Does clinician-initiated Clostridioides difficile testing improve outcomes of patients with Clostridioides Difficile infection?

BACKGROUND: Clostridioides difficile (C. difficile) is a common hospital-acquired infection which can lead to major implications for patients and our health care system. In this study, we examine a policy change at a single-site Veterans Affairs Healthcare system that allowed bedside nurses to order C. difficile testing in addition to physicians on the time to obtain test results and initiate treatment. METHODS: The time to receive results and initiate treatment were analyzed before and after the policy change, and between physicians and nurses using descriptive statistics and paired student t-tests. Variables associated with lower ordering times were also analyzed using logistic regression while adjusting for patient admission location and length of inpatient hospital stay. RESULTS: The difference in time to obtain the result both before and after the policy change and between ordering provider type were both statistically significant (P < .05). In unadjusted models, nurses were associated with faster test results compared to physicians (OR (95% CI) 1.72 (1.45-2.05). CONCLUSIONS: Allowing bedside nurses more autonomy to order the stool sample significantly decreased the amount of time to receive the results, potentially decreasing the risk of additional infections among patients and decreasing the economic burden on the hospital.

Optimizing the effectiveness of a mechanical suture-based anulus fibrosus repair construct in an acute failure laboratory simulation.

STUDY DESIGN: In vitro comparative, laboratory experiments. OBJECTIVE: This study developed a laboratory apparatus that measured resistance to failure using pressures similar to intradiscal pressure of a lumbar spinal disk. Various combinations of an anular repair device were compared. SUMMARY OF BACKGROUND CONTEXT: Herniated material of the intervertebral disk is removed during a lumbar discectomy; however, the defect in the anulus fibrosus remains and can provide a pathway for future herniation. Repairing the anulus fibrosus could mitigate this reherniation and improve patient outcomes. METHODS: A pneumatic cylinder was used to increase the pressure of a sealed chamber until artificial nucleus pulposus material was expulsed through either a 3-mm circular (diameter) or a 6-mm slit anular defect created in a surrogate anulus fibrosus. Each unrepaired condition was compared with 3 repaired conditions using a commercially available soft tissue repair system. The repaired conditions included: (1) a single tension band; (2) 2 tension bands in a cruciate pattern; or (3) 2 tension bands in a parallel pattern. Maximum pressure at the point of extrusion of the internal chamber material and failure or nonfailure of the repair was measured. RESULTS: Significant differences were detected (P<0.05) in maximum failure pressures for the nonrepaired (control) versus repaired conditions. With 1 or 2 tension bands repairing the circular defect, the maximum failure pressure increased by approximately 76% and 131%, respectively. In addition, the failure pressure for 2 tension bands in either a cruciate or parallel configuration was not different, and was approximately 32% higher (P<0.05) than a single tension band in the case of the circular defect. Similar results were seen for the slit defect, with the exception that no difference between the repaired conditions (ie, single vs. 2 tension bands) was detected. CONCLUSIONS: This laboratory simulation demonstrated that repairing the anulus fibrosus after a discectomy procedure can be beneficial for retaining intradiscal material. The use of 2 tension bands, versus a single tension band, in either a cruciate or parallel configuration may further improve the ability to retain disk material.