Download or read book Effectiveness of Early Diagnosis Prevention and Treatment of Clostridium Difficile Infection written by and published by . This book was released on with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Early Diagnosis Prevention and Treatment of Clostridium Difficile written by Mary Butler and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: OBJECTIVE: Update a 2011 review of differences in accuracy of diagnostic tests and the effects of interventions to prevent and treat Clostridium difficile infection (CDI) in adults. DATA SOURCES: Medline(r), the Cochrane Clinical Trials Registry, and Embase(r) from 2010 through April 2015 plus reference lists of included studies and recent systematic reviews. METHODS: Two investigators screened abstracts and full texts of identified references for eligibility. Eligible studies included studies of sensitivity and specificity for diagnostic tests in patients at risk for CDI. We included randomized controlled trials or high-quality cohort studies enrolling adult patients with CDI or suspected CDI for treatment interventions. Prevention studies also included adult patients at risk for CDI and observational study designs. Two investigators extracted data, assessed individual study risk of bias, and evaluated the strength of evidence for each comparison and outcome. Pooled estimates were analyzed to assess the efficacy and comparative effectiveness of a variety of treatments. RESULTS: We identified 37 diagnostic studies and 56 studies evaluating prevention or treatment interventions to update the review. High-strength evidence showed that nucleic amplification tests were sensitive and specific for CDI when using culture as the reference standard. Low-strength evidence was found that some institutional prevention interventions, such as antibiotic prescribing practices and transmission interruption (terminal room cleaning with hydrogen peroxide vapor and handwashing campaigns), reduce CDI incidence. Low-strength evidence also suggested that prevention programs can be sustained over several years. For CDI treatment, vancomycin is more effective than metronidazole (high-strength evidence), and the effect does not vary by severity (moderate-strength evidence). Fidaxomicin remains noninferior to vancomycin for the initial cure of CDI (moderate-strength evidence) but is superior to vancomycin for prevention of recurrent CDI (now high-strength evidence). Although both fecal microbiota transplantation (FMT) and probiotics were the subject of a significant number of new studies, the overall high risk of bias of many of these studies necessitated ratings of low strength of evidence. Specifically, low-strength evidence suggests that FMT may have a significant effect on reducing recurrent CDI. Similarly, low-strength evidence suggests that lactobaccilus strains and multiorganism probiotics also can reduce recurrent CDI. However, Saccharomyces boulardii was no more effective than placebo in preventing recurrent CDI. Evidence for FMT for refractory CDI was insufficient. Few studies reported adverse events; when reported, few events were noted. CONCLUSIONS: Research on diagnostic testing for and interventions to treat CDI expanded considerably in 4 years. Nucleic acid amplification tests have high sensitivity and specificity for CDI. Vancomycin is more effective than metronidazole for initial CDI, while fidaxomicin is more effective than vancomycin for the prevention of recurrent CDI. FMT and lactobacillus probiotics to restore colonic biodiversity and improve patient resistance to CDI or recurrence have low-strength but relatively consistent positive evidence for efficacy.

Download or read book Effectiveness of Early Diagnosis Prevention and Treatment of Clostridium Difficile Infection written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-04-06 with total page 266 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clostridium difficile infection (CDI) is a serious healthcare-associated infection and a growing health care problem. C. difficile is a Gram-positive, spore-forming, anaerobic bacterium that, when ingested, can cause CDI if it is a toxigenic strain. CDI symptoms include varying levels of diarrhea severity, as well as pseudomembranous colitis and toxic megacolon. CDI incidence is estimated at 6.5 cases per 10,000 patient days in hospital. About 250,000 hospitalizations were associated with CDI in 2005. Direct attributable mortality from CDI has been reported to be as high as 6.9 % of cases. Elderly people in hospitals account for the vast majority of severe morbidity and mortality. Residents of long-term care facilities are also at higher risk. Incidence rates may increase by fourfold or fivefold during outbreaks. In addition to institutional care environments, C. difficile is also common in the community, being easily isolated from soil and water samples. Community-associated CDI rates are generally much lower, accounting for 27 % of all CDI cases in a recent prevalence study, but are also on the rise. However, the source of the C. difficile organisms responsible for cases of CDI in the community is not well understood. In order for CDI to develop, a person must be infected with a strain of C. difficile capable of making toxin in the person's colon. Approximately 1–2 % of healthy individuals are colonized with C. difficile. If these people have usual, healthy colonic flora, the risk of CDI is very low. There is a small risk of CDI if the colon flora becomes disturbed, commonly through antibiotic use, while the person is colonized with a toxigenic strain. Antibiotics that disturb colon flora enough to allow CDI to develop must get into the colon, and they are associated with alterations in relative amounts of colon bacterial constituents. The immune status of the patient also contributes to the risk of developing CDI and the experienced severity. Other risk factors include increasing age, female gender, comorbidities, gastrointestinal procedures, and use of gastric acid suppression medications. Risk profiles for recurrent CDI are similar. One study, which statistically modeled CDI within the hospital setting, suggested that reducing patient susceptibility to infection is more effective in reducing CDI cases than lowering transmission rates. The purpose of this systematic review was to provide an overarching assessment of the evidence for comparing the accuracy of diagnostic tests and the effectiveness of prevention and treatment interventions on initial and recurrent CDI-related patient outcomes in adult patients. The major impetus of this review is the presence of clinical disease, not asymptomatic carriage of the C. difficile organism. The review focuses on adult patients because adults, and particularly elderly adults, carry the large majority of the morbidity and mortality burden. The following Key Questions (KQs) form the basis for this review: KQ 1. How do different methods for detection of toxigenic C. difficile to assist with diagnosis of CDI compare in their sensitivity and specificity? Do the differences in performance measures vary with sample characteristics? KQ 2. What are effective prevention strategies? What is the effectiveness of current prevention strategies? What are the harms associated with prevention strategies? How sustainable are prevention practices in health care (outpatient, hospital inpatient, extended care) and community settings? KQ 3. What are the comparative effectiveness and harms of different antibiotic treatments? Does effectiveness vary by disease severity or strain? Does effectiveness vary by patient characteristics: age, gender, comorbidity, hospital- versus community-acquired setting? How do prevention and treatment of CDI affect resistance of other pathogens? KQ 4. What are the effectiveness and harms of nonstandard adjunctive interventions? In patients with relapse/recurrent CDI?

Download or read book Future Research Needs for Prevention and Treatment of Clostridium Difficile Infection written by Hussein Z. Noorani and published by . This book was released on 2012 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Clostridium difficile infection (CDI) is a serious healthcare-associated infection and a growing health care problem, especially with the emergence of more virulent strains in the early 2000s. CDI is now the most common cause of nosocomial infectious diarrhea and is increasing in incidence and, in all likelihood, severity. A comparative effectiveness review (CER) was prepared by the Minnesota Evidence-based Practice Center (EPC) on Comparative Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection (December 2011). The purpose of the CER was to provide an overarching assessment of the evidence for comparing the accuracy of diagnostic tests and the effectiveness of prevention and treatment interventions on initial and recurrent CDI-related patient outcomes in adults. Limited high-quality evidence was available to support the diagnostic, preventive, and treatment practices for CDI carried out by providers in hospital, long-term care, and outpatient settings. Inconsistency in definitions of diarrhea, severity, resolution of symptoms, recurrence, or cure contributed to the difficulty in drawing conclusions from the evidence. There were a number of important evidence gaps identified in the CER. The objective of this Future Research Needs project was to systematically prioritize evidence gaps on prevention and treatment of CDI, and to develop a list of research questions to address the prioritized gaps. Although different diagnostic methods for toxigenic Clostridium difficile were evaluated in the CER, diagnostic methods were not included in this project primarily because polymerase chain reaction testing is rapidly becoming the standard diagnostic test for the infection.

Download or read book Future Research Needs for Prevention and Treatment of Clostridium Difficile Infection written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-04-04 with total page 66 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clostridium difficile infection (CDI) is a serious healthcare-associated infection and a growing health care problem, especially with the emergence of more virulent strains in the early 2000s. Clostridium difficile was first recognized as having the ability to cause pseudomembranous colitis in the late 1970s. CDI is now the most common cause of nosocomial infectious diarrhea. Asymptomatic colonization in healthy adults has been observed in only 3 percent of persons, while the prevalence of such colonization among residents in long-term-care facilities approaches 50 percent. Individuals colonized with Clostridium difficile serve as a reservoir for infection by contaminating the environment with Clostridium difficile spores, thus leading to the spread of the organism on the hands of health care workers or via use of medical equipment. CDI is increasing in incidence and, in all likelihood, severity. The number of cases diagnosed among patients discharged from hospitals increased from 31 per 100,000 persons in 1996 to 84 per 100,000 persons in 2005. Infection due to a relatively new strain of Clostridium difficile, termed “North American pulsed-field gel electrophoresis type 1” (NAP1), is felt to be at least partially responsible for this increased incidence of CDI as well as for the increased severity of clinical illness. The NAP1 strain is capable of producing more than 15 times the quantity of both toxins A and B, which are directly responsible for the damage to the intestinal tract of infected patients. Hence, CDI is not only now more common, but also more severe, leading to an attributable mortality of up to 16 percent of all deaths. A comparative effectiveness review (CER) was prepared by the Minnesota Evidence-based Practice Center (EPC) on Comparative Effectiveness of Early Diagnosis, Prevention, and Treatment of Clostridium difficile Infection (December 2011). The purpose of the CER was to provide an overarching assessment of the evidence for comparing the accuracy of diagnostic tests and the effectiveness of prevention and treatment interventions on initial and recurrent CDI related patient outcomes in adults. Key informants, provided input to the EPC on the scope of the CER, agreed that its greatest contribution to the field could be to have an independent organization provide a comprehensive review of the major concerns of the field for both clinicians and researchers. The major impetus underlying the SR was a concern about the presence of clinical disease, not asymptomatic carriage of the Clostridium difficile organism.1 Molecular epidemiological studies whose main purpose was to identify the strains of Clostridium difficile present in the population were outside the scope of the CER. The CER focused on adult patients as they, particularly elderly adults, carry the most of the morbidity and mortality burden.The CER addressed the following Key Questions (KQs): 1. How do different methods for detection of toxigenic Clostridium difficile to assist with diagnosis of CDI compare in their sensitivity and specificity? a. Do the differences in performance measures vary with sample characteristics? 2. What are effective prevention strategies? a. What is the effectiveness of current prevention strategies? b. What are the harms associated with prevention strategies? c. How sustainable are prevention practices in health care (outpatient, hospital inpatient, extended care) and community settings? 3. What are the comparative effectiveness and harms of different antibiotic treatments? a. Does effectiveness vary by disease severity or strain? b. Does effectiveness vary by patient characteristics: age, gender, comorbidity, hospital versus community-acquired setting? c. How do prevention and treatment of CDI affect resistance of other pathogens? 4. What are the effectiveness and harms of nonstandard adjunctive interventions? a. In patients with relapse/recurrent CDI?

Download or read book Chalk Talks in Internal Medicine written by Somnath Mookherjee and published by Springer Nature. This book was released on 2020-09-30 with total page 347 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides teaching scripts for medical educators in internal medicine and coaches them in creating their own teaching scripts. Every year, thousands of attending internists are asked to train the next generation of physicians to master a growing body of knowledge. Formal teaching time has become increasingly limited due to rising clinical workload, medical documentation requirements, duty hour restrictions, and other time pressures. In addition, today’s physicians-in-training expect teaching sessions that deliver focused, evidence-based content that is integrated into clinical workflow. In keeping with both time pressures and trainee expectations, academic internists must be prepared to effectively and efficiently teach important diagnostic and management concepts. A teaching script is a methodical and structured plan that aids in effective teaching. The teaching scripts in this book anticipate learners’ misconceptions, highlight a limited number of teaching points, provide evidence to support the teaching points, use strategies to engage the learners, and provide a cognitive scaffold for teaching the topic that the teacher can refine over time. All divisions of internal medicine (e.g. cardiology, rheumatology, and gastroenterology) are covered and a section on undifferentiated symptom-based presentations (e.g. fatigue, fever, and unintentional weight loss) is included. This book provides well-constructed teaching scripts for commonly encountered clinical scenarios, is authored by experienced academic internists and allows the reader to either implement them directly or modify them for their own use. Each teaching script is designed to be taught in 10-15 minutes, but can be easily adjusted by the reader for longer or shorter talks. Teaching Scripts in Internal Medicine is an ideal tool for internal medicine attending physicians and trainees, as well as physician’s assistants, nurse practitioners, and all others who teach and learn internal medicine.

Download or read book Use of a Clinical Pathway to Facilitate the Translation and Utilization of AHRQ EPC Report Findings written by Emilia Flores and published by . This book was released on 2018 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Clinical pathways are one method of promoting the uptake of evidence into clinical practice. The ECRI Institute-Penn Medicine EPC incorporated the updated 2016 AHRQ EPC report on Early Diagnosis, Prevention, and Treatment of Clostridium difficile in the development of a clinical pathway for treatment of Clostridium difficile infection (CDI) in the acute care setting. This EPC report was selected as it complements other CDI initiatives currently being undertaken at the University of Pennsylvania Health System (UPHS). The objective of this pilot project was to assess the incremental value of including AHRQ EPC report findings in the pathway development process, as well as examine the value these reports may contribute to the process, and the time and resource requirements for this activity. METHODS: UPHS is a multicenter academic health care system in the Philadelphia region. We recruited a clinical owner and a representative multidisciplinary stakeholder panel to participate in the development of a clinical pathway, including experts from infectious diseases, infection control, antimicrobial stewardship, pharmacy, hospital medicine, and the UPHS CDI initiative, as well as clinical informatics. This process was facilitated by the PennPathways Program Manager and Director of the Penn Medicine Center for Evidence-based Practice (CEP). ECRI Institute was responsible for conducting a rapid evidence review. CEP used their existing 10-step framework for developing and disseminating clinical pathways across a geographically distributed health system. Steps include: 1. Identifying an engaged clinical owner;2. Recruiting representative stakeholders;3. Conducting a rapid review of existing guidelines and pathways;4. Developing a prototype pathway;5. Reviewing the rapid review and pathway prototype with stakeholders;6. Conducting additional rapid reviews as necessary;7. Updating the pathway using asynchronous feedback by stakeholders as necessary;8. Quality assurance and finalizing content and meta-data;9. Developing a messaging strategy and disseminating; and10. Monitoring utilization and updating. Steps 4, 7, 9, and 10 are facilitated via a Web-based tool (Dorsata Inc., Washington, DC). RESULTS: We initiated our evidence review (step 3) with a review of the AHRQ EPC report on CDI infection. We noted that the report lacked a synthesis of existing guidelines and pathways--products that are critical to the standard pathway development process at Penn Medicine. To address this gap, our partners at ECRI Institute conducted a rapid review of recent guidelines and pathways (step 3). We reviewed these two evidence products with the stakeholder group (step 5) and found that the EPC report was beneficial in that it provided a common understanding of the evidence, which was especially useful for stakeholders less familiar with the current evidence. During the stakeholder review, we identified several differences between the EPC report and recommendations from existing guidelines, which prompted important internal discussions regarding evidence-based treatment. In this respect, the EPC report served as an evidence standard. The CDI treatment clinical pathway was approved by the clinical stakeholders and disseminated through our PennPathways site on April 16, 2018. As of August 31, 2018, the pathway has been viewed 325 times. Total direct project hours were 331. The two project activities with the highest number of direct hours were the rapid evidence review (272 hours) and pathway development (37 hours). The CDI clinical pathway was also deposited to the CDS Connect website to facilitate dissemination and development of computer readable content across other health systems and settings. DISCUSSION: This pilot suggests that AHRQ EPC reports can provide value in the process of developing clinical pathways, but that inclusion of guideline recommendation summaries and guideline quality assessments and pathways from professional organizations, governments and major academic medical centers, will be necessary to meet their full potential. Our findings also suggest that providers utilize clinical pathways when available.

Download or read book Guideline for Isolation Precautions in Hospitals written by Julia S. Garner and published by . This book was released on 1983 with total page 80 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Clostridioides difficile written by Henning Sommermeyer and published by Springer. This book was released on 2021-09-28 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The book provides a comprehensive overview of the current knowledge about Clostridioides (C.) difficile (formerly known as Clostridium difficile) and Clostridioides difficile infections (CDI). The diseases caused by C. difficile range from mild diarrhea to fulminant and in some cases fatal colitis. Historically, CDI was considered mainly as a hospital-acquired problem. Today, a significant portion of CDI is community acquired. Triggered by the introduction of new antibiotics, hypervirulent and multi-drug resistant strains of C. difficile (e.g., C. difficile ribotype R027) have emerged and spread across the globe. The volume covers the microbiology, pathophysiology, epidemiology, risk factors for CDI, diagnosis, clinical pictures, treatment and prophylaxis. It includes an extensive reference list that allows an easy navigation through the original research publications. Clostridioides difficile helps the reader gain a better understanding of C. difficile, the challenges that may arise and the available treatment options. Given its broad coverage and features, it will appeal to a wide readership, from gastroenterologists through general physicians, nurses, and other healthcare providers, to students.

Download or read book Manual of Childhood Infections written by Mike Sharland and published by Oxford University Press, USA. This book was released on 2011-04-07 with total page 913 pages. Available in PDF, EPUB and Kindle. Book excerpt: This manual gives information on the causative organisms, epidemiology and clinical features of all important childhood infections. It includes guidance on the clinical management of the infections and on steps to be taken to prevent future cases.

Download or read book Clinical Algorithms in General Surgery written by Salvatore Docimo Jr. and published by Springer. This book was released on 2019-02-04 with total page 786 pages. Available in PDF, EPUB and Kindle. Book excerpt: As the field of general surgery continues to expand, the diagnostic and therapeutic pathways are becoming more complex. The diagnostic modalities available to the clinician can be both very helpful but also overwhelming considering the findings can often determine the scope of treatment for a patient. This text will take the major pathologies of the systems commonly studied in general surgery and present them in a unique format based upon algorithms. The algorithms will begin with the clinical presentation of the patient, work its way through the various diagnostic modalities available to the surgeon, and finally allow the physician to make a decision regarding treatment options based upon various patterns in the algorithms. This text will become a very useful resources for surgeons as it allows complex clinical pathways to be conveniently organized in logical algorithms. It will become a concise yet comprehensive manual to assist in clinical decision making. All algorithms will be reviewed by experts in their field and include the most up-to-date clinical and evidence-based information. Clinical Algorithms in General Surgery provides a useful resource for surgeons in clinical practice as well as surgical residents, and surgical attendings who are preparing for board examinations. See sample algorithm in Attachments.

Download or read book The ASCRS Manual of Colon and Rectal Surgery written by David E. Beck and published by Springer Science & Business Media. This book was released on 2009-06-12 with total page 1042 pages. Available in PDF, EPUB and Kindle. Book excerpt: The ASCRS Textbook of Surgery of the Colon and Rectum offers a comprehensive textbook designed to provide state of the art information to residents in training and fully trained surgeons seeking recertification. The textbook also supports the mission of the ASCRS to be the world’s authority on colon and rectal disease. The combination of junior and senior authors selected from the membership of the ASCRS for each chapter will provide a comprehensive summary of each topic and allow the touch of experience to focus and temper the material. This approach should provide the reader with a very open minded, evidence based approach to all aspects of colorectal disease. Derived from the textbook, The ASCRS Manual of Surgery of the Colon and Rectum offers a “hands on” version of the textbook, written with the same comprehensive, evidence-based approach but distilled to the clinical essentials. In a handy pocket format, readers will find the bread and butter information for the broad spectrum of practice. In a consistent style, each chapter outlines the condition or procedure being discussed in a concise outline format – easy to read, appropriately illustrated and referenced.

Download or read book Principles and Practice of Pediatric Infectious Diseases written by Sarah S. Long and published by Saunders. This book was released on 2008 with total page 1618 pages. Available in PDF, EPUB and Kindle. Book excerpt: "In print, online, or on your mobile device, Principles and Practice of Pediatric Infectious Disease provides the comprehensive and actionable coverage you need to understand, diagnose, and manage the ever-changing, high-risk clinical problems caused by infectious diseases in children and adolescents. With new chapters, expanded and updated coverage, and increased worldwide perspectives, this authoritative medical reference offers the latest need-to-know information in an easily-accessible, high-yield format for quick answers and fast, effective intervention!"--Publisher's website.

Download or read book CDC Yellow Book 2018 Health Information for International Travel written by Centers for Disease Control and Prevention CDC and published by Oxford University Press. This book was released on 2017-04-17 with total page 705 pages. Available in PDF, EPUB and Kindle. Book excerpt: THE ESSENTIAL WORK IN TRAVEL MEDICINE -- NOW COMPLETELY UPDATED FOR 2018 As unprecedented numbers of travelers cross international borders each day, the need for up-to-date, practical information about the health challenges posed by travel has never been greater. For both international travelers and the health professionals who care for them, the CDC Yellow Book 2018: Health Information for International Travel is the definitive guide to staying safe and healthy anywhere in the world. The fully revised and updated 2018 edition codifies the U.S. government's most current health guidelines and information for international travelers, including pretravel vaccine recommendations, destination-specific health advice, and easy-to-reference maps, tables, and charts. The 2018 Yellow Book also addresses the needs of specific types of travelers, with dedicated sections on: · Precautions for pregnant travelers, immunocompromised travelers, and travelers with disabilities · Special considerations for newly arrived adoptees, immigrants, and refugees · Practical tips for last-minute or resource-limited travelers · Advice for air crews, humanitarian workers, missionaries, and others who provide care and support overseas Authored by a team of the world's most esteemed travel medicine experts, the Yellow Book is an essential resource for travelers -- and the clinicians overseeing their care -- at home and abroad.

Download or read book Infectious Diseases in the Intensive Care Unit written by Manish Soneja and published by Springer. This book was released on 2021-08-02 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Infections in intensive care is a very broad topic, and this book provides concise yet comprehensive coverage. It focuses on the appropriate and judicious use of microbiological, radiological and point-of-care tests in diagnostic work-ups and evidence-based management protocols. Moreover, it offers essential information on the diagnosis and management of commonly encountered infections in the intensive care unit, making it a handy ready-reference manual for intensivists.

Download or read book Biotherapeutic Agents and Infectious Diseases written by Gary W. Elmer and published by Springer Science & Business Media. This book was released on 1999-01-07 with total page 393 pages. Available in PDF, EPUB and Kindle. Book excerpt: Authoritative investigators active in the discovery, development, and application of biological anti-infective agents concisely review their use and potential in preventing and treating human disease. Focusing on biotherapeutic entities that have been tested in controlled studies, the prominent experts illuminate the scientific underpinnings of their therapeutic power, assess their possible risks in the treatment of infectious diseases, and outline the research needed to better define their effectiveness. In addition, they also consider how biotherapeutic agents may be genetically engineered for maximum intestinal and vaginal production of bioactive substances in vivo. Biotherapeutic Agents and Infectious Diseases brings together all the evidence needed to understand and capitalize on the considerable promise of this significant new class of biotherapeutic entities.

Download or read book Clinical Infectious Diseases Study Guide written by Joseph Domachowske and published by Springer Nature. This book was released on 2020-08-05 with total page 357 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is meticulously designed for the busy student, trainee, or seasoned physician looking to enhance or refresh skills in infectious diseases. It is intended to provide a solid resource for students and physicians in need of a concise yet comprehensive background of the material. Each chapter begins with a summary of the topic, a brief case description, definitions, critical teaching points, and tables, figures, photos, and other visual materials to reinforce learning. The chapters take a systems based approach to infections before concluding with the essentials of diagnostic microbiology to leave users with a practical toolkit for real-world clinics. Authored by two expert educators and dual infectious diseases and pediatrics specialists, Clinical Infectious Diseases Study Guide is the only updated study guide designed for medical students, fellows, residents, and trainees who need a strong foundation in infectious diseases. This includes infectious disease specialists in both adult and pediatric care, various internal medicine subspecialists, and hospitalists.