Impact of an electronic smart order-set for diagnostic stewardship of Clostridiodes difficile infection (CDI) in a community healthcare system in South Florida.

BACKGROUND: Inappropriate testing for Clostridiodes difficile infection (CDI) increases health care onset cases and contributes to overdiagnosis and overtreatment of patients in a community health care system. METHODS: An electronic smart order set for the testing of CDI was created and implemented to improve the appropriateness of testing. A retrospective review of patients who were tested for CDI, pre and post, was conducted to determine if inappropriate stool testing for CDI decreased post-implementation of the order set. RESULTS: 224 patients were tested for CDI during the study period with the post-implementation period having a higher proportion of patients who met appropriate testing criteria defined by presence of diarrhea (80.5% vs 61.3%; P = .002). The rate of inappropriate CDI stool testing decreased from 31.1% to 11.0% after implementation (P < .001). A higher proportion of CDI patients were readmitted within 30 days of discharge (54.2% vs 33.0%; P = 0.001) during the post-implementation period. CONCLUSIONS: There was a significant reduction in inappropriate CDI testing following the implementation of the order set. There was an observed increase in the proportion of patients who underwent recent gastrointestinal surgery which may have contributed to the increase in 30-day readmission rates during the post-implementation period.

[Reproductive risk factors of breast cancer in patients attended at a second level urban hospital]. / Factores de riesgo reproductivo para cáncer de mama en pacientes atendidas en un hospital urbano de segundo nivel.

OBJECTIVE: To evaluate the implication of reproductive risk factors for breast cancer of patients at a breast clinic of a second level urban hospital. PATIENTS AND METHOD: Women with breast cancer and randomly selected age-matched control subjects were evaluated. Age, age of menarche and menopause, age of first full term pregnancy, number of pregnancies, lactation, family history of breast cancer and family history of other cancers were analyzed. RESULTS: Sixty-six cases with breast cancer and 132 controls were study. Cases were older at first full term pregnancy (25.8 +/- 6.4 vs 23.3 +/- 5 years old, p = 0.01) and presented frequently first full term pregnancies after 30 years old (19.6 vs. 6%, p = 0.01); these differences also were significative for cases of 50 years or older. Cases younger than 50 years old had short lifetime lactation (11.5 +/- 8.2 vs. 27 +/- 30 months, p < 0.001), and few presented lactation longer than 12 months (27.8 vs 55.8%, p = 0.02). CONCLUSIONS: In this research the most important breast cancer risk factor for women older than 50 years old was the age of first full term pregnancy. For women younger than 50 years old periods of lifetime lactation shorter than 12 months seems a risk factor.