The survey was completely anonymous, but collected information
on the medical level of the provider (i.e., physician, physician assistant or nurse, medic), branch of service, any specialty training, deployment experience, current assignment location, and any recent education in the area of TD. The survey included multiple types of question formats including ranking, multiple choice, and Likert-type scale. Multiple-choice selleck kinase inhibitor questions on deployment-related diagnosis and management were scenario-based and designed to have a step-wise increase in complexity and/or severity and included: loose motions (unformed stools that did not meet TD definition), mild TD (three loose stools in 24 h with no activity limitations), mild TD with limitations (two loose stools in 8 h with some
activity limitations), moderate to severe TD (six loose stools in 24 h with no activity limitations), moderate TD with limitations (three loose stools in 24 h with some activity limitations), severe inflammatory TD (two loose stools in 8 h with fever and activity limitations), dysentery (three loose stools in 24 h with blood streaks), viral GSK2126458 molecular weight gastroenteritis (two loose stools in 8 h with vomiting predominate illness), and persistent diarrhea (14 d loose stools). The choices of treatment and management, from oral and/or IV rehydration and follow-up to management with antibiotics and nonantibiotic antidiarrheal medications (i.e, bismuth subsalicylate, diphenoxylate/atropine, and loperamide), were identical for each of the clinical scenarios, and one or more treatment modalities could be selected for any given scenario. In addition to univariate analyses describing provider characteristics and knowledge, attitude and practices outcomes, multiple-choice questions were scored
as correct/incorrect based on consensus among three clinicians (D. R. T, J. W. S., M. S. R.) with greater than 30 years of combined experience in research and clinical management of TD during deployment and from referenced published treatment guidelines.6,15 For each of nine TD management scenarios, a score was assigned based on a provider’s selection from Florfenicol among 10 various treatment options which included: fluid therapy [rehydration (oral), rehydration (IV)], nonantibiotic antidiarrheal medications (bismuth subsalicylate, diphenoxylate/atropine, and loperamide), and antibiotic antidiarrheal medications (ciprofloxacin, azithromycin, trimethoprim/sulfamethoxazole, rifaximin, and metronidazole). A provider could select any single or combination of therapy for each scenario. Specific to each scenario, a particular therapy could be scored as 1 (well evidenced), 0 (acceptable, not optimal), or −1 (not recommended).