Libyan breast cancer: Health services and biology. Diagnosis delay and prognostic value of DNA pploidy, S-phase fraction, and Ki-67 and Bcl-2 immunohistochemistry

The aim of this study was to investigate the diagnosis delay and its impact on the stage of disease. The study also evaluated a nuclear DNA content, immunohistochemical expression of Ki-67 and bcl-2, and the correlation of these biological features with the clinicopathological features and patient outcome. 200 Libyan women, diagnosed during 2008–2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. Also retrospective preclinical and clinical data were collected from medical records on a form (questionnaire) in association with the interview. Tumor material of the patients was collected and nuclear DNA content analysed using DNA image cytometry. The expression of Ki-67 and bcl-2 were assessed using immunohistochemistry (IHC). The studies described in this thesis show that the median of diagnosis time for women with breast cancer was 7.5 months and 56% of patients were diagnosed within a period longer than 6 months. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was also associated with initial breast symptom(s) that did not include a lump, old age, illiteracy, and history of benign fibrocystic disease. The patients who showed diagnosis delay had bigger tumour size (p<0.0001), positive lymph nodes (p<0.0001), and high incidence of late clinical stages (p<0.0001). Biologically, 82.7% of tumors were aneuploid and 17.3% were diploid. The median SPF of tumors was 11% while the median positivity of Ki-67 was 27.5%. High Ki-67 expression was found in 76% of patients, and high SPF values in 56% of patients. Positive bcl-2 expression was found in 62.4% of tumors. 72.2% of the bcl-2 positive samples were ER-positive. Patients who had tumor with DNA aneuploidy, high proliferative activity and negative bcl-2 expression were associated with a high grade of malignancy and short survival. The SPF value is useful cell proliferation marker in assessing prognosis, and the decision cut point of 11% for SPF in the Libyan material was clearly significant (p<0.0001). Bcl-2 is a powerful prognosticator and an independent predictor of breast cancer outcome in the Libyan material (p<0.0001). Libyan breast cancer was investigated in these studies from two different aspects: health services and biology. The results show that diagnosis delay is a very serious problem in Libya and is associated with complex interactions between many factors leading to advanced stages, and potentially to high mortality. Cytometric DNA variables, proliferative markers (Ki-67 and SPF), and oncoprotein bcl-2 negativity reflect the aggressive behavior of Libyan breast cancer and could be used with traditional factors to predict the outcome of individual patients, and to select appropriate therapy.

Family ownership – a source of sustainable success in listed companies

Extant research on exchange-listed firms has acknowledged that the concentration of ownership and the identity of owners make a difference. In addition, studies indicate that firms with a dominant owner outperform firms with dispersed ownership. During the last few years, scholars have identified one group of owners, in particular, whose ownership stake in publicly listed firm is positively related to performance: the business family. While acknowledging that family firms represent a unique organizational form, scholars have identified various concepts and theories in order to understand how the family influences organizational processes and firm performance. Despite multitude of research, scholars have not been able to present clear results on how firm performance is actually impacted by the family. In other words, studies comparing the performance of listed family and other types of firms have remained descriptive in nature since they lack empirical data and confirmation from the family business representatives. What seems to be missing is a convincing theory that links the involvement and behavioral consequences. Accordingly, scholars have not yet come to a mutual understanding of what precisely constitutes a family business. The variety of different definitions and theories has made comparability of different results difficult for instance. These two issues have hampered the development of a rigorous theory of family business. The overall objective of this study is to describe and understand how the family as a dominant owner can enhance firm performance, and can act a source of sustainable success in listed companies. In more detail, in order to develop understanding of the unique factors that can act as competitive advantages for listed family firms, this study is based on a qualitative approach and aims at theory development, not theory verification. The data in this study consist of 16 thematic interviews with CEOs, members of the board, supervisory board chairs, and founders of Finnish listed-family firms. The study consists of two parts. The first part introduces the research topic, research paradigm, methods, and publications, and also discusses the overall outcomes and contributions of the publications. The second part consists of four publications that address the research questions from different viewpoints. The analyses of this study indicate that family ownership in listed companies represents a structure that differs from the traditional views of agency and stewardship, as well as from resource-based and stakeholder views. As opposed to these theories and shareholder capitalism which consider humans as individualistic, opportunistic, and self-serving, and assume that the behaviors of an investor are based on the incentives and motivations to maximize private profits, the family owners form a collective social unit that is motivated to act together toward their mutual purpose or benefit. In addition, socio-emotional and psychological elements of ownership define the family members as owners, rather than the legal and financial dimensions of ownership. That is, collective psychological ownership of family over the business (F-CPO) can be seen as a construct that comprehensively captures the fusion between the family and the business. Moreover, it captures the realized, rather than merely potential, family influence on and interaction with the business, and thereby brings more theoretical clarity of the nature of the fusion between the family and the business, and offers a solution to the problem of family business definition. This doctoral dissertation provides academics, policy-makers, family business practitioners, and the society at large with many implications considering family and business relationships.

Syntyykö Suomeen puulaaksoja - Suomen puutuoteteollisuuden pk-yritysten tila ja tulevaisuus

Metsäteollisuus on tullut Suomeen ulkomaisen pääoman ja tietotaidon avulla vajaat kaksisataa vuotta sitten. Se on toiminut melkein koko jatkosodan jälkeisen ajan suojatussa ympäristössä ja ulkomaisesta kilpailusta riippumattomassa toimintaympäristössä. Kuten Porter ja muut ovat todistaneet, tällainen toimintaympäristö ei kehitä kansainvälisesti kilpailukykyistä teollisuutta globaaleilla markkinoilla. Liittyminen Euroopan unioniin ja sittemmin Euroopan rahaliittoon saattoi puunjalostusteollisuuden täysin uudenlaiseen kilpailutilanteeseen. Sama tapahtui myös alan pk-yrityksille, jotka olivat joutuneet toimimaan heikosti kilpailluilla raaka-ainemarkkinoilla. Tutkimus on tulevaisuudentutkimus, jossa tutkimusongelmia lähestytään kolmen teorian avulla. Porterin klusteriteoria tarjoaa mahdollisuuden arvioida metsäteollisuutta sekä kokonaisuutena että toimivana monimuotoisena organisaationa, jossa kustannukset ja hinta muodostuvat arvoketjun toimijoiden osakustannuksista. Bionomiateoria eli darvinistinen talousteoria testaa suomalaisen puunjalostusteollisuuden pk-yritysten kilpailukykyä ja paineita hakeutua edullisemmille toiminta- alueille. Evoluutioteoria tarkastelee sukupolvenvaihdoksen problematiikkaa. Sukupolvenvaihdoksen onnistuminen muodostuu puutoimialan elämän ja kuoleman kysymykseksi. Tämä on etenkin pk-yrityksiä kohtaava ongelma. Asiaa selvitettiin Mauno Rintalan suorittamalla kyselytutkimuksella Puuteollisuusyrittäjien jäsenistön keskuudessa. Ongelma johtuu suurista sodan jälkeen syntyneistä ikäluokista. Nämä vuosina 1945– 50 syntyneet ovat siirtymässä eläkkeelle vuosien 2005 ja 2015 välillä. Kyseisissä ikäluokissa yritystiheys on noin kaksi kertaa suurempi kuin sen jälkeisissä ikäluokissa. Suoritetun kyselyn sekä muiden suomalaisten ja kansainvälisten tutkimusten perusteella näyttää siltä, että eläkkeelle siirryttäessä vain noin 30 %:lla yrityksistä on jatkaja tiedossa suvusta tai lähipiiristä. Tämä merkitsee sitä, että 70 % eläköityvän ikäluokan omistamista yrityksistä poistuu pysyvästi markkinoilta. Suomessa poistuma merkitsee noin 40 % koko yritysvarannosta eli noin 80 000 yritystä. Tilastot toimivien yritysten määrästä ovat kuitenkin hyvin ristiriitaisia, joten todellista määrää on mahdoton arvioida. Noin suuren määrän poistuminen markkinoilta uhkaa jo hyvinvointivaltion perusrakenteita. Tutkimustulos edellyttää nopeita toimenpiteitä teollisten pkyritysten pelastamiseksi ja säilyttämiseksi Suomessa. Sukupolvenvaihdoksen onnistuminen on tässä prosessissa ensiarvoisessa asemassa. Kaikkien edellä mainittujen yritysten poistuminen markkinoilta edellyttäisi noin 400 000 uuden yrityksen perustamista, koska ainoastaan noin 20 % yrityksistä selviää ensimmäiset kolme vuotta. Tutkimukseen perustuen esitetään prosessimalli sukupolvenvaihdoksen suorittamiseksi. Suomen tärkeimmissä kilpailijamaissa valtioiden metsäomistus on määräävässä asemassa. Meillä metsät ovat yksityisessä omistuksessa ja vain pieni osa valtion omistuksessa. Puumarkkinat toimivat markkinatalouden ehdoilla ilman valtion ohjausta. Ongelmaksi on kehittymässä puun saanti. Metsänomistus on sukupolvien myötä hajaantunut hyvin pieniksi metsälöiksi. Nykyiset metsänomistajat asuvat kaupungeissa ja ovat pääosin palkkatyössä. He eivät ole samalla tavoin riippuvaisia puutuloista kuin heidän esi-isänsä. Metsäverotuksen uudistuminen lisää puun saannin epävarmuutta. Se on muuttumassa pinta-alaverotuksesta puun myynnin verotukseen. Puun myynti on vilkasta ennen järjestelmien vaihtumista ja vähäisempää sen jälkeen. Myös näitä ongelmia on pyritty ratkomaan uudenlaisen metsänomistusmallin avulla. Puuteollisuus on hyvin vanha teollisuudenala. Raaka-aine muodostaa määräävän osan kustannuksista. Muutokset ovat hitaita ja todelliset innovaatiot pitkäkestoisia. Uusia innovaatioita tapahtuu harvoin. Kannattavuutta parannetaan tuoteprosessien ja arvoketjujen kehittämisen kautta. Yhteiskunnan osuus alan kehittämisessä ja säilyttämisessä on ratkaiseva. Asioiden moninaisuus tekee tutkimuksen vaikeaksi, mutta sitäkin tärkeämmäksi kansantalouden kannalta. Tällaisissa suurissa murroksissa korostuu kaikkien päättävien tahojen henkinen valmius ja tahto tehdä oikeita ratkaisuja oikeaan aikaan.

Tehohoitopotilaan siirtotiedote hoitotyön päätöksenteon tukena - retrospektiivinen asiakirja-analyysi vuosilta 2001-2013

Tuija Lehtikunnas: Intensive care patient handover document in support of decision-making in nursing work - Retrospective document analysis for the period 2001–2013 University of Turku, Faculty of Medicine, Nursing Science Annales Universitatis Turkuensis Turku 2016 ABSTRACT The continuity of care and flow of information must be ensured when transferring the responsibility of care, whether this is done within an organisation or from one organisation to another. The purpose of this study was to describe and compare the nursing handover documents of long-term intensive care patients and changes to these documents during the years 2001–2013. Research data comprehended long-term intensive care patient handover documents (N = 250). Data was gathered from one university hospital intensive care unit and subjected to a content analysis of technical implementation, structure and content at five different time points. In addition to this, the nursing handover documents were analysed from a nursing decision-making standpoint. Sub-data (n = 5 x 50) from the years 2001, 2002, 2004, 2006 and 2013 was gathered. The first sub-data was manual, written on paper with a pen. The rest of the sub-data obtained was entered in a dedicated intensive care information system. The study developed an intensive care patient nursing handover document analysis framework, which was used to deductively analyse the research data. The results indicated that the transitioning to electronic records reinforced structure and identification improving the reusability of data was increased. Although intensive care nursing was recorded on nursing handover documents more comprehensively in more recent sub-data, it was done selectively with regard to overall patient care, e.g. there are no entries concerning the psychological support and counselling of patients or family members. Nursing handover documents do not contain a systematic description of the patient's communication and functional capacity at the moment of transfer. The patient's condition at the moment of transfer is not clearly indicated on the handover documents. Plans for follow-up treatment are not recorded at all. Nursing decision-making is difficult to find on the nursing handover documents used as research data. The study developed a handover document model for intensive care nursing that supports nursing decision-making and the continuity of care. Developmental recommendations focus on the management of co-operation within organisations for ensuring the continuity of care and enhancing each area of nursing in recording nursing handover documents by planning nursing for the patient, taking follow-up treatment resources into consideration. Keywords: Intensive care nursing, nursing decision-making, nursing records, information flow, nursing handover document, continuity of care