A model for organ donation in switzerland, the latin organ donation programme (lodp); an ongoing successful regional initiative

Background: The 1st Swiss federal Transplant Law was finally enforced in July 2007 with the obligation to promote quality and efficiency in transplant procedures. The LODP was created to develop organ and tissue donation in the Latin area of Switzerland covering seventeen hospitals (29% of the population).Methods: Each of the partner hospitals designated at least one Local Donor Coordinator (LDC), member of the Intensive Care team, trained in the organ donation (OD) process. The principal tasks of the LDC's are the introduction of OD procedures, organisation of educational sessions for hospital staff and execution of the Donor Action programme. The LODP has been operational since July 2009, when training of the LDC's was completed, the web-site and hotline activated and the attendance of Transplant Procurement Coordinators (TPC) during the OD process organised.Results: National and regional guidelines are accessible on the LODP website. The Hospital Attitude Survey obtained a 57% return rate. Many of the staff requested training and sessions are now running in the partner hospitals. The Medical Record Revue revealed an increase in the conversion rate from 3.5% to 4.5%. During the 5 years before creation of LODP the average annual number of utilised donors was 31, an increase of 70%, has since been observed.Conclusion: This clear progression in utilised donors in the past two years can be attributed to the fact that partner hospitals benefit from the various support given (hotline, website and from TPC's). Despite the increase in OD within the LODP the Swiss donation rates remain low, on average 11.9 donors per million population. This successful model should be applied throughout Switzerland, but the crucial point is to obtain financial support.

How to operate a university institute as a radiological emergency service?

The Institute of Radiation Physics (IRA) is attached to the Department of Medical Radiology at the Vaud University Hospital Center (CHUV) in Lausanne. The Institute's main tasks are strongly linked to the medical activities of the Department: radiotherapy, radiodiagnostics, interventional radiology and nuclear medicine. The Institute also works in the fields of operational radiation protection, radiation metrology and radioecology. In the case of an accident involving radioactive materials, the emergency services are able to call on the assistance of radiation protection specialists. In order to avoid having to create and maintain a specific structure, both burdensome and rarely needed, Switzerland decided to unite all existing emergency services for such events. Thus, the IRA was invited to participate in this network. The challenge is therefore to integrate a university structure, used to academic collaborations and the scientific approach, to an interventional organization accustomed to strict policies, a military-style command structure and "drilled" procedures. The IRA's solution entails mobilizing existing resources and the expertise developed through professional experience. The main asset of this solution is that it involves the participation of committed collaborators who remain in a familiar environment, and are able to use proven materials and mastered procedures, even if the atmosphere of an accident situation differs greatly from regular laboratory routines. However, this solution requires both a commitment to education and training in emergency situations, and a commitment in terms of discipline by each collaborator in order to be integrated into a response plan supervised by an operational command center.

HMG CoA reductase inhibitors (statins) for preventing acute kidney injury after surgical procedures requiring cardiac bypass.

BACKGROUND: Acute kidney injury (AKI) is common in patients undergoing cardiac surgery among whom it is associated with poor outcomes, prolonged hospital stays and increased mortality. Statin drugs can produce more than one effect independent of their lipid lowering effect, and may improve kidney injury through inhibition of postoperative inflammatory responses. OBJECTIVES: This review aimed to look at the evidence supporting the benefits of perioperative statins for AKI prevention in hospitalised adults after surgery who require cardiac bypass. The main objectives were to 1) determine whether use of statins was associated with preventing AKI development; 2) determine whether use of statins was associated with reductions in in-hospital mortality; 3) determine whether use of statins was associated with reduced need for RRT; and 4) determine any adverse effects associated with the use of statins. SEARCH METHODS: We searched the Cochrane Renal Group's Specialised Register to 13 January 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA: Randomised controlled trials (RCTs) that compared administration of statin therapy with placebo or standard clinical care in adult patients undergoing surgery requiring cardiopulmonary bypass and reporting AKI, serum creatinine (SCr) or need for renal replacement therapy (RRT) as an outcome were eligible for inclusion. All forms and dosages of statins in conjunction with any duration of pre-operative therapy were considered for inclusion in this review. DATA COLLECTION AND ANALYSIS: All authors extracted data independently and assessments were cross-checked by a second author. Likewise, assessment of study risk of bias was initially conducted by one author and then by a second author to ensure accuracy. Disagreements were arbitrated among authors until consensus was reached. Authors from two of the included studies provided additional data surrounding post-operative SCr as well as need for RRT. Meta-analyses were used to assess the outcomes of AKI, SCr and mortality rate. Data for the outcomes of RRT and adverse effects were not pooled. Adverse effects taken into account were those reported by the authors of included studies. MAIN RESULTS: We included seven studies (662 participants) in this review. All except one study was assessed as being at high risk of bias. Three studies assessed atorvastatin, three assessed simvastatin and one investigated rosuvastatin. All studies collected data during the immediate perioperative period only; data collection to hospital discharge and postoperative biochemical data collection ranged from 24 hours to 7 days. Overall, pre-operative statin treatment was not associated with a reduction in postoperative AKI, need for RRT, or mortality. Only two studies (195 participants) reported postoperative SCr level. In those studies, patients allocated to receive statins had lower postoperative SCr concentrations compared with those allocated to no drug treatment/placebo (MD 21.2 µmol/L, 95% CI -31.1 to -11.1). Adverse effects were adequately reported in only one study; no difference was found between the statin group compared to placebo. AUTHORS' CONCLUSIONS: Analysis of currently available data did not suggest that preoperative statin use is associated with decreased incidence of AKI in adults after surgery who required cardiac bypass. Although a significant reduction in SCr was seen postoperatively in people treated with statins, this result was driven by results from a single study, where SCr was considered as a secondary outcome. The results of the meta-analysis should be interpreted with caution; few studies were included in subgroup analyses, and significant differences in methodology exist among the included studies. Large high quality RCTs are required to establish the safety and efficacy of statins to prevent AKI after cardiac surgery.

Pankkitoiminnan riskienhallinta ja riskienhallintaraportointi Puolassa

Tutkimuksessa tarkastellaan julkisesti noteerattujen pankkien riskienhallintaraportoinnin nykykäytäntöä Puolassa. Tutkimus jakaantuu kahteen osaan: Tutkimuksen ensimmäisessä osassa esitellään pankkitoimintaa, pankkitoiminnan riskejä ja riskienhallintaa. Pankkitoiminnan riskejä ovat luotto- ja markkinariskit, lisäksi puhutaan operatiivisista ja ympäristöriskeistä. Tutkimuksen toisessa osassa selvitetään ja kuvataan sitä, millaista on tutkimuksen kohdeyritysten riskienhallinta ja riskienhallintaraportointi, tutkimuksen tarkoituksena on myös verrata pankkien riskienhallintaraportointia keskenään. Tutkimuksen kohteena on 13 Varsovan pörssissä listattua pankkia. Tutkimusaineistona käytetään näiden pankkien vuoden 2005 vuosikertomuksia. Kysymyksessä on laadullinen tapaustutkimus, jolle on tyypillistä kuvaileva ja selittävä tutkimusote. Aineiston analyysimenetelmänä on käytetty pattern matchingiä, jonka avulla tutkitaan aineistosta löytyviä riskienhallintaraportoinnin osatekijöitä/indikaattoreita ja verrataan niitä oletettuihin malleihin. Tutkittujen riskienhallintaraporttien perusteella voidaan todeta, että pankkitoiminnan ydinriskeistä: luotto-, korko-, valuutta- ja likviditeettiriskeistä raportoidaan hyvin. Sen sijaan puutteita löytyy operatiivisten ja ympäristöriskien raportoinnista. Suurin osa pankeista raportoi operatiivisista riskeistä, mutta raportointi on pintapuolista ja analysointi puuttuu. Ympäristöriskeistä raportointi ei ole yleistä. Raportoinnin laajuus ja informatiivisuus vaihtelevat pankkien kesken: Suuret, kansainväliset pankkikonsernit raportoivat riskeistään laajasti ja informatiivisesti, kun taas pienemmillä, kansallisilla pankeilla raportointi jää usean pankin kohdalla suppeaksi. Syitä raportoinnin eroille on monia: Yksi syistä on IFRS-standardien vakiintumaton käyttö pienimmillä, kansallisilla pankeilla verrattuna kansainvälisiin pankkikonserneihin. Kansainvälisillä pankkikonserneilla on paremmat valmiudet raportoida riskienhallinnastaan verrattuna pienimpiin pankkeihin, jotka julkaisivat tilinpäätöksensä ensimmäistä kertaa IFRS-standardien mukaisesti vuonna 2005. Yhtenä selittävänä tekijänäraportoinnin eroille voidaan myös mainita omistuspohja: sijoittajainformaation merkitys on korostunut erityisesti organisaatioissa, joissa on laaja, kansainvälinen omistuspohja. Sen sijaan valtio-omisteisessa yrityksessä sijoittajainformaation merkitys on vähäisempi. Myös yrityskulttuuri vaikuttaa siihen, missä laajuudessa, ja mitä tietoa yritys antaa julkisuuteen. Pankit ovat myös tarkkoja maineestaan, mitä tietoa voidaan julkaista ja mitä vaikutuksia tiedon julkaisemisellaon yrityskuvaan. Sen sijaan pankin koolla ei välttämättä ole vaikutusta riskienhallintaraportoinnin laajuuteen ja informatiivisuuteen.

Hypertension and intra-operative incidents: a multicentre study of 125000 surgical procedures in Swiss hospitals

Background: It is debated whether chronic hypertension increases the risk of cardiovascular incidents during anaesthesia. Methods: We studied all elective surgical operations performed in adults under general or regional anaesthesia between 2000 and 2004, in 24 hospitals collecting computerised clinical data on all anaesthetia since 1996. The focus was on cardiovascular incidents, though other anaesthesia-related incidents were also evaluated. Results: Among 124 939 interventions, 27 881 (22%) were performed in hypertensive patients. At least one cardiovascular incident occurred in 7549 interventions (6% [95% CI 5.9-6.2%]). The average adjusted odds ratio of cardiovascular risk in patients with chronic hypertension was 1.38 (95% CI 1.27-1.49). However, across hospitals, adjusted odd ratios varied from 0.41 up to 2.25. Hypertension did not increase the risk of other incidents. Conclusions: Hypertensive patients are still at risk of intra-operative cardiovascular incidents. The heterogeneity of the risk to develop cardiovascular incidents varied across hospitals, despite taking into account casemix and hospital characteristics. These variations suggest that anaesthetic practices differ across anesthesia services

Introducing massively parallel computers into operational weather forecasting

Numerical weather prediction and climate simulation have been among the computationally most demanding applications of high performance computing eversince they were started in the 1950's. Since the 1980's, the most powerful computers have featured an ever larger number of processors. By the early 2000's, this number is often several thousand. An operational weather model must use all these processors in a highly coordinated fashion. The critical resource in running such models is not computation, but the amount of necessary communication between the processors. The communication capacity of parallel computers often fallsfar short of their computational power. The articles in this thesis cover fourteen years of research into how to harness thousands of processors on a single weather forecast or climate simulation, so that the application can benefit as much as possible from the power of parallel high performance computers. The resultsattained in these articles have already been widely applied, so that currently most of the organizations that carry out global weather forecasting or climate simulation anywhere in the world use methods introduced in them. Some further studies extend parallelization opportunities into other parts of the weather forecasting environment, in particular to data assimilation of satellite observations.

Tuning the design procedures for laser processed microwave mechanics

This research has been focused at the development of a tuned systematic design methodology, which gives the best performance in a computer aided environment and utilises a cross-technological approach, specially tested with and for laser processed microwave mechanics. A tuned design process scheme is also presented. Because of the currently large production volumes of microwave and radio frequency mechanics even slight improvements of design methodologies or manufacturing technologies would give reasonable possibilities for cost reduction. The typical number of required iteration cycles could be reduced to one fifth of normal. The research area dealing with the methodologies is divided firstly into a function-oriented, a performance-oriented or a manufacturability-oriented product design. Alternatively various approaches can be developed for a customer-oriented, a quality-oriented, a cost-oriented or an organisation-oriented design. However, the real need for improvements is between these two extremes. This means that the effective methodology for the designers should not be too limited (like in the performance-oriented design) or too general (like in the organisation-oriented design), but it should, include the context of the design environment. This is the area where the current research is focused. To test the developed tuned design methodology for laser processing (TDMLP) and the tuned optimising algorithm for laser processing (TOLP), seven different industrial product applications for microwave mechanics have been designed, CAD-modelled and manufactured by using laser in small production series. To verify that the performance of these products meets the required level and to ensure the objectiveness ofthe results extensive laboratory tests were used for all designed prototypes. As an example a Ku-band horn antenna can be laser processed from steel in 2 minutes at the same time obtaining a comparable electrical performance of classical aluminium units or the residual resistance of a laser joint in steel could be limited to 72 milliohmia.

Ideal and reality: do countries adopt and follow recommended procedures in comprehensive multiyear planning guidelines for national immunization programmes?

BACKGROUND: Meticulous steps and procedures are proposed in planning guidelines for the development of comprehensive multiyear plans for national immunization programmes. However, we know very little about whether the real-life experience of those who adopt these guidelines involves following these procedures as expected. Are these steps and procedures followed in practice? We examined the adoption and usage of the guidelines in planning national immunization programmes and assessed whether the recommendations in these guidelines are applied as consistently as intended. METHODS: We gathered information from the national comprehensive multiyear plans developed by 77 low-income countries. For each of the 11 components, we examined how each country applied the four recommended steps of situation analysis, problem prioritization, selection of interventions, and selection of indicators. We then conducted an analysis to determine the patterns of alignment of the comprehensive multiyear plans with those four recommended planning steps. RESULTS: Within the first 3 years following publication of the guidelines, 66 (86%) countries used the tool to develop their comprehensive multiyear plans. The funding conditions attached to the use of these guidelines appeared to influence their rapid adoption and usage. Overall, only 33 (43%) countries fully applied all four recommended planning steps of the guidelines. CONCLUSIONS: Adoption and usage of the guidelines for the development of comprehensive multiyear plans for national immunization programmes were rapid. However, our findings show substantial variation between the proposed planning ideals set out in the guidelines and actual use in practice. A better understanding of factors that influence how recommendations in public health guidelines are applied in practice could contribute to improvements in guidelines design. It could also help adjust strategies used to introduce them into public health programmes, with the ultimate goal of a greater health impact.

Medical physicists' implication in radiological diagnostic procedures: results after 1 y of experience.

Since January 2008-de facto 2012-medical physics experts (MPEs) are, by law, to be involved in the optimisation process of radiological diagnostic procedures in Switzerland. Computed tomography, fluoroscopy and nuclear medicine imaging units have been assessed for patient exposure and image quality. Large spreads in clinical practice have been observed. For example, the number of scans per abdominal CT examination went from 1 to 9. Fluoroscopy units showed, for the same device settings, dose rate variations up to a factor of 3 to 7. Quantitative image quality for positron emission tomography (PET)/CT examinations varied significantly depending on the local image reconstruction algorithms. Future work will be focused on promoting team cooperation between MPEs, radiologists and radiographers and on implementing task-oriented objective image quality indicators.

Tuotantolaitteiden kvalifiointi ja prosessin validointi GMP-tuotantoa varten

GMP-säädösten mukaan aktiivisten lääkeaineiden, kriittisten lääkeaineintermediaattien ja lääkeapuaineiden valmistusprosessit pitää validoida. Validointityöhön kuuluu oleellisesti tuotantolaitteiden kvalifiointi ja prosessin validointi. Käytännössä tuotantolaitteiden kvalifiointi toteutetaan tekemällä laitteille suunnitelmien tarkastus (DQ), asennus- ja käyttöönottotarkastus (IQ), toiminnan testaus (OQ) sekä suorituskykytestit (PQ). Tuotantolaitteiden kvalifiointiin kuuluu myös laitteiden asianmukaisten kalibrointi-, kunnossapito- ja puhdistusohjeiden sekä työ- ja toimintaohjeiden (SOP:ien) laatiminen. Prosessin validoinnissa laaditaan dokumentoidut todisteet siitä, että prosessi toimii vakaasti ja tuotteelle asetetut vaatimukset täyttyvät johdonmukaisesti. GMP-tuotantolaitteiden kvalifiointiin ja lääkevalmistusprosessin validointiin on laadittu erilaisia GMP-säädöksiä noudattavia yleisiä validointiohjeita, kuten PIC/S:n ja FDA:n ohjeet kvalifioinnista ja validoinnista. IVT/SC on laatinut yksiselitteiset validointistandardit validointityön selventämiseksi. Validoinnin tilastolliseen tarkasteluun on käytettävissä GHTF:n laatimat tilastolliset validointimenetelmät. Yleensä tuotantolaitteiden kvalifiointi ja prosessin validointi tehdään ennen lääkevalmisteen kaupallisen tuotannon aloittamista. Kvalifiointi- ja validointityö voidaan tehdä kuitenkin myös tuotannon yhteydessä (konkurrentisti) tai retrospektiivisesti käyttäen hyväksi valmistettujen tuotantoerien prosessitietoja. Tässä työssä laadittiin Kemira Fine Chemicals Oy:n Kokkolan GMP-tuotantolinjan lääkeaineintermediaattiprosessin validoinnin yleissuunnitelma (VMP), joka sisältää sekä tuotantolaitteiden kvalifiointisuunnitelman että prosessin validointisuunnitelman. Suunnitelmissa huomioitiin tuotantolaitteiden aikaisempi käyttö muuhun hienokemikaalituotantoon ja tuotantolinjan muuttaminen GMP-vaatimusten mukaiseksi. Työhön kuului myös tuotantolaitteiden kvalifiointityön tekeminen laaditun suunnitelman mukaisesti.

Laatujärjestelmän rakentaminen ja laatukäsikirjan mallintaminen energiayhtiölle

Työ on osa Kotkan Energia Oy:ssä toteutettua laatuprojektia. Työllä haettiin uutta, oikeaa suuntaa jo aiemmin käynnistetylle laadun kehitykselle. Työn tavoitteena oli rakentaa yhtiölle asiakaslähtöinen laatujärjestelmä, joka kattaa kaikki Kotkan Energian toiminnot. Lisäksi diplomityöhön kuului järjestelmän dokumentointi ja erityisesti laatukäsikirjan mallintaminen. Laatujärjestelmän pohjana käytettiin ISO DIS 9001:2000 -laatustandardiehdotusta. Uudistetun standardiluonnoksen katsottiin palvelevan vanhoja ISO-laatustan-dardeja paremmin energiayhtiön tarpeita, koska ehdotus korostaa asiakastyytyväisyyttä, prosessiajattelua ja jatkuvaa parantamista. Diplomityöprojekti jakaantui selkeästi kolmeen osaan. Ensimmäisessä vaiheessa laatujärjestelmän ja laadun kehittämisen nykytilanne kartoitettiin haastattelujen ja aiemmin laaditun laatumateriaalin avulla. Selvityksen perusteella toisessa vaiheessa tehtiin kehitysehdotuksia ja -suunnitelmia sekä käynnistettiin järjestelmän perusrakenteiden luominen ja henkilöstön koulutus. Laatujärjestelmän keskeisiä osia rakennettiin yhteistyössä koko henkilöstön kanssa. Diplomityön kolmannessa vaiheessa Kotkan Energian menettelytavat dokumentoitiin laatukäsikirjan asiakirjoiksi. Dokumentointiin sisältyivät sekä vanhat, uudistetut että suunnitellut toimintaperiaatteet. Samalla käynnistettiin myös prosessien menettelyohjeiden laatiminen. Laatuprojektin aikana kehitettiin useita uusia ja toimivia käytäntöjä sekä niihin liittyviä dokumentteja. Näiden luotujen menettelytapojen kautta on jo saatu aikaan laadun parannusta. Osana työtä luotiin Kotkan Energian prosessien kuvaustapa. Muita tärkeimpiä ideoituja ja toteutettuja uusia työkaluja laadun hallintaan ovat tiimisopimus, asiakaspalautelomake, toimittajien arviointilomake, poikkeamaraportti sekä koulutus- ja matkatietolomake. Laatujärjestelmän viimeistelyyn ja kehittämiseen liittyvät ideat jalostettiin jatkosuunnitelmiksi.

Identification and Management of Operational Risks in IT Organization of Financial Service Provider

Työn tavoitteena on tunnistaa toiminnallisia riskitekijöitä rahoituspalveluita tarjoavan yrityksen IT-organisaatiossa sekä löytää arkipäiväisiä keinoja hallita näitä riskejä. Työssä riskejä on myös tarkasteltu mahdollisen ulkoistuksen yhteydessä. Fuusiot ovat yleisiä rahoitusalan yrityksissä. Yhteenliittymien tuloksena yritysten IT-arkkitehtuuri voi olla monimutkainen ja kulttuurierot yrityksessä suuria. Synergia- ja mittakaavaetuja saadakseen yritys keskittää toimintojaan ja IT-ratkaisujaan. Riskien tunnistaminen on riskienhallintaprosessin tärkein vaihe. Tässä tutkimuksessa riskit ja riskitekijät tunnistettiin itsearvioinnin avulla kysymyssarjoja hyväksikäyttäen. Monet riskitekijät liittyivät sisäisen valvonnan ja seurannan puutteisiin. Myöhemmin näille riskeille pohdittiin työryhmässä käytännönläheisiä hallintakeinoja. Yritys voi siirtää tai jakaa IT -riskejä ulkoistamalla. Ulkoistaminen voi kuitenkin tuoda mukaan myös uusia riskitekijöitä. Ennen ulkoistamispäätöstä yrityksen sisäisten prosessien ja organisaation on oltava järjestyksessä, jotta sopimuksen kannattavuutta voidaan verrata luotettavasti saman palvelun tuottamiseen sisäisesti.