Use of computer decision support in an antimicrobial stewardship program (ASP).

OBJECTIVE: Document information needs, gaps within the current electronic applications and reports, and workflow interruptions requiring manual information searches that decreased the ability of our antimicrobial stewardship program (ASP) at Intermountain Healthcare (IH) to prospectively audit and provide feedback to clinicians to improve antimicrobial use. METHODS: A framework was used to provide access to patient information contained in the electronic medical record, the enterprise-wide data warehouse, the data-driven alert file and the enterprise-wide encounter file to generate alerts and reports via pagers, emails and through the Centers for Diseases and Control's National Healthcare Surveillance Network. RESULTS: Four new applications were developed and used by ASPs at Intermountain Medical Center (IMC) and Primary Children's Hospital (PCH) based on the design and input from the pharmacists and infectious diseases physicians and the new Center for Diseases Control and Prevention/National Healthcare Safety Network (NHSN) antibiotic utilization specifications. Data from IMC and PCH now show a general decrease in the use of drugs initially targeted by the ASP at both facilities. CONCLUSIONS: To be effective, ASPs need an enormous amount of "timely" information. Members of the ASP at IH report these new applications help them improve antibiotic use by allowing efficient, timely review and effective prioritization of patients receiving antimicrobials in order to optimize patient care.

Improving tuberculosis screening and isoniazid preventive therapy in an HIV clinic in Addis Ababa, Ethiopia.

BACKGROUND: The World Health Organization (WHO) recommends active tuberculosis (TB) case finding among people living with human immunodeficiency virus (HIV) in resource-limited settings using a symptom-based algorithm; those without active TB disease should be offered isoniazid preventive therapy (IPT). OBJECTIVE: To evaluate rates of adherence to WHO recommendations and the impact of a quality improvement intervention in an HIV clinic in Addis Ababa, Ethiopia. DESIGN: A prospective study design was utilized to compare TB symptom screening and IPT administration rates before and after a quality improvement intervention consisting of 1) educational sessions, 2) visual reminders, and 3) use of a screening checklist. RESULTS: A total of 751 HIV-infected patient visits were evaluated. The proportion of patients screened for TB symptoms increased from 22% at baseline to 94% following the intervention (P < 0.001). Screening rates improved from 51% to 81% (P < 0.001) for physicians and from 3% to 100% (P < 0.001) for nurses. Of the 281 patients with negative TB symptom screens and eligible for IPT, 4% were prescribed IPT before the intervention compared to 81% after (P < 0.001). CONCLUSIONS: We found that a quality improvement intervention significantly increased WHO-recommended TB screening rates and IPT administration. Utilizing nurses can help increase TB screening and IPT provision in resource-limited settings.

[Hiatal hernia and reflux esophagitis]. / Hiatushernie og refluksøsofagitt.

Between 1985 and 1987, 25 patients had abdominal operations for hiatal hernia and/or gastroesophageal reflux disease. Eight of them had complicated reflux esophagitis. One patient had a Belsey Mark IV repair, the others had a Nissen fundoplication. There was no mortality. After a median follow-up of 16 months (range 3-38) six patients had symptoms of "gas-bloat". The esophagitis was healed in ten patients. 22 patients were completely or fairly satisfied with the results of the surgery. Two patients were not satisfied. Both had complicated reflux esophagitis before they were operated on. Patients with esophagitis should be evaluated for surgery before stricture or Barrett's ulcer develop.

Digital rectal examination to screen for prostatic cancer.

In a prospectively designed study 480 men, aged 45-67 years of age having routine medical examinations as part of the Occupational Health Service Program, underwent digital rectal examination to screen for early prostatic cancer. 26 men were referred to the Urology Service of the Aust-Agder Central Hospital for repeat examinations and further diagnostic procedures. Biopsies were performed on 16 patients, and transrectal ultrasound examination on 9. One patient was found to have prostate cancer. The value of an organized screening program for the detection of early prostatic cancer still seems to be under discussion.