Low C-reactive protein values at admission predict mortality in patients with severe community-acquired pneumonia caused by Streptococcus pneumoniae that require intensive care management.

PURPOSE: To identify risk factors associated with mortality in patients with severe community-acquired pneumonia (CAP) caused by S. pneumoniae who require intensive care unit (ICU) management, and to assess the prognostic values of these risk factors at the time of admission. METHODS: Retrospective analysis of all consecutive patients with CAP caused by S. pneumoniae who were admitted to the 32-bed medico-surgical ICU of a community and referral university hospital between 2002 and 2011. Univariate and multivariate analyses were performed on variables available at admission. RESULTS: Among the 77 adult patients with severe CAP caused by S. pneumoniae who required ICU management, 12 patients died (observed mortality rate 15.6 %). Univariate analysis indicated that septic shock and low C-reactive protein (CRP) values at admission were associated with an increased risk of death. In a multivariate model, after adjustment for age and gender, septic shock [odds ratio (OR), confidence interval 95 %; 4.96, 1.11-22.25; p = 0.036], and CRP (OR 0.99, 0.98-0.99 p = 0.034) remained significantly associated with death. Finally, we assessed the discriminative ability of CRP to predict mortality by computing its receiver operating characteristic curve. The CRP value cut-off for the best sensitivity and specificity was 169.5 mg/L to predict hospital mortality with an area under the curve of 0.72 (0.55-0.89). CONCLUSIONS: The mortality of patients with S. pneumoniae CAP requiring ICU management was much lower than predicted by severity scores. The presence of septic shock and a CRP value at admission <169.5 mg/L predicted a fatal outcome.

Réhabilitation améliorée après chirurgie--L'ere de la prise en charge optimale du patient chirurgical [Enhanced Recovery After Surgery--optimal management of the surgical patient].

Enhanced Recovery After Surgery (ERAS) is a multimodal, standardized and evidence-based perioperative care pathway. With ERAS, postoperative complications are significantly lowered, and, as a secondary effect, length of hospital stay and health cost are reduced. The patient recovers better and faster allowing to reduce in addition the workload of healthcare providers. Despite the hospital discharge occurs sooner, there is no increased charge of the outpatient care. ERAS can be safely applied to any patient by a tailored approach. The general practitioner plays an essential role in ERAS by assuring the continuity of the information and the follow-up of the patient.

Immigrant Families and the School in Spain: Dynamics and Factors that Influence their Relations

In Spain, academic debate and school administrations have evolved to the extent that relations between the school, the family and the surrounding environment are now considered as crucial to student achievement at school and to the good functioning of the educational system as a whole. Despite this development, change is slow in practice and often complicated due to the emerging resistance of families and schools, given that they have always maintained relations marked by an imbalance of power. Our theoretical and especially our empirical work has focused on the relations between immigrant families and the school system in Spain. In view of the above, the creation of what we call positive relational dynamics and communication in schools is conditioned by the attitudes and behaviour of the school administration, professionals and families. However, the physical space in which these relations take place must also be taken into consideration. Regarding school organisation, we have emphasised the role of the school’s administration. By differentiating the range of management models, we note the ones that facilitate more relations and communication with and among families (especially the one we have called the horizontal participative model) and those that discourage them. However, the multiple and complex range of attitudes among teachers and families must always be taken into account.

Diagnosis and Management of Upper Tract Urothelial Carcinoma.

While UTUC is relatively uncommon, it has an aggressive natural history and poor prognosis, which has not substantially improved over the past two decades. Nevertheless, continued research has led to the discovery of risk factors improving the prevention and early detection of UTUC. Although RNU remains the standard treatment for localized invasive UTUC, nephron-sparing surgery for selected patients has made considerable progress in the recent years. The stagnation in the prognosis of UTUC over the past two decades highlights the necessity for incorporating multimodal approaches including refinements in systemic chemotherapy and radiotherapy to attain better outcomes for patients with UTUC.

Time patterns and perceptions of online learning success factors

Online learning provides the opportunity to work on academic tasks at any time at the same time as doing other activities, such as using in web 2.0 tools. This study identifies factors that contribute to success in online learning from the students¿ perspective and their relationship with time patterns. A survey of learning outputs was used to find relationships between students¿ satisfaction, knowledge acquisition and knowledge transfer with time for working on academic tasks. In this study, 199 students from a university in Mexico completed the survey. Findings suggest that knowledge transfer has a significant association with the number of hours online per day, hours spent on social networks and the use made of e-learning during working hours. Learner satisfaction has a strong relationship with the time in years a learner has been using the Internet and the number of hours devoted to the course per week. The findings of this research will be helpful for faculty and instructional designers for implementing learning strategies.

The transtheoretical model in weight management: Validation of the Processes of Change Questionnaire

Objective: The processes of change implied in weight management remain unclear. The present study aimed to identify these processes by validating a questionnaire designed to assess processes of change (the P-Weight) in line with the transtheoretical model. The relationship of processes of change with stages of change and other external variables is also examined. Methods: Participants were 723 people from community and clinical settings in Barcelona. Their mean age was 32.07 (SD = 14.55) years; most of them were women (75.0%), and their mean BMI was 26.47 (SD = 8.52) kg/m2. They all completed the P-Weight and the stages of change questionnaire (SWeight), both applied to weight management, as well as two subscales from the Eating Disorders Inventory-2 and Eating Attitudes Test-40 questionnaires about the concern with dieting. Results: A 34-item version of the PWeight was obtained by means of a refinement process. The principal components analysis applied to half of the sample identified four processes of change. A confirmatory factor analysis was then carried out with the other half of the sample, revealing that the model of four freely correlated first-order factors showed the best fit (GFI = 0.988, AGFI = 0.986, NFI = 0.986, and SRMR = 0.0559). Corrected item-total correlations (0.322-0.865) and Cronbach"s alpha coefficients (0.781-0.960) were adequate. The relationship between the P-Weight and the S-Weight and the concern with dieting measures from other questionnaires supported the validity of the scale. Conclusion: The study identified processes of change involved in weight management and reports the adequate psychometric properties of the P-Weight. It also reveals the relationship between processes and stages of change and other external variables.

Factors Affecting Innovation Adoption in Organizations: The Case of Corporate Website Adoption

Diplomityössä tutkittiin innovaatioiden omaksumista organisaatioissa, ja tarkoituksena oli selvittää tekijät, jotka vaikuttivat omaksumisajankohtaan sekä luokitella yritykset omaksujaryhmiin. Työn empiirinen osuus tarkasteli yritysten internet-kotisivujen omaksumista. Tutkimuksen empiirinen aineisto kerättiin postikyselyn avulla, ja vastausprosentti kyselyssä oli melko hyvä (60%). Aikaisempien tutkimusten pohjalta muodostettiin eri tekijöille mittarit, jotka analyysien perusteella olivat erittäin luotettavia. Regressioanalyysia sovellettiin, kun pyrittiin selvittämään omaksumisajankohtaan vaikuttavia tekijöitä, ja klusterianalyysiä käytettiin apuna omaksujaluokkien muodostamisessa. Omaksujaluokkien väliset erot selvitettiin varianssianalyyseillä. Tutkimuksessa löydettiin kolme omaksumisajankohtaan vaikuttavaa tekijää: (1) innovaation koettu suhteellinen hyöty, (2) yritysjohdon sitoutuminen omaksumisprosessiin, sekä (3) yrityksen strategisten partnereiden määrä. Yritykset luokiteltiin neljään omaksujaluokkaan (innovaattorit, aikaiset omaksujat, aikainen enemmistö ja myöhäinen enemmistö) innovatiivisuuden perusteella. Innovatiivisuutta mitattiin kolmella indikaattorilla, jotka olivat: (1) ajankohta, jolloin yritys tuli tietoiseksi internet-sivuista, (2) ajankohta, jolloin tehtiin omaksumispäätös sekä (3) aika, joka kului internet-sivujen käyttöönottoon. Omaksujaluokkien välillä tunnistettiin lukuisia eroja eri ominaisuuksien suhteen.

Frequent users of the emergency department in a universal health coverage system : a randomized controlled trial of a case-management intervention

BACKGROUND: Frequent emergency department users represent a small number of patients but account for a large number of emergency department visits. They should be a focus because they are often vulnerable patients with many risk factors affecting their quality of life (QoL). Case management interventions have resulted in a significant decrease in emergency department visits, but association with QoL has not been assessed. One aim of our study was to examine to what extent an interdisciplinary case management intervention, compared to standard emergency care, improved frequent emergency department users' QoL. METHODS: Data are part of a randomized, controlled trial designed to improve frequent emergency department users' QoL and use of health-care resources at the Lausanne University Hospital, Switzerland. In total, 250 frequent emergency department users (≥5 attendances during the previous 12 months; ≥ 18 years of age) were interviewed between May 2012 and July 2013. Following an assessment focused on social characteristics; social, mental, and somatic determinants of health; risk behaviors; health care use; and QoL, participants were randomly assigned to the control or the intervention group (n=125 in each group). The final sample included 194 participants (20 deaths, 36 dropouts, n=96 in the intervention group, n=99 in the control group). Participants in the intervention group received a case management intervention by an interdisciplinary, mobile team in addition to standard emergency care. The case management intervention involved four nurses and a physician who provided counseling and assistance concerning social determinants of health, substance-use disorders, and access to the health-care system. The participants' QoL was evaluated by a study nurse using the WHOQOL-BREF five times during the study (at baseline, and at 2, 5.5, 9, and 12 months). Four of the six WHOQOL dimensions of QoL were retained here: physical health, psychological health, social relationship, and environment, with scores ranging from 0 (low QoL) to 100 (high QoL). A linear, mixed-effects model with participants as a random effect was run to analyze the change in QoL over time. The effects of time, participants' group, and the interaction between time and group were tested. These effects were controlled for sociodemographic characteristics and health-related variables (i.e., age, gender, education, citizenship, marital status, type of financial resources, proficiency in French, somatic and mental health problems, and behaviors at risk).

Impact of case management on frequent users quality of life : a randomized controlled trial

BACKGROUND: Frequent emergency department users represent a small number of patients but account for a large number of emergency department visits. They should be a focus because they are often vulnerable patients with many risk factors affecting their quality of life (QoL). Case management interventions have resulted in a significant decrease in emergency department visits, but association with QoL has not been assessed. One aim of our study was to examine to what extent an interdisciplinary case management intervention, compared to standard emergency care, improved frequent emergency department users' QoL. METHODS: Data are part of a randomized, controlled trial designed to improve frequent emergency department users' QoL and use of health-care resources at the Lausanne University Hospital, Switzerland. In total, 250 frequent emergency department users (≥5 attendances during the previous 12 months; ≥ 18 years of age) were interviewed between May 2012 and July 2013. Following an assessment focused on social characteristics; social, mental, and somatic determinants of health; risk behaviors; health care use; and QoL, participants were randomly assigned to the control or the intervention group (n=125 in each group). The final sample included 194 participants (20 deaths, 36 dropouts, n=96 in the intervention group, n=99 in the control group). Participants in the intervention group received a case management intervention by an interdisciplinary, mobile team in addition to standard emergency care. The case management intervention involved four nurses and a physician who provided counseling and assistance concerning social determinants of health, substance-use disorders, and access to the health-care system.

Implementation of Customer Relationship Management Strategy in Pulp Company

Työn tarkoituksena oli löytää Asiakkuuksienhallintastrategian käyttöönoton ongelmakohtia asiakkuuksienhallintaan erikoistuneen konsulttiyrityksen asiakasyrityksen taholta. Lisäksi työssä etsitään ratkaisuja asiakkuusteorian viemiseksi käytäntöön. Työn anti on asiakkuusstrategian käytäntöön panon ongelmakohtien paikallistaminen, prosessin vaiheiden kuvaaminen sekä asiakkuuksienhallinnan tutkiminen lähtökohtana asiakkaalle tuotettu arvo. Asiakkuusstrategian implementoinnin ongelmakohtien ja kriittisten menestystekijöiden kuvaus ja vertailu käsitellään empiirisessä osassa suhteuttaen teoriaosuuden materiaaliin. CRM Group:n kannalta työ mahdollistaa osaltaan asiakasprojektien kehitystyön.Kirjallisuusosan pohjalta implementoinnin kannalta kriittisiksi menestystekijöiksi nousivat tietoteknisten ratkaisujen sulauttaminen osaksi asiakkuusstrategiaa tukevia toimintoja, aidon synergian löytäminen asiakas – toimittaja –suhteeseen sekä asiakkuusstrategiaa kehittävän organisaation sisäinen resursointi ja henkilöstön sitouttaminen.

Performance Measurement as Part of Management

To achieve success in a constantly changing environment and with ever-increasing competition, companies must develop their operations continuously. To do this, they must have a clear vision of what they want to be in the future. This vision can be attained through careful planning and strategising. One method of transforming a strategy and vision into an everyday tool used by employees is the use of a balanced performance measurement system. The importance of performance measurement in the implementation of companies' visions and strategies has grown substantially in the last ten years. Measures are derived from the company's critical success factors and from many different perspectives. There are three time dimensions: past, present and future. Many such performance measurement systems have been created since the 1990s. This is a case study whose main objective is to provide a recommendation for how the case company could make use of performance measurement to support strategic management. To answer this question, the study uses literature-based research and empirical research at the case company's premises. The theoretical part of the study consists of two sections: introducing the Balanced Scorecard and discussing how it supports strategic management and change management. The empirical part of this study determines the company's present performance measurement situation through interviews in the company. The study resulted in a recommendation to the company to start developing the Balanced Scorecard system. By setting up this kind process, the company would be able to change its focus more towards the future, beginning to implement a more process-based organisation and getting its employees to work together towards common goals.

Clinical management and burden of bipolar disorder: a multinational longitudinal study (WAVE-bd Study)

BACKGROUND: Studies in bipolar disorder (BD) to date are limited in their ability to provide a whole-disease perspective--their scope has generally been confined to a single disease phase and/or a specific treatment. Moreover, most clinical trials have focused on the manic phase of disease, and not on depression, which is associated with the greatest disease burden. There are few longitudinal studies covering both types of patients with BD (I and II) and the whole course of the disease, regardless of patients' symptomatology. Therefore, the Wide AmbispectiVE study of the clinical management and burden of Bipolar Disorder (WAVE-bd) (NCT01062607) aims to provide reliable information on the management of patients with BD in daily clinical practice. It also seeks to determine factors influencing clinical outcomes and resource use in relation to the management of BD. METHODS: WAVE-bd is a multinational, multicentre, non-interventional, longitudinal study. Approximately 3000 patients diagnosed with BD type I or II with at least one mood event in the preceding 12 months were recruited at centres in Austria, Belgium, Brazil, France, Germany, Portugal, Romania, Turkey, Ukraine and Venezuela. Site selection methodology aimed to provide a balanced cross-section of patients cared for by different types of providers of medical aid (e.g. academic hospitals, private practices) in each country. Target recruitment percentages were derived either from scientific publications or from expert panels in each participating country. The minimum follow-up period will be 12 months, with a maximum of 27 months, taking into account the retrospective and the prospective parts of the study. Data on demographics, diagnosis, medical history, clinical management, clinical and functional outcomes (CGI-BP and FAST scales), adherence to treatment (DAI-10 scale and Medication Possession Ratio), quality of life (EQ-5D scale), healthcare resources, and caregiver burden (BAS scale) will be collected. Descriptive analysis with common statistics will be performed. DISCUSSION: This study will provide detailed descriptions of the management of BD in different countries, particularly in terms of clinical outcomes and resources used. Thus, it should provide psychiatrists with reliable and up-to-date information about those factors associated with different management patterns of BD. TRIAL REGISTRATION NO: ClinicalTrials.gov: NCT01062607.

Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults between 1992 and 2007

PURPOSE: to assess the trends of prevalence of self-reported cardiovascular risk factors (CV RFs: hypertension, hypercholesterolemia, diabetes) and their management for the period of 1992 to 2007 in Switzerland. METHODS: four health interview surveys conducted between 1992 and 2007 in representative samples of the Swiss population (63,782 subjects overall). Self-reported CV RFs prevalence, treatment and control levels were computed after weighting. Weights were calculated by raking ratio such that the marginal distribution of the weighted totals conforms to the marginal distribution of the target population. Multivariate analysis was conducted using logistic regression. RESULTS: prevalence of all CV RFs increased between 1992 and 2007. Also, the prevalence of self-reported treatment among subjects with CV RFs increased, as confirmed by multivariate analysis: OR for hypolipidemic treatment relative to 1992: 0.64 [0.52-0.78]; 1.39 [1.18-1.65] and 2.00 [1.69-2.36] for 1997, 2002 and 2007, respectively. Still, in 2007, circa 40% of hypertensive, 60% of hypercholesterolemic and 50% of diabetic subjects weren't treated. On the other hand, there is an increase of the prevalence of controlled RFs as reported by treated subjects. This was confirmed by multivariate analysis 12.1 [12.0 - 12.2]; 4.16 [4.1 - 4.23] and 2.85 [2.79 - 2.90] for hypertension, hypercholesterolemia and diabetes, respectively, in 2007, relative to 1992. CONCLUSION: the prevalence of self-reported hypertension, hypercholesterolemia and diabetes increased between 1992 and 2007 in the Swiss population. Despite a good control of treated subjects, still a significant percentage of subjects with CV RFs are not treated.

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.

Risk Management Services in Energy Production

Työ käsittelee energian tuotannossa esiintyviä tärkeimpiä taloudellisia ja teknisiä riskejä sekä niiden hallitsemista energian tuottajan näkökulmasta. Ensiksi käsitellään yleisesti riskienhallintaa, eri riskityyppejä ja esitetään periaatteellinen riskienhallintaprosessi. Sen jälkeen tarkastellaan energiamarkkinoiden nykytilannetta lähinnä Pohjoismaiden tasolla ja verrataan sitä aikaisempaan tilanteeseen energian tuottajan kannalta. Tämä siksi, että energiamarkkinoiden vapautuminen on muuttanut merkittävästi energian tuotantoon liittyviä taloudellisia riskejä, käytännössä lisännyt niitä. Pääpaino on energian tuotannossa esiintyvien olennaisten riskien tarkastelussa ja niiden hallitsemisessa. Ensin esitellään työn kannalta olennaiset riskit ja tekijät joista ne aiheutuvat. Jokainen riski ja sen aiheuttamat haitat liiketoiminnalle kuvataan lyhyesti. Sen jälkeen kiinnitetään huomiota asioihin, jotka ovat tyypillisiä energian tuotannolle ja aiheuttavat samalla erikoisvaatimuksia riskienhallinnalle. Sitten käydään läpi sopivat riskienhallinnan menetelmät, jotka ovat yleisesti käytössä energian tuotannossa, aiemmin esitetyille olennaisille riskeille. Esitetyistä riskienhallinta menetelmistä useimpia ei ole kohdistettu millekään yksittäiselle riskille, vaan monia niistä voidaan käyttää useammankin riskin hallintaan.