Paul Gemmel

Prosthetic joint infections: radionuclide state-of-the-art imaging

Prosthetic joint replacement surgery is performed with increasing frequency. Overall the incidence of prosthetic joint infection (PJI) and subsequently prosthesis revision failure is estimated to be between 1 and 3%. Differentiating infection from aseptic mechanical loosening, which is the most common cause of prosthetic failure, is especially important because of different types of therapeutic management. Despite a thorough patient history, physical examination, multiple diagnostic tests and complex algorithms, differentiating PJI from aseptic loosening remains challenging. Among imaging modalities, radiographs are neither sensitive nor specific and cross-sectional imaging techniques, such as computed tomography and magnetic resonance imaging, are limited by hardware-induced artefacts. Radionuclide imaging reflects functional rather than anatomical changes and is not hampered by the presence of a metallic joint prosthesis. As a result scintigraphy is currently the modality of choice in the investigation of suspected PJI. Unfortunately, there is no true consensus about the gold standard technique since there are several drawbacks and limitations inherent to each modality. Bone scintigraphy (BS) is sensitive for identifying the failed joint replacement, but cannot differentiate between infection and aseptic loosening. Combined bone/gallium scintigraphy (BS/GS) offers modest improvement over BS alone for diagnosing PJI. However, due to a number of drawbacks, BS/GS has generally been superseded by other techniques but it still may have a role in neutropenic patients. Radiolabelled leucocyte scintigraphy remains the gold standard technique for diagnosing neutrophil-mediated processes. It seems to be that combined in vitro labelled leucocyte/bone marrow scintigraphy (LS/BMS), with an accuracy of about 90%, is currently the imaging modality of choice for diagnosing PJI. There are, however, significant limitations using in vitro labelled leucocytes and considerable effort has been devoted to developing alternative radiotracers, such as radiolabelled HIGs, liposomes, antigranulocyte antibodies and fragments, as well as more investigational tracers such as radiolabelled antibiotics, antimicrobial peptides, bacteriophages and thymidine kinase. On the other hand, positron emission tomography (PET) is still growing in the field of PJI imaging with radiotracers such as 18F-fluorodeoxyglucose (FDG), 18F-FDG white blood cells and 18F-fluoride. But unfortunately this superb tomographic technique will only receive full acceptance when specific PET uptake patterns can be successfully developed. The emergence of hybrid modality imaging using integrated single photon emission computed tomography (SPECT) and PET with computed tomography (SPECT/CT and PET/CT) may also have a contributing role for more accurate assessment of joint replacement complications, especially combined with new radiotracers such as 68Ga and 64Cu. Finally, in searching for infection-specific tracers, currently there is no such diagnostic agent available.

3D-printing techniques in a medical setting: a systematic literature review

BackgroundThree-dimensional (3D) printing has numerous applications and has gained much interest in the medical world. The constantly improving quality of 3D-printing applications has contributed to their increased use on patients. This paper summarizes the literature on surgical 3D-printing applications used on patients, with a focus on reported clinical and economic outcomes.MethodsThree major literature databases were screened for case series (more than three cases described in the same study) and trials of surgical applications of 3D printing in humans.Results227 surgical papers were analyzed and summarized using an evidence table. The papers described the use of 3D printing for surgical guides, anatomical models, and custom implants. 3D printing is used in multiple surgical domains, such as orthopedics, maxillofacial surgery, cranial surgery, and spinal surgery. In general, the advantages of 3D-printed parts are said to include reduced surgical time, improved medical outcome, and decreased radiation exposure. The costs of printing and additional scans generally increase the overall cost of the procedure.Conclusion3D printing is well integrated in surgical practice and research. Applications vary from anatomical models mainly intended for surgical planning to surgical guides and implants. Our research suggests that there are several advantages to 3D-printed applications, but that further research is needed to determine whether the increased intervention costs can be balanced with the observable advantages of this new technology. There is a need for a formal cost–effectiveness analysis.

Managing Engagement Behaviors in a Network of Customers and Stakeholders Evidence From the Nursing Home Sector

Firms striving for long-term profitability need to build stronger customer-firm relationships by getting their customers more engaged with the firm. One path to this end is introducing practices to manage different forms of customer engagement behaviors (CEBs). To develop more effective and efficient CEB management practices, this research proposes and empirically tests a theoretical model on managerial and psychological processes to encourage CEBs that are embedded in a broader network of customers and stakeholders. Based on qualitative and quantitative studies in nursing homes, we demonstrate that organizational support and overall service quality toward significant others influence some forms of CEBs—more particularly feedback and positive word of mouth (WOM) behaviors—through customer affect toward the organization. It is interesting to note that customer affect toward the organization encourages WOM behaviors, while it discourages feedback behaviors. Conversely, managerial processes that increase customer role readiness—such as organizational socialization and support from other customers—were found to have a positive impact on all forms of CEBs. This research helps managers of nursing homes and other services with a broad network of customers and stakeholders to improve existing CEB management practices and develop new CEB management practices that are beneficial for the firm and its stakeholders.

How to Govern Business Services Exchanges: Contractual and Relational Issues

With firms concentrating on core competencies, more emphasis has been placed on outsourcing and the dealing with external sourcing agents. This has lead to a stronger academic focus on buyer-seller exchanges and the corresponding mechanisms for governing these exchanges. This paper gives an overview of previous research investigating the exchange governance phenomenon based on transaction cost theory or cooperative interorganizational relationships. The results reveal that few research studies have investigated the overall picture of exchange governance, including both contractual and relational governance and taking into account antecedents as well as performance outcomes of the governance mechanisms involved. Moreover, despite the service-dominant logic shift, limited attention is given to specific service characteristics and their impact on exchange governance. In this paper, we attempt to meld economic and social related antecedents into a model with regard to exchange governance in business services settings. Contractual and relational governance issues and their impact on performance outcomes are also considered. The resulting model indicates that to efficiently govern business services exchanges, more emphasis should be placed on behavioral uncertainty, human and process asset specificity and contractual governance. We conclude the paper by discussing several directions for future research.

Hospital Process Orientation (HPO): The development of a measurement tool

This paper looks at how process orientation can be measured using data from one large European university hospital. After a restructuring in divisions and the implementation of the care programmes and clinical pathways, hospital management came to the conclusion that they had no tools to evaluate if these changes were resulting in a process orientation on the work-floor. In agreement with hospital management, an existing tool of Business Process Orientation measurement was adopted and adapted to the specific context of healthcare. This paper reports on how the measurement tool was changed and validated in order to come up with a useful instrument to measure the process orientation of the employees in the hospital. The Hospital Process Orientation (HPO) tool can be useful to measure the effects of changes that are assumed to lead to more process orientation or even patient focus. In this way the pay-off of these investments can be made more tangible. The HPO tool offers hospitals a way to evaluate how they are evolving towards more process orientation.

Admission scheduling in acute care hospitals: does the practice fit with the theory?

Admission scheduling is identified as an important strategy to match supply and demand in acute care hospitals. During the last decades, many different theoretical models of admission scheduling have been developed, but only a few of them have reached the stage of implementation. Several authors have given some indication that there may be a gap between theory and practice of admission scheduling. In this study we try to describe this gap using a two‐stage research methodology: an extensive literature review in order to determine the theoretical functional requirements for a system that supports the admission scheduling decision and a telephone survey in order to learn more about the admission scheduling practice in Belgian hospitals. The study finds a large gap between the theoretical requirements and the practical application of admission scheduling in hospitals. In summary, most hospitals have not worked out an admission scheduling policy indicating which resources are critical in the scheduling process and how information on the availability of these resources can be captured.

The Project Scheduling Game (PSG): Simulating Time/Cost Trade-Offs in Projects

The Project Scheduling Game is an IT-supported simulation game that illustrates the complexity of scheduling a real-life project. The project is based on a sequence of activities for a large real-life project at the Vlaamse Maatschappij voor Watervoorziening, which aims at the expansion of the capacity to produce purified water. The basic problem type that we use in the game has been described in the literature as a CPM (critical path method) network problem, and focuses on the time/cost relationship in each activity of the project. Indeed, by allocating resources to a particular activity, the manager decides about the duration and corresponding cost of each network activity. The manager schedules the project with the negotiated project deadline in mind, focusing on the minimization of the total project cost.

Purchased business services influence downstream supply chain members

Purpose – Supply chain management and business networks have gained increased attention in services settings. The purpose of this research is to investigate the impact of external purchased services by a service provider on the satisfaction of downstream supply chain members, i.e. end‐users. The focus is on transaction‐specific satisfaction as it provides in‐depth information on specific satisfaction elements.Design/methodology/approach – To test the propositions, one business service provider purchasing a service from an external supplier is selected. Data are collected by sending a web survey to the business service providers customers. partial least squares (PLS) is used to analyze the data as transaction‐specific satisfaction is considered as a formative construct.Findings – PLS analyses indicate that the elements determining satisfaction with the external supplier and those determining satisfaction with the business service provider differ. Moreover, transaction‐specific satisfaction of end‐users wi...

The impact of organizational support and leader–member exchange on the work‐related behaviour of nursing professionals: the moderating effect of professional and organizational identification

AIM The aim of this study was to examine the relations between perceived organizational support, the quality of leader-member exchange, in-role and extra-role behaviour, professional identification and organizational identification among registered nurses and nurse assistants. BACKGROUND Theoretically, employees will reciprocate received beneficial treatment with positive attitudes and behaviour. Recently, it has been shown that this principle may be more complex than originally anticipated. DESIGN A quantitative, cross-sectional survey design was used. The quality of social exchange and identification was scored by the involved registered nurses and nurse assistants; in-role and extra-role behaviour was rated by the head nurse. METHODS The survey was administered to nurses and nurse assistants (n = 196) working in five Belgian nursing homes. Data were collected from February-March 2012. Pearson correlation analyses, t-test analyses and hierarchical regression were used to analyse the data. RESULTS Our results showed no relationship between perceived organizational support and leader-member exchange and in-role behaviour. A positive relationship was found between perceived organizational support and extra-role behaviour and a trend towards significance between leader-member exchange and extra-role behaviour. Organizational and professional identification moderated the relationship between perceived organizational support and extra-role behaviour. CONCLUSIONS Our study demonstrates the importance of social exchange to nurses and nurse assistants and therefore nursing administrators and leaders. When registered nurses and nurse assistants perceive high-quality social exchange, they are more likely to go the extra mile on behalf of the organization. Fostering social identification could enhance this.

The ties that bind: an integrative framework of physician-hospital alignment

BackgroundAlignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship.DiscussionEmpirical studies and management theory (agency theory and social exchange theory) are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration.SummaryHospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives.