Unanswered clinical questions in the management of cardiometabolic risk in the elderly: a statement of the Spanish society of internal medicine.

BACKGROUND Despite the progressive increase in life expectancy and the relationship between aging with multi-morbidities and the increased use of healthcare resources, current clinical practice guidelines (CPG) on cardiometabolic risk cannot be adequately applied to elderly subjects with multiple chronic conditions. Its management frequently becomes complicated by both, an excessive use of medications that may lead to overtreatment, drug interactions and increased toxicity, and errors in dosage and non-compliance. Concerned by this gap, the Spanish Society of Internal Medicine created a group of independent experts on cardiometabolic risk who discussed what they considered to be unanswered questions in the management of elderly patients. DISCUSSION Current guidelines do not specifically address the problem of elderly with multiple chronic conditions. For this reason, the combined use of the limited available evidence, clinical experience and common sense, could all help us to address this unmet need. In very old people, life expectancy and functionality are the most important factors for guiding potential treatments. Their higher propensity to develop serious adverse events and their shorter lifespan could prevent them from obtaining the potential benefits of the interventions administered. SUMMARY In this document, experts on cardiometabolic risk factors have established a number of consensual recommendations that have taken into account international guidelines and clinical experience, and have also considered the more effective use of healthcare resources. This document is intended to provide general recommendations for clinicians and to promote the effective use of procedures and medications.

Model for managing non-core ideas to new companies, products and services in a Finnish forest company

Suomalainen metsäteollisuus on muutoksen partaalla. Uutisissa on nähty miten metsäyrityksen sulkevat tehtaita ja paperikoneita. Suomalaisessa metsäteollisuudessa keskitytään tällä hetkellä lähinnä kulujen alentamiseen ja tuottavuuden parantamiseen. Edellytyssille, että suomalainen metsäteollisuus pysyy kilpailukykyisenä, ovat kuitenkinuudet innovaatiot ja toimialojen välinen yhteistyö. Työn tavoitteena oli luoda toimintamalli UPM-Kymmene Oyj:lle, minkä avulla ydinliiketoimintaan kuulumattomat tuote- ja palveluideat saataisiin hyödynnettyä. Aihe on erittäin ajankohtainen, mikäli halutaan pitää tuotanto jatkossakin Suomessa. Luotumalli painottaa pk-sektorin roolia ja potentiaalia kehittää UPM-Kymmeneltä peräisin olevia ja heidän ydinliiketointaan kuulumattomista tuote ja palveluideoistauusia yrityksiä, tuotteita ja palveluita. Malli edustaa uudenlaista ajattelutapaa ja sen käyttöönotto vaatii perinteisen yrityskulttuurin uudistamista UPM-Kymmenessä.

Palveluhankintojen analysointi ja mittaaminen, case Stora Enso Saimaa Services Oy

Tutkimuksen tavoitteena oli luoda Stora Enso Saimaa Services Oy:lle palveluhankintojen suorituskyvyn mittaristo Balanced Scorecardin avulla. Yrityksen palveluhankintakentän kirjavuuden vuoksi työ rajattiin koskemaan vain Etelä-Karjalan Yrityksiltä (= EKY) ostettavia kunnossapitopalveluja. Mittariston muodostamisen lähtökohtana oli hankintatoimen strateginen tavoite, kokonaiskustannusten alentaminen. Tämä tavoite konkretisoituu parhaiten hankintojen elinkaarikustannusten minimoimisena. Työssä käytettiin kvalitatiivista tutkimusmenetelmää. Tutkimuskohdetta analysoitiin tapaustutkimusmenetelmällä. Aineisto kerättiin sisäisille asiakkaille suunnatulla puolistrukturoidulla haastatteluilla, ostajien ajankäytönseurantakyselyllä sekä osallistuvalla havainnoinnilla. Haastatteluja tehtiin 10 ja kyselyjä 6. Palveluhankintojen elinkaarikustannusten ja mittaamisen osalta on tehty tutkimuksia hyvin vähän. EKY-palveluhankintoihin onnistuttiin kuitenkin luomaan tasapainotettu mittaristo palvelujen erityispiirteet huomioiden. EKY-elinkaarikustannusanalysoinnissa keskityttiin palveluhankintojen keskeisiin kustannuskomponentteihin kuten transaktiokustannusteoriaan, hintojen määräytymiseen ja huonon laadun kustannuksiin. Näiden pohjalta kriittisiksi palveluhankintojen menestystekijöiksi nousivat mm. ostajien ajankäytön suuntaaminen strategisiin työtehtäviin, hintojen hallinta sekä toimittajien laadun arviointi. Nämä tekijät muotoiltiin EKY-palveluhankintojen tuloskorttiin ja niihin valittiin hankintatoimen mittausmalleista sopivat suorituskyvyn mittarit. Mittarit jaettiin EKY-palveluhankintoihin määriteltyihin neljään näkökulmaan Balanced Scorecard -prosessin mukaisesti.

Strategic supply lead time management. Case Nokia Networks, Hardware Services

Teollisuuden palveluiden on huomattu olevan potentiaalinen lisätulojen lähde. Teollisuuden palveluiden dynaamisessa maailmassa räätälöinti ja kyky toimia nopeasti ovat kriittisiä asiakastyytyväisyyden ja kilpailuedun luomisprosessin osia. Toimitusketjussa käytetyn ajan lyhentämisellä voidaan saavuttaa sekä paremmat vasteajat, että alhaisemmat kokonaiskustannukset. Tutkielman tavoitteena on kuvata teollisuuden palveluiden dynaamista ympäristöä: asiakastarvetta, sekä mahdollisuuksia kaventaa pyydetyn ja saavutetun toimitusajan välistä eroa. Tämä toteutetaan pääosin strategisen toimitusajan hallinnan keinoin. Langattomien tietoliikenneverkkojen operaattorit haluavat vähentää ydinosaamiseensa kuulumatomiin toimintoihin, kuten ylläpitoon sitoutuneita pääomia. Tutkielman case osiossa varaosapalvelujen toimitusketjun kysyntä-, materiaali- ja informaatiovirtoja analysoidaan niin kvalitatiivisten haastatteluiden, sisäisten dokumenttien, kuin kvantitatiivisten tilastollisten menetelmienkin avulla. Löydöksiä peilataan vallitsevaa toimitusketjun ja ajanhallinnan paradigmaa vasten. Tulokset osoittavat, että vahvan palvelukulttuurin omaksuminen ja kokonaisvaltainen toimitusketjun tehokkuuden mittaaminen ovat ajanhallinnan lähtökohtia teollisuuden palveluissa.

Incumbent audit firm-provided tax services and the clients with low financial reporting quality

This study investigates whether incumbent audit firm-provided tax services enhance or impair the likelihood of acknowledging client companies’ low financial reporting quality. In particular, we examine the association between tax-related fees and the likelihood of timely restatements, and internal control weakness disclosures among a sample of US companies that all have misstatements in financial information. The empirical findings indicate that companies paying higher tax-related fees are less likely to disclose SOX 404 internal control weakness disclosures, implying that underlying control problems are unacknowledged when incumbent audit firm provided tax-related fees are higher. However, the findings suggest that just providing both audit and tax-related services does not have an impact on audit quality per se, but rather it is the magnitude of the tax-related fees in particular that counts. We also find some evidence suggesting that companies paying higher tax-related fees have higher likelihood of restatement lags, whereas companies paying smaller tax-related fees to their audit firm restate financial statements in a timelier manner. Overall, the findings suggest that audit scrutiny of client companies with low quality financial reporting is weaker when the magnitude of tax-related fees is higher.

Setting priorities in clinical and health services research: Properties of an adapted and updated method

Objectives: The objectives of this study is to review the set of criteria of the Institute of Medicine (IOM) for priority-setting in research with addition of new criteria if necessary, and to develop and evaluate the reliability and validity of the final priority score. Methods: Based on the evaluation of 199 research topics, forty-five experts identified additional criteria for priority-setting, rated their relevance, and ranked and weighted them in a three-round modified Delphi technique. A final priority score was developed and evaluated. Internal consistency, test–retest and inter-rater reliability were assessed. Correlation with experts’ overall qualitative topic ratings were assessed as an approximation to validity. Results: All seven original IOM criteria were considered relevant and two new criteria were added (“potential for translation into practice”, and “need for knowledge”). Final ranks and relative weights differed from those of the original IOM criteria: “research impact on health outcomes” was considered the most important criterion (4.23), as opposed to “burden of disease” (3.92). Cronbach’s alpha (0.75) and test–retest stability (interclass correlation coefficient = 0.66) for the final set of criteria were acceptable. The area under the receiver operating characteristic curve for overall assessment of priority was 0.66. Conclusions: A reliable instrument for prioritizing topics in clinical and health services research has been developed. Further evaluation of its validity and impact on selecting research topics is required

Improving product profitability control in continuous IT-services

The target of the thesis is to improve product profitability control in continuous IT-services. Accurate product cost accounting and correctly allocated revenues are a necessity for good product profitability control. The focus of the study is on costs and revenues that are not traced directly to services. The thesis is focused on revenue allocations as revenue allocation methods have not been used in the case company before. In order to achieve the target revenue allocation methods, which improve the product profitability accounting and control, are presented. The research methods used in the thesis are literature review and empirical case study. The research approach is constructive. The theoretical part is composed of literature and articles that create a base for the empirical part. Internal interviews describe the current situation in the company and based on it development actions are planned. The part of the empirical case study is seen mostly in the limitations as the research is limited to concern only one department in the company. Problems in the revenue tracing are caused by customer specific services and lack of service definitions because of which the revenues are not traced correctly. Methods to allocate revenues are presented in the thesis and stand-alone revenue allocation method is the most suitable one because it is fair and it can be modified. Approximate product profitability analysis is done in the thesis and the results of it indicate that some services are profitable and some unprofitable.

Interoperability and Services Through Shared Identifiers

Poster at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Työvoiman vaihtuvuus ja sen syyt. Case: CGI – Global HR Shared Services, Filippiinit

Tämän Pro Gradu -tutkimuksen tavoite on Filippiineillä toimivan kohdeorganisaation sisäisen HR Shared Services palvelukeskuksen kokeman henkilöstön vaihtuvuuden erityispiirteiden sekä syiden ymmärtäminen. Tätä kautta pyritään hahmottamaan myös sopivia vaihtuvuuden hallintakeinoja organisaatiotasolla. Tapaustutkimus toteutettiin laadullisen tutkimuksen keinoja ja sekundaarista lähtödataa käyttäen. Tutkimustulokset osoittivat, että kohdeorganisaatio paini useiden toimiala- ja maakohtaisten vaihtuvuuden tekijöiden lisäksi muutamien organisaatiokohtaisten haasteiden kanssa, jotka heijastuivat sen kokemaan työvoiman vaihtuvuuteen. Yksikön tulee muun muassa panostaa sisäisiin urakehitysmahdollisuuksiin sekä johtajien ja uusien työntekijöiden koulutukseen. Suuri osa löydetyistä vaihtuvuuden syistä on ainakin osin organisaation hallittavissa ja tätä kautta saatiin luotua lista suositelluista toimenpiteistä, joilla kohdeorganisaatio voi pyrkiä hallitsemaan henkilöstönsä vaihtuvuutta.

Innovation Ecosystem Perspectives on Financial Services Innovation

The context of financial services has been characterised by changes in the regulatory, technological and societal landscape. Consumers are increasingly interested in mobile payments, crowdfunding and microfinance services, either for themselves or because collaborative consumption is viewed as a more sustainable. Retail branches are re-organised to further meet the expectations of customers, start-ups focusing on technology for financial services (i.e. Fintech) are ever growing and financial services companies reinforce their own innovation practices (e.g. creation of innovation labs or venture capital investment funds). The innovation ecosystem around financial services companies represents the many actors with whom they can co-create and co-produce innovative new services for their customers (or for themselves). The innovation process is no longer a closed internal effort but needs to include external actors from the innovation ecosystem. This topic is especially interesting in a small and open economy where the financial centre takes a prominent place in the economy. The research question is therefore “How does the innovation ecosystem influence the innovation process within financial services companies?”. The influence of the innovation ecosystem on the innovation process within financial service companies mainly comes from its social capital and value creation efforts. However learning to work and exchange in an innovation ecosystem is also expected to influence the innovation process in place. Realizing the potential of the innovation ecosystem requires sufficient capabilities to manage new information coming from the innovation ecosystem. The professional associations provide the necessary coordination among actors in the innovation ecosystem to co-create and appropriate value, while fostering co-evolution within the innovation ecosystem.

Industry specific lifecycle services for process critical motors

This Master’s Thesis examines industrial service business and studies how Global Technical Support Center Finland, part of ABB Oy, can develop its lifecycle services based on availability related customer needs. Focus is in three most business critical industry segments OGP (Oil, Gas and Petrochemical), Power and Metals. The research was conducted as a qualitative case study, including literature review and empirical part. The literature review explores industrial service business, product lifecycle services and related customer needs, product effectiveness and maintenance. This study contains also characteristics of constructive research. Primary material was gathered through internal and external interviews. Both theme and semi-structured interviews were performed. This research has shown that customers have different needs depending of the industry segment where they operate. Most remarkable differences are related to maintenance schedules. The main outcomes of the study are the industry specific lifecycle service models that combine company recommendations with customer specific needs. Other development needs were related to proactivity, condition based monitoring, information sharing and lifecycle estimations.

Using Network Analysis to Understand and Advance Falls Prevention Services and Programs

The purpose of this study was to understand referral linkages that exist among falls prevention agencies in a southern Ontario region using network analysis theory. This was a single case study which included fifteen individual interviews. The data was analyzed through the constant comparative approach. Ten themes emerged and are classified into internal and external factors. Themes associated with internal factors are: 1) health professionals initiating services; 2) communication strategies; 3) formal partnerships; 4) trust; 5) program awareness; and 6) referral policies. Themes associated with external factors are: 1) client characteristics; 2) primary and community care collaboration; 3) networking; and 4) funding. Recommendations to improve the referral pathway are: 1) electronic database; 2) electronic referral forms; 3) educating office staff; and 4) education days. This study outlined the benefit of using network analysis to understand referral pathways and the importance of implementing strategies that will improve falls prevention referral pathways.

Professional Services

This is a study on “Professional Services: Civil Liability for Deficiency”. This study is made with special reference to medical profession. The importance of qualitative professional services does not require any emphasis. It is a matter of great concern for the people as they are consumers.This study is divided into 12 chapters. The introductory chapter deals with characteristics of profession, basis of professional liability and international efforts to check abuse of position by professional men. Consumers as laymen can not perceive the intricacies of professional services. As a result professional men could misuse their superior position to expose consumers to hardship through deficient services. This is obvious from the fact that deficiency in professional services has assumed a menacing proportion. It is indicative of failure of internal control through self-regulation to check the abuse of position by the professional men. The professional bodies entrusted with the task of enforcing disciplinary measures show a very callous and indifferent attitude towards the repressive conduct of their members. These bodies are more concerned to protect the interest of their members. They are not free from institutional bias. They have put the interest of consumers into oblivion. In effect remedies through professional bodies has become a myth. All these factors make the external control of professional services mandatory to protect the consumers from the clutches of unscrupulous professional men, who abuse their superior position. The professional men who abuse their position are exposed to liability. Their liability arises under contract, tort and statutory law. The present study substantially concentrates on professional liability of medical men. The obvious reason is that of all professional services medical services are the frequently availed services by the consumers. Medical negligence cases account for bulk of the professional negligence cases. ln India also large number of cases are coming before consumer forae. The legal principles evolved in this sphere of professional service confers an insight into legal control of other professional services as well. The same principles are applied to other professions also, as by and large all the professions share common characteristics. Such principles are modified wherever necessary to make room for differential aspects of particular profession

Poland’s internal security as exemplified by the tasks and activities of the Internal Security Agency in the period 2007–2015

The text analyses Poland's internal security illustrated with the example of the tasks and activities of one of the Polish special services, the Internal Security Agency (pol. Agencja Bezpieczeństwa Wewnętrznego – ABW). Although the Internal Security Agency was established as a counter-intelligence service, the scope of its tasks and activities places it among the criminal intelligence services, which is poorly effective in terms of the eradication of crime targeted at the state's internal security. The analysis of the issues of state security in the context of the ISA's activity has been elaborated in the present text with the following research questions: (1) To what extent does the statutory scope of the ISA's tasks lower the effectiveness of the actions aimed at combating crime threatening state security? (2) To what extent does the structural pathology inside the ISA lower the effectiveness of the actions aimed at combating crime threatening state security? The text features an extensive analysis of three major issues: (1) the ISA's statutory tasks (with particular consideration of de lege lata and de lege ferenda regulations), (2) the dysfunctional character of the ISA's activity in relation to the scope of its statutory tasks, and (3) the structural pathology resulting from the 'politicisation' of the Internal Security Agency.

Internal rents and corporate property management: a study into the use of internal rents in UK corporate organisations

Research in the late 1980s showed that in many corporate real estates users were not fully aware of the full extent of their property holdings. In many cases, not only was the value of the holdings unknown, but there was uncertainty over the actual extent of ownership within the portfolio. This resulted in a large number of corporate occupiers reviewing their property holdings during the 1990s, initially to create a definitive asset register, but also to benefit from an more efficient use of space. Good management of corporately owned property assets is of equal importance as the management of other principal resources within the company. A comprehensive asset register can be seen as the first step towards a rational property audit. For the effective, efficient and economic delivery of services, it is vital that all property holdings are utilised to the best advantage. This requires that the property provider and the property user are both fully conversant with the value of the property holding and that an asset/internal rent/charge is made accordingly. The advantages of internal rent charging are twofold. Firstly, it requires the occupying department to “contribute” an amount to the business equivalent to the open market rental value of the space that it occupies. This prevents the treating of space as a free good and, as individual profit centres, each department will then rationalise its holdings to minimise its costs. The second advantage is from a strategic viewpoint. By charging an asset rent, the holding department can identify the performance of its real estate holdings. This can then be compared to an internal or external benchmark to help determine whether the company has adopted the most efficient tenure pattern for its properties. This paper investigates the use of internal rents by UK-based corporate businesses and explains internal rents as a form of transfer pricing in the context of management and responsibility accounting. The research finds that the majority of charging organisations introduced internal rents primarily to help calculate true profits at the business unit level. However, less than 10% of the charging organisations introduced internal rents primarily to capture the return on assets within the business. There was also a sizeable element of the market who had no plans to introduce internal rents. Here, it appears that, despite academic and professional views that internal rents are beneficial in improving the efficient use of property, opinion at the business and operational level has not universally accepted this proposition.