Military fi eld and naval therapy from the origins to the present day

The article contains brief information about the origin and development of therapeutic care in the Russian Army and Navy. The transition from the “army clinic” of prof. M.Ya. Mudrov to the medical discipline “Military fi eld therapy” (“Naval therapy”) is described.

Modernizing Childbirth in Colonial Bengal: A History of Institutionalization and Professionalization of Midwifery, c.1860-1947

<p>In colonial India, medicalization of childbirth has been historically perceived as an attempt to ‘sanitise’ the zenana (secluded quarters of a respectable household inhabited by women) as the chief site of birthing practices and to replace the dhais (traditional birth attendants ) with trained midwives and qualified female doctors. This thesis has taken a broader view of the subject but in doing so, focusses on Bengal as the geographical area of study. It has argued that medicalization of childbirth in Bengal was preceded by the reconstitution of midwifery as an academic subject and a medical discipline at the Calcutta Medical College. The consequence was the gradual ascendancy of professionalized obstetrics that prioritised research, surgical intervention and ‘surveillance’ over women’s bodies. The thesis also shows how the medicalization of childbirth was supported by the reformist and nationalist discourses of the middle-class Bengalis in the late nineteenth and early twentieth centuries. The thesis begins from the 1860s when the earliest scientific essays on childbirth and pregnancy began to appear in Bengali women’s magazines such as Bamabodhini Patrika. It ends in the 1940s, when nationalism profoundly influenced the professionalization of obstetrics - midwifery being perceived as the keystone in a nation’s progress. Bengal being the earliest seat of British power in India it was also the first to experience contact with the western civilization, culture and thought. It also had the most elaborate medical establishment along western medical lines since the foundation of the Calcutta Medical College in 1835. It is argued in the extant literature that unlike the West where professionalized obstetrics was characterised as essentially a male domain, the evolving professional domain of obstetrics in Bengal was dominated by female doctors alone. Questioning that argument, the thesis demonstrates that the domain of obstetrics in Bengal was since the 1880s shared by both female and male doctors, although the role of the latter was more pedagogic and ideological than being directly interventionist. Together they contributed to the evolution of a new medical discourse on childbirth in colonial Bengal. The thesis shows how the late nineteenth century initiatives to reform birthing practices were essentially a modernist response of the western educated colonized middle class to the colonial critique of Indian socio-cultural codes that also included an explicit reference to the ‘low’ status of Bengali women. Reforming midwifery constituted one of the ways of modernizing the middle class women as mothers. In the twentieth century, the argument for medicalization was further driven by nationalist recognition of family and health as important elements of the nation building process. It also drew sustenance from international movements, such as the global eugenic discourse on the centrality of ‘racial regeneration’ in national development, and the maternal and infant welfare movement in England and elsewhere in the inter-war years. The thesis provides a historical analysis of how institutionalization of midwifery was shaped by the debates on women’s question, nationalism and colonial public health policies, all intersecting with each other in Bengal in the inter-war years. The thesis has drawn upon a number of Bengali women’s magazines, popular health magazines, and professional medical journals in English and Bengali that represent both nationalist and official viewpoints on the medicalization of childbirth and maternal and infant health. It has also used annual reports of the medical institutions to chart the history of institutionalization of midwifery and draws upon archival sources - the medical and educational proceedings in particular - in the West Bengal State Archives and the National Archives of India.</p>

Modernizing Childbirth in Colonial Bengal: A History of Institutionalization and Professionalization of Midwifery, c.1860-1947

<p>In colonial India, medicalization of childbirth has been historically perceived as an attempt to ‘sanitise’ the zenana (secluded quarters of a respectable household inhabited by women) as the chief site of birthing practices and to replace the dhais (traditional birth attendants ) with trained midwives and qualified female doctors. This thesis has taken a broader view of the subject but in doing so, focusses on Bengal as the geographical area of study. It has argued that medicalization of childbirth in Bengal was preceded by the reconstitution of midwifery as an academic subject and a medical discipline at the Calcutta Medical College. The consequence was the gradual ascendancy of professionalized obstetrics that prioritised research, surgical intervention and ‘surveillance’ over women’s bodies. The thesis also shows how the medicalization of childbirth was supported by the reformist and nationalist discourses of the middle-class Bengalis in the late nineteenth and early twentieth centuries. The thesis begins from the 1860s when the earliest scientific essays on childbirth and pregnancy began to appear in Bengali women’s magazines such as Bamabodhini Patrika. It ends in the 1940s, when nationalism profoundly influenced the professionalization of obstetrics - midwifery being perceived as the keystone in a nation’s progress. Bengal being the earliest seat of British power in India it was also the first to experience contact with the western civilization, culture and thought. It also had the most elaborate medical establishment along western medical lines since the foundation of the Calcutta Medical College in 1835. It is argued in the extant literature that unlike the West where professionalized obstetrics was characterised as essentially a male domain, the evolving professional domain of obstetrics in Bengal was dominated by female doctors alone. Questioning that argument, the thesis demonstrates that the domain of obstetrics in Bengal was since the 1880s shared by both female and male doctors, although the role of the latter was more pedagogic and ideological than being directly interventionist. Together they contributed to the evolution of a new medical discourse on childbirth in colonial Bengal. The thesis shows how the late nineteenth century initiatives to reform birthing practices were essentially a modernist response of the western educated colonized middle class to the colonial critique of Indian socio-cultural codes that also included an explicit reference to the ‘low’ status of Bengali women. Reforming midwifery constituted one of the ways of modernizing the middle class women as mothers. In the twentieth century, the argument for medicalization was further driven by nationalist recognition of family and health as important elements of the nation building process. It also drew sustenance from international movements, such as the global eugenic discourse on the centrality of ‘racial regeneration’ in national development, and the maternal and infant welfare movement in England and elsewhere in the inter-war years. The thesis provides a historical analysis of how institutionalization of midwifery was shaped by the debates on women’s question, nationalism and colonial public health policies, all intersecting with each other in Bengal in the inter-war years. The thesis has drawn upon a number of Bengali women’s magazines, popular health magazines, and professional medical journals in English and Bengali that represent both nationalist and official viewpoints on the medicalization of childbirth and maternal and infant health. It has also used annual reports of the medical institutions to chart the history of institutionalization of midwifery and draws upon archival sources - the medical and educational proceedings in particular - in the West Bengal State Archives and the National Archives of India.</p>

The social role of pediatrics in the past and present times

Pediatrics and society are closely related. This link is as old as the history of Pediatrics, and dates to the second half of the eighteenth century. The vocation of the first European pediatric schools, indeed, was clinical and scientific, as well as social. The founding fathers of Pediatrics were scientists of great talent, and many of them benefactors and philanthropists. They spent their lives assisting the suffering childhood, and became promoters and organizers of social securities for the poorest and most vulnerable categories. The attention to the problems of abandonment was closely linked to study, prevention, and treatment of pathologies (especially infectious, deficiency and neurological ones). The profile and activity of pediatricians grew in the following decades after the birth of the first pediatric schools. The University institutions contributed to provide a further impulse to childcare as well as cultural authority, also thanks to the foundation of the first chairs and scientific journals of Pediatrics. The relevance and prestige of the studies performed rapidly spread throughout Europe, and also reached our country, contributing to a progressive and relevant improvement in the quality of children’s care, and in the meantime to the decrease of neonatal and infant mortality rates.Today’s pediatricians, as in the past, must spend his efforts to face the needs of children and their families, be their social receptor, interpreter if necessary, and credible and authoritative interlocutor beside institutions. The current coronavirus pandemic dramatically exposed social inequalities and inequities. In this new scenario, the pediatrician’s role of defender of all children becomes even more necessary and indispensable. Here we trace the historical steps which led to the birth and development of pediatrics, as independent medical discipline with ethical and social vocation. Its rise within the University institutions is analyzed, as well as the contribution of the greatest European and Italian masters. Finally, the role of today’s pediatrician is described, his responsibilities also in dealing with new health critical issues, related to the biological, cultural, and psychological changes of the patients of present days. He must have holistic competences, to effectively take care of all children. In addition, he must socially act to guarantee the best possible context for the well-being of the child.

Introduction: Stories of Science and Empire

In this introduction, Taylor-Pirie appraises the intersections of the ‘imaginative architecture of science and empire’ by examining how, as a fledging medical discipline at the fin de siècle, parasitology entered into significant encounters and exchanges with the literary and historical imagination. Introducing readers to Nobel Prize–winning parasitologist Ronald Ross (1857–1932), Taylor-Pirie lays the foundations for the rest of the book by examining how forms such as poetry and biography, genres such as imperial romance and detective fiction, and modes such as adventure and the Gothic together informed how tropical diseases, their parasites, and their vectors were understood in relation to race, gender, and nation. In addition to considering the contemporaneous public understanding of science, she also explores how parasitologists were often engaged in writing their own histories of the discipline, a practice that led to a predominantly white, predominantly male understanding of science that finds a legacy in gender disparities in STEM and biases in popular histories of medicine in favour of a mode of ‘heroic biography’. She provides a brief critical overview of the field of literature and science and places her methodology and the field in the context of contemporary topics like the Covid-19 pandemic, Black Lives Matter protests, and the heritage culture wars.

Kedudukan Majelis Kehormatan Disiplin Kedokteran Indonesia dalam Penyelesaian Sengketa Medis antara Dokter dan Pasien

This article aims to analyze the position of the Indonesian Medical Discipline Honorary Council in the Settlement of Disputes between Doctors and Patients. Medical disputes due to alleged violations of medical discipline should be resolved through the Indonesian Medical Discipline Honorary Council, however currently there are still medical disputes that are reported to the court without going through the Indonesian Medical Doctors Honorary Council. This study uses a normative juridical research method with a statute approach and a conceptual approach. The results of this study are based on Article 66 paragraph (1) and paragraph (3) of Law Number 29 of 2004 concerning Medical Practices, there is still legal uncertainty regarding the resolution of medical disputes between doctors and patients, because the word "can" contained in paragraph (1) can mean that the complaint against the Indonesian Medical Discipline Honorary Council may or may not be made. Whereas in paragraph (3) it is stated that it is possible to resolve medical disputes through the courts, which can cause medical dispute resolution to be carried out through the courts.

Next-Generation Sequencing Mutational Landscape and Clinical Features of Chinese Adults with Myeloproliferative Neoplasms

Myeloproliferative neoplasms (MPNs) include three classical subtypes: polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). Since prefibrotic primary myelofibrosis (pre-PMF) was recognized as a separate entity in the 2016 revised classification of MPN, it has been a subject of debate among experts due to its indefinite diagnosis. However, pre-PMF usually has a distinct outcome compared with either ET or overt PMF. We conducted a retrospective study of MPN patients from October 2014 to June 2020 in the Fourth Affiliated Hospital of Zhejiang University. Patients who were diagnosed with ET, pre-PMF or overt-MF according to the 2016 WHO Classification were included. We reviewed the clinical parameters, haematologic information, and genetic mutations of patients using next-generation sequencing (NGS). Mutation screening was performed in 44 patients by next-generation sequencing techniques, 84 genes and 258 mutations were detected. JAK2 was the most frequently mutated gene (25/44, 56.82%), followed by TET2 (14/44, 31.82%), KMT2C (13/44, 29.55%), and ASXL1 (10/44, 23.73%) in MPN (Figure 1-A). The VAFs of all studied genes with mutation frequencies &gt;10% are shown in Figure 1-B. Of the 20 patients with ET, 9 (45%) were positive for the JAK2 mutation, 5 (25%) carried FAT1, 5 (25%) carried KMT2C, and 4 (20%) carried CALR. Of the 5 patients with pre-PMF, 4 (80%) carried JAK2, 3 (60%) carried EP300, and 2 (40%) carried TET2. Of the 19 patients with overt PMF, 12 (63%) carried JAK2, 10 (53%) carried TET2, 7 (37%) carried ASXL1, and 6 (32%) carried KMT2C, as reported in Figure 2. The median follow-up was 36 months for ET, 42 months for pre-PMF, and 53 months for overt PMF. Overall survival between pre-PMF, overt PMF, and ET was significantly different (P&lt;0.001), as shown in Figure 3. During the follow-up time, only one death of ET was registered, so we analysed the impact of clinical parameters and mutational status at diagnosis on outcome in PMF, including pre-PMF and overt PMF. We performed Kaplan-Meier curves to examine the relationships between the clinical parameters and patient survival. We found that male sex (P=0.0107), MPN10 symptoms (P=0.0354), anaemia (haemoglobin&lt;120g/L, P=0.0239), and thrombocytopenia (platelet count &lt;100 ×10 9/L, P=0.0002) were significantly related to inferior OS (Figure 4). Pre-PMF patients exhibited higher leukocyte counts, higher LDH values, a higher frequency of splenomegaly, and a higher incidence of hypertension than ET patients. On the other hand, pre-PMF patients had higher platelet counts and haemoglobin levels than overt PMF patients. Molecular analysis revealed that the frequency of EP300 mutations was significantly increased in pre-PMF patients compared with ET and overt PMF patients. In terms of outcome, male sex, along with symptoms including MPN10, anaemia, thrombocytopenia, and KMT2A and CUX1 mutations, indicated a poor prognosis for PMF patients. In conclusion, we identified differences in the clinical, haematologic, and molecular presentations of ET, pre-PMF, and overt PMF patients, indicating that comprehensive evaluation of not only BM features but also clinical, haematologic, and molecular profiles is needed for accurate diagnosis and treatment of these three disease entities. The molecular analysis revealed that pre-PMF might be relevant to EP300 mutation, demonstrating the value of molecular examination. The results of this study indicated that comprehensive evaluation of BM features, clinical phenotypes, haematologic parameters, and molecular profiles is needed for the accurate diagnosis and treatment of ET, pre-PMF, and overt PMF patients. Acknowledgment:The research was supported by the Public Technology Application Research Program of Zhejiang, China (LGF21H080003), the Key Project of Jinhua Science and Technology Plan, China (2020XG-29 and 2020-3-011), the Academician Workstation of the Fourth Affiliated Hospital of the Zhejiang University School of Medicine (2019-2024), the Key Medical Discipline of Yiwu, China (Hematology, 2018-2020) and the Key Medical Discipline of Jinhua, China (Hematology, 2019-2021). Correspondence to: Dr Jian Huang, Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine. N1 Shangcheng Road. Yiwu, Zhejiang, Peoples R China. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Uncommon Hpgd Mutation Identified in Familial Erythrocytosis

Familial erythrocytosis (congenital erythrocytosis, FE), is a rare congenital disorder defined by elevated hemoglobin and hematocrit, with different genetic background. Clinically, FE is difficult to distinguish from polycythemia vera（PV）. A 53-years-old male was diagnosed with polycythemia vera without discovery of the JAK2 mutation when he was 31-years-old. The patient's family history revealed his father， a 86-years-old male， also suffered polycythemia for more than 20 years. The pedigree of the Chinese family with erythrocytosis is shown in Figure 1a. The index patient was a 53-years-old male (patient Ⅱ-1, Fig.1), who was hospitalized in our department in 2019 with a 22-year history of elevated red cell mass (RCM). When he was 31-years-old, he initially diagnosed with polycythemia vera without discovery of the JAK2 mutation. Over the last two decades he had irregular phlebotomy almost every two years and seldom prescribed any cytoreductive treatment. At our department he accepted 2 venesections because of Hct level of 64%. Upon medical history taking he reported that his father had suffered by polycythemia with more than 20 years, and were undergoing occasional phlebotomies.The father of the index patient was a 86-years-old male (patient Ⅰ-1, Fig.1), who was diagnosed with polycythemia for more than 20 years and suffered from diabetes. Similar to his son, he did not use any cytoreductive agent, and he had been phlebotomized occasionally. He was chronically treated with low-dose of aspirin . In our department he was treated with erythrocyte separation because of Hct level of 58.9%. He did not report any thrombembolic event. For the last one year of follow-up, the patient continued taking aspirin and her Hct level fluctuated between 54% and 57% while rejected to receive erythrocyte separation again.The elder sister (subject Ⅱ-2 Fig.1) of the index patient did not have any clinical and laboratory signs of elevated RCM as of January 2019, she was a 57-years-old female, who suffered from hypertension and diabetes.The daughter (subject Ⅲ-1 Fig.1) and the nephew (subject Ⅲ-2 Fig.1) of the index patient also did not have any clinical and laboratory signs of elevated RCM as of January 2019. They were subjected to whole exome sequencing (WES), the results revealed four mutations in all three of them, among, a frameshift mutation in the 15-hydroxyprostaglandin dehydrogenase（HPGD） gene is contained in both father and son, which at position c.310_311 ,translating into c.310_311delCT nucleotide mutation and p.L104Afs*3 amino acid mutation. In order to verify the mutation, we adopt the method of Sanger sequencing, then confirmed the presence of the same HPGD frameshift mutation in the index patient and his father. However, The mutation was absent in the elder sister of the index patient, when she was examined by WES and Sanger sequence. The ARHGAP26 mutation is contained in all three of them, but is a type of somatic mutation. The two mutations of VHL and FANCD2 are inexistent in the index patient, but are contained in his father and his elder sister. In conclusion, here we reported the first extensive genetic and clinical study of a family with two members carrying the HPGD gene frameshift mutation. Although functional studies were not made to confirm the pathogenic role of this mutation, the type and location of the mutation suggest that it can be the cause of the erythrocytosis observed in two patients. This study demonstrated the utility of the WES/NGS as the tool for identification of mutations in congenital erythrocytosis as well as helps to discovery these rare erythrocytosis-associated genes. The role and pathogenesis in haematopathy of HPGD mutation has been seriously underestimated, which is deserved to be explored in depth. Acknowledgment:The research was supported by the Public Technology Application Research Program of Zhejiang, China (LGF21H080003), the Key Project of Jinhua Science and Technology Plan, China (2020XG-29 and 2020-3-011), the Academician Workstation of the Fourth Affiliated Hospital of the Zhejiang University School of Medicine (2019-2024), the Key Medical Discipline of Yiwu, China (Hematology, 2018-2020) and the Key Medical Discipline of Jinhua, China (Hematology, 2019-2021). Correspondence to: Dr Jian Huang, Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine. N1 Shangcheng Road. Yiwu, Zhejiang, Peoples R China. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Relapse with BCR-ABL1 Elevation in Chronic Myeloid Leukemia after Progression to Multiple Myeloma from Monoclonal Gammopathy of Undetermined Significance with a Persistent KMT2D Mutation

Chronic myeloid leukemia (CML) and monoclonal gammopathy of undetermined significance (MGUS) are two different hematologic malignancies, the former arising from the myeloid cell lineage, and the latter arising from plasma cells. The concurrent diagnosis of CML and MGUS progression to multiple myeloma (MM) in one patient is an extremely rare event. A 59-year-old male was diagnosed with CML and MGUS with no discomfort in August 2012. Bone marrow (BM) aspiration suggested chronic myelogenous leukemia in chronic phase and perhaps myeloproliferative with 6.5% mature plasma cells (Figure 1A). FISH analysis detected that the BCR-ABL1 expression was 130%. And Next-generation sequencing (NGS) of BM showed: ASXL1 , KMT2D , SPEN , BRINP3 , ANKRD26 , PLCG1 , CUX1 were mutated (Figure 2I). The patient started oral imatinib 400 mg per day and achieved a complete cytogenetic response at 3 months. In September 2019, his IgG levels were 2,790 mg/dl (Figure 2J and serum immunofixation electrophoresis revealed monoclonal (M) protein of IgG-Lambda type (Figure 1E). BM aspiration revealed 9.5% plasma cell infiltration, including 6% mature plasma cells and 3.5% proplasmacyte (Figure 1C and 2H). Flow cytometry in BM showed 6.3% plasmacytoma and abnormal cell expressing CD38+CD138+CD56+CD117+clambda+ (Figure 1F). BM biopsy showed hematopoietic hyperplasia with abnormal growth of immature cells (Figure 1B). Fluorescent in situ hybridization (FISH) was negative. Mutations of KMT2D, SPEN, BRINP3, ANKRD26, PLCG1, CUX1, and ZMYM3 still existed(Figure 2I). In January 2020, examination of a new BM aspiration revealed that mature plasma cells were 3% and plasmablast and proplasmacyte were 4.5% (Figure 2H). In February 2020, he stopped IM therapy with undetectable BCR-ABL1 copies because he met the requirement of stopping TKI therapy . In March 2020, IgG levels were 3520 mg/dl and serum immunofixation electrophoresis still revealed monoclonal (M) protein of IgG-Lambda type. His BM aspiration demonstrated 13.5% plasma cells in April 2020 (Figure 2B and 2H). Flow cytometry in BM showed 6.44% (Figure 2F). BM biopsy showed extremely increased proliferation with abnormal growth of abnormal cells (Figure 2A). FISH demonstrated the presence of t(4;14)(p16;q32)(IGH/FGFR3) , 13q14 deletion（RB-1） and 13q14.3 （D13S319） (Figure 2C, 2D and 2E). The patient was diagnosed as MM (IgGλ type, D-S stage IA; ISS stage II) . BCR-ABL1 copies were still not detected at this point (Figure 2G). The patient continued his follow-up treatment of MM without chemotherapy.However, in June 2020, he was considered to have a molecular relapse with 0.2013% BCR-ABL1 copies in the peripheral blood (Figure 2G). NGS showed that the variant allele fractions of KMT2D, SPEN, BRINP3, ANKRD26, PLCG1, CUX1, and ZMYM3 mutations were similar to former . He restarted 400 mg daily IM therapy and BCR-ABL1 copies were undetectable againafter one month therapy (Figure 2G). BM aspiration revealed that the percentage of plasma cells increased to 25.5% in August 2020 (Figure 2H). Then the patient was started on treatment for ISS stage II standard risk myeloma with ID regimen: ixazomib 4 mg on days 1, 8 , 15 and dexamethasone 20 mg on days 1, 8, 15 , 22 in 28-day cycles. After 6 cycles , the patient got VGPR. BM aspiration demonstrated 13% plasma cells (Figure 2H). And he continued to receive myeloma treatment and imatinib . BCR-ABL1 were &lt;MR4.5 (Figure 2G). Our research indicated that KMT2D mutation may make MGUS progress to MM with NK cells functional defects and then promote the recurrence of BCR-ABL1. Co-existence of these two diseases is rare, therefore, additional investigations are warranted. Acknowledgment:The research was supported by the Public Technology Application Research Program of Zhejiang, China (LGF21H080003), the Key Project of Jinhua Science and Technology Plan, China (2020XG-29 and 2020-3-011), the Academician Workstation of the Fourth Affiliated Hospital of the Zhejiang University School of Medicine (2019-2024), the Key Medical Discipline of Yiwu, China (Hematology, 2018-2020) and the Key Medical Discipline of Jinhua, China (Hematology, 2019-2021). Correspondence to: Dr Jian Huang, Department of Hematology, The Fourth Affiliated Hospital of Zhejiang University School of Medicine. N1 Shangcheng Road. Yiwu, Zhejiang, Peoples R China. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

52. Direct Communication Improves Response Time to Acceptance of Antimicrobial Stewardship Interventions

Background Hospital antimicrobial stewardship program (ASP) reviews broad-spectrum antibiotics and recommends interventions to optimise antimicrobial use. However, about 30% of interventions are not accepted. This project aims to improve the response rate and time for acceptance of ASP interventions by direct communication with providers (via call or text messaging) once an intervention was made. Methods Pre-direct communication (PC) phase lasted from 1st Jan - 31st Dec 2017. A typed intervention was placed into the patient’s medical records for the team to review. Thereafter, a direct communication (DC) phase ran from 1st Jan 2018 - 31st Jan 2019. Teams were immediately notified of any ASP interventions made via a call or text message, in addition to the document placed in the medical records. Specialty, acceptance rates, type of intervention and time to acceptance was recorded. Overall acceptance was counted if team followed the ASP recommendations within 48 hours. Results A total of 621 interventions were made over the 25-month period (PC n=334, DC n=287). We found that direct communications did not improve the overall acceptance rates (PC 66% vs. DC 65%, p=0.791), but significantly improved same day acceptance rates (PC 15% [49/334] vs. DC 33% [96/287], p&lt; 0.001). This trend for higher same-day acceptance was also noted regardless of specialty. It increased from 15% to 45% (p&lt; 0.001) for medicine & 15% to 25% (p=0.025) for surgery. Furthermore, overall acceptance for medical discipline was significantly higher in the DC phase (68% to 80%, p=0.024); no significant difference noted for the surgical disciplines. Same-day acceptance also improved when we compared the most common types of interventions (culture based de-escalation, discontinue antibiotic, narrow empirical coverage). In addition, DC helped narrow empiric antibiotic choices, with improvements in both same-day and overall acceptance of interventions (increased from 8% to 43%, p&lt; 0.001 and 57% to 78%, p=0.12, respectively). Conclusion Direct communication with clinicians boosted same-day acceptance for ASP interventions. In addition, it increased overall acceptance for medical disciplines, and to narrow empiric antibiotic use. Future efforts will focus on in-person strategy with surgical teams for fruitful results. Disclosures All Authors: No reported disclosures