Horizontally acquired papGII-containing pathogenicity islands underlie the emergence of invasive uropathogenic Escherichia coli lineages.

Escherichia coli is the leading cause of urinary tract infection, one of the most common bacterial infections in humans. Despite this, a genomic perspective is lacking regarding the phylogenetic distribution of isolates associated with different clinical syndromes. Here, we present a large-scale phylogenomic analysis of a spatiotemporally and clinically diverse set of 907 E. coli isolates, including 722 uropathogenic E. coli (UPEC) isolates. A genome-wide association approach identifies the (P-fimbriae-encoding) papGII locus as the key feature distinguishing invasive UPEC, defined as isolates associated with severe UTI, i.e., kidney infection (pyelonephritis) or urinary-source bacteremia, from non-invasive UPEC, defined as isolates associated with asymptomatic bacteriuria or bladder infection (cystitis). Within the E. coli population, distinct invasive UPEC lineages emerged through repeated horizontal acquisition of diverse papGII-containing pathogenicity islands. Our findings elucidate the molecular determinants of severe UTI and have implications for the early detection of this pathogen

Improving productivity and worker conditions in assembly : part 2 : rapid deployment of learnable robot skills

Collaborative robots (cobots) have a strong potential to improve both productivity as well as the working conditions of assembly operators by assisting in their tasks and by decreasing their physical and cognitive stress. The use of cobots in factories however introduces multiple challenges: how should the overall assembly architecture look like? How to allocate specific (sub)tasks to the operator or the cobot? How to program and deploy the cobot? How to make changes to the robot program? In this paper dilogy, we briefly highlight our recent contributions to this field. In part I we presented our collaborative architecture for human-robot assembly tasks and discussed the working principles of our task allocation framework, based upon agent capabilities and ergonomic measurements. In this second part we focus on our programming by demonstration approach targeted at expediting the deployment of learnable robot skills

Setting the context for a complex dental intervention of role substitution in care homes: initial process evaluation findings

Background The oral health and quality-of-life of older adults residing in care homes is poorer than those in the community. Oral health care provision is often unavailable and a concern and challenge for managers. The use of Dental Therapists and Dental Nurses rather than dentists could potentially meet these needs. ObjectivesSENIOR (uSing rolE-substitutioN In care homes to improve oRal health) is a randomised controlled trial designed to determine whether role substitution could improve oral health for this population. A parallel process evaluation was undertaken to understand context. This paper reports on the first phase of the process evaluation.Materials and MethodsSemi-structured interviews were conducted with 21 key stakeholders who either worked or had experience of dependent care settings. Questions were theoretically informed by the: Promoting Action on Research Implementation in Health Services (PAHRIS) framework. The focus was on contextual factors that could influence adoption in practice and the pathway-to-impact. Interviews were fully transcribed and analysed thematically.ResultsThree themes (receptive context, culture, and leadership) and 11 codes were generated. Data shows the complexity of the setting and contextual factors that may work as barriers and facilitators to intervention delivery. Managers are aware of the issues regarding oral health and seek to provide best care, but face many challenges including staff turnover, time pressures, competing needs, access to services and financial constraints. Dental professionals recognise the need for improvement and view role substitution as a viable alternative to current practice. ConclusionAlthough role substitution could potentially meet the needs of this population, an in-depth understanding of contextual factors appeared important in understanding intervention delivery and implementation.<br/

Survival Data and Predictors of Functional Outcome an Average of 15 Years after the Fontan Procedure: The Pediatric Heart Network Fontan Cohort

ObjectiveMulticenter longitudinal outcome data for Fontan patients surviving into adulthood are lacking. The aim of this study was to better understand contemporary outcomes in Fontan survivors by collecting follow‐up data in a previously well‐characterized cohort.DesignBaseline data from the Fontan Cross‐Sectional Study (Fontan 1) were previously obtained in 546 Fontan survivors aged 11.9 ± 3.4 years. We assessed current transplant‐free survival status in all subjects 6.8 ± 0.4 years after the Fontan 1 study. Anatomic, clinical, and surgical data were collected along with socioeconomic status and access to health care.ResultsThirty subjects (5%) died or underwent transplantation since Fontan 1. Subjects with both an elevated (>21 pg/mL) brain natriuretic peptide and a low Child Health Questionnaire physical summary score (<44) measured at Fontan 1 were significantly more likely to die or undergo transplant than the remainder, with a hazard ratio of 6.2 (2.9–13.5). Among 516 Fontan survivors, 427 (83%) enrolled in this follow‐up study (Fontan 2) at 18.4 ± 3.4 years of age. Although mean scores on functional health status questionnaires were lower than the general population, individual scores were within the normal range in 78% and 88% of subjects for the Child Health Questionnaire physical and psychosocial summary score, and 97% and 91% for the SF‐36 physical and mental aggregate score, respectively. Since Fontan surgery, 119 (28%) had additional cardiac surgery; 55% of these (n = 66) in the interim between Fontan 1 and Fontan 2. A catheter intervention occurred in 242 (57%); 32% of these (n = 78) after Fontan 1. Arrhythmia requiring treatment developed in 118 (28%) after Fontan surgery; 58% of these (n = 68) since Fontan 1.ConclusionsWe found 95% interim transplant‐free survival for Fontan survivors over an average of 7 years of follow‐up. Continued longitudinal investigation into adulthood is necessary to better understand the determinants of long‐term outcomes and to improve functional health status.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110738/1/chd12193.pd

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological systematic review of health technology assessments

Background: Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods: We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results: The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. Conclusions: The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Healthcare Logistics in the CIB Research Group at KU Leuven

status: Published onlin

A Framework for Operational Excellence in Hospital Logistics

The paradigm shift from volume-based to value-based care drives healthcare organisations towards aligning logistics and medical processes. The Institute for Healthcare Improvement (IHI) suggests health policy makers to follow the Quadruple Aim strategy as a guide for reforming the health system. The overall population health and the individual patients' experience of care are at the centre of this strategy, while simultaneously pursuing lower costs and improving staff satisfaction. Altogether, optimizing the Quadruple Aim provides a measure for value in healthcare. Value is defined as the ratio of quality of care over cost. In this dissertation, we call for action to control the costs by streamlining the internal hospital supply chain processes. Though often overlooked in the past, healthcare logistics, also referred to as healthcare Supply Chain Management (SCM), is put forward as a crucial strategic target for efficiency improvements in hospitals. Supply chain concepts are designed to reduce costs, enhance visibility and streamline processes to the benefit of value-based care. Moreover, SCM enhances integration among departments and therefore positively impacts hospital performance through the effective use of resources. Today, hospitals face multiple operational challenges, such as poor inventory control, redundant distribution channels, standardization issues, lack of data, etc. which hinder the material and information flows and cause misalignment between patient care and supporting logistics services. The literature rarely addresses how logistics contribute to value creation in healthcare by pursuing operational excellence. As a first step to efficiency improvement, hospitals must be able to measure the performance of the supply chain to identify the main source of waste and inefficiency. However, lack of performance management systems as well as lack of expertise in Operations Research and Operations Management (OR/OM) ask for a rigorous methodology that takes into account the complex nature of the health system. A data-driven approach is needed to evaluate logistics processes, monitor performance and gain actionable insights to control the increasing healthcare expenses. Therefore, this dissertation presents a healthcare logistics performance management framework. On the one hand, we focus on internal hospital supply chain practices, including storage and distribution of disposable medical supplies. Performance management, on the other hand, allows to improve system understanding, identify efficiency gains, implement continuous improvement programs and enhance decision-making capabilities by monitoring the relevant Key Performance Indicators (KPIs). The framework developed in this dissertation will serve as proof-of-concept to show how logistics contribute to healthcare by adopting SCM practices and addressing the unique challenges inherent to the hospital supply chain. OR/OM tools from industrial engineering applications (e.g. simulation, multi-criteria decision making, etc.) play a key role in bringing objectivity in decision making and promoting data-driven process improvement. Moreover, this reference framework incorporates stakeholder feedback to stimulate more informed decision making, to reduce supply chain fragmentation and to provide a common vocabulary and negotiation power. Hence, the framework is an orchestrator for supply chain integration in healthcare by enabling uniform performance measurement and increasing data transparency. From both a theoretical and practical point of view, contributions are made when developing the healthcare logistics performance management framework: (i) The Analytic Network Process (ANP) allows to prioritize KPIs, which constitute the elements of the "operational excellence" definition in healthcare. The ANP-based prototype is presented to translate strategic/tactical objectives into operational KPIs according to the studied application. (ii) ANP and Discrete-Event Simulation (DES) are combined into a hybrid tool to quantify the logistics impact for value-based healthcare. The Internal Logistics Efficiency Performance (ILEP) index is introduced as a multi-dimensional evaluation tool for adopting SCM practices and identifying potential efficiency gains. Besides the well-known trade-off between service level and cost, we show that standardization is an important factor to streamline inventory and distribution processes. (iii) Possibly conflicting stakeholder perspectives are integrated in the framework. In contrast to early-participation of the stakeholders, our approach aims to first increase understanding in order to create awareness of SCM. As a result, the framework promotes stakeholder commitment to strive towards value improvement, which is considered to be a shared goal that unites the interests of all stakeholders. (iv) From a practical point of view, the framework aims to bridge the gap between theory and practice-based SCM. The applicability of the framework is demonstrated using real-life case studies focusing on storing and distributing surgical disposables throughout the operating theatre. In addition, we present an implementation roadmap acting as a guideline for implementing various logistics strategies in different contexts using the framework as a blueprint. This dissertation concludes with a note on how the digitalization trend will impact healthcare SCM.status: publishe

Optimization of Operations by Simulation - a Case Study at the Red Cross Flanders

status: publishe