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Die Digitale Transformation ist komplex und eine große Herausforderung für Organisationen. Der Einsatz digitaler Technologien erlaubt neue, durchgängigere, kundenorientiertere Leistungen, fordert aber gleichzeitig unterschiedlichste, teils massive interne Veränderungen. Dabei fehlt oft die Übersicht darüber, worüber Klarheit geschaffen und was gemacht werden sollte. Um Abhilfe zu schaffen, wurde der Digital Transformation Orchestrator entwickelt.

Objective: To determine the correlation between intraoperative changes of electrocochleography (ECochG) responses and traumatic cochlear implant insertions as well as postoperative hearing loss. Methods: ECochG, radiological, and audiological data were collected prospectively in a cochlear implant recipient with otosclerosis and assumed cochlear trauma during electrode insertion. A systematic review was conducted within PubMed-NCBI, EMBASE, and the Cochrane Library using the terms “Cochlear implant” and “Electrocochleography.” Original studies that evaluated intraoperative ECochG responses and postoperative hearing loss were selected and analyzed. Results: The case report revealed a drop of intra- and extracochlear ECochG signals during electrode insertion. The postoperative computed tomography scan suggested a scalar dislocation. There was no measurable hearing 4 weeks after surgery. Within the database search, nine articles met the inclusion criteria. All were case series reports (range from 2 to 36 subjects) with a total of 173 subjects. Due to the heterogeneous data, a meta-analysis was unfeasible. Conclusions: In concordance with some findings in the literature, the presented case report suggests that a drop of intra- and extracochlear ECochG signals during the insertion of the electrode array is associated with cochlear trauma and postoperative hearing loss in some cases. However, the literature is inconclusive regarding the correlation between intraoperative changes of the ECochG signals and postoperative hearing preservation. More studies investigating the correlation are needed to provide sufficient data.

Founded in 2005 at the Institute of Information Systems at the University of St. Gallen (IWI-HSG), the Competence Center Health Network Engineering (CC HNE) represented an association of researchers and practitioners whose goal was to support the transformation of the Swiss healthcare system with models and methods from the St. Gallen business engineering approach. This paper provides a retrospective of the work of the CC HNE. Starting with a motivation for the research focus as well as a classification in the research of the IWI-HSG, the main research results of the Competence Center are presented. This includes in particular work on networkability, performance management and maturity models as well as a Networkability Maturity Model. Subsequently, it will be discussed how the research results have found their way into practice (keyword: relevance). Here, the focus is on established communities of practice, whereby the application of the results in the context of the IT community of practice is examined in more detail. Finally, the results are subjected to a critical appraisal and an outlook on the need for further research is given.

The topics in this book cover a broad range of research interests: from business engineering and its application in corporate and business networking contexts to design science research as well as applied topics, where those research methods have been employed for modeling, data warehousing, information systems management, enterprise architecture management, management of large and complex projects, and enterprise transformation. The book is a Festschrift for Robert Winter in order to appreciate his work and to honor him as a personality with a high reputation in the information systems community. To this end, many professional colleagues or long-time companions both from the Institute of Information Management at the University of St. Gallen as well as from the international research community dedicated articles on topics related to Robert’s research. They reflect his ambition to uncompromisingly conduct high-class research that fuels the research community and at the same time contributes to improved industrial practice. The book is organized in three major parts: Part I “Business Engineering and Beyond” focuses on the methodology strongly shaped by Robert in St. Gallen with a focus on research being applied in corporate contexts. Part II “Design Science Research” spans from reflections on the practice of design science research to perspectives on design science research methodologies and eventually up to considerations to teach design science research methodology. Part III “Applied Fields” combines various applications of design science and related research methodologies with practical problems and future research topics.

Multiport laparoscopy is the gold-standard approach for cholecystectomy, and single-port laparoscopy has been developed to further reduce its invasiveness. A specific robotic single-port platform (da Vinci single-site, Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2011, which could technically facilitate single-site cholecystectomy. Current data show its feasibility; however, detailed short- and long-term analyses of costs and comparisons relative to multiport laparoscopy are not available to date. Patients who underwent robotic single-site cholecystectomy for benign, clinically noninflammatory disease between 2011 and 2015 were matched for disease, age, gender, BMI, ASA classification, diagnosis, and elapsed year of surgery to a cohort of multiport cholecystectomies. Demographic, perioperative, and long-term data were collected retrospectively and analyzed. Perioperative and long-term costs including re-operations due to the primary procedure until February 2017 were compared across both cohorts. 99 patients who underwent robotic single-site cholecystectomy were matched to 99 patients with multiport cholecystectomy. A higher rate of outpatient procedures in the robotic cohort (31.3 vs. 17.2%, p = 0.0305) was found, and demographic parameters and perioperative clinical outcomes were similar. Perioperative costs were significantly higher for the robotic single-site patients (6158.0 vs. 4288.0 USD, p

Robotic technology shows some promising early outcomes indicating potentially improved outcomes particularly for challenging bariatric procedures. Still, health care providers face significant clinical and economic challenges when introducing innovations. Prospectively derived administrative cost data of patients who were coded with a primary diagnosis of obesity (ICD-10 code E.66.X), a procedure of gastric bypass surgery (CHOP code 44.3), and a robotic identifier (CHOP codes 00.90.50 or 00.39) during the years 2012 to 2015 was analyzed and compared to the triggered reimbursement for this patient cohort. A total of 348 patients were identified. The mean number of diagnoses was 2.7 and the mean length of stay was 5.9 days. The overall mean cost per patients was Swiss Francs (CHF) from 2012 to 2014 that was 21,527, with a mean reimbursement of CHF 24,917. Cost of the surgery in 2015 was comparable to the previous years with CHF 22,550.0 (p = 0.6618), but reimbursement decreased significantly to CHF 20,499.0 (0.0001). The average cost for robotic gastric bypass surgery fell well below the average reimbursement within the Swiss DRG system between 2012 and 2014, and this robotic procedure was a DRG winner for that period. However, the Swiss DRG system has matured over the years with a significant decrease resulting in a deficit for robotic gastric bypass surgery in 2015. This stipulates a discussion as to how health care providers should continue offering robotic gastric bypass surgery, particularly in the light of developing clinical evidence.

Purpose: In Gustilo grade III open fractures, it remains unknown which demographic or clinical features may be associated with an infection resistant to the administered prophylactic agent, compared to one that is susceptible. Methods: This was a retrospective case-control study on patients hospitalized from 2004 to 2009. Results: We identified 310 patients with Gustilo-III open fractures, 36 (12%) of which became infected after a median of tendays. In 26 (72%) of the episodes the pathogen was susceptible to the prophylactic antibiotic agent prescribed upon admission, while in the other ten it was resistant. All antibiotic prophylaxis was intravenous; the median duration of treatment was threedays and the median delay between trauma and surgery was oneday. In multivariate analysis adjusting for case-mix, only Gustilo-grade-IIIc fractures (vascular lesions) showed tendency to be infected with resistant pathogens (odds ratio 10; 95% confidence interval 1.0-10; p = 0.058). There were no significant differences between cases caused by antibiotic resistant and susceptible pathogen cases in patient's sex, presence of immune suppression, duration and choice of antibiotic prophylaxis, choice of surgical technique or materials, time delay until surgery, use of bone reaming, fracture localization, or presence of compartment syndrome. Conclusion: We were unable to identify any specific clinical parameters associated with infection with antibiotic resistant pathogens in Gustilo-grade III open fractures, other than the severity of the fracture itself. More research is needed to identify patients who might benefit from a broader-spectrum antibiotic prophylaxis.

Pharmacokinetic characteristics of benzylpenicillin and its benzylpenicilloyl (BPO)-derivatives were studied in serum and milk of health cows, using a classical biological assay ( Sarcina lutea test) and a competitive ELISA for BPO detection. The plasma level and passage into milk was determined after intramuscular administration of penethamate-hydroiodide and benzylpenicillin-procaine. In serum of cows receiving penethamate hydroiodide, BPO seemed to persist for a rather long time; the reason for this observation was not clarified. The effect of local (intramammary) application of penicillin G was followed with milk from cows having healthy and mastitic quarters. In all cases, it was found that BPO was not excreted any longer than active penicillin G in milk. In a further survey, 1015 bulk milk samples from two large dairy regions were examined with the ELISA and a biological assay using Bacillus stearothermophilus var. calidolactis . None of the samples showed detectable BPO or antibiotic residues. It is concluded that milk containing inactive penicillin derivatives, like BPO, is not an important source to cause allergies.

For decades much effort has been made to improve project management capabilities. Still, the failure rate remains high, especially for large IT projects. Our postmortem analysis of 15 large IT projects of the Swiss Federal Administration, with an accumulated loss of one billion U.S. dollars, shows that while project management deficits account for some of the failures, project failure is primarily caused by poor project governance capabilities. Based on insights gained from the initial failure analysis, the Swiss Federal Government decided to assess all its large IT projects based on our co-designed framework. Meanwhile, also private companies have assessed IT projects applying our framework. As a consequence, valuable discussions and measures have been initiated and sporadically projects were stopped. The data gained by these assessments will allow to identify patterns that promise to be a reference for governance actors and bodies what information to ask for, when to intervene, and how.

As a primary factor of technological innovation, process orientation contributes significantly to an organization's overall productivity and quality improvement. While this proposition has been confirmed for profit-oriented organizations of various industries, little research exists that validates the same statement in the healthcare sector. This paper proposes and evaluates a theoretical model that investigates the effect of process orientation on hospitals' competitiveness and performance. The concept of the balanced scorecard is applied to comprehensively cover all facets that constitute healthcare quality innovation. A set of hypotheses is proposed conceptualizing the direct and indirect effects of process orientation on hospitals' performance (identified as patient satisfaction and financial performance) through an increase of integral competitiveness (identified as workforce conditions, operational performance and clinical quality). The model is empirically tested by means of a questionnaire-based survey among clinical and administrative management of hospitals in Switzerland. 145 complete questionnaires from 129 hospitals are analyzed. Statistical results affirm that process orientation significantly enhances hospital performance. Workforce conditions and clinical quality prove to have a significant positive effect on patient satisfaction, whereas the hypothesized positive effect of operational efficiency on patient satisfaction is not supported. Moreover, results attest the positive effect of workforce conditions and operational efficiency on financial performance, while rejecting the effect of clinical quality on financial performance.

Purpose: The optimal duration of concomitant antibiotic therapy after surgical intervention for implant-free chronic osteomyelitis is unknown. No randomized data exist. Available recommendations are based on expert's opinion. We evaluated the duration of post-surgical antibiotic treatment related to remission of chronic osteomyelitis. Methods: This was a retrospective single-centre study at Geneva University Hospitals with a minimal follow-up of two years after treatment. We used multivariate logistic regression analysis with exclusion of pediatric cases and of implant-related chronic osteomyelitis. Results: A total of 49 episodes of implant-free chronic osteomyelitis in 49 adult patients were studied. The median number of surgical interventions was two (range, 1-10). The median duration of post-debridement antibiotic treatment was eightweeks (range, 4-14weeks). Thirty-nine patients (80%) were in remission after a minimal follow-up of twoyears. In multivariate logistic regression analysis, one week of intravenous therapy had the same remission as two to threeweeks (0.2, 0.1-1.9) or ≥ 3weeks (0.3, 0.1-2.4). More than sixweeks of total antibiotic treatment equalled ≤ six weeks (0.8, 0.1-5.2). Conclusions: In chronic osteomyelitis in adults, a post-debridement antibiotic therapy beyond six weeks, or an IV treatment longer than one week, did not show enhanced remission incidences. Prospective randomized trials are required to confirm this observation

Background: : Pneumocystis jirovecii is an opportunistic pathogen that causes pneumonia, particularly in immunodeficient hosts. Materials and Methods: : We retrospectively compared the results obtained by two staining methods (toluidine blue and calcofluor white) and two quantitative (q) real time PCR assays for the detection of P. jirovecii in bronchoalveolar lavage (BAL) specimens. For the qPCR assays, we used newly selected probes and primers targeting the Kex-1 gene, which codes for a serine endoprotease, and compared the results to those from the published assay targeting the β-tubulin gene. Results: : A total of 1,843 BAL specimens were analyzed microscopically in parallel, and 74 (4.0%) were found to be positive with both stains, 23 (1.2%) were positive only with the toluidine blue stain, and six (0.3%) only with the calcofluor stain (p = 0.003). Of these, a selection of 186 consecutive BAL fluid samples were tested by qPCR using the respective different primer pairs. 21 of the 186 samples (11.3%) were microscopically positive with both stains as well as qPCR positive after 18-31 cycles (corresponding to 5.24 × 106 copies/ml to 640 copies/ml of native BAL) using the Kex-1 primer pair and between 21-33 cycles using the β-tubulin assay. A good correlation between semi-quantitative microscopy and the number of PCR cycles needed for a positive signal was noted. Of the remaining 165 samples, 153 (82%) were both microscopically and PCR negative (PCR with the two sets of primers); the remaining 12 samples (7%) were Kex-1-based PCR positive (from cycles 33 to 41, corresponding to 160 copies/ml of BAL or less) but microscopically negative. Of these latter samples, ten (6%) were also positive (from cycles 34 to 38) with the primers targeting the β-tubulin gene. Taking microscopy as a reference, the sensitivity of qPCR targeting the Kex-1 gene was 100%, and the specificity was 92.4%. Conclusion: : The sensitive qPCR analysis proved to be a rapid and reliable method to detect P. jirovecii in BAL

Breakthrough candidemia (BTC) on fluconazole was associated with non-susceptible Candida spp. and increased mortality. This nationwide FUNGINOS study analyzed clinical and mycological BTC characteristics.A 3-year prospective study was conducted in 567 consecutive candidemias. Species identification and antifungal susceptibility testing (CLSI) were performed in the FUNGINOS reference laboratory. Data were analyzed according to STROBE criteria.43/576 (8%) BTC occurred: 37/43 (86%) on fluconazole (28 prophylaxis, median 200 mg/day). 21% BTC vs. 23% non-BTC presented severe sepsis/septic shock. Overall mortality was 34% vs. 32%. BTC was associated with gastrointestinal mucositis (multivariate OR 5.25, 95%CI 2.23-12.40, p 0.001) and graft-versus-host-disease (6.25, 1.00-38.87, p = 0.05), immunosuppression (2.42, 1.03-5.68, p = 0.043), and parenteral nutrition (2.87, 1.44-5.71, p = 0.003). Non-albicans Candida were isolated in 58% BTC vs. 35% non-BTC (p = 0.005). 63% of 16 BTC occurring after 10-day fluconazole were non-susceptible (Candida glabrata, Candida krusei, Candida norvegensis) vs. 19% of 21 BTC (C. glabrata) following shorter exposure (7.10, 1.60-31.30, p = 0.007). Median fluconazole MIC was 4 mg/l vs. 0.25 mg/l (p 0.001). Ten-day fluconazole exposure predicted non-susceptible BTC with 73% accuracy.Outcomes of BTC and non-BTC were similar. Fluconazole non-susceptible BTC occurred in three out of four cases after prolonged low-dose prophylaxis. This implies reassessment of prophylaxis duration and rapid de-escalation of empirical therapy in BTC after short fluconazole exposure.

Clinical experience suggests that a high proportion of orthopaedic infections occur in persons with diabetes.We reviewed several databases of adult patients hospitalized for orthopaedic infections at Geneva University Hospitals from 2004 to 2014 and retrieved 2740 episodes of infection.Overall, diabetes was noted in the medical record for 659 (24%) of these cases. The patients with, compared with those without, diabetes had more than five times more foot infections (274/659 [42%] vs 155/2081 [7%]; p0.01) and a significantly higher serum C-reactive protein level at admission (median 96 vs 70 mg/L; p0.01). Diabetic patients were older (median 67 vs 52 years; p0.01), more often male (471 [71%] vs 1398 [67%]; p = 0.04), and had more frequent polymicrobial infections (219 [37%] vs 353 [19%]; p0.01), including more gram-negative non-fermenting rods (90 [15%] vs 168 [9%]; p0.01). Excluding foot infections from these analyses did not change the statistically significant differences. Diabetes was present in 17% of all infected orthopaedic patients without foot involvement. In Geneva canton, the overall prevalence of diabetes is estimated at 5.1%, while we have found that the prevalence is 13% in our hospitalized adults.Diabetes is present in 24% of all adult patients hospitalized for surgery for an orthopaedic infection, a prevalence that is several times higher than for the general population and twice as high as that for the population of hospitalized patients. Compared with non-diabetics, patients with diabetes have significantly more infections that are polymicrobial, including gram-negative non-fermenting rods.

Objective.To obtain an unbiased estimate of the excess hospital length of stay (LOS) and cost attributable to extended-spectrum β-lactamase (ESBL) positivity in bloodstream infections (BSIs) due to Enterobacteriaceae.Design.Retrospective cohort study.Setting.A 2,200-bed academic medical center in Geneva, Switzerland.Patients.Patients admitted during 2009.Methods.We used multistate modeling and Cox proportional hazards models to determine the excess LOS and adjusted end-of-LOS hazard ratio (HR) for ESBL-positive and ESBL-negative BSI. We estimated economic burden as the product of excess LOS and average bed-day cost. Patient-level accounting data provided a complementary analysis of economic burden. A predictive model was fitted to national surveillance data.Results.Thirty ESBL-positive and 96 ESBL-negative BSI cases were included. The excess LOS attributable to ESBL-positive and ESBL-negative BSI was 9.4 (95% confidence interval [CI], 0.4–18.4) and 2.6 (95% CI, 0.7–5.9) days, respectively. ESBL positivity was therefore associated with 6.8 excess days and CHF 9,473 per BSI. The adjusted end-of-LOS HRs for ESBL-positive and ESBL-negative BSI were 0.62 (95% CI, 0.43–0.89) and 0.90 (95% CI, 0.74–1.10), respectively. After reimbursement, the average financial loss per acute care episode in ESBL-positive BSI, ESBL-negative BSI, and control cohorts was CHF 48,674, 48,131, and 13,532, respectively. Our predictive model estimated that the nationwide cost of third-generation cephalosporin resistance would increase from CHF 2,084,000 in 2010 to CHF 3,526,000 in 2015.Conclusions.This is the first hospital-wide analysis of excess LOS attributable to ESBL positivity determined using multistate modeling to avoid time-dependent bias. These results may inform health-economic evaluations of interventions targeting ESBL control.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an escalating problem in hospitals worldwide. The hospital reservoir for MRSA includes recognized and unrecognized colonized or infected patients, as well as previously colonized or infected patients readmitted to the hospital. Early and appropriate infection control measures (ICM) are key elements to reduce MRSA transmission and to control the hospital reservoir.Objective: To describe the role of an expert system applied to the control of MRSA at a large medical center (1,600 beds) with high endemic rates.Methods: The University Hospital of Geneva has an extended hospital information system (HIS), DIOGENE, structured with an open distributed architecture. It includes administrative, medical, nursing, and laboratory applications with their relational databases. Among available patient databases, clinical microbiology laboratory and admission-discharge-transfer (ADT) databases are used to generate computer alerts. A laboratory alert (lab alert) is printed daily in the Infection Control Program (ICP) offices, listing all patients with cultures positive for MRSA detected within the preceding 24 hours. Patients might be either newly detected patients colonized or infected with MRSA, or previously recognized MRSA patients having surveillance cultures. The ICP nurses subsequently go to the ward or call the ward personnel to implement ICM. A second alert, the “readmission alert,” detects readmission to the hospital of any patient previously colonized or infected with MRSA by periodic queries (q 1 min) to the ADT database. The readmission alert is printed in the ICP offices, but also forwarded with added guidelines to the emergency room.Results: During the first 12 months of application (July 1994 to June 1995), the lab alert detected an average of 4.6 isolates per day, corresponding to 314 hospital admissions (248 patients); the use of this alert saved time for the ICP nurses by improving work organization. There were 438 readmission alerts (1.2 alerts per day) over the study period; of 347 patients screened immediately upon readmission, 114 (33%) were positive for MRSA carriage. Delayed recognition of readmitted MRSA carriers decreased significantly after the implementation of this alert; the proportion of MRSA patients recognized at the time of admission to the hospital increased from 13% in 1993 to 40% in 1995 (PConclusions: Hospital information system-based alerts can play an important role in the surveillance and early prevention of MRSA transmission, and it can help to recognize patterns of colonization and transmission.

Because persistence of infections associated with prosthetic material despite the use of appropriate antibiotics is a major clinical problem, the antimicrobial susceptibility of bacteria responsible for a chronic subcutaneous tissue cage infection in rat was investigated ex vivo. Three to 6 weeks after the initiation of infection, suspensions of two strains of Staphylococcus aureus recovered from the foreign body surface and surrounding fluid were exposed to either oxacillin, vancomycin, fleroxacin, gentamicin, or rifampin. The MBCs of these bacteria were markedly elevated, in most cases 128 to greater than 256 times higher than the MBC of batch culture S. aureus in either logarithmic or stationary phase. Kinetic studies showed the bacteria did not grow when incubated for 2 h in Mueller-Hinton broth, possibly reflecting dormancy. Their killing was slow and incomplete by all antibiotics at greater than 8 times their MIC. These data provide direct evidence of a decreased susceptibility of S. aureus to the killing effect of antimicrobials during chronic foreign body infections in vivo.

Hospitals as the main entities of healthcare need to respond to policy initiatives affecting in particular the quality, efficiency and costs of health service delivery as well as cope with continuous technological advancements. Considering the information intensive character of healthcare, a shift in a hospital’s business policy also induces potentials and pitfalls to the management of health information technology. In this sense, this paper strives to find an answer to the problem how to reduce misalignment of the business and IT architecture in hospitals. Following the design science research methodology, this paper emphasises the description of a method named H-BIT, which may support decision-makers in overcoming this alignment problem. Implications for healthcare practice are reported based on the experiences that were gained from the exemplary application of the method at a larger hospital.

Summary Objectives To assess the risk factors for recurrence of septic arthritis with an emphasis on the duration of antibiotic treatment, to gather data for a prospective study on an optimized antibiotic treatment in adults with septic arthritis. Methods This was a retrospective single-center study conducted for the period 1996–2008. Results A total of 169 episodes of septic arthritis in 157 adult patients (median age 63 years; 65 females) were included. In 21 episodes (21/169, 12%), arthritis recurred after the end of antibiotic treatment. Multivariate analysis showed that Gram-negative infection (odds ratio (OR) 5.9, 95% confidence interval (CI) 1.4–25.3), immune suppression (OR 5.3, 95% CI 1.3–22.0), and lack of surgical intervention were associated with recurrence. The size of the infected joint, the number of surgical drainages (OR 1.3, 95% CI 1.0–1.7), arthrotomy vs. arthroscopic drainage (OR 0.5, 95% CI 0.2–1.8), duration of antibiotic therapy (OR 1.0, 95% CI 0.95–1.05), and duration of intravenous antibiotic therapy (OR 1.0, 95% CI 1.0–1.0) were not. Seven days of intravenous therapy had the same success rate as 8–21 days (OR 0.4, 95% CI 0.1–1.7) and >21 days (OR 1.1, 95% CI 0.4–3.1). Fourteen days or less of total antibiotic treatment had the same outcome as 15–28 days (OR 0.4, 95% CI 0.1–2.3) or >28 days (OR 0.4, 95% CI 0.1–1.6). Conclusions In this retrospective study of adults with septic arthritis, the duration of antibiotic therapy, or an early switch from intravenous to oral administration, did not statistically influence the risk of recurrence. Due to study limitations, the data cannot be used directly for antibiotic therapy recommendations for septic arthritis. Prospective randomized trials are warranted to optimize the antibiotic treatment of septic arthritis.

The vision of the Competence Center Health Network Engineering is to support the public and private stakeholders of healthcare by means of practical and forward-looking artifacts. Transdisciplinary research approaches, such as the innovative inclusion of very diverse individuals and groups of this domain, helps us to innovate our environment.

OBJECTIVES: In the treatment of prosthetic joint infections (PJI), the benefit of antibiotic therapy for more than 6 weeks after surgery is uncertain. We compared PJI cure rates according to the duration of antibiotics, 6 versus 12 weeks. METHODS: A prospective observational non-randomized study in Geneva University Hospitals 1996-2007. RESULTS: A total of 144 PJI (62 hip arthroplasties, 62 knee arthroplasties, and 20 hip hemiarthroplasties) were included with a prolonged follow-up ranging from 26 to 65 months. Surgical treatment included 60 debridements with implant retention, 10 one-stage exchanges of the prosthesis, 57 two-stage exchanges, and 17 Girdlestone procedures or knee arthrodeses. Seventy episodes (49%) received 6 weeks antibiotic therapy and 74 episodes, 12 weeks. Cure was achieved in 115 episodes (80%). Cure rate did not change according to the duration of intravenous antibiotics (>8 days, 8-21 days, >21 days) (Kruskal-Wallis-test; p = 0.37). In multivariate analysis, none of the following parameters was statistically significantly associated with cure: two-stage exchange (odds ratio 1.1,95%CI 0.2-4.8); number of debridements (0.9, 0.4-1.9); six weeks antibiotherapy (2.7, 0.96-8.3); duration of intravenous course (1.0, 0.96-1.03); sinus tract (0.6, 0.2-1.7); or MRSA infection (0.5, 0.2-1.5), although implant retention showed a tendency for less cure (0.3, 0.1-1.1). CONCLUSIONS: Following surgery for treatment of PJI, antibiotic therapy appears able to be limited to a 6-week course, with one week of intravenous administration. This approach needs confirmation in randomized trials.

Objectives The value of non-bone microbiological cultures in the diagnosis of osteomyelitis with sinus tract is not clear. We aimed to establish the concordance between deep sinus tract cultures and bone cultures in cases of osteomyelitis with a cutaneous fistula. Methods This was a non-randomized, prospective diagnostic trial at the Orthopedic Service of the University Hospital of Geneva. Each patient with osteomyelitis with a cutaneous sinus tract had four microbiological samples taken: two consecutive sinus tract cultures with bone contact at different times (samples A-1 and A-2), surgical bone biopsy performed through the sinus tract (sample B), and a surgical bone biopsy performed through an uninfected area outside the sinus tract (sample C), the latter considered as the ‘gold standard'. Results One hundred and forty-one patients with 154 episodes of osteomyelitis were included in the study. When both sinus tract cultures yielded the same microorganism (86.4%), the concordance between both samples A and sample C was 96%. In the case of identical sinus tract culture infections, sensitivity was 91%, specificity 86%, and accuracy 90%. The accuracy in monomicrobial infections (50%) was higher than in polymicrobial infections (94.3% vs. 78.9%, respectively; p =0.02). Conclusions In cases of monomicrobial osteomyelitis with sinus tract, two concordant tract cultures with bone contact accurately predict the pathogen.

The structural transformation of modern societies (e.g., aging of population, mobility) as well as continuously increasing market dynamics (e.g., mergers, technological advancement) induces health care organizations to reduce their costs while enhancing service delivery. In other industrial sectors this was achieved by optimizing cooperation, coordination, and communication particularly with regard to the supplier base. However, as the pressure to innovate will increase extensively in the next years, similar developments are becoming relevant for the health care supply chain. In this paper, the authors adapt the current findings on supplier relationship management (SRM) to the health care context. The authors analyze theoretical foundations of SRM and explore a particular area of application in health care, namely the ordering of pharmaceuticals by hospitals. Finally, on the basis of a case study, applications of different SRM services are discussed.