Iowa City Research Articles

Spleen size change after hepatitis C treatment: a simple parameter to predict clinical outcomes.

Portal hypertension contributes to splenomegaly in cirrhotic patients. Reduction in spleen size may represent improvement in portal hypertension. The goal was to determine whether reduction in spleen size following sustained virologic response (SVR) in patients with hepatitis C virus (HCV) cirrhosis is associated with lower risk of liver-related adverse outcomes. A retrospective cohort study was performed regarding HCV-infected patients treated with direct-acting antiviral agents at the Iowa City Veterans Administration Medical Center between 2014 and 2019. Patients with cirrhosis and splenomegaly on baseline ultrasound were included. Spleen size, platelet counts, decompensations, hepatocellular carcinoma (HCC) status, and mortality were recorded through July 31, 2021. Decrease in spleen size ≥1.5 cm was regarded as significant. Intergroup comparisons were performed on SPSS 28. Eighty patients with cirrhosis and splenomegaly before SVR were identified. Spleen sizes decreased significantly after SVR in 31 patients over a median of 1 year (Group A), whereas 49 patients did not meet this endpoint (Group B). Lack of spleen size reduction was associated with the presence of varices before SVR (odds ratio (OR): 5.3, p < 0.01). Group A had significantly greater increases in platelet count after SVR than did Group B. Patients in Group B had greater risk of HCC (OR: 9.7, CI: 1.2-79; p = 0.03) and death (OR: 3.6, CI: 1.1-12; p = 0.04). Reduced spleen size in patients with HCV cirrhosis after SVR is associated with greater increment in platelet count, decreased risk of HCC, and reduced mortality compared to patients whose spleen size does not decrease.

Investigation of the Pier Response during the Lateral Slide of Multi-Span Bridges

Lateral slide-in bridge construction—also referred to as slide-in bridge construction (SIBC)—has gained increasing attention as a viable accelerated bridge construction (ABC) approach. Although SIBC has been successfully employed on multiple single-span bridge projects, the use of SIBC on multi-span bridges is rare. Adding more spans creates a more complex system that requires connections (and other details) that were previously not needed in a single-span slide. Also, it is a concern that the multi-span bridge would need to slide on piers, which creates possible uplift and overturning scenarios. As such, it was vitally important to understand the structural response of the substructure during the bridge sliding. Although much general information on lateral slides as an ABC method was available, very little literature had been published related explicitly to such construction for multi-span bridges. The objective of this research was to develop durable design details to be used with the lateral slide concept with a focus on pier connection details and evaluate the performance of the bridge pier during the sliding. To achieve the goal, relevant information was collected and evaluated by conducting a literature review on various details and construction approaches for previously completed lateral slide projects. Further, a three-span, 300 ft long steel girder bridge on IA 1 southwest of Iowa City, Iowa, U.S., was monitored using gauges during the slide-in. The results indicated that the current slide-in practice works well with the multi-span steel girder superstructure and the wall pier. No significant response from the substructure was visually observed during the slide-in, and no cracking occurred on the concrete deck or piers. This indicated that the superstructure with steel girders and concrete diaphragms could be built with the lateral slide-in method. The significant strain was measured from the pile strain gauges. However, the piles were functionally adequate to carry the vertical load, and the moment carried by each pile was minimal. An uplifting action was captured on Pier 1. However, this effect was minimal on Pier 2.

In Memoriam: Richard H. Grimm, Jr, MD, MPH, PhD (August 22, 1946-September 8, 2022).

In Memoriam: Richard H. Grimm, Jr, MD, MPH, PhD (August 22, 1946-September 8, 2022).

Birthdays.

Journal of Palliative MedicineVol. 26, No. 3 Personal ReflectionBirthdaysW. David ClarkW. David ClarkAddress correspondence to: W. David Clark, MD, Internal Medicine-Palliative Care, Division of General Internal Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA E-mail Address: w-david-clark@uiowa.eduInternal Medicine-Palliative Care, Division of General Internal Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA.Search for more papers by this authorPublished Online:1 Mar 2023https://doi.org/10.1089/jpm.2022.0466AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Birthdays." Journal of Palliative Medicine, 26(3), p. 443FiguresReferencesRelatedDetails Volume 26Issue 3Mar 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:W. David Clark.Birthdays.Journal of Palliative Medicine.Mar 2023.443-443.http://doi.org/10.1089/jpm.2022.0466Published in Volume: 26 Issue 3: March 1, 2023PDF download

Writing the History of Legal Abortion.

Writing the History of Legal Abortion Johanna Schoen (bio) I started to research the history of legal abortion in the early 2000s, when the papers of a North Carolina abortion provider, Dr. Takey Crist, fell into my lap. Crist had wanted to donate his papers to an archive, and I volunteered to help him. Indeed, I ended up organizing his entire collection and, following that, the collections of a number of other abortion providers.1 When I began this work, I could not conceive of a world in which the U.S. Supreme Court might overturn Roe v. Wade. The providers I met, by that time all in their sixties and seventies, were full of passion and fervor about the 1970s, when they had taken the political moment to open the first legal abortion clinics. They were strong believers in a woman’s right to choose, to control her body, to determine her future. In addition, politics looked different twenty years ago. One of the first abortion providers Crist introduced me to was his friend Susan Hill, who owned the National Women’s Health Organization (NWHO), the largest group of free-standing abortion clinics after Planned Parenthood. As a twenty-four-year-old social worker, Susan had helped to open an abortion clinic in Florida two weeks after the Roe decision. Even the judges appointed by Republican presidents, she told me in the early 2000s, tended to be fair when she met them in court. By the late 1970s, she had founded the NWHO and was opening clinics in some of the most under-served areas in this country, including, in the early 1990s, the “Pink Clinic” in Jackson, Mississippi, which became the defendant in the Dobbs case.2 To open her clinics and to keep them open and services unobstructed, she had spent her life in court.3 I could not imagine a Republican Party interested in alienating a large voting block and losing abortion as the easy political rallying point [End Page 22] it had been since the 1980s. Clearly, I was wrong—which just shows that you should never ask a historian to predict the future. By the time the U.S. Supreme Court did overturn Roe with its decision in Dobbs v. Jackson Women’s Health, I was no longer surprised. I was also twenty years older and more cynical. When I first began to research legal abortion, I was fascinated with the stories of young feminists who, in the early 1970s, had had no doubt about their ability to open abortion clinics and offer health care to women across the country. Their political commitment and compassion were deeply moving; they believed that their actions could change the world. Of course, sometimes their political convictions were also didactic and funny. For a few years, while I taught at the University of Iowa, I sat on the board of the Emma Goldman Clinic in Iowa City, the longest running feminist health collective in the country. When I confessed to one of the directors that I had never seen my cervix—in the world of women’s health clinics this was seen as a prerequisite on the path to a feminist consciousness—she assured me that I could call on their services any time. I never took her up on this offer. As a historian, I was interested in the fault lines that existed in the world of abortion care. I wanted to tell the heroic stories of young women activists who had overcome sexism and patriarchy to establish women’s health clinics and the stories of young male doctors committed to legal abortion care who had dared their colleagues to integrate abortion into their OB-GYN clinics. I also wanted to know what decades of harassment had done to the abortion provider community and how members coped with it. Had the relentless antiabortion propaganda changed their feelings about their work? And if so, how had they responded to these changes? Learning about antiabortion politics and harassment was easy. The papers of Takey Crist and Susan Hill were full of antiabortion materials—pamphlets and leaflets handed out on picket lines, letters by antiabortion activists to convert or threaten...

They Have All Gone Away: Farms, Families, and Change

They Have All Gone AwayFarms, Families, and Change Paula Nelson Curtis Harnack, We Have All Gone Away. Iowa City: University of Iowa Press, 2011 (reprint of 1973 edition). 188 pp. $19.95 (paper). Sara DeLuca, Dancing the Cows Home: A Wisconsin Girlhood. St. Paul: Minnesota Historical Society Press, 1996. 232 pp. $15.95 (paper). Sara DeLuca, The Crops Look Good: News from a Midwestern Family Farm. St. Paul: Minnesota Historical Society Press, 2015. 254 pp. $17.95 (paper). Farming was once central to American life. In 1790, ninety-six percent of the population lived in rural areas, most on farms; in 1860, eighty percent of Americans still lived on farms or in small towns. Farming was the route to independence, self-sufficiency, security, and prosperity. The work was hard, but it brought reassuring seasonal routines: the births and deaths of livestock; planting, growing, and harvesting crops; family births, maturity, aging, deaths. Farms provided an organic unity that conveyed lessons about nature and the human condition that were sometimes hard to learn. For some families, the farm became a sacred entity, standing apart from and above the family. Even in today's modern, super-mechanized agriculture, there remains great pride in having had multiple generations farm the same ground. There is regret, even grief, when the farm is sold and bulldozers erase decades of family history. Post-Civil War urbanization and industrialization, however, created new technologies, new opportunities, and new values that undermined agriculture's cultural primacy. Working set hours for pay appealed to farm children, as did chances for entertainment and the possibility of socializing [End Page 213] with people beyond family and the farm neighborhood. By the 1920s, slightly more Americans lived in cities than in rural areas. Farm mechanization and consolidation accelerated the trend: farmers made up forty-one percent of the workforce in 1900; 21.5 percent in 1930; four percent in 1970; and only 1.9 percent in 2000–2002.1 Although all farm families struggled with the vagaries of nature, low crop prices, and an over-abundance of work, they were not all the same, as the books reviewed here illustrate. Both authors describe farm families' lives and labors from the late nineteenth through late twentieth centuries, but some reveal significant dissent from the belief that farming offered the best life. By the end of each memoir, no one from these families farmed. The poignant title of Curtis Harnack's classic memoir about his extended family in Plymouth County, Iowa, We Have All Gone Away, sums up the history of midwestern agriculture. The careful planning and hard work of his grandfather John Harnack, who acquired 240 acres of northwest Iowa land in the 1880s, led to prosperity and more comforts than most farm families enjoyed. A skilled carpenter, he raised a landmark barn and other outbuildings, planted fruit trees and berry bushes, built a large house to replace the first home, a 6x10 cabin, and created a successful farm. By 1900 the family had running water and a complete bathroom in the house. They were prosperous, even during the Great Depression. Curtis Harnack grew up in an atypical family arrangement. His mother, Carrie Meyer, earned a college degree and taught school for ten years before marrying Henry Harnack in 1920. They shared the substantial farm home with Henry's brother, Jack, and his wife, Lizzie Meyer, Carrie's youngest sister. Curtis, born in 1927, was the youngest of four. When Henry Harnack died of pneumonia six months after Curtis's birth, Carrie decided to stay on the farm with Jack, Lizzie, and their three children so that her children would have a father figure in Uncle Jack. Nonetheless, she made sure that her children knew that they would leave the farm for brighter futures elsewhere. Uncle Jack had never wanted to farm, but fell into it when his father retired. Lizzie, much to her disappointment, had to leave school after eighth grade to care for her ailing stepmother and do the household work. Unhappy with their lot, Jack and Lizzie also expected their children to move up and out. Despite the wariness of the second generation of Harnacks toward farm life, Harnack's memoir...

Angel De Cora, Karen Thronson, and the Art of Place: How Two Midwestern Women Used Art to Negotiate Migration and Dispossession by Elizabeth Sutton

Reviewed by: Angel De Cora, Karen Thronson, and the Art of Place: How Two Midwestern Women Used Art to Negotiate Migration and Dispossession by Elizabeth Sutton Emily C. Burns Elizabeth Sutton, Angel De Cora, Karen Thronson, and the Art of Place: How Two Midwestern Women Used Art to Negotiate Migration and Dispossession. Iowa City: University of Iowa Press, 2020. xix, 168 pp. $49.95 (paper). Histories built on comparative case studies often lead to new discoveries by focusing on examples that are both parallel and divergent. This is the model undergirding art historian Elizabeth Sutton's comparative study of Ho-Chunk artist Angel De Cora and the author's great-grandmother Karen Thronson, a Norwegian immigrant to the Midwest. Pairing these two figures' stories and the spaces of subjugation and assimilation that operated for both Native nations and Scandinavian immigrant communities in the [End Page 197] Midwest allows readers to consider the power of objects to engage with place, identity, culture, gender, and memory. Sutton argues that these artists, contemporaries who never met, both engaged in community-building through art production to, in Sutton's words, "connect with place and validate self and group identity" (1). The act of creating in a variety of media—and in particular engaging with long-standing practices in their respective communities—helped these individuals to navigate their identities in the context of expected assimilation. There is much to recommend in this discussion, that centers on female makers and challenges art history's traditional hierarchies that tend to devalue craft. Sutton's focus on minoritized experience recasts ongoing narratives of settler colonialism and cultural subjugation. The text also takes seriously the possibilities of "visual coding" (24, 56) as a strategy that Thronson and De Cora employed to speak to U.S. and non-U.S. audiences simultaneously. This question—what modes of cultural expression could be non-threatening to dominant culture—offers the book's key investigation of artistic agency and messaging. The text also highlights the role of organizations and publication outlets for communicating ideas of identity. The study, however, leaves some important questions tantalizingly unanswered. There is a promising synergy between the presentation of handicraft from Scandinavia and Native American design in ladies' magazine cultures (83), but this is not probed further. The crucial scholarship by art historian Elizabeth Hutchinson on De Cora's navigations of modern and Native identities is listed in the bibliography but is not cited or directly engaged in the content of the book, although the author does come to similar conclusions about how De Cora strategically sought to build a compatibly Native American and modern artistic practice. A dialogue with Hutchinson's conclusions on this topic would have also enabled greater clarity of Sutton's contributions, especially in her original research of design projects by De Cora's female students at Carlisle Indian Industrial School and the ways that De Cora encouraged her students to develop individual expression via a larger understanding of Native American art practices in the early twentieth century (108–116). I also would have appreciated a citation for her use of Lakota interpretations of color in the Carlisle student work (112) as well as some discussion of De Cora's painting in the Native American boarding school exhibition at the Universal Paris Exposition of 1900 when her participation in several other World's Fair displays is noted (57). Tonalism as an aesthetic practice, which De Cora employed, is never really defined or productively [End Page 198] engaged as an aesthetic (48, 65), which makes it difficult to trace the artists' adaptation of it. The project might have benefited from further integration of the main figures. Each chapter oscillates between the two subjects, and the brief conclusion does not fully show how they are complements or foils for each other. Do we really see either figure more clearly in this comparison? An extended article focusing on key similarities, such as immigration and dispossession, might have been more effective as a comparative study. Indeed, while the artists share a gender identity and the use of art to connect with their respective communities, certainly the experiences of Norwegian immigrant women and Native American women significantly diverge in...

:Experimental: American Literature and the Aesthetics of Knowledge

:<i>Experimental: American Literature and the Aesthetics of Knowledge</i>

Symptoms of the Self: Tuberculosis and the Making of the Modern Stage, by Roberta Barker, Iowa City: University of Iowa Press, 2022.

Symptoms of the Self: Tuberculosis and the Making of the Modern Stage, by Roberta Barker, Iowa City: University of Iowa Press, 2022.

Phipps Site Ceramics: A Typological, Morphological, and Contextual Analysis of a Mid-Twentieth Century Legacy Collection. Joseph A. Tiffany. 2021. Report 25. Office of the State Archaeologist, University of Iowa, Iowa City. xi + 89 pp. $15.00 (paperback), LOC Control Number 2021922931.

Phipps Site Ceramics: A Typological, Morphological, and Contextual Analysis of a Mid-Twentieth Century Legacy Collection. Joseph A. Tiffany. 2021. Report 25. Office of the State Archaeologist, University of Iowa, Iowa City. xi + 89 pp. $15.00 (paperback), LOC Control Number 2021922931.

Editorial Comment.

No AccessJournal of UrologyAdult Urology30 Jan 2023Editorial CommentThis article comments on the following:Artificial Urinary Sphincter Cuff Downsizing Improves Continence and Patient Satisfaction in Cases of Sub-cuff Atrophy Bradley A. Erickson Bradley A. EricksonBradley A. Erickson Division of Functional Urology, University of Iowa, Iowa City, Iowa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003138.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . Artificial urinary sphincter cuff downsizing improves continence and patient satisfaction in cases of sub-cuff atrophy. J Urol.2023; 209(4). Google Scholar 2. . Proof of concept: exposing the myth of urethral atrophy after artificial urinary sphincter via assessment of circumferential recovery after capsulotomy and intraoperative pressure profiling of the pressure regulating balloon. Investig Clin Urol.2018; 59(4):275-279. Google Scholar 3. . Urethral atrophy after implantation of an artificial urinary sphincter: fact or fiction?BJU Int.2016; 117(4):669-676. Google Scholar 4. . Difference between urethral circumference and artificial urinary sphincter cuff size, and its effect on postoperative incontinence. J Urol.2014; 191(1):138-142. Link, Google Scholar Submitted July 27, 2022; accepted December 6, 2022; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology30 Dec 2022Artificial Urinary Sphincter Cuff Downsizing Improves Continence and Patient Satisfaction in Cases of Sub-cuff Atrophy Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bradley A. Erickson Division of Functional Urology, University of Iowa, Iowa City, Iowa More articles by this author Expand All Submitted July 27, 2022; accepted December 6, 2022; published 000. Advertisement PDF downloadLoading ...

“WOKE” DIVERSITY STRATEGIES: SCIENCE OR SENSATIONALISM?

Academy of Management PerspectivesIn-Press “WOKE” DIVERSITY STRATEGIES: SCIENCE OR SENSATIONALISM?Bobbi Thomason Thomason, Tina Opie, Beth Livingston and Traci SitzmannBobbi Thomason ThomasonPepperdine University, 5262, 24255 Pacific Coast Hwy, Malibu, Malibu, California, United States, 90263-3999; , Tina OpieBabson College, 1445, Babson Park, Massachusetts, United States; , Beth LivingstonUniversity of Iowa, Iowa City, United States; and Traci SitzmannUniversity of Colorado Denver, 12226, Denver, Colorado, United States; Published Online:23 Jan 2023https://doi.org/10.5465/amp.2022-0181AboutSectionsPDF/EPUB ToolsDownload CitationsAdd to favoritesTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail FiguresReferencesRelatedDetails In-Press Permissions Metrics in the past 12 months History Received 1 October 2022 Published online 23 January 2023 InformationCopyright 2022Download PDF

Associations Between Urological Chronic Pelvic Pain Syndrome Symptom Flares, Illness Impact, and Health Care Seeking Activity: Findings From the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns Study.

Most studies on interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome use typical or average levels of pelvic pain or urological symptom intensity as their outcome, as both are associated with reduced quality of life. Symptom exacerbations or "flares" have also been found to be associated with reduced quality of life, but no studies, to our knowledge, have investigated whether these associations are independent of typical pelvic pain levels and thus might be useful additional outcome measures (or stated differently, whether reducing flare frequency even without reducing mean pain intensity may be important to patients). We used screening visit and weekly run-in period data from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns Study to investigate associations between flare frequency and multiple measures of illness impact and health care seeking activity, independent of typical nonflare and overall pelvic pain levels. Among the 613 eligible participants, greater flare frequency was associated with worse condition-specific illness impact (standardized β coefficients=0.11-0.68, P trends < .0001) and health care seeking activity (odds ratios=1.52-3.94, P trends .0039 to < .0001) in analyses adjusted for typical nonflare and overall pelvic pain levels. Experiencing ≥1/d was also independently associated with worse general illness impact (standardized β coefficients=0.11-0.25). Our findings suggest that flare frequency and possibly other flare characteristics may be worth considering as additional outcome measures in urological chronic pelvic pain syndrome research to support the development of new preventive and therapeutic flare strategies.

Deformations of Log Terminal and Semi Log Canonical Singularities

Abstract In this paper, we prove that klt singularities are invariant under deformations if the generic fiber is $\mathbb {Q}$ -Gorenstein. We also obtain a similar result for slc singularities. These are generalizations of results of Esnault-Viehweg [Math. Ann.271 (1985), 439–449] and S. Ishii [Math. Ann.275 (1986), 139–148; Singularities (Iowa City, IA, 1986) Contemporary Mathematics, vol. 90 (American Mathematical Society, Providence, RI, 1989), 135–145].

Investigation of a distinctive plant-based black paint on Bwa and Mossi polychrome wood masks from Burkina Faso

A distinctive, thickly applied, plant-based black paint is used for raised designs on painted wood masks made by multiple cultural groups in Africa’s Western Sudan region, where the color black represents age, health, wisdom and well-being. Black, red and white masks are particularly characteristic of the Burkina Faso region. For this study, black paint was sampled from six wood Burkinabè masks in the University of Iowa’s Stanley Museum of Art collection (Iowa City, IA, USA). Christopher Roy (1947-2019), a specialist in Burkinabè material culture, described the procedure for making this black paint by laborious processing of Acacia nilotica seed pods. The process was recreated in the lab, and the newly created samples compared with paint from the objects. The application of analytical techniques to corroborate Roy’s field descriptions of the black paint’s manufacture and cultural use will be discussed.

Perceptions of an automated benchmarking dashboard for antimicrobial stewardship programs among antimicrobial stewards within the veterans' health administration: a multicenter qualitative study.

To evaluate the impact of a multicenter, try automated dashboard on ASP activities and its acceptance among ASP leaders. Frontline stewards were asked to participate in semi-structured interviews before and after implementation of a web-based ASP information dashboard providing risk-adjusted benchmarking, longitudinal trends, and analysis of antimicrobial usage patterns at each facility. The study was performed at Iowa City VA Health Care System. ASP team members from nine medical centers in the VA Midwest Health Care Network (VISN 23). Semi-structured interviews were conducted pre- and post-implementation, with interview guides informed by clinical experiences and the Consolidated Framework for Implementation Research (CFIR). Participants evaluated the dashboard's ease of use, applicability to ongoing ASP activities, perceived validity and reliability, and relative advantage over other ASP monitoring systems. Compared to established stewardship data collection and reporting methods, participants found the dashboard more intuitive and accessible, allowing them to reduce dependence on other systems and staff to obtain and share data. Standardized and risk-adjusted rankings were largely accepted as a valuable benchmarking method; however, participants felt their facility's characteristics significantly influenced the rankings' validity. Participants recognized staffing, training, and uncertainty with using the dashboard as an intervention tool as barriers to consistent and comprehensive dashboard implementation. Participants generally accepted the dashboard's risk-adjusted metrics and appreciated its usability. While creating automated tools to rigorously benchmark antimicrobial use across hospitals can be helpful, the displayed metrics require further validation, and the longitudinal utility of the dashboard warrants additional study.

Postpartum contraception counseling and uptake in an uninsured population

Objective: Assess postpartum contraceptive preferences and use before and after implementation of interventions to improve contraceptive counseling at a free clinic for uninsured pregnant patients. Methods: This was a pre- and post-intervention observational study in Iowa City, Iowa, that included patients from February 2019 – December 2021. Multilingual educational charts and an electronic medical record (EMR) template reminder to prompt antenatal contraceptive discussion were implemented in April 2021. Results: There were 117 pre-intervention patients and 33 post-intervention. Prior to the intervention, 30% of patients had no documentation of contraceptive counseling; afterward, 3% had no documentation (p=.001). Thirty-three percent of patients obtained highly or moderately effective contraception prior to the interventions and 52% did after (p=.068). Conclusions: Multi-lingual educational handouts and an EMR template reminder were associated with increased postpartum contraceptive counseling; contraceptive use also generally increased with the interventions. Increasing access to contraceptive education may increase contraceptive autonomy in underserved populations.

1807. Tracking antibiotic de-escalation using a novel metric, days of antibiotic spectrum coverage (DASC)

Abstract Background In the United States, days of therapy (DOT) is the currently preferred method for measuring antibiotic consumption. A major disadvantage of DOT is that it does not account for the antimicrobial’s spectrum. Antibiotic de-escalation is therefore not well-captured by DOT. To overcome the limitation of DOT, we recently proposed a new metric, days of antibiotic spectrum coverage (DASC). DASC is calculated by multiplying DOT and the antibiotic spectrum coverage (ASC) score, which was assigned based on the activities of each antibiotic agent for 11 wild type bacteria and 5 acquired resistance patterns. Here we evaluate the performance of DASC using antibiotic consumption data where the main antimicrobial stewardship program (ASP) activity is daily prospective audit-and-feedback of all inpatients on antibiotics. Methods We analyzed the retrospective cohort of inpatient antibiotic use at Iowa City VA Health Care System from 2017 to 2021. Total monthly DOT was the aggregation of monthly DOT for each antibiotic. DASC for each antibiotic was calculated by multiplying ASC for each antibiotic to DOT. DASC for each antibiotic was aggregated to total monthly DASC. Days-present was used as a denominator for both metrics. Trends of total monthly DOT and DASC were analyzed by simple linear regression. Results There was no significant trend in monthly DOT (Figure A: beta= 0.30, 95%CI: -0.67 to 1.27, p=0.55), but there was a significant downward trend in monthly DASC (Figure B: beta= -6.89, 95%CI: -12.7 to -0.98, p=0.03). Conclusion While a significant downward trend was seen using monthly DASC, no trend was observed using monthly DOT. In contrast to DOT, which captures antibiotic consumption without considering the spectrum, DASC captures both antibiotic consumption and spectrum, suggesting DASC can add another dimension in tracking inpatient antibiotic use. DASC is easily calculated if DOT for each antibiotic is available. Metrics that don’t capture antimicrobial spectrum may not be able detect improvements in avoiding unnecessary use of broad-spectrum antimicrobials, an important target of ASPs. Disclosures Daniel J. Livorsi, MD, Merck &amp; Co.: Grant/Research Support Michihiko Goto, MD MSCI, Merck &amp; Co.: Grant/Research Support.

2246. Urine Culture Clinical Decision Support Menu for Reducing Inappropriate Lab Ordering

Abstract Background Antibiotic treatment of asymptomatic bacteriuria (ASB) is unnecessary except in pregnant women or those undergoing invasive urologic procedures. Unnecessary treatment of ASB is an important driver of inappropriate antimicrobial use (IAU), leading to antimicrobial resistance, Clostridioides difficile infection, adverse drug events, and increased costs. Because ASB requires detection to be treated, unnecessary urine cultures (UC) are a key cause of IAU. Strong evidence supports not obtaining a UC from asymptomatic patients. Methods To reduce unnecessary UC orders at the Minneapolis Veterans Affairs Health Care System (MVAHCS), UC orders within the electronic health record (EHR) were redirected to a UC clinical decision support (CDS) menu (Figure 1). Selection of an indication from the defined list is required to place a UC order and provides tracking. UC order data was obtained from the Corporate Data Warehouse (CDW), the VA’s data program. Patient bed days were collected from a CDW dashboard developed by the Iowa City Veteran’s Affairs Health Care System. Data was visualized using Microsoft Power BITM platform. FIGURE 1.Urine culture clinical decision support menu. Urine culture orders are items numbered 10-26. Results The UC CDS menu was implemented at the MVAHCS in September 2020. UC orders from 16 months prior to implementation (9/1/2018 - 12/31/2019) was compared to orders 16 months after implementation (9/1/2020 - 12/31/2021). Data from 1/1/2020 - 8/31/2020 was not included due to atypical patient care patterns during the COVID-19 pandemic.4 The monthly number of UC orders after implementation significantly decreased from an average of 765 to 564, a 26.3% reduction (P &amp;lt; .001; 2-sided t-test) (Figure 2). The average patient bed days prior to and following implementation was not significantly different (Figure 3). Most UC orders came from the UC CDS menu (8103, 89.8%) compared to orders placed from other order menus or directly from the drug file (920, 10.2%). The most common indication selected was dysuria, frequency, and urgency (4050, 44.9%) followed by fever or sepsis (1230, 13.6%) then pre-operative urologic screening (1056, 11.7%) (Figure 4). FIGURE 2.Urine culture lab count before and after urine culture clinical decision support menu intervention.FIGURE 3.Patient bed days before and after urine culture clinical decision support menu intervention.FIGURE 4.Urine culture orders by indication. Non-intervention labs are listed as no indication/other order. Conclusion Implementation of a UC CDS menu within the MVAHCS EHR resulted in significantly fewer UC orders. Most UC orders had an appropriate indication suggesting the decrease was primarily due to preventing unnecessary UC orders. Disclosures All Authors: No reported disclosures.

Auditory Environments and Hearing Aid Feature Activation Among Younger and Older Listeners in an Urban and Rural Area.

The purpose of this study was to investigate differences in auditory environments and hearing aid feature activation between younger listeners with normal hearing and older listeners with hearing loss in an urban and rural location. We hypothesized that (1) urban dwellers and younger listeners would encounter more diverse and demanding auditory environments than rural dwellers and older listeners, respectively; (2) the advanced hearing aid features (noise reduction and directional microphone) of urban dwellers and younger listeners would be activated more frequently than rural dwellers and older listeners, respectively. The design of this study was cross-sectional with repeated measures. A total of 12 older adults with hearing loss (OHL-U) and 11 younger adults with normal hearing (YNH-U) were recruited from an urban area (Berkeley, California) and 13 older adults with hearing loss (OHL-R) and 10 YNH-U were recruited from a rural area (Iowa City, Iowa). Participants wore hearing aids that recorded data about their listening environments and completed ecological momentary assessments for 1 week. The YNH-U group experienced higher sound pressure levels and hearing aid features were activated more frequently than in the OHL groups. The OHL-R group experienced significantly less diverse sound pressure levels than the YNH-U group. The YNH-R group had sound levels between the YNH-U group and the OHL groups but without significant differences from any other group. The YNH groups showed a greater likelihood of hearing aid feature activation than the OHL-R group. Demographics affect auditory environments and the activation of hearing aid features. Younger urban dwellers have the most diverse or demanding auditory environments and hearing aid feature activation, and older, rural dwellers with hearing loss have the least diverse or demanding auditory environments and hearing aid feature activation. Future studies of real-world auditory environments and audiology intervention effectiveness should consider location in recruitment and interpretation of results.