ensure adherence to post-abortion care guidelines in rural settings. Such initiatives may have far-reaching implications for maternal health outcomes and general health equity.

Obstacles to meeting nutritional recommendations in a tertiary pediatric intensive care unit.

Optimal nutrition is associated with positive outcomes in critically ill children. In 2017, the Society of Critical Care Medicine (SCCM) and the American Society of Parenteral and Enteral Nutrition (ASPEN) updated guidelines for nutritional support for this population. However, implementation of these guidelines may be delayed due to clinical barriers. We aimed to assess our practice against the recommendations of the ASPEN guidelines, hypothesizing that caregiver bias and clinical factors may hinder their implementation in our pediatric intensive care unit (PICU). We focused on two ASPEN recommendations: (1) feeding within 48 h (48H) of admission and (2) meeting two thirds of estimated caloric requirements after seven calendar days. All children aged 1 month to 16 years admitted to our PICU from July 2017 to January 2020 were eligible. Using a retrospective chart review, nutritional and clinical data were collected at the time of admission, at 48H, and 7 calendar days after admission. A total of 533 patients were included. After 48H of admission to the PICU, 402 out of 533 (75.4%) patients received feeding. The following factors were associated with not reaching nutritional goals at 48H: invasive ventilation support, inotropic and vasoactive support, and extracorporeal life support. After 7 days, 95 out of 118 (80.5%) received two thirds of caloric needs. At 7 days, the main obstacle to meeting caloric goals was invasive ventilation. In a representative tertiary PICU, barriers to meeting ASPEN nutritional recommendations included hemodynamic instability or invasive ventilator support, especially within the first 48H of admission.

Student survey of simulation standards for continuous improvement (S4CI): Establishing reliability and validity.

In 2021 INACSL published their updated guidelines which should be integrated throughout the nursing curriculum and be measured to allow students to learn skills, develop clinical reasoning abilities and become competent in caring for patients/families in a safe environment. This study is designed as a cross-sectional survey study collecting data from nursing and Interprofessional Education students at the UH Mānoa. The authors reviewed existing tools and adapted items as needed with the consultation of subject matter experts. They validated the tool by administering surveys to nursing and interprofessional students following simulation exercises. Confirmatory factor analysis to verify the factor structure and reliability tests were performed to assess the internal consistency of each item within a measure, respectively. Survey data from 1182 respondents showed reproducible factor results with strong correlation and reliability results showed high coefficient alpha values for all measures. The S4CI is a valid and standardized tool to provide faculty with valuable feedback to evaluate learning, optimize achievement and improve aspects of activities in nursing and interprofessional educational simulations. The study is, however, limited by sample size and generalizability, as it was conducted in a single center.

Abstract TP122: Impact of 2021 Seconary Stroke Prevention Guidelines on Post Stroke Care Plans for Patients Transferred to Long Term Acute Care Facilities

Background: Classification of etiologic ischemic stroke subtype guides post-stroke care and secondary prevention. Etiologic ischemic stroke subtypes are often not clearly documented in post-stroke care plans especially when transferring from one facility to another. In 2021, AHA/ASA published updated secondary stroke prevention guidelines recommending identifying etiologic ischemic stroke subtypes when possible. The impact of this on post-stroke care is unknown. Methods: Charts of all patients ages 18 and up, admitted from 1/1/20 to 5/23/21 and from 1/1/22 to 5/23/23 to 3 long-term acute care (LTAC) facilities, on antiplatelet therapy, and with an ascertainable history of stroke within 90 days of admission, were retrospectively reviewed to assess for documentation of ischemic stroke subtype at discharge/transfer to an LTAC facility and to assess for appropriateness of secondary stroke prevention therapies. Care plans from those two time periods were compared to assess for any impact the 2021 guidelines may have had on discharge practices. Results: Subtypes were not defined for the majority of ischemic strokes. Classification by etiologic subtype was observed in 33% of cases. Classification by territory or location was more common (Fig. 1). One-quarter of patients were on dual antiplatelet therapy (DAPT) and 75% of patients were on single antiplatelet therapy (SAPT) with more patients on DAPT in the latter time period (Fig. 2A). Rationale for DAPT were not provided for the majority of patients and NIHSS and ABCD2 scored were also not commonly provided for patients on DAPT (Fig. 2B). Close to 90% of patients were treated with antihypertensives and statin therapy at discharge to LTAC; 71% of patients were treated with diabetic therapies at discharge; stroke education at discharge to LTAC was documented for 43% of patients; and LDL was documented in 56% of patients (Fig. 3). Conclusions: Etiologic ischemic stroke subtypes were not documented for the majority of patients transferred to LTACs. Despite recent guideline revisions, an increase in documentation of stroke subtype was not observed. Optimal secondary stroke prevention strategies were difficult to assess without this information including appropriate antiplatelet regimens. Our findings highlight the importance of the need to improve post-stroke care plans at discharge and transfer including documentation of etiologic ischemic stroke subtypes to facilitate optimal post-stroke care across all transitions.

Updated Expert Opinion Guidelines Regarding the Effects of Immunosuppressive Agents on Patch Testing.

Updated Expert Opinion Guidelines Regarding the Effects of Immunosuppressive Agents on Patch Testing.

Treatment coverage of the 2024 updated WHO guidelines for patients with chronic hepatitis B

Treatment coverage of the 2024 updated WHO guidelines for patients with chronic hepatitis B

Applying an updated brain injury guideline classification to interhospital transfer of patients with traumatic brain injury: Who benefits most?

Applying an updated brain injury guideline classification to interhospital transfer of patients with traumatic brain injury: Who benefits most?

INDIVIDUAL ARTICLE: Appraisal of Ruxolitinib 1.5% Cream as a First-Line Topical Therapeutic Agent for Adolescents and Adults With Mild-to-Moderate Atopic Dermatitis.

Dermatology has entered the long-awaited paradigm shift from steroidal to non-steroidal therapeutics for the topical treatment of atopic dermatitis. Topical Janus kinase (JAK) inhibitors have garnered a strong recommendation for the treatment of adult atopic dermatitis (AD) by the American Academy of Dermatology in the most recent updated guidelines as of 2023. Ruxolitinib 1.5% cream is the only FDA-approved topical JAK inhibitor available in the US and is approved for the short-term and intermittent chronic treatment of mild-to-moderate AD in adolescents and adults aged &gt;= 12 years with up to 20% affected body surface area (BSA). Since approval in 2021, ruxolitinib cream has been shown to be consistently effective across disease severities, age groups, and anatomic sites of special interest (ie, head and neck region, hands). Real-world usage as monotherapy and in combination with other topicals have confirmed its efficacy in practice and further led to reduced usage of topical corticosteroids. Ruxolitinib cream also has the potential to reduce economic costs due to AD-related decline in work productivity. Here, we review the most up-to-date clinical trial and real-world efficacy data that position ruxolitinib 1.5% cream as a first-line AD therapeutic. J Drugs Dermatol. 2025;24:2(Suppl 2):s5-15.

PD-L1 testing patterns in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) in the U.S.

Pembrolizumab with/without platinum+5-FU is approved for the first-line (1L) treatment of R/M HNSCC, and its monotherapy use requires PD-L1 Combined Positive Score (CPS)≥1. We aimed to understand PD-L1 testing patterns and associations with patient characteristics and treatment choice in R/M HNSCC. Adults with R/M HNSCC initiating 1L systemic therapy were included from a U.S. nationwide database primarily compromised of community practices (07/01/2019-12/31/2023). PD-L1 testing patterns, treatment sequence, and time gaps related to testing and treatment initiation were summarized. Logistic regression was used to test associations between patient characteristics and PD-L1 testing patterns, and between CPS scores and 1L pembrolizumab monotherapy use. Of 2,207 patients, 32.7% received PD-L1 testing before 1L therapy initiation, 17.4% after 1L therapy initiation, and 50.0% were never tested. Most patients (55.9%) who tested positive before 1L therapy received pembrolizumab monotherapy while those who tested negative received pembrolizumab+platinum+5-FU most commonly (31.6%). Among patients untested before 1L therapy, the most common 1L treatment was pembrolizumab monotherapy (24.3%). Patients with an ECOG≥2 had higher odds of being tested before 1L therapy (OR: 1.42, p<0.01). CPS scores were associated with higher odds of receiving 1L pembrolizumab monotherapy (OR: 4.11 and 4.96 for CPS 1-19 and≥20, respectively; both p<0.0001). This study revealed low utilization of PD-L1 testing to guide treatment choice and impactful gaps between specimen collection, the receipt of results, and 1L therapy initiation. There is a need to improve clinician awareness of the importance of PD-L1 testing and an opportunity for updated guidelines on testing.

AGA Clinical Practice Guideline on the Prevention and Treatment of Hepatitis B Virus Reactivation in At-Risk Individuals.

Hepatitis B reactivation (HBVr) can occur due to a variety of immune-modulating exposures, including multiple drug classes and disease states. Antiviral prophylaxis can be effective in mitigating the risk of HBVr. In select cases, clinical monitoring without antiviral prophylaxis is sufficient for managing the risk of HBVr. This clinical practice guideline update aims to inform frontline health care practitioners by providing evidence-based practice recommendation for the management of HBVr in at-risk individuals. The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence and make recommendations. The panel conducted a systematic evidence review to identify new studies since publication of the first version of this clinical practice guideline in 2014. The Evidence to Decision framework was used to develop recommendations regarding the role of antiviral prophylaxis and monitoring without antiviral prophylaxis for management of HBVr. Clinical recommendations were based on the balance between desirable and undesirable effects, patient values, costs, and health equity considerations. The panel agreed on 4 recommendations. Based on evidence and baseline risk assessment, the panel made a strong recommendation in favor of antiviral prophylaxis for individuals at high risk of HBVr. For individuals at moderate risk of HBVr, a conditional recommendation was made in favor of antiviral prophylaxis. For individuals at low risk of HBVr, a conditional recommendation was made in favor of monitoring alone without antiviral prophylaxis. Monitoring should be performed at 1- to 3-month intervals, and must include assessment of hepatitis B viral load in addition to assessment of alanine aminotransferase. For individuals deemed to be at-risk of HBVr, the panel agreed on a strong recommendation in favor of testing for HBV; given universal Centers for Disease Control and Prevention screening guidance for hepatitis B for all adults 18 years and older by testing for HBV surface antigen, hepatitis B surface antibody, and total hepatitis B core antibody, stratifying screening practices by magnitude of HBVr risk is no longer needed. This document provides updated guidance for the management of HBVr in at-risk individuals. Limitations and gaps in the evidence are highlighted. This guideline is expected to require updating in 5 years from publication.

American Association of Clinical Endocrinology Clinical Practice Guideline on Pharmacologic Management of Adults With Dyslipidemia.

To review the evidence and provide updated and new recommendations for the pharmacologic management of adults with dyslipidemia to prevent adverse cardiovascular outcomes. These recommendations are intended for use by clinicians, health care team members, patients, caregivers, and other stakeholders. This guideline was developed by a multidisciplinary task force of content experts and guideline methodologists based on systematic reviews of randomized controlled trials or cohort studies from database inception to November 7, 2023. An updated literature search was completed for any additional articles published by May 31, 2024. Clinical questions addressing nonstatin medications and patient-important outcomes were prioritized. The task force assessed the certainty of the evidence and developed recommendations using the Grading of Recommendations Assessment, Development, and Evaluation framework. All recommendations were based on the consideration of the certainty of the evidence across patient-important outcomes, in addition to issues of feasibility, acceptability, equity, and patient preferences and values. This guideline update includes 13 evidence-based recommendations for the pharmacologic management of adults with dyslipidemia focused on patient-important outcomes of atherosclerotic cardiovascular disease (ASCVD) risk reduction. The task force issued a good practice statement to assess the risk of ASCVD events for primary prevention in adults with dyslipidemia. The task force suggested the use of alirocumab, evolocumab, or bempedoic acid for adults who have ASCVD or who are at increased risk for ASCVD in addition to standard care. The task force suggested against the use of these medications in adults without ASCVD. There was insufficient evidence to recommend for or against the addition of inclisiran. For adults with hypertriglyceridemia and ASCVD or increased risk of ASCVD, the task force suggested the use of eicosapentaenoic acid but not eicosapentaenoic acid plus docosahexaenoic acid and strongly recommended against the use of niacin. There was insufficient evidence for recommendations regarding pharmacologic management in adults with severe hypertriglyceridemia (≥500mg/dL). The task force suggested a low-density lipoprotein cholesterol treatment goal of <70mg/dL in adults with dyslipidemia and ASCVD or at increased risk of ASCVD. Pharmacotherapy is recommended in adults with dyslipidemia to reduce the risk of ASCVD events. There are several effective and safe treatment options for adults with dyslipidemia who have ASCVD or at increased risk of ASCVD who need additional lipid-lowering medications. Shared decision-making discussions are essential to determine the best option for each individual.

Diagnostic Accuracy of The Bethesda System for Reporting Thyroid Cytopathology: An Institution Experience — 2023 Guidelines Update

Diagnostic Accuracy of The Bethesda System for Reporting Thyroid Cytopathology: An Institution Experience — 2023 Guidelines Update

H. pylori treatment in a resistant world: Regional strategies for effective eradication: A narrative review

The transmission of Helicobacter pylori (H. pylori) is still a major global health concern. As antibiotic resistance increases, the efficacy of traditional treatment plans—which are mostly dependent on proton pump inhibitors and antibiotics—is being gradually undermined. This review examines the regional variations in H. pylori treatment guidelines, shaped by local resistance patterns, healthcare infrastructure, and available therapies. In regions with high resistance, such as South Asia, bismuth quadruple therapy has become the preferred first-line option, offering higher eradication rates. In contrast, countries like Japan and South Korea have seen improved outcomes with the introduction of potassium-competitive acid blockers (P-CABs) and high dose amoxicillin-based regimens respectively. These regional disparities highlight the significance of tailoring H. pylori treatment to local resistance trends in order to tackle the growing threat of antibiotic resistance. The purpose of this review is to investigate geographical variations in Helicobacter pylori antibiotic resistance patterns and their impact on treatment methods. By highlighting how resistance trends impact therapeutic outcomes, this review seeks to guide clinicians in selecting the most effective, region-specific therapies for H. pylori eradication. Additionally, it underscores the critical need for ongoing research to better understand resistance dynamics and inform updated treatment guidelines, ensuring improved patient outcomes and combating the global rise of antimicrobial resistance.

P-1149. Short versus Long Duration of Antibiotic Therapy in Pediatric Intensive Care Unit Patients with Uncomplicated Community Acquired Pneumonia: Impact of an Institutional Guideline Update

Abstract Background Community acquired pneumonia (CAP) is a significant cause of morbidity and antibiotic overutilization among pediatric patients. The 2011 Infectious Diseases Society of America (IDSA) guidelines recommend a treatment duration of 10 days for pediatric CAP but recognize that shorter courses may be appropriate in certain settings. In February 2022, based on newer literature and extrapolations from the adult population, Michigan Medicine updated its institutional guidelines to recommend an antibiotic duration of 5 days to treat uncomplicated CAP in hospitalized pediatric patients. However, there remains limited evidence to support a shorter duration of therapy for patients admitted to the pediatric intensive care unit (PICU). Baseline characteristics of patients treated for uncomplicated CAP in the PICU at Michigan Medicine from November 2020 to December 2023 Methods This was a single-center, retrospective cohort study of patients aged 6 months to 17 years old with CAP who were admitted to the PICU at Michigan Medicine from November 2020 to December 2023. Patients with complicated CAP, hospital acquired or ventilator associated pneumonia, cystic fibrosis, severe neutropenia, solid organ or stem cell transplant, tracheostomy dependence, sickle cell disease, or suspicion for fungal infection were excluded from the study. The primary outcome was treatment failure, defined as a composite of readmission, emergency department or outpatient visit, need for antibiotic retreatment, or death attributable to CAP within 30 days of completing antibiotic therapy. Clinical outcomes of patients treated for uncomplicated CAP in the PICU at Michigan Medicine before and after the institutional guideline update Results A total of 128 patients met eligibility criteria; 59 (46%) patients were treated before the guideline update and 69 (54%) were treated after the guideline update. The median antibiotic treatment duration was 7.71 days in the pre-guideline update group and 5.58 days in the post-guideline update group (P &amp;lt; 0.001). Three patients in the pre-guideline update group and five patients in the post-guideline update group experienced 30-day treatment failure, which was not a statistically significant difference (P = 0.615). There was no difference in the median hospital length of stay between groups. Conclusion This study demonstrated that a shorter course of antibiotic therapy did not increase the rate of treatment failure compared to a standard course of therapy for patients admitted to the PICU with uncomplicated CAP. Disclosures All Authors: No reported disclosures

Consensus on the Cosmetic Use of a Novel Botulinum Neurotoxin Type A Product (NEWLUX®) for Facial Expression Muscles: 2024 Guidelines and Discussions by Korean Experts

Background: Botulinum neurotoxin type A (BoNTA) is widely used in aesthetic facial rejuvenation medicine. The exponential growth in using BoNTA for cosmetic purposes in Korea necessitates an update to the existing practice guidelines, building upon the consensus established by Korean experts in 2013. Aims: This work aims to provide an updated Korean consensus guideline for the safe and effective use of a novel BoNTA product (NEWLUX) for facial expression muscles. Methods: A panel of ten Korean experts in dermatology, plastic surgery, aesthetic medicine, and clinical anatomy convened in February 2024. They reviewed prior guidelines, including the 2013 Korean consensus, and shared their expertise on dosage, injection techniques, and potential complications associated with the use of the novel BoNTA product for facial expression muscles. The recommendations aimed to guide the best practices of the average aesthetic healthcare professional. Results: The panel reached a consensus on various aspects of using the BoNTA product, including recommended injection sites, dosages, and techniques for different aesthetic conditions caused by facial expression muscles. The resulting guideline emphasizes safety and efficacy, with recommendations based on the collective experience of the expert panel. Conclusion: This updated consensus guideline provides practical recommendations from Korean experts on the use of the novel BoNTA product for facial expression muscles. The guidelines will ensure safe and effective treatments while reflecting the latest advancements in the field.

372. Impact of Updated 2020 Public Health Service Guidelines on Deceased Organ Donors and Transplant Recipients

Abstract Background New guidelines for assessing solid organ donors and recipients for Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV) infection were published by the US Public Health Service (PHS) in 2020 and implemented into Organ Procurement and Transplantation Network (OPTN) policy on 3/1/21. Changes included a shorter risk criteria inclusionary timeframe and the removal of 4 risk criteria. Methods We analyzed OPTN deceased donor and transplant data 2 years pre-(3/1/19-2/28/21) and post-(3/1/21-3/1/23) implementation of the updated guidelines. For Kaplan-Meier survival analyses, the post- cohort included recipients transplanted before 1/1/23 to ensure recipients had at least 1 year follow-up plus a 3-month data lag. Utilization rates, defined as number of organs transplanted divided by number of available organs from donors with at least 1 organ recovered for the purpose of transplant, are shown for thoracic organs. Non-use rates, defined as number of organs recovered for the purpose of transplant but not transplanted divided by the total number of organs recovered for the purpose of transplant, are shown for abdominal organs. Results The proportion of donors considered to have PHS risk factors decreased by approximately 10% post-policy, both overall and by organ type (Fig. 1). There were no major differences pre- to post- in reported donor HIV, HCV or HBV NAT test results (Fig2. ). Post-policy, utilization rates for heart and lung for donors with risk factors were 34.9% and 17.5% respectively, compared to 34.3% and 20.0% pre-policy; while kidney and liver non-use rates for donors with risk factors were 20.3% and 8.2% respectively, compared to 17.2% and 7.9% pre-policy. There was no significant change in 1-year post-transplant patient survival for recipients who received organs from donors with PHS risk factors (Fig. 3). Conclusion Less restrictive PHS guidelines led to fewer donors being classified as having risk factors for disease transmission. Updated guidelines did not significantly affect donor infectious disease test results or post-transplant survival for recipients. Changes in donor organ utilization and non-use may be due to donor pool changes and/or overlapping policy implementations, and further investigation is warranted. Disclosures Lara A. Danziger-Isakov, MD, MPH, Aicuris: clinical research contract, paid to institutio|Ansun BioPharma: clinical research contract, paid to institution|Astellas: Advisor/Consultant|Astellas: clinical research contract, paid to institutio|Merck: clinical research contract, paid to institutio|Pfizer: Grant/Research Support|Takeda: clinical research contract, paid to institutio

P-530. Clinician Utilization of CDC-aligned HIV PrEP Panels

Abstract Background In Dec 2021, the CDC issued updated guidelines for HIV PrEP. Diagnostic panels were developed to facilitate the baseline evaluation and monitoring of patients for HIV, STIs, HBV, and HCV among PrEP users. Methods Retrospective analysis of results reported for HIV PrEP panels ordered between Feb 2023 and Mar 2024. The panels were developed to capture HIV PrEP testing for baseline (BL) evaluation and for monitoring of oral and injectable agents in males and females. Tests were aligned with those recommended by the 2021 updated guidelines and included panels with and without HIV-1 RNA PCR. Standalone testing was also available. Testing intervals were assessed. Results 31,347 unique patients had PrEP-related testing. Of those, 25,373 had one or more tests with 146 (0.6%) testing positive for HIV at baseline. 14,480 unique patients had two or more HIV PrEP tests on different dates. 98% were male with a median age of 36 years. 20 of those patients tested positive for HIV (0.14%). Of those, 15 tested positive for HIV Ag/Ab, but 14 were negative for HIV RNA. 5 patients were positive for HIV-1 RNA, but tested negative for HIV Ag/Ab. The HIV false positive rate was 0.25%. There were 5 HIV RNA positive tests out of 52,050 negative HIV Ag/Ab tests (0.001%). Testing closely adhered to recommended intervals for both oral and injectable agents. 15,041 out of 25,227 patients (59.6%) had an STI test during the analysis. 2,876 out of 15,041 patients had at least one STI during PrEP treatment (19.1%). Chlamydia was diagnosed in 5.8% and gonorrhea in 9.2%. 6.7% of patients were positive for treponemal antibodies with 5.1% RPR reactive. STI co-infections were also seen. Those with active HBV and HCV infections while on PrEP were each 0.3%. Conclusion In this large laboratory cohort of patients utilizing HIV PrEP testing, HIV infections were rare, supporting the low rates seen in HIV PrEP trials. Infections were mainly found at BL screening. False positive HIV Ag/Ab results were consistent with published reports. STI rates are significant with approximately 1/5 of patients testing positive, although active HBV and HCV infections were very low for those utilizing PrEP. Disclosures Charles M. Walworth, MD, Labcorp: Employee|Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) Laura Gillim, PhD, Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) David Alfego, PhD, Labcorp: Employee|Labcorp: Stocks/Bonds (Public Company) Ato Aikins, PhD, Labcorp: Employee