Multimorbidity networks of chronic obstructive pulmonary disease and heart failure in men and women: Evidence from the EpiChron Cohort.

Patients with heart failure (HF) and/or chronic obstructive pulmonary disease (COPD) constitute a complex population with different phenotypes based on pathophysiology, comorbidity, sex and age. We aimed to compare the multimorbidity patterns of HF and COPD in men and women using network analysis. Individuals aged 40 years or older on 2015 of the EpiChron Cohort (Aragon, Spain) were stratified by sex and as having COPD (n = 28,608), HF (n = 13,414), or COPD and HF (n = 3952). We constructed one network per group by obtaining age-adjusted phi correlations between comorbidities. For each sex, networks differed between the three study groups; between sexes, similarities were found for the two HF groups. We detected some specific diseases highly connected in all networks (e.g., cardio-metabolic, respiratory diseases, and chronic kidney failure), and some others that were group-specific that would require further study. We identified common clusters (i.e., cardio-metabolic, cardiovascular, cancer, and neuro-psychiatric) and others specific and clinically relevant in COPD patients (e.g., behavioral risk disorders were systematically associated with psychiatric diseases in women and cancer in men). Network analysis represents a powerful tool to analyze, visualize, and compare the multimorbidity patterns of COPD and HF, also facilitated by developing an ad hoc website.

Information specialist collaboration in Europe: collaborative methods, processes, and infrastructure through EUnetHTA.

The history of European health technology assessment (HTA) goes back more than 30 years. Almost as old as HTA agencies themselves is the desire to achieve European collaboration. This gained further impetus with the establishment of the European Network of Health Technology Assessment (EUnetHTA) in 2006. In this context, the field of information management faced specific challenges. Although these services are an integral part of HTA and information specialists play a key role here, this field is often not adequately represented in the HTA agencies within EUnetHTA. Furthermore, the organization of HTA production, including the types of HTAs produced, as well as funding, varies considerably. In order to meet these different conditions, information specialists have created various products and defined processes. With the EUnetHTA guideline, a common methodological understanding for the production of rapid Relative Effectiveness Assessments now exists. Furthermore, the Standard Operating Procedures map the complex information retrieval processes within EUnetHTA in a hands-on manner. The newly established Information Specialist Network (ISN) will in future ensure that information specialists are involved in all EUnetHTA assessments and that the methods are applied consistently in all assessments. In addition, the steering committee of the ISN manages enquiries and can be contacted to discuss methodological issues. Major barriers such as heterogeneity in the daily work of the EUnetHTA members can only be overcome through more collaboration and training.

[Service rendered's assessment of a pharmaceutical information center on patients care]. / Évaluation du service rendu d'un centre d'information pharmaceutique sur la prise en charge des patients.

The Question-Answer (Q/R) service of Lyon's teaching hospital, offers reliable and updated information for healthcare professionals (HP). The impact of Q/R activity on patient outcome was measured by using a survey to assess user's satisfaction and impact on HP knowledge and/or patients cares. The compatibility of this tool with daily use had been assessed too. MATERIALS AND METHODS: The survey was sent prospectively, for 9 months in 2018, to all HP whose enquiry was linked to a particular patient's care. The survey was posted 24-48h after the answer had been provided. RESULTS: 41 survey over 55 sent were returned (74.5%). The level of satisfaction measured is mostly good or excellent on all evaluated items. The HP surveyed consider that the responses provided have a potential positive impact on their professional knowledge and practices (97.6%), on the patient's care (n=36/37) and patient outcome (n=22/23). CONCLUSION: High level of satisfaction with the Q/R service and positive impact of this specialized Q/R service on improvement of HP knowledge and patient's care. This tool can be used in daily practice.

Standardised mortality ratios as a user-friendly performance metric and trigger for quality improvement in a Flemish hospital network: multicentre retrospective study.

OBJECTIVE: To illustrate the development and use of standardised mortality rates (SMRs) as a trigger for quality improvement in a network of 27 hospitals. DESIGN: This research was a retrospective observational study. The primary outcome was in-hospital mortality. SMRs were calculated for All Patient Refined-Diagnosis-Related Groups (APR-DRGs) that reflect 80% of the Flemish hospital network mortality. Hospital mortality was modelled using logistic regression. The metrics were communicated to the member hospitals using a custom-made R-Shiny web application showing results at the level of the hospital, patient groups and individual patients. Experiences with the metric and strategies for improvement were shared in chief medical officer meetings organised by the Flemish hospital network. SETTING: 27 Belgian hospitals. PARTICIPANTS: 1 198 717 hospital admissions for registration years 2009-2016. RESULTS: Patient gender, age, comorbidity as well as admission source and type were important predictors of mortality. Altogether the SMR models had a C-statistic of 88%, indicating good discriminatory capability. Seven out of ten APR-DRGs with the highest percentage of hospitals statistically significantly deviating from the benchmark involved malignancy. The custom-built web application and the trusted environment of the Flemish hospital network created an interoperable strategy to get to work with SMR findings. Use of the web application increased over time, with peaks before and after key discussion meetings within the Flemish hospital network. A concomitant reduction in crude mortality for the selected APR-DRGs from 6.7% in 2009 to 5.9% in 2016 was observed. CONCLUSIONS: This study reported on the phased approach for introducing SMR reporting to trigger quality improvement. Prerequisites for the successful use of quality metrics in hospital benchmarks are a collaborative approach based on trust among the participants and a reporting platform that allows stakeholders to interpret and analyse the results at multiple levels.

Needs assessment for improving library support for dentistry researchers.

OBJECTIVE: To better support dentistry researchers in the ever-changing landscape of scholarly research, academic librarians need to redefine their roles and discover new ways to be involved at each stage of the research cycle. A needs assessment survey was conducted to evaluate faculty members' research support needs and allow a more targeted approach to the development of research services in an academic health sciences library. METHODS: The anonymous, web-based survey was distributed via email to full-time researchers at the Faculty of Dentistry, University of Toronto. The survey included twenty questions inquiring about researchers' needs and behaviors across three stages of the research cycle: funding and grant applications, publication and dissemination, and research impact assessment. Data were also collected on researchers' use of grey literature to identify whether current library efforts to support researchers should be improved in this area. RESULTS: Among library services, researchers considered support for funding and grant applications most valuable and grey literature support least valuable. Researcher engagement with open access publishing models was low, and few participants had self-archived their publications in the university's institutional repository. Participants reported low interest in altmetrics, and few used online tools to promote or share their research results. CONCLUSIONS: Findings indicate that increased efforts should be made to promote and develop services for funding and grant applications. New services are needed to assist researchers in maximizing their research impact and to increase researcher awareness of the benefits of open access publishing models, self-archiving, and altmetrics.

Assessing coastal wetland vulnerability to sea-level rise along the northern Gulf of Mexico coast: Gaps and opportunities for developing a coordinated regional sampling network.

Coastal wetland responses to sea-level rise are greatly influenced by biogeomorphic processes that affect wetland surface elevation. Small changes in elevation relative to sea level can lead to comparatively large changes in ecosystem structure, function, and stability. The surface elevation table-marker horizon (SET-MH) approach is being used globally to quantify the relative contributions of processes affecting wetland elevation change. Historically, SET-MH measurements have been obtained at local scales to address site-specific research questions. However, in the face of accelerated sea-level rise, there is an increasing need for elevation change network data that can be incorporated into regional ecological models and vulnerability assessments. In particular, there is a need for long-term, high-temporal resolution data that are strategically distributed across ecologically-relevant abiotic gradients. Here, we quantify the distribution of SET-MH stations along the northern Gulf of Mexico coast (USA) across political boundaries (states), wetland habitats, and ecologically-relevant abiotic gradients (i.e., gradients in temperature, precipitation, elevation, and relative sea-level rise). Our analyses identify areas with high SET-MH station densities as well as areas with notable gaps. Salt marshes, intermediate elevations, and colder areas with high rainfall have a high number of stations, while salt flat ecosystems, certain elevation zones, the mangrove-marsh ecotone, and hypersaline coastal areas with low rainfall have fewer stations. Due to rapid rates of wetland loss and relative sea-level rise, the state of Louisiana has the most extensive SET-MH station network in the region, and we provide several recent examples where data from Louisiana's network have been used to assess and compare wetland vulnerability to sea-level rise. Our findings represent the first attempt to examine spatial gaps in SET-MH coverage across abiotic gradients. Our analyses can be used to transform a broadly disseminated and unplanned collection of SET-MH stations into a coordinated and strategic regional network. This regional network would provide data for predicting and preparing for the responses of coastal wetlands to accelerated sea-level rise and other aspects of global change.

[Adapting the service portfolio of a public health organisation to shrinking resources]. / Adaptación de los servicios de una organización de salud pública a la disminución de los recursos.

This paper describes the review process of the Agency of Public Health of Barcelona's service portfolio in response to the budget cuts introduced since 2010 in the public administrations in Spain. A working group reviewed the different business activities, taking into account their costs and generated revenue and their justification, assessing factors such as the existence of legal constraints, tied funding, explicit demands from the founding administrations and other actors that may be capable of undertaking particular activities. The changes and their consequences are described. The new service portfolio has been consolidated and is considered ratified by the Agency board, which was renewed after political changes. We conclude that this is because it was based on professional consensus and management criteria, which are key for the smooth operation of a public autonomous executive organisation.

Monitoring the web to support vaccine coverage: results of two years of the portal VaccinarSì.

OBJECTIVES: The increasingly widespread use of the Internet by the population to collect information regarding health and medical treatments and the circulation of many non-scientific documents on the effectiveness and safety of vaccines has led the Italian Society of Hygiene (SItI), in 2013, to promote a portal to provide scientific information that is verified and easily understood to counteract the rampant misinformation on health treatments and combat the phenomenon of vaccine hesitancy. METHODS: The project was launched in May 2013 and provides a portal with six main sections (vaccine preventable diseases, registered vaccines, benefits and risks of vaccination, against misinformation, pros & cons and travel immunizations) and other headings that relate to scientific events, comics and news coverage concerning vaccines. The contents are validated and evaluated by a scientific committee of high profile scientists and experts in computer-mediated communication. RESULTS: In the first two years of activity, the portal has published more than 250 web pages on all aspects related to vaccinations. The number of individual users was 860,411, with a constant increase over time. Of these, about 21.7% returned to the website at least once. The total visits in 24 months were 1,099,670, with a total page count of 2,530,416. The frequency of contact was almost exclusively Italian (95.6%), with a higher proportion of males (54.1%) and younger age groups (25-34 years, 33.5%, and18-24 years, 27.5%). The data also show a significant position of the website in the major web search engines. The website has been certified by the Health On the Net Foundation. It is connected with the main social networks and it has recently opened its first regional section (Veneto). CONCLUSIONS: The strong, progressive increase in web contacts, the involvement of several institutional bodies, and the appreciation of various stakeholders give an absolutely positive assessment of the first two years of the VaccinarSì project. The success of the website suggests future developments, with updates, sections devoted to regional problems, in-depth news analysis, and international expansion. The authors conclude that initiatives like this are to be implemented and constitute an effective way to counteract vaccine hesitancy.

United Kingdom: Health System Review.

This analysis of the United Kingdom health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. It provides an overview of how the national health services operate in the four nations that make up the United Kingdom, as responsibility for organizing health financing and services was devolved from 1997. With devolution, the health systems in the United Kingdom have diverged in the details of how services are organized and paid for, but all have maintained national health services which provide universal access to a comprehensive package of services that are mostly free at the point of use. These health services are predominantly financed from general taxation and 83.5% of total health expenditure in the United Kingdom came from public sources in 2013. Life expectancy has increased steadily across the United Kingdom, but health inequalities have proved stubbornly resistant to improvement, and the gap between the most deprived and the most privileged continues to widen, rather than close. The United Kingdom faces challenges going forward, including how to cope with the needs of an ageing population, how to manage populations with poor health behaviours and associated chronic conditions, how to meet patient expectations of access to the latest available medicines and technologies, and how to adapt a system that has limited resources to expand its workforce and infrastructural capacity so it can rise to these challenges.

Israel: Health System Review.

Israel is a small country, with just over 8 million citizens and a modern market-based economy with a comparable level of gross domestic product per capita to the average in the European Union. It has had universal health coverage since the introduction of a progressively financed statutory health insurance system in 1995. All citizens can choose from among four competing, non-profit-making health plans, which are charged with providing a broad package of benefits stipulated by the government. Overall, the Israeli health care system is quite efficient. Health status levels are comparable to those of other developed countries, even though Israel spends a relatively low proportion of its gross domestic product on health care (less than 8%) and nearly 40% of that is privately financed. Factors contributing to system efficiency include regulated competition among the health plans, tight regulatory controls on the supply of hospital beds, accessible and professional primary care and a well-developed system of electronic health records. Israeli health care has also demonstrated a remarkable capacity to innovate, improve, establish goals, be tenacious and prioritize. Israel is in the midst of numerous health reform efforts. The health insurance benefits package has been extended to include mental health care and dental care for children. A multipronged effort is underway to reduce health inequalities. National projects have been launched to measure and improve the quality of hospital care and reduce surgical waiting times, along with greater public dissemination of comparative performance data. Major steps are also being taken to address projected shortages of physicians and nurses. One of the major challenges currently facing Israeli health care is the growing reliance on private financing, with potentially deleterious effects for equity and efficiency. Efforts are currently underway to expand public financing, improve the efficiency of the public system and constrain the growth of the private sector.

Infrastructure to support learning health systems: are we there yet? Innovative solutions and lessons learned from American Recovery and Reinvestment Act CER investments.

The 11 big health data networks participating in the AcademyHealth Electronic Data Methods Forum represent cutting-edge efforts to harness the power of big health data for research and quality improvement. This paper is a comparative case study based on site visits conducted with a subset of these large infrastructure grants funded through the Recovery Act, in which four key issues emerge that can inform the evolution of learning health systems, including the importance of acknowledging the challenges of scaling specialized expertise needed to manage and run CER networks; the delicate balance between privacy protections and the utility of distributed networks; emerging community engagement strategies; and the complexities of developing a robust business model for multi-use networks.

[The Millennia 2015 Women and eHealth Study 2010-2012: networks and innovative programs]. / Étude Millennia 2015 « Femmes et eSanté 2010-2012 ¼ - Réseaux et technologies innovantes.

The Women and eHealth Study 2010-2012 is conducted with the vision to constitute a Millennia 2015 powerful demonstration of women empowerment in the arena of eHealth and telemedicine through digital solidarity and gender equity. The overall objective is to stimulate more women to use advanced technologies combined with innovative integrated collaborative leadership programs. The article describes the study and the subsequent networks WeTelemed and WeObservatory conducted by women in developing countries with the ambition to reach the populations living in isolated communities.

Mapping knowledge translation and innovation processes in Cancer Drug Development: the case of liposomal doxorubicin.

We explored how the knowledge translation and innovation processes are structured when theyresult in innovations, as in the case of liposomal doxorubicin research. In order to map the processes, a literature network analysis was made through Cytoscape and semantic analysis was performed by GOPubmed which is based in the controlled vocabularies MeSH (Medical Subject Headings) and GO (Gene Ontology). We found clusters related to different stages of the technological development (invention, innovation and imitation) and the knowledge translation process (preclinical, translational and clinical research), and we were able to map the historic emergence of Doxil as a paradigmatic nanodrug. This research could be a powerful methodological tool for decision-making and innovation management in drug delivery research.