Treatment Recommendations Research Articles

Impact of doxycycline discharge kits on appropriate treatment of sexually transmitted infections among patients in the ED.

Chlamydia trachomatis is the most prevalent, reportable sexually transmitted infection (STI) in the United States. In 2021, the Centers for Disease Control and Prevention (CDC) updated treatment recommendations from a single azithromycin 1000mg dose to doxycycline 100mg twice daily for seven days for the treatment of chlamydia infections. In response to changes in treatment recommendations and addressing patient barriers to treatment, pharmacists at an urban, academic medical center collaborated with the state health department to create doxycycline kits dispensed upon emergency department (ED) discharge. To evaluate if ED doxycycline discharge kits improve appropriate and timely treatment of chlamydia. This was a single center, retrospective, chart review study of adult patients with a positive chlamydia test while seen in the ED between September 1, 2021 and September 30, 2023. Patients with a listed allergy to doxycycline and those who were incarcerated and/or pregnant were excluded. The primary outcome was appropriate, guideline recommended chlamydia treatment before and after doxycycline discharge kit implementation. Secondary outcomes included rate of ED return visits within 90days for STI-related complaints, time to treatment in those who received a prescription for doxycycline versus doxycycline kit, and rate of doxycycline initiation via emergency medicine (EM) pharmacist culture call-back list. A total of 170 patients were enrolled in the study, 72 patients in the pre-kit group and 98 patients in the post-kit group. Significantly more patients received appropriate treatment in the post kit group (pre-kit (45.8%) vs post-kit (69.1%); CI 95% 2.63 (1.4-5.0); p=0.002). Time to definitive treatment was significantly shorter in the post-kit group (22.7h pre-kit vs 1.3h post-kit; p<0.001). Doxycycline discharge kits significantly increased guideline-directed treatment and decreased time-to-treatment for chlamydia in the ED population at an urban academic medical center.

Recommendation of the Appropriate Treatments Using Carbon Nanotubes in Drought Stress Conditions in Maize Genotypes (Zea mays L) in Preliminary Study Based on Treatment × Trait

Recommendation of the Appropriate Treatments Using Carbon Nanotubes in Drought Stress Conditions in Maize Genotypes (Zea mays L) in Preliminary Study Based on Treatment × Trait

Outcomes of neoadjvuant chemotherapy versus chemoradiation for esophageal adenocarcinoma: A National Cancer Database analysis.

416 Background: While neoadjuvant chemoradiation (NCRT) has been the acceptable standard of care for esophageal adenocarcinoma (EAC), there has been a paradigm shift from recent trials have shown that neoadjuvant chemotherapy (NAC) is either equivalent or superior to NCRT. We sought to examine the outcomes of NAC versus NCRT in esophageal cancer from the National Cancer Database (NCDB). Methods: Utilizing the NCDB, we identified esophagectomy patients with EAC who underwent multiagent NCT versus multiagent NCRT. Overall Survival (OS) was analyzed with the Kaplan-Meier method and multivariate analysis (MVA) was performed to identify predictors of OS. Propensity score matching (PSM) was used to correct for baseline differences between groups. Results: After PSM, we identified 1007 patients in each group. Groups were equally balanced in age, gender, T/N stage, grade, and facility volume. There was improved lymphadenectomy and higher use of adjuvant therapy in NCT patients. There were significant improvements in R0 resection and pathologic response associated with NCRT patients. There was a significant improvement in OS in NCT versus NCRT. The median and 5-year OS was 42.7 months and 42% in NCT patients versus 34.2 months and 35% in NCRT patients (p = 0.001). For pathologic complete responders, median and 5-year OS was 101 months and 64% in NCT patients versus 71.2 months and 53% in NCRT patients (p = 0.04). On MVA, improved mortality was associated with female gender, pathologic N0, &gt;10 nodes removed, pathologic partial or complete response, R0, well/moderate grade, NCT, adjuvant chemotherapy, and higher facility volume. There was also no survival benefit to adjuvant chemoradiation. Conclusions: Despite higher R0 and pathologic response associated with NCRT, NCT was superior to NCRT for OS in EAC patients. NCRT needs to be re-examined in its role as a treatment recommendation for operable EAC patients. Multivariate analysis for overall survival. Variable HR 95% CI P value Age 1.01 1.00 – 1.02 0.004 SexMaleFemale Reference0.79 0.64 – 0.98 0.03 Charlson Deyo score01 Reference1.05 0.91 – 1.21 0.54 Pathologic N-stageN0N+ Reference1.82 1.58 – 2.10 &lt;0.001 LN removed&lt;10&gt;10 Reference0.81 0.68 – 0.97 0.02 ResponseNonePartialComplete Reference0.810.61 0.69 – 0.940.50 – 0.75 0.008&lt;0.001 Margin statusR0R1 Reference1.24 1.01 – 1.52 0.04 GradeWell/moderatePoor Reference1.35 1.18 – 1.54 &lt;0.001 Preop radiationYesNo Reference0.77 0.67 – 0.88 &lt;0.001 Adjuvant therapyNoneChemotherapyChemoradiation Reference0.770.83 0.65 – 0.920.64 – 1.08 0.0040.17 Facility volumeLow (≤10/year)Medium (11-19/year)High (≥20/year) Reference0.860.78 0.72 – 1.030.67 – 0.90 0.10&lt;0.001

P-1655. Impact of an Educational Leaflet on Urinary Tract Infections, Asymptomatic Bacteriuria, and Antibiotics for Adults ≥65 years

Abstract Background Adults ≥65yrs are at high risk of harm from antibiotic overuse due to misdiagnosis of asymptomatic bacteriuria (ASB) as urinary tract infection (UTI). Alongside strategies to improve clinician prescribing, patients should be educated on ASB and empowered to discuss harms and benefits of antibiotic treatment. Previously, we used a user-centered design process to develop a patient-focused educational leaflet on UTI, ASB, and antibiotic use (Figure 1). Here, we tested whether the leaflet improved patients’ knowledge about ASB and willingness to avoid unnecessary antibiotics.Figure 1.A three-page antibiotic education designed with patients, caregivers, and clinicians. Methods In an online survey experiment of US adults ≥65yrs, respondents read a scenario of themselves as an asymptomatic patient with a positive urine test during prescreening for non-urologic surgery. Respondents were randomized to one of four experimental conditions which varied educational leaflet provision and the surgeons’ treatment recommendation (Figure 2). Outcome measures included whether respondents thought they (as the patient described in the case) had a UTI, how comfortable they would be not taking antibiotics, and their knowledge about UTIs, ASB, and antibiotics Results Figure 2 shows characteristics of the 504 study respondents [completion=89%]. Compared to those not provided the educational leaflet, respondents shown the educational leaflet were less likely to believe they had UTI (p&amp;lt; .001), were more comfortable not taking antibiotics (p&amp;lt; .001), and answered more knowledge questions correctly (p&amp;lt; .001) (Figures 3&amp;4). Conversely, respondents who were told the surgeon recommends antibiotics were more likely to believe they had UTI (p&amp;lt; .001) and less comfortable with not taking antibiotics (p=.013) but did not differ in their knowledge (p=.096). Conclusion A patient-centered educational leaflet, designed with patients, caregivers, and clinicians, was effective in aligning antibiotic treatment preferences with clinical guidelines and improving knowledge about UTI, ASB, and antibiotics. Findings offer important preliminary evidence on the potential for patient/caregiver-focused education to help prepare patients/caregivers to engage in treatment decisions and contribute to reducing antibiotic overuse and its associated harms. Disclosures All Authors: No reported disclosures

P-1574. Asymptomatic Bacteriuria Not a Predictor of Clinical Failure in Uncomplicated Urinary Tract Infections (uUTI): A Prospective Analysis of Women Treated for uUTI from the REASSURE Trial

Abstract Background Per FDA Guidance, the primary efficacy endpoint for trials evaluating antimicrobials for treatment of UTI is a combined clinical/microbiologic response. Overall success requires both resolution of UTI symptoms and demonstration that the causative uropathogen is reduced to &amp;lt; 103 CFU/mL at a fixed time point after randomization, regardless of whether the patient is asymptomatic. Previously, we retrospectively evaluated the impact of post treatment asymptomatic bacteriuria (ASB) for Phase 3 clinical trial patients with UTI and found that ASB was not a predictor of subsequent clinical failure. In this study, we prospectively assessed the impact of post treatment ASB on subsequent clinical response for adult women with uUTI. Methods Study IT001-310 was a Phase 3 randomized, double-blind, double-dummy, active controlled trial to evaluate the safety and efficacy of sulopenem/probenecid (SUL) versus amoxicillin/clavulanate (AMC) for the treatment of uncomplicated UTI (uUTI). Adult women were randomized to receive SUL or AMC, both bid for 5 days. The primary efficacy outcome was overall success (combined clinical/microbiologic success) at the Test of Cure (TOC) visit in the mMITT population. ASB at TOC was prespecified as an additional efficacy endpoint to be assessed, and the presence of ASB at the End of Treatment (EOT) and TOC visit was evaluated to see if it impacted clinical response at the following visit. Results 2,222 women were randomized; 990 (44.6%) were in the mMITT population. ASB was the reason for nonresponse in 74 (14.2%) and 93 (19.9%) patients treated with SUL and AMC, respectively. As shown in the table, for both treatment arms, the presence of ASB at the EOT and TOC visit did not lead to clinical failure at the following visit. Conclusion SUL and AMC, both β-lactams, appear to have similar effects on the frequency of post treatment ASB. For patients in both treatment arms, the presence of ASB a week after completing UTI therapy was not a marker of subsequent clinical failure. The inclusion of ASB as part of the primary endpoint for studies of UTI should be reconsidered. Inclusion of microbiologic results from asymptomatic patients after complete resolution of uUTI symptoms is a practice inconsistent with available treatment recommendations. Disclosures Steven I. Aronin, MD, Iterum Therapeutics: Employee|Iterum Therapeutics: Employee|Iterum Therapeutics: Stocks/Bonds (Public Company)|Iterum Therapeutics: Stocks/Bonds (Public Company) Michael Dunne, MD, Iterum Therapeutics: Advisor/Consultant|Iterum Therapeutics: Board Member|Iterum Therapeutics: Stocks/Bonds (Public Company) Sailaja Puttagunta, MD, Iterum Therapeutics: Employee|Iterum Therapeutics: Employee|Iterum Therapeutics: Stocks/Bonds (Public Company)|Iterum Therapeutics: Stocks/Bonds (Public Company)

P-1209. Changes in Antiviral Prescription for Children with Influenza in U.S. Emergency Departments During the COVID-19 Pandemic: New Vaccine Surveillance Network (NVSN), 2016-2023

Abstract Background Despite recommendations from CDC and ACIP, antiviral prescription for children who are at higher risk of severe influenza (including those &amp;lt; 5 years and those with certain underlying conditions) in emergency departments (EDs) remains suboptimal. This study assessed changes in antiviral prescription for children at higher risk of severe influenza in EDs from the pre-COVID-19-pandemic period to the COVID-19 pandemic period. Demographic and clinical characteristics of children at higher risk of severe influenza(1) enrolled in the ED with laboratory confirmed influenza, stratified by pandemic periods (N=2,5001). (1) Defined as children &amp;lt;5 years old and/or those with any underlying medical condition. Methods Data from NVSN, a 7-site, prospective surveillance study of acute respiratory illnesses, were analyzed. Children at higher risk for severe influenza in EDs with confirmed influenza by research or clinical testing were included. We compared children who received antiviral prescriptions with those who did not. The study period was categorized into pre-pandemic (12/01/2016 to 03/31/2020) and late pandemic (07/01/2021 to 03/31/2023) periods. We used mixed-effects Poisson regression to compare antiviral prescription incidence proportions before the pandemic and during the late pandemic period. Mixed-effects logistic regression was used to evaluate factors associated with antiviral prescription during the late pandemic period among children at higher risk. Incidence proportion ratios from mixed-effects Poisson model(1) among children at higher risk of severe influenza (N=2,500). (1) The estimates presented are from a mixed-effects Poisson model with a log link and random intercepts for study sites, with outcome as number of children with an antiviral prescription. Results A total of 3,436 children in the ED tested positive for influenza, of whom 2,500 (73%) were classified as higher risk for severe influenza. Pre-pandemic, 31% were prescribed antivirals compared to 12% during the late pandemic among those at higher risk (Table 1). Prescription of antivirals for children at higher risk decreased by 69% in 2021-2022 and by 55% in 2022-2023 compared to the pre-pandemic (Table 2, Figure 1). Symptom duration and clinical influenza testing were significantly associated with antiviral prescription among children at higher risk during the late pandemic period (Figure 2). Percent of antiviral prescriptions among children at higher risk of severe influenza illness presenting to the emergency departments of seven children’s hospitals, stratified by clinical influenza testing (N=2,500). Conclusion Influenza antiviral prescription among children at higher risk for severe influenza in EDs decreased significantly during the COVID-19 pandemic compared to the pre-pandemic, despite treatment recommendations. While clinical testing has increased during the COVID-19 pandemic and is associated with prescription of influenza antivirals, prescription remains low. Efforts are needed to improve antiviral prescriptions for children at higher risk for severe influenza in EDs. Adjusted odds ratios of antiviral prescription among children at higher risk of severe influenza illness presenting to the emergency departments of seven children’s hospitals during the pandemic period (2021-2023; N=459). We used logistic regression to compare the odds of antiviral prescription, adjusting for age, symptom duration, clinical influenza testing (rapid antigen or PCR), influenza season, peak influenza season, and study site as a random effect. Disclosures James W. Antoon, MD, PhD, MPH, AstraZeneca: Advisor/Consultant|NIH: Grant/Research Support James Chappell, MD, PhD, Merck: Grant/Research Support Janet A. Englund, MD, Abbvie: Advisor/Consultant|AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Board Member|Pfizer: Grant/Research Support|Pfizer: Speaker at meeting|SanofiPasteur: Advisor/Consultant|Shinogi: Advisor/Consultant Geoffrey A. Weinberg, MD, Inhalon: Advisor/Consultant|Merck &amp; Company: Honoraria for textbook chapter preparation Mary A. Staat, MD, MPH, Cepheid: Grant/Research Support|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Up-To-Date: Honoraria Elizabeth P. Schlaudecker, MD, MPH, Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Rangaraj Selvarangan, BVSc, PhD, D(ABMM), FIDSA, FAAM, Abbott: Grant/Research Support|Abbott: Honoraria|BioMerieux: Grant/Research Support|Cepheid: Grant/Research Support|Diasorin: Grant/Research Support|GSK: Advisor/Consultant|Hologic: Grant/Research Support|Luminex: Grant/Research Support|Qiagen: Grant/Research Support Christopher J. Harrison, MD, GSK: Grant/Research Support|Medscape: Honoraria|Merck: Grant/Research Support|Pfizer: Grant/Research Support|UpToDate: Honoraria Natasha B. Halasa, MD, MPH, Merck: Grant/Research Support

P-1394. Scenario Projections of Congenital Syphilis Cases in California, 2023–2030

Abstract Background The yearly number of congenital syphilis (CS) cases in California is at its highest point since 1950. We explored how efforts in California to 1) reduce syphilis cases; and 2) increase adequate syphilis treatment among infected pregnant persons could impact CS case projections through 2030. Yearly projected incidence by scenario comparing the baseline scenario to a 10% reduction in infections, 10% increase in treatment adequacy, and both interventions combined Methods We developed a scenario modeling framework to project CS incidence between 2023–2030 using California 2015–2022 surveillance data on CS cases and female syphilis cases of childbearing age (15–44 years). We compared a baseline scenario where existing trends continued without additional interventions to scenarios that considered 1) the impact of an absolute reduction of 2–10% in the rate of female syphilis cases per year; and 2) a 2–10% increase in the proportion of pregnant persons adequately treated for syphilis. Results A reduction in the absolute rate of female syphilis cases by 2–10% led to an 8–31% decrease in cumulative CS cases between 2023–2030. Increasing the proportion of pregnant persons adequately treated for syphilis by 2–10% over baseline led to a 1–8% decrease in cumulative CS cases. Combining both scenarios resulted in an 8–37% reduction in cumulative cases. Conclusion This model shows that to reduce CS case incidence in California, the most important upstream intervention is to reduce the rate of syphilis among females. To this end, syphilis screening and treatment among those who infect females must be improved. Additionally, even assuming no changes in syphilis incidence in females, CS cases could be reduced to a lesser extent by increasing the proportion of pregnant persons with syphilis who are adequately treated above current rates. The results of this study can inform syphilis screening and treatment recommendations, and the magnitude of future CS case reduction will depend on intervention scope and implementation. Disclosures All Authors: No reported disclosures

P-2021. How Have COVID-19 Treatment Guidelines and the Scientific Evidence Evolved throughout the Pandemic and Endemic Eras?

Abstract Background With progressive understanding of the natural history of COVID-19 and accumulation of knowledge on clinical management, treatment guidelines recommended several options including remdesivir (RDV), a broad-spectrum antiviral. Given the evolving nature of COVID-19, it is critical to capture the totality of scientific evidence to inform clinical decision making. We conducted a systematic literature review (SLR) to summarize the mortality endpoint for RDV among hospitalized adults throughout COVID-19 eras and contrasted with evidence informing treatment recommendations in clinical guidelines. Methods We systematically searched MEDLINE, Embase and Cochrane Library databases for interventional and observational studies examining RDV efficacy. Clinical trial registries, Cochrane COVID-19 Study Register, and conference abstracts were hand-searched (Fig1). Case reports and case studies were excluded. A review of most recent RDV recommendations across guidelines was conducted. Results From Dec ’19 to Dec ’22, 123 relevant publications were identified. In ’23, the evidence grew significantly, with 70 new publications. In total, 193 publications were evaluated, and 122 unique studies were included. While early randomized clinical trials (RCT) and small sample size observational studies did not universally demonstrate a significant difference in mortality in all severity groups of RDV-treated patients, real-world studies with larger sample sizes showed a significant impact across disease severity levels, regardless of COVID-19 era (Table1). Guideline recommendations for COVID-19 treatment with RDV are based on early RCTs (Table2) and most have not been updated (Fig2). Conclusion Our comprehensive evaluation of scientific literature indicates that evidence of RDV impact on mortality in hospitalized COVID-19 patients continued to grow and cover full range of disease severity. Guideline recommendations have not evolved in parallel which may explain differing recommendations in certain subgroups (e.g. IMV/ECMO). To assure that providers in the hospital setting are aware of and deploy evidence-based optimal care for patients with COVID-19, recommendations should rely on current evidence, including real-world data. Disclosures Essy Mozaffari, PharmD, MPH, MBA, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Michele Bartoletti, MD, PhD, Advan pharma: Advisor/Consultant|Advan pharma: Honoraria|Biomereux: Honoraria|Gilead: Advisor/Consultant|Gilead: Honoraria|Infectopharma: Advisor/Consultant|Msd: Advisor/Consultant|Msd: Grant/Research Support|Msd: Honoraria|Pfizer: Honoraria Alpesh N. Amin, MD, MBA, Alexion: Advisor/Consultant|Aseptiscope: Advisor/Consultant|AstraZeneca: Advisor/Consultant|Bayer: Advisor/Consultant|Dexcom: Advisor/Consultant|Eli Lilly: Advisor/Consultant|Ferring: Advisor/Consultant|Gilead: Advisor/Consultant|GSK: Advisor/Consultant|Heartrite: Advisor/Consultant|Nova Nordisk: Advisor/Consultant|Pfizer: Advisor/Consultant|Renibus: Advisor/Consultant|Reprieve: Advisor/Consultant|Salix: Advisor/Consultant|Seres: Advisor/Consultant|Spero: Advisor/Consultant Yohei Doi, MD, PhD, bioMerieux: Lecture fees|Entasis: Grant/Research Support|Fujifilm: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|GSK: Advisor/Consultant|KANTO CHEMICAL CO.,INC.: Grant/Research Support|KANTO CHEMICAL CO.,INC.: Patent for genotyping kit|MeijiSeika Pharma: Advisor/Consultant|Moderna: Advisor/Consultant|MSD: Lecture fees|Pfizer: Advisor/Consultant|Shionogi &amp; Co., Ltd.: Grant/Research Support|Shionogi &amp; Co., Ltd.: Lecture fees Paul LOUBET, MD, PhD, Astrazeneca: Advisor/Consultant|Gilead: Advisor/Consultant|Moderna: Advisor/Consultant|Pfizer: Advisor/Consultant Christina G. Rivera (O'Connor), Pharm.D, Gilead Sciences: Board Member Michael Roshon, MD/PhD, MD/PhD, Gilead: Honoraria Thomas F. Oppelt, PharmD, BCPS, Gilead Sciences, Inc: I am an employee of Gilead Sciences, Inc|Gilead Sciences, Inc: Stocks/Bonds (Public Company) Mel Chiang, Ph.D., Gilead Sciences: I am an employee of Gilead Sciences|Gilead Sciences: Stocks/Bonds (Public Company)

The Challenge of Managing Neuropathic Pain in Children and Adolescents with Cancer

Neuropathic pain (NP) is a common complication associated with some types of childhood cancer, mainly due to nerve compression, chronic post-surgical pain, chemotherapy, and radiotherapy. NP is usually less responsive to traditional analgesics, and there is generally a lack of evidence on its management in cancer patients, leading to recommendations often based on clinical trials conducted on other forms of non-malignant NP. In pediatric oncology, managing NP is still very challenging for physicians. Different factors contribute to increasing the risk of undertreatment: (a) children may be unable to describe the quality of pain; therefore, the risk for NP to be underestimated or remain unrecognized; (b) specific tools to diagnose NP have not been validated in children; (c) there is a lack of randomized clinical trials involving children, with most evidence being based on case series and case reports; (d) most drugs used for adult patients are not approved for childhood cancers, and drug regulation varies among different countries; (e) recommendations for pediatric pain treatment are still not available. In this paper, a multidisciplinary team will review the current literature regarding children with cancer-related NP to define the best possible diagnostic strategies (e.g., clinical and instrumental tests) and propose a therapeutic care pathway, including both non-pharmacological and pharmacological approaches, which could help pediatricians, oncologists, neurologists, and pain therapists in designing the most effective multidisciplinary approach.

Cutting Through Stigma: Suggested Best Practices for a Harm Reduction Approach to Nonsuicidal Self‐Injury

ABSTRACTFor many counselors, both topics of nonsuicidal self‐injury (NSSI) and harm reduction practices can feel intimidating and unclear. Yet, depending on the client, discussion of complete and immediate cessation from NSSI can feel impossible and isolating. This article combines harm reduction principles, a concept initially developed for addiction treatment, with select existing recommendations for NSSI treatment to offer a clinician's guide to best practices for harm reduction implementation with clients engaging in NSSI. By meeting clients where they are and offering a supportive space to brainstorm nontraditional treatment options, counselors can maintain the core principles of the American Counseling Association's Code of Ethics and limit the number of individuals who seek help through online sources. Ethical considerations and implications for counseling are included.

P-1591. Harnessing Artificial Intelligence for Rapid Interpretation of BCID2 Results: A Pre-Validation Study of a Generative Pre-trained Transformer (GPT)

Abstract Background Artificial intelligence (AI) has great potential to enhance patient care, but significant questions remain about implementation and safety. Antimicrobial stewardship programs (ASP) could leverage AI to assist with prospective audit and feedback (PAF) interventions such as interpretation of blood culture results and rapid optimization of antimicrobials. At our institution, PAF interventions are performed by the ASP as soon as possible when BioFire® Blood Culture Identification 2 Panel (BCID2) results are available. However, these interventions are time consuming and often delayed due to limited resources. To address this gap, we developed a Generative Pre-trained Transformer (GPT) tool to assist non-infectious disease (ID) providers with interpretation of BCID2 results. Herein, we aim to describe the process of training the GPT and report pilot study results of the tool’s accuracy compared with ASP recommendations. Methods Using OpenAI’s GPT-4.0, our GPT was trained to synthesize patient-specific treatment advice by analyzing BCID2 results and anonymized patient data. Training focused on applying local as well as national evidence-based recommendations for the management of bacteremia, and providing feedback to the GPT when errors were recognized. A scoring rubric was designed to compare GPT treatment recommendations to gold standard ASP recommendations for the management of bacteremia (Figure 1). An independent infectious disease expert reviewer applied the rubric to determine the accuracy of the GPTs recommendations. Results Five cases of bacteremia were retrospectively reviewed. The GPT recommendations were 67% concordant with best practices, compared to 93% for the ASP (Table 1). Conclusion In this pilot study, a GPT was trained to interpret and manage bacteremia and achieved 67% concordance with best practices. Although inferior to ASP recommendations, GPT is a promising AI tool that warrants further investigation to aid in ASP interventions. Our GPT has been retrained based on our findings, and a larger prospective validation study is underway. Disclosures Daniel Tassone, PharmD, BCIDP, Merck: Honoraria

Nanotechnology and Artificial Intelligence in Dyslipidemia Management—Cardiovascular Disease: Advances, Challenges, and Future Perspectives

This narrative review explores emerging technologies in dyslipidemia management, focusing on nanotechnology and artificial intelligence (AI). It examines the current treatment recommendations and contrasts them with the future prospects enabled by these innovations. Nanotechnology shows significant potential in enhancing drug delivery systems, enabling more targeted and efficient lipid-lowering therapies. In parallel, AI offers advancements in diagnostics, cardiovascular risk prediction, and personalized treatment strategies. AI-based decision support systems and machine learning algorithms are particularly promising for analyzing large datasets and delivering evidence-based recommendations. Together, these technologies hold the potential to revolutionize dyslipidemia management, improving outcomes and optimizing patient care. In addition, this review covers key topics such as cardiovascular disease biomarkers and risk factors, providing insights into the current methods for assessing cardiovascular risk. It also discusses the current understanding of dyslipidemia, including pathophysiology and clinical management. Together, these insights and technologies hold the potential to revolutionize dyslipidemia management, improving outcomes and optimizing patient care.

P-993. Increased Reporting of RPR Seronegative Infants with Congenital Syphilis to the Chicago Department of Public Health, A Quality Improvement Project

Abstract Background We are in the midst of an epidemic of congenital syphilis (CS). Nationwide CS diagnosis and treatment recommendations provided by the Centers for Disease Control are dependent on the timing of maternal treatment, and laboratory and procedural results of the mother and infants. There are specific circumstances where infants with a non-reactive rapid plasma reagin (RPR-) should receive a 10-day course of treatment in the context of inadequate maternal treatment. Depending on the institutional reporting practices of CS to departments of public health, there may be scenarios where RPR-based reporting protocols will leave out this specific cohort. Methods Baseline data of Infants stratified by RPR status was collected through electronic medical record (EMR) review for those born at the University of Chicago Comer Children’s Hospital in Chicago, IL between January 2011 and December 2022, using billing codes &amp; penicillin administration data. From September 1st, 2023, through March 31st, 2024, a quality improvement intervention was implemented that involved communicating with the hospital’s Pediatric Infectious Diseases specialists, Pediatric &amp; Newborn Hospitalists, Neonatologists, Infection Prevention &amp; Control, and Chicago Department of Public Health (CDPH). The intervention components included 1) formalize expectation to page Pediatric ID on-call team all infants with concern for maternal syphilis exposure, 2) create an Epic Smart Phrase to standardize data presentation for clinical and reporting purposes, 3) standardize ICD-10 diagnosis coding practices, and 4)email reminders monthly to teams involved. Results 154 infants were identified who had a CDC case definition of CS and received penicillin administration therapy. Infants with CS from 2011-2022 showed 107/154 (69.4%) were RPR- and 41/154 (26.6%) were RPR- and received &amp;gt; 1 day of penicillin. At the end of the first PDSA cycle, a total of 22 infants were reported to CDPH with 36% (n=8) being RPR-. Conclusion Our Quality Improvement project identified a large percentage of infants diagnosed and treated with CS who were not reported to the CDPH with our previous RPR-positive – based reporting strategy. We implemented an intervention that successfully improved reporting of this specific type of patient. Disclosures Allison H. Bartlett, MD, MS, CVS/Caremark: Advisor/Consultant

Exploring the Social Media Discussion of Breast Cancer Treatment Choices: Quantitative Natural Language Processing Study.

Early-stage breast cancer has the complex challenge of carrying a favorable prognosis with multiple treatment options, including breast-conserving surgery (BCS) or mastectomy. Social media is increasingly used as a source of information and as a decision tool for patients, and awareness of these conversations is important for patient counseling. The goal of this study was to compare sentiments and associated emotions in social media discussions surrounding BCS and mastectomy using natural language processing (NLP). Reddit posts and comments from the Reddit subreddit r/breastcancer and associated metadata were collected using pushshift.io. Overall, 105,231 paragraphs across 59,416 posts and comments from 2011 to 2021 were collected and analyzed. Paragraphs were processed through the Apache Clinical Text Analysis Knowledge Extraction System and identified as discussing BCS or mastectomy based on physician-defined Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) concepts. Paragraphs were analyzed with a VADER (Valence Aware Dictionary for Sentiment Reasoning) compound sentiment score (ranging from -1 to 1, corresponding to negativity or positivity) and GoEmotions scores (0-1) corresponding to the intensity of 27 different emotions and neutrality. Of the 105,231 paragraphs, there were 7306 (6.94% of those analyzed) paragraphs mentioning BCS and mastectomy (2729 and 5476, respectively). Discussion of both increased over time, with BCS outpacing mastectomy. The median sentiment score for all discussions analyzed in aggregate became more positive over time. In specific analyses by topic, positive sentiments for discussions with mastectomy mentions increased over time; however, discussions with BCS-specific mentions did not show a similar trend and remained overall neutral. Compared to BCS, conversations about mastectomy tended to have more positive sentiments. The most commonly identified emotions included neutrality, gratitude, caring, approval, and optimism. Anger, annoyance, disappointment, disgust, and joy increased for BCS over time. Patients are increasingly participating in breast cancer therapy discussions with a web-based community. While discussions surrounding mastectomy became increasingly positive, BCS discussions did not show the same trend. This mirrors national clinical trends in the United States, with the increasing use of mastectomy over BCS in early-stage breast cancer. Recognizing sentiments and emotions surrounding the decision-making process can facilitate patient-centric and emotionally sensitive treatment recommendations.

Interplay between depression and sexuality

Disorders of sexual function are afrequent comorbidity of depression and have complex interactions on psychological, sexual and relationship qualities. To determine the prevalence of sexual functional disorders in depressed patients, the effects of antidepressant drugs and development of treatment recommendations. Evaluation of the current literature and discussion of fundamental studies. Depression and sexual dysfunction frequently affect each other in complex ways which makes it important to address interpersonal relationship dynamics and to include these in the therapy. The use of serotonergic antidepressants can greatly increase the risk for sexual dysfunction by up to 27times. In addition to (couples) therapeutic interventions, reducing the dose or switching medications to, e.g., bupropion or using additive medications can also be treatment options. Despite the shame associated with the topic, it is crucial for therapists to address sexual topics early and openly. Relationship dynamics should be considered during therapy. If antidepressant medications are used it is recommended to provide a more detailed clarification for patients about their potential sexual side effects and their limited treatment options before starting the medication.

Prevalence of cardiometabolic co-morbidities in patients with vs persons without chronic hepatitis B: The FitLiver cohort study.

Chronic hepatitis B (CHB) affects > 300 million people worldwide. The combination of CHB and cardiometabolic co-morbidities increases the risk of liver-related morbidity and mortality. However, international guidelines for CHB treatment do not provide recommendations for follow-up examinations or treatment of patients with CHB and cardiometabolic comorbidities. In studies investigating cardiometabolic co-morbidity in patients with CHB, inconsistent findings have been observed, and both lower and higher prevalence of cardiometabolic co-morbidities compared to the general population have been reported. It is unclear whether patients with CHB living in Denmark have an increased prevalence of cardiometabolic co-morbidities. To investigate the prevalence of cardiometabolic comorbidities in patients with CHB and matched non-CHB comparison group. We examined patients with CHB and age-, sex-, body mass index (BMI)-, and country-of-birth matched comparison group. Defining cardiometabolic co-morbidity: Obesity (BMI > 25 kg/m2/abnormal waist-to-hip ratio), metabolic dysfunction-associated steatotic liver disease (MASLD), hypercholesterolemia (total-cholesterol > 5 mmol/L/statin use), hypertension (systolic ≥ 135 mmHg/ diastolic ≥ 85 mmHg/antihypertensive medication) and type 2 diabetes (T2D) (2-hour oral glucose tolerance test glucose > 11.1 mmol/L/HbA1c > 48 mmol/mol/ antidiabetic medication). Physical activity was evaluated using maximal oxygen consumption (VO2max), activity monitors, and a questionnaire. We included 98 patients with CHB and 49 persons in the comparison group. The two groups were well-matched, showing no significant differences in age, sex, BMI, country-of-birth, education, or employment. Among patients with CHB, the following prevalence of cardiometabolic co-morbidity was found: 77% were obese, 45% had MASLD, 38% had hypercholesterolemia, 26% had hypertension, and 7% had T2D, which did not differ significantly from the comparison group, apart from lower prevalence of hemoglobin A1c (HbA1c) ≥ 48 mmol/L or known T2D. Both groups had low VO2max of 27 mL/kg/minute in the patients with CHB and 30 mL/kg/minute in the comparison group, and the patients with CHB had a shorter self-assessed sitting time. The patients with CHB and the comparison group were well-matched and had a similar prevalence of cardiometabolic comorbidities. Furthermore, both groups had low levels of physical fitness.

O-03 DELAYED PUBERTY AND GIANT PROLACTINOMA IN A 14-YEAR-OLD GIRL WITH A HISTORY OF ANOREXIA NERVOSA

Abstract Introduction Giant prolactinomas are rare, especially in children and adolescents and often resistant to the recommended first-line cabergoline monotherapy. In addition, possible second line guideline treatment recommendations (surgery, radiotherapy, temozolomide) are not suitable. Clinical Case A 14-year-old girl (51kg/155,7cm/BMI 18.4 kg/m2, bone age 14.37) was referred to pediatric endocrinologist because of primary amenorrhea and delayed puberty. Two years earlier, she underwent a brief episode of anorectic behavior (rapid weight loss of 15.4 kg) but recovered before the age of 14. Results Clinical examination was normal, excluding Tanner stage M2P3. No galactorrhea was evident. Laboratory work-up revealed hyperprolactinemia (S-PRL 26 817 mU/l (86-324)). Estradiol and gonadotropins were consistent with the pubertal stage (S-Estdiol 0.02 nmol/l; S-FSH 3.2 U/l, S-LH &amp;lt;1.0 U/l). Thyroid function and cortisol secretion (P-Corsol 411 nmol/l, P-ACTH 21 ng/l) were normal, but S-TPOAb elevated at 350 kU/l (&amp;lt;34 kU/l). Genetic testing for AIP, MEN1, GNAS1, MAX, SDHA, SDHC, SDHD, SDHAF2, PRKAR1a mutations was negative. Abdominal ultrasound revealed a small uterus. Brain MRI showed a giant prolactinoma, (21x30x40 mm; Fig. 1A) which extended to the dorsum sellae, infiltrated the left cavernous sinus, filled the suprasellar cistern compressed the optic chiasm. Neuro-ophthalmological examination; visual acuity, fields was normal. Prolactin level was repeatedly high (30 210 mU/l; 78% (23 672 mU/l) biologically active. The patient was put on cabergoline (0,5mg/week) and the dose was doubled one month later as the prolactin remained high (14 509 mU/l). Tumor size was unchanged on 4 months follow-up MRI. The case was discussed at the multidisciplinary pituitary tumor board. Neither surgery nor radiotherapy were recommended and temozolomide was unsuitable. Cabergoline was increased to 1,5mg/week. At 5 months, the patient had primary hypothyroidism (P-TSH 5,00 mU/l, free-T4 11; S-PRL 4509 mU/l) and was put on L-T4 (50µg/day). 11C-methionine PET/MRI demonstrated significant uptake throughout the tumor tissue. Tumor size had decreased slightly. Cabergoline was increased to 3mg/week; 11 months after initiation of the treatment, S-PRL had decreased to 4800mU/l. Though no clinical signs of puberty were evident, estradiol and gonadotropin levels had risen (S-Estdiol 0.21 nmol/l, LH 18 IU/l, FSH 7.4 IU/l). Cabergoline was increased to 3.5mg/week. After 13 months of treatment, S-PRL was 3523, S-Estdiol 0.08, FSH 5.9, LH 7.7, TSH 0.08, free-T4 17. Cabergoline was increased to 4mg/week. Next examination, including MRI and laboratory tests, is scheduled 2 months later. Conclusion Treatment of adolescents with giant prolactinoma is challenging. There is an unmet need for second line tailored treatments, such as combined D2 and SST2&amp;5 receptor agonist therapy (cabergoline+pasireotide), which, for this case, is the planned second line experimental treatment.Figure 1:

'Diagnosis and Treatment of Hypersensitivity Pneumonitis' S2k Guideline of the German Respiratory Society and the German Society for Allergology and Clinical Immunology.

German recommendations for the diagnosis of hypersensitivity pneumonitis (HP), also known as extrinsic allergic alveolitis (EAA), were last published in 2007 [1]. The current S2k Guideline for the Diagnosis and Treatment of Hypersensitivity Pneumonitis (HP) replaces these diagnostic recommendations. They were supplemented by the aspect of chronic, and in particular of the chronic fibrotic phenotype of HP, and also, as first HP guideline, include treatment recommendations. Based on current scientific evidence and on expert opinion 12 consensus recommendations were developed. They include important statements summarizing the diagnostic process, the treatment indication and therapeutic strategies for patients with HP. Particular emphasis was placed on the different clinical courses (acute and chronic) and their characteristics (inflammatory and/or fibrotic pattern), which present differential diagnostic challenges and ultimately result in different treatment approaches. In addition to general information (diagnosis, classification, clinical disease course, epidemiology, pathogenesis, risk factors, prognosis and special aspects associated with occupational disease), the guideline will present the various clinical disease entities of HP, some in detail, others in tabular form. A major focus is on the various diagnostic steps and the different treatment approaches. The background information serves to provide a deeper understanding and inform the implementation of the recommendations. In particular, other current international guidelines for the diagnosis of HP as well as German guidelines for the diagnosis of Interstitial lung diseases (ILDs) (Leitlinien zur Diagnostik interstitieller Lungenerkrankungen) in general and for the pharmacotherapy of fibrotic ILDs were integrated and considered in this guideline [2-6].

Evaluation of the evidence-based practices for the management of PCOS in the Latin America context: the consensus of the Latin American Association of Gynecological Endocrinology (ALEG)

Objectives Polycystic Ovary Syndrome (PCOS) is a complex condition affecting approximately 1 in 10 women of reproductive age. However, limited data are available regarding the specific characteristics and needs of women with PCOS in Latin America. This consensus sought to evaluate the evidence-based practices for the management of PCOS for Latin American populations, consolidate regional insights, identify eventual gaps in implementation and identify key research opportunities. Methods Using the Delphi strategy, experts from various Latin American countries selected and reviewed a subset of recommendations from the 2023 International Evidence-Based Guideline (EBG) for the Assessment and Management of PCOS. Virtual and in-person meetings facilitated discussions on the selected recommendations, followed by voting rounds to achieve consensus. Results A total of 33 recommendations for PCOS diagnosis and treatment were evaluated. In the initial voting round, 25 recommendations achieved strong agreement (80%–100% support), while eight received less than 80% agreement. After further discussions on their relevance and potential to influence behavior change among health professionals and public health policies, the remaining recommendations achieved near-unanimous support in the second round. Conclusions This consensus underscored evidence-based practices for PCOS diagnosis and treatment deemed appropriate for the Latin American context. It also highlighted implementation barriers such as cost and accessibility, while identifying opportunities for research to improve PCOS management and address regional challenges. These findings aim to enhance clinical care and inform public health strategies tailored to the needs of Latin American women living with PCOS.

Psoriasis-Arthritis: Update der EULAR-Empfehlungen

Objective: New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA. Methods: Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined. Results: The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed. Conclusion: These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.