160. Urgent Care Prescriber Perspectives on Antibiotic Prescribing During the COVID-19 Pandemic

Background Urgent care practices were significantly impacted by the COVID-19 pandemic. Studies conducted early in the pandemic demonstrated dramatic decreases in outpatient antibiotic prescribing, particularly amongst agents typically used for respiratory infections. We observed a 33% decline in urgent care antibiotics prescribing during the COVID-19 pandemic in our urgent care clinics. We investigated the prescriber experience to elucidate factors influencing antibiotic use for respiratory conditions during the COVID-19 pandemic at two academic urgent care clinics. Methods We employed a mix method approach, first distributing a survey to all full-time prescribers. We then followed up with qualitative interviews (12 of 22 prescribers) which was conducted by a single, trained interviewer using a standardized guide. Interviews were recorded and transcribed verbatim. Each transcription was independently reviewed and coded by two blinded investigators using standardized themes and adjudicated by a third investigator for stability, robustness, and interrater reliability. Individually, researchers identified and coded key themes and statements. These themes were then discussed as a group and combined where they shared meaning. This project was reviewed and deemed to be non-human subjects research by the Stanford University School of Medicine Panel on Human Subjects in Medical Research. Results A total of 20 of the 22 prescribers (13 MDs and 9 APPs) completed the survey (91% response rate). Notably, only 25% of prescribers agreed that COVID-19 had changed their antibiotic prescribing practices for patients with respiratory infections despite objective data that all prescribed less. In the qualitative interviews, we identified four major themes impacting the appropriateness of antibiotic prescribing practices as shown in Table 1. Conclusion Urgent care prescribers attributed a decrease in antibiotic prescribing during COVID-19 to changes in patient expectations and knowledge base, a switch to telemedicine-based encounters, and changing epidemiology. These shifts could be utilized by outpatient antimicrobial stewardship efforts to sustain low prescribing rates for conditions in which antibiotics are generally not indicated. Disclosures Marisa Holubar, MD, MS, Nothing to disclose

Using the Work Experience Survey and the Job Accommodation Network to Identify Reasonable Accommodations in the Workplace: Case Studies of African American Women With Multiple Sclerosis

PurposeFour African American women with multiple sclerosis (MS) participated in an evaluation of barriers to their continued employment.MethodsA trained interviewer completed the Work Experience Survey (WES) in teleconsultation sessions with each participant to identify their: (a) barriers to worksite access, (b) difficulties performing essential functions of their positions, (c) concerns regarding continued mastery of their careers, and (d) extent of job satisfaction.ResultsResulting largely from the physiological, sensory, and cognitive sequelae of their disease, participants reported a wide range of difficulties in performing essential functions of their jobs (15–45) that have the potential to significantly affect their productivity. Career mastery problems reflected issues associated with MS such as “believing that others think I do a good job” and “having the resources (e.g., knowledge, tools, supplies, and equipment) needed to do the job.” Other career mastery concerns reflected idiosyncratic aspects of a specific job setting such as “being able to speak with my supervisor about promotion.” Considering these barriers and relationships with employers, the majority of participants reported low levels of job satisfaction.ConclusionThe interviewer concluded the WES interview by recommending a job accommodation plan, which included suggestions from Job Accommodation Network (JAN) consultants. The interviewer also offered guidelines for the employee to follow in requesting job modifications and assistive technology.

Predictors of Smoking Resumption After Acute Coronary Syndrome: A Prospective Study in Western Iran

Background: Despite the health benefits of smoking cessation on patients with cardiovascular diseases (CVDs), some resume smoking even after their discharge from hospital with acute coronary syndrome (ACS). Objectives: This study aimed to determine the predictors of smoking resumption after ACS in western Iran. Methods: This prospective cohort study was performed on 175 patients admitted to the Imam Ali Cardiovascular Center, Kermanshah, Iran, with a diagnosis of ACS from January 2018 to December 2018. Data were collected by a trained interviewer using a checklist developed based on the study objectives. Differences between groups were evaluated by independent t-test, chi-square, and Fisher’s exact tests. The relationship between smoking resumption and predicting variables was assessed using univariate and multivariate logistic regression models (Forward LR). Results: All participants were male with a mean age of 56.30 ± 8.91 (M ± SD) years. Three months post-discharge, 137 (78.3%) patients quit smoking, and 38 (21.7%) patients resumed it. The patients who resumed smoking were more likely to be divorced (20.6% vs. 0.7%), unemployed or retired (73.7% vs. 63.5%), have smokers in household (86.8% vs. 50.4%), and have history of depression (52.7% vs. 20.4%) (P-values < 0.05). The independent predictors of smoking resumption were divorce (OR 4.2, 95% CI: 1.31 - 19.01), having smokers in household (OR 12.08, 95% CI: 3.45 - 40.81), and history of depression (OR 12.16, 95% CI: 3.68 - 39.04). Conclusions: Divorce, having smokers in household, and history of depression were identified as the independent predictors of smoking resumption in ACS patients. Those who have these characteristics should be viewed as having a high risk of smoking relapse and be provided with more support to quit smoking.

Identifying the job accommodation needs of american workers with mid-career neurological disabilities: A multiple case study investigation

METHODS: Four employed people with neurological disabilities who took part in a larger job retention project funded by the United States Department of Labor completed structured interviews to determine their needs for employment accommodations during COVID-19. A trained interviewer administered the Work Experience Survey (WES) in teleconsultation sessions with each participant to identify: (a) barriers to worksite access, (b) difficulties performing essential job functions, (c) concerns regarding continued job mastery, and (d) extent of job satisfaction. RESULTS: Owing primarily to the sequelae of their disabling conditions and less so to social distancing requirements and telecommuting technology, participants reported a wide range of accessibility barriers and difficulties in performing essential functions of their jobs that they believed had the potential to significantly affect their ongoing productivity. Considering the stress and uncertainty that have accompanied the COVID-19 pandemic, it is surprising that the majority of participants reported high levels of job mastery and job satisfaction. CONCLUSION: The interviewer concluded the WES interview by recommending a job accommodation plan, which included suggestions from Job Accommodation Network (JAN) consultants.

Prescribers’ perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis

Background The indication for prescribing a particular medication, or its reason for use (RFU) is a crucial piece of information for all those involved in the circle of care. Research has shown that sharing RFU information with physicians, pharmacists and patients improves patient safety and patient adherence, however RFU is rarely added on prescriptions by prescribers or on medication labels for patients to reference. Methods Qualitative interviews were conducted with 20 prescribers in Southern Ontario, Canada, to learn prescribers’ current attitudes on the addition of RFU on prescriptions and medication labels. A trained interviewer used a semi-structured interview guide for each interview. The interviews explored how the sharing of RFU information would impact prescribers’ workflows and practices. Interviews were recorded, transcribed and thematically coded. Results The analysis yielded four main themes: Current Practice, Future Practice, Changing Culture, and Collaboration. Most of the prescribers interviewed do not currently add RFU to prescriptions. Prescribers were open to sharing RFU with colleagues via a regional database but wanted the ability to provide context for the prescribed medication within the system. Many prescribers were wary of the impact of adding RFU on their workflow but felt it could save time by avoiding clarifying questions from pharmacists. Increased interprofessional collaboration, increased patient understanding of prescribed medications, avoiding guesswork when determining indications and decreased misinterpretation regarding RFU were cited by most prescribers as benefits to including RFU information. Conclusions Prescribers were generally open to sharing RFU and clearly identified the benefits to pharmacists and patients if added. Critically, they also identified benefits to their own practices. These results can be used to guide the implementation of future initiatives to promote the sharing of RFU in healthcare teams.

Human myiasis survey in Ilam Province, Southwest of Iran

Akbari M, Rafinejad J, Hanafi-Bojd AA, Aivazi AA, Biglarian A, Sheikhi S, Shavali Z, Akbarzadeh K. 2020. Human myiasis survey in Ilam Province, Southwest of Iran. Nusantara Bioscience 12: 143-147. Myiasis is the infestation of live human and vertebrate animals with dipterous larvae, which at least for a period. Ilam Province of Iran is one of the most important animal husbandry areas, especially nomadic, in Iran. The objective of this study was to identify the prevalence of myiasis in shepherds in Ilam Province. A cross-sectional study was conducted among the shepherds in Ilam Province, western Iran. Out of the 11 counties in Ilam Province, 6 were randomly chosen from three different climates for this study. A questionnaire was used by a trained interviewer to obtain the information from subjects. The disease has been seen in spring, summer, and autumn seasons. About 94.1% of people have been infested at least once. Pharyngeal myiasis had the highest prevalence with 58.3%. Itchy, painful throat, sneeze, cough, and headache were common symptoms. About 85.1% of people described the symptoms of the disease as severe and very severe. About 75.4% stated that the duration of the disease was more than 5 days. According to the results of the study, it was found that the prevalence of myiasis among shepherds in the Ilam Province is high and it is necessary to take appropriate measures to control the disease and increase health literacy.

Cultural adaptation and content validity of a Chinese translation of the ‘Person-Centered Primary Care Measure’: findings from cognitive debriefing

ObjectivesTo develop an equivalent Chinese translation of the Person-Centered Primary Care Measure (PCPCM) and to establish its cultural adaptability and content validity through cognitive debriefing.DesignThe original English PCPCM was first translated into Chinese by double forward-translation by professional translators. The reconciliated Chinese version was then doubly back-translated into English by two other professional translators blinded to the forward-translation. On affirmation on its linguistic equivalence with the developers of the original English PCPCM, the reconciliated Chinese PCPCM was sent for cognitive debriefing with 20 Chinese-speaking primary care subjects by a trained interviewer using structured probing questions to collect their opinions on the clarity, comprehensibility and relevance of each item and response option in the Measure.SettingSubjects were invited from a primary care clinic in Hong Kong to undergo the cognitive debriefing interviews. The interviews were divided into four groups chronologically to allow revision of the items to be made in between.ParticipantsTen males and 10 females above the age of 18 completed the cognitive interviews. They were all Cantonese-speaking Chinese recruited by convenience sampling. Subjects with cognitive impairment, could not read Chinese, too old or too sick to complete the interviews were excluded from the study.ResultsAn average of 3.3 min (range 3–4 min) was required for the subjects to self-complete the Measure. All items were generally perceived to be easily understood and relevant. Modifications were made to items with the content validity index (CVI) on clarity or understanding <0.8 in each round of the interviews or if a majority of the subjects suggested rewording. Revisions were made to two items in the Chinese PCPCM throughout the whole cognitive debriefing process before the final version was confirmed. The average CVI on clarity of the Chinese PCPCM items ranged from 0.75 to 1. The average CVI on understanding ranged from 0.7 to 1. The average CVI on relevance ranged from 0.55 to 1.ConclusionsThe content validity of the PCPCM was ascertained in terms of its clarity, understandability and relevance to allow further testing of its psychometric properties in a larger Chinese population.

Effects of Sharing Data With Teachers on Student Physical Activity and Sedentary Behavior in the Classroom

Background: Data-driven decision making is an accepted best practice in education, but teachers seldom reflect on data to drive their physical activity (PA) integration efforts. The purpose of this study was to explore the impact of a data-sharing intervention with classroom teachers on teacher-directed movement integration and students’ PA and sedentary behavior. Methods: Teacher-directed movement behaviors from 8 classroom teachers in 1 primary school were systematically observed during four 1-hour class periods before (pre) and after (post) an intervention in which teachers individually discussed student movement data with a trained interviewer. Teachers’ K–2 students (N = 132) wore accelerometers for 10 school days both preintervention and postintervention. Results: Multilevel mixed effects regression indicated a nonsignificant increase in teacher-directed movement from preintervention to postintervention (+7.42%, P = .48). Students’ classroom time spent in moderate to vigorous PA increased (males: +2.41 min, P < .001; females: +0.84 min, P = .04) and sedentary time decreased (males: −9.90 min, P < .001; females: −7.98 min, P < .001) postintervention. Interview data inductively analyzed revealed teachers’ perspectives, including their surprise at low student PA during the school day. Conclusions: Findings suggest that sharing data with classroom teachers can improve student PA and decrease sedentary behavior at school.

Translation and Linguistic Validation of the Korean Version of the Wisconsin Stone Quality of Life Questionnaire

Purpose: Although cure rate and efficacy of treatment for urinary stone disease have been improved, clinicians have been indifferent to the quality of life (QoL) of stone patients in Korea. The objective of this study was to develop a Korean version of Wisconsin questionnaire about quality of life questionnaire (K-WISQOL) of stone patients for use in Korea.Methods: Linguistic validation was permitted for translation by its developers. Three bilingual nonspecialists and 11 panels who were actively involved in treating urinary stone patients performed the translation and linguistic validations. A trained interviewer and 5 Korean patients carried out cognitive debriefing.Results: Noun words such as “energy” and “responsibilities” were very difficult to translate to Korean. They were substituted by more comprehensive words. After backward translation, translated sentences showed a good agreement with the original WISQOL. During backward translation and the second reconciliation, previously translated Korean version was revised in 5 sentences. In the cognitive debriefing process, all 5 patients thought that these questions explained the patient’s situation well. Most of these respondents answered that explanatory notes of questionnaire were well written and the format of the questionnaire was easy to follow.Conclusions: The present study demonstrated that, despite language differences, translation and linguistic validation of the KWISQOL were successfully performed. This K-WISQOL could be useful tools for treatment plan and patient care.

Development of Dietary Knowledge and Adherence Questionnaires for Lebanese Adolescents and Their Parents

The availability of practical tools to assess dietary knowledge and adherence is essential to evaluate the effectiveness of dietary interventions. The aims of this paper were to develop reliable dietary knowledge and adherence questionnaires, suitable for Lebanese adolescents and their parents, and to estimate the feasibility of conducting studies involving such participants in the school-based setting. Eight Lebanese high schools participated in this study (involving 220 adolescents aged 15–18 years). Self-administered dietary knowledge and adherence questionnaires (the Dietary Knowledge Questionnaire (DKQ) and the Dietary Adherence Questionnaire (DAQ), respectively) were completed by the high school students and their parents. A 24 h recall was additionally administered for the adolescents by a dietitian and a trained interviewer at school, in order to validate the adolescents’ answers in the DAQ. The cognitive interview method was used to qualitatively evaluate the questionnaires. The resulting Cronbach’s alpha ranged from 0.61 to 0.78 for the adolescent questionnaires and from 0.46 to 0.89 for the parental ones. In addition, 23 items (out of 25) of the adolescent DAQ matched with the administered 24 h recall. A significant negative correlation was found between the knowledge score (DKQ) and the unhealthy items of the adolescent DAQ. There was a significant positive correlation between the DKQ of the parents and the knowledge score of their children. This is the first study of dietary questionnaires involving Lebanese high school students from different regions, while also including their parents.