Education on Blastic Plasmacytoid Dendritic Cell Neoplasm Significantly Impacts the Interdisciplinary Physician Team

Background: Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive malignancy that originates from precursors of plasmacytoid dendritic cells. BPDCN is a difficult disease to diagnose and manage and it is often misdiagnosed or underreported. The literature widely supports the need for an interdisciplinary team of physicians with specialized expertise to care for patients with BPDCN, such as dermatologists, pathologists, hematologists/oncologists (hem/oncs), stem cell transplant physicians and others. Aim: The objective of this study was to determine if online education could improve the knowledge of the interdisciplinary physician team members about BPDCN as well as their skills and confidence diagnosing this rare malignancy. Methods: Dermatologists, pathologists, and hem/oncs participated in a series of 6 live continuing medical education (CME)-certified activities, after which the recorded content was posted online as a single online enduring CME-certified activity. Content for the CME activities was developed by a multidisciplinary group of BPDCN experts and was delivered through an approximately 1-hour lecture. Data presented here is for the online enduring activity only. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. Three multiple choice questions assessed knowledge/skills, and 1 question rated on a Likert-type scale assessed confidence. A paired samples t-test was conducted for significance testing on overall average number of correct responses and for confidence rating, and a McNemar's test was conducted at the question and learning objective level (5% significance level, P <.05). Data were collected from December 10, 2020 to May 3, 2021. Results: There were 246 dermatologists, 302 pathologists, and 316 hem/oncs included in this analysis, for overall n=864. PRACTICE SETTING: Dermatologists: 57% community, 15% academic, 13% government, 15% other; Pathologists: 37% community, 37% other, 23% academic, 4% government; Hem/Oncs: 48% community, 31% academic, 14% government, 7% other.OVERALL RESULTS: Overall 46% of dermatologists, 42% of pathologists, and 48% of hem/oncs improved their knowledge/skills related to BPDCN (P <.001 for all), showing a relative increase in responses correct from pre- to post-CME of 67% for dermatologists, 38% for pathologists, and 45% for hem/oncs.CONFIDENCE: 50% of dermatologists, 50% of pathologists, and 49% of hem/oncs had a measurable increase in confidence (P <.001 for all), resulting in 30% of dermatologists, 31% of pathologists, and 36% of hem/oncs who were mostly or very confident diagnosing BPDCN post-CME (9%, 14%, 17% pre-CME, respectively).The Table shows the mean percentage of correct responses by learning objective and the question used to test each learning objective. 20%/54% of dermatologists, 22%/57% of pathologists, and 20%/55% of hem/oncs improved/reinforced their knowledge of the most common cutaneous manifestations of BPDCN and 26%, 22%, 25% need additional education, respectively. CME improved skills ordering tests to diagnose BPDCN, however 57% of dermatologists, 58% of pathologists, and 45% of hem/oncs demonstrate a need for additional education about stains that can aid in diagnosing BPDCN. Conclusions: This online CME-certified educational activity led to statistically significant improvements in the knowledge and skills of dermatologists, pathologists, and hem/oncs about BPDCN as well as their skills and confidence diagnosing this rare malignancy. The results indicate that unique educational methodologies which are available on-demand can be effective tools for advancing clinical decision making. Additional education is recommended on the topics of cutaneous manifestations of BPDCN and case-based education to improve skills diagnosing BPDCN. Acknowledgements: This CME activity was supported by an independent educational grant from Stemline Therapeutics, Inc. Reference: https://www.medscape.org/viewarticle/942245 Figure 1 Figure 1. Disclosures Stein: Amgen: Consultancy, Speakers Bureau; Celgene: Speakers Bureau; Stemline: Speakers Bureau. Sweet: Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees; AROG: Membership on an entity's Board of Directors or advisory committees; Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol Meyers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees. Guitart: Miragen, Kyowa Kirin: Consultancy; Galderma: Consultancy, Research Funding; Solygenix, Elorac, Nanostring: Research Funding. Pemmaraju: LFB Biotechnologies: Consultancy; Aptitude Health: Consultancy; Stemline Therapeutics, Inc.: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding; Incyte: Consultancy; Daiichi Sankyo, Inc.: Other, Research Funding; Plexxicon: Other, Research Funding; Springer Science + Business Media: Other; Cellectis S.A. ADR: Other, Research Funding; CareDx, Inc.: Consultancy; Affymetrix: Consultancy, Research Funding; Roche Diagnostics: Consultancy; Novartis Pharmaceuticals: Consultancy, Other: Research Support, Research Funding; Blueprint Medicines: Consultancy; Celgene Corporation: Consultancy; DAVA Oncology: Consultancy; Sager Strong Foundation: Other; ASCO Leukemia Advisory Panel: Membership on an entity's Board of Directors or advisory committees; ASH Communications Committee: Membership on an entity's Board of Directors or advisory committees; MustangBio: Consultancy, Other; Abbvie Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other, Research Funding; Dan's House of Hope: Membership on an entity's Board of Directors or advisory committees; HemOnc Times/Oncology Times: Membership on an entity's Board of Directors or advisory committees; Samus: Other, Research Funding; Bristol-Myers Squibb Co.: Consultancy; Protagonist Therapeutics, Inc.: Consultancy; Clearview Healthcare Partners: Consultancy; ImmunoGen, Inc: Consultancy; Pacylex Pharmaceuticals: Consultancy. Poligone: Stemline, Helsinn, Kyowa Kirin: Consultancy; Soligenix, Miragen, Helsinn, Bioniz: Research Funding; Stemline, Therakos, Regeneron: Speakers Bureau.

Impact of surgeon and anaesthesiologist sex on patient outcomes after cardiac surgery: a population-based study

BackgroundEffective teamwork between anaesthesiologists and surgeons is essential for optimising patient safety in the cardiac operating room. While many factors may influence the relationship between these two physicians, the role of sex and gender have yet to be investigated.ObjectivesWe sought to determine the association between cardiac physician team sex discordance and patient outcomes.DesignWe performed a population-based, retrospective cohort study.Participants and settingAdult patients who underwent coronary artery bypass grafting (CABG) and/or aortic, mitral or tricuspid valve surgery between 2008 and 2018 in Ontario, Canada.Primary and secondary outcome measuresThe primary outcome was all-cause 30-day mortality. Secondary outcomes included major adverse cardiovascular events at 30 days and hospital and intensive care unit lengths of stay (LOS). Mixed effects logistic regression was used for categorical outcomes and Poisson regression for continuous outcomes.Results79 862 patients underwent cardiac surgery by 98 surgeons (11.2% female) and 279 anaesthesiologists (23.3% female); 19 893 (24.9%) were treated by sex-discordant physician teams. Physician sex discordance was not associated with overall patient mortality or LOS; however, patients who underwent isolated CABG experienced longer hospital LOS when treated by an all-male physician team as compared with an all-female team (adjusted OR=1.07; p=0.049). When examining the impact of individual physician sex, the length of hospital stay was longer when isolated CABG procedures were attended by a male surgeon (OR=1.10; p=0.004) or anaesthesiologist (OR=1.02; p=0.01).ConclusionsPatient mortality and length of stay after cardiac surgery may vary by sex concordance of the attending surgeon–anaesthesiologist team. Further research is needed to examine the underlying mechanisms of these observed relationships.

Diversity and Inclusion in Science

The complexity of most primary immunodeficiencies together with the increasingly complicated treatment regimens require a working partnership between the patient, their families, and the medical team. As a woman in medicine in general, and in clinical immunology and allergy in particular, I find it very important to work as a respected, valued, and equal part of a team, with a dedicated contribution to improve patient care and partake in research. Equally important is having the safety of a balanced family life and physical/mental health and wellness. I find myself very lucky at this point in my life, being part of a great physician team and having full support from my spouse

Application of an Innovative Model for the Risk Management of COVID-19 in a Multinational Manufacturing Company

The COVID-19 incidence in 61 manufacturing plants in Europe (EU), North America (NA) and Latin-America (LATAM) was compared with the incidence observed in the countries where the plants are located in order to evaluate the application of an innovative model for COVID-19 risk management. Firstly, a network of local and global teams was created, including an external university occupational physician team for scientific support. In July 2020, global prevention guidelines for the homogenous management of the pandemic were applied, replacing different site or regional procedures. A tool for COVID-19 monitoring was implemented to investigate the relationship between the incidence rates inside and outside the plants. In the period of May–November 2020, 565 confirmed cases (EU 330, NA 141, LATAM 94) were observed among 20,646 workers with different jobs and tasks, and in the last two months 85% EU and 70% NA cases were recorded. Only in 10% of cases was a possible internal origin of the contagion not excluded. In the EU and NA, unlike LATAM, the COVID-19 incidence rates inside the sites punctually followed the rising trend outside. In conclusion, the model, combining a global approach with the local application of the measures, maintains the sustainability in the manufacturing industry.

The perceived contributions of non-physician team members to residents’ interprofessional education during a critical care rotation

Background: During rotations, post-graduate medical residents must learn about interprofessional teamwork and collaboration. Our study examined the role of non-physician healthcare team members in such education, from the perspectives of both residents and team members themselves. Methods: This qualitative study took place in the intensive care unit (ICU) of a teaching hospital in a Canadian city. We conducted semi-structured individual and focus group interviews with both residents (n = 6) and the team members with whom they collaborated: pharmacists, nurses, respiratory therapists, and a social worker (n = 19). Results: We developed a number of themes about interprofessional education (IPE) in this context from the data, including the presence of planned, unplanned, and tacit teaching; the influence of contextual factors like ICU culture, work demands, resident motivation, power hierarchies, and perceptions of ‘good’ and ‘bad’ residents; the gap between team member perceptions of their contribution to residents’ IP education and residents’ own perceptions; and concerns about the transferability of IPE to other contexts. Conclusions: The influence of non-physician team members on residents’ IPE in the clinical environment is an understudied topic. While our study was limited to one ICU, the themes that emerged may be of interest to others in similar contexts.

1344. Impact of Pharmacist-Physician Team on Antimicrobial Utilization at a Pediatric Hospital

Background “Handshake stewardship” is now considered a leading practice in antimicrobial stewardship (AMS) by The Joint Commission. This study aims to evaluate the impact of a pharmacist-led and physician-pharmacist led handshake stewardship method on antimicrobial utilization at a pediatric hospital. Methods This was a single-center, retrospective quality improvement study at a teaching children’s hospital in central Texas. We retrospectively measured hospital-wide antimicrobial utilization from June 2015 to May 2020. We compared the time periods with an ID pharmacist participating in handshake stewardship ([A] July 2012 to April 2015,[B] May 2015 to May 2018 and [D] August 2019 to May 2020) and without an ID pharmacist ([C] June 2018 to July 2019). We also compared time periods with only an ID pharmacist led ASP [A] compared to a physician-pharmacist led ASP [B].The primary endpoint was days of therapy per 1,000 patient days (DOT/1000 PD). Table 1. Overall Antimicrobial Utilization During Changes in ASP Structure Results Antimicrobial utilization during pharmacist-led ASP [A] was significantly higher than during the pharmacist-physician led ASP time period [B] (95% CI, 68.8-76.8; P=0.001). No significant difference was observed for mean hospital-wide antimicrobial, meropenem, piperacillin-tazobactam, or cefepime DOT/1000 PD from period [B] to [C]. However, the increase in mean DOT/1000 PD during these time periods was statistically significant for ceftriaxone (95% CI, 6.3-23.9; P=0.001) and vancomycin (95% CI, 1.2-18.1; P=0.03). For time period [C] to [D], there was a statistically significant reduction in mean DOT/1000 PD seen in overall antimicrobial use (95% CI, 156.9-313.6; P< 0.0001). Statistically significant decreases in DOT/1000 patient days were also seen for cefepime (95% CI, 11.4-36.4; P< 0.0007), ceftriaxone (95% CI, 5.0-24.8; P=0.005), and vancomycin (95% CI, 6.1-23.1; P=0.002). No difference was seen for piperacillin-tazobactam or meropenem DOT from [C] to [D]. Figure 1. Hospital-Wide Monthly Days of Therapy per 1000 Patient Days Conclusion Active engagement with frontline providers via handshake stewardship offers a more successful approach to decreasing antimicrobial utilization. A greater reduction in overall antimicrobial utilization was seen when the ASP was led by a pharmacist-physician team compared to when it was pharmacist-led without a physician champion. Disclosures All Authors: No reported disclosures

The Impact of Joining a Team on the Initial Trust in Online Physicians

Introduction: Trust is a major challenge for the online market and this is especially the case for e-consultation platforms. Research that promotes online physician trust is highly desirable. In this study, we focus on whether joining a team led by a well-known physician will increase physician trust and what team characteristics will affect this trust. Materials and Methods: Brand extension theory is applied to the healthcare context to explain the impact of joining a team on physician trust. Specifically, both team strength and team similarity are hypothesized to have the main effects. In addition, team size is hypothesized to have a moderating effect. A 2 × 2 × 2 experiment was conducted to test the proposed research model. Results: The results indicated that joining a team would significantly increase physician trust (p < 0.001). Both team strength (p < 0.001) and team similarity (p < 0.001) had positive impacts on physician trust. In addition, a larger team size resulted in a reduced positive effect of team strength on physician trust (p < 0.001). Conclusions: Joining a physician team is an effective and low-cost method to address the initial trust problem of unknown online physicians.

Risk-Aware Machine Learning Classifier for Skin Lesion Diagnosis

Knowing when a machine learning system is not confident about its prediction is crucial in medical domains where safety is critical. Ideally, a machine learning algorithm should make a prediction only when it is highly certain about its competency, and refer the case to physicians otherwise. In this paper, we investigate how Bayesian deep learning can improve the performance of the machine–physician team in the skin lesion classification task. We used the publicly available HAM10000 dataset, which includes samples from seven common skin lesion categories: Melanoma (MEL), Melanocytic Nevi (NV), Basal Cell Carcinoma (BCC), Actinic Keratoses and Intraepithelial Carcinoma (AKIEC), Benign Keratosis (BKL), Dermatofibroma (DF), and Vascular (VASC) lesions. Our experimental results show that Bayesian deep networks can boost the diagnostic performance of the standard DenseNet-169 model from 81.35% to 83.59% without incurring additional parameters or heavy computation. More importantly, a hybrid physician–machine workflow reaches a classification accuracy of 90 % while only referring 35 % of the cases to physicians. The findings are expected to generalize to other medical diagnosis applications. We believe that the availability of risk-aware machine learning methods will enable a wider adoption of machine learning technology in clinical settings.