2124. The Epidemiology, Demographics, and Geographical Distribution of Human Non-Tuberculosis Mycobacteria (NTM) Disease in the Endemic Central Florida Region

Abstract Background Of the >100,000 people in the United States infected yearly with non-tuberculosis mycobacteria (NTM), Florida has the highest yearly incidence and prevalence of NTM disease. However, little has been documented on the epidemiology and distribution of NTM disease within Central Florida. Methods A retrospective case review study was conducted from January, 2011 to December, 2017 at a large tertiary acute care medical center in Tampa, Florida to identify all NTM infection cases. Demographics (age, sex at birth, ethnicity), comorbidities, HIV testing status, residential zip code, NTM species, and specimen sources were collected. Results Of the 507 isolates, Mycobacterium abscessus group was the most common (45.4%; n = 230), and contained M. abscessus spp. abscessus (34.5%; n = 175), M. abscessus spp. massilense (8.7%; n = 44), and M. abscessus spp. bolletii (1.18%; n = 6). Other rapid growers were M. fortuitum species (6.9%; n = 35) and M. chelonae (2.56%; n = 13). Of the slower growers, M. gordonae (19.9%; n = 101) and M. avium complex (8.28%; n = 42) were the most common. Of the M. avium complex, M. chimera was most common (4.9%; n = 25). Samples were mostly isolated from sputum (51.7%; n = 262), bronchial lavage (26%; n = 132), skin and soft tissue (11%; n = 58), and blood (7.1%; n = 36). Of the 361 unique patients, average age was 59.2 years (12 to 95 years), with 47.6% (n = 172) greater than 65 years of age, and mostly male 57.9% (n = 208). Caucasians represented 73.4% (n = 265) of our cohort, and African Americans and Hispanics represented 16.3% (n = 59) and 6.8% (n = 24), respectively. Most cases were in those residing outside the Tampa Bay metro area 81.2% (n = 293/361). Notable comorbidities included COPD (n = 83), cystic fibrosis (n = 41), lung transplant (n = 40), heart transplant (n = 12), pulmonary fibrosis (n = 12), and renal transplant (n = 7). A total of 145 individuals received HIV testing at the hospital facility, and of these 44 individuals were living with HIV. Conclusion This study identified a diversity of NTM species across a wide geographical and demographic distribution in the endemic Central Florida region. M. abscessus group had the highest prevalence. This is valuable in understanding which populations are at risk for developing NTM infection in this area of Florida. Disclosures All authors: No reported disclosures.

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Multi-Disciplinary Skull Base Conference and its Effects on Patient Management

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211021251 ◽

2021 ◽

pp. 000348942110212

Author(s):

Nathan Kemper ◽

Scott B. Shapiro ◽

Allie Mains ◽

Noga Lipschitz ◽

Joseph Breen ◽

...

Keyword(s):

Skull Base ◽

Medical Center ◽

Academic Medical Center ◽

Significant Proportion ◽

Internal Auditory Canal ◽

Patient Characteristics ◽

Management Plan ◽

Case Review ◽

Retrospective Case ◽

Lateral Skull Base

Objective: Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic. Methods: Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized. Results: A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered. Conclusions: For a significant proportion of patients with pathology of the lateral skull base, the management plan changed as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes.

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An innovative resident-driven mortality case review curriculum to teach and drive system-based practice improvements in the United States

Journal of Educational Evaluation for Health Professions ◽

10.3352/jeehp.2018.15.31 ◽

2018 ◽

Vol 15 ◽

pp. 31

Author(s):

Nila S. Radhakrishnan ◽

Margaret C. Lo ◽

Rohit Bishnoi ◽

Subhankar Samal ◽

Robert Leverence ◽

...

Keyword(s):

Quality Improvement ◽

Systems Of Care ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

The United States ◽

Case Review ◽

Failure To Rescue ◽

Internal Medicine Residents ◽

Mortality Case

Purpose: Traditionally, the morbidity and mortality conference (M&MC) is a forum where possible medical errors are discussed. Although M&MCs can facilitate identification of opportunities for systemwide improvements, few studies have described their use for this purpose, particularly in residency training programs. This paper describes the use of M&MC case review as a quality improvement activity that teaches system-based practice and can engage residents in improving systems of care. Methods: Internal medicine residents at a tertiary care academic medical center reviewed 347 consecutive mortalities from March 2014 to September 2017. The residents used case review worksheets to categorize and track causes of mortality, and then debriefed with a faculty member. Selected cases were then presented at a larger interdepartmental meeting and action items were implemented. Descriptive statistics and thematic analysis were used to analyze the results. Results: The residents identified a possible diagnostic mismatch at some point from admission to death in 54.5% of cases (n= 189) and a possible need for improved management in 48.0% of cases. Three possible management failure themes were identified, including failure to plan, failure to communicate, and failure to rescue, which accounted for 21.9%, 10.7 %, and 10.1% of cases, respectively. Following these reviews, quality improvement initiatives proposed by residents led to system-based changes. Conclusion: A resident-driven mortality review curriculum can lead to improvements in systems of care. This novel type of curriculum can be used to teach system-based practice. The recruitment of teaching faculty with expertise in quality improvement and mortality case analyses is essential for such a project.

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Increasing HIV Testing and Viral Suppression via Stigma Reduction in a Social Networking Mobile Health Intervention Among Black and Latinx Young Men and Transgender Women Who Have Sex With Men (HealthMpowerment): Protocol for a Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/24043 ◽

2020 ◽

Vol 9 (12) ◽

pp. e24043

Author(s):

Kathryn Elizabeth Muessig ◽

Jesse M Golinkoff ◽

Lisa B Hightow-Weidman ◽

Aimee E Rochelle ◽

Marta I Mulawa ◽

...

Keyword(s):

Hiv Testing ◽

Viral Suppression ◽

The United States ◽

Hiv Care ◽

Hiv Status ◽

Mhealth Intervention ◽

Sex With Men ◽

The University ◽

Living With Hiv ◽

Hiv Negative

Background Stigma and discrimination related to sexuality, race, ethnicity, and HIV status negatively impact HIV testing, engagement in care, and consistent viral suppression (VS) among young Black and Latinx men who have sex with men and transgender women who have sex with men (YBLMT). Few interventions address the effects of intersectional stigma among youth living with HIV and those at risk for HIV within the same virtual space. Objective Building on the success of the HealthMpowerment (HMP) mobile health (mHealth) intervention (HMP 1.0) and with the input of a youth advisory board, HMP 2.0 is an app-based intervention that promotes user-generated content and social support to reduce intersectional stigma and improve HIV-related outcomes among YBLMT. The primary objective of this study is to test whether participants randomized to HMP 2.0 report improvement in HIV prevention and care continuum outcomes compared with an information-only control arm. We will also explore whether participant engagement, as measured by paradata (data collected as users interact with an mHealth intervention, eg, time spent using the intervention), mediates stigma- and HIV care–related outcomes. Finally, we will assess whether changes in intersectional stigma and improvements in HIV care continuum outcomes vary across different types of social networks formed within the intervention study arms. Methods We will enroll 1050 YBLMT aged 15 to 29 years affected by HIV across the United States. Using an HIV-status stratified, randomized trial design, participants will be randomly assigned to 1 of the 3 app-based conditions (information-only app-based control arm, a researcher-created network arm of HMP 2.0, or a peer-referred network arm of HMP 2.0). Behavioral assessments will occur at baseline, 3, 6, 9, and 12 months. For participants living with HIV, self-collected biomarkers (viral load) are scheduled for baseline, 6, and 12 months. For HIV-negative participants, up to 3 HIV self-testing kits will be available during the study period. Results Research activities began in September 2018 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #829805) with institutional reliance agreements with the University of North Carolina at Chapel Hill, Duke University, and SUNY Downstate Health Sciences University. Study recruitment began on July 20, 2020. A total of 205 participants have been enrolled as of November 20, 2020. Conclusions Among a large sample of US-based YBLMT, this study will assess whether HMP 2.0, an app-based intervention designed to ameliorate stigma and its negative sequelae, can increase routine HIV testing among HIV-negative participants and consistent VS among participants living with HIV. If efficacious and brought to scale, this intervention has the potential to significantly impact the disproportionate burden of HIV among YBLMT in the United States. Trial Registration ClinicalTrials.gov NCT03678181; https://clinicaltrials.gov/ct2/show/study/NCT03678181. International Registered Report Identifier (IRRID) DERR1-10.2196/24043

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Not a Tumor-Nonspecific Orbital Inflammation

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1722636 ◽

2021 ◽

Author(s):

James A. Garrity

Keyword(s):

Medical Center ◽

Tertiary Care ◽

Symptomatic Treatment ◽

Case Review ◽

Retrospective Case ◽

Histologic Subtype ◽

Orbital Inflammation ◽

Tertiary Care Medical Center ◽

Disease Free

Abstract Objective This study was aimed to illustrate the features and complexities of nonspecific orbital inflammation via discussion of two representative cases. Design Present study is a retrospective case review. Setting The study was conducted at a tertiary care medical center. Participants Two patients with nonspecific orbital inflammation were participants of this retrospective study. Main Outcome Measures Outcome of the study was disease-free patients and off all medications. Results At follow-up, both patients are disease free and off all medications. Conclusion Surgery plays a diagnostic and therapeutic role. While the clinical subtype is important for differential diagnosis and symptomatic treatment, the histologic subtype is similarly important. For inflammatory dacryoadenitis, surgery can be therapeutic. For extensive granulomatosis with polyangiitis, debulking surgery may allow better penetration of medications, especially rituximab.

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Increasing HIV Testing and Viral Suppression via Stigma Reduction in a Social Networking Mobile Health Intervention Among Black and Latinx Young Men and Transgender Women Who Have Sex With Men (HealthMpowerment): Protocol for a Randomized Controlled Trial (Preprint)

10.2196/preprints.24043 ◽

2020 ◽

Author(s):

Kathryn Elizabeth Muessig ◽

Jesse M Golinkoff ◽

Lisa B Hightow-Weidman ◽

Aimee E Rochelle ◽

Marta I Mulawa ◽

...

Keyword(s):

Hiv Testing ◽

Viral Suppression ◽

The United States ◽

Hiv Care ◽

Hiv Status ◽

Mhealth Intervention ◽

Sex With Men ◽

The University ◽

Living With Hiv ◽

Hiv Negative

BACKGROUND Stigma and discrimination related to sexuality, race, ethnicity, and HIV status negatively impact HIV testing, engagement in care, and consistent viral suppression (VS) among young Black and Latinx men who have sex with men and transgender women who have sex with men (YBLMT). Few interventions address the effects of intersectional stigma among youth living with HIV and those at risk for HIV within the same virtual space. OBJECTIVE Building on the success of the HealthMpowerment (HMP) mobile health (mHealth) intervention (HMP 1.0) and with the input of a youth advisory board, HMP 2.0 is an app-based intervention that promotes user-generated content and social support to reduce intersectional stigma and improve HIV-related outcomes among YBLMT. The primary objective of this study is to test whether participants randomized to HMP 2.0 report improvement in HIV prevention and care continuum outcomes compared with an information-only control arm. We will also explore whether participant engagement, as measured by paradata (data collected as users interact with an mHealth intervention, eg, time spent using the intervention), mediates stigma- and HIV care–related outcomes. Finally, we will assess whether changes in intersectional stigma and improvements in HIV care continuum outcomes vary across different types of social networks formed within the intervention study arms. METHODS We will enroll 1050 YBLMT aged 15 to 29 years affected by HIV across the United States. Using an HIV-status stratified, randomized trial design, participants will be randomly assigned to 1 of the 3 app-based conditions (information-only app-based control arm, a researcher-created network arm of HMP 2.0, or a peer-referred network arm of HMP 2.0). Behavioral assessments will occur at baseline, 3, 6, 9, and 12 months. For participants living with HIV, self-collected biomarkers (viral load) are scheduled for baseline, 6, and 12 months. For HIV-negative participants, up to 3 HIV self-testing kits will be available during the study period. RESULTS Research activities began in September 2018 and are ongoing. The University of Pennsylvania is the central institutional review board for this study (protocol #829805) with institutional reliance agreements with the University of North Carolina at Chapel Hill, Duke University, and SUNY Downstate Health Sciences University. Study recruitment began on July 20, 2020. A total of 205 participants have been enrolled as of November 20, 2020. CONCLUSIONS Among a large sample of US-based YBLMT, this study will assess whether HMP 2.0, an app-based intervention designed to ameliorate stigma and its negative sequelae, can increase routine HIV testing among HIV-negative participants and consistent VS among participants living with HIV. If efficacious and brought to scale, this intervention has the potential to significantly impact the disproportionate burden of HIV among YBLMT in the United States. CLINICALTRIAL ClinicalTrials.gov NCT03678181; https://clinicaltrials.gov/ct2/show/study/NCT03678181. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/24043

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A fully automated inpatient transport system

Technology and Health Care ◽

10.3233/thc-212880 ◽

2021 ◽

pp. 1-8

Author(s):

Joseph Mendlovic ◽

Eli Gargir ◽

David E. Katz

Keyword(s):

Adverse Events ◽

Transport System ◽

Medical Center ◽

Tertiary Care ◽

Transport Systems ◽

Case Review ◽

Patient Identification ◽

Retrospective Case ◽

Tertiary Care Medical Center ◽

Large Tertiary Care

BACKGROUND: The transport of the inpatients to and from locations inside the hospital can vary in complexity depending on the patient location, status, and logistical needs. Most transport systems have not developed at the same speed as other medically related technologies. We conducted a pilot study of a new automated transport system for patients within the hospital. METHODS: Our innovative system was introduced in January 2020. We present a retrospective case review of all in-patient transport request during April 15, 2020 through May 30, 2020 at the Shaare Zedek Medical Center, Jerusalem, Israel. The system is fully automated and works via smartphone and electronic medical record integration. Transfer requests are processed on the basis of priority, proximity, and availably. RESULTS: During the study period there were 15, 581 transfer requests. Mean times to hospital destinations ranged from 9:25 to 28:02 minutes. Overall, mean times were quicker for emergency and surgical services. Trip times by priority code were likely influence by unmeasured confounders. There were no reported patient identification adverse events. Peak requests occurred during 0900-1500, and at the beginning of the week. CONCLUSION: Our automated in-patient transfer system appears to be efficient, safe, well received, and capable of servicing our large tertiary care medical center. Future controlled studies are needed to assess efficacy, adverse events, and clinical outcomes.

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Making a Big Impact on Expanding HIV Inpatient Testing with a Small EHR Modification

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1074 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S426-S426

Author(s):

Tri Nguyen

Keyword(s):

Hiv Testing ◽

Medical Center ◽

Hiv Positive ◽

Screening Methods ◽

Inpatient Setting ◽

Jersey City ◽

Cdc Guidelines ◽

Inpatient Settings ◽

Living With Hiv ◽

Number Of Individuals

Abstract Background The CDC estimates over 1.2 million Americans are living with HIV and, of those, approximately 14% are unaware of their HIV-positive status. Since 2014, most hospitals adopted some form of Electronic Health Records (EHR) and the Centers for Medicare & Medicaid Services extended Medicare coverage for annual HIV screenings. Despite these developments, there has been limited progress in expanding HIV testing in inpatient settings. The present study was conducted at Jersey City Medical Center (JCMC) in an effort to expand HIV testing by implementing EHR modification in the form of testing prompts. Methods This study began on January 1, 2016 at JCMC, a teaching hospital that passed all lab work orders through an EHR system. The number of daily orders for HIV screenings was recorded for 145 consecutive days before EHR modification (n = 145) to establish baseline data. EHR modification occurred on the 146th day of the study (May 25, 2016). This modification featured testing prompts displaying CDC guidelines for screening patients over the age of 18 for HIV whenever a physician ordered lab work for admitted patients. Orders for HIV screenings on this transitional date were excluded from analysis. After EHR modification was completed, the number of daily orders for HIV screenings was recorded for an additional 145 consecutive days (n = 145) for comparison. Testing data was available for all 145 consecutive days before and 145 consecutive days after EHR modification. Results Since the beginning of this study—before testing prompts were implemented—JCMC inpatient units ordered an average of 8.53 (SD=3.25) HIV screenings per day. The average number of daily orders for HIV screenings increased twofold after EHR modification (M=17.39, SD=4.26), t(288) = 19.90, P < .001. JCMC identified 86 HIV-positive and linked over 90% of these patients to care. Conclusion Conventional HIV screening methods in the inpatient setting might not be sufficient at detecting most HIV-positive cases. By implementing testing prompts in its EHR system to encourage increased testing for HIV, Jersey City Medical Center was able to increase the number of individuals aware of their HIV status and link them to care as needed. Disclosures T. Nguyen, Gilead FOCUS: Employee, Grant recipient

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The Role of Health Education Specialists in Conducting Rapid HIV Testing

American Journal of Health Studies ◽

10.47779/ajhs.2014.208 ◽

2020 ◽

Vol 29 (1) ◽

Author(s):

Anthony Santella ◽

Jacquie Fraser ◽

Angela Prehn

Keyword(s):

United States ◽

Health Education ◽

Hiv Testing ◽

The United States ◽

People Living With Hiv ◽

Hiv Status ◽

Rapid Hiv Testing ◽

Testing Strategies ◽

Living With Hiv

There are over one million people living with HIV in the United States; an estimated 16% are unaware of their status. More innovative testing strategies are needed, as evidence suggests that persons most at risk for HIV, or who may present with early infections, are not being reached. Expanding the role of health education specialists can make HIV testing routine and more accessible, and help achieve the national goals of decreasing HIV infection and increasing knowledge of HIV status. This paper focuses on the role of Certified Health Education Specialists (CHES)/Master CHES as being professionally prepared to conduct HIV testing.

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Decreasing Trends in HIV Testing among Adults in Georgia: Analysis of the 2010-2014 BRFSS Data

10.20944/preprints201609.0014.v1 ◽

2016 ◽

Author(s):

Benjamin E. Ansa ◽

Sashia White ◽

Yunmi Chung ◽

Selina A. Smith

Keyword(s):

Hiv Testing ◽

Hiv Transmission ◽

The United States ◽

Behavioral Risk ◽

Hiv Diagnosis ◽

High Risk Behaviors ◽

Behavioral Risk Factor Surveillance ◽

Risk Factor Surveillance ◽

Persons Living With Hiv ◽

Living With Hiv

Georgia is ranked fifth highest among states for rates of HIV diagnosis. About 4% of persons living with HIV infection in the United States reside in Georgia, and almost 19% of these people do not know their HIV status. The present study examined the trends and associated factors of HIV testing among adults in Georgia between 2010 and 2014 by analyzing data of the Behavioral Risk Factor Surveillance System (BRFSS). A total of 30,791 persons aged ≥18 years were identified who responded to the question “Have you ever been tested for HIV?” Overall, there were 11,543 respondents who had been tested for HIV, with a decrease in percentage from 49.4% in 2010 to 43.7% in 2014 (p<0.001). Factors associated with HIV testing were being black (p<0.001), being younger than 55 years (p<0.001), single (p=0.02), attaining education level above high school (P<0.001), engaging in HIV high-risk behaviors (p<0.001), and not having healthcare coverage (p=0.03). Overall in Georgia, there has been a decline in the temporal trend of HIV testing, and more than half of adults have never been tested for HIV. For reducing HIV transmission in Georgia, enhancing access and utilization of HIV testing should be a public health priority.

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Otomastoiditis caused by non-tuberculous mycobacteria: report of 16 cases, 3 with infection intracranially

The Journal of Laryngology & Otology ◽

10.1017/s0022215115001309 ◽

2015 ◽

Vol 129 (7) ◽

pp. 644-655 ◽

Cited By ~ 6

Author(s):

L Lundman ◽

H Edvardsson ◽

K Ängeby

Keyword(s):

Antibiotic Treatment ◽

Relevant Literature ◽

Mycobacterial Infection ◽

Mycobacterium Abscessus ◽

Mycobacterium Fortuitum ◽

Case Review ◽

Referral Centre ◽

Retrospective Case ◽

Tertiary Referral Centre ◽

Medical Interventions

AbstractObjective:To analyse the clinical presentation, treatment and outcome in patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria.Methods:A retrospective case review of 16 patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria from 2000 to 2012 was conducted in a hospital and tertiary referral centre in Sweden. The main outcome measures were microbiology findings, and surgical and medical interventions and outcomes. In addition, the relevant literature was reviewed.Results:In three patients with otomastoiditis, the disease had spread intracranially. The bacteriological findings revealed Mycobacterium abscessus (n = 12), Mycobacterium fortuitum (n = 2) and Mycobacterium avium complex (n = 2). Surgical treatment was undertaken in all but three patients, including exploration of the temporal lobe in one patient. Systemic antibiotic treatment was given to all but one patient. Eight patients healed completely. Eight patients developed hearing loss. Two patients had relapse of the mycobacterial infection several months after the antibiotic treatment had been discontinued.Conclusion:Non-tuberculous otomastoiditis is a severe ear disease with challenging considerations, and should be treated aggressively in order to avoid morbidity.

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