Patients recognize the inherently unappealing nature of FMT, but they are nonetheless open to considering it as a treatment alternative for recurrent CDI, especially when recommended by a physician.

C lostridium difficile infection (CDI) is an inflammatory diarrheal illness frequently associated with antibiotic use and characterized by disruptions in the normal intestinal microbiota (1). In recent years, CDIs have become more frequent, severe and refractory to therapy (2-9). It is estimated that 10% to 35% of patients treated with standard antibiotic therapy will progress to develop a recurrence (10-12). Up to 65% of patients treated with antibiotics for recurrent CDI will progress to develop a chronic, recurring form of the disease (13,14).Fecal microbiota transplantation (FMT) has demonstrated significant value as a therapy for recurrent CDI. A systematic review found that 92% of patients treated with FMT for CDI or pseudomembranous colitis experienced rapid resolution of infection and symptoms (15). More recently, the first randomized controlled trial (RCT) of FMT was stopped early because of the treatment failure rate in the control groups; 94% of patients with recurrent CDI were cured with FMT, compared with 31% treated with vancomycin and 23% treated with vancomycin and sham FMT (gastric lavage) (16).Despite increasing evidence supporting its safety and efficacy, FMT is infrequently used in medical practice. There is a widely held belief that FMT was seldom used because patients had a strong aversion to METHODS: An electronic survey was distributed to physicians to assess their experience with CDI and attitudes toward FMT. RESULTS: A total of 139 surveys were sent and 135 were completed, yielding a response rate of 97%. Twenty-five (20%) physicians had treated a patient with FMT, 10 (8%) offered to treat with FMT, nine (7%) referred a patient to receive FMT, and 83 (65%) had neither offered nor referred a patient for FMT. Physicians who had experience with FMT (performed, offered or referred) were more likely to be male, an infectious diseases specialist, >40 years of age, fellowship trained and practicing in an urban setting. The most common reasons for not offering or referring a patient for FMT were: not having 'the right clinical situation' (33%); the belief that patients would find it too unappealing (24%); and institutional or logistical barriers (23%). Only 8% of physicians predicted that the majority of patients would opt for FMT if given the option. Physicians predicted that patients would find all aspects of the FMT process more unappealing than they would as providers. CONCLUSIONS: Physicians have limited experience with FMT despite having treated patients with multiple recurrent CDIs. There is a clear discordance between physician beliefs about FMT and patient willingness to accept FMT as a treatment for recurrent CDI.

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Objectives: To evaluate the economic viability of shared medical appointments (SMAs) in dermatology. Secondary objectives include a comparison of the hourly adjusted census levels generated by SMAs compared with regular clinic appointments (RCAs), as well as a comparison between the economic viability of dermatology SMAs and SMAs in other fields of medicine.

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