Jessica Seidelman

An educational initiative in response to identified PrEP prescribing needs among PCPs in the Southern U.S.

ABSTRACT Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, but many primary care physicians (PCPs) have not incorporated PrEP into practice. While PrEP may be a key strategy to reducing high HIV transmission rates in the southern US, knowledge about PrEP prescribing patterns among PCPs in this region is lacking. An online survey was sent to a large network of PCPs at an academic medical center in North Carolina in October 2015. The survey was repeated in September 2016, after an educational intervention that included on-site trainings at 14 PCP offices. Chi-square tests were used to compare PrEP prescribing patterns among providers. The initial survey was sent to 389 PCPs, with 115 (30%) responding. Of these, 78% reported seeing men who have sex with men (MSM). Only 17% had prescribed PrEP. The most frequently identified barrier was lack of knowledge (60%). When the survey was repeated after the educational initiative, 79 PCPs (20%) responded. Of these, 90% reported seeing MSM, and 35% had prescribed PrEP. PCPs who had attended a training were more likely to have prescribed PrEP (OR 4.84, CI 1.77–13.21). In conclusion, PrEP prescribing among PCPs in the southern US is low. A survey among PCPs identified lack of knowledge as a barrier to prescribing, motivating an institutional-wide educational campaign in response. Further efforts are needed to continue to raise awareness and educate PCPs in the South about PrEP.

Caught on Capsule: Iron-deficiency Anemia Due to Hookworm Infection.

PRESENTATION A tiny ingestible camera identified an otherwise elusive source of anemia in a 63-year-old man. The patient presented to an outside hospital with a 2-week history of generalized weakness, malaise, nausea, and loss of appetite. He denied rectal bleeding. His past medical history was significant for a Billroth II gastric bypass and prior gastric angioectasias. Initial laboratory studies showed that his hemoglobin level, at 7.3 g/dL, was lower than it had been 1 week earlier, when it was 9.9 g/dL, and that, in turn, was reduced from a baseline measurement of 13-15 g/dL, which had been obtained several months prior. Results were also remarkable for leukocytosis at 21.4 10 cells/mm. A rectal examination revealed brown stool that proved positive for blood with a Hemoccult test. Push enteroscopy, with intubation of afferent and efferent limbs of the patient’s Billroth reconstruction, showed mild erythema in the gastric remnant but no angioectasias, ulcers, or evidence of bleeding. Colonoscopy subsequently disclosed internal grade I hemorrhoids and melena throughout the colon and distal small bowel. No source of bleeding was evident. Five units of packed red blood cells did not produce an appreciable increase in his hemoglobin. He was then transferred to our hospital for further workup for a presumed source of bleeding in the small bowel. Upon the patient’s presentation, his wife reported that he had been having dark-colored stools for the past 3-4 years. He had undergone upper endoscopy 1 year earlier and been diagnosed with an angioectasia. This was treated with argon plasma coagulation.

Caught on Colonoscopy: Schistosomiasis Manifesting as a Single Colonic Polyp

PRESENTATION A screening colonoscopy identified an unexpected diagnosis in a 64-year-old male patient. He was an asymptomatic landscaper who presented for a first-time screening colonoscopy based on age. His only active medical issue was psoriasis, for which he took apremilast. At the time of colonoscopy, he denied any bright red blood per rectum, melena, changes in stooling habits, abdominal pain, nausea, vomiting, changes in appetite, weight loss, or night sweats. He did not report any family history of colon cancer. He was a lifelong nonsmoker and denied any current alcohol use. He lived in North Carolina in a home with his wife, 3 sons, 3 daughters-in-law, and a 2-year-old granddaughter. There were no pets in the home. He grew up in Luzon, Philippines, where he worked as a rice paddy farmer. He emigrated to the United States in 1995.

Neurosurgical Device-Related Infections

In this review article, we discuss the epidemiology, microbiology, diagnosis, treatment and prevention of infections associated with cerebrospinal fluid shunts, cerebrospinal fluid drains, and deep brain stimulators. We also briefly discuss prevention strategies with appropriate antibiotics, devices, and operating room practices to decrease the risk of these infections.

To Be a CLABSI or Not to Be a CLABSI—That is the Question: The Epidemiology of BSI in a Large ECMO Population

identified venues to receive this education. Nurses with master’s degrees were less likely to believe that nurses might play a role in ASPs, perhaps due to greater familiarity with the current state of ASP, and perhaps, therefore, they were less likely to think “outside the box” regarding a nursing role. Nonetheless, most nurses felt that they played a role in antimicrobial stewardship. The strengths of this study include the large number of nursing respondents across different hospitals and patient care units. The study also has several limitations. The survey had a relatively low response rate, and because responses to the survey were voluntary, respondents may not be representative of all nurses at our hospital system. Similarly, responses obtained from nurses in our institution may not be generalizable among all nurses. This study illustrates a need to educate nurses on general principles of antimicrobial stewardship, and our findings point to multiple areas for nursing-targeted interventions that merit additional research. Nurses could ensure or facilitate acquisition of proper allergy histories, blood culture techniques, prioritization of antimicrobial administration, and antimicrobial de-escalation. Given the number of bedside nurses in practice, such interventions have the potential to substantially lower inappropriate antimicrobial utilization.