Impact of a telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol.

BACKGROUND: Pediatric rheumatic diseases have a significant impact on children's quality of life and family functioning. Disease control and management of the symptoms are important to minimize disability and pain. Specialist clinical nurses play a key role in supporting medical teams, recognizing poor disease control and the need for treatment changes, providing a resource to patients on treatment options and access to additional support and advice, and identifying best practices to achieve optimal outcomes for patients and their families. This highlights the importance of investigating follow-up telenursing (TN) consultations with experienced, specialist clinical nurses in rheumatology to provide this support to children and their families. METHODS/DESIGN: This randomized crossover, experimental longitudinal study will compare the effects of standard care against a novel telenursing consultation on children's and family outcomes. It will examine children below 16 years old, recently diagnosed with inflammatory rheumatic diseases, who attend the pediatric rheumatology outpatient clinic of a tertiary referral hospital in western Switzerland, and one of their parents. The telenursing consultation, at least once a month, by a qualified, experienced, specialist nurse in pediatric rheumatology will consist of providing affective support, health information, and aid to decision-making. Cox's Interaction Model of Client Health Behavior serves as the theoretical framework for this study. The primary outcome measure is satisfaction and this will be assessed using mixed methods (quantitative and qualitative data). Secondary outcome measures include disease activity, quality of life, adherence to treatment, use of the telenursing service, and cost. We plan to enroll 56 children. DISCUSSION: The telenursing consultation is designed to support parents and children/adolescents during the course of the disease with regular follow-up. This project is novel because it is based on a theoretical standardized intervention, yet it allows for individualized care. We expect this trial to confirm the importance of support by a clinical specialist nurse in improving outcomes for children and adolescents with inflammatory rheumatisms. TRIAL REGISTRATION: ClinicalTrial.gov identifier: NCT01511341 (December 1st, 2012).

ECG interpretation during the acute phase of coronary syndromes: in need of improvement?

QUESTION UNDER STUDY: Emergency room (ER) interpretation of the ECG is critical to assessment of patients with acute coronary syndromes (ACS). Our aim was to assess its reliability in our institution, a tertiary teaching hospital. METHODS: Over a 6-month period all consecutive patients admitted for ACS were included in the study. ECG interpretation by emergency physicians (EPs) was recorded on a preformatted sheet and compared with the interpretation of two specialist physicians (SPs). Discrepancies between the 2 specialists were resolved by an ECG specialist. RESULTS: Over the 6-month period, 692 consecutive patients were admitted with suspected ACS. ECG interpretation was available in 641 cases (93%). Concordance between SPs was 87%. Interpretation of normality or abnormality of the ECG was concordant between EPs and SPs in 475 cases (74%, kappa = 0.51). Interpretation of ischaemic modifications was concordant in 69% of cases, and as many ST segment elevations were unrecognised as overdiagnosed (5% each). The same findings occurred for ST segment depressions and negative T waves (12% each). CONCLUSIONS: Interpretation of the ECG recorded during ACS by 2 SPs was discrepant in 13% of cases. Similarly, EP interpretation was discrepant from SP interpretation in 25% of cases, equally distributed between over- and underdiagnosing of ischaemic changes. The clinical implications and impact of medical education on ECG interpretation require further study.

Teaching-service integration: implications and roles in experiences of Undergraduate Courses in Nursing

The study aimed at understanding the implications of the teaching-service integration to nursing education from the perspective of teachers, students and professionals in Primary Healthcare as well as identifying the roles of teachers and professionals who follow practical experiences in education. This is a case study of qualitative approach carried out in five undergraduate courses in Nursing in the state of Santa Catarina. A total of 22 teachers and 14 professionals were interviewed and five focus groups were conducted with students. Results are presented in two categories: Implications of the teaching-service integration to education in Nursing: contributing factors and intervening factors and Relationships established in the experiences: a unison speech and a dissonant practice. The contributions of the teaching-service integration are undeniable. Despite this belief, there are intervening factors that need to be on the agenda for discussion. The role of facilitator in education emerged strongly despite conflicting perceptions remain.

Pleasure-suffering indicators of nursing work in a hemodialysis nursing service

OBJECTIVE To measure the pleasure and suffering indicators at work and relate them to the socio-demographic and employment characteristics of the nursing staff in a hemodialysis center in southern Brazil. METHOD Quantitative research, with 46 workers. We used a self-completed form with demographic and labor data and the Pleasure and Suffering Indicators at Work Scale (PSIWS). We conducted a bivariate and correlation descriptive analysis with significance levels of 5% using the Epi-Info® and PredictiveAnalytics Software programs. RESULTS Freedom of Speech was considered critical; other factors were evaluated as satisfactory. The results revealed a possible association between sociodemographic characteristics and work, and pleasure and suffering indicators. There was a correlation between the factors evaluated. CONCLUSION Despite the satisfactory evaluation, suffering is present in the studied context, expressed mainly by a lack of Freedom of Speech, with the need for interventions to prevent injury to the health of workers.

Identifying the gap between need and intervention for alcohol use disorders in Europe.

AIMS: A literature review of existing research on the prevalence of alcohol use disorders (AUDs) and availability of alcohol interventions in Europe was conducted. The review also explored what is known about the gap between need and provision of alcohol interventions in Europe. METHODS: The review search strategy included: (i) descriptive studies of alcohol intervention systems in Europe; (ii) studies of alcohol service provision in Europe; and (iii) studies of prevalence of AUD and alcohol needs assessment in Europe. RESULTS: Europe has a relatively high level of alcohol consumption and the resulting disabilities are the highest in the world. Most research on implementation of alcohol interventions in Europe has been restricted to screening and brief interventions. Alcohol needs assessment methodology has been developed but has not been applied in comparative studies across countries in Europe. CONCLUSIONS: This review points to key gaps in knowledge related to alcohol interventions in Europe. There is a lack of comparative data on variations in alcohol treatment systems across European countries and there is also a lack of comparative data on the prevalence of alcohol use disorders across European countries and the relative gap between need and access to treatment. The forthcoming Alcohol Measures for Public Health Research Alliance (AMPHORA) research project work package on 'Early identification and treatment' aims to address these gaps.

Putting Public Service Motivation into Context. A Balance Between Universalism and Particularism

Research on Public Service Motivation (PSM) has increased enormously in the last 20 years. Besides the analysis of the antecedents of PSM and its impact on organizations and individuals, many open questions about the nature of PSM itself still remain. This article argues that the theoretical construct of PSM should be contextualized by integrating the political and administrative contexts of public servants when investigating their specific attitudes towards working in a public environment. It also challenges the efficacy of the classic four-dimensional structure of PSM when it is applied to a specific context. The findings of a confirmatory factor analysis from a dataset of 3754 employees of 279 Swiss municipalities support the appropriateness of contextualizing parts of the PSM construct. They also support the addition of an extra dimension called, according to previous research, Swiss democratic governance. With regard to our results, there is a need for further PSM research to set a definite measure of PSM, particularly in regard to the international diffusion of empirical research on PSM.Points for practitionersThis study shows that public service motivation is a relevant construct for practitioners and may be used to better assess whether public agents are motivated by values or not. Nevertheless, it stresses also that the measurement of PSM must be adapted to the institutional context as well. Public managers interested in understanding better the degree to which their employees are motivated by public values must be aware that the measurement of this PSM construct has to be contextualized. In other words, PSM is also a function of the institutional environment in which organizations operate.

Dental service utilization by Europeans aged 50 plus.

OBJECTIVES: To describe variations in the utilization of dental services by persons aged 50+ from 14 European countries and to identify the extent to which such variations are attributable to differences in oral health need and in accessibility of dental care. METHODS: We use data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Waves 2 and 3) and estimate a series of multivariate logistic regression models to analyze variations in dental service utilization (overall dental attendance, preventive treatment and/or operative treatment, dental attendance in early life years) RESULTS: Overall dental attendance and incidence of solely preventive treatment are comparatively high in the Netherlands, Sweden, Denmark, Germany, and Switzerland. In contrast, overall dental attendance is relatively low in Spain, Italy, France, Greece, Poland, and Ireland. Moreover, a high incidence of solely operative treatment is observed in Austria, Italy, and France, whereas in the Netherlands, Sweden, Denmark, Switzerland, and Ireland, the incidence of solely operative treatment is comparably low. By and large, these variations persist even when controlling for cross-country differences in oral health need and in accessibility of dental care. CONCLUSIONS: In comparison with other European regions, there is a tendency toward more frequent and preventive dental treatment of the elderly populations residing in Scandinavia and Western Europe. Such utilization patterns appear only partially attributable to differences in need for and accessibility of dental care.

Accreditation of forensic pathology service: a priviledge or a nightmare?

Forensic experts play a major role in the legal process as they offer professional expert opinion and evidence within the criminal justice system adjudicating on the innocence or alleged guilt of an accused person. In this respect medico-legal examination is an essential part of the investigation process, determining in a scientific way, the cause(s) and manner of unexpected and/or unnatural death or bringing clinical evidence in case of physical, psychological or sexual abuse in living people. From a legal perspective, these types of investigation must meet international standards i-e it should be independent, effective and prompt. Ideally the investigations should be conducted by board certified experts in forensic medicine, endowed with a solid experience in this field, without any hierarchical relationship with the prosecuting authorities and having access to appropriate facilities in order to provide forensic reports of high quality. In this respect, there is a need for any private or public national or international authority including non-governmental organisations seeking experts qualified in forensic medicine,to have at disposal a list of specialists working in accordance with high standards of professional performance within forensic pathology services that have been successfully submitted to an official accreditation/certification process using valid and acceptable criteria. To reach this goal the National Association of Medical examiners (NAME) has elaborated an accreditation/certification check-list which should be served as decision-making support to assist inspectors appointed to evaluate applicants. In the same spirit than NAME Accreditation Standards, ECLM board decided to set up an ad hoc working group with the mission to elaborate an accreditation/certification procedure similar to the NAME's one but taking into account the realities of forensic medicine practices in Europe and restricted to post-mortem investigations. This accreditation process applies to services and not to individual practitioners by emphasizing policies and procedures rather than professional performance. In addition the standards to be complied with should be considered as the minimum standards needed to get the recognition of performing and reliable forensic pathology service.

From geriatric service to primary care: a retrospective pharmaceutical analysis of the medical prescription

Introduction The population of elderly persons is increasing andnegative outcomes due to polymedication are frequent. Discrepanciesin information about medication are frequent when older persons aretransitioning from hospital to home, increasing the risk of hospitalreadmission. The aims of this study were a) to determine discrepanciesin medical regimen indicated in two official discharge documents(DS = discharge summary, DP=discharge prescription); b) to characterizethe pharmacotherapy prescribed in older patients dischargedfrom a geriatric service.Materials & Methods Elderly patients (N=230) discharged from thegeriatric service (CHUV, Lausanne) over a 6-month period (January toJune 2009) were selected. Community pharmacists compared DS andDP to identify discrepancies including (a) drugs' name; (b) schedule ofadministration, dosage, frequency, prn prescription, treatment durationand galenic formulation. Beers' criteria were applied to identifypotentially inappropriate drugs and a descriptive analysis of drug costs,prescription profiles and generics were also performed.Results On average, patients were 82 ± 7 years old and stayed23.0 ± 11.6 days in the geriatric service. The delay between the datesof patient's discharge with the DP and the sending of the DS to hisgeneral physician averaged 14.0 ± 7.5 days (range 1-55). The DPhad an average of 10.0 ± 3.3 drugs (range 2-19). 77% of patients hadat least one discrepancy. A drug was missing on the DS in 57.8% ofpatients and 19.6% had a missing prn prescription. Among the 2312drugs prescribed, 3% belonged to Beers' list. They were prescribed to61 patients (26.5%), with 6 patients cumulating two Beers' potentiallyinappropriate drugs in their treatment. Analgesics (85% of thepatients), anticoagulants (80%), mineral supplements (77%), laxatives(52%) and antihypertensives (46%) were the drug classes most frequentlyprescribed. Mean costs of treatment as per DP was160.4 ± 179.4 Euros. Generic prescription represented more than 5%of the costs for 3 therapeutic classes (cholesterol-lowering agents(64%), antihypertensives (50%) and antidepressants (47%)).Discussion & Conclusion The high discrepancy rate between medicationlisted in the DP and the DS highlights a need for safetyimprovement. Potential benefits are expected from reinforced pharmacist-physician collaboration in transition from hospital to primarycare. In addition, even though Beers' criteria are questionable, thedrugs prescribed in this already fragile population, and the potentialopportunities of economical optimizations, are advocating thedevelopment and the scientific evaluation of a structured advancedcollaborative pharmacy practice service. This foresees improvedeffectiveness, safety and efficiency in the medication management ofelderly persons.

Wärtsilä Field Service - Kehittämisen välineenä oppiva organisaatio ja innovaatiot

Pro gradu tutkimuksessa käsitellään oppivan organisaation ja innovatiivisuuden teorioita eri näkökulmista. Kirjallisuuskatsauksen jälkeen esitellään Turun Wärtsilä Field Service, ja empiirisessä osiossa teetetään edellä mainittuihin aiheisiin liittyen kaksi ryhmähaastattelua osaston työntekijöillä. Tämä pro gradu syntyi tarpeesta toteuttaa tutkimus Wärtsilä Field Servicessä tekijöistä, jotka vaikuttavat innovatiiviseen toimintaa sekä tiedon välittymiseen. Haastattelujen pohjalta syntyy ensi kertaa suomenkielistä materiaalia Wärtsilä kenttähuollon työntekijöiden mielipiteistä ja innovatiivisuutta estävistä ja edistävistä tekijöistä. Tämä on myös gradun päätutkimus kohde. Oppivat organisaatiot pyrkivät jatkuvasti uusiutumaan ympäristön vaatimustenmukaisesti ja analysoimaan omaa toimintaansa. Täten yksilöiltä edellytetään jatkuvaa muutosvalmiutta, innovatiivisuutta ja oppimisvalmiutta. Tämän perusteella,tässä tutkimuksessa, innovatiivisuus oletetaan kuuluvaksi myös erottamattomastioppiviin organisaatioihin. Lisäksi informaation välittyminen huomioidaan tutkimuksessa keskeisenä tekijänä, sillä innovatiivisuus kanavoituu yrityksen eduksi parhaiten, mikäli työntekijät saadaan jakamaan tietoa avoimesti. Tutkimuksen tavoitteena on palvella johtoa, ja antaa pohja selvitystyölle kehitettäessä yrityksen toimintaa, ja kerättäessä ideoita, jotka lopulta tuottavat lisäarvoa yrityksen toiminnalle. Ryhmähaastattelujen tuloksena syntyy ehdotelmia toteuttamiskelpoisista arkipäivän toimintaan liittyvistä parannuksista, joita Wärtsilän kenttähuollossa on mahdollista soveltaa.

Value added logistical support service. Part 1 : Trends and new concept model

The aim of `Valssi' study was to find out the service requirements in `business-to-business' (B2B) markets and to present a new logistics service concept, where the traditional logistics service is expanded with significant manufacturing and value addedfacilities. The traditional third-party logistics service providers are not necessarily able to offer services, which cover widely the needs of potential customers. The study has been outlined to spare part markets in metal industry. In the second phase of the Valssi-project the aim is to examine the economical conditions and potentiality of the new logistics business concept. This research report (Part 1) concentrates on examining current trends in global and domestic logistics markets. Based on detailed survey among the participating companies, the study presents basis for a new logistics business concept model. The developed concept consists of 12 different service modules, which are split into deeper details of processes. The integration of worldwide supplier and service provider network together with customer companies systems is a challenge. The report focuses on evaluating the requirements for the new business concept from the customer-companies point of view. The study paints an overall picture of distribution and service provider network including an abstract about the software and system integration possibilities. As a result of the survey, it can be concluded that thereis need for the new business concept among the participating companies, and a modular service concept meets the requirements of them, because the new sophisticated concept considers the specialities involved in spare part logistics in metal industry.

Generation and interconnection capacity expansion in cross-border electricity markets : the need for policy coordination

Electricity is a strategic service in modern societies. Thus, it is extremely important for governments to be able to guarantee an affordable and reliable supply, which depends to a great extent on an adequate expansion of the generation and transmission capacities. Cross- border integration of electricity markets creates new challenges for the regulators, since the evolution of the market is now influenced by the characteristics and policies of neighbouring countries. There is still no agreement on why and how regions should integrate their electricity markets. The aim of this thesis is to improve the understanding of integrated electricity markets and how their behaviour depends on the prevailing characteristics of the national markets and the policies implemented in each country. We developed a simulation model to analyse under what circumstances integration is desirable. This model is used to study three cases of interconnection between two countries. Several policies regarding interconnection expansion and operation, combined with different generation capacity adequacy mechanisms, are evaluated. The thesis is composed of three papers. The first paper presents a detailed description of the model and an analysis of the case of Colombia and Ecuador. It shows that market coupling can bring important benefits, but the relative size of the countries can lead to import dependency issues in the smaller country. The second paper compares the case of Colombia and Ecuador with the case of Great Britain and France. These countries are significantly different in terms of electricity sources, hydro- storage capacity, complementarity and demand growth. We show that complementarity is essential in order to obtain benefits from integration, while higher demand growth and hydro- storage capacity can lead to counterintuitive outcomes, thus complicating policy design. In the third paper, an extended version of the model presented in the first paper is used to analyse the case of Finland and its interconnection with Russia. Different trading arrangements are considered. We conclude that unless interconnection capacity is expanded, the current trading arrangement, where a single trader owns the transmission rights and limits the flow during peak hours, is beneficial for Finland. In case of interconnection expansion, market coupling would be preferable. We also show that the costs of maintaining a strategic reserve in Finland are justified in order to limit import dependency, while still reaping the benefits of interconnection. In general, we conclude that electricity market integration can bring benefits if the right policies are implemented. However, a large interconnection capacity is only desirable if the countries exhibit significant complementarity and trust each other. The outcomes of policies aimed at guaranteeing security of supply at a national level can be quite counterintuitive due to the interactions between neighbouring countries and their effects on interconnection and generation investments. Thus, it is important for regulators to understand these interactions and coordinate their decisions in order to take advantage of the interconnection without putting security of supply at risk. But it must be taken into account that even when integration brings benefits to the region, some market participants lose and might try to hinder the integration process. -- Dans les sociétés modernes, l'électricité est un service stratégique. Il est donc extrêmement important pour les gouvernements de pouvoir garantir la sécurité d'approvisionnement à des prix abordables. Ceci dépend en grande mesure d'une expansion adéquate des capacités de génération et de transmission. L'intégration des marchés électriques pose des nouveaux défis pour les régulateurs, puisque l'évolution du marché est maintenant influencée par les caractéristiques et les politiques des pays voisins. Il n'est pas encore claire pourquoi ni comment les marches électriques devraient s'intégrer. L'objectif de cette thèse est d'améliorer la compréhension des marchés intégrés d'électricité et de leur comportement en fonction des caractéristiques et politiques de chaque pays. Un modèle de simulation est proposé pour étudier les conditions dans lesquelles l'intégration est désirable. Ce modèle est utilisé pour étudier trois cas d'interconnexion entre deux pays. Plusieurs politiques concernant l'expansion et l'opération de l'interconnexion, combinées avec différents mécanismes de rémunération de la capacité, sont évalués. Cette thèse est compose de trois articles. Le premier présente une description détaillée du modèle et une analyse du cas de la Colombie et de l'Equateur. Il montre que le couplage de marchés peut amener des bénéfices importants ; cependant, la différence de taille entre pays peut créer des soucis de dépendance aux importations pour le pays le plus petit. Le second papier compare le cas de la Colombie et l'Equateur avec le cas de la Grande Bretagne et de la France. Ces pays sont très différents en termes de ressources, taille des réservoirs d'accumulation pour l'hydro, complémentarité et croissance de la demande. Nos résultats montrent que la complémentarité joue un rôle essentiel dans l'obtention des bénéfices potentiels de l'intégration, alors qu'un taux élevé de croissance de la demande, ainsi qu'une grande capacité de stockage, mènent à des résultats contre-intuitifs, ce qui complique les décisions des régulateurs. Dans le troisième article, une extension du modèle présenté dans le premier article est utilisée pour analyser le cas de la Finlande et de la Russie. Différentes règles pour les échanges internationaux d'électricité sont considérées. Nos résultats indiquent qu'à un faible niveau d'interconnexion, la situation actuelle, où un marchand unique possède les droits de transmission et limite le flux pendant les heures de pointe, est bénéfique pour la Finlande. Cependant, en cas d'expansion de la capacité d'interconnexion, «market coupling» est préférable. préférable. Dans tous les cas, la Finlande a intérêt à garder une réserve stratégique, car même si cette politique entraine des coûts, elle lui permet de profiter des avantages de l'intégration tout en limitant ca dépendance envers les importations. En général, nous concluons que si les politiques adéquates sont implémentées, l'intégration des marchés électriques peut amener des bénéfices. Cependant, une grande capacité d'interconnexion n'est désirable que si les pays ont une complémentarité importante et il existe une confiance mutuelle. Les résultats des politiques qui cherchent à préserver la sécurité d'approvisionnement au niveau national peuvent être très contre-intuitifs, étant données les interactions entre les pays voisins et leurs effets sur les investissements en génération et en interconnexion. Il est donc très important pour les régulateurs de comprendre ces interactions et de coordonner décisions à fin de pouvoir profiter de l'interconnexion sans mettre en danger la sécurité d'approvisionnement. Mais il faut être conscients que même quand l'intégration amène de bénéfices pour la région, certains participants au marché sont perdants et pourraient essayer de bloquer le processus d'intégration.

Load and Performance Testing of Web Applications on Service Based Environments

Suorituskyky- ja kuormitustestien tekeminen sovelluksille on erittäin tärkeä osa tuotantoprosessia nykypäivänä. Myös Web-sovelluksia testataan yhä enemmän. Tarve suorituskyky- ja kuormitustestien tekemiselle on selvä. Testattavan ympäristön tämänhetkinen, mutta myös tulevaisuuden toimivuus taataan oikein tehdyillä testeillä ja niitä seuraavilla korjaustoimenpiteillä. Suurten käyttäjämäärien testaaminen manuaalisesti on kuitenkin hyvin vaikeaa. Sirpaleisen ympäristön, kuten palveluihin perustuvien Web-sovellusympäristöjen testaaminen on haaste. Tämän työn aiheena on arvioida työkaluja ja menetelmiä, joilla raskaita teollisia Web-sovelluksia voidaan testata. Tavoitteena on löytää testausmenetelmiä, joilla voidaan luotettavasti simuloida suuria käyttäjämääriä. Tavoitteena on myös arvioida erilaisten yhteyksien ja protokollien vaikutusta Web-sovelluksen suorituskykyyn.

Kunnossapitopalveluita tarjoavan yrityksen markkinapotentiaalin kartoittaminen, case: ABB Service Oy

Tämän tutkimuksen aiheena on markkinapotentiaalin kartoittaminen Satakunnassa. Esimerkkiyrityksenä on kansainvälinen kunnossapitopalveluita tarjoava yritys ABB Service Oy. Työn tavoitteena on selvittää markkinatutkimuksen avulla yrityksen markkinapotentiaali kohdealueella. Teoriaosassa käsitellään markkinapotentiaalin määräytymisen teoriaa sekä esitellään markkinointi- ja markkinatutkimuksen vaiheita. Empiirisessä osassa esitellään sekä kohdeyritys että sen toimiala. Esimerkkiyrityksen markkinapotentiaalin määrittämiseksi tehty kvalitatiivinen puhelinhaastattelututkimus käydään pääpiirteittäin läpi. Yritysten keskittyessä ydinosaamiseensa sekä teollisuuden koneiden ja laitteiden automatisoituessa yritykset ostavat yhä enemmän kunnossapitopalveluita ulkopuolelta. Näin ollen erikoisosaamistaan hyödyntävälle kunnossapitoyritykselle löytyy yhä kasvavat markkinat. Tutkimuksen tuloksista selviää, että esimerkkiyritys tunnetaan varsin hyvin kohdealueella. Markkinoiden mahdollisilla asiakkailla tulee olla kolme ominaisuutta: kiinnostus, tulot ja mahdollisuus ostaa tuote. Näillä perusteilla etsittiin kohdeyrityksen segmenttiin sopivat potentiaaliset uudet asiakkaat. Satakunnan markkinoilla parhaiten tulevat menestymään yritykset, jotka haluavat sitoutua näille markkinoille.

Development of e-Service tools for customer services and processes, Case: KONE Oyj Finland

Tutkimuksen tavoitteena oli selvittää miten kehittää yrityksen nykyistä e-palvelujärjestelmää, Internet -teknologiaan perustuvaa sähköisiä kommunikaatio- ja tiedonjakojärjestelmää, yrityksen business-to-business asiakkuuksien johtamisessa. Tavoitteena oli myös luoda ehdotukset uusista e-palvelusopimusmalleista. Tutkimuksen teoriaosuudessa pyrittiin kehittämään aikaisempiin tutkimuksiin, tietokirjallisuuteen ja asiantuntijoihin perustuva viitekehysmalli. Empiirisessä osassa tutkimuksen tavoitteisiin pyrittiin haastattelemalla yrityksen asiakkaita ja henkilöstöä, sekä tarkastelemalla asiakaskontaktien nykyistä tilaa ja kehittymistä. Näiden tietojen perusteella selvitettiin e-palvelun käyttäjien tarpeita, profiilia ja valmiuksia palvelun käyttöön sekä palvelun nykyistä houkuttelevuutta. Tutkimuksen teoriaosan lähdeaineistona käytettiin kirjallisuutta, artikkeleita ja tilastoja asiakashallinnasta sekä e-palveluiden, erityisesti Internet ja verkkopalveluiden markkinoinnista, nykytilasta sekä palveluiden kehittämisestä. Lisäksi tutkittiin kirjallisuutta arvoverkostoanalyysistä, asiakkaan arvosta, informaatioteknologiasta, palvelun laadusta ja asiakastyytyväisyydestä. Tutkimuksen empiirinen osa perustuu yrityksen henkilöstöltä sekä asiakkailta haastatteluissa kerättyihin tietoihin, yrityksen ennalta keräämiin materiaaleihin sekä Taloustutkimuksen keräämiin tietoihin. Tutkimuksessa käytettiin case -menetelmää, joka oli yhdistelmä sekä kvalitatiivista että kvantitatiivista tutkimusta. Casen tarkoituksena oli testata mallin paikkansapitävyyttä ja käyttökelpoisuutta, sekä selvittää onko olemassa vielä muita tekijöitä, jotka vaikuttavat asiakkaan saamaan arvoon. Kvalitatiivinen aineisto perustuu teemahaastattelumenetelmää soveltaen haastateltuihin asiakkaisiin ja yrityksen työntekijöihin. Kvantitatiivinen tutkimus perustuu Taloustutkimuksen tutkimukseen ja yrityksen asiakaskontakteista kerättyyn tietoon. Haastatteluiden perusteella e-palvelut nähtiin hyödyllisinä ja tulevaisuudessa erittäin tärkeinä. E-palvelut nähdään yhtenä tärkeänä kanavana, perinteisten kanavien rinnalla, tehostaa business-to-business -asiakkuuksien johtamista. Tutkimuksen antamien tulosten mukaan asiakkaiden palveluun liittyvän tieto-, taito-, tarpeellisuus- ja kiinnostavuustasojen vaihtelevaisuus osoittaa selvän tarpeen eritasoisille e-palvelupaketti ratkaisuille. Tuloksista muodostettu ratkaisuehdotus käsittää neljän eri e-palvelupaketin rakentamisen asiakkaiden eri tarpeita mukaillen.