University Of Mississippi Medical Center Research Articles

High risk of psychological disorders: anxiety and depression in adolescent girls with polycystic ovary syndrome

Study objective: This study is aimed to assess the prevalence of psychological disorders among different racial/ethnic group of normal weight and overweight adolescents with polycystic ovary syndrome (PCOS)from a state in southeastern US. Design, setting, and participants: The data of 157,459 adolescents were collected through “the Patient Cohort Explorer” system at the University of Mississippi Medical Center (UMMC) from January 2013 to December 2019.Unidentified patients were searched with diagnosis code for PCOS, age, race/ethnicity, and associated diagnosis including weight gain, anxiety, depression, ADHD, and behavioral concerns. Interventions: None. Main outcome measures: Prevalence of PCOS and psychological disorders. Results: A total of 712 adolescents with PCOS were diagnosed in clinics during the period of study. Collected data indicated that prevalence of PCOS in adolescents seen in clinics was less than 1% with no significant difference by race or ethnicity. Almost 45% of patients suffered from one or more psychological disorders. (Anxiety: 18%, Depression: 16%, ADHD: 9%). Conclusions: Results from this study provide the first evidence of prevalence of PCOS and psychological disorders in adolescents with PCOS in a southern state. Our findings of a high prevalence of psychological disorders suggest that early screening for mental health symptoms must be considered during primary care clinical assessment of adolescents with PCOS. Left undiagnosed and/or untreated, chronic anxiety and depression may exacerbate mental health issues in this vulnerable population.

Abstract B21: Factors affecting outcomes in patients with squamous cell carcinoma of oropharynx

Abstract Objective: To study factors affecting outcomes such as overall survival (OS) and locoregional control (LRC), in patients with squamous cell carcinomas of oropharynx treated with definitive radiation therapy (RT), with or without concurrent chemotherapy. Method: Retrospective analysis of 83 patients with squamous cell carcinoma of oropharynx treated with definitive radiation therapy at University of Mississippi Medical Center. All patients were treated to 70 Gy utilizing intensity-modulated radiation treatment. Stage III and IV patients also received concurrent chemotherapy with weekly cisplatin. Chi-square test was used to test the goodness of fit, OS and LRC comparing races were generated by using log rank test and Kaplan-Meier method. The covariables associated with the OS and LRC were determined by multivariate Cox regression model. Hazards ratio (HR) was used to estimate time to event outcome with associated 95% confidence intervals (CIs) and P values. Median follow-up for the entire group was 39 months. Results: Of the total 83 eligible patients 51.8% were black, 48.5% were white, and 2.4% wee other. Stage distribution (per American Joint Committee on Cancer-AJCC 7th Ed) between blacks vs. whites for Stage I and II was 50% vs. 50%; for Stage III, 41.6% vs. 58.3%; and for Stage IV, 55.2% vs. 41.8%. In the univariate analysis, insurance, HPV/p16, body mass index (BMI), and race are the variables that affected the outcomes. In the multivariate analysis, HPV/p16, BMI, race, and tonsil subsite are shown to be significant. Age, gender, income level, employment, distance from facility, smoking, alcohol, and marital status are not shown to be significant. LRC for black patients was 49% vs. 72% in white patients (P = 0.022). Three-year OS for black patients was 49.2% vs. 66% for white patients (P = 0.010). HR for black patients was 0.13 with 95% CI 0.03- 0.61 (P= 0.009); HR for white patients was 0.24 with 95% CI 0.56- 1.06 (P= 0.061). OS for Stage IV black patients was 28% vs. 82% for white patients (P=0.006). In this cohort, HPV/p16 black positive patients were 75%, black negative 33%, white positive 87%, and white negative 50%, respectively. HR for HPV/p16 positive was 0.23 with 95% CI 0.07-0.71(P = 0.01). HR for tonsil subsite was 0.37 with 95% CI 0.15-0.91 (P=0.031). HR for BMI was 5.27 with 95% CI 1.79-15.5 (P = 0.003). The race, HPV/p16, BMI, and tonsil subsite were all independently associated with worse OS on multivariate analysis. HR for black patients was 0.16 with 95% CI 0.03-0.73 (P= 0.019), HR for HPV/p16 positive was 0.24 with 95% CI 0.07-0.73 (P = 0.013), HR for tonsil subsite was 0.41 with 95% CI 0.17-0.99 (P = 0.048), and HR for BMI was 5.59 with 95% CI 1.90-16.39 (P= 0.002). Race, HPV/p16, BMI, and tonsil subsite were all independently associated with worse locoregional failure on multivariate analysis. Conclusion: Among all the covariables examined, race, HPV/p16 status, BMI, and tonsil subsite were shown to be affecting the locoregional and overall survival outcomes. Racial factor appears to be more significant in patients with Stage IV disease. Citation Format: Mary R. Nittala, Eldrin Bhanat, Srinivasn Vijayakumar, Madhava R. Kanakamedala. Factors affecting outcomes in patients with squamous cell carcinoma of oropharynx [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B21.

4146 Establishment of Screening Methods for G6DP Deficiency – Translational and Clinical Applications

OBJECTIVES/GOALS: To develop feasible screening methods for activity of the enzyme Glucose-6-phosphate dehydrogenase (G6PD) with point of care applicability. METHODS/STUDY POPULATION: Current knowledge establishes the relevance of G6PD as a critical therapeutic determinant for effective antimalarial therapy due to the occurrence of mutations that lead to post-treatment severe adverse effects. We present our findings on development of cost effective point-of-care screening methodologies to ascertain G6PD deficiency. RESULTS/ANTICIPATED RESULTS: Using Patient Cohort Explorer and data from the Department of Pathology, we established the prevalence of G6PD deficiency at the University of Mississippi Medical Center, Jackson, MS as high as 11.8% (African-American males in all population, n = 2518). Next, for selection of potential target groups, we set up a protocol for recruitment of volunteers based on ethnic background, parental ethnicity, and medical history. G6PD activity was evaluated using point of care methods [Trinity Biotech test or CareSTART Biosensor], and Gold Standard quantitative spectrophotometric assay (LabCorp). Determinations in >20 subjects have showed comparable concordance. If used with a conservative interpretation of the signal, the Trinity Biotech test showed superior potential for use in the field relative to the CareSTART Biosensor. DISCUSSION/SIGNIFICANCE OF IMPACT: We established the prevalence of G6PD deficiency in our medical center. We have also setup tests for point-of-care assessment of G6PD. Pending evaluation of the relative tests performance, we will be in position to screen individuals and select them for a prospective clinical trial to evaluate the safety of antimalarial agents on scope of G6PD deficiency.

AJP-Regulatory, Integrative and Comparative Physiology: Looking Toward the Future

<i>AJP-Regulatory, Integrative and Comparative Physiology</i>: Looking Toward the Future

Do Undergraduate Choices Predict Medical Gross Anatomy Performance?

A 2019 study conducted by Robertson et al. suggested that the amount of prior anatomy experience does not predict the performance of first‐year medical students in medical gross anatomy at the University of Mississippi Medical Center (UMMC). In recent years, it has not been possible for UMMC to accept non‐state residents to its medical program. Thus, nearly seventy‐five percent of first‐year medical students matriculate from one of five major in‐state institutions. At current writing, four of the five schools directly communicate with the UMMC admissions program regarding the relationship between their courses and UMMC’s specific institutional mission. First‐year students enter UMMC with a wide range of previous undergraduate and graduate degrees. The undergraduate choices investigated were which institution(s) students attended, what type and how many degree(s) they attained, and whether they took an anatomy course prior to attending UMMC. We hypothesized 1) that undergraduate degree does not predict performance in a medical gross anatomy course, 2) individuals with science majors are more likely to have prior anatomy experience, 3) the collaboration of the previous institution with UMMC does not predict performance in a medical gross anatomy course, and 4) students from Mississippi College who have prior anatomy experience will perform better in the medical gross course at UMMC. Mississippi College implements a gross anatomy curriculum that is nearly identical to the course taught at UMMC. Data was collected from 280 first‐year medical students at UMMC in the fall of 2016 and fall of 2017. Using a self‐reported survey, data was collected on the number and type of prior degrees and prior anatomy experience. The course director provided student performance data in the medical gross anatomy course. The office of admissions of the medical school confirmed the prior degrees and previous academic institutions of the students. Quantitative analysis was used to determine the validity of the research hypotheses. The results of this study could provide additional guidance to undergraduate students during the degree selection process prior to applying to medical school.

Medical Students’ Fear of Death in a Gross Anatomy Course with Cadaveric Dissection

BackgroundPrior research suggests that medical students with higher fear of death are more likely to feel that providing care to terminally ill patients would have a negative personal impact. This negative perception concerning end‐of‐life care may carry into students’ careers as clinicians. Previous studies have shown that physicians with higher fear of death reported more difficulty in end‐of‐life communication and decision‐making. Because cadaveric dissection serves as an important introduction to death and dying issues, it is important to understand how this experience relates to students’ fear of death.AimThe current study aimed to identify which demographic characteristics are associated with medical student fear of death and describe how fear of death changes throughout the duration of a gross anatomy course with cadaveric dissection.MethodsProcedures were carried out according to the protocol approved by the Institutional Review Board of the University of Mississippi Medical Center (IRB # 2018‐0221) and informed consent was obtained from all participants. First year medical gross anatomy students’ were surveyed during the fall semester of 2019. Fear of death was surveyed using sixteen items from three subscales of the Multidimensional Fear of Death Scale (MFODS): Fear of the Dead (6 items), Fear of Being Destroyed (4 items), and Fear for the Body After Death (6 items). For each item, students use a Likert type scale to select the degree to which they agree or disagree with the statement, with lower scores indicating a higher fear of death. Baseline fear of death scores and demographic data (age, gender, undergraduate GPA, MCAT, and prior anatomy experience) were collected on the first day of the course, prior to beginning cadaveric dissection. These baseline scores were then correlated to demographics. To determine how fear of death changed throughout the course, the MFODS was also given at each of the four block examinations. This data was analyzed using repeated measures ANOVA.ResultsOf the 170 students invited to participate, 143 (84.1%) completed the baseline survey. Of those students, 57.3% had a prior anatomy experience while only 25.2% had prior exposure to cadavers. At the time of the baseline survey, average scores for the MFODS subscales were: Fear of the Dead (20.13 out of 30); Fear of Being Destroyed (13.57 out of 20); Fear for the Body After Death (22.99 out of 30). Complete data is currently being collected and analyzed.DiscussionResults of this study will determine if medical students’ fear of death is associated with specific demographic characteristics and how fear of death changes throughout a gross anatomy course. Understanding these relationships will allow instructors to implement interventions to support students with higher fear of death and identify a time point at which an intervention would be most beneficial. Ultimately, this would provide another means to support medical students and train physicians who are well equipped to handle end‐of‐life issues.

A Cancer Center and Research Institute at the University of Mississippi Medical Center.

A Cancer Center and Research Institute at the University of Mississippi Medical Center.

The Role of Public Health Partnerships in the Success of the Jackson Heart Study Undergraduate Training and Education Center.

The Jackson Heart Study (JHS) is a single-site prospective epidemiologic investigation of cardiovascular disease (CVD) among African Americans from the central Jackson, Mississippi area. The study is a collaboration between Jackson State University (JSU), University of Mississippi Medical Center (UMMC), Tougaloo College (TC), and the Mississippi State Department of Health (MSDH). The JHS Undergraduate Training and Education Center (JHSUTEC) at TC was developed to increase the numbers of college-aged African American students entering public health and health-related fields. To achieve this goal, the UTEC designed the Jackson Heart Study (JHS) Scholars program. JHS Scholars are required to take additional classes and participate in public health and/or biomedical research. The scholars engage in research locally during the academic year. However, many scholars participate in research outside of the Jackson Metropolitan area during the summer. Because of this, national collaborators were needed to act as mentors and hosts. Since the inception of the JHSUTEC, more than 15 collaborations have been formed that have shared resources and student successes. As of May 2018, more than150 students have successfully completed the JHS Scholars program and many have continued into careers in public health, biomedical research, and medicine. Since 2004, JHS scholars have published 29 papers and 15 scholars have received diversity supplements. Collaborative activities and public health partnerships have contributed to the success of the JHSUTEC program and have served as a pathway of entry into STEM fields for minority students.

Research Highlights

Daniel Zieman, BA, University of South Alabama College of Medicine, Mobile, AL. Caroline Doo, MD, Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, MS. Vinayak K. Nahar, MD, PhD, MS, FRSPH, Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, and Department of Preventive Medicine, School of Medicine/John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS. The authors declare no conflict of interest. Correspondence concerning this article should be addressed to Vinayak K. Nahar, MD, PhD, MS, FRSPH, Department of Dermatology, School of Medicine, University of Mississippi Medical Center, 2500 North State Street–L216, Jackson, MS 39216. E-mail: [email protected]; [email protected]

Editorial.

The year 2020 has been designated as the “Year of the Nurse and Midwife” by the World Health Organization, in honor of the 200th anniversary of the birth of Florence Nightingale. Although midwives are only occasionally involved in the care of individuals with MS, the essential role of nursing professionals in the comprehensive management of the disease cannot be overemphasized. Indeed, nurses are often at the forefront, ensuring optimal continuity and coordination of care and providing ongoing communication with the patients and their families, and with other health care professionals. While we have been publishing articles specifically dedicated to nursing research and nursing practice in IJMSC, I do hope to see more submissions from our nurse colleagues in 2020.The article selected for continuing education credits in this issue focuses on an alternative treatment used and contemplated by some people with MS: helminth immunotherapy. Along with increasingly potent disease-modifying therapies targeting the immune system, other less conventional treatment avenues are being proposed, and are often the source of heated discussions on public online forums. Our patients expect us to educate them about all options available, yet the evidence regarding alternative treatments is often limited or conflicting. Donkers and colleagues give us insight into patients' thoughts about helminth immunotherapy, which is an important first step in fostering better conversations and educational opportunities.Outcome measurement is an increasingly common discussion topic in clinical practice nowadays. Two articles in this issue reflect ongoing work on the validity and clinical relevance of outcome scales in MS, whether they are clinician-administered such as the Expanded Disability Status Scale (Alonso and colleagues) or self-administered such as the Multiple Sclerosis Self-Management Scale–Revised (Saadat and colleagues).I often explain to health care professionals in training that a diagnosis of MS does not describe the impact of the disease on a person's daily activities. The study by Goverover and colleagues reminds us of the pervasive decrease in activity participation experienced by patients with MS and of the association between neurologic deficits (such as motor and cognitive impairment) and comorbidities (such as depression) and these limitations. Fortunately, we also know that physical activity and exercise can help fight the consequences of MS, as illustrated by the articles from Canning and Hicks and from Kasser and colleagues. Another common consequence of MS is chronic pain. The results from the randomized controlled trial of cognitive behavioral therapy reported by Gromisch and colleagues suggest that this therapy could be a useful intervention, at a time when nonpharmacologic interventions for chronic pain management are increasingly sought after.I am delighted to announce that Dr. Alissa Willis, Chair of the Department of Neurology at the University of Mississippi Medical Center, has joined our editorial team as Associate Editor starting January 2020 after having served as a board member for many years. Our entire team wishes you a happy and fulfilling year.

Promises Unbroken: A Commitment to Diversity and Inclusion at the University of Mississippi Medical Center.

Promises Unbroken: A Commitment to Diversity and Inclusion at the University of Mississippi Medical Center.

Continuing the Vision at the University of Mississippi Medical Center.

Continuing the Vision at the University of Mississippi Medical Center.

Acute kidney injury associated with preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome.

To determine the prevalence of acute kidney injury (AKI), placental abruption and postpartum hemorrhage in patients with preeclampsia or HELLP syndrome. A retrospective study of patients with preeclampsia or HELLP syndrome treated at the University of Mississippi Medical Center from January 2000 through December 2010. Relationships among the obstetric complications of placental abruption, postpartum hemorrhage, and AKI (serum creatinine >107µmol/L) of women with preeclampsia or HELLP syndrome. Additional analysis was undertaken to explore if there was a correlation between postpartum hemorrhage/placental abruption and the severity of HELLP syndrome according to the Mississippi classification system. Data from 1276 women over 11years were included in the analysis. 67 of 466 patients (14.4%) with HELLP syndrome and 38 of 810 preeclampsia patients (4.7%) met criteria for AKI. Women with either placental abruption or postpartum hemorrhage had statistically significant increased odds of also having AKI (p<0.01). Women with HELLP and AKI were also more likely to experience either placental abruption or postpartum hemorrhage. Women with Class 1 HELLP with placental abruption or postpartum hemorrhage were also more likely to have AKI than women with preeclampsia. HELLP syndrome, AKI and placental abruption or postpartum hemorrhage appear to be interrelated. AKI occurs more frequently in women with HELLP syndrome with or without associated postpartum hemorrhage and placental abruption.

The University of Mississippi Medical Center's Path for Quality Improvement.

The University of Mississippi Medical Center's Path for Quality Improvement.

In Memoriam

HomeHypertensionVol. 75, No. 1In Memoriam Free AccessObituaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessObituaryPDF/EPUBIn MemoriamGerry McAlpin Trudie J. Meyer Trudie J. MeyerTrudie J. Meyer Correspondence to Trudie Meyer, Hypertension Managing Editor, American Heart Association National Center, 7272 Greenville Ave, Dallas, TX 75231. Email E-mail Address: [email protected] Managing Editor, Hypertension Search for more papers by this author Originally published2 Dec 2019https://doi.org/10.1161/HYPERTENSIONAHA.119.14365Hypertension. 2020;75:5Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: December 2, 2019: Ahead of Print It is with a heavy heart I report that Gerry McAlpin, Hypertension’s Assistant Managing Editor and longtime Hypertension employee, passed away very unexpectedly on October 24, 2019.Gerry began working for Hypertension in 2002 as Managing Editor with Dr John Hall as Editor-in-Chief. When Dr Hall finished his final term in 2012, Gerry kept her position at the University of Mississippi Medical Center next to Dr Hall, and simultaneously worked part-time for Hypertension as an Assistant Managing Editor under new Editor-in-Chief Anna Dominiczak and Managing Editor Denise Kuo. Gerry recently retired from the University of Mississippi Medical Center and her many years of service beside Dr Hall and moved to Tennessee to be closer to her sister’s family and to aid in the care of her aging mother.Download figureDownload PowerPointDr Hall had the following remembrances of Gerry:“I had the great privilege of working closely with Gerry for over 20 years. I admired her steady, calm professionalism, her intelligence, her superb technical expertise and especially her integrity. She served as the lead administrator for our Department of Physiology and Biophysics and then as Managing Editor of the American Journal of Physiology: Regulatory, Integrative and Comparative Physiology, from 1996 to 2001, and as Managing Editor of Hypertension from 2002 to 2012. We were extremely fortunate to benefit from Gerry’s expertise during the transition of both journals from cumbersome and inefficient systems for submission and review of hard-copy manuscripts (including a reviewer database that consisted mainly of 3 x 5 cards and the editor’s memory) to modern online, electronic processes. Most of us had no idea how to do this. The editors, editor assistants, and many of the authors and reviewers needed quite a bit of tutoring from Gerry. She was patient and unflappable and led us into a highly efficient and effective process for electronic submission as well as rapid review and publishing of manuscripts. Gerry was a reserved and humble person, a valued colleague, and a friend to those who had the privilege of getting to know her. Thank you Gerry. We will remember.”When I transitioned to Hypertension as Managing Editor just over a year ago, Gerry was extremely generous with her time and expertise to help the journal and myself succeed in any way she could. She was a steady and knowledgeable guide always supporting her colleagues and co-workers, Stephanie Allbritton and Renata Gil, at Hypertension. I think I speak for the Hypertension Editorial Office and the AHA journal portfolio when we say Gerry’s experience, guidance, sense of humor, honesty, and long tenure with the AHA journals will be deeply missed.On first glance, you may not expect it, but Gerry was always down for an adventure. She loved to travel and scuba dive. I am told she made a cheesecake so delicious that it made decent churchgoers argue over her last piece at a church event, resulting in a tug-of-war struggle with the cheesecake ending up on the floor. Knowing it was too good for the garbage, they quickly scooped it off the floor and decided maybe it would be better to share.Gerry is survived by her mother, Lena McAlpin; sister and brother in-law Tracie and Shane Woidtke; niece and nephew Skyler and Knox Woidtke; many cousins, 2 aunts and an uncle.Please join us in thinking of her family and our Hypertension Editorial Office as we mourn our friend and colleague.Trudie J. MeyerManaging Editor, HypertensionAcknowledgmentsThank you to Jonathan Schultz, Stephanie Allbritton and Renata Gil for draft review.FootnotesCorrespondence to Trudie Meyer, Hypertension Managing Editor, American Heart Association National Center, 7272 Greenville Ave, Dallas, TX 75231. Email trudie.[email protected]org Previous Back to top Next FiguresReferencesRelatedDetails January 2020Vol 75, Issue 1 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.119.14365PMID: 31786972 Originally publishedDecember 2, 2019 PDF download Advertisement

A Multicenter Study Evaluating Perceptions and Knowledge of Inpatient Glycemic Control Among Resident Physicians: Analyzing Themes to Inform and Improve Care

Objective: In this descriptive study, we evaluated perceptions and knowledge of inpatient glycemic control among resident physicians. Methods: We performed this study at four academic medical centers: the University of Mississippi Medical Center, University of Virginia Health System, University of Louisville Health Sciences Center, and Emory University. We designed a questionnaire, and Institutional Review Board approval was granted at each institution prior to study initiation. We then administered the questionnaire to Internal Medicine and Medicine-Pediatric resident physicians. Results: A total of 246 of 438 (56.2%) eligible resident physicians completed the Inpatient Glycemic Control Questionnaire (IGCQ). Most respondents (85.4%) reported feeling comfortable treating and managing inpatient hyperglycemia, and a majority (66.3%) agreed they had received adequate education. Despite self-reported comfort with knowledge, only 51.2% of respondents could identify appropriate glycemic targets in critically ill patients. Only 45.5% correctly identified appropriate inpatient random glycemic target values in noncritically ill patients, and only 34.1% of respondents knew appropriate preprandial glycemic targets in noncritically ill patients. A small majority (54.1%) were able to identify the correct fingerstick glucose value that defines hypoglycemia. System issues were the most commonly cited barrier to successful inpatient glycemic control. Conclusion: Most respondents reported feeling comfortable managing inpatient hyperglycemia but had difficulty identifying appropriate inpatient glycemic target values. Future interventions could utilize the IGCQ as a pre- and postassessment tool and focus on early resident education along with improving system environments to aid in successful inpatient glycemic control. Abbreviations: DM = diabetes mellitus; Emory = Emory University Healthcare; IGC = inpatient glycemic control; IGCQ = Inpatient Glycemic Control Questionnaire; IRB = Institutional Review Board; PGY = postgraduate year; UMMC = University of Mississippi Medical Center; UVA = University of Virginia Health System; UL = University of Louisville Health Sciences Center.

570. Impact of Discontinuation of Methicillin-Resistant Staphylococcus aureus Contact Precautions on Bloodstream Infection Rates at an Academic Medical Center

BackgroundContact precautions (CP) in methicillin-resistant Staphylococcus aureus (MRSA) patients along with hand hygiene has been considered a gold standard to prevent transmission. The actual impact of these measures in reducing MRSA infections is still controversial. At our institution, we evaluated the impact of discontinuation of MRSA CP on hospital-onset (HO) and community-onset (CO) MRSA bloodstream (BSI) rates. We also analyzed consequential cost savings.MethodsThe University of Mississippi Medical Center is a 700+ bed academic facility located in Jackson, MS. Patients admitted to any inpatient units with diagnoses or history of MRSA infection or colonization were subjected to CP during their stay. In July 2018, we discontinued MRSA CP across all inpatient units (except neonatal intensive care unit). HO MRSA BSI rate was calculated per National Healthcare Safety Network (NHSN) laboratory-identified event. CO MRSA BSI was reported per NHSN admission prevalence rate. One-way Analysis of Variance (ANOVA) was performed to compare pre-and post-intervention data.ResultsThere was a rise in HO MRSA BSI rate after discontinuation of CP (July 2018-March 2019) in comparison to the 9-month pre-intervention period (October 2017-June 2018); however, the difference was not statistically significant (1.79/10,000 patient-days vs. 1.2/10,000 patient-days; P = 0.056). Similarly, CO MRSA BSI prevalence rate did not show a statistically significant difference between pre- and post-intervention period (0.103 vs. 0.08; P = 0.584).The total annualized cost savings on personal protective equipment (PPE) was an estimated $193,398 post-intervention. Hand hygiene (HH) compliance was higher in post-intervention compared with pre-intervention period (83% vs. 78%, P = 0.0007).ConclusionAt our institute, discontinuation of MRSA CP was associated with an insignificant rise in HO MRSA BSI rates. No impact was observed on CO MRSA BSI prevalence. We had a 34% reduction in PPE expenditure. We observed an increase in HH compliance post-discontinuation of CP, but it did not reduce MRSA BSI rates. Further studies are needed to evaluate the impact of bundling hand hygiene practices with other horizontal strategies (prevention bundles, chlorhexidine bathing, environmental disinfection practices) in prevention of MRSA infections. Disclosures All authors: No reported disclosures.

1154. Impact of Educational Feedback on Reducing Hospital-Onset Catheter-Associated Urinary tract Infections at an Academic Medical Center

BackgroundHigh regulatory burden on hospital-onset (HO) infections has increased performance pressure on infection prevention programs. Despite the availability of comprehensive prevention guidelines, a major challenge has been communication with frontline staff to integrate appropriate prevention measures into practice. The objective of our study was to evaluate the impact of educational intervention on HO CAUTI rates and urinary catheter days.MethodsAt the University of Mississippi Medical Center, Infection prevention (IP) reports unit-based monthly HO infections via email to respective unit managers and ordering physician providers. Starting May 2018, IP assessed compliance to CAUTI prevention strategies per SHEA/IDSA practice recommendations (2014). HO CAUTI cases with noncompliance were labeled as “preventable” infections and educational justification was provided in the email report. No other interventions were introduced during the study period. CAUTI data were collected using ongoing surveillance per NHSN and used to calculate rates per 1,000 catheter days. One-way analysis of variance (ANOVA) was used to compare pre- and post-intervention data.ResultsPrior to intervention (July 2017–March 2018), HO CAUTI rate was 1.43 per 1,000 catheter days. In the post-intervention period (July 2018–March 2019), HO CAUTI rate decreased to 0.62 per 1,000 catheter days. Comparison of pre- and post-intervention rates showed a statistically significant reduction in HO CAUTIs (P = 0.04). The total number of catheter days reduced, but the difference was not statistically significant (8,604 vs. 7,583; P = 0.06). Of the 14 HO CAUTIs in post-intervention period, 64% (8/14) were reported preventable. The preventable causes included inappropriate urine culturing practice in asymptomatic patients (5) or as part of pan-culture without urinalysis (2), and lack of daily catheter assessment for necessity (1).ConclusionAt our institute, regular educational feedback by IP to frontline staff resulted in a reduction of HO CAUTIs. Feedback measure improved accountability, awareness and engagement of frontline staff in practicing appropriate CAUTI prevention strategies. Disclosures All authors: No reported disclosures.

1189. Effectiveness of Multimodal Intervention Strategies to Improve Hand Hygiene Compliance at an Academic Medical Center

BackgroundSince the early 19th century, hand hygiene (HH) has been recognized as the most important factor in preventing healthcare-associated infections (HAI). Still, improving HH compliance is a major hurdle for most healthcare facilities. Our study objective was to evaluate effectiveness of bundled intervention tools in increasing hand hygiene (HH) compliance.MethodsThe study was performed at the University of Mississippi Medical Center located in Jackson, MS. A multidisciplinary HH team was established in January 2016. Team members included infection prevention, nurse managers, physician, resident, housekeeping, process engineers, and ancillary staff. Hand hygiene compliance was determined based on room entry and exit observations. Intervention strategies were based on Joint Commission Center’s Targeted Solutions Tool (TST) to identify barriers in HH compliance, standardization of data collection, covert observer training and Just-in-time training of providers. Other strategies implemented included education and feedback, rewards and recognition, and system change measures during the 3-year study period (timeline in Table 1). Hand hygiene compliance was calculated based on number of compliance opportunities/total number of observations. One-way Analysis of Variance (ANOVA) was performed to analyze HH data. We did not assess the concomitant reduction in HAI rates as simultaneous HAI prevention strategies confounded analysis.ResultsBased on total 95,491 observations performed (January 2016- December 2018), there was a statistically significant improvement in HH compliance during the study period from 66.5% in 2016 to 73% in 2017 and 79.5% in 2018 (P = 0.04).ConclusionAt our institution, we observed a 56% improvement in hand hygiene compliance over 36-months timeframe. Multidisciplinary team involvement and multimodal intervention strategies play crucial role in improvement and sustainment of HH compliance. Disclosures All authors: No reported disclosures.

Pharmacist linkage in care transitions: From academic medical center to community

ObjectivesTo improve the care of patients discharged from the University of Mississippi Medical Center (UMMC) after treatment for acute myocardial infarction, heart failure, pneumonia, and chronic obstructive pulmonary disease; reduce preventable hospital readmissions; and inform future care transition collaborations between hospital teams and community pharmacies. SettingStudy was conducted at UMMC, UMMC outpatient pharmacies, and targeted community pharmacies. Practice descriptionUMMC is the state’s only academic health science center, providing all levels of care. Participants were at UMMC’s 722-bed hospital in Jackson, MS. Participating pharmacies included 2 UMMC outpatient pharmacies and community pharmacy research partner sites within 60 miles of UMMC. Practice innovationA pharmacist transitions coordinator (PTC) worked with inpatient and community-based pharmacists to provide predischarge medication reconciliation and 30 days of medications on discharge. The PTC with access to inpatient and outpatient records facilitated communication among settings/providers. Community pharmacists provided telephonic and face-to-face medication therapy management (MTM). EvaluationThe project was structured as a prospective, randomized controlled trial of pharmacist-led care coordination during transition from inpatient to community setting, with follow-up MTM by community pharmacists. In this intention-to-treat analysis, readmission rates were assessed with propensity adjustment. Drug therapy problems (DTPs) identified/resolved were assessed and reported through descriptive statistics. ResultsNinety-six patients were enrolled. Positive outcomes in overall reduced readmission rates were observed in the intervention group at 30, 60, 90, and 180 days, although statistical significance was not achieved because of limited enrollment. Approximately 60% participated in MTM postdischarge, with 453 interventions and 169 DTPs identified and addressed (98% > 1 DTP; 20% > 5 DTPs). Implementation experience includes PTC successes, new partnerships, and connectivity among all providers, as well as enrollment challenges, follow-up, and service delivery timeframe. ConclusionWith access to patient records, pharmacists have the potential to positively affect patient outcomes through medication management during care transitions.