NTIMICROBIAL RESISTANCE IS A serious public threat that is exacerbated by the gradual withdrawal of the pharmaceutical industry from new antimicrobial agent development. 1 Overuse of antimicrobial agents fosters the spread of antimicrobial-resistant organisms. 2,3 Despite recent trends that demonstrate reduced outpatient use of antimicrobial agents, prescribing continues to significantly exceed prudent levels. 4-8 Approximately 50% of courses of ambulatory antimicrobial drugs are prescribed for patients with viral respiratory infections and therefore are not clinically indicated. 9-12 Behavioral facilitators of antimicrobial overuse and barriers to prudent use operate on both clinicians and patients. 13-16 Patient demand, perceived or actual, creates chal-See also pp 2315 and 2354.

ONITORING THE SAFETY OF approved medical productsisofvitalpublichealth importance, given that in clinical practice such medical products are often used in numbers far greater and in patient populations more diverse than when studied in premarket evaluations and clinical trials. [1][2][3][4][5][6] Within the broad range of medical products, implantable medical devices represent high-risk products that are uniquely challenging to monitor because there is little consensus regarding the most appropriate methods to account for the complex interactions amongdevices,medications,patients,and implanting physicians. In addition, the lack of unique medical device identifiers challenges the effective use of administrative claims data and electronic health records as a primary data source to evaluate manufacturer-specific device safety. 7 To support clinical research and quality-improvement efforts, detailed clinical registries have been established in recent years at the state, regional, and national levels for many high-risk implantable medical devices, [8][9][10][11] which may provide unique opportunities to pro-spectively monitor the safety of such devices. 12 The Massachusetts statewide coronary intervention registry 13 was established in 2003 to monitor the quality of care of hospitals and physicians in the state. This registry is a mandatory clinical outcomes registry based on the American College of Cardiology National Cardiovascular Data Repository (NCDR) CathPCI data set and includes For editorial comment see p 2065.

A standalone PDA-based CDSS for acute RTIs used at the point-of-care can encourage better outpatient antimicrobial prescribing practices and easily gather a rich set of clinical data.