IDSA Emerging Infections Network



IDSA Emerging Infections Network

Report for Member Opinion Feedback Query

Overall response rate: 275/967 (28.4%) physicians responded based on one mailing.

Summary by topic

Listserv

A large majority believes that the number of postings is just right (81%). About 61% believe that postings have an adequate number of responses (32% were neutral), while almost three-quarters (71%) agree that postings generate substantive responses from other members.

Almost three-quarters of respondents agree that experts should be recruited to respond to postings (71%). Four in five respondents (82%) want to be able to search past postings, and over half would be willing to check a box on each posting to indicate its relevance to them (64%).

Surveys

A large majority believes that the usual survey length is acceptable (94%), that results are available in a timely fashion (82%), and that the frequency should remain the same (87%).

Many respondents did not agree that we should switch to an internet-only based format. Overall, one-quarter of respondents (25%) disagree, while less than half agree (46%). Of the respondents who returned the survey by fax, half (49%) disagree.

A large majority agree that they’d be willing to answer one question on each survey regarding its personal relevance (88%). Just over half of respondents (59%) agree that members should help to determine future survey topics, while one-third (33%) were neutral. Interest in sequential, very-short surveys over time was expressed by almost three-quarters of respondents (72% agree while only 10% disagree).

Length of this survey was acceptable to two-thirds (65%), while 28% of respondents were neutral.

Future Options

Less than half of respondents were interested in a question of the month (46% agree). Interest in visiting the EIN website to participate in projects was higher (67% agree).

More than three-quarters of respondents were interested in expert opinion pieces (79% agree, while only 10% disagree).

RESULTS: LISTSERV QUESTIONS

Question 1: The number of listserv postings is:

Too few 11 (4%)

Just right 213 (81%)

Too many 40 (15%)

Question 2: EIN listserv postings have an adequate number of responses:

Strongly disagree 0

Disagree 17 (6%)

Neutral 85 (32%)

Agree 153 (58%)

Strongly agree 9 (3%)

Question 3: EIN listserv postings generate substantive responses from other members:

Strongly disagree 0

Disagree 13 (5%)

Neutral 64 (24%)

Agree 179 (68%)

Strongly agree 8 (3%)

Question 4: Experts should be recruited so that one could respond to every EIN posting:

Strongly disagree 6 (2%)

Disagree 24 (9%)

Neutral 45 (17%)

Agree 130 (49%)

Strongly agree 59 (22%)

Question 5: I would like to be able to search easily for past listserv postings:

Strongly disagree 4 (2%)

Disagree 8 (3%)

Neutral 38 (14%)

Agree 142 (54%)

Strongly agree 73 (28 %)

Question 6: I would be willing to check a reply box on each posting to indicate whether that posting was relevant to my practice:

Strongly disagree 7 (3%)

Disagree 39 (15%)

Neutral 50 (19%)

Agree 148 (56%)

Strongly agree 22 (8%)

Comments regarding the listserv: 37 individuals fell into several categories.

(Group 1) Most comments (N=14) reflected concern about ‘trivial or anecdotal responses’. One person wrote that ‘expert opinions without peer review are a dangerous precedent.’ Some concern was also expressed regarding duplication of responses in different e-mail postings.

Two opposing views, with approximately equal numbers of individuals holding each view, focused on the purpose and nature of the listserv. (Group 2) The most vocal group expressed a belief that the listserv is for EMERGING infectious diseases and not for general diagnosis/management or consult questions (N=5). (Group 3) The opposite view was expressed by 6 individuals, who called the listserv a ‘valuable resource’ to solicit helpful opinions for difficult cases. One individual wrote, ‘One can also get a feel for how colleagues are thinking about issues that doesn’t come through in journal articles, or even editorials.’ Another wrote, ‘I find the ability to network difficult cases is invaluable, and allows others to be exposed to these cases as well.’

(Group 4) The final category of comments included a variety of suggestions for change and improvement of the listserv that are listed below:

● My specialty is pediatric ID and it would be useful to have pedi-related topics, too.

● What I think would be more generally helpful is your notion of an expert (at some level) respond to the question. When the CDC people chose to respond, that is usually very informative.

● I suggest making the Subject line titles of Query, EPI, Clinical more prominent--especially the queries--I believe this will increase the query yield.

● Too many of the answers are personal anecdotes and not based on data. Having said that, I don't know what you can do about it. I don't know how you would limit or screen submissions--that would kind of defeat the whole purpose of having a listserv. Having "experts" answer questions may help but also may be difficult logistically to do for every question submitted.

● The EIN is being used increasingly by some to solicit opinions on diagnosis and management of individual patients. I think that this should be discouraged for several reasons. It was not the original intent of the EIN and the more that it is used in this way the EIN will become increasingly ineffective. Also, there are some risk management issues which should probably be addressed if this activity is to continue. I would encourage development of a separate website/chat room for case management issues.

● While I find it great to read other people's interesting cases, sometimes I wish there was a separate listserv for such use.

● For those of us who practice clinical medicine, I often wonder about the ability to read and answer so many of these inquiries. You have a difficult job. Again, hearing about unusual situations was how HIV AIDS was first recognized in NYC. I guess this is why I read your messages (sometimes in bunches when time allows, looking for those kernels of new information or concerns).

● I would discourage too much "filtering".

● Asking a member who is qualified to write a SHORT expert response with a few references would be nice.

● If someone poses a question, it might be helpful to collect the responses over a defined time such as 1-2 weeks and then post them together to cut down on the total postings for a particular issue-perhaps it would be possible to do this for less urgent questions if there was some way to make the postings urgent v. non-urgent.

● Including the original questions on each post is VERY helpful. Also, if all the responses (emails) could be delivered once per day with an index it would greatly cut down on all the messages received.

● How about a review of all the subjects that we have had so far?

● Can the postings of answers be batched into one response to the question posed? This would bring together all opinions and allow for substantive, relevant responses.

● It would be better if there was more input from, say, CDC members or other experts on significant new findings EARLY (i.e., the c diff new toxin strain, etc)-especially now bird flu, etc. I envision a one page summary of what is NEW that week, etc. …

● Questions about individual problem cases should have some standard format as postings frequently are simply requesting more data. However, it is always interesting to see that we are all having similar struggles with problem cases.

RESULTS: SURVEY QUESTIONS

Question 7: The length of EIN surveys is typically:

Too short 0

Acceptable 257 (94%)

Too long 15 (6%)

Question 8: Results of EIN surveys are available in a timely fashion:

Strongly disagree 2 (1%)

Disagree 9 (3%)

Neutral 40 (15%)

Agree 201 (74%)

Strongly agree 21 (8%)

Question 9: The frequency of EIN surveys should:

Increase 12 (5%)

Remain the same 232 (87%)

Decrease 22 (8%)

Question 10: EIN should switch to an internet-based survey format (i.e., no fax responses):

Strongly disagree 19 (7%)

Disagree 50 (18%)

Neutral 78 (29%)

Agree 82 (30%)

Strongly agree 44 (16%)

Question 11: I would be willing to answer 1 question on each survey regarding its relevance to my practice:

Strongly disagree 3 (1%)

Disagree 7 (3%)

Neutral 21 (8%)

Agree 194 (72%)

Strongly agree 44 (16%)

Question 12: EIN should allow members to help determine future survey topics (i.e., internet voting):

Strongly disagree 4 (1%)

Disagree 18 (7%)

Neutral 89 (33%)

Agree 148 (54%)

Strongly agree 13 (5%)

Question 13: I would be interested in sequential, very short surveys to track changes over time:

Strongly disagree 5 (2%)

Disagree 22 (8%)

Neutral 47 (17%)

Agree 175 (64%)

Strongly agree 23 (8%)

Comments regarding surveys/queries: 16 individuals fell into several categories. Six individuals focused on the electronic format and/or the ability to fax query responses; all wished to preserve the ability to keep using fax machines. Three individuals had specific questions or comments about validity or follow-up analyses, e.g., ‘Who currently designs and initiates surveys? It’s mysterious where they come from.’ Another respondent suggested that the section on comments by members by region ‘is distracting and usually unscientific.’ The final group of miscellaneous comments included, ‘Is there feedback to the questions people post following the surveys?’ Only one person commented on Q.13 (sequential, very short surveys) and he/she was concerned that this concept ‘might be misleading unless there is evidence that the EIN is a representative sample of some population. Absent such evidence, I think we should be clear this is an ad-hoc group.’

RESULTS: FUTURE OPTIONS

Question 14: I would be interested in a question of the month on the EIN web page:

Strongly disagree 6 (2%)

Disagree 38 (14%)

Neutral 102 (38%)

Agree 114 (42%)

Strongly agree 12 (4%)

Question 15: I would be interested in visiting the EIN web site to participate in projects to predict trends in infectious diseases:

Strongly disagree 2 (1%)

Disagree 25 (9%)

Neutral 64 (24%)

Agree 161 (60%)

Strongly agree 18 (7%)

Comments regarding these two web site questions were all positive (N=4). Two members suggested that a direct link from an e-mail would be necessary.

Question 16: I would be interested in reading an expert opinion piece based on recent postings:

Strongly disagree 5 (2%)

Disagree 21 (8%)

Neutral 31 (11%)

Agree 158 (58%)

Strongly agree 56 (21%)

Comments regarding this issue fell into three camps: pro (N=7), con (N=3) and those who like the concept but fear it’s not feasible (N=2). Those who were against expert opinions felt that there is value in the practicing physicians’ opinions and that academics aren’t necessarily more helpful. One individual also suggested that expert opinions might discourage participation or intimidate private practice ID physicians.

Question 17: This survey was too long:

Strongly disagree 25 (9%)

Disagree 152 (56%)

Neutral 76 (28%)

Agree 17 (6%)

Strongly agree 0

Miscellaneous comments regarding EIN program

Several individuals had comments regarding other issues, including:

● Would be interested in seeing EIN expand to include designed multi-site observational studies of infrequently encountered issues i.e., a studies network.

● Need to include some alerts. Consider future and possible links with ProMed, PubMed, IDSA listserv, other.

● Might do more as a sentinel network with structured responses short of survey, and report results on listserv w/in a week.

Specific Observations and Survey Suggestions

|● I have had 4 cases of enterococcal endocarditis (native valve) in the past 7 months. One was a 22yo who required valve replacement. |

|● Just the casual observation that a substantial portion of our inpatient consult service these days seems to involve MRSA and/or C.diff! |

|● What are people recommending with regard to avian and/or pandemic influenza - airborne precautions or respiratory droplet precautions? |

|Are recommended precautions being modified based on the status of avian influenza or phase of a pandemic? |

|● Ongoing outbreak of Rotavirus gastroenteritis in adults in this area of West Texas. |

|● Evolving MRSA-CA and virulence still a very concerning problem. Why do quinolones not work for Staph aureus in vivo? |

|● Is there a reluctance by neurologists or neurosurgeons to make a dx of CJD because of the implications for infection control such as in |

|the OR? |

|● 5 people in Springfield, IL were overcome today carbon monoxide from the charcoal grill used in their powerless home after tornadoes |

|disrupted electricity |

|● Still problems with stubborn, relapsing C diff |

|● What isolation precautions would the epidemiologist colleagues take for a hospitalized child in diapers, who has a previous h/o |

|colonization with ESBL producing E coli? |

|● Do you see increased incidence of invasive group A strep in children or adults? |

|● Two recent cases of pulmonary TB-this is most unusual here |

|●I had suggested to Larry a survey - what do people actually do in real practice for healthcare workers s/p a needlestick from a hep C |

|positive patient. We talked about it but it never got off the ground. My thoughts remain - this is a crucial area of no real hard data - |

|what do ID docs recommend re testing and treatment in this setting. |

|● I wish we had a survey about how different hospitals or health care systems deal with infection control for resistant GNR infections |

|including ESBL and Acinetobacter |

|● Please do a survey on: vancomycin use, high dose v. regular dose, failures, are meds helpful, restrictions |

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