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Miguel de Cervantes's Don Quijote, Part One (1605) purports to be an historical chronicle of the exploits of a mad Manchegan knight, a conceit which Don Quijote, Part Two (1615) develops by staging encounters between Don Quixote and Sancho Panza and characters who have read the 'true history' of Part One. This structure culminates in the episodes involving the Duke and Duchess, assiduous readers of Part One who concoct elaborate pranks at Quixote's and Sancho's expense. Consumed by their merrymaking, the Duke and Duchess reveal themselves to be quixotic in a peculiarly literary way: they ape Quixote's madness by miming his exaggerated imitation of literature. In this way, Part One, like the books of knight errantry that drive Quixote insane, becomes the stimulus for extravagant behaviour. This identification simultaneously celebrates and satirizes the popular reception and power of Cervantes's own work, which itself achieves a bizarre capacity to drive sane individuals to behavioural extremes. [ABSTRACT FROM AUTHOR]

Background Asymptomatic bacteriuria is common in hospitalized patients with urinary catheters. Inappropriate urine culturing as part of reflexive response to fever contributes to unnecessary and excessive antibiotic use, selection for resistant organisms, increased risk for Clostridium difficile infections, and false elevation in catheter-associated urinary tract infection (CAUTI) rates. This project aimed to implement an evidence-based urine culture algorithm in a 33-bed neurocritical care unit, a unit with a historically elevated CAUTI rate due to a high prevalence of noninfectious fever. Methods A multidisciplinary quality improvement project was initiated in August 2018 by the Infection Prevention, Quality and Safety, Neurocritical Care, Trauma, and Neurosurgery teams of an urban academic health center. The group implemented a urine culture algorithm that was adapted from the Infectious Diseases Society of America (IDSA) guidelines that clearly highlighted appropriate indications for sending urine cultures. The team agreed to utilize a urinalysis with reflex to culture as the preferred method to evaluate for CAUTI. The algorithm was implemented in September 2018. Outcomes were compared for pre-implementation (March-August 2018) and post-implementation (September 2018–February 2019). Results The NHSN CAUTI rate decreased from 4.52/1,000 Foley days to 1.27/1,000 Foley days (P-value 0.037) as a result of the intervention. The number of urine cultures ordered decreased by 82% after implementation. No cases of bacteremia or mortality secondary to a urinary source were identified during the project. Total days of antibiotic therapy for the unit was similar between the pre- and post-implementation time periods (P = 0.631). Conclusion Implementation of a urine culture algorithm in a neurocritical care unit resulted in reduced CAUTI rate with less financial and operational waste in unnecessary orders and treatment, without resulting in adverse events to patients as a result of missed diagnosis. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Objectives: To investigate reticulocyte hemglobin content (CHr) as a primary screening test to detect iron deficiency (ID) in healthy toddlers. Demographic and dietary risk factors associated with ID were studied for an association with low CHr.Methods: This was a prospective cross-sectional study of healthy toddlers aged 12 to 36 months coming to well-child visits at two military pediatric ambulatory clinics in the Washington, DC, area from August 2006 to November 2007. Data were collected on medical, demographic, and dietary intake by parental questionnaire. A sample of blood was drawn from each subject for complete blood count and CHr. A logistic regression model was used to determine which factors may be predictive of ID.Results: A total of 144 children were studied. An abnormal low CHr of 27.5 was identified in 18.8% of our toddler population. Two variables were determined to be independent predictors of low CHr; an age of 12 to 23 months and black race.Conclusions: Used alone as a primary screening marker, CHr identified a high prevalence of ID in our population of toddlers. Black race and younger age were associated with a lower CHr. Larger studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]