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Ennakkoluuloton kurkistus uuden ajan alun pimeämmälle puolelle

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Puolustusvoimien organisaatiokulttuurin soveltuvuus oppivan kriisinhallintaorganisaation rakentamiseen

Puolustusvoimien yhtenä päätehtävänä on sotilaallinen kriisinhallinta. Kriisinhallinnan toimintaympäristö on muuttunut viime vuosikymmeninä entistä haastavammaksi. Puolustusvoimat on pyrkinyt vastaamaan muuttuvan toimintaympäristön asettamiin haasteisiin pyrkimällä omaksumaan oppivan organisaation mallin mukaisia piirteitä. Tutkimuksen päämäärä on selvittää Puolustusvoimien organisaatiokulttuurin nykytilaa ja tulevaisuuden näkymiä, sekä selvittää oppivan organisaation mallin soveltuvuutta kriisinhallinnan toimintaympäristöön. Tutkielmassa käsitellään oppivan organisaation vaatimuksia organisaatiokulttuurille. Tutkimus on lähestymistavaltaan laadullinen johtamisen tutkimus. Aineiston analyysimenetelmänä käytettiin sisällön analyysia. Tutkimuksen aineiston keruussa tukeuduttiin valmiisiin aineistoihin. Keskeisimmiksi lähteiksi valikoituivat aikaisemmat tutkimukset aihealueesta yritysmaailman näkökulmasta. Organisaatiokulttuurin merkitys oppivalle organisaatiolle on keskeinen. Johtajan yksi tärkeimmistä tehtävistä on luoda organisaatioon kulttuuri, joka tukee organisaation tavoitteita. Avoin dialogi alaisten ja esimiesten välillä, toimiva palautejärjestelmä ja alaisten sitouttaminen ovat keskeisiä tekijöitä kehitettäessä organisaatiota. Puolustusvoimat on tietoisesti pyrkinyt omaksumaan oppivan organisaation toimintatapoja 2000-luvulla. Puolustusvoimat on pyrkinyt vastaamaan sillä toimintaympäristön muutoksen asettamiin haasteisiin. Organisaatiokulttuurin kehittäminen on pitkä prosessi, jonka taakse pitää saada koko organisaation henkilöstö. Puolustusvoimien organisaatiokulttuuria on pyritty muuttamaan kohti oppivan organisaation ideaalimallia. Puolustusvoimat on asettanut tavoitteen, mutta sitoutumisen ja toteutumisen valvonta on jätetty liian vähälle. Ilman valvontaa ja palautetta muutosten toimivuudesta ei prosessi etene. Kriisinhallinnan toimintaympäristössä oppivalle organisaatiolle ja avoimelle organisaatiokulttuurille on tilausta. Vaativan kriisinhallintaoperaation organisaatiokulttuurin tutkiminen ja kartoittaminen olisi tarkoituksen mukaista. Toimintaympäristön asettamat haasteet saattavat edistää henkilöstön sitoutumista ja kulttuurin muutosta.

MicroRNAs as novel regulators of skeletal homeostasis

The human skeleton is composed of bone and cartilage. The differentiation of bone and cartilage cells from their bone marrow progenitors is regulated by an intrinsic network of intracellular and extracellular signaling molecules. In addition, cells coordinate their differentiation and function through reciprocal cell‐to‐cell interactions. MicroRNAs (miRNAs) are small, single‐stranded RNA molecules that inhibit protein translation by binding to messenger RNAs (mRNAs). Recent evidence demonstrates the involvement of miRNAs in multiple biological processes. However, their role in skeletal development and bone remodeling is still poorly understood. The aim of this thesis was to elucidate miRNA‐mediated gene regulation in bone and cartilage cells, namely in osteoblasts, osteoclasts, chondrocytes and bone marrow adipocytes. Comparison of miRNA expression during osteogenic and chondrogenic differentiation of bone marrow‐derived mesenchymal stem cells (MSCs) revealed several miRNAs with substantial difference between bone and cartilage cells. These miRNAs were predicted to target genes essentially involved in MSC differentiation. Three miRNAs, miR‐96, miR‐124 and miR‐199a, showed marked upregulation upon osteogenic, chondrogenic or adipogenic differentiation. Based on functional studies, these miRNAs regulate gene expression in MSCs and may thereby play a role in the commitment and/or differentiation of MSCs. Characterization of miRNA expression during osteoclastogenesis of mouse bone marrow cells revealed a unique expression pattern for several miRNAs. Potential targets of the differentially expressed miRNAs included many molecules essentially involved in osteoclast differentiation. These results provide novel insights into the expression and function of miRNAs during the differentiation of bone and cartilage cells. This information may be useful for the development of novel stem cell‐based treatments for skeletal defects and diseases.

Immediate Decision-Making and Information Needs in Intensive Care Coordination

The aim of this study was to develop a theoretical model for information integration to support the deci¬sion making of intensive care charge nurses, and physicians in charge – that is, ICU shift leaders. The study focused on the ad hoc decision-making and immediate information needs of shift leaders during the management of an intensive care unit’s (ICU) daily activities. The term ‘ad hoc decision-making’ was defined as critical judgements that are needed for a specific purpose at a precise moment with the goal of ensuring instant and adequate patient care and a fluent flow of ICU activities. Data collection and research analysis methods were tested in the identification of ICU shift leaders’ ad hoc decision-making. Decision-making of ICU charge nurses (n = 12) and physicians in charge (n = 8) was observed using a think-aloud technique in two university-affiliated Finnish ICUs for adults. The ad hoc decisions of ICU shift leaders were identified using an application of protocol analysis. In the next phase, a structured online question¬naire was developed to evaluate the immediate information needs of ICU shift leaders. A national survey was conducted in all Finnish, university-affiliated hospital ICUs for adults (n = 17). The questionnaire was sent to all charge nurses (n = 515) and physicians in charge (n = 223). Altogether, 257 charge nurses (50%) and 96 physicians in charge (43%) responded to the survey. The survey was also tested internationally in 16 Greek ICUs. From Greece, 50 charge nurses out of 240 (21%) responded to the survey. A think-aloud technique and protocol analysis were found to be applicable for the identification of the ad hoc decision-making of ICU shift leaders. During one day shift leaders made over 200 ad hoc decisions. Ad hoc decisions were made horizontally, related to the whole intensive care process, and vertically, concerning single intensive care incidents. Most of the ICU shift leaders’ ad hoc decisions were related to human resources and know-how, patient information and vital signs, and special treatments. Commonly, this ad hoc decision-making involved several multiprofessional decisions that constituted a bundle of immediate decisions and various information needs. Some of these immediate information needs were shared between the charge nurses and the physicians in charge. The majority of which concerned patient admission, the organisation and management of work, and staff allocation. In general, the information needs of charge nurses were more varied than those of physicians. It was found that many ad hoc deci-sions made by the physicians in charge produced several information needs for ICU charge nurses. This meant that before the task at hand was completed, various kinds of information was sought by the charge nurses to support the decision-making process. Most of the immediate information needs of charge nurses were related to the organisation and management of work and human resources, whereas the information needs of the physicians in charge mainly concerned direct patient care. Thus, information needs differ between professionals even if the goal of decision-making is the same. The results of the international survey confirmed these study results for charge nurses. Both in Finland and in Greece the information needs of charge nurses focused on the organisation and management of work and human resources. Many of the most crucial information needs of Finnish and Greek ICU charge nurses were common. In conclusion, it was found that ICU shift leaders make hundreds of ad hoc decisions during the course of a day related to the allocation of resources and organisation of patient care. The ad hoc decision-making of ICU shift leaders is a complex multi-professional process, which requires a lot of immediate information. Real-time support for information related to patient admission, the organisation and man¬agement of work, and allocation of staff resources is especially needed. The preliminary information integration model can be applied when real-time enterprise resource planning systems are developed for intensive care daily management

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