There are many ways that you can help contribute to an FDA-approved FMT product. You may serve as a clinical site, enrolling patients directly, or you may help refer patients that might qualify for the trial, so that together we can rapidly move towards a robust validated FMT treatment. Even simply completing this survey will help us understand practices in the field to design a clinical trial that matches clinical practice.

Please help us by completing the short survey regarding your interest in contributing to a clinical program to evaluate the safety and efficacy of FIN-403, an encapsulated microbiota preparation to prevent recurrence of recurrent Clostridium difficile infection. 

Please provide your facility's name:

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* 1. Please provide your facility's name:

Please provide a physician contact:

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* 2. Please provide a physician contact:

Please indicate the contact physician's speciality

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* 3. Please indicate the contact physician's speciality

What is the physician's preferred method of contact?

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* 4. What is the physician's preferred method of contact?

If the physician is not the primary point of contact, please provide an additional contact from your facility for us to reach out to with more information on the FIN-403 clinical program (eg. Clinical Research Coordinator).

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* 5. If the physician is not the primary point of contact, please provide an additional contact from your facility for us to reach out to with more information on the FIN-403 clinical program (eg. Clinical Research Coordinator).

Would you like more information about being a study site?

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* 6. Would you like more information about being a study site?

Would you like more information on being a referral site?

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* 7. Would you like more information on being a referral site?

What could we do to help incentivize you to refer patients to a nearby clinical site, even if you aren’t able to serve as a site yourself?

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* 8. What could we do to help incentivize you to refer patients to a nearby clinical site, even if you aren’t able to serve as a site yourself?

In the last six months, how many patients has your facility treated with FMT?

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* 9. In the last six months, how many patients has your facility treated with FMT?

What percentage of patients treated with FMT would prefer capsules over other methods (e.g. colonoscopy, enema, naso-enteric tube)?

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* 10. What percentage of patients treated with FMT would prefer capsules over other methods (e.g. colonoscopy, enema, naso-enteric tube)?

0 100
i We adjusted the number you entered based on the slider’s scale.
What percentage of your patients treated with FMT would meet the following key eligibility criteria (having the inclusion criteria and not having any exclusion criteria)?

Inclusion:
Recurrent C. difficile - associated diarrhea (CDAD) defined as:
a) ≥ 3 episodes of C. difficile infection (CDI) with 2 within the previous 12 months, inclusive of current episode who have responded to standard of care  antibiotics; OR
b) 2 CDI episodes requiring hospitalization within the previous 12 months who have responded to standard of care antibiotics*.

Exclusion:
1. Inability (e.g. dysphagia) or unwilling to swallow capsules
2. Admitted to or expected to be admitted to an acute care facility or intensive care unit
3. Active inflammatory bowel disease

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* 11. What percentage of your patients treated with FMT would meet the following key eligibility criteria (having the inclusion criteria and not having any exclusion criteria)?

Inclusion:
Recurrent C. difficile - associated diarrhea (CDAD) defined as:
a) ≥ 3 episodes of C. difficile infection (CDI) with 2 within the previous 12 months, inclusive of current episode who have responded to standard of care  antibiotics; OR
b) 2 CDI episodes requiring hospitalization within the previous 12 months who have responded to standard of care antibiotics*.

Exclusion:
1. Inability (e.g. dysphagia) or unwilling to swallow capsules
2. Admitted to or expected to be admitted to an acute care facility or intensive care unit
3. Active inflammatory bowel disease

0 100
i We adjusted the number you entered based on the slider’s scale.
How does your facility diagnose Clostridium difficile infection?

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* 12. How does your facility diagnose Clostridium difficile infection?

  Never Sometimes Often Always
PCR/NAAT for C. difficile toxin gene
Toxin A/B EIA
GDH EIA then toxin A/B EIA
Other
Has your facility served as a study site in a clinical trial before?

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* 13. Has your facility served as a study site in a clinical trial before?

Do you have any competing clinical trials in recurrent Clostridium difficile infection?

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* 14. Do you have any competing clinical trials in recurrent Clostridium difficile infection?



Thank you!

T