Quality of Disease Management and Risk of Mortality in English Primary Care Practices

OBJECTIVE: To investigate whether better management of chronic conditions by family practices reduces mortality risk. DATA: Two random samples of 5 million patients registered with over 8,000 English family practices followed up for 4 years (2004/5-2007/8). Measures of the quality of disease management for 10 conditions were constructed for each family practice for each year. The outcome measure was an indicator taking the value 1 if the patient died during a specified year, 0 otherwise. STUDY DESIGN: Cross-section and multilevel panel data multiple logistic regressions were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures. PRINCIPAL FINDINGS: Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression. CONCLUSIONS: The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 782 [95 percent CI: 423, 1140]. A longer study period may be necessary to detect any mortality impact of better management of other conditions.

Sisäinen tulosraportointi tietojohtamisen näkökulmasta. Case: Elcoteq Network Oyj

Tutkielman tarkoituksena oli tutkia, mitkä tekijät vaikuttavat sisäisen laskennan tulostiedon oikeellisuuteen ja miten tietojohtamisen keinoin voidaan taata yhteensopivuus ulkoisen ja sisäisen laskentatiedon välillä. Tekijöiden tunnistamisen ja huomioonottamisen kautta voidaan kehittää organisaation tietämystä ja suorituskykyä. Tutkimus oli empiirinen ja kuvaileva tapaustutkimus. Kvalitatiivista aineistoa kerättiin pääasiassa kyselylomakkeen, havainto -ja dokumenttiaineiston avulla. Aineisto analysoitiin teemoittelun avulla. Laskentaorganisaatioissa havaittiin mekaanisen ja orgaanisen tietopääomaympäristön piirteitä, jotka asettavat tiedon välitykselle,vuorovaikutukselle ja tietämyksen kehittymiselle omat rajoitteensa. Laskentaorganisaatioiden toimintaa ohjasivat mekaaniselle ympäristölle tyypilliset vastuu - ja raportointisuhteet, aikataulut ja raportointikäytännöt. Raportointijärjestelmään tarvittaisiin lisäkoulutusta, tiedon vertailtavuuteen ja tiedon oikeellisuuden takaamiseen lisää työvälineitä. Tiedon välittämistä ja kommunikointia pitäisi tehostaa aktiivisemmalla sähköisellä viestinnällä, mutta myös monipuolisemmalla viestintäkanavien käytöllä. Laskentaorganisaatioiden toimintaympäristössä havaittiin orgaanisen tietopääomaympäristön piirteitä, mikä edellyttäisi dialogia tukevien teknologioiden ja toimintatapojen tehokkaampaa käyttöä. Haasteena on maantieteellisen etäisyyden aiheuttamat rajoitteet sekä toiminnan mekaaninen luonne. Uutta konseptia käyttöönotettaessa keskustelut ja vuorovaikutus tukivat mallin kehittämistä ja käytännön sisäistämistä osaksi organisaation tietämystä. Viestintäkanavien käytön tehostamisella voitaisiin edesauttaa tiedon välittymistä. Tietämyksen ja suorituskyvyn kehittäminen laskentaorganisaatioissa edellyttää kuitenkin vuorovaikutteisuuden ja dialogin tukemista.

IAS 14 - Segment Reporting; The Requirements and Implementation

The principal aim of this study is to clarify the requirements of segment reporting and compare the requirements with the actual! implementation on different business lines. The empirical part was concluded by interviewing randomly selected companies that are publicly listed on the Helsinki Exchanges. The theoretical part of the study (chapters 2 and 3) will give basic information about shifting to IAS -standards and the requirements of IAS -standards. In order to meet the principal aim, a pre-empiric research was conducted by studying the annual accounts (year 2002) of randomly selected companies that already follow the IAS -standards of reporting. The companies in the pre-empiric research consist of both domestic and foreign companies. The aim of the pre-empiric study was to give a basis for the interview process on the empiric part of the study. The study indicates that implementing segment reporting has not brought any major concerns or problems. This is due to the fact that most companies that were examined - being publicly listed companies - have traditionally had a clear division between their geographical and commercial segments, and also been obliged to give reports according to these segments. In case of changes in corporate structure, shifting on new lines of businesses or downsizing of operations, the problems in reporting according to IAS -standards, may arise. Such changes will also require changes on information systems, providing the essential information for segment reporting. According to this study, most companies choose the commercial segment as their primary segment for reporting. The pre-empiric study indicates, that most of the companies already following the IAS -standards, still have a lot of improvement to do, in order to meet all the IAS requirements.

Evaluation of Software Development Practices through Error Analysis

This thesis studies evaluation of software development practices through an error analysis. The work presents software development process, software testing, software errors, error classification and software process improvement methods. The practical part of the work presents results from the error analysis of one software process. It also gives improvement ideas for the project. It was noticed that the classification of the error data was inadequate in the project. Because of this it was impossible to use the error data effectively. With the error analysis we were able to show that there were deficiencies in design and analyzing phases, implementation phase and in testing phase. The work gives ideas for improving error classification and for software development practices.

The genomics of micronutrient requirements.

Healthy nutrition is accepted as a cornerstone of public health strategies for reducing the risk of noncommunicable conditions such as obesity, cardiovascular disease, and related morbidities. However, many research studies continue to focus on single or at most a few factors that may elicit a metabolic effect. These reductionist approaches resulted in: (1) exaggerated claims for nutrition as a cure or prevention of disease; (2) the wide use of empirically based dietary regimens, as if one fits all; and (3) frequent disappointment of consumers, patients, and healthcare providers about the real impact nutrition can make on medicine and health. Multiple factors including environment, host and microbiome genetics, social context, the chemical form of the nutrient, its (bio)availability, and chemical and metabolic interactions among nutrients all interact to result in nutrient requirement and in health outcomes. Advances in laboratory methodologies, especially in analytical and separation techniques, are making the chemical dissection of foods and their availability in physiological tissues possible in an unprecedented manner. These omics technologies have opened opportunities for extending knowledge of micronutrients and of their metabolic and endocrine roles. While these technologies are crucial, more holistic approaches to the analysis of physiology and environment, novel experimental designs, and more sophisticated computational methods are needed to advance our understanding of how nutrition influences health of individuals.

Prevalence of smoking among dentists in Catalonia - Spain (2006). Literature review of smoking cessation practices in the dental office

Objective: The objective of this study was to collect data on the prevalence of smokers among Catalonian dentists (by age and sex) and compare them with existing data on the general population, doctors, registered nurses and pharmacists. The overall prevalence of smokers in Catalonia (2006) was 34.5% of men and 24.3% of women. Data available on the prevalence of smoking among doctors (26.3% men and 22.1% women), pharmacists (19.8% men and 20.6% women) and registered nurses (34.1% men and 35.3% women) relates to the year 2002. Study design: In September 2006, Catalonian dentists (n=3,799) were asked about their habits in relation to tobacco in a self-administered questionnaire, on use and opinions with respect to dental amalgam. Five hundred and seventynine questionnaires were received, of which 538 answered the question on smoking (14.2% of the sample universe). Results: The prevalence of smokers among dentists is lower (24.9% of men and 18.4% of women) than in the general population and other healthcare professionals. In dentists in the age group between 25 and 34 years, the prevalence was 26.1% in men and 14.9% in women, while the prevalence in this age group in the general population was 43.6% and 37.1%, respectively. Conclusion: Catalonian dentists have a much lower prevalence of tobacco use than the general population and lower even than other healthcare professionals. Given that non-smoking healthcare professionals have better awareness for providing recommendations for smoking prevention and cessation, Catalonian dentists may be a valid group for performing this task for which there is scientific evidence.

WWW-pohjaisen sovelluksen automatisoitu testaus ja sitä edistävät ohjelmointikäytännöt

Ohjelmistotestauksen avulla voidaan tarkastella sovelluksen vastaavuutta vaatimuksiin. Tavoitteena on löytää sovelluksesta virheitä, ja siten parantaa sovelluksen laatua. Sovelluksen laatu voidaan määritellä useilla mittareilla, kuten esimerkiksi testattavuudella. Tässä työssä tarkastellaan WWW-sovelluksen automatisoidun testauksen toteutusta, jossa käytetään apuna testauskehystä. Automatisoituun testaukseen kuuluu testitapausten suunnittelu sekä toteutus, joiden lopputuloksena on uudelleenajettavia testitapauksia. Testaus keskittyy sovelluksen toiminnallisuuteen ja jättää tietokantaan päivitettävien tietojen tarkastamisen tekemättä. Testaus suoritetaan ilman tarkempaa tietoa sovelluksen sisäisestä toiminnasta. Testattava sovellus on Mobilding-hankkeessa toteutettu WWW-sovellus, jonka avulla hallinnoidaan rakennuksen elementtejä. Työssä vertaillaan WWW-sovelluksen käyttöliittymän testaukseen soveltuvia testauskehyksiä, ja pyritään tuomaan esille niiden ominaispiirteitä. Työn tuloksena on uudelleensuoritettavia testitapahtumia. Lisäksi pohditaan ohjelmointikäytäntöjä, joilla voidaan edistää automatisoitua testausta. Ohjelmointikäytännöt perustuvat työn toteutuksen aikana havaittuihin ongelmiin.

Swiss family physicians' perceptions and attitudes towards knowledge translation practices.

BACKGROUND: Several studies have been performed to understand the way family physicians apply knowledge from medical research in practice. However, very little is known concerning family physicians in Switzerland. In an environment in which information constantly accumulates, it is crucial to identify the major sources of scientific information that are used by family physicians to keep their medical knowledge up to date and barriers to use these sources. Our main objective was to examine medical knowledge translation (KT) practices of Swiss family physicians. METHODS: The population consisted of French- and German-speaking private practice physicians specialised in family medicine. We conducted four interviews and three focus groups (n = 25). The interview guides of the semi-structured interviews and focus groups focused on (a) ways and means used by physicians to keep updated with information relevant to clinical practice; (b) how they consider their role in translating knowledge into practice; (c) potential barriers to KT; (d) solutions proposed by physicians for effective KT. RESULTS: Family physicians find themselves rather ambivalent about the translation of knowledge based on scientific literature, but generally express much interest in KT. They often feel overwhelmed by "information floods" and perceive clinical practice guidelines and other supports to be of limited usefulness for their practice. They often combine various formal and informal information sources to keep their knowledge up to date. Swiss family physicians report considering themselves as artisans, caring for patients with complex needs. CONCLUSION: Improved performance of KT initiatives in family medicine should be tailored to actual needs and based on high quality evidence-based sources.

Standard care practices and psychosocial interventions aimed at reducing parental distress following stillbirth: A systematic narrative review

Objective: To summarise and critically evaluate the evidence informing the provision of standard care practices and psychosocial interventions following stillbirth. Background: Stillbirth is increasingly recognised as a significant bereavement experience with the potential to cause substantial psychological distress for parents. Standard care practices and psychosocial interventions to support parents have undergone dramatic changes, with limited basis in evidence. Methods: A systematic narrative review was conducted of quantitative studies examining interventions designed to reduce psychological distress in parents following the loss of a stillborn baby. Results: Twenty-five studies met the inclusion criteria for the review. Substantial methodological weaknesses were identified among reviewed studies, including small and heterogeneous loss samples, weak study designs and lack of clarity in reported methods and outcomes. Inadequate replication of many findings substantially limits the generalisability of the evidence. Conclusion: Tentative evidence was found for the provision of mementoes of the baby and information regarding the cause of the loss, support group attendance, and cognitive behavioural interventions for parents identified with clinical levels of distress. Contradictory findings for the impact of contact with the baby prevent the formation of clear conclusions for this practice. Due to the methodological weaknesses prevalent in the research identified, the current evidence base is not considered sufficiently able to reliably inform care practices and intervention approaches. High-quality research evidence in this field is urgently required.

Paediatric end-of-life care needs in Switzerland: current practices, and perspectives from parents and professionals. A study protocol.

AIM: To present a protocol for a multi-phase study about the current practice of end-of-life care in paediatric settings in Switzerland. BACKGROUND: In Switzerland, paediatric palliative care is usually provided by teams, who may not necessarily have specific training. There is a lack of systematic data about specific aspects of care at the end of a child's life, such as symptom management, involvement of parents in decision-making and family-centred care and experiences and needs of parents, and perspectives of healthcare professionals. DESIGN: This retrospective nationwide multicentre study, Paediatric End-of-LIfe CAre Needs in Switzerland (PELICAN), combines quantitative and qualitative methods of enquiry. METHODS: The PELICAN study consists of three observational parts, PELICAN I describes practices of end-of-life care (defined as the last 4 weeks of life) in the hospital and home care setting of children (0-18 years) who died in the years 2011-2012 due to a cardiac, neurological or oncological disease, or who died in the neonatal period. PELICAN II assesses the experiences and needs of parents during the end-of-life phase of their child. PELICAN III focuses on healthcare professionals and explores their perspectives concerning the provision of end-of-life care. CONCLUSION: This first study across Switzerland will provide comprehensive insight into the current end-of-life care in children with distinct diagnoses and the perspectives of affected parents and health professionals. The results may facilitate the development and implementation of programmes for end-of-life care in children across Switzerland, building on real experiences and needs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01983852.

Sickness certification in primary care: a survey on views and practices among Swiss physicians.

QUESTIONS UNDER STUDY: Studies from several countries (Scandinavia, United Kingdom) report that general practitioners (GPs) experience problems in sickness certification. Our study explored views of Swiss GPs towards sickness certification, their practice and experience, professional skills and problematic interactions with patients. METHODS: We conducted an online survey among GPs throughout Switzerland, exploring behaviour of physicians, patients and employers with regard to sickness certification; GPs' views about sickness certification; required competences for certifying sickness absence, and approaches to advance their competence. We piloted the questionnaire and disseminated it through the networks of the five Swiss academic institutes for primary care. RESULTS: We received 507 valid responses (response rate 50%). Only 43/507 GPs experienced sickness certification as problematic per se, yet 155/507 experienced problems in sickness certification at least once a week. The 507 GPs identified estimating a long-term prognosis about work capacity (64%), handling conflicts with patients (54%), and determining the reduction of work capacity (42%) as problematic. Over 75% would welcome special training opportunities, e.g., on sickness certifications during residency (93%), in insurance medicine (81%), and conflict management (80%). CONCLUSION: Sickness certification as such does not present a major problem to Swiss GPs, which contrasts with the experience in Scandinavian countries and in the UK. Swiss GPs did identify specific tasks of sickness certification as problematic. Training opportunities on sick-leave certification and insurance medicine in general were welcomed.

English as a medium of instruction in teaching other languages: attitudes and practices

Internationalisation of HE and emergence of English as a global academic lingua franca used by people who share neither a common native tongue nor cultural and educational background have not only offered more opportunities but also raised challenges. According to recent European surveys, the percentage of pupils attaining the level of independent user in English varies from 14% to 82%, which evidences the potential and the complexity for English as a medium of instruction at tertiary level. This study aims to present the model of foreign language instruction at Vytautas Magnus University where one third of 30 languages are taught through English. It investigates the attitudes and practices of teachers in delivering their English-medium language courses by discussing the questions whether teaching other languages through English is psychologically, culturally and educationally preferable for teachers and students, whether it can limit the content taught and require a special methodology, how the teaching process changes with multiple languages used in the classroom and what level of English is necessary for teachers and students to ensure high quality of English-medium language teaching. The study is based on qualitative methodology with 12 language teachers participating as respondents. The results reveal areas in need of improvement.