Medical Research Articles

The Minority Tax: Stories from Family Physicians.

The minority tax has been defined as a set of disparities that those who are underrepresented in medicine face in addition to clinical care, education, and research responsibilities. These taxes include systemic racism, diversity efforts, clinical and promotion disparities, lack of faculty development, and isolation. Much has been added to the literature to better define and characterize the minority tax and propose suggestions for mitigations. This article builds on the existing literature that defines clinical efforts and diversity efforts disparities by exploring the intersections of these disparities through the experiences of family medicine faculty in the clinical environment. The authors, who are all academic family medicine physicians from minoritized communities, use their lived experiences to share how the diversity efforts disparity impacts patient care. Themes noted include health system wide challenges for patients whose preferred language is not English and the importance of racial and ethnic concordance between patients and the physician workforce.

Sports Medicine Surgeons Utilize Social Media to Network With Other Surgeons and Increase Patient Engagement: A Scoping Review.

The purpose of this scoping review was to identify how social media is used by sports medicine surgeons and how this is perceived by patients. In accordance with PRISMA-ScR guidelines, PubMed, Embase, and Cochrane Library databases were searched in April 2024 for studies published after 2014. Studies were included if they met these criteria: evaluated sports medicine fellowship-trained orthopaedic surgeons, evaluated patient preferences regarding social media use among these surgeons, reported purpose of social media use, and were written in English. Studies that were not written in English, did not specifically evaluate sports medicine surgeons, or evaluated a singular procedure were excluded. The initial search identified 328 studies, 6 of which were included in this scoping review, each of which were cross-sectional studies. Four (67%) studies evaluated how sports medicine surgeons use social media and two (33%) evaluated patient experiences of consuming surgeons' social media content. Twitter was the most popular social media site among sports medicine orthopaedic surgeons with online social media presence scores in the top 10%. Academic sports medicine surgeons were more likely than non-academic surgeons to be active on social media. Increased Twitter use was correlated with increased research productivity and citation impact. Patients were interested in educational videos and live question-answer sessions from their sports medicine surgeons, irrespective of platform used. Twitter and YouTube are popular platforms among sports medicine surgeons, particularly for professional networking and patient education. However, Instagram has emerged as the leading platform in terms of user engagement, making it an effective tool for fostering patient interaction and promoting clinical practice. These findings suggest that surgeons should prioritize Instagram alongside other platforms to effectively enhance their professional presence. III, systematic review of Level III studies.

An Assessment of the Nutritional Profile of Foods Accessible to Incarcerated Males in Alabama.

Many chronic medical conditions that can result from poor nutrition are more prevalent in the incarcerated population than in the general population. With the increasing prevalence of chronic medical conditions and limited knowledge on foods accessible to the population, this study assessed the 4-week menu fed to all incarcerated males at state-run facilities in Alabama. Compared with the Acceptable Macronutrient Distribution Range for the average incarcerated male, the percentage of energy from total fat, saturated fat, sodium, and cholesterol exceeded the recommendation. In contrast, the menu failed to provide the recommended fiber intakes and most vitamins and minerals met less than two thirds of recommendations. Small revisions in the menu could minimize the risk of developing chronic medical conditions and increase quality of life.

Bibliometric analysis methods for the medical literature

A bibliometric analysis of medical literature provides valuable insights into the structure, trends, and impact of research in the medical field. It can be a critical tool for advancing knowledge, improving healthcare outcomes, and supporting strategic decisions in the medical and scientific communities. In this article, the authors describe a step-by-step approach on how to perform a bibliometric analysis of the medical literature, based on review of many different styles of bibliometric analyses in various fields of medicine and surgery.

The effects of integrated traditional Chinese and western medicine rehabilitation programs on post-acute ankle sprain: A randomized controlled trial study protocol.

Ankle sprain is a common clinical disease, which has the highest incidence rate among joint and ligament injuries. And acute ankle sprains can easily develop into chronic ankle instability, thereby increasing the difficulty of treatment. The current clinical guidelines for post-acute ankle sprains are still controversial. Pain and functional impairment are the most significant symptoms after ankle sprain. The main purpose of this study is to explore the safety and effectiveness of the intervention of integrated traditional Chinese and Western medicine rehabilitation programs on post-acute ankle sprains. This study is a single center, prospective, intervention randomized controlled trial with a control group. 174 patients of 18-35 years old with post-acute ankle sprain will be included. A randomized controlled study is conducted and divided into a control group and an experimental group. The control group receive routine treatment, while the experimental group receive integrated traditional Chinese and western medicine rehabilitation programs. The intervention lasted for a total of 2 weeks. The main outcome measures are Visual Analog Scale and Short Form McGill Pain Questionnaire; the secondary outcome measures are the Foot Ankle Ability Assessment Scale, AOFAS Ankle Posterior Foot Scale, torque and gait. This study protocol aims to evaluate the safety and effectiveness of integrated traditional Chinese and western medicine rehabilitation programs by comparing the results of two groups before and after treatment. This protocol will follow the SPIRIT guidance. At present, there is a lack of rehabilitation management for post-acute ankle sprains. Therefore, this study has the potential to improve the healthcare for post-acute ankle sprains patients and might be used for future standardized evidence-based rehabilitation concepts. The trial was registered at Chinese Clinical Trial Registry https://www.chictr.org.cn/showproj.html?proj=234465 (Registration No.: ChiCTR2400087456). Date: 2024-07-29.

Reimagining the Medical School Accreditation Process in a Rapidly Changing Health Care Environment.

Health care is changing rapidly due to advances in biomedical science and technology, as well as an expanding body of medical knowledge. This transformation necessitates a reevaluation of medical education models. The medical school accreditation process, administered through the Liaison Committee on Medical Education (LCME) for MD-granting schools in the United States and Canada, plays a crucial role in maintaining educational standards. However, current LCME accreditation standards sometimes conflict with innovative educational practices, potentially hindering necessary progress. This Commentary considers how the accreditation process could better support medical education as it advances and adapts to the evolving needs of the health care environment. The authors propose strategies to enhance the accreditation process and better serve medical schools: align accreditation with competency-based education, share best practices identified during the accreditation process, encourage innovation, address financial burdens associated with preparing for accreditation, support institutional missions, embrace advances in science and technology, and facilitate rapid curriculum changes. Balancing compliance with innovation would help schools optimize the educational journey for future physicians and advance the shared goals of improved medical education and patient care.

Epistemic Shortcuts and Unjust Diagnostic Practices

ABSTRACT When diagnosing psychological disorders, doctors are expected to take the mental anguish of patients and offer fast and accurate explanations. The pressure that comes with this often leaves doctors in need of epistemic shortcuts for faster diagnoses. One such epistemic shortcut is to lean on statistical data when offering a diagnosis. When used justly, doctors consider a patient’s testimony, exhibited symptoms and statistical data relating to the general features of the patient such as age, weight and sex to determine if a patient has a given disorder or illness. Practices such as this have the capacity to yield good results at a quick pace, however, such practices may also be abused. With a focus on gender statistics and psychological diagnoses, I argue that systematic practices of epistemic injustice may occur when the statistical data becomes over-valued and the epistemic privilege of patients to be able to assert their own bodily and mental experiences is ignored. This places patients at risk of misdiagnosis, long-term damage and pain, or even death. It also produces patient mistrust both of themselves and of the medical community, which can carry further repercussions for public health.

Validity and Reliability Study of the Turkish Adaptation of the "Medical Office Survey on Patient Safety Culture".

The safety culture within health care organizations is essential for ensuring patient well-being and optimizing health care delivery. This study addresses the pressing need to establish a culture of patient safety within primary health care settings. The aim is to conduct a comprehensive validity and reliability study for the Turkish adaptation of the "Medical Office Survey on Patient Safety Culture" (MOSPSC) scale, designed to assess patient safety culture in primary care medical offices. The research model follows rigorous methodology, including a systematic translation and adaptation process aligned with World Health Organization guidelines. A diverse sample of 402 family physicians from primary health care centers across Turkey participated in the study. Descriptive results highlight participants' characteristics, work environments, and experiences in primary care. The scale's construct validity is evaluated using the Kaiser-Meyer-Olkin (KMO) and Bartlett tests, while its reliability is assessed through internal consistency analyses, including Cronbach α, split-half reliability, and item-total correlation. Results indicate strong internal consistency, with Cronbach α values ranging from 0.42 to 0.91 for scale dimensions and an overall value of 0.89. Construct validity assessment attests to the scale's appropriateness for assessing patient safety culture. Challenges in conducting factor analysis due to participant responses are discussed. The study contributes to the field by providing a validated and reliable tool specifically tailored for assessing patient safety culture in primary care medical offices. The Turkish adaptation of the MOSPSC scale offers health care professionals and organizations a valuable instrument for enhancing patient safety culture, identifying areas for improvement, and ultimately optimizing patient care within primary health care settings.

Medical Student Musculoskeletal Knowledge: Examining the Impact and Value of an Orthopaedic Surgery Clerkship Using the Freedman and Bernstein Examination

PurposeGiven the importance of musculoskeletal knowledge but the limited orthopaedic instruction offered in medical school, our Orthopaedic Surgery Department developed a three-week clerkship for interested students. This study assesses the clerkship’s impact on medical student musculoskeletal knowledge through administration of the Freedman and Bernstein Basic Cognitive Musculoskeletal Examination.MethodsMedical students enrolled in the orthopaedic surgery clerkship between February 2019 and May 2024 were asked to participate in pre- and post-clerkship surveys using the Freedman and Bernstein Basic Cognitive Musculoskeletal Examination. Raw and weighted scores were computed according to the guidelines provided by Freedman and Bernstein. Averaged scores were used to compute mean pre- and post-test scores.ResultsThere were 64 responses to the pre-test and 33 responses to the post-test. The mean pre-test weighted score was 54% with 12 students (18.8%) passing. The mean post-test score was 70% with 17 students (51.5%) passing. Raw scores showed that musculoskeletal knowledge improved from pre-test (M = 55.13, SD = 19.90) to post-test (M = 70.22, SD = 14.70; p < .001). The results comparing weighted scores showed that the participants’ musculoskeletal knowledge also improved from pre-test (M = 52.86, SD = 21.12) to post-test (M = 67.11, SD = 19.02; p < .001).ConclusionWhile students demonstrated improved musculoskeletal knowledge after completing our institution’s orthopaedic surgery clerkship, almost half of the students did not pass the post-test. Most of the students who did not pass the post-test expressed definite or possible interest in pursuing an orthopaedic surgery residency.

Recent Advancements in Drug Targeting for Ferroptosis as an Antitumor Therapy: Development of Novel therapeutics.

The primary objective of this review is to provide updated mechanisms that regulate ferroptosis sensitivity in cancer cells and recent advancements in drug targeting for ferroptosis as an antitumor therapy. To achieve these objectives, a comprehensive literature review was conducted, analyzing recent studies on ferroptosis, including its cellular, molecular, and gene-level characteristics. The review involved an evaluation of advancements in ferroptosis drug research across various medical domains, with particular attention to novel therapeutic approaches in nano-medicine, TCM, and Western medicine. The review also included an assessment of how ferroptosis influences cancer treatment, including its role in tumor drug resistance and immuno-therapy, and provided a detailed analysis of pharmacological activators of ferroptosis. The review highlights several key findings, like primary mechanisms that regulate cancer cell sensitivity to ferroptosis, and provides an overview of the latest advancements in ferroptosis drug research. The review reveals that ferroptosis has both beneficial and detrimental effects on human cancer, reflecting its complex role in cancer progression and treatment. The review also emphasizes the dual nature of ferroptosis, noting its potential as both a tumor suppressor and an oncogenic factor. Additionally, it provides a comprehensive examination of various pharmacological agents that activate ferroptosis and their potential therapeutic applications. In conclusion, ferroptosis represents a promising target for cancer therapy, given its distinctive characteristics and significant role in tumor biology. The review underscores the need for further research to clarify the complex roles of ferroptosis in carcinogenesis and to optimize the development of novel therapeutics targeting this form of cell death. It also highlights current challenges and opportunities in the field, including the potential for overcoming cancer metastasis through ferroptosis modulation and the need for continued exploration of pharmacological activators to advance therapeutic strategies.

P-1890. Implementation and outcomes of a fully remote tele-ID and tele-OPAT program at a regional medical center

Abstract Background Infectious diseases (ID) consult services and outpatient parenteral antimicrobial therapy (OPAT) programs have traditionally been restricted to well-equipped academic medical centers. However, the integration of telehealth technologies into ID specialty care now allows for the expansion of ID expertise to underserved medical communities, including non-academic medical centers, and community and rural hospitals. Our initiative pioneered a comprehensive tele-ID service, encompassing both inpatient consultations and a tele-OPAT service for post-discharge management. Herein, we describe the program structure and outcomes from the first year of our integrated tele-ID and tele-OPAT program, implemented at a 144-bed community hospital in Vermont. Methods The program featured an inpatient tele-ID consult service supported by local nurse tele-presenters who would facilitate physical exams for a remote ID physician using videoconferencing technology. Patients deemed appropriate for OPAT were referred to the remote tele-OPAT team which consisted of a nurse coordinator, an ID pharmacist, and the current ID physician attending the inpatient service. The nurse coordinator's responsibilities included communicating with the local case management team, home health, and post-discharge facilities to ensure orders were placed, and communications were triaged for the tele-OPAT team. The ID pharmacist reviewed OPAT regimens for appropriateness and monitored outpatient labs for safety and dose adjustments. Tele-OPAT patients were seen locally by the ID physician in a pre-existing clinic with the assistance of a nurse tele-presenter. Results Ninety patients were enrolled in the tele-OPAT program in the first twelve months. Of these, 62 (68.9%) completed therapy without adverse event (AE) or 30-day readmission. 30-day readmission occurred in 14 patients (15.6%) and 20 patients (22.2%) had a documented AE during therapy, with 10 patients (11.1%) experiencing line-related issues. Conclusion Our telehealth initiative successfully expanded ID expertise to an underserved community hospital, with a majority of patients completing therapy without AEs or readmissions, demonstrating the efficacy and safety of remote ID consultations and tele-OPAT services. Disclosures All Authors: No reported disclosures

ФЕНОТИПИЧЕСКИЕ И МОЛЕКУЛЯРНО-ГЕНЕТИЧЕСКИЕ МЕТОДЫ ОПРЕДЕЛЕНИЯ АНТИБИОТИКОРЕЗИСТЕНТНОСТИ МИКРООРГАНИЗМОВ В ВЕТЕРИНАРИИ

The paper presents scientific approaches to solving a global problem, namely the increasing antibiotic resistance among opportunistic and weakly pathogenic microorganisms, which pose a significant risk both in human medicine and in animal husbandry. In this regard, phenotypic, analytical and molecular methodo-logical methods for determining and studying the antibiotic resistance of microorganisms are presented. Of the phenotypic methods, the method of standard disks and the method of serial dilutions, which are based on the diffusion of antibacterial drugs from the carrier onto a solid nutrient medium and inhibition of the growth of the studied culture of the microorganism, have received wide application. Among the analytical methods for detecting antibiotic resistance, electrophoretic, immunochemical (immunochromatography), UV and mass spectrometry are distinguished. The most promising and effective is mass spectrometry, in particular the MALDI-TOF test, which is the most optimal for routine determination of the sensitivity of a number of cultures of microorganisms. The molecular approach, namely the use of PCR using molecular beacons and DNA genes, expands the possibility of monitoring the resistance of microorganisms, and makes it possible to determine the mechanism of formation of resistance to antibacterial drugs by the presence of resistance genes. The analysis of methodological approaches made it possible to identify the following determinants of resistance: carbapenemase in Enterobacterales spp, P. aeruginosa and Acineto-bacter; Extended-spectrum B-lactamases in Enterobacterales; mcr-mediated encoded resistance to poly-myxins in gram-negative microorganisms; mecA/mecC, mediated resistance to beta-lactams in S.aureus; and vanA/vanB, mediated resistance to glycopeptides in E. faecium and E. faecalis. An analysis of the data of available scientific publications allows us to state that different methodological approaches provide different accuracy in indicating variants of resistance determinants. It should be noted that the presence of several databases of antibiotic resistance genes makes it difficult to use them to determine the phenotype of drug sensitivity. However, the use of genomic data to determine antibiotic resistance is crucial for the development of clinical metagenomics.

Potential of Green Gold Nanoparticles Synthesized from Punica granatum Extract on Leishmaniasis and Breast Cancer Treatment

AbstractIn the current study, the physicochemical properties and biological activities of gold nanoparticles (AuNP) synthesized in small sizes by Punica granatum using the green synthesis method and the chemical method were compared. UV–vis peak of chemically and biologically synthesized AuNPs was confirmed at 540 nm and 535 nm, respectively. By FT‐IR analysis, it was revealed that there were active biomolecules in Punica granatum extract for the synthesis of green AuNPs. According to XRD results, broad spectra were obtained. The crystalline nature of Green AuNP was demonstrated. Using SEM and DLS, it was observed that green AuNP had dimensions between 4–6 nm and chemical AuNP had dimensions between 6–12 nm. Punica granatum‐based AuNPs were more effective in the MDA‐MB‐231 breast cancer cell line than AuNPs by chemical method. It has also been revealed that green AuNPs are much more effective than chemical AuNPs against L. infantum parasites. As a result, Punica granatum‐based green AuNPs have been proven to be functionally more efficient and effective than chemically prepared AuNPs. Our study will encourage researchers to increase the synthesis of green NPs for medical use.

P-1213. Optimizing the synergy between Aztreonam &amp; Avibactam for NDM plus OXA48 producing Carbapenem resistant Klebsiella pneumoniae infections: an innovative infusion method

Abstract Background Ceftazidime-avibactam (CAZ AVI) along with aztreonam (ATM) is used off-label for NDM+OXA48 producing carbapenem resistant Klebsiella pneumoniae (CR Kp). If the level of AVI is maintained at 2.5 μg/ml, it protects ATM from OXA48 &amp; allows it to act against such CR Kp. In such a situation the MIC to ATM has been found in a published report to be 2 μg/ml. Table shows the measured protein bound drug levels. Estimated free drug levels are shown in brackets. Methods We used CAZ AVI (CAZ 2 grams and AVI 0.5 gram) infusion over 3 hours &amp; ATM 2 grams infusion over the 2nd half an hour as shown in figure 1, in 5 patients infected with NDM+OXA48 CR Kp, as a proof-of-concept PK study. The rationale of starting the ATM infusion after the CAZ AVI infusion is begun is to allow AVI levels to build up &amp; prevent inactivation of ATM by ESBL &amp; OXA48. The administration of ATM over half an hour, rather than by a more prolonged infusion, may ensure a relatively high initial level of ATM, which is expected to remain for a considerable time owing to its long half life. Infusion strategy for Ceftazidime-Avibactam (CAZ-AVI) &amp; Aztreonam (ATM) Results After measurement of protein bound levels, free AVI (fAVI) &amp; free ATM (fATM) levels were estimated from the known extent of protein binding. As shown in table 1, all levels of estimated fAVI were above 2.5 mcg/ml. The estimated levels of fATM, at 5 hours after beginning the infusion were at or above 15.6 mcg/ml, with a mean of 45.6 mcg/ml &amp; range of 15.6 to 98.2 mcg/ml. Hence time above 4 times the assumed ATM MIC of 2 mcg/ml, for more than 50% of the dosing interval was easily achieved in all the patients. Conclusion Thus, the PK/PD index obtained is higher than that needed for optimal killing &amp; can suppress resistance which may be useful from the perspective of antimicrobial stewardship. Disclosures Rajeev Soman, MBBS, MD (General Medicine), FIDSA, Astellas: Honoraria|Biomeriux: Honoraria|Cipla: Honoraria|Emcure: Honoraria|Gilead: Honoraria|Glenmark: Honoraria|Gufic: Honoraria|Intas: Honoraria|MSD: Honoraria|Mylan: Honoraria|Pfizer: Honoraria Saiprasad Patil, Global Medical Affairs, Glenmark Pharmaceuticals Limited: Employee Amullya Pednekar, Global Medical Affairs, Glenmark Pharmaceuticals Limited: Employee Hanmant Barkate, Global Medical Affairs, Glenmark Pharmaceuticals Limited: Employee

P-507. Implementation of Guideline-Based HIV Prevention at an Academic Primary Care Clinic

Abstract Background Primary care providers often lack familiarity with pre-exposure prophylaxis (PrEP) for HIV and miss screening for high-risk behavior. From 2017-2019 the Academic Internal Medicine Clinic (AIMC) at University Hospital in Newark, NJ averaged 2 PrEP prescriptions/year. Multiple resident lectures to improve screening and treatment saw minimal improvement to 4 PrEP prescriptions/year from 2020 to 2021, all of which were refills. This QA/QI project uses Epic smart tools to speed integration of guideline directed HIV prevention at AIMC. Methods Intervention: A PrEP screening smartlist was created in Epic and implemented in the common healthcare maintenance (HCM) smartphrase used by residents at AIMC. A positive screen directs the user to another smartphrase which guides the user to start or continue PrEP safely. Assessment: 2021 CDC HIV PrEP Guidelines were used. Charts from 100 patients randomly selected from 5320 patients visiting AIMC in 2023 were reviewed for documentation of PrEP screening. Epic was queried and charts were reviewed to find all patients prescribed PrEP by AIMC residents in 2023. Results Of patients seen by residents at AIMC in 2023, 23% were screened for PrEP compared to 0% in previous years. 11 unique patients were prescribed PrEP, 5 of which were new prescriptions. 22% of patients seen in 2023 were new to the clinic. Of these, 52% used the common HCM smartphrase, 38% used a personal HCM smartphrase, and 10% used outdated versions of the common HCM smartphrase. When the common HCM smartphrase was used, 72% of users screened for PrEP, 8% deferred screening to a future visit, and 20% removed the screening tool. Conclusion This study shows that an intuitive smart tool can create immediate change in a resident training program. Outdated versions of HCM copied forward from old visits were the largest barrier to this initiative, however this should spontaneously improve each year with 22% of patients in the year new to the clinic. Future directions include: tool use training, email reminders to use the smartphrase or to update personal templates annually to include updated guidelines, resident champions, and/or resident surveys. Disclosures Shobha Swaminathan, MD, Viiv Healthcare: Advisor/Consultant

P-945. “Bug Of The Day”: An Infectious Disease Interest Group Initiative to Provide Weekly Doses of Infectious Education

Abstract Background Medical education continues to accommodate advancements in technology. Currently within the social media era students can access vast amounts of information through various platforms. As education evolves with technology, educators must understand social media platforms in order to maximize their impact. The Infectious Disease Interest Group (IDIG) has initiated “Bug of The Day”, a social media initiative to increase medical student exposure to the field of Infectious Disease. Methods IDIG formed a committee of 7-10 medical students who collaborate to produce informative posts about microorganisms. These posts include a compelling question, detailed explanations, and facts to assist medical students in solidifying their knowledge of important organisms. Metrics obtained through the study consist of user interaction with posts including likes, comments, shares, amount of votes, and profile interaction. An online survey will be administered assessing student satisfaction of the posts, and to what degree these posts benefit their knowledge of ID. Results Sixten “Bug of The Day (BOTD)” posts have been shared on our instagram with posts being published twice a week. The average number of accounts reached by a BOTD post is 148.6, with an average of 76% selecting the right answer. The highest number of profile visits from a BOTD story post was 62 accounts. A survey distributed via instagram revealed that 95% of respondents enjoyed the content (n = 19), while 100% reported that the content not only proved helpful but also increased their appreciation for microbiology (n = 18). Conclusion The use of social media in education has been slowly adopted as we’ve delved deeper into the technology era. The field of Infectious Disease spans into many different specialities, making medical students' knowledge of microorganisms essential regardless of their desired career path. BOTD demonstrates that students engage with online Infectious Disease educational material through the use of social media. The survey to be administered will assess student satisfaction with the initiative, and could demonstrate the benefit of utilizing such a platform to build upon student knowledge. Disclosures Joseph Patrik Hornak, MD, Innoviva Specialty Therapeutics: Advisor/Consultant|Innoviva Specialty Therapeutics: Advisor/Consultant

LNQ 2023 challenge: Benchmark of weakly-supervised techniques for mediastinal lymph node quantification

Accurate assessment of lymph node size in 3D CT scans is crucial for cancer staging, therapeutic management, and monitoring treatment response. Existing state-of-the-art segmentation frameworks in medical imaging often rely on fully annotated datasets. However, for lymph node segmentation, these datasets are typically small due to the extensive time and expertise required to annotate the numerous lymph nodes in 3D CT scans. Weakly-supervised learning, which leverages incomplete or noisy annotations, has recently gained interest in the medical imaging community as a potential solution. Despite the variety of weakly-supervised techniques proposed, most have been validated only on private datasets or small publicly available datasets. To address this limitation, the Mediastinal Lymph Node Quantification (LNQ) challenge was organized in conjunction with the 26th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2023). This challenge aimed to advance weakly-supervised segmentation methods by providing a new, partially annotated dataset and a robust evaluation framework. A total of 16 teams from 5 countries submitted predictions to the validation leaderboard, and 6 teams from 3 countries participated in the evaluation phase. The results highlighted both the potential and the current limitations of weakly-supervised approaches. On one hand, weakly-supervised approaches obtained relatively good performance with a median Dice score of 61.0%. On the other hand, top-ranked teams, with a median Dice score exceeding 70%, boosted their performance by leveraging smaller but fully annotated datasets to combine weak supervision and full supervision. This highlights both the promise of weakly-supervised methods and the ongoing need for high-quality, fully annotated data to achieve higher segmentation performance.

P-2190. Gender Differences in Hepatitis C Treatment in the New York City Jail System, 2019-2023

Abstract Background Little is known about Hepatitis C (HCV) care outcomes among women experiencing incarceration. Women make up only 7% of the New York City (NYC) jail population, but represent 18% of individuals diagnosed with active HCV. This study examines progress through the HCV care cascade among women and men in the NYC jail system and describes potential gender-related factors in cascade outcomes. Methods Persons admitted to the NYC jail system and who completed a medical intake between October 2019 and December 2023 were included in this retrospective cohort analysis. We constructed a care cascade describing rates of universal opt-out HCV screening, confirmatory testing, diagnosis, linkage to jail-based clinical HCV care, and jail-based HCV treatment among the jail population stratified by documented gender. Demographic characteristics and medical history were also examined and stratified by documented gender. Results 71,130 persons were included in our analysis, of whom 5,085 (7.1%) were women and 66,045 (92.9%) were men. Compared to men, women were screened at higher rates (88.7% vs. 28.1%; p&amp;lt; 0.001), underwent confirmatory testing at lower rates (9.6% vs 11.2%; p=0.002), and had similar rates of active HCV (51.2% vs 47.8%; p=0.22). Women with active HCV were seen by an HCV clinician at similar rates as men (55.4% vs. 59.6%; p=0.32) but initiated HCV treatment at nearly half the rate of men (15.3% vs. 30.3%; p&amp;lt; 0.001). Additionally, women in the NYC jails had significantly higher rates of homelessness (23.5% vs. 19.5%), HIV (3.7% vs. 2.7%), mental health needs (53.7% vs. 30.8%), and history of select substance use disorders (58.6% vs. 45.8%) when compared to men (p&amp;lt; 0.001). Conclusion Large HCV treatment gaps exist between women and men experiencing incarceration. Disproportionally higher rates of comorbid medical, mental health, and substance use disorders and more re-entry support needs likely contribute to treatment disparities. Gender-specific strategies centered on the needs of women with justice involvement are needed to enhance the equitable uptake of jail-based HCV treatment. Enhancing treatment access for all persons with justice involvement is critical for HCV elimination efforts. Disclosures All Authors: No reported disclosures

P-1423. Barriers to Care: Improving Outpatient Follow-Up for Patients on Long-Term Oral Antimicrobial Therapies

Abstract Background Best practice for patients on COpAT (Complex Outpatient Antimicrobial Therapy) includes close follow-up once discharged from the hospital. However, some patients discharged with COpAT do not receive monitoring for complications, increasing their risk for re-admission. There is limited analysis regarding patient-specific social determinants of health (SDOH) that may contribute to a reduced follow-up rate. We aimed to determine the percentage of patients discharged on long-term oral antibiotics who received recommended outpatient Infectious Disease (ID) support and potential barriers to follow-up for quality improvement.Table 1:Outcomes associated with social determinants of healthSelected social determinants of health associated with specified monitoring and outcomes. Bolded values are considered statistically significant. Methods In this single-center cohort, patients discharged between 1/1/2021 and 12/31/2022, on ≥ 2 weeks of oral antibiotics, age &amp;gt; 18 years, with inpatient ID consult, and with recommendations for follow-up in the University of Utah ID Clinic were examined. SDOH included distance from the medical center, age, race/ethnicity, employment status, substance use, homelessness, and history of bipolar disorder/psychoses. We assessed patient outcomes of treatment failure or lost to follow-up within 90 days post-discharge. We also evaluated the time to appointment, lab monitoring, and number of adverse drug events (ADEs) after discharge. Results One hundred ninety-seven patients met the inclusion criteria for the cohort. Median times to suggested lab monitoring and ID appointment were 13 and 21 days post-discharge respectively. 71% completed lab monitoring within 90 days of discharge. After 90 days, 19% of patients were lost to follow up and 20% had experienced treatment failure. Those younger than 55, unemployed, or experiencing substance use were more often lost to follow-up. Individuals with substance use or age &amp;lt; 55 had a longer time to lab monitoring. Patients with a history of substance use had fewer ADEs (Table 1). Conclusion SDOH that contribute to patient outcomes include a history of substance use and unemployment, suggesting an area of clinical quality improvement. Additionally, those younger than 55 were more often lost to follow-up. Further examination of follow-up protocol for these patients is important to improve patient outcomes. Disclosures Russell J. Benefield, PharmD, BCPS-AQ ID, Paratek Pharmaceuticals: Grant/Research Support Laura Certain, MD, PhD, Zimmer Biomet: Advisor/Consultant

Jiawei Suanzaoren decoction for the treatment of perimenopausal insomnia: clinical observation and experimental study

BackgroundTraditional Chinese medicine has a good clinical therapeutic effect on perimenopausal insomnia, Jiawei Suanzaoren Tang (JW-SZRT) has a significant therapeutic effect on people with yin deficiency and fire excess type insomnia.MethodFirstly, 80 cases of perimenopausal yin deficiency and fire excess type insomnia were included in the study. The treatment group was treated with Jiawei Suanzaoren decoction, while the control group was treated with lorazepam for 4 weeks. The study observed and compared the Pittsburgh Sleep Quality Index (PSQI), Kupperman score, Polysomnography (PSG) and sex hormone levels of two groups before and after treatment. Secondly, we also conducted network pharmacology analysis and mechanism research. We first searched public databases for the targets of the compound known tobe associated with JW-SZRT, as well as those predicted to be targets of insomnia, and then used software Cytoscape 3.7.2, GO and KEGG to identify enriched gene pathways and networks. Networks and pathways that overlapped between Insomnia-associated proteins and JW-SZRT target proteins were then used to predict candidate protein targets of JW-SZRT in insomnia. Finally, 40 rats were selected in animal experimentation and 30 perimenopausal insomnia rat models were created through ovariectomy and a modified multi-platform water environment 72-hour sleep deprivation method. The model group received normal saline, the western medicine group received lorazepam suspension, and the Chinese medicine group received Jiawei Suanzaoren decoction. The sham surgery group was given routine feeding. The sleep condition, the levels of blood hormone levels and the expression levels of 5-Hydroxytryptamine (5-HT) and Gamma-Aminobutyric Acid receptor A (GABAA) receptor in the hypothalamus were compared between groups.ResultsIn clinical observation, the sleep condition and the changes of hormone levels between the treatment group and the control group were statistically significant (P &amp;lt; 0.05). The results of network pharmacology indicate that in the main signaling pathways for treating insomnia, it is speculated that Jiawei Suanzaoren Tang can regulate the signaling pathway of neuroactive ligand receptor interactions by inhibiting the activation of related proteins, thereby improving sleep. Animal experiments have also shown that the JW-SZRT can significantly improve the sleep conditions of insomnia rats during perimenopause, and the expression levels of 5-HT and GABAA receptors in the hypothalamus had a significant difference between groups in animal experiments (P &amp;lt; 0.05).ConclusionJiawei Suanzaoren Decoction can improve the perimenopausal insomnia. The mechanism behind this improvement may be related to the regulation of Estradiol (E2), Follicle-Stimulating Hormone (FSH), and luteinizing hormone (LH) levels, as well as the mRNA expression levels of 5-HT1a, 5-HT2a, GABAARα1, and GABAARγ2 receptors in the hypothalamus.