Knowledge Management: the Bridge between Information and Best Practice

In 2004, as part of its Regional Advisory Council (RAC), the National Network of Libraries of Medicine New England Region (NN/LM NER) formed the Hospital Library Subcommittee, with the charge to promote the value of hospital libraries throughout the region. Over its 7-year tenure, the Subcommittee has tracked a gradual decline in support for hospital libraries, as evidenced by budget cuts and library closures. The status quo had ultimately become untenable. In 2009, the Subcommittee began to shift focus from library advocacy towards a new strategy: a 5-year plan to assist hospital libraries with the transition to healthcare knowledge services centers (HKSCs) within their institutions. Presented at the Midwest Chapter, MLA/IHSLA Annual Meeting, Indianapolis, October 9, 2011

A Strategic Plan for Transitioning to a Healthcare Knowledge Services Center in New England (poster)

In 2004, as part of its Regional Advisory Council (RAC), the National Network of Libraries of Medicine New England Region (NN/LM NER) formed the Hospital Library Subcommittee, with the charge to promote the value of hospital libraries throughout the region. Over its 7-year tenure, the Subcommittee has tracked a gradual decline in support for hospital libraries, as evidenced by budget cuts and library closures. The status quo had ultimately become untenable. In 2009, the Subcommittee began to shift focus from library advocacy towards a new strategy: a 5-year plan to assist hospital libraries with the transition to healthcare knowledge services centers (HKSCs) within their institutions. Presented at the Medical Library Association Annual Meeting, Minneapolis, MN, May 17, 2011

Knowledge Management: A Regional Initiative (Presentation)

In 2004, as part of its Regional Advisory Council (RAC), the National Network of Libraries of Medicine New England Region (NN/LM NER) formed the Hospital Library Subcommittee, with the charge to promote the value of hospital libraries throughout the region. Over its 7-year tenure, the Subcommittee has tracked a gradual decline in support for hospital libraries, as evidenced by budget cuts and library closures. The status quo had ultimately become untenable. In 2009, the Subcommittee began to shift focus from library advocacy towards a new strategy: a 5-year plan to assist hospital libraries with the transition to healthcare knowledge services centers (HKSCs) within their institutions. Presented at the NAHSL/NY-NJ MLA Conference, Uncasville, Conn., October 31, 2011

Knowledge Management Awareness Webinar

In 2004, as part of its Regional Advisory Council (RAC), the National Network of Libraries of Medicine New England Region (NN/LM NER) formed the Hospital Library Subcommittee, with the charge to promote the value of hospital libraries throughout the region. Over its 7-year tenure, the Subcommittee has tracked a gradual decline in support for hospital libraries, as evidenced by budget cuts and library closures. The status quo had ultimately become untenable.In 2009, the Subcommittee began to shift focus from library advocacy towards a new strategy: a 5-year plan to assist hospital libraries with the transition to healthcare knowledge services centers (HKSCs) within their institutions. This webinar explains knowledge management and introduces a model template for a Healthcare Knowledge Management Center

Developing a Strategic Plan for Transitioning to Healthcare Knowledge Services Centers (HKSCs)

Faced with a negative trend in the form of downsizing, layoffs, and closures, a small committee of hospital librarians in New England formed in 2004 to provide library advocacy. Between 2008 and 2010, 23 hospital libraries closed in New England. In 2010, the committee shifted its focus from advocacy to a platform for change. This resulted in the creation of the Healthcare Knowledge Services Center (HKSC) Template. The Template is the basis for a three-phase, 5-year strategic plan to establish several regional pilots, transitioning traditional hospital libraries to healthcare knowledge services centers. This article focuses on phase one of the strategic plan: Development

HKSC Field Guide for Developing a Healthcare Knowledge Services Center

Knowledge is the foundation of our work as librarians; however, because it is intangible, we work directly with assets that result from knowledge. Content, people, and technology are the core knowledge assets. Knowledge assets are referenced throughout the HKSC Field Guide where we define a path to delivering knowledge services. Delivering the best content is achieved through the innovation and competencies of library professionals who leverage technologies to benefit their constituents. The result is excellent knowledge services. This field guide is organized in chapters that are aligned with modules of the HKSC Model Template. The HKSC Field Guide is laid out in a linear progression of activities, with simple commentary to encourage the reader’s thinking toward eventual outcomes and changes that are required to make a transition from a library setting to a Healthcare Knowledge Services Center (HKSC) operation. It is expected that the successful manager will make several passes through the entire guide, gaining a better understanding of all the pieces that must be in place for a strategic and successful plan. Each module/chapter provides descriptions to explain the module theme and to share ideas on how to proceed with the process. Following descriptions and guidance is a worksheet for taking notes and a checklist of tasks. The intent of each worksheet is to focus on a specific data collection, a strategic planning activity, and/or to note details describing required resources. Chapters conclude with a checklist for you to sign off on for tasks considered and/or completed. Some forms may not be completed until multiple passes have been made through the guide; managers are encouraged to refine and hone activities in fine-tuning their work. A separate document (in MS Word format) supplies both worksheets and checklists for you to edit electronically –or- to create separate editable documents in modular fashion

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication