Effect of an antimicrobial stewardship intervention on outcomes for patients with Clostridium difficile infection.

Background: Although antimicrobial stewardship programs (ASPs) are uniquely positioned to improve treatment of Clostridium difficile infection (CDI) through targeted interventions, studies to date have not rigorously evaluated the influence of ASP involvement on clinical outcomes attributed to CDI.

Methods: We performed a quasiexperimental study of adult patients with CDI before (n = 307) and after (n = 285) a real-time ASP review was initiated. In the intervention group, an ASP pharmacist was notified of positive CDI results and consulted with the care team to initiate optimal therapy, minimize concomitant antibiotic and acid-suppressive therapy, and recommend surgical/infectious diseases consultation in complicated cases.

Central line-associated bloodstream infections in non-ICU inpatient wards: a 2-year analysis.

Objective: Little is known about patient-specific factors contributing to central line-associated bloodstream infection (CLABSI) outside of the intensive care unit (ICU). We sought to describe these factors and hypothesized that dialysis patients would comprise a significant proportion of this cohort.

Design: Retrospective observational study from January 2010 to December 2011.

Impact of postplacement adjustment of peripherally inserted central catheters on the risk of bloodstream infection and venous thrombus formation.

Objective: Peripherally inserted central catheter (PICC) tip malposition is potentially associated with complications, and postplacement adjustment of PICCs is widely performed. We sought to characterize the association between central line-associated bloodstream infection (CLABSI) or venous thrombus (VT) and PICC adjustment.

Design: Retrospective cohort study.

Evidence of disparity in the application of quality improvement efforts for the treatment of acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice Initiative in Michigan.

Background: Racial disparities exist in the management of patients with cardiovascular disease in the United States. The aim of the study was to evaluate if a structured initiative for improving care of patients with acute myocardial infarction (Guidelines Applied in Practice [GAP]) led to comparable care of white and nonwhite patients admitted to GAP hospitals in Michigan.

Methods: Medicare patients comprised 2 cohorts: (1) those admitted before GAP implementation (n = 1,368) and (2) those admitted after GAP implementation (n = 1,489).

The association between guideline-based treatment instructions at the point of discharge and lower 1-year mortality in Medicare patients after acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) initiative in Michigan.

Background: The American College of Cardiology's Guidelines Applied in Practice (GAP) initiative for acute myocardial infarction (AMI) has been shown to increase the use of guideline-based therapies and improve outcomes in patients with AMI. It is unknown whether hospitals that are more successful in using the standard discharge contract--a key component of GAP that emphasizes guideline-based medications, lifestyle modification, and follow-up planning--experience a proportionally greater improvement in patient outcomes.

Methods: Medicare patients treated for AMI in all 33 participating GAP hospitals in Michigan were enrolled.

Sex differences in the application of evidence-based therapies for the treatment of acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice projects in Michigan.

Background: Studies have shown that women with acute myocardial infarction (AMI) are less likely to receive evidence-based care compared with men. The American College of Cardiology's AMI Guidelines Applied in Practice (GAP) program has been shown to increase the rates of evidence-based medicine use and reduce mortality in patients with AMI. The objective of this study was to investigate the relative benefits of the GAP program in men and women.

Guideline-based standardized care is associated with substantially lower mortality in medicare patients with acute myocardial infarction: the American College of Cardiology's Guidelines Applied in Practice (GAP) Projects in Michigan.

Objectives: We sought to assess the impact of the American College of Cardiology's Guidelines Applied in Practice (GAP) project for acute myocardial infarction (AMI) care, encompassing 33 acute-care hospitals in southeastern Michigan, on rates of mortality in Medicare patients treated in Michigan.

Background: The GAP project increases the use of evidence-based therapies in patients with AMI. It is unknown whether GAP also can reduce the rate of mortality in patients with AMI.

Analysis of OBQI outcomes in participating Michigan home health agencies.

As part of the Centers for Medicare & Medicaid Services' plan to implement Outcome-Based Quality Improvement (OBQI) in home health settings nationwide, a pilot project was initiated in 5 states. This article analyzes the results of the Michigan Peer Review Organization's (MPRO's) pilot project in terms of changes in patient outcomes that occurred in participating home health agencies between 2000 and 2001. Participating agencies had statistically significant improvements when comparing their performance in 2001 versus their performance in 2000.

Impact of intraguild predators on survival of a forest-floor wolf spider.

We investigated the impact of variation in densities of a guild of generalist predators on survival of young wolf spiders of the genus Schizocosa. Numbers of other spiders and centipedes were reduced by >80% in fenced 4-m plots in an experiment that was replicated twice in each of three forest locations. Schizocosa survival during the 1st month was low (<50%) in all three locations, but did not differ between predator-reduction and control plots.