1132. Evaluating an Amoxicillin Dosing Regimen for Community Acquired Pneumonia: A Quality Improvement Initiative Using Clinical and Laboratory Data

Background Amoxicillin 90 mg/kg/day divided twice daily is recommended for children with mild community acquired pneumonia (CAP). While adequate for fully susceptible Streptococcus pneumoniae isolates, three times daily dosing allows achievement of greater amoxicillin exposure, which may be necessary for isolates with penicillin minimum inhibitory concentrations (MIC) of ≥ 2 μg/mL. We evaluated our current twice daily amoxicillin dosing strategy by characterizing 1) the MIC distribution among S. pneumoniae isolates and 2) the frequency of clinical amoxicillin treatment failures. Methods We performed a retrospective cohort study of all S. pneumoniae isolates from sterile and non-sterile sites between 2017-2020. Breakpoints established by the CLSI were used for both meningitis and non-meningitis isolates. Only the first isolate per patient was included. We also evaluated the frequency of amoxicillin treatment failure in patients diagnosed with CAP who were discharged from the ED in 2019. CAP was defined as a discharge diagnosis code for pneumonia and an antibiotic prescription. Treatment failure was defined as an ED or primary care revisit, or admission, within 14 days during which an antibiotic change was made. Results 28 S. pneumoniae isolates were identified from sterile sites between 2017-2020 and 171 isolates were identified overall. All isolates from sterile sites had penicillin MICs of ≤ 2 μg/mL and 165 (96%) of isolates overall had penicillin MICs of ≤ 2 μg/mL (Table 1). Of these, 10 isolates had MICs of 2 μg/mL, all from non-sterile sites. In 2019, 589 patients were treated for CAP in the ED; 447 (76%) received amoxicillin and 142 (24%) were treated with alternative antibiotics. Treatment failures occurred in 15 amoxicillin-treated patients (3.3%, 95% confidence interval 1.9-5.5%) and in 5 patients (3.5%, 95% confidence interval 1.2-8.0%) treated with alternative antibiotics. Conclusion In vitro penicillin resistance was rare at our institution. Further, given that S. pneumoniae is rarely identified by culture, we also demonstrated that clinical amoxicillin treatment failures were infrequent using twice daily amoxicillin dosing. Coupled with provider and family preference, these data supported continuing our current practice of twice daily amoxicillin dosing. Disclosures All Authors: No reported disclosures

Grounds for surrogate decision-making in Japanese clinical practice: a qualitative survey

Background In the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements. Methods In this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care hospitals. Results A total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference-oriented factor (Type 1), patient interest-oriented factor (Type 2), family preference-oriented factor (Type 3), and balanced patient/family preference-oriented factor (Type 4). The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker. Conclusions Surrogate decision-makers based their decisions on important aspects related to a patient’s life, and they considered not only the patient’s preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective.

Grounds for surrogate decision-making in Japanese clinical practice: A qualitative survey

Background In the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements.Methods In this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care hospitals.Results A total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference–oriented factor (Type 1), patient interest–oriented factor (Type 2), family preference–oriented factor (Type 3), and balanced patient/family preference–oriented factor (Type 4). The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker.Conclusions Surrogate decision-makers based their decisions on important aspects related to a patient’s life, and they considered not only the patient’s preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective.

Judgment grounds in surrogate decision-making in Japanese clinical practice: A qualitative survey

BackgroundSurrogate decision-making is expected to become more prevalent in Japanese clinical practice. Recent years have seen an increase in activities to promote advance care planning (ACP), potentially affecting the manner in which judgments are made in surrogate decision-making. This study aimed to clarify judgment grounds on which surrogate decisions are made in Japan.MethodsThis qualitative study was based on semi-structured interviews regarding judgment grounds in surrogate decision-making for critical life-sustaining treatment choices in acute hospitals. ResultsA total of 228 participants met the inclusion criteria, and 15 were selected for interviews. We qualitatively analyzed the content of 14 interview transcripts, excluding one which did not meet the inclusion criteria. Based on this analysis, four core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making were extracted. The four core categories were as follows: Patient preference-oriented factor (Type 1); Patient interest-oriented factor (Type 2); Family preference-oriented factor (Type 3); and Balanced patient/family preference-oriented factor (Type 4). The Type 4 core category represented attempts to balance preferences of the patient with those of the surrogate decision-maker. ConclusionsSurrogate decision-makers based their decisions on important matters related to a patient’s life not only on the preferences and best interests of the patient, but also on their own preferences. As the need for surrogate decisions increase in the future, decision-makers will need to consider judgment grounds from a more diverse perspective.

The judgment grounds in surrogate decision-making in Japanese clinical practice: A qualitative survey

Background Surrogate decision-making is expected to become more prevalent in Japanese clinical practice. In recent years, activities to promote advanced care planning (ACP) have gathered momentum, which may potentially affect the ways in which judgments are made in surrogate decision-making. The purpose of this study is to clarify the current judgment grounds on which surrogate decisions are made in Japan. Methods We adopted a qualitative research method that was based on semi-structured interviews to reveal the judgment grounds in surrogate decision-making involving critical, life-sustaining treatment choices in acute hospitals. Results We received a list of 228 participants who met the inclusion criteria. Of these, we interviewed 15 participants. We analyzed the content of the 14 transcribed texts, eliminating one text that did not meet the inclusion criteria. We extracted a total of four core categories, 17 categories, 35 subcategories, and 55 codes for qualitative analysis of interviews regarding the judgement grounds in surrogate decision-making. The four core categories are as follows: Type 1 "Patient preference-oriented factor," Type 2 "Patient interest-oriented factor," Type 3 "Family preference-oriented factor," and Type 4 "Balanced patient/family preference-oriented factor." Type 4 was the reasoning related to an attempt to balance preferences of the patient and those of the surrogate decision-maker. Conclusions This study revealed the current status of surrogate decision-making about important matters related to a patient’s life in Japan. Surrogate decision-makers base their decisions not only on the preferences and best interests of the patient, but on their own preferences as well. In the future, we believe that surrogate decisions-makers will be required to consider the judgment grounds from a more diverse perspective and that such attitudes should be ethically accepted.

The judgment grounds in surrogate decision-making in Japanese clinical practice: A qualitative survey

Background Surrogate decision-making is expected to become more prevalent in Japanese clinical practice. In recent years, activities to promote advanced care planning (ACP) have gathered momentum ,which may potentially affect the ways in which judgments are made in surrogate decision-making. The purpose of this study is to clarify the current judgment grounds on which surrogate decisions are made in Japan. Methods We adopted a qualitative research method that was based on semi-structured interviews to reveal the judgement grounds in surrogate decision-making involving critical, life-related choices in acute hospitals. Results We interviewed 15 participants. We analyzed the content of the 14 transcribed texts, eliminating one text that does not meet the inclusion criteria. We extracted a total of 4 core categories, 17 categories, 35 subcategories, and 55 codes as an analysis results of interviews regarding the judgment grounds in surrogate decision-making. The four categories are as follows: type 1“Patient preference-oriented factor”, type2“Patient interest-oriented factor”, type3“Family preference-oriented factor”,and type4 “Balanced patient/family preference-oriented factor”. Conclusions This study revealed the current status of surrogate decision-making in Japan: when making decisions about important matters related to a patient’s life, surrogate decision-makers base their decisions not only on the preferences and best interests of the patient, but on their own preferences as well. Included in the preferences of surrogate decision-makers were their own views of life and death, their values, and care burden. Given the cultural and social backgrounds in Japan, it remains unclear whether ACP can be properly reflected in judgment grounds in surrogate decision-making. It would be undesirable to base judgments solely on the principle of respect for autonomy or the principles of surrogate decision-making. In the future, we believe that surrogate decisions-makers will be required to consider the judgment grounds from a more diverse perspective and that such attitudes should be ethically accepted.

Individual Preference Framework or Group Preference Framework? Which Will Regulate the Impact Path of Product Facilities on Residents’ Waste-Sorting Behavior Better

To effectively deal with the waste management problems faced by cities, it is of great significance to promote the sorting and recycling of municipal solid waste. Given the correlation between individual behavior and psychological preferences and external situations, this study explored the mechanism of individual preference framework and group preference framework in the impact path of product facilities on residents’ waste-sorting behavior. Based on a questionnaire survey (N = 1505), combined with correlation analysis, difference analysis, hierarchical regression analysis, sensitivity analysis, and other methods, the study found that differences in residents’ age, education background, and monthly income lead to differences in residents’ sorting behaviors, and individuals of young age and low monthly income have higher sorting behaviors than others. Interestingly, highly educated individuals did not show high sorting behavior. Both individual preference and group preference frameworks play a regulating role in the influence path of product facilities on waste-sorting behavior, but a group preference framework (including family preference, organizational preference and social preference) plays the more significant regulating role. Additionally, social preference variables are the most prominent regulatory factors and have a greater “amplifier” effect in the impact of product facilities on waste-sorting behavior. Based on these findings, this study identifies the corresponding policy implications.

School choice and post hoc family preference in Spain: Do they match up?

The process of school choice depends on a wide range of circumstances including those related to the accessibility to schools and parental preferences. This paper has three goals: (1) Identify whether the preferences for the different kinds of schools (public, publicly-funded private, or private) vary according to the family’s traits; (2) estimate the degree of concurrence between the kind of school their children attend and the kind of school the parents prefer a posteriori; and (3) identify which social groups demonstrate lower levels of concurrence. We used a sub-sample of people with children registered in compulsory grades or post-compulsory grades up to university from representative national survey (2012). Results show that post hoc school preferences differ by educational level, economic status, religious orientation, and size of town. Likewise, we find divergences between the school parents prefer and the school their children attend, something that occurs more frequently among those with less economic resources.

BASELINE FRAILTY EVALUATION IN DRUG DEVELOPMENT

Older people are high consumers of medicines, but despite this they have often been excluded from clinical trials. Reasons for exclusion have frequently been poorly justifiable, and have included predefined arbitrary upper age limits, lists of different comorbidities, polypharmacy or physician/patient/family preference. This selection bias is even more evident for the frail older adults. Consequently, the evidence base in this age group is often limited at the time of market authorisation. The benefit/risk analysis for the frail older adult may well be different from that of younger people, and a lack of data may result in inappropriate prescribing.