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16 results

  • Outcomes of clinical decision support for outpatient management of Clostridioides difficile infection

  • Tiffany Wu, Susan L. Davis, Brian Church, George J. Alangaden, Rachel M. Kenney
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 43 / Issue 10 / October 2022
    Published online by Cambridge University Press:
    29 September 2021, pp. 1345-1348
    Print publication:
    October 2022
  • Objective:

    To determine the impact of clinical decision support on guideline-concordant Clostridioides difficile infection (CDI) treatment.

    Design:

    Quasi-experimental study in >50 ambulatory clinics.

    Setting:

    Primary, specialty, and urgent-care clinics.

    Patients:

    Adult patients were eligible for inclusion if they were diagnosed with and treated for a first episode of symptomatic CDI at an ambulatory clinic between November 1, 2019, and November 30, 2020.

    Interventions:

    An outpatient best practice advisory (BPA) was implemented to notify prescribers that “vancomycin or fidaxomicin are preferred over metronidazole for C.difficile infection” when metronidazole was prescribed to a patient with CDI.

    Results:

    In total, 189 patients were included in the study: 92 before the BPA and 97 after the BPA. Their median age was 59 years; 31% were male; 75% were white; 30% had CDI-related comorbidities; 35% had healthcare exposure; 65% had antibiotic exposure; 44% had gastric acid suppression therapy within 90 days of CDI diagnosis. The BPA was accepted 23 of 26 times and was used to optimize the therapy of 16 patients in 6 months. Guideline-concordant therapy increased after implementation of the BPA (72% vs 91%; P = .001). Vancomycin prescribing increased and metronidazole prescribing decreased after the BPA. There was no difference in clinical response or unplanned encounter within 14 days after treatment initiation. Fewer patients after the BPA had CDI recurrence within 14–56 days of the initial episode (27% vs 7%; P < .001).

    Conclusions:

    Clinical decision support increased prescribing of guideline-concordant CDI therapy in the outpatient setting. A targeted BPA is an effective stewardship intervention and may be especially useful in settings with limited antimicrobial stewardship resources.

Genome Editing and Engineering
  • From TALENs, ZFNs and CRISPRs to Molecular Surgery
  • Edited by Krishnarao Appasani
  • Foreword by George M. Church
  • Published online:
    30 July 2018
    Print publication:
    23 August 2018
  • Recent advances in genome editing tools using endonucleases such as TALENs, ZFNs, and CRISPRs, combined with genomic engineering technologies, have opened up a wide range of opportunities from applications in the basic sciences and disease biology research, to the potential for clinical applications and the development of new diagnostic tools. This complete guide to endonuclease-based genomic engineering gives readers a thorough understanding of this rapidly expanding field. Chapters cover the discovery, basic science, and application of these techniques, focusing particularly on their potential relevance to the treatment of cancer, and cardiovascular and immunological disease. The final section discusses the legal and ethical issues which accompany the technology. Providing authoritative coverage of the potential that genome editing and engineering have, this is an ideal reference for researchers and graduate students and those working in the biotechnology and pharmaceutical industries, as well as in a clinical setting.