c-diff
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New Treatment for Clostridium Difficile Infection
Fidaxomicin is a new antibiotic that is soon to be released by the FDA for Clostridium Difficile Infections in adults. This new drug is a macrocyclic RNA polymerase inhibitor. It has narrow spectrum of activity, almost C-Diff specific. Since monitoring the 1990’s of C-Diff has reached an all time high. Research shows that it has a higher clinical cure rate than it current treatment, oral vancomycin and metronidazole. Research also shows that there are fewer patient relapse following initial treatment.
Current Treatment: Limit use of antibiotics. If antibiotics are needed for prolonged durations probiotics are recommended. Avoid the use of antiperistalsis agent that may precipitate toxic mega colon. For mild to moderate cases of C- Diff metronidazole 500mg orally three times per day for 10-14 days. Vancomycin 125mg orally four times a day for 10-14 days is drug of choice for severe cases. If there is an ileus vancomycin can be administered rectally. IV metronidazole may be administered for complicated cases. IV vancomycin is not used for C-Diff because it does not reach the colon for absorption. Therefore patients may be on two forms of vancomycin for two different infections.
Dosage and Administration: Study Phase III trial administered 200mg of fidaxomicin oral dose every 12 hours for 10 days. This is most likely the recommended dose.
Clinical Efficacy: With the above dosing researchers are getting clinical cure rates of 88.2% over vancomycin of 85.8% and recurrence rates of 15.4% over vancomycin of 25.3%. Fidaxomicin has faster resolution of C-Diff symptoms of 60 hours due to the high fecal concentrations, nearly 100%.
Safety and Tolerability: No major adverse reactions and no recognized drug interactions.
This drug is not on the market as of yet. The FDA is trying to push fidaxomicin through the last stages of trials because of its statistics and promise for C-Diff infection. Fidaxomicin is expected to released by June/July.
Brief Update: A Call to Action
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I know it’s been a long time since I posted anything here. Life intervened.
Since it’s Nov 1st and the start of NaNoWriMo, I know I’ll be formulating a writing ritual. I might as well add the blog as another of my writing outlets. I tend to thrive on peer pressure, so if you’d like to add me as a writing buddy, my username is “igeekrn”. I promise to follow you back and support you on your project…quest….thing. I have a rough plot and some character sketches but haven’t started the novel itself. Once I get a bit more clear on the project, I’ll post some updates and maybe a snippet or two of the more coherent parts.
Transforming the Clinical Workspace – GTD?
Posted by admin | Filed under Health Care
Nurses are a busy lot.
They race around attending to patient needs, interacting with other members of the health care team, and trying to manage the documentation burden. They are bombarded with tasks from many different directions, and held accountable for completing them in a timely fashion. All this in a work environment created by non-clinicians, using tools thrust upon them, and retrofitted with technology that didn’t exist when the work environment was originally designed. To make matters worse, little to no room exists for improvisation, as uniformity and control are believed to be the safest route to regulatory compliance and meeting financial goals.
The problem is multiplied when you consider the expense of ongoing staff training. Hospitals have so many competing priorities, staff training can be sparse. Add the ongoing nursing shortage, and it might not be possible to relieve nurses from their shift work to participate in training sessions even if offered.
These environmental factors weigh heavily on nurses. Their strong desire to provide exceptional, error-free care in this context creates an environment of pressure and stress that leads to all sorts of adverse effects, including lateral violence, job dissatisfaction, high rates of attrition, and lowered job performance.
So how do we improve this situation? Some key changes that should be considered in all institutions is to include nurses on building committees, involve them in work flow and process improvement activities, and find ways to encourage improvisation and innovation at the bedside.
What to do about the flow of information? It certainly is dynamic and from varied sources. Some pieces of data require action, some need to be saved for later reference. It would be useful if the system could prompt when action is necessary. There is a need for a system to reliably store this. What does this sound like? How about GTD? I was re-reading David Allen’s book a few days after attending the Genesys/MI-HIMSS meeting, and realized that GTD is perfect for clinical organization. It’s what we are doing already, yet in an informal manner and with ineffective tools. I am currently reviewing “Getting Things Done” from a nurse’s perspective, and am excited to think of the application of these methods to clinical nursing practice.
Do you think the GTD methodology could help you organize and plan your shift? What pitfalls can you envision?
Thanks to MI-HIMSS and Genesys for putting on the meeting last week. Ann Hendrich discussed the findings of a large study she has been conducting on how nurses spend their time full-text available here, which was the inspiration for this post.
