Tuottavuuden mittaaminen ja johtaminen Etelä-Karjalan keskussairaalassa

Tutkimuksen tavoitteena oli arvioida, miten tuottavuustietoa voidaan hyödyntää johtamisen tukena ja kuinka tuottavuustietoa tällä hetkellä hyödynnetään Etelä-Karjalan keskussairaalassa (EKKS). Tuottavuuden mittaamisessa hyödynnetään Terveyden- ja hyvinvoinnin laitoksen (THL) vuosittain julkaisemassa Hoito-toiminnan tuottavuus -tilastossa käytettävää tuottavuuden mittaamismenetelmää, jossa panoksina ovat sairaalan tai erikoisalan hoitotoiminnasta aiheutuneet kustannukset ja tuotoksina NordDRG-ryhmittelijän avulla painotetut hoitojaksot ja käynnit. Tutkimuksessa arvioitiin tuottavuuden mittaamiseen liittyvien mahdollisten virhetekijöiden vaikutusta sairaalan tuottavuuteen EKKS:n tapauksessa ja tämän perusteella tunnistettiin, miten THL:n julkaisemaa tuottavuustilastoa ja sisäistä tuottavuustietoa voidaan hyödyntää sairaalan johtamisen tukena. Pääasiallisena aineistona työssä käytettiin EKKS:n henkilöstön haastatteluja ja sairaalan taloudellisia raportteja sekä THL:n julkista ja julkaisematonta aineistoa. THL:n kehittämän hoitotoiminnan tuottavuuden mittaamismenetelmän havaittiin soveltuvan yksittäisen sairaalan käyttöön tietyin muutoksin. Vaadittavien muutosten lisäksi tutkimuksessa tunnistettiin taustatekijät, jotka THL:n tuottavuustilaston ja sisäisen tuottavuustiedon tulkitsijan tulee ottaa huomioon. EKKS:n tuottavuustietojen keruussa havaittiin kehittämiskohteita, joita paran-tamalla tuottavuustiedon luotettavuutta ja hyödynnettävyyttä voidaan edelleen kehittää. Tuottavuustiedon hyödyntämistä voidaan niin ikään edelleen kehittää EKKS:ssa.

A cell spot microarray method for high-throughput biology

High-throughput screening of cellular effects of RNA interference (RNAi) libraries is now being increasingly applied to explore the role of genes in specific cell biological processes and disease states. However, the technology is still limited to specialty laboratories, due to the requirements for robotic infrastructure, access to expensive reagent libraries, expertise in high-throughput screening assay development, standardization, data analysis and applications. In the future, alternative screening platforms will be required to expand functional large-scale experiments to include more RNAi constructs, allow combinatorial loss-of-function analyses (e.g. genegene or gene-drug interaction), gain-of-function screens, multi-parametric phenotypic readouts or comparative analysis of many different cell types. Such comprehensive perturbation of gene networks in cells will require a major increase in the flexibility of the screening platforms, throughput and reduction of costs. As an alternative for the conventional multi-well based high-throughput screening -platforms, here the development of a novel cell spot microarray method for production of high density siRNA reverse transfection arrays is described. The cell spot microarray platform is distinguished from the majority of other transfection cell microarray techniques by the spatially confined array layout that allow highly parallel screening of large-scale RNAi reagent libraries with assays otherwise difficult or not applicable to high-throughput screening. This study depicts the development of the cell spot microarray method along with biological application examples of high-content immunofluorescence and phenotype based cancer cell biological analyses focusing on the regulation of prostate cancer cell growth, maintenance of genomic integrity in breast cancer cells, and functional analysis of integrin protein-protein interactions in situ.

Abordagem fisioterapêutica na dor pós-operatória: a eletroestimulação nervosa transcutânea (ENT)

This study provides an update on the use of Transcutaneous Eletric Nerve Stimulation (TENS) as a non-pharmacological resource of postoperative pain relief. National and international references regarding the use of TENS for the relief of postoperative pain had been selected, highlighting its mechanism of action, parameters of application, contraindications, side-effect and results. TENS is a non-pharmacological resource that has its mechanism of action based on the gate theory. It consists of a device that emits electric impulses in the skin through electrodes. It is a low cost technique, easily applicable, presents few collateral effects, good effectiveness related to the reduction of the painful perception, allowing early mobilization and reduced pharmacological analgesic consumption. TENS represents another option in the control of postoperative pain and should be inserted in a multiprofessional context.

The impact of a chest tube management protocol on the outcome of trauma patients with tube thoracostomy

ABSTRACTObjective:to investigate the effect of standardized interventions in the management of tube thoracostomy patients and to assess the independent effect of each intervention.Methods:A chest tube management protocol was assessed in a retrospective cohort study. The tube thoracostomy protocol (TTP) was implemented in August 2012, and consisted of: antimicrobial prophylaxis, chest tube insertion in the operating room (OR), admission post chest tube thoracostomy (CTT) in a hospital floor separate from the emergency department (ED), and daily respiratory therapy (RT) sessions post-CTT. The inclusion criteria were, hemodynamic stability, patients between the ages of 15 and 59 years, and injury severity score (ISS) < 17. All patients had isolated injuries to the chest wall, lung, and pleura. During the study period 92 patients were managed according to the standardized protocol. The outcomes of those patients were compared to 99 patients treated before the TTP. Multivariate logistic regression analysis was performed to assess the independent effect of each variable of the protocol on selected outcomes.Results:Demographics, injury severity, and trauma mechanisms were similar among the groups. As expected, protocol compliance increased after the implementation of the TTP. There was a significant reduction (p<0.05) in the incidence of retained hemothoraces, empyemas, pneumonias, surgical site infections, post-procedural complications, hospital length of stay, and number of chest tube days. Respiratory therapy was independently linked to significant reduction (p<0.05) in the incidence of seven out of eight undesired outcomes after CTT. Antimicrobial prophylaxis was linked to a significant decrease (p<0.05) in retained hemothoraces, despite no significant (p<0.10) reductions in empyema and surgical site infections. Conversely, OR chest tube insertion was associated with significant (p<0.05) reduction of both complications, and also significantly decreased the incidence of pneumonias.Conclusion:Implementation of a TTP effectively reduced complications after CTT in trauma patients.

Use of raw Euphorbia tirucalli extract for inhibition of ascitic Ehrlich tumor

Objective: to evaluate the effect of the Euphorbia tirucalli hydroalcoholic extract (ETHE) on the development of Ehrlich Tumor, in its ascitic form. Methods: we intraperitoneally inoculated 15 Swiss mice with 10.44 x 107 cells of Ehrlich Tumor and divided them in two groups one day after: ETHE Group (eight mice), treated with a dosage of 125 mg/kg/day of EHTE for five days; and Control Group (seven mice), treated only with 0.9% isotonic saline solution over the same period. The treatment was done by gavage. Ten days after inoculation, four mice from each group were sacrificed for quantification of tumor cell number, ascitic fluid volume and bone marrow cell number. The remaining animals were maintained to evaluate survival. Results: The ascitic fluid volume and the tumor cell number were decreased in the ETHE group when compared with the control group, but with no statistical significance. On the other hand, survival was higher in the ETHE group, as well as the number of bone marrow cells. Conclusion: Treatment with ETHE after inoculation of Ehrlich Tumor decreases its development and increases survival and the bone marrow cellularity, thus reducing the myelosuppression present in the Ehrlich Tumor bearing mice.

The analysis of knowledge retention mechanisms for leaving experts

The goal of this thesis is studying knowledge retention mechanisms used in cases of single experts’ leaving in the case company, analyzing the reason for the mechanisms choice and successfulness of knowledge retention process depending of that choice. The theoretical part discusses the origins of knowledge retention processes in the theoretical studies, the existing knowledge retention mechanisms and practical issues of their implementation. The empirical part of the study is designed as employees’ interview with later discussion of the findings. The empirical findings indicate the following reasons for knowledge retention mechanisms choice: type of knowledge retained, specialty of leaving experts and time and distance issues of a particular case. The following factors influenced the success of a retention process: choice of knowledge retention mechanisms, usage of combination of mechanisms and creation of knowledge retention plans. The results might be useful for those interested in factors influencing knowledge retention processes in cases of experts’ departure.

Siiderin ja long drink -juomien sekoitusprosessin kehittäminen

Diplomityössä perehdytään Hartwall Lahden tuotantolaitoksen juomanvalmistuksen osaston siiderin ja long drink –juomien valmistusprosessin kehittämiseen. Diplomityön tavoitteena oli löytää prosessin ongelma- ja poikkeamakohtia, tutkia mahdollisia hävikkikohteita ja suorittaa laadun osalta ajoseurantamittauksia. Ongelmakohtien pohjalta laadittiin parannusehdotuksia ja niitä toteutettiin jo tämän projektin aikana. Ongelma- ja poikkeamakohtia tutkittiin ajoprosessin aikana. Hävikkitutkimus kohdennettiin aromiliuoksen annostelulinjaan, nestesokerin an-nostelulinjaan ja tuotteiden alku- ja lopputyönnöille painetankkeihin. Painetankkien osalta mahdollisia hävikkikohteita tutkittiin kokeellisen toiminnan avulla ajo-prosessin aikana. Ajoprosessin käynnistyksen jälkeen selvitettiin milloin valmis tuote on painetankkien venttiilimatriisilla. Uudet parametrit alku- ja lopputyönnöille määritettiin tuoteputken, painetankkien pohjaputkien ja venttiilimatriisin tilavuuksien avulla. Hävikkitutkimuksen tuloksena saatiin pienennettyä hävikkiä ja näin ollen syntyi kustannussäästöjä. Hiilidioksidin sitoutuvuutta tutkittiin mittauksien avulla valmistusprosessin aikana. Mittauksien perusteella havaittiin, että hiilidioksidipitoisuus laskee painetankissa. Tämä johtuu valmiin tuotteen lämpötilamuutoksista. Tuotteen lämpötilaa voidaan tasata esimerkiksi levylämmönvaihtimen avulla.

VVER-440 Thermal Hydraulics as a Computer Code Validation Challenge

This thesis concentrates on the validation of a generic thermal hydraulic computer code TRACE under the challenges of the VVER-440 reactor type. The code capability to model the VVER-440 geometry and thermal hydraulic phenomena specific to this reactor design has been examined and demonstrated acceptable. The main challenge in VVER-440 thermal hydraulics appeared in the modelling of the horizontal steam generator. The major challenge here is not in the code physics or numerics but in the formulation of a representative nodalization structure. Another VVER-440 specialty, the hot leg loop seals, challenges the system codes functionally in general, but proved readily representable. Computer code models have to be validated against experiments to achieve confidence in code models. When new computer code is to be used for nuclear power plant safety analysis, it must first be validated against a large variety of different experiments. The validation process has to cover both the code itself and the code input. Uncertainties of different nature are identified in the different phases of the validation procedure and can even be quantified. This thesis presents a novel approach to the input model validation and uncertainty evaluation in the different stages of the computer code validation procedure. This thesis also demonstrates that in the safety analysis, there are inevitably significant uncertainties that are not statistically quantifiable; they need to be and can be addressed by other, less simplistic means, ultimately relying on the competence of the analysts and the capability of the community to support the experimental verification of analytical assumptions. This method completes essentially the commonly used uncertainty assessment methods, which are usually conducted using only statistical methods.

Wine, alcohol and atherosclerosis: clinical evidences and mechanisms

Atherosclerosis is a chronic inflammatory disease which may cause obstructions of the coronary, cerebral and peripheral arteries. It is typically multifactorial, most often dependent on risk factors such as hypercholesterolemia, diabetes, smoking, hypertension, sedentarism, and obesity. It is the single main cause of death in most developed countries due to myocardial infarction, angina, sudden death, and heart failure. Several epidemiological studies suggest that moderate alcohol intake, especially red wine, decrease cardiac mortality due to atherosclerosis. The alcohol effect is described by a J curve, suggesting that moderate drinkers may benefit while abstainers and heavy drinkers are at higher risk. Experimental studies indicate that most beneficial effects of drinking are attributable to flavonoids that are present in red wine, purple grape juice and several fruits and vegetables. The mechanisms include antiplatelet actions, increases in high-density lipoprotein, antioxidation, reduced endothelin-1 production, and increased endothelial nitric oxide synthase expression which causes augmented nitric oxide production by endothelial cells. These findings lead to the concept that moderate red wine drinking, in the absence of contraindications, may be beneficial to patients who are at risk of atherosclerotic cardiovascular events. Moreover, a diet based on fruits and vegetables containing flavonoids may be even more beneficial.

Relationship between Daily Habits, Oral Microbiota and Caries with Special Reference to Xylitol

Caries is a plaque-associated multifactorial chronic disease. Oral hygiene habits, sugar, and oral micobiota interactions are important for caries to occur. Xylitol has been shown to reduce caries mainly due to its effects on mutans streptococci (MS). The purpose of this study was to evaluate the relationship of daily oral health habits and bacterial level on the caries occurrence and to study the effect of xylitol on the composition of oral microflora. A total of 192, 10-12 years old, male school children had been screened for salivary MS. Healthy subjects with high MS counts participated in two parallel double-blinded, randomised, controlled trials. In the first 5-week trial, subjects were assigned into xylitol (n=35) and sorbitol gum (n=38) groups. At baseline, children were examined using International Caries Detection and Assessment System (ICDAS) criteria and interviewed for oral health habits. In the second 4-week trial, subjects were assigned into xylitol (n=25) and saccharine mouthrinse (n=25) groups. In the end of both interventions, saliva samples were collected. The samples were analysed for changes in MS counts and changes in the composition of the oral microbiota assessed by the Human Oral Microbe Identification Microarray (HOMIM). Relationships between daily habits, bacterial levels and caries were evaluated. Daily use of sweets and soft drinks were the habits significantly associated with caries severity measured by ICDAS Caries Index (CI), while toothbrushing was the only habit associated with the low caries severity. Abiotrophia defectiva and Actinomyces meyeri/ A. odontolyticus were significantly higher in caries-affected children while Shuttleworthia satelles was significantly higher in caries-free children. Xylitol showed significant reduction in salivary levels of MS in both trials. No significant effects on other members of the microbiota were found when evaluated by HOMIM. In conclusion, other members of oral microbiota than MS may be associated with caries occurrence or absence. The use of xylitol had significant effect on MS with no effects on the other members of the salivary microbiota.

Tuotekehitysprosessin alkupään järjestäminen pelialan yrityksessä

Tämän diplomityön tarkoitus on rakentaa mobiilipeliyritykselle tuotekehitysprosessin alkupään prosessi tuotekehityksen tehostamiseksi. Toimialan dynaamisuudesta ja hyperkilpailullisuudesta johtuen sekä projektien abstraktin luonteen takia tulee mobiilipelikehitysyritysten erityisesti panostaa tuotekehityksen alkuvaiheisiin. Työ tutkii yleisiä tuotekehityksen periaatteita sekä yleisiä olemassaolevia tuotekehitysprosesseja. Tarkastelun kohteena ovat erityisesti innovatiivinen organisaatio ja benchmarking tuotekehityksen apuna. Yleisesti tuotekehitysprosesseista tutustutaan yleisimpiin malleihin, jotka ovat olleet valtavirran käytössä jo pitkään. Prosessien tarkastelun lisäksi niitä tutkitaan kriittisesti ja löydetään osa-alueita, joihin tulee keskittyä erityisesti tuotekehitysprosessin alkupään järjestämisessä. Lisäksi työssä paneudutaan alan menestyneiden yritysten toimintatapoihin, joista haetaan oppia rakennettavaan malliin. Työssä käsitellään myös toimialan ominaispiirteitä, joista johtuen perinteiset tuotekehitysprosessit eivät ole optimaalisia alalle. Työn tuloksena saadaan virtaviivainen prosessimalli, joka maksimoi luovuuden, mutta säästää resursseja ja luo selkeät linjat prosessin läpivientiin. Rakennettuun malliin pohditaan myös kehitysehdotuksia, ja sille on laadittu kevyt jatkokehityssuunnitelma. Malli menee suoraan yrityksen käyttöön, joten lopullinen malli tulee myös hioutumaan tuotekehitysprojektien edetessä. Työssä on erityistä se, että työn tekijä on toiminut alalla työtehtävissä, ja malli on hioutunut pitkän ajan kuluessa. Täten suuri osa työstä on tekijän hiljaisen tiedon avaamista ja pohtimista.

Can course format influence the performance of students in an advanced cardiac life support (ACLS) program?

Advanced cardiac life support (ACLS) is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003) and Model 2 (N = 2085; 2003-2007). Model 2 increased practical skill activities to 75% of the total versus 60% in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85% in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given). Compared to Model 1, Model 2 presented odds ratios (OR) indicating better performance in the theoretical (OR = 1.34; 95%CI = 1.10-1.64), practical (OR = 1.19; 95%CI = 0.90-1.57), and combined (OR = 1.38; 95%CI = 1.13-1.68) outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students.

Protein turnover, amino acid requirements and recommendations for athletes and active populations

Skeletal muscle is the major deposit of protein molecules. As for any cell or tissue, total muscle protein reflects a dynamic turnover between net protein synthesis and degradation. Noninvasive and invasive techniques have been applied to determine amino acid catabolism and muscle protein building at rest, during exercise and during the recovery period after a single experiment or training sessions. Stable isotopic tracers (13C-lysine, 15N-glycine, ²H5-phenylalanine) and arteriovenous differences have been used in studies of skeletal muscle and collagen tissues under resting and exercise conditions. There are different fractional synthesis rates in skeletal muscle and tendon tissues, but there is no major difference between collagen and myofibrillar protein synthesis. Strenuous exercise provokes increased proteolysis and decreased protein synthesis, the opposite occurring during the recovery period. Individuals who exercise respond differently when resistance and endurance types of contractions are compared. Endurance exercise induces a greater oxidative capacity (enzymes) compared to resistance exercise, which induces fiber hypertrophy (myofibrils). Nitrogen balance (difference between protein intake and protein degradation) for athletes is usually balanced when the intake of protein reaches 1.2 g·kg-1·day-1 compared to 0.8 g·kg-1·day-1 in resting individuals. Muscular activities promote a cascade of signals leading to the stimulation of eukaryotic initiation of myofibrillar protein synthesis. As suggested in several publications, a bolus of 15-20 g protein (from skimmed milk or whey proteins) and carbohydrate (± 30 g maltodextrine) drinks is needed immediately after stopping exercise to stimulate muscle protein and tendon collagen turnover within 1 h.

Sensory evaluation of black instant coffee beverage with some volatile compounds present in aromatic oil from roasted coffee

The oil obtained from Brazilian roasted coffee by supercritical CO2 extraction shows considerable aromatic properties, mainly composed by five aromatic compounds, 2-methylpyrazine; 2-furfurylalcohol, 2,5-dimethylpyrazine; γ-butyrolactone and 2-furfurylacetate. Sensory analyses were used to verify the influence of a mixture of these important classes of aromatic coffee compounds (pyrazines, furans and lactones) and of the roasted coffee aromatic oil on the coffee aroma and flavour of black instant freeze and spray-dried coffee beverages. In the acceptance evaluation of the aroma, the samples prepared with freeze-dried instant coffee without the mixture of volatile compounds (sample 4) were not significantly different from the freeze-dried instant coffee in which the aromatic coffee oil was added (sample 5) and from the sample prepared with freeze-dried coffee in which the mixture of the five volatile was added (sample 3), coincidentally from the same drying process. Therefore, sample (3) did not differ from samples prepared with spray dried instant coffee without (sample 1) and to which (sample 2) the mixture of volatile was added. Therefore, with respect to this attribute, the addition of this mixture did not interfere in this drink acceptance. Taking into consideration the flavor, samples prepared with freeze-dried instant coffee in which the aromatic coffee oil was added (5) and the samples with (3) and without (4) the mixture of the five volatile was added did not differ significantly, however sample (4) did not differ from samples (1) and (2). Regarding this attribute, the addition of the aromatic oil of roasted coffee or a mixture of volatile in samples of freeze-dried instant coffee had a better acceptance than those dried by spray dryer (1) and (2). Thus, the enrichment of drinks with the aromatic oil of roasted coffee, or even with the mixture of the five components did not influence the consumer acceptance with respect to the aroma, but exerts influence with respect to flavour.

Study of bacteria Gluconobacter sp.: isolation, purification, phenotypic and molecular identification

The importance of the study of acetic bacteria, on species of the Gluconobacter genus is based on its industrial application, as these possess the capacity of bioconversion of sorbitol to sorbose, enabling the process of vitamin C production. The study involved samples collected in industries of soft drinks, flowers, fruits and honey, followed by purification, phenotypic identification, molecular identification with the use of primer defined from Nucleotide Sequence Database consultation. Strains preserved were identified as members of the Acetobacteraceae family, Gluconobacter genus. 110 strains had been isolated of substrate: Pyrostegia venusta (ker-gawler), honey, Vitis vinifera (grape), Pyrus communis (pear), Malus sp. (apple) and in two samples of soft drinks. Of this total 57 strains had been recovered in manitol medium (manitol, yeast extract, peptone), 12 in YMG medium (glucose, manitol, yeast extract, ethanol, acetic acid), 41 in enrichment medium (De Ley and Swings) and later in the GYC medium (glucose, yeast extract and calcium carbonate). 68 strains were identified as Gram negative bacilli rods. Of these, 31 were characterized biochemically as belonging to the Acetobacteriaceae family as they were catalase positive, oxidase negative and producers of acid from glucose. The characterization of these strains was complemented with the biochemistry tests: gelatin liquefaction, nitrate reduction, indole and H2S production, oxidation of ethanol to acetic acid and molecular tests for genus identification. Only eight strains were characterized as pertaining to the Gluconobacter genus. The strains are maintained in collection cultures at the Microbiology Laboratory of the Biology Department at the São Paulo State University (UNESP) in Assis, stored in malt extract at -196 ºC.