Coagulase-negative staphylococci: contagious or environmental?: outline of two ongoing studies

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Offer, demand, and needs in training and education: a study focusing on microbial culture collections within the MIRRI Consortium

The bioeconomy is fueled by Biological Resource Centers, which play a vital role in harnessing and preserving the world's biodiversity [1]. MIRRI (the Microbial Resource Research Infrastructure: www.mirri.org) is an EU-project involving a total of 33 partners, aiming to provide facilitated access to microbial resources, associated data and expertise, and promote knowledge transfer and foster innovation. One crucial step is to properly define our stakeholder community and identify their current and future needs, and match them to our offer. In order to achieve these goals, MIRRI surveyed both its partners, and current and potential users of microbial resources and services. Here we present and analyze some of the results of this survey, focusing on training and education. Despite current trends and benefits in increased use and production of contents in new formats (e.g. video, interactive), and use of new tools and technologies (e.g. e-learning, b-learning), training within MIRRI still has an overwhelming dominance of classic content types and delivery methodologies. Also, we identified a much wider untapped market for education and training within our customer base, and we estimate a spike in demand of training from culture collections, particularly from the profit sector. Additional efforts are clearly necessary in adjusting our offer, adapting contents and content delivery and focusing on cost-efficiency and proper advertising to increase visibility, and better serve the needs of our customers

Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error : the ELMO cluster randomized trial

Background: Inappropriate laboratory test ordering poses an important burden for healthcare. Clinical decision support systems (CDSS) have been cited as promising tools to improve laboratory test ordering behavior. The objectives of this study were to evaluate the effects of an intervention that integrated a clinical decision support service into a computerized physician order entry (CPOE) on the appropriateness and volume of laboratory test ordering, and on diagnostic error in primary care. Methods: This study was a pragmatic, cluster randomized, open-label, controlled clinical trial. Setting: Two hundred eighty general practitioners (GPs) from 72 primary care practices in Belgium. Patients: Patients aged >= 18 years with a laboratory test order for at least one of 17 indications: cardiovascular disease management, hypertension, check-up, chronic kidney disease (CKD), thyroid disease, type 2 diabetes mellitus, fatigue, anemia, liver disease, gout, suspicion of acute coronary syndrome (ACS), suspicion of lung embolism, rheumatoid arthritis, sexually transmitted infections (STI), acute diarrhea, chronic diarrhea, and follow-up of medication. Interventions: The CDSS was integrated into a computerized physician order entry (CPOE) in the form of evidence-based order sets that suggested appropriate tests based on the indication provided by the general physician. Measurements: The primary outcome of the ELMO study was the proportion of appropriate tests over the total number of ordered tests and inappropriately not-requested tests. Secondary outcomes of the ELMO study included diagnostic error, test volume, and cascade activities. Results: CDSS increased the proportion of appropriate tests by 0.21 (95% CI 0.16-0.26, p < 0.0001) for all tests included in the study. GPs in the CDSS arm ordered 7 (7.15 (95% CI 3.37-10.93, p = 0.0002)) tests fewer per panel. CDSS did not increase diagnostic error. The absolute difference in proportions was a decrease of 0.66% (95% CI 1.4% decrease-0.05% increase) in possible diagnostic error. Conclusions: A CDSS in the form of order sets, integrated within the CPOE improved appropriateness and decreased volume of laboratory test ordering without increasing diagnostic error

ICO & Co. Werkmap voor interculturalisering van opleidings- en tewerkstellingsinitiatieven

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Klebsiella pneumoniae can be highly prevalent in the environment of cows without causing mastitis

Introduction: Bulk milk coli count is one of the parameters of Flemish milk quality control. In surveillance of the coli count subclinical Klebsiella mastitis turns out to be an emerging problem in well-managed Flemish dairy herds. This is in contrast with various outbreak reports with high production losses or lethal outcome in other countries. Bedding materials and faeces are frequently pinpointed as potential sources of mastitic Klebsiella. This study was designed to further elucidate Klebsiella pneumoniae transfer to quarter milk with a molecular typing technique of high discriminating power. Materials and Methods: A longitudinal study was carried out in 6 Flemish dairy herds from May 2008 until May 2009. In each herd 10 cows were randomly selected (4 cows of first, 3 cows of second and 3 cows of third or higher parity). All cows were housed in free-stalls with sawdust bedded cubicles. Each month, coliforms were isolated from sawdust stock, sawdust bedding, faeces, and quarter milk. Isolates which tested positive for Klebsiella pneumonia by PCR were further typed to strain level by Pulsed Field Gel Electrophoresis (PFGE). Band patterns were clustered with the BioNumerics version 5.10 software (Applied Maths, Sint-Martens-Latem, Belgium). Results: Of 73 sawdust stock and 73 sawdust bedding samples 6 and 20 contained K. pneumoniae, respectively. In faeces 121 of 566 samples contained K. pneumoniae while in the 2796 quarter milk samples only two turned out to be positive. In total 108 different K. pneumoniae strains were typed. The six isolates from sawdust stock belonged to six different strains. In sawdust bedding 18 different strains were detected (1 to 5 per herd) and in faeces 92 different strains were observed (1 to 27 per herd). The two isolates from milk were from the same herd (not from the same cow or quarter) but differed in PFGE pattern. However, the same PFGE type of one of these isolates was also present in one sawdust bedding sample of that herd. No similarity was found between strains of sawdust stock and strains of other sources. Discussion: Monthly sampling, bacterial isolation and typing of K. pneumoniae strains with a highly discriminating genotypic method as PFGE on cow and environmental level in 60 cows of 6 well managed dairy farms could not reveal a strong transfer pattern of K. pneumoniae towards udder quarters. The low incidence of K. pneumoniae intramammary infection in an environment where K. pneumoniae is highly prevalent, suggests that infection with K. pneumoniae can be facilitated by failure of cow defence mechanisms rather than by K. pneumoniae pathogenicity factors