Medical Specialties Research Articles

Abstract TP141: Who Obtains Informed Consent for Endovascular Thrombectomy in Acute Stroke? A Survey of Clinicians.

Introduction: Informed consent (IC) plays a central role in medical care and research. Practices for endovascular thrombectomy (EVT) in acute stroke are not well elucidated. We investigated the clinical roles and medical specialties of individuals who obtain IC for EVT, aiming to provide insights for enhancing the process in contemporary stroke care. Methods: We conducted a survey from July to December 2023 among clinicians involved in acute stroke care. Utilizing Qualtrics, we disseminated a structured questionnaire through various national and international platforms including the American Academy of Neurology and StrokeNet. This analysis summarizes findings pertaining to the characteristics of those who obtain EVT IC at the respondents’ institution. Results: Among 168 participants, 71% were staff physicians, 70% practiced in the United States (US), and 70% were based at academic centers. The most common medical specialties obtaining EVT IC were neurology (77%), followed by neurosurgery (41%), radiology (30%) and emergency medicine (10%) ( Table 1 ). Staff physician (61%) was the most common clinical role involved, followed by fellows (43%), residents (48%), and advanced practice providers (APP, 36%) ( Table 2 ). Non-US institutions were more likely to utilize a provider from neurology alone (50% vs. 31%, p=0.016) and staff physicians (76% vs. 54%, p=0.008), while US institutions were more likely to utilize providers from neurosurgery (51% vs. 18%, p<0.001), APPs (43 vs. 18%, p=0.002) and residents (56% vs. 28%, p=0.001). Non-academic institutions more frequently used emergency medicine providers (25% vs. 5%, p<0.001) and APPs (50% vs. 31%, p=0.031), while academic institutions commonly utilized neurosurgery providers (48% vs. 18%, p=0.001), residents (59% vs. 13%, p<0.001) and fellows (52% vs. 18%, p<0.001). Conclusion: This study highlights the diverse medical specialties and clinical roles of persons obtaining IC for EVT, with neurologists and staff physicians being the most frequently utilized. These variations likely reflect availability and capacity of certain providers in different settings. Future efforts to optimize the IC process should be multi-disciplinary, with standardized content that addresses issues such as ischemic core volume, outcome expectations and diversity.

Enhancing AI Chatbot Responses in Health Care: The SMART Prompt Structure in Head and Neck Surgery.

This study aims to evaluate the impact of prompt construction on the quality of artificial intelligence (AI) chatbot responses in the context of head and neck surgery. Observational and evaluative study. An international collaboration involving 16 researchers from 11 European centers specializing in head and neck surgery. A total of 24 questions, divided into clinical scenarios, theoretical questions, and patient inquiries, were developed. These questions were entered into ChatGPT-4o both with and without the use of a structured prompt format, known as SMART (Seeker, Mission, AI Role, Register, Targeted Question). The AI-generated responses were evaluated by experienced head and neck surgeons using the Quality Analysis of Medical Artificial Intelligenceinstrument (QAMAI), which assesses accuracy, clarity, relevance, completeness, source quality, and usefulness. The responses generated using the SMART prompt scored significantly higher across all QAMAI dimensions compared to those without contextualized prompts. Median QAMAI scores for SMART prompts were 27.5 (interquartile range [IQR] 25-29) versus 24 (IQR 21.8-25) for unstructured prompts (P < .001). Clinical scenarios and patient inquiries showed the most significant improvements, while theoretical questions also benefited, but to a lesser extent. The AI's source quality improved notably with the SMART prompt, particularly in theoretical questions. This study suggests that the structured SMART prompt format significantly enhances the quality of AI chatbot responses in head and neck surgery. This approach improves the accuracy, relevance, and completeness of AI-generated information, underscoring the importance of well-constructed prompts in clinical applications. Further research is warranted to explore the applicability of SMART prompts across different medical specialties and AI platforms.

Protocol publication rate and comparison between article, registry and protocol in RCTs.

Increasing transparency in clinical research is crucial to avoid misleading conclusions. Registering clinical trials prior to participant enrolment is mandatory, and the publication of trial protocols could further enhance transparency. However, the impact of protocol publication on primary outcomes (PO) and sample sizes (SS) remains unclear. This study aimed to determine the rates of trial protocol publication and registration for a sample of randomized controlled trials (RCTs) and to compare the consistency of published and registered PO and SS. A search was conducted in MEDLINE via PubMed® for RCT reports indexed in May and June 2023 across various medical specialties, focusing on general and high-impact factor journals. Data were extracted regarding trial registration, protocol publication, and comparisons were made between PO and SS in articles, registries, and published protocols. Out of 1119 references, 589 (52.6%) were RCTs. The corresponding protocol was published for 146 RCTs (24.8%) including 40 over 140 (28.6%) (6 without end date available) after the trial had ended. Sixty-two (42.4%) protocols were published before the trial conclusion, with no significant differences between PO and SS in published protocols and their corresponding articles. Five hundred and twenty-eight (89.6%) RCTs were registered, 225 over 510 (44%) were registered before the study start with no differences in PO and SS between article and registry. Articles published in generalist or high impact factor journals were associated with higher frequencies of published protocols and trial registration and a lower frequency of difference in PO and SS between articles, registries, and published protocols. While publishing trial protocols may enhance transparency in peer-review process, the initial registered protocol alone appears sufficient for ensuring consistency in primary outcomes and sample sizes. Protocol publication does not seem to provide additional significant benefits in terms of outcome reporting.

An Updated Demographic Profile of Orthopaedic Surgery Using a New ABOS Data Set.

The orthopaedic surgery physician workforce is predominately White and male and has been identified as the least diverse medical specialty. Increasing efforts toward diversification within orthopaedic surgery are underway. Evaluating the effectiveness of these programs requires a thorough understanding of the current demographic profile of the profession. The American Board of Orthopaedic Surgery (ABOS) is the leading board certification organization for orthopaedic surgeons in the United States. The ABOS began collecting self-reported race/ethnicity and sex/gender data of its examinees and diplomates in 2017. This new data set of ABOS was analyzed to describe both the current demographic profile of orthopaedic surgery and trends over time. Underrepresented minority (URM) was defined as a group that is less well represented in orthopaedic surgery than in US census data and includes female, American Indian or Alaska Native, Black or African American, Hispanic/Latino, and Native Hawaiian or Other Pacific Islander categories. Of the 21,025 currently practicing ABOS diplomates with time-limited ABOS certificates (issued since 1986), 19,912 (94.7%) provided sex/gender data, and 19,876 (94.5%) provided race/ethnicity data. Approximately 84.78% selected male and 8.43% female. The majority identified as White (73.67%), whereas 16.35% selected a URM race/ethnicity category. There have been significant increases in the proportions of female (odds ratio [OR] = 4.72, 95% confidence interval [CI] = 3.64-6.11, p < 0.001) and URM (OR = 2.31, 95% CI = 1.80-2.96, p < 0.0001). Diplomates among orthopaedic surgeons attaining ABOS board Diplomates from 1989 to present. Among the subspecialties, pediatric orthopaedics reported the highest percentage of females (30.4%). Spine had both the lowest percentage of females (2.63%) and the highest percentage of URMs (8.97%). Sports had the lowest percentage of URMs at 5.63%. Orthopaedic surgery in 2023 remains largely White and male. However, there have been promising trends toward diversification of orthopaedic surgery both in terms of gender and race/ethnicity. Specialties within orthopaedics have a wide variety of demographic profiles. Level IV Retrospective Cohort Study. See Instructions for Authors for a complete description of levels of evidence.

Performance of Chat Generative Pre-Trained Transformer on Personal Review of Learning in Obstetrics and Gynecology.

Chat Generative Pre-Trained Transformer (ChatGPT) is a popular natural-language processor that is able to analyze and respond to a variety of prompts, providing eloquent answers based on a collection of Internet data. ChatGPT has been considered an avenue for the education of resident physicians in the form of board preparation in the contemporary literature, where it has been applied against board study material across multiple medical specialties. The purpose of our study was to evaluate the performance of ChatGPT on the Personal Review of Learning in Obstetrics and Gynecology (PROLOG) assessments and gauge its specialty specific knowledge for educational applications. PROLOG assessments were administered to ChatGPT version 3.5, and the percentage of correct responses was recorded. Questions were categorized by question stem order and used to measure ChatGPT performance. Performance was compared using descriptive statistics. There were 848 questions without visual components; ChatGPT answered 57.8% correct (N = 490). ChatGPT performed worse on higher-order questions compared with first-order questions, 56.8% vs 60.5%, respectively. There were 65 questions containing visual data, and ChatGPT answered 16.9% correctly. The passing score for the PROLOG assessments is 80%; therefore ChatGPT 3.5 did not perform satisfactorily. Given this, it is unlikely that the tested version of ChatGPT has sufficient specialty-specific knowledge or logical capability to serve as a reliable tool for trainee education.

Abstract TP123: Physician perspectives on acute evaluation and determining goals of stroke care for people living with dementia or disability: Results from the SEED mixed-methods study

Background: Around one in three strokes are experienced by people living with disability or dementia (PLWD), yet there is currently no consensus to guide physicians in evaluating baseline status in this patient population and determining goals of care. We sought to understand how physicians currently approach this complex issue and what challenges they encounter as a critical step towards informing evidence-based best practices for PLWD. Methods: Through separate recruitment strategies, we invited physicians involved in stroke care to participate in semi-structured, in-depth interviews and an online survey, inquiring into perspectives on evaluation and management of PLWD. Interviews were recorded, transcribed, and analyzed applying an interpretive grounded theory approach, using constant comparison throughout the coding process to establish themes and subthemes. Results were triangulated with findings from a descriptive analysis of survey responses. Results: Twenty-eight physicians participated in interviews, while 134 provided survey data, representing 17 countries and 10 medical specialties. Among factors most frequently rated as extremely important in stroke care decision-making (by ≥40% of respondents) were severity of pre-existing dementia/disability and baseline quality of life. Concurrently, interviews highlighted considerable challenges in assessing these factors given time constraints in the acute setting and crudeness of popular screening measures, which fail to capture relevant nuances in patients’ baseline status. Participants further spoke to uncertainties in determining goals of care that align with patients’ best interest. Here, emphasis was placed on the inappropriateness of a mainstream conceptualization of a favorable outcome as maintaining independence, and the need to consider variability in personal and cultural values, support networks, and the broader socioeconomic context. In navigating the complexities of patient-centric care for PLWD who are often unable to voice their wishes, family input and advanced care directives were identified as key facilitators. Conclusions: This mixed-methods study highlights the need for creating evidence-based, tailored strategies for assessing pre-stroke status and defining favourable outcomes for PLWD. Achieving these goals relies on future research co-production with PLWD and their families, ensuring integration of patient priorities and appropriate operationalization of relevant post-stroke outcomes.

National institutes of health: Analysis of gender differences in anesthesiology research funding.

Although studies have shown an increase in the representation of women in academic anesthesiology, it remains one of the medical specialties most dominated by men. While gender disparities have been identified in academic anesthesiology, literature on discrepancies in funding allocated by the National Institutes of Health (NIH) is scarce. The objective of the present study was to explore these discrepancies from 2017 to 2020 and assess potential changes in funding trends over time. Publicly available funding data was retrospectively obtained from the NIH Research Portfolio Online Reporting Tools Expenditure and Results (RePORTER) database for fiscal years 2017 to 2020. Information regarding each principal investigator (PI) was obtained from the Scopus database and institutional websites. For statistical comparison of continuous variables, Mann-Whitney U tests were performed. Simple linear regression analyses assessed the relationship between fiscal year and number of NIH grants awarded to PIs. Median NIH amount per grant [interquartile range (IQR)] was determined to be $359,038 ($233,947-$476,933) for PIs that were men, greater than that of $330,865 ($164,268-$458,785) for PIs that were women (p < .05). Similarly, men received a greater median NIH grant amount per PI, with a value of $348,751 ($222,043-$442,075), compared to women who received $268,634 ($161,159-$414,384) (p < .05). When stratified by terminal degree, significantly higher median grant amounts (p < .05) were awarded to MD and PhD holders who were men versus their women counterparts. Lastly, an increasing trend in obtaining NIH grants between 2017 and 2020 was observed for PIs that were men overall, including PIs holding MD/PhD degrees (p < .05). No such trend was observed for PIs who were women. This study demonstrates a significantly greater number of NIH grants and higher award values allocated to researchers who were men than researchers who were women in academic anesthesiology over the past four years. Moreover, an increase in the number of grants secured by PIs who were women from 2017-2020 was not observed. In the future, longitudinal trends in NIH funding for principal investigators (PIs) of both genders in anesthesiology should be investigated.

2021 European Society of Cardiology guidelines on cardiac pacing and cardiac resynchronisation therapy : Statement of endorsement by the NVVC.

The European Society of Cardiology (ESC) has updated its guidelines on cardiac pacing and cardiac resynchronisation. As the majority are classII recommendations (61%) and based on expert opinion (59%), acritical appraisal for the Dutch situation was warranted. Aworking group has been established, consisting of specialists in cardiology, cardiothoracic surgery, geriatrics, allied professionals in cardiac pacing, and patient organisations with support from the Knowledge Institute of the Dutch Association of Medical Specialists. They assessed the evidence leading to the recommendations and the suitability for daily Dutch practice. Several recommendations have been amended or omitted altogether if aconflicting Dutch guideline has recently been published, such as aguideline on performing magnetic resonance imaging in patients with cardiac implantable electronic devices. The recent Dutch guideline on implantable cardioverter defibrillator implantation in patients with non-ischaemic cardiomyopathy has recommended implanting cardiac resynchronisation therapy devices without adefibrillator function. Shared decision making has received amore prominent role in the ESC guidelines and is discussed in more detail in this document. The recommendations given in this document are intended for health care professionals involved in the care of patients with an indication for cardiac pacing and are approved by the participating professional societies and the patient organisation Harteraad.

WCN25-151 Perception of Nephrology Practice and Attitude in a sample of Iraqi medical Specialists

WCN25-151 Perception of Nephrology Practice and Attitude in a sample of Iraqi medical Specialists

Metrics for Evaluating Telemedicine in Randomized Controlled Trials: Scoping Review.

Telemedicine involves medical, diagnostic, and treatment-related services using telecommunication technology. Not only does telemedicine contribute to improved patient quality of life and satisfaction by reducing travel time and allowing patients to be seen in their usual environment, but it also has the potential to improve disease management by making it easier for patients to see a doctor. Recently, owing to IT developments, research on telemedicine has been increasing; however, its usefulness and limitations in randomized controlled trials remain unclear because of the multifaceted effects of telemedicine. Furthermore, the specific metrics that can be used as cross-disciplinary indicators when comparing telemedicine and face-to-face care also remain undefined. This review aimed to provide an overview of the general and cross-disciplinarity metrics used to compare telemedicine with in-person care in randomized controlled trials. In addition, we identified previously unevaluated indicators and suggested those that should be prioritized in future clinical trials. MEDLINE and Embase databases were searched for publications that met the inclusion criteria according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews). Original, English-language articles on randomized controlled trials comparing some forms of telemedicine with face-to-face care from January 2019 to March 2024 were included, and the basic information and general metrics used in these studies were summarized. Of the 2275 articles initially identified, 79 were included in the final analysis. The commonly used metrics that can be used across medical specialties were divided into the following 3 categories: (1) patient-centeredness (67/79, 85%), including patient satisfaction, workload, and quality of life; (2) patient outcomes (57/79, 72%), including general clinical parameters such as death, admission, and adverse events; and (3) cost-effectiveness (40/79, 51%), including cost assessment and quality-adjusted life year. Notably, only 25 (32%) of 79 studies evaluated all the 3 categories. Other metrics, such as staff convenience, system usability, and environmental impact, were extracted as indicators in different directions from the three categories above, although few previous reports have evaluated them (staff convenience: 8/79, 10%; system usability: 3/79, 4%; and environmental impact: 2/79, 3%). A significant variation was observed in the metrics used across previous studies. Notably, general indicators should be used to enhance the understandability of the results for people in other areas, even if disease-specific indicators are used. In addition, indicators should be established to include all three commonly used categories of measures to ensure a comprehensive evaluation: patient-centeredness, patient outcomes, and cost-effectiveness. Staff convenience, system usability, and environmental impact are important indicators that should be used in future trials. Moreover, standardization of the evaluation metrics is desired for future clinical trials and studies. Open Science Forum Registries YH5S7; https://doi.org/10.17605/OSF.IO/YH5S7.

European training requirements in Neonatology 2021-towards a unified training standard for Neonatologists.

The European Society for Paediatric Research (ESPR) first developed recommendations for a Neonatology specific European training curriculum in 1998, with updates in 2007 and 2021. The aim of these recommendations was to define a common, European standard of training for national educational programmes for Neonatologists. Following the Union of European Medical Specialists' (UEMS) framework of European Training Requirements (ETR), and similar to the American Board of Pediatrics (ABP) recommendations, graduates of training programmes conforming to the ETR will be eligible throughout Europe for recognition of equality of training, and with that should be enabled to freedom-of-movement. This concept also accounts for neonatal specialists. We therefore present the pan-European work on the ETR Neonatology in its third iteration (ETR III), summarising the basic requirements for contemporary training programmes, trainers, and training centres in neonatology. We highlight the European School of Neonatology (ESN) as a comprehensive online educational platform which provides the theoretical and practical background to satisfy the ETR-III. Lastly, we introduce the European Board of Neonatal & Child Health Research (EBNCHR) as a committee dedicated to gaining acceptance for the concept of harmonising education and training in Neonatology and recognising Neonatology as a Paediatric subspecialty in every European Union member state. IMPACT: Neonatology currently is not uniformly recognised as a Paediatric subspecialty throughout the 27 European countries. Hence, training in Neonatology formerly followed no commonly agreed standard throughout the European Union (EU). To ensure a minimum standard of care, an agreed minimum standard of training is required. The European Society for Paediatric Research (ESPR) has led on generating an EU-accredited, pan-European Syllabus for Neonatal training in Europe, the European Training Requirements (ETR) in Neonatology (2021). This article presents the ETR Neonatology from commissioning to accreditation and discusses means of how high-grade post-graduate education, aligned with the ETR can be achieved by practitioners.

Assessing the disconnect between student interest and education in artificial intelligence in medicine in Saudi Arabia

BackgroundAlthough artificial intelligence (AI) has gained increasing attention for its potential future impact on clinical practice, medical education has struggled to stay ahead of the developing technology. The question of whether medical education is fully preparing trainees to adapt to potential changes from AI technology in clinical practice remains unanswered, and the influence of AI on medical students’ career preferences remains unclear. Understanding the gap between students’ interest in and knowledge of AI may help inform the medical curriculum structure.MethodsA total of 354 medical students were surveyed to investigate their knowledge of, exposure to, and interest in the role of AI in health care. Students were questioned about the anticipated impact of AI on medical specialties and their career preferences.ResultsMost students (65%) were interested in the role of AI in medicine, but only 23% had received formal education in AI based on reliable scientific resources. Despite their interest and willingness to learn, only 20.1% of students reported that their school offered resources enabling them to explore the use of AI in medicine. They relied mainly on informal information sources, including social media, and few students understood fundamental AI concepts or could cite clinically relevant AI research. Students who cited more scientific primary sources (rather than online media) exhibited significantly higher self-reported understanding of AI concepts in the context of medicine. Interestingly, students who had received more exposure to AI courses reported higher levels of skepticism regarding AI and were less eager to learn more about it. Radiology and pathology were perceived to be the fields most strongly affected by AI. Students reported that their overall choice of specialty was not impacted by AI.ConclusionFormal AI education seems inadequate despite students’ enthusiasm concerning the application of such technology in clinical practice. Medical curricula should evolve to promote structured, evidence-based AI literacy to enable students to understand the potential applications of AI in health care.

Geriatric medicine in Spain's healthcare system: Past and future

Geriatrics is the medical specialty that cares for health problems of older persons, including acute care, chronic care and rehabilitation, in various settings such as the community, hospitals and long-term care. This article analyzes the situation of geriatric medicine in Spain before and after the COVID-19 pandemic, highlighting the challenges and changes needed to improve geriatric care in the future. The first part of this paper describes the main landmarks of the Spanish health system. In 1986, a key law (Ley General de Sanidad) was approved by the Spanish Parliament, launching the development of the national health care system. In parallel, we describe and comment the development of geriatrics in Spain along this period is described. Later, the interactions between the health system and geriatrics along the next decades is reported, using 2020 (when started the COVID-19 pandemic started) as deadline of our past history. In the second part, the most important characteristics of the current situation of Spanish and European geriatric medicine are described, in order to propose ideas on how geriatric care can be designed and reimagined in the future.

Co-Designing a Digital Brief Intervention to Reduce the Risk of Prescription Opioid-Related Harm Among People With Chronic Noncancer Pain: Qualitative Analysis of Patient Lived Experiences.

Opioid medications are important for pain management, but many patients progress to unsafe medication use. With few personalized and accessible behavioral treatment options to reduce potential opioid-related harm, new and innovative patient-centered approaches are urgently needed to fill this gap. This study involved the first phase of co-designing a digital brief intervention to reduce the risk of opioid-related harm by investigating the lived experience of chronic noncancer pain (CNCP) in treatment-seeking patients, with a particular focus on opioid therapy experiences. Eligible patients were those aged between 18 and 70 years with CNCP at a clinically significant level of intensity (a score of ≥4 of 10). Purposive sampling was used to engage patients on public hospital waitlists via mail or through the treating medical specialist. Participants (N=18; n=10 women; mean age 49.5 years, SD 11.50) completed semistructured telephone interviews. Interviews were transcribed verbatim, thematically analyzed using grounded theory, and member checked by patients. Eight overarching themes were found, listed in the order of their prominence from most to least prominent: limited treatment collaboration and partnership; limited biopsychosocial understanding of pain; continued opioid use when benefits do not outweigh harms; a trial-and-error approach to opioid use; cycles of hopefulness and hopelessness; diagnostic uncertainty; significant negative impacts tied to loss; and complexity of pain and opioid use journeys. The findings of this study advance progress in co-designing digital brief interventions by actively engaging patient partners in their lived experiences of chronic pain and use of prescription opioid medications. The key recommendations proposed should guide the development of personalized solutions to address the complex care needs of patients with CNCP.

P-961. Preventing HIV Transmission: The Impact of Early HIV Prevention Education on The Road to Residency

Abstract Background The emergence of HIV pre-exposure prophylaxis, or PrEP, has been effective and pivotal in reducing HIV transmission and incidence over the past decade. However, its utilization remains relatively low in the United States as barriers to acquiring PrEP persist. Some of these barriers include HIV risk perception, stigma, and provider bias. Therefore, this report investigates how increasing early career awareness of PrEP amongst fourth year medical students (MS4) matriculating into various specialties impacts their confidence around PrEP. Methods Anonymous, online, optional, pre- and post-intervention surveys were conducted to MS4s assessing awareness, knowledge, and perceived comfort around HIV prevention and prescribing PrEP. Students received a 1.5-hour lecture regarding statistics, formulations, indications, and side effects of PrEP from an HIV specialist. Additionally, students’ knowledge around the material was gauged through three interactive patient cases regarding HIV prevention throughout lecture material. Results Twenty-three pre- and post-intervention surveys were completed assessing familiarization and comfortability around PrEP. Seven (30%) of the students are pursuing internal medicine, five (22%) family medicine, three (13%) psychiatry, two (9%) OBGYN, and five (22%) in various specialties. Prior to attending the lecture, most students were aware of PrEP (91.3%), but most were uncomfortable initiating such a conversation with a patient (56.5%). The primary, initial limitation students cited in starting a PrEP conversation was their own knowledge around HIV prevention tools (39.1%). After the lecture, the primary constraint remained (39.1% vs. 26%), but a new challenge emerged: students’ comfort level in eliciting a comprehensive sexual history (21.7%). Conclusion These findings demonstrate the advantages of introducing HIV PrEP education to graduating medical students. To assist in curbing HIV transmission rates, PrEP utilization must be increased across various medical specialties. Integrating PrEP education within medical school curriculum could be vital in achieving broader aims to end the HIV epidemic. Further investigation should explore alternative approaches to bolster HIV PrEP education across all levels of medical education. Disclosures Joseph Patrik Hornak, MD, Innoviva Specialty Therapeutics: Advisor/Consultant|Innoviva Specialty Therapeutics: Advisor/Consultant

P-1738. Effectiveness of Clinical Pharmacist-Driven Antimicrobial Stewardship (ASP) in Bacteremic Patients in India

Abstract Background Antimicrobial resistance is a prevalent problem, especially in low-middle-income countries. Infectious disease physicians are a scarce commodity and are unable to fully shoulder the complete responsibility of antimicrobial stewardship implementation in a health care setting. Thus, we set out to assess the utility of a Clinical pharmacist-led ASP in optimising antimicrobial use in bacteremic patients. SOURCE OF INFECTION Methods This is a prospective audit and feedback of bacteremic patients led by a clinical pharmacist with minimal input and sign-off from an ID specialist. A month of observation (July 2023) was followed by a 3-month intervention period from August to October 2023 in the medical and surgical speciality departments of a large tertiary care hospital in Southern India. RECOMMENDATION ACCEPTANCE RATE Results 103 and 218 patients were noted to be bacteremic during baseline and intervention, respectively. The mean age was 48.2, and 66% were male. The majority of positive blood cultures were from Haematology (19%), Hepatology(15%), Nephrology(14%) and others (52%). The average length of stay was 19 days and 16.6 days in baseline and intervention phases, respectively. The predominant organisms were carbapenem-resistant and extended-spectrum beta-lactamase-producing enterbacteriaceae and coagulase-negative staphylococci (CoNS). The common sources of bacteremia were central line-associated bloodstream infection (CLABSI) and gut translocation during febrile neutropenia. (Table 1). The DOT in the observation phase was 1517/1000 Patient-Days (PD), and the intervention phase's average DOT was 1326/1000PD, and there was a significant reduction in antibiotic utilisation in the intervention (P=0.003). The length of therapy was 16.6 and 11.06 days, with in-hospital mortality of 13.6% and 8% in the observation and intervention phases, respectively. Clinical pharmacist recommendations were either fully or partially accepted in 75% of the cases in the intervention phase (Table 2). Conclusion A clinical pharmacist-led ASP showed a reduction in significant antimicrobial use with 75% acceptance of recommendation and no difference in mortality even in bacteremic patients. Disclosures All Authors: No reported disclosures

P-55. Knowledge of Respiratory Syncytial Virus (RSV) Vaccine in Pregnant Women: A survey among Healthcare Professionals

Abstract Background Respiratory Syncytial Virus (RSV) is a leading cause of acute lower respiratory tract infection (RTI), playing a significant role in infant mortality under six months of age, especially in low and middle-income countries. In August 2023, the U. S. Food &amp; Drug Administration approved active immunization of pregnant women between 32 to 36 weeks gestational age for the prevention of lower RTI and severe lower RTI caused by RSV in infants up to 6 months of age. Figure 1. Distribution of responses according to medical specialt Methods An electronic survey comprised of 18 questions was administered to primary care physicians, internists, gynecologists, and pediatricians. The survey included 4 items to gather participant characteristics, 1 addressing general vaccination recommendations during pregnancy, 5 covering general aspects of the RSV vaccine, 7 focusing on knowledge of the RSV vaccine during pregnancy and 1 item to ascertain whether they recommend this vaccine. If participants lacked prior knowledge of the vaccine or its use in pregnant patients, the survey was concluded Figure 2. Previous Knowledge of RSV Vaccine by Medical Speciality Results 168 responses were received, the distribution by specialties is shown in Figure 1. A total of 76/168 doctors (45.2%) were aware of the existence of a vaccine against RSV (Figure 2), 52/76 (68.4%) had knowledge of the vaccine targeted to pregnant women (Figure 3). Among the doctors familiar with this vaccine, 29/52 (55.8%) knew that it is a single-dose vaccine. Additionally, 28/52 (53.8%) were aware of when it should be administered, 31/52 (59.6%) knew it is a seasonal vaccine and 27/52 (51.9%) were previously aware of its efficacy in providing protection to infants up to 6 months old. Furthermore, 100% of the surveyed expressed that they would recommend the vaccine once it is approved in Mexico Figure 3. Previous knowledge of the vaccine targeted to pregnant women Conclusion Only 27/168 (16%) of the surveyed demonstrated a satisfactory knowledge about the RSV vaccination in pregnant women, including details such as dosage, indication, timing of administration and efficacy. These surveys serve to assess physicians knowledge on the topic under study, and are valuable educational tools for the respondents by provifing information and reliable sources for further reading of the topic. Nevertheless our findings highlight the need for additional comprehensive educational campaigns targeting healthcare providers Disclosures All Authors: No reported disclosures

Definition of clinical immunology around the globe

Immunology has gradually become a core part of many medical specialties. Immune cells and immune mediators are now known to participate in the pathogenesis of a wide variety of diseases and therapies based on the modulation of immune function are increasingly used. Traditionally, clinical immunologists have studied patients with inborn errors of immunity (IEI), previously known as primary immunodeficiencies, and with allergic conditions. More recently, clinical immunology has become involved with a broader array of disorders. The Clinical Immunology Committee of the International Union of Immunological Societies set out to understand how clinical immunologists perceive their specialty to identify similarities and differences in training and practice around the globe. For this purpose, a specific questionnaire was designed and distributed amongst our member societies. More than 500 participants answered the questionnaire, 80% of whom had completed their training. Roughly two thirds of respondents were physicians directly involved in patient care. We found that though the number of diseases and processes in which immune mechanisms are involved has considerably grown, 90% of participants agree with the 1993 World Health Organization definition of Clinical Immunology. We propose that the increased complexity of the field opens a need for multidisciplinary teams of clinicians and basic researchers and for a broader training of specialists.

Evaluating and Comparing the Content Coverage of Quality Measure Sets from Israel, the United States, and the United Kingdom.

Quality of care can be measured in several dimensions: different clinical disciplines, structures/processes/outcomes of care (SPO), and also different domains of quality (effectiveness, safety, care coordination, patient-centeredness, efficiency, timeliness, and community/population health). To our knowledge, no previous study has compared different sets of performance measures in terms of how well they cover these different aspects of quality. Compare the content coverage of major quality measure sets from Israel, the US, and the UK. Review and categorization of performance measure sets, with disagreements between reviewers resolved through consensus. We selected three sets of quality measures: HEDIS, the Healthcare Effectiveness Data and Information Set (USA), QOF, the Quality and Outcomes Framework (UK), and QICH, Quality Indicators for Community Healthcare (Israel). All measures were classified along three dimensions-clinical specialty, SPO, and seven domains of healthcare quality. We then compared the distribution of measures in each of the three sets, using Fischer's exact tests and post hoc tests of pairwise differences. In the medical specialty domain, all three countries focused primarily on family medicine/primary care. All three measure sets focused heavily on process measures, though to different extents, and all emphasized effectiveness of care, community/population health, and communication and care coordination over other domains of quality. The measure sets we examined, which overwhelmingly measure processes of care, should be encouraged to add structure and outcomes measures. All three measure sets under-emphasize certain aspects of quality such as timeliness, care coordination, efficiency, and patient-centeredness. Finally, and most importantly, all three measure sets focused overwhelmingly on measuring the activities of family physicians; attention should be given to building measures that will examine the activities of other clinicians.

Nationwide evaluation of medical training in psychiatry and psychotherapy in Germany

To date there has been no evaluation of further training and working conditions in medical specialist training in psychiatry and psychotherapy in Germany. In order to counteract the lack of young talent and ensure long-term care for patients, quality assurance is essential. The evaluation aims to identify strengths and weaknesses of the further training and to derive measures for improvement. For abetter classification, acomparison is also made with other disciplines with medical specialist further training. The online-based survey took place from 15 May 2023 to 30 June 2023. The results refer to 315 questionnaires from 202 physicians in further training and 113 medical specialists (specialist title for less than 3 years). Of those surveyed 64% were satisfied with the quality and implementation of the general psychiatry part, only 11% were considering changing their specialty and 18% were considering moving their job abroad due to the training conditions. There is aneed for improvement in induction and in the organization of the training. In addition, significant time and financial burdens for mandatory external training events as well as the lack of compatibility between training and research, teaching and care work responsibilities were criticized. Overall, it appears that the working conditions are better than in other disciplines. With respect to the potential for improvement, the creation of financing for further training is essential; certificates for high quality training and the publication of positive examples can also contribute to quality assurance and improvement.