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  1. Article ; Online: Validating agent-based simulation model of hospital-associated Clostridioides difficile infection using primary hospital data.

    Scaria, Elizabeth / Safdar, Nasia / Alagoz, Oguzhan

    PloS one

    2023  Volume 18, Issue 4, Page(s) e0284611

    Abstract: As agent-based models (ABMs) are increasingly used for modeling infectious diseases, model validation is becoming more crucial. In this study, we present an alternate approach to validating hospital ABMs that focuses on replicating hospital-specific ... ...

    Abstract As agent-based models (ABMs) are increasingly used for modeling infectious diseases, model validation is becoming more crucial. In this study, we present an alternate approach to validating hospital ABMs that focuses on replicating hospital-specific conditions and proposes a new metric for validating the social-environmental network structure of ABMs. We adapted an established ABM representing Clostridioides difficile infection (CDI) spread in a generic hospital to a 426-bed Midwestern academic hospital. We incorporated hospital-specific layout, agent behaviors, and input parameters estimated from primary hospital data into the model, referred to as H-ABM. We compared the predicted CDI rate against the observed rate from 2013-2018. We used colonization pressure, a measure of nearby infectious agents, to validate the socio-environmental agent networks in the ABM. Finally, we conducted additional experiments to compare the performance of individual infection control interventions in the H-ABM and the generic model. We find that the H-ABM is able to replicate CDI trends during 2013-2018, including a roughly 46% drop during a period of greater infection control investment. High CDI burden in socio-environmental networks was associated with a significantly increased risk of C. difficile colonization or infection (Risk ratio: 1.37; 95% CI: [1.17, 1.59]). Finally, we found that several high-impact infection control interventions have diminished impact in the H-ABM. This study presents an alternate approach to validation of ABMs when large-scale calibration is not appropriate for specific settings and proposes a new metric for validating socio-environmental network structure of ABMs. Our findings also demonstrate the utility of hospital-specific modeling.
    MeSH term(s) Humans ; Clostridioides difficile ; Clostridium Infections/epidemiology ; Infection Control ; Computer Simulation ; Hospitals ; Cross Infection/epidemiology
    Language English
    Publishing date 2023-04-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0284611
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Validating agent-based simulation model of hospital-associated Clostridioides difficile infection using primary hospital data.

    Elizabeth Scaria / Nasia Safdar / Oguzhan Alagoz

    PLoS ONE, Vol 18, Iss 4, p e

    2023  Volume 0284611

    Abstract: As agent-based models (ABMs) are increasingly used for modeling infectious diseases, model validation is becoming more crucial. In this study, we present an alternate approach to validating hospital ABMs that focuses on replicating hospital-specific ... ...

    Abstract As agent-based models (ABMs) are increasingly used for modeling infectious diseases, model validation is becoming more crucial. In this study, we present an alternate approach to validating hospital ABMs that focuses on replicating hospital-specific conditions and proposes a new metric for validating the social-environmental network structure of ABMs. We adapted an established ABM representing Clostridioides difficile infection (CDI) spread in a generic hospital to a 426-bed Midwestern academic hospital. We incorporated hospital-specific layout, agent behaviors, and input parameters estimated from primary hospital data into the model, referred to as H-ABM. We compared the predicted CDI rate against the observed rate from 2013-2018. We used colonization pressure, a measure of nearby infectious agents, to validate the socio-environmental agent networks in the ABM. Finally, we conducted additional experiments to compare the performance of individual infection control interventions in the H-ABM and the generic model. We find that the H-ABM is able to replicate CDI trends during 2013-2018, including a roughly 46% drop during a period of greater infection control investment. High CDI burden in socio-environmental networks was associated with a significantly increased risk of C. difficile colonization or infection (Risk ratio: 1.37; 95% CI: [1.17, 1.59]). Finally, we found that several high-impact infection control interventions have diminished impact in the H-ABM. This study presents an alternate approach to validation of ABMs when large-scale calibration is not appropriate for specific settings and proposes a new metric for validating socio-environmental network structure of ABMs. Our findings also demonstrate the utility of hospital-specific modeling.
    Keywords Medicine ; R ; Science ; Q
    Subject code 360
    Language English
    Publishing date 2023-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: A Review of Clostridioides difficile Infection and Antibiotic-Associated Diarrhea.

    Abad, Cybéle Lara R / Safdar, Nasia

    Gastroenterology clinics of North America

    2021  Volume 50, Issue 2, Page(s) 323–340

    Abstract: Antibiotic-associated diarrhea and Clostridioides difficile infection (CDI) occur frequently among adults. The pathophysiology of CDI is related to disruption of normal gut flora and risk factors include hospitalization, use of antibiotic therapy, and ... ...

    Abstract Antibiotic-associated diarrhea and Clostridioides difficile infection (CDI) occur frequently among adults. The pathophysiology of CDI is related to disruption of normal gut flora and risk factors include hospitalization, use of antibiotic therapy, and older age. Clinical manifestations can range from mild disease to toxic megacolon. Diagnosis is challenging and is based on a combination of clinical symptoms and diagnostic tests. Therapy includes cessation of antibiotics, or use of other agents depending on the severity of illness. Many novel agents for the treatment and prevention of CDI show promise and are under investigation.
    MeSH term(s) Adult ; Aged ; Anti-Bacterial Agents/adverse effects ; Clostridioides ; Clostridioides difficile ; Clostridium Infections/diagnosis ; Clostridium Infections/drug therapy ; Diarrhea/chemically induced ; Diarrhea/drug therapy ; Humans
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2021-04-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 92114-2
    ISSN 1558-1942 ; 0889-8553
    ISSN (online) 1558-1942
    ISSN 0889-8553
    DOI 10.1016/j.gtc.2021.02.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Integrating infection control and environmental management work systems to prevent Clostridioides difficile infection.

    Keating, Julie A / Parmasad, Vishala / McKinley, Linda / Safdar, Nasia

    American journal of infection control

    2023  Volume 51, Issue 12, Page(s) 1444–1448

    Abstract: Effective infection prevention and control within health care settings requires collaboration and coordination between infection control and environmental management teams. However, the work systems of these teams can be difficult to integrate despite ... ...

    Abstract Effective infection prevention and control within health care settings requires collaboration and coordination between infection control and environmental management teams. However, the work systems of these teams can be difficult to integrate despite their shared goals. We provide results from a qualitative study of Clostridioides difficile infection prevention in Veterans Affairs facilities regarding challenges in coordination between these teams and opportunities to improve coordination and maximize infection prevention activities.
    MeSH term(s) Humans ; Conservation of Natural Resources ; Clostridium Infections/prevention & control ; Infection Control ; Qualitative Research ; Cross Infection/prevention & control
    Language English
    Publishing date 2023-06-16
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 392362-9
    ISSN 1527-3296 ; 0196-6553
    ISSN (online) 1527-3296
    ISSN 0196-6553
    DOI 10.1016/j.ajic.2023.06.008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: The role of the gut microbiome in colonization resistance and recurrent

    Seekatz, Anna Maria / Safdar, Nasia / Khanna, Sahil

    Therapeutic advances in gastroenterology

    2022  Volume 15, Page(s) 17562848221134396

    Abstract: The species composition of the human gut microbiota is related to overall health, and a healthy gut microbiome is crucial in maintaining colonization resistance against pathogens. Disruption of gut microbiome composition and functionality reduces ... ...

    Abstract The species composition of the human gut microbiota is related to overall health, and a healthy gut microbiome is crucial in maintaining colonization resistance against pathogens. Disruption of gut microbiome composition and functionality reduces colonization resistance and has been associated with several gastrointestinal and non-gastrointestinal diseases. One prime example is
    Plain language summary: The Role of the Gut Microbiome in
    Language English
    Publishing date 2022-11-18
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2440710-0
    ISSN 1756-2848 ; 1756-283X
    ISSN (online) 1756-2848
    ISSN 1756-283X
    DOI 10.1177/17562848221134396
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: "What brought you in today?": Modeling patient-provider clinic visits to characterize rural providers' antibiotic treatment decisions.

    Legenza, Laurel / Morris, Ashley O / Safdar, Nasia / Chui, Michelle A

    Research in social & administrative pharmacy : RSAP

    2023  Volume 19, Issue 6, Page(s) 896–905

    Abstract: Background: Designing clinical decision support (CDS) tools is challenging because clinical decision-making must account for an invisible task load: incorporating non-linear objective and subjective factors to make an assessment and treatment plan. This ...

    Abstract Background: Designing clinical decision support (CDS) tools is challenging because clinical decision-making must account for an invisible task load: incorporating non-linear objective and subjective factors to make an assessment and treatment plan. This calls for a cognitive task analysis approach.
    Objectives: The objectives of this study were to 1.) understand healthcare providers' decision making during a typical clinic visit, and 2.) explore how antibiotic treatment decisions are made when they arise.
    Methods: Two cognitive task analysis methods were applied - Hierarchical Task Analysis (HTA) and Operations Sequence Diagramming (OSD) - to 39 h of observational data collected at family medicine, urgent care, and emergency medicine clinical sites.
    Results: The resulting HTA models included a coding taxonomy detailing ten cognitive goals and associated sub-goals and demonstrated how the goals occur as interactions between the provider and electronic health record, the patient, and the physical clinic environment. Although the HTA detailed resources for antibiotic treatment decisions, antibiotics were a minority of drug classes ordered. The OSD shows the sequence of events and when decisions are made solely at the provider level and when shared decision making occurs with the patient. Qualitative data from the observations informed a constructed vignette case example portraying select tasks from the HTA.
    Conclusions: These findings emphasize that the scope of disease states presenting to a generalist clinical setting is broad and could include acute exacerbations of rare diseases within a time-pressured environment. CDS must be accessible, time efficient, and fit within the resource gathering task before treatment decisions are made.
    MeSH term(s) Humans ; Clinical Decision-Making ; Patients ; Ambulatory Care Facilities ; Ambulatory Care ; Anti-Bacterial Agents/therapeutic use
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-02-17
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2192059-X
    ISSN 1934-8150 ; 1551-7411
    ISSN (online) 1934-8150
    ISSN 1551-7411
    DOI 10.1016/j.sapharm.2023.02.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Treatment issues in recurrent

    Budi, Noah / Safdar, Nasia / Rose, Warren E

    FEMS microbes

    2020  Volume 1, Issue 1, Page(s) xtaa001

    Abstract: Clostridioides ... ...

    Abstract Clostridioides difficile
    Language English
    Publishing date 2020-09-23
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2633-6685
    ISSN (online) 2633-6685
    DOI 10.1093/femsmc/xtaa001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Population and hospital-level COVID-19 measures are associated with increased risk of hospital-onset COVID-19.

    Schmitz, Emily / Anderson, Laura / Hatas, Gabrielle / Stevens, Linda / Osman, Fauzia / Schweizer, Marin / Safdar, Nasia / Shirley, Daniel

    Infection control and hospital epidemiology

    2024  , Page(s) 1–3

    Abstract: A review of hospital-onset COVID-19 cases revealed 8 definite, 106 probable, and 46 possible cases. Correlations between hospital-onset cases and both HCW and inpatient cases were noted in 2021. Rises in community measures were associated with rises in ... ...

    Abstract A review of hospital-onset COVID-19 cases revealed 8 definite, 106 probable, and 46 possible cases. Correlations between hospital-onset cases and both HCW and inpatient cases were noted in 2021. Rises in community measures were associated with rises in hospital-onset cases. Measures of community COVID-19 activity might predict hospital-onset cases.
    Language English
    Publishing date 2024-03-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639378-0
    ISSN 1559-6834 ; 0195-9417 ; 0899-823X
    ISSN (online) 1559-6834
    ISSN 0195-9417 ; 0899-823X
    DOI 10.1017/ice.2024.29
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Letter to the Editor.

    Baus, Courtney J / Schulz, Lucas T / Lepak, Alexander J / Safdar, Nasia

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2021  Volume 73, Issue 8, Page(s) 1548

    Language English
    Publishing date 2021-07-28
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciab661
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Surgical Site Infection Prevention Using "Strike Teams": The Experience of an Academic Colorectal Surgical Department.

    Hatharaliyadda, Buddhi / Schmitz, Michelle / Mork, Anne / Osman, Fauzia / Heise, Charles / Safdar, Nasia / Pop-Vicas, Aurora

    Journal for healthcare quality : official publication of the National Association for Healthcare Quality

    2024  Volume 46, Issue 1, Page(s) 22–30

    Abstract: Abstract: Surgical site infections (SSIs) are healthcare-acquired infections with substantial morbidity. Surgical site infection persist because of low adherence to prevention bundles comprising multiple infection control elements. We propose the " ... ...

    Abstract Abstract: Surgical site infections (SSIs) are healthcare-acquired infections with substantial morbidity. Surgical site infection persist because of low adherence to prevention bundles comprising multiple infection control elements. We propose the "Strike Team" as an implementation strategy to improve adherence and reduce SSI in colorectal surgery. At an academic medical center, a multidisciplinary Strike Team met monthly to review colorectal SSI cases, audit and discuss barriers to adherence to SSI prevention bundle, and propose actionable feedback. The latter was shared with frontline clinicians by the Strike Team's surgical leaders in everyday practice. Colorectal SSI rates and bundle adherence data were disseminated quarterly via the hospital intranet and reviewed with surgeons at departmental meetings. Trends in adherence and SSI rates were analyzed by regression analysis using a time series model. While the Strike Team was active, adherence to antibiotic prophylaxis, maintenance of normoglycemia, and standardized intraoperative skin preparation significantly increased (p < .05). There was a trend toward statistically significant reduction in SSI (p = .07), although it was not maintained once the Strike Team activity was disrupted by the COVID-19 pandemic. Colorectal SSI prevention requires a resource-intensive, multidisciplinary approach with numerous strategies to improve adherence to infection control bundles, as illustrated by our SSI Strike Team experience.
    MeSH term(s) Humans ; Surgical Wound Infection/prevention & control ; Pandemics ; Antibiotic Prophylaxis ; Academic Medical Centers ; Colorectal Neoplasms
    Language English
    Publishing date 2024-01-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1472097-8
    ISSN 1945-1474 ; 1062-2551
    ISSN (online) 1945-1474
    ISSN 1062-2551
    DOI 10.1097/JHQ.0000000000000412
    Database MEDical Literature Analysis and Retrieval System OnLINE

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