Quality of radiotherapy care by development of e-feedback knowledge

The aim of this three phase study was to develop quality of radiotherapy care by the e-Feedback knowledge of radiotherapy -intervention (e-Re-Know). In Phase I, the purpose was to describe the quality of radiotherapy care and its deficits experienced by cancer patients. Based on the deficits in patient education in Phase II, the purpose was to describe cancer patients’ e-knowledge expectations in radiotherapy. In Phase III, the purpose was to develop and evaluate the outcomes of the e-Re-Know among breast cancer patients. The ultimate aim was to develop radiotherapy care to support patients’ empowerment with patient e-education. In Phase I (2004-2005), the descriptive design was used, and 134 radiotherapy patients evaluated their experiences by Good Nursing Care Scale for Patients (GNCS-P) in the middle of RT period. In Phase II (2006-2008), the descriptive longitudinal design was used and 100 radiotherapy patients’ e-knowledge expectations of RT were evaluated using open-ended questionnaire developed for this study before commencing first RT, in the middle of the treatment, and concluding RT period. In Phase III, firstly (2009-2010), the e-Re-Know intervention, i.e. knowledge test and feedback, was developed in terms of empowering knowledge and implemented with e-feedback approach based on literature and expert reviews. Secondly (2011-2014), the randomized controlled study was used to evaluate the e-Re-Know. Breast cancer patients randomized to either the intervention group (n=65) receiving the e-Re-Know by e-mail before commencing first RT and standard education or the control group (n=63) receiving standard education. The data were collected before commencing first RT, concluding last RT and 3 months after last RT using RT Knowledge Test, Spielberger’s State Trait Inventory (STAI) and Functional Assessment of Cancer Therapy - Breast (FACT-B) –instruments. Data were analyzed using statistical methods and content analysis. The study showed radiotherapy patients experienced quality of care high. However, there were deficits in patient education. Furthermore, radiotherapy patients’ multidimensional e-knowledge expectations through Internet covered mainly bio-physiological and functional knowledge. Thus, the e-Re-Know was developed and evaluated. The study showed when breast cancer patients’ carried out the e-Re-Know their knowledge of side effects self-care was significantly increased and quality of life (QOL) significantly improved in line with decrease in anxiety from time before radiotherapy period to three months after. In addition, the e-Re-Know has potential to have positive effects on anxiety and QOL, regardless of patient characteristics or knowledge level. The results support the theory of empowering patient education suggesting that empowerment can be supported by confirming patients’ understanding of own knowledge level. In summary, the e-Feedback knowledge of radiotherapy (e-Re-Know) intervention can be recommended in development of quality of radiotherapy care experienced by breast cancer patients. Further research is needed to assess and develop patient-centred quality of care by patient education among cancer patients.

The effects of derivative use on equity fund performance

Investing in mutual funds has become more popular than ever and the amount of money invested in mutual funds registered in Finland has hit its all-time high. Mutual funds provide a relatively low-cost method for private investors to invest in stock market and achieve diversified portfolios. In finance there is always a tradeoff between risk and return, where higher expected returns can usually be achieved only by taking higher risks. Diversifying the portfolio gets rid some of the risk but systematic risk cannot be diversified away. These risks can be managed by hedging the investments with derivatives. The use of derivatives should improve the performance of the portfolios using them compared to the funds that don’t. However, previous studies have shown that the risk exposure and return performance of derivative users does not considerably differ from nonusers. The purpose of this study is to examine how the use of derivatives affects the performance of equity funds. The funds studied were 155 equity funds registered in Finland in 2013. Empirical research was done by studying the derivative use of the funds during a 6-year period between 2008–2013. The performance of the funds was studied quantitatively by using several different performance measures used in mutual fund industry; Sharpe Ratio, Treynor Ratio, Jensen's alpha, Sortino Ratio, M2 and Omega Ratio. The effect of derivative use on funds' performance was studied by using a dummy variable and comparing performance measures of derivative-users and nonusers. The differences in performance measures between the two groups were analyzed with statistical tests. The hypothesis was that funds' derivative use should improve their performance relative to the funds that don't use them. The results of this study are in line with previous studies that state that the use of derivatives does not improve mutual funds' performance. When performance was measured with Jensen's alpha, funds that did not use derivatives performed better than the ones that used them. When measured with other performance measures, the results didn’t differ between two groups.