Assessing chronic disease management in European health systems : concepts and approaches

This book comprises two volumes and builds on the findings of the DISMEVAL project (Developing and validating DISease Management EVALuation methods for European health care systems), funded under the European Union's (EU) Seventh Framework Programme (FP7) (Agreement no. 223277). DISMEVAL was a three-year European collaborative project conducted between 2009 and 2011. It contributed to developing new research methods and generating the evidence base to inform decision-making in the field of chronic disease management evaluation (www.dismeval.eu). In this book, we report on the findings of the project's first phase, capturing the diverse range of contexts in which new approaches to chronic care are being implemented and evaluating the outcomes of these initiatives using an explicit comparative approach and a unified assessment framework. In this first volume, we describe the range of approaches to chronic care adopted in 12 European countries. By reflecting on the facilitators and barriers to implementation, we aim to provide policy-makers and practitioners with a portfolio of options to advance chronic care approaches in a given policy context.

Supplier Evaluation on the Standard Material and Component Markets in the Electronic Manufacturing Equipment Industry

Ty��n tavoitteena oli arvioida ja selvitt���� toimittajasuhteeseen vaikuttavia tekij��it�� JOT Automation Group Oyj.n ja sen alihankkijoiden v��lisess�� yhteisty��ss�� ja muodostaa yrityksen kilpailukyky�� parantava toimittaja-arviointiprosessi. Ty��ss�� keskityttiin tarkastelemaan yleisill�� materiaali- ja komponenttimarkkinoilla toimivia toimittajia elektroniikkateollisuuden tuotantoj��rjestelmien valmistuksessa. Ensin tutustuttiin toimittajasuhdetta ja sen arviointia k��sitelleeseen kirjallisuuteen. Teorian tueksi tehtiin haastatteluja ja kartoitettiin ensisijaisia tarpeita ja tavoitteita arviointiprosessille. Valmis prosessi testattiin k��yt��nn��ss�� kahden eri case-esimerkin avulla. Prosessista muodostui kahteen eri ty��kaluun jakautunut kokonaisuus, joista auditointi arvioi toimittajan kyvykkyytt�� vastatta sille asetettuihin vaatimuksiin. Toimittajan suorituskyvyn mittaaminen puolestaan testaa ja vertaa jatkuvasti toiminnan todellista tasoa auditoinnissa saatuihin tuloksiin. Ty�� sis��lt���� selvityksen ja ohjeistuksen toimittaja-arviointiprosessin k��yt��st��. Prosessin k��ytt�� alentaa toimittajaan kohdistuvaa materiaalien saatavuuteen ja hankintaan liittyvi�� riskej��. Esimerkeist�� saadut kokemukset osoittivat, ett�� prosessin avulla p����st����n pureutumaan t��rkeisiin ydinalueisiin ja kehitt��m����n niit�� sek�� toimittajalle, ett�� ostajayritykselle edullisella tavalla. Toimittaja-arviointiprosessista kehittyy toimintatapa yrityksen ja sen toimittajan v��lisen suhteen yll��pit��miseksi.

Data collection and criticality analysis for cost effective maintenance during the life cycle of a flue gas line

Ty��n tarkoituksena oli ker��t�� k��ytt��varmuustietoa savukaasulinjasta kahdelta suomalaiselta sellutehtaalta niiden k��ytt����notosta aina t��h��n p��iv����n asti. K��ytt��varmuustieto koostuu luotettavuustiedoista sek�� kunnossapitotiedoista. Ker��tyn tiedon avulla on mahdollista kuvata tarkasti laitoksen k��ytt��varmuutta seuraavilla tunnusluvuilla: suunnittelemattomien h��iri��iden lukum����r�� ja korjausajat, laitteiden seisokkiaika, vikojen todenn��k��isyys ja korjaavan kunnossapidon kustannukset suhteessa savukaasulinjan korjaavan kunnossapidon kokonaiskustannuksiin. K��ytt��varmuustiedon ker��ysmetodi on esitelty. Savukaasulinjan kriittisten laitteiden m����rittelyyn k��ytetty metodi on yhdistelm�� kyselytutkimuksesta ja muunnellusta vian vaikutus- ja kriittisyysanalyysist��. Laitteiden valitsemiskriteerit lopulliseen kriittisyysanalyysiin p����tettiin k��ytt��varmuustietojen sek�� kyselytutkimuksen perusteella. Kriittisten laitteiden m����ritt��misen tarkoitus on l��yt���� savukaasulinjasta ne laitteet, joiden odottamaton vikaantuminen aiheuttaa vakavimmat seuraukset savukaasulinjan luotettavuuteen, tuotantoon, turvallisuuteen, p����st��ihin ja kustannuksiin. Tiedon avulla rajoitetut kunnossapidon resurssit voidaan suunnata oikein. Kriittisten laitteiden m����ritt��misen tuloksena todetaan, ett�� kolme kriittisint�� laitetta savukaasulinjassa ovat molemmille sellutehtaille yhteisesti: savukaasupuhaltimet, laahakuljettimet sek�� ketjukuljettimet. K��ytt��varmuustieto osoittaa, ett�� laitteiden luotettavuus on tehdaskohtaista, mutta periaatteessa samat p����linjat voidaan n��hd�� suunnittelemattomien vikojen todenn��k��isyytt�� esitt��viss�� kuvissa. Kustannukset, jotka esitet����n laitteen suunnittelemattomien kunnossapitokustannusten suhteena savukaasulinjan kokonaiskustannuksiin, noudattelevat hyvin pitk��lle luotettavuusk��yr����, joka on laskettu laitteen seisokkiajan suhteena k��ytt��tunteihin. K��ytt��varmuustiedon ker��ys yhdistettyn�� kriittisten laitteiden m����ritt��miseen mahdollistavat ennakoivan kunnossapidon oikean kohdistamisen ja ajoittamisen laitteiston elinaikana siten, ett�� luotettavuus- ja kustannustehokkuusvaatimukset saavutetaan.

Evaluation of winter temperatures on apple budbreak using grafted twigs

Temperature is the main climate factor related to induction, maintenance and dormancy release in apple (Malus domestica Borkh.). The inadequate chilling exposure in apples causes budbreak problems, resulting in decrease in yield potential. Thus, the knowledge of physiological principles and environmental factors determining the dormancy phenomenon, especially winter temperature effects, it is necessary for the efficient selection of cultivars in a productive region. In addition, it is indispensable to adapt the orchard management aiming to decrease the problems caused by lack chilling during winter. The objective of this study was to evaluate the influence of different thermal conditions during the dormancy period on budbreak of apple cultivars. One-year-old twigs of 'Castel Gala' and 'Royal Gala' cultivars, grafted on M7 rootstock, were submitted to temperatures of 5, 10 and 15��C for different exposure periods (168; 336; 672; 1,008 and 1,344 hours). After treatments execution, the plants were kept in a greenhouse at 25��C. Budbreak was quantified when accumulated 3,444; 6,888; 10,332; 13,776; 17,220 and 20,664 GDH��C after temperature treatments. The cultivars responded differently to temperature effect during the winter period. The temperature of 15��C during winter shows a greater effectiveness on 'Castel Gala' apple budbreak while in the 'Royal Gala' apples the temperatures of 5 and 10��C show better performance. 'Castel Gala' cultivar (low chilling requirement) may supply its physiological necessities, may be capable to budburst, even when subjected to higher temperatures in relation to 'Royal Gala' apples (high chilling requirement).

Wireless Applications Evaluation and Development Process: Case -Paper Industry Logistics

S��hk��isen liiketoiminnan ja mobiliteetin konvergenssi yhdess�� teknologisen innovaation kiihtyv��n vauhdin kanssa ovat saaneet aikaan kiinnostusta langattomia liiketoimintaratkaisuja kohtaan. T��m��n diplomity��n tavoitteena oli tutkia s��hk��isen liiketoiminnan langattomien sovellusten arviointi- ja kehitysprosessia. Ty�� keskittyy tarkastelemaan paperiteollisuuden toimitusketjun langatonta seurantaa. Tutkimuksessa esitet����n langattoman s��hk��isen liiketoiminnan m����ritelm��, kuvaillaan langattomuuden eri sovellusalueita ja sovellusten arviointi- ja kehitysprosessin strategisia sek�� teknologisia ulottuvuuksia. Ty�� luo viitekehyksen, jonka avulla tarkastella langattomien teknologioiden merkityst�� logistiikassa. Tutkimuksen merkitt��vin tulos on prosessimalli sovellusten arvioimiseksi ja kehitt��miseksi. Mallilla kehitetty langaton sovellus osoittautui tarkastelussa hy��dylliseksi toimitusketjun hallinnassa.

The Dynamic Customer Portfolio Method in Customer Relationship Management

Tutkielman tavoitteena on m����ritell�� keskeiset ja sopivat asiakasportfoliomallit ja asiakasmatriisit asiakassuhteen m����ritt��miseen. Tutkimus keskittyy asiakassuhteen arvottamiseen ja avainasiakkaiden m����ritt��miseen kohdeyrityksess��. Keskeisimm��t ja sopivimmat asiakasportfliomallit huomioidaan asiakkaiden arvioinnissa. Tutkielman teoriaosassa esitell����n tunnetuimmat ja k��ytetyimm��t asiakasportfoliomallit ja matriisit alan kirjallisuuden perusteella. T��m��n lis��ksi asiakasportfoliomalleihin yhdistet����n n��k��kulmia suhdemarkkinoinnin, asiakkuuksien johtamisen ja tuoteportfolioiden teorioista. Keskeisimm��t kirjallisuuden l��hteet ovat johtamisen ja markkinoinnin alalta. Tutkielman empiriaosassa esitell����n kohdeyritys ja sen t��m��n hetkinen asiakassuhteiden johtamisk��yt��nt��. Lis��ksi tehd����n parannusehdotuksia kohdeyrityksen nykyiseen asiakassuhteiden arvottamismenetelm����n jotta asiakassuhteiden arvon laskeminen vastaisi mahdollisimman hyvin kohdeyrityksen nykyisi�� tarpeita. Asiakassuhteen arvon m����ritt��miseksi k��ytet����n my��s fokusryhm��haastattelua. Avainasiakkaat m����ritell����n ja tilannetta havainnollistetaan sijoittamalla avainasiakkaat asiakasportfolioon.

Evaluation and realisation of a market entry method: The entry of a small high technology company into the British construction software markets

Tutkielman tavoitteena on tutkia, mik�� olisi parhaiten case-yritykselle sopiva menetelm�� tulla tekem����n kauppaa ulkomaan markkinoille. Kaikki yleiset kansainv��lisille markkinoilletulomenetelm��t esitet����n ja niiden edut ja haitat tuodaan esille. Selvitt��ess�� teht��v��nantajayrityksen resurssit, odotukset ja vaatimukset todetaan, ett�� yhteisty��ss�� teht��v�� markkinoilletulo on p��tevin vaihtoehto. T��m��n j��lkeen valitaan parhaiten tarkoitukseen sopiva yritys ennalta valitusta yritysvaihtoehtojen ryhm��st�� ja testataan t��m��n yrityksen yhteisty��sopivuus case-yrityksen kanssa. Yritysten v��linen yhteisty��sopivuus arvioidaan analysoimalla yritykset haastattelujen avulla ja tutkielmassa esitettyjen teorioiden avulla. Sopivuus todetaan hyv��ksi, kattaen 71 prosenttia analysoiduista kohdista. Kaksikymment��yhdeks��n prosenttia kohdista todetaan kohdiksi, joissa yritysten v��linen yhteisymm��rrys ei ole toimeksiantajayrityksen minimivaatimukset t��ytt��v����. N��it�� kohtia tullaan k��ytt��m����n suunnittelun pohjana kun suunnitellaan jatkoneuvotteluja yhteisty��n k��ynnist��miseksi.

Non-invasive diagnostic and prognostic evaluation of liver cirrhosis and portal hypertension.

Cirrhosis is the ���nal stage of most of chronic liver diseases, and is almost invariably complicated by portal hypertension, which is the most important cause of morbidity and mortality in these patients. This review will focus on the non-invasive methods currently used in clinical practice for diagnosing liver cirrhosis and portal hypertension. The ���rst-line techniques include physical examination, laboratory parameters, transient elastography and Doppler-US. More sophisticated imaging methods which are less commonly employed are CT scan and MRI, and new technologies which are currently under evaluation are MR elastography and acoustic radiation force imaging (ARFI). Even if none of them can replace the invasive measurement of hepatic venous pressure gradient and the endoscopic screening of gastroesophageal varices, they notably facilitate the clinical management of patients with cirrhosis and portal hypertension, and provide valuable prognostic information.

European Stroke Organisation (ESO) guidelines for the management of temperature in patients with acute ischemic stroke.

BACKGROUND: Hyperthermia is a frequent complication in patients with acute ischemic stroke. On the other hand, therapeutically induced hypothermia has shown promising potential in animal models of focal cerebral ischemia. This Guideline Document presents the European Stroke Organisation guidelines for the management of temperature in patients with acute ischemic stroke. METHODS: A multidisciplinary group identified related questions and developed its recommendations based on evidence from randomized controlled trials elaborating the Grading of Recommendations Assessment, Development, and Evaluation approach. This Guideline Document was reviewed within the European Stroke Organisation and externally and was approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee. RESULTS: We found low-quality evidence, and therefore, we cannot make any recommendation for treating hyperthermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and hyperthermia; moderate evidence to suggest against routine prevention of hyperthermia with antipyretics as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and normothermia; very low-quality evidence to suggest against routine induction of hypothermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke. CONCLUSIONS: The currently available data about the management of temperature in patients with acute ischemic stroke are limited, and the strengths of the recommendations are therefore weak. We call for new randomized controlled trials as well as recruitment of eligible patients to ongoing randomized controlled trials to allow for better-informed recommendations in the future.

Fetal laser therapy: applications in the management of fetal pathologies.

Fetoscopic coagulation of placental anastomoses is the treatment of choice for severe twin-to-twin transfusion syndrome. In the present day, fetal laser therapy is also used to treat amniotic bands, chorioangiomas, sacrococcygeal teratomas, lower urinary tract obstructions and chest masses, all of which will be reviewed in this article. Amniotic band syndrome can cause limb amputation by impairing downstream blood flow. Large chorioangiomas (>4 cm), sacrococcygeal teratomas or fetal hyperechoic lung lesions can lead to fetal compromise and hydrops by vascular steal phenomenon or compression. Renal damage, bladder dysfunction and lastly death because of pulmonary hypolasia may be the result of megacystis caused by a posterior urethral valve. The prognosis of these pathologies can be dismal, and therapy options are limited, which has brought fetal laser therapy to the forefront. Management options discussed here are laser release of amniotic bands, laser coagulation of the placental or fetal tumor feeding vessels and laser therapy by fetal cystoscopy. This review, largely based on case reports, does not intend to provide a level of evidence supporting laser therapy over other treatment options. Centralized evaluation by specialists using strict selection criteria and long-term follow-up of these rare cases are now needed to prove the value of endoscopic or ultrasound-guided laser therapy.

Cost evaluation and comparison of three decision strategies for cardiac revascularization : results of the suspected CAD protocol of the European CMR registry

Background: The public health burden of coronary artery disease (CAD) is important. Perfusion cardiac magnetic resonance (CMR) is generally accepted to detect and monitor CAD. Few studies have so far addressed its costs and costeffectiveness. Objectives: To compare in a large CMR registry the costs of a CMR-guided strategy vs two hypothetical invasive strategies for the diagnosis and the treatment of patients with suspected CAD. Methods: In 3'647 patients with suspected CAD included prospectively in the EuroCMR Registry (59 centers; 18 countries) costs were calculated for diagnostic examinations, revascularizations as well as for complication management over a 1-year follow-up. Patients with ischemia-positive CMR underwent an invasive X-ray coronary angiography (CXA) and revascularization at the discretion of the treating physician (=CMR+CXA strategy). Ischemia was found in 20.9% of patients and 17.4% of them were revascularized. In ischemia-negative patients by CMR, cardiac death and non-fatal myocardial infarctions occurred in 0.38%/y. In a hypothetical invasive arm the costs were calculated for an initial CXA followed by FFR testing in vessels with ���50% diameter stenoses (=CXA+FFR strategy). To model this hypothetical arm, the same proportion of ischemic patients and outcome was assumed as for the CMR+CXA strategy. The coronary stenosis - FFR relationship reported in the literature was used to derive the proportion of patients with ���50% diameter stenoses (Psten) in the study cohort. The costs of a CXA-only strategy were also calculated. Calculations were performed from a third payer perspective for the German, UK, Swiss, and US healthcare systems.

Capability matrix ��� Identifying and evaluating the key capabilities of purchasing and supply management

Organizations gain resources, skills and technologies to find out the ultimate mix of capabilities to be a winner in the competitive market. These are all important factors that need to be taken into account in organizations operating in today's business environment. So far, there are no significant studies on the organizational capabilities in the field of PSM. The literature review shows that the PSM capabilities need to be studied more comprehensively. This study attempts to reveal and fill this gap by providing the PSM capability matrix that identifies the key PSM capabilities approached from two angles: there are three primary PSM capabilities and nine subcapabilities and, moreover, the individual and organizational PSM capabilities are identified and evaluated. The former refers to the PSM capability matrix of this study which is based on the strategic and operative PSM capabilities that complement the economic ones, while the latter relates to the evaluation of the PSM capabilities, such as the buyer profiles of individual PSM capabilities and the PSMcapability map of the organizational ones. This is a constructive case study. The aim is to define what the purchasing and supply management capabilities are and how they can be evaluated. This study presents a PSM capability matrix to identify and evaluate the capabilities to define capability gaps by comparing the ideal level of PSM capabilities to the realized ones. The research questions are investigated with two case organizations. This study argues that PSM capabilities can be classified into three primary categories with nine sub-categories and, thus, a PSM capability matrix with four evaluation categories can be formed. The buyer profiles are moreover identified to reveal the PSM capability gap. The resource-based view (RBV) and dynamic capabilities view (DCV) are used to define the individual and organizational capabilities. The PSM literature is also used to define the capabilities. The key findings of this study are i) the PSM capability matrix to identify the PSM capabilities, ii) the evaluation of the capabilities to define PSM capability gaps and iii) the presentation of the buyer profiles to identify the individual PSM capabilities and to define the organizational PSM capabilities. Dynamic capabilities are also related to the PSM capability gap. If a gap is identified, the organization can renew their PSM capabilities and, thus, create mutual learning and increase their organizational capabilities. And only then, there is potential for dynamic capabilities. Based on this, the purchasing strategy, purchasing policy and procedures should be identified and implemented dynamically.

Prototype of a web-based participative decision support platform in natural hazards and risk management

This paper presents the current state and development of a prototype web-GIS (Geographic Information System) decision support platform intended for application in natural hazards and risk management, mainly for floods and landslides. This web platform uses open-source geospatial software and technologies, particularly the Boundless (formerly OpenGeo) framework and its client side software development kit (SDK). The main purpose of the platform is to assist the experts and stakeholders in the decision-making process for evaluation and selection of different risk management strategies through an interactive participation approach, integrating web-GIS interface with decision support tool based on a compromise programming approach. The access rights and functionality of the platform are varied depending on the roles and responsibilities of stakeholders in managing the risk. The application of the prototype platform is demonstrated based on an example case study site: Malborghetto Valbruna municipality of North-Eastern Italy where flash floods and landslides are frequent with major events having occurred in 2003. The preliminary feedback collected from the stakeholders in the region is discussed to understand the perspectives of stakeholders on the proposed prototype platform.

Spatiotemporal Aspects of Environmental Monitoring in the Complex Coastal Region of Southwest Finland

The management and conservation of coastal waters in the Baltic is challenged by a number of complex environmental problems, including eutrophication and habitat degradation. Demands for a more holistic, integrated and adaptive framework of ecosystem-based management emphasize the importance of appropriate information on the status and changes of the aquatic ecosystems. The thesis focuses on the spatiotemporal aspects of environmental monitoring in the extensive and geomorphologically complex coastal region of SW Finland, where the acquisition of spatially and temporally representative monitoring data is inherently challenging. Furthermore, the region is subject to multiple human interests and uses. A holistic geographical approach is emphasized, as it is ultimately the physical conditions that set the frame for any human activity. Characteristics of the coastal environment were examined using water quality data from the database of the Finnish environmental administration and Landsat TM/ETM+ images. A basic feature of the complex aquatic environment in the Archipelago Sea is its high spatial and temporal variability; this foregrounds the importance of geographical information as a basis of environmental assessments. While evidence of a consistent water turbidity pattern was observed, the coastal hydrodynamic realm is also characterized by high spatial and temporal variability. It is therefore also crucial to consider the spatial and temporal representativeness of field monitoring data. Remote sensing may facilitate evaluation of hydrodynamic conditions in the coastal region and the spatial extrapolation of in situ data despite their restrictions. Additionally, remotely sensed images can be used in the mapping of many of those coastal habitats that need to be considered in environmental management. With regard to surface water monitoring, only a small fraction of the currently available data stored in the Hertta-PIVET register can be used effectively in scientific studies and environmental assessments. Long-term consistent data collection from established sampling stations should be emphasized but research-type seasonal assessments producing abundant data should also be encouraged. Thus a more comprehensive coordination of field work efforts is called for. The integration of remote sensing and various field measurement techniques would be especially useful in the complex coastal waters. The integration and development of monitoring system in Finnish coastal areas also requires further scientific assesement of monitoring practices. A holistic approach to the gathering and management of environmental monitoring data could be a cost-effective way of serving a multitude of information needs, and would fit the holistic, ecosystem-based management regimes that are currently being strongly promoted in Europe.

Evaluation of Teacher Education Programs by Students and Graduates

The purpose of this research was to do a repeated cross-sectional research on class teachers who study in the 4th year and also graduated at the Faculty of Education, University of Turku between the years of 2000 through 2004. Specifically, seven research questions were addressed to target the main purpose of the study: How do class teacher education masters��� degree senior students and graduates rate ���importance; effectiveness; and quality��� of training they have received at the Faculty of Education? Are there significant differences between overall ratings of importance; effectiveness and quality of training by year of graduation, sex, and age (for graduates) and sex and age (for senior students)? Is there significant relationship between respondents��� overall ratings of importance; effectiveness and their overall ratings of the quality of training and preparation they have received? Are there significant differences between graduates and senior students about importance, effectiveness, and quality of teacher education programs? And what do teachers��� [Graduates] believe about how increasing work experience has changed their opinions of their preservice training? Moreover the following concepts related to the instructional activities were studied: critical thinking skills, communication skills, attention to ethics, curriculum and instruction (planning), role of teacher and teaching knowledge, assessment skills, attention to continuous professional development, subject matters knowledge, knowledge of learning environment, and using educational technology. Researcher also tried to find influence of some moderator variables e.g. year of graduation, sex, and age on the dependent and independent variables. This study consisted of two questionnaires (a structured likert-scale and an open ended questionnaire). The population in study 1 was all senior students and 2000-2004 class teacher education masters��� degree from the departments of Teacher Education Faculty of Education at University of Turku. Of the 1020 students and graduates the researcher was able to find current addresses of 675 of the subjects and of the 675 graduates contacted, 439 or 66.2 percent responded to the survey. The population in study 2 was all class teachers who graduated from Turku University and now work in the few basic schools (59 Schools) in South- West Finland. 257 teachers answered to the open ended web-based questions. SPSS was used to produce standard deviations; Analysis of Variance; Pearson Product Moment Correlation (r); T-test; ANOVA, Bonferroni post-hoc test; and Polynomial Contrast tests meant to analyze linear trend. An alpha level of .05 was used to determine statistical significance. The results of the study showed that: A majority of the respondents (graduates and students) rated the overall importance, effectiveness and quality of the teacher education programs as important, effective and good. Generally speaking there were only a few significant differences between the cohorts and groups related to the background variables (gender, age). The different cohorts were rating the quality of the programs very similarly but some differences between the cohorts were found in the importance and effectiveness ratings. Graduates of 2001 and 2002 rated the importance of the program significantly higher than 2000 graduates. The effectiveness of the programs was rated significantly higher by 2001 and 2003 graduates than other groups. In spite of these individual differences between cohorts there were no linear trends among the year cohorts in any measure. In respondents��� ratings of the effectiveness of teacher education programs there was significant difference between males and females; females rated it higher than males. There were no significant differences between males��� and females��� ratings of the importance and quality of programs. In the ratings there was only one difference between age groups. Older graduates (35 years or older) rated the importance of the teacher training significantly higher that 25-35 years old graduates. In graduates��� ratings there were positive but relatively low correlations between all variables related to importance, effectiveness and quality of Teacher Education Programs. Generally speaking students��� ratings about importance, effectiveness and quality of teacher education program were very positive. There was only one significant difference related to the background variables. Females rated higher the effectiveness of the program. The comparison of students��� and graduates��� perception about importance, effectiveness, and quality of teacher education programs showed that there were no significant differences between graduates and students in the overall ratings. However there were differences in some individual variables. Students rated higher in importance of ���Continuous Professional Development���, effectiveness of ���Critical Thinking Skills��� and ���Using Educational Technology��� and quality of ���Advice received from the advisor���. Graduates rated higher in importance of ���Knowledge of Learning Environment��� and effectiveness of ���Continuous Professional Development���. According to the qualitative data of study 2 some graduates expressed that their perceptions have not changed about the importance, effectiveness, and quality of training that they received during their study time. They pointed out that teacher education programs have provided them the basic theoretical/formal knowledge and some training of practical routines. However, a majority of the teachers seems to have somewhat critical opinions about the teacher education. These teachers were not satisfied with teacher education programs because they argued that the programs failed to meet their practical demands in different everyday situations of the classroom e.g. in coping with students��� learning difficulties, multiprofessional communication with parents and other professional groups (psychologists and social workers), and classroom management problems. Participants also emphasized more practice oriented knowledge of subject matter, evaluation methods and teachers��� rights and responsibilities. Therefore, they (54.1% of participants) suggested that teacher education departments should provide more practice-based courses and programs as well as closer collaboration between regular schools and teacher education departments in order to fill gap between theory and practice.