Single-centre study surveying neurology trainees’ and faculty’s perceptions of the impact of the COVID-19 pandemic on residents’ medical education

ObjectiveTo assess perceptions of our neurology residents and faculty regarding training experience and medical education during the early COVID-19 pandemic.MethodsWe distributed two online, voluntary and anonymous surveys to trainees and teaching faculty of our Neurology Department at Henry Ford Hospital. Surveys inquired about trainees’ stress, well-being, clinical experience and satisfaction with medical education and available support resources during the first wave of the COVID-19 pandemic in Michigan (mid-March to June 2020).ResultsA total of 17/31 trainees and 25/42 faculty responded to the surveys. Eight (47%) trainees reported high stress levels. Nine (57%) were redeployed to cover COVID-19 units. Compared with non-redeployed trainees, redeployed residents reported augmented medical knowledge (89% vs 38%, p=0.05). There was no difference in the two groups regarding overall satisfaction with residency experience, stress levels and didactics attendance. Twenty-one (84%) faculty felt that the redeployment interfered with trainees education but was appropriate, while 10 (59%) trainees described a positive experience overall. Both trainees and faculty believed the pandemic positively impacted trainees’ experience by increasing maturity level, teamwork, empathy, and medical knowledge, while both agreed that increased stress and anxiety levels were negative outcomes of the pandemic. Twelve (70%) trainees and 13 (52%) faculty were interested in pursuing more virtual didactics in the future.ConclusionOur findings provide an objective assessment of residents' experience during the COVID-19 pandemic and can guide teaching programmes in their medical education response in the face of future global crises.

688. Incidence and Risk Factors for Prosthetic Valve Endocarditis Following TAVR: 2015-2019

Background Transcatheter aortic valve replacement (TAVR) is increasingly used for lower risk patients. Incidence of TAVR endocarditis ranges from 0.2% to 3.3%. The purpose of this study was to determine local incidence and risk factors of prosthetic valve infective endocarditis (PVIE) in a contemporary cohort. Methods IRB approved retrospective, nested case-control study evaluated the 1-year incidence and risk factors for PVIE among TAVR recipients from 2015 to 2019. Inclusion: ≥ 18 years, TAVR procedure at Henry Ford Health System. Exclusion: repeat TAVR. PVIE cases were matched with controls who did not experience PVIE. PVIE defined as diagnosis documentation in the electronic medical record. Figure 1. Study Design Results 23/1266 patients were identified as cases corresponding to a 1-year incidence of 1.82%. The median time to PVIE was 127 days and 35% occurred within 60 days. The most frequently isolated organisms were streptococci (26%), MRSA (13%), and MSSA (13%). Baseline demographics and comorbidities for 23 PVIE cases and 161 controls are displayed in Table 1. Significant risk factors for PVIE in bivariate analysis included STS-PROM (Society of Thoracic Surgeons Predicted Risk of Mortality), median: 4.1 controls and 6.4 cases (p = 0.012). Age, BMI, and comorbidities were not significantly different. Diabetes was notably more frequent among cases (36% vs 48%, p = 0.274). Patients with PVIE had more post-op RBC transfusions (5% vs 21.7% p = 0.003), ECG changes (23% vs 43.5%, p = 0.035), heart block (15.5% vs 34.8%, p = 0.038), longer length of stay (2 days, range 1 to 4 vs 4 to 11, p = 0.004), and thirty-day readmission (10.6% vs 52.2%, p < 0.001). Results displayed in Table 2. Table 1. Patient Characteristics and Risk Factor Analysis Table 2. Additional Outcomes Conclusion The results from this study give insight to the local incidence, microbiology, and risk of PVIE following TAVR. Future directions include a larger evaluation of modifiable risks such as diabetes management and examining the heart block patients who received permanent pacemaker implants. Disclosures Rachel Kenney, PharmD, Medtronic, Inc. (Other Financial or Material Support, spouse is an employee and shareholder) Janet F. Wyman, DNP, CNS-BC, FACC, Edwards Lifesciences (Consultant) Dee Dee Wang, MD, Edwards LifeSciences (Consultant) Brian O'Neill, MD, Edwards Lifesciences (Consultant)

867. Telehealth and HIV Care During the COVID-19 Pandemic

Background The COVID-19 Pandemic led to many restrictions in health care services, and as a consequence, an expansion of telehealth capabilities. In order to meet the needs of PLWH along the Care Continuum, we developed a process to promote the use of our MyChart app. This HIPAA-compliant app allows patients to view their medical records, communicate with their providers, make appointments, and have video visits on their smart devices. This report describes our preliminary findings. Methods PLWH enrolled in the Ryan White Program, in the Infectious Diseases Clinic at Henry Ford Hospital who had not used telehealth services were asked to sign up for our MyChart (electronic medical record software) initiative. A telehealth Navigator interviewed and taught PLWH how to download and use MyChart, and supplied pre-loaded phones, as needed, to make virtual visits accessible. We collected demographic and clinical information and reasons for not using telehealth services. Results From October 2020 to May 2021, 209 PLWH were enrolled into our pilot program (Table 1). Of these: 48% were 45-64 years old (yo), while 21% were >/+ 60 yo and 3% < 25 yo; 75% were male, 85% Black; 48% MSM, and 84% virally suppressed (HIV RNA < 200 copies/mm3). When asked why they were not using telehealth services, 29% reported a lack of technology or capability to install MyChart on their phones, 27% needed further education, and 18% and had not prioritized installation of the application. Conclusion The crises created by the COVID-19 pandemic revealed a new role for telehealth services. Although available to all PLWH in our RW program, many had never used telehealth services. Over half lacked compatible devices or needed help to download or use the app. Compared to younger PLWH, older individuals were more likely to need assistance. Further work is needed to understand and promote digital parity. Disclosures All Authors: No reported disclosures

569. Characterization of COVID-19 Vaccine Breakthrough Infections in Metropolitan Detroit

Background Although COVID-19 vaccines are very effective, vaccine breakthrough infections have been reported, albeit rarely. When they do occur, people generally have milder COVID-19 illness compared to unvaccinated people. A total of 10,262 (0.01%) SARS-CoV-2 vaccine breakthrough infections had been reported as of April 30, 2021. The objective of this study was to evaluate the effectiveness of COVID-19 vaccines and characterize breakthrough infections in our patient population. Methods This was a retrospective review of all consecutive COVID-19 vaccine breakthrough infections at Henry Ford Health System (HFHS) in metropolitan Detroit, Michigan, from December 17, 2020 to June 7, 2021. Centers for Disease Control (CDC)'s breakthrough infection definition (detection of SARS-CoV-2 RNA or antigen in a respiratory sample ≥14 days after completion all recommended doses of COVID-19 vaccine) was used to identify cases. Vaccination status was extracted from the electronic medical records using Epic™ SlicerDicer. Results A total of 228,674 patients, including healthcare workers (HCW), were fully vaccinated in our healthcare system. We evaluate 299 patients for breakthrough infection but only 179 (0.08%) patients met the definition; 108 (60%) were female with median age of 59, 60 (33%) were HCW, and 11 (6%) were immunocompromised. The majority (92%) were asymptomatic (62 or 35%) or had mild/moderate illness (102 or 57%); 14 (8%) had severe or critical illness. The status of one patient was unknown. Of those who were symptomatic, 24 (13%) required hospitalization, and 3 (2%) required intensive unit care. One patient admitted for heart failure exacerbation died unexpectedly prior to being discharged. Nine had previous COVID-19 within 4 months but only one was symptomatic; this likely represented residual shedding in the asymptomatic patients. Conclusion COVID-19 vaccine was very effective among our patients and breakthrough infections were rare. Moreover, the vaccine reduced disease severity and mortality. Efforts should aim to increase vaccine uptake. Disclosures All Authors: No reported disclosures

1377. Impact of Pre-Transplant Infectious Diseases Wellness Visit on Vaccine Uptake in Solid Organ Transplant Candidates

Background Despite published guidelines, vaccine uptake in solid organ transplant candidates (SOTc) remains suboptimal. We established an Infectious Disease pre-transplant clinic (IDPT) to perform a wellness visit for all SOTc. The visit was conducted by a nurse practitioner (NP) primarily and included pre-transplant assessment and optimization of vaccinations. We report the preliminary results of this pilot project on vaccine uptake in SOTc. Methods Retrospective review was done on all SOTc referred to the IDPT from January 2020 to February 2021 at Henry Ford Transplant Institute in Detroit, MI. SOTc were patients listed for different types of transplants. Sociodemographic data, comorbidities, vaccination status for influenza, pneumococcus, hepatitis B, Tdap, Td, and varicella zoster were assessed from electronic medical records and the Michigan Care Improvement Registry that includes vaccination records. Follow up was at least 3 months after IDPT visit. Binomial analysis was performed comparing vaccine uptake in a previous institutional cohort of 530 SOTc from January 2015 to December 2016 in which there was no IDPT visit. Data was analyzed using EpiInfo ver. 7.2.4.0. Results A total of 183 SOTc were evaluated in IDPT. Baseline characteristics are shown in Table 1. Median age was 57 years, mean Charlson Comorbidity Index was 4.1. Majority of IDPT visits were done by the NP and most were video visits given the COVID-19 pandemic. Vaccine uptake improved post IDPT for all vaccines and most notably for hepatitis B, varicella zoster and pneumococcal 13V vaccines (Table 2). Of the SOTc, 38 (20.8%) received their vaccines during the IDPT visit or shortly after. Compared to the prior cohort, all vaccines rates improved with the post IDPT visit (p< 0.001) (Table 3). IDPT and vaccines - ID week 2021 - Table 1 IDPT and vaccines - ID week 2021 - Table 2 IDPT and vaccines - ID week 2021 - Table 3 Conclusion IDPT clinic visits significantly improved vaccine uptake in SOTc at our institution. Approximately one in five SOTc had vaccines administered at the time of IDPT visit or shortly after. Implementation of an Infectious Diseases wellness visit as a requirement for all SOTc can provide opportunities to greatly optimize vaccine completion before transplantation. Disclosures All Authors: No reported disclosures

Validity and Reliability of Persian Version of Henry Ford Hospital Headache Disability Inventory Questionnaire

Background: A limited number of headache disability indices exist that can evaluate and manage different disabilities related to headache among Iranian patients. Objective: This study aimed to translate and validate the Persian version of the Henry Ford headache disability inventory (HDI). Methods: The original questionnaire was translated and culturally adapted to the Persian setting. A total of 250 patients with chronic headache were enrolled in this study. The questionnaire’s face validity, content validity, and convergent validity with Short-Form Health Survey (SF-36) were evaluated and a confirmatory factor analysis (CFA) was conducted. Its internal consistency was also assessed and its short- and long-term test-retest reliability were examined by intraclass correlation coefficient (ICC). Results: The content validity indices were 0.85, 0.99, and 0.97 for simplicity, relevance, and clarity, respectively. The content validity ratio was calculated as one for all items. The findings of CFA confirmed that this index had a good fit. Cronbach’s alpha was 0.91, 0.82, and 0.86 for the entire questionnaire as well as its functional and emotional subscales, respectively. The ICC was also calculated as 0.97 for the total inventory. The convergent validity showed significant negative correlations between HDI and short-form health survey items. Conclusion: The validity and reliability of the Persian version of the HDI were confirmed. This questionnaire can explore the disabilities of Persian-speaking people with headache disorders.

Lessons from CSCMP Supply Chain Hall of Famer Henry Ford and the research that they call for in modern supply chains

PurposeThis paper considers CSCMP Supply Chain Hall of Famer Henry Ford's innovation and its transformative impact on supply chain management. Credited with the assembly line, Ford's innovation also included a supply chain design around the concept of flow, integrated supply and the enablement of economies of scale and productivity to drive down consumer prices and create affordable product for a growing market.Design/methodology/approachThis paper considers literature and builds upon the history of the innovation to consider supply chain implications and future opportunities to further the innovation into modern supply chains.FindingsFord did not “invent” the assembly line but he did build the supply chain around it. He stewarded core supply chain principles of great relevance well before they become popular, including a focus on lifelong learning, making failure safe, waste elimination and helping make the world a better place. There are many opportunities to continue to build upon the innovation for future supply chain success.Originality/valueThe supply chain field is sometimes said to be “historically challenged.” This paper reviews the essence and lessons learned from the assembly line and supply chain design and the leadership principles of Henry Ford and the Ford production system. We also connect leadership principles of the Ford supply chain to those of Ohno and Deming to map out the evolution of the Ford supply chain management approach over multiple decades and into the supply chain body of knowledge. Finally, we reflect upon how supply chain design aspects of the Ford supply chain may need to further evolve into the future. Based upon this reflection we recommend opportunities for further research and innovation that build upon the supply chain management roots provided by Henry Ford.

“A última aventura" de Romy Pocztaruk: uma viagem entre as utopias e ruínas na Região Amazônica

Este artigo analisa a série de fotografias A última aventura (2011) da artista Romy Pocztaruk. A artista, em suas fotografias revela as ruínas de Fordlândia demonstrando o fracasso do projeto utópico de Henry Ford e o cenário desolado das cidades que foram construídas ao redor da Rodovia Transamazônica. No ensaio A nostalgia das ruínas de Andreas Huyssen podemos compreender que as ruínas da modernidade demonstram o declínio das promessas modernas, que falharam ou que não se concretizaram ainda.

ANALISA DRUG RELATED PROBLEMS (DRPs) PADA PASIEN CHRONIC KIDNEY DISEASE (CKD) DI INSTALASI RAWAT INAP KLINIK SARI MEDIKA KABUPATEN SEMARANG

Drug Related Problems (DRPs) merupakan kejadian yang tidak diinginkan yang dialami oleh pasien dan berkaitan dengan pengobatan sehingga berpotensi mengganggu keberhasilan terapi. Penelitian ini bertujuan untuk mengetahui dan menganalisa DRPs yang terjadi pada pasien Chronic Kidney Disease (CKD) di instalasi rawat inap klinik Sari Medika kabupaten Semarang. Penelitian ini merupakan penelitian deskriptif dengan pengumpulan data secara retrospektif pada pasien CKD yang diperoleh dari data rekam medis. Pengambilan sampel menggunakan teknik purposive sampling. Acuan yang digunakan pada penelitian ini adalah Pharmacotherapy Handbook 9th edition 2015, Kidney Disease Improving Global Outcomes (KDIGO), The Renal Drug Handbook 3rd edition 2009, Panduan Praktik Klinis & Clinical Pathway Penyakit Jantung, Pembuluh Darah 2016, dan Henry Ford Health System 6th edition 2011. Hasil penelitian yang dilakukan pada 84 pasien CKD menunjukkan bahwa terdapat DRPs pada 66 pasien dengan kategori yaitu indikasi tanpa terapi (30.86%), terapi tanpa indikasi (6.17%), dosis sub terapi (1.23%), dosis obat berlebih (13.58%), pemilihan obat tidak tepat (45.68%), dan penderita gagal menerima obat (2.47%).