Bile duct stones, strictures and iatrogenic lesions: studies on early diagnosis and treatment.

Aims: This study was carried out to investigate the role of common liver function tests, and the degree of common bile duct dilatation in the differential diagnosis of extrahepatic cholestasis, as well as the occurrence, diagnosis and treatment of iatrogenic bile duct injuries. In bile duct injuries, special attention was paid to gender and severity distribution and long-term results. Patients and methods: All consecutive patients with diagnosed common bile duct stones or malignant strictures in ERCP between August 2000 and November 2003. Common liver function tests were measured in the morning before ERCP on all of these 212 patients, and their common bile duct diameter was measured from ERCP films. Between January 1995 and April 2002, 3736 laparoscopic cholecystectomies were performed and a total of 32 bile duct injuries were diagnosed. All pre-, per-, and postoperative data were collected retrospectively; and the patients were also interviewed by phone. Results: Plasma bilirubin proved to be the best discriminator between CBD stones and malignant strictures (p≤0.001 compared to other liver function tests and degree of common bile duct dilatation). The same effect was seen in Receiver Operating Characteristics curves (AUC 0.867). With a plasma bilirubin cut-off value of 145 μmol/l, four out of five patients could be classified correctly. The degree of common bile duct dilatation proved to be worthless in differential diagnostics. After laparoscopic cholecystectomy the total risk for bile duct injury was 0.86%, including cystic duct leaks. 86% of severe injuries and 88% of injuries requiring operative treatment were diagnosed in females. All the cystic duct leakages and 87% of the strictures were treated endoscopically. Good long-term results were seen in 84% of the whole study population. Conclusions: Plasma bilirubin is the most effective liver function test in differential diagnosis between CBD stones and malignant strictures. The only value of common bile duct dilatation is its ability to verify the presence of extrahepatic cholestasis. Female gender was associated with higher number of iatrogenic bile duct injuries, and in particular, most of the major complications occur in females. Most of the cystic duct leaks and common bile duct strictures can be treated endoscopically. The long-term results in our institution are at an internationally acceptable level.

Teollisten palveluiden tarjoajien ja asiakkaan välisen yhteistyösuhteen kehittäminen

Työssä tutkitaan asennetun laitekannan kunnossapitopalveluun perustuvan yritysten välisen yhteistyösuhteen kehittämisen edellytyksiä. Tutkimus pohjautuu teollisten palveluiden, yritysten välisten yhteistyösuhteiden ja palveluiden kehittämisen osatekijöiden ja menestystekijöiden teoreettiseen tarkasteluun, sekä kohdeyrityksille suoritetun kvalitatiivisen haastattelututkimuksen tulosten analysointiin teoreettisen viitekehyksen valossa. Tavoitteena on muodostaa ehjä ja hallittava kokonaisuus monialaisen ongelmakentän kriittisistä osatekijöistä, sekä niiden keskinäisistä kausaliteeteista. Yritysten välisen yhteistyön lähtökohtana on, että kaikki yhteistyön osapuolet saavuttavat toiminnalla hyötyjä omasta näkökulmastaan tarkasteltuna. Yhteistyösuhteen kehittäminen ja yhteisen arvon toteutuminen edellyttää näin ollen, että tarjottavan palvelukokonaisuuden sisältämät potentiaaliset hyödyt ja toisaalta myös niitä vastaavat riskit ymmärretään sekä palveluntarjoajan että asiakkaan organisaatiossa. Yhteistyösuhteen kehittäminen edellyttää edelleen myös, että suhteen kehittymistä ja saavutettavia hyötyjä pystytään mittaamaan relevanttien mittareiden avulla. Tutkimuksessa keskitytään hyötypotentiaalin selvittämisen edellytyksiin, sekä hyötyjen viestimisen haasteisiin molempia osapuolia palvelevasta objektiivisesta näkökulmasta. Haastattelututkimuksessa havaittujen ongelmakohtien pohjalta eritellään kehityskohteita ja ratkaisuehdotuksia päätöksenteon tueksi sekä laajojen palvelukokonaisuuksien ja niihin liittyvän ongelmakentän hahmottamisen ja hallinnan helpottamiseksi.

Sisäisen raportoinnin kehittäminen autoliikkeessä

Diplomityön tavoitteena oli kehittää kohdeyrityksen sisäistä raportointia niin, että informaatiota voidaan hyödyntää päivittäisessä päätöksenteossa tehokkaammin. Tarkoituksena oli saada aikaan yksinkertainen ja selkeä raportointijärjestelmä, joka tuottaa raportteja eri organisaatiotasojen tarpeisiin. Työn teoriaosuudessa käytiin läpi informaation ja raportoinnin merkitystä yrityksen operatiiviseen toimintaan, yleisimpiä tieto- ja informaatiojärjestelmiä sekä suorituskyvyn mittaamista. Empiriaosuudessa selvitettiin kohdeyrityksen toimintaprosessit, määriteltiin eri organisaatiotasojen tieto- ja raportointitarpeet sekä suoritettiin uuden raportointijärjestelmän implementointi. Saatujen tulosten mukaan sisäisen raportoinnin tulee koostua sen käyttäjien tarpeista ja yrityksen kannalta merkityksellisestä informaatiosta. Työssä esitetty uusi raportointijärjestelmä tukee kohdeyrityksen päivittäistä päätöksentekoa tuottamalla olennaisia raportteja eri aikaväleiltä ja organisaatiotasoilta.

IT architecture for category driven corporate procurement measurement

The purpose of this thesis was to investigate creating and improving category purchasing visibility for corporate procurement by utilizing financial information. This thesis was a part of the global category driven spend analysis project of Konecranes Plc. While creating general understanding for building category driven corporate spend visibility, the IT architecture and needed purchasing parameters for spend analysis were described. In the case part of the study three manufacturing plants of Konecranes Standard Lifting, Heavy Lifting and Services business areas were examined. This included investigating the operative IT system architecture and needed processes for building corporate spend visibility. The key findings of this study were the identification of the needed processes for gathering purchasing data elements while creating corporate spend visibility in fragmented source system environment. As an outcome of the study, roadmap presenting further development areas was introduced for Konecranes.

Development of IT Service Management in a Large International Company

The purpose of this Master’s thesis is to examine the IT Service Management (ITSM) capabilities of a large international company and develop a design for the IT Service Management of the company. The thesis consists of two parts: a literature review and a case study. The first part is the literature review. It examines different aspects of IT Service Management. The purpose of the literature review is to increase the credibility of the case study. In the case study, the IT Service Management of a large industrial company is assessed, and an improved design for IT Service Management is created. The services are limited to common IT services, and management is limited to operative management. To assess and develop the case company’s IT Service Management, the IT organization and its ITSM capabilities are analyzed, and on the basis of the analyses, an improved IT Service Management model is created. As a result of the analyses, it was found out that the management of the IT organization is function-oriented. Therefore, the organization needs a management model that breaks the functional borders and brings services to the center of management. The designed model aspires to achieve this by defining IT services and modeling management processes from the service perspective.

Prognosis of after spot volumes at the Scandinavian electricity market

The Thesis is dedicated to development of an operative tool to support decision making in after spot trading on the Nordic electricity market. The basics of the Nordic electricity market, trading mechanisms on the spot and after spot markets are presented in the Thesis. Mathematical equations that describe electricity balance condition in the power system are offered. The main driving factors that impact deviation of actual electricity balance from the scheduled one (object) in the power system have been explored and mathematically defined. The behavioral model of the object and principal trends in change of state of the object under an impact of the driving factors are determined with the help of regression analysis made in Microsoft Office Excel. The behavioral model gives an indication for the total regulation volume (Elbas trades volume, volume of regulation market, balance power) for a certain hour that serves as the base input in estimating prices on the after spot markets. Proposals for development of methodologies of forecasting the after spot electricity prices are offered.

Posada en funcionament d'una oficina de tramitació ràpida (OTRA) de la Direcció General d'Indústria, del Govern de les Illes Balears

La Direcció General d’Indústria té com a principal finalitat el control de les instal•lacions i de diferents activitats de l’àmbit industrial; exerceix aquesta funció mitjançant la tramitació de documentacions tècniques i la inspecció. Com tota Administració Pública, es troba en un entorn molt dinàmic, on només les empreses més competitives poden subsistir i els ciutadans tenen noves necessitats molt diferents de les de fa un temps. Ambdós, empreses i ciutadans, exigeixen serveis de qualitat a un sector públic que no té altra alternativa que caminar en la mateixa direcció. L’objectiu d’aquest treball és planificar una sèrie d’accions estratègiques que permetran la millora dels serveis oferts a fi de complir amb les expectatives de la ciutadania. S’ha realitzat una anàlisi interna i de l’entorn de l’organització, el resultat de la qual ha estat la detecció d’una sèrie de punts de millora. A continuació s’ha definit una pla operatiu de qualitat, emmarcat dins del segon Pla Estratègic de Qualitat del Govern de les Illes Balears, amb tres propostes d’actuació: la separació de funcions, la tramitació ràpida d’expedients i el pla de formació. Les propostes esmentades constitueixen les bases d’una nova unitat orgànica (Oficina de Tramitació Ràpida), el model organitzatiu de la qual queda definit en els diferents apartats del treball. Igualment, s’hi descriu el procés de posada en funcionament dels distints procediments que es vagin adaptant al nou sistema i la planificació dels treballs a dur a terme, que seguiran el cicle de la qualitat de Deming, és a dir, planificar, fer, verificar i actuar.

Implantació d'un sistema de gestió integrada: ISO 9001:00, ISO 14001:04 i OHSAS 18001:07, en un centre d'estètica i perruqueria

En aquests últims anys, són moltes les empreses que han optat per la utilització de sistemes de gestió normalitzats, per a garantir la rendibilitat i fiabilitat dels resultats de la implantació del sistema de gestió en qüestió. A la dècada dels 90 va ser quan la implantació de sistemes de gestió va començar a ser important en la majoria de sectors econòmics. L’evolució en els sistemes de gestió a trets generals va iniciar-se primerament en l’àmbit de la qualitat, seguidament en la gestió ambiental i en última instància en la prevenció de riscos laborals. Aquests tres tipus de sistemes de gestió, en els últims anys s’han anat integrant, de manera que s’han reduït els recursos i els esforços emprats en la gestió, millorant significativament l’eficàcia i l’eficiència d’aquests sistemes. L’objectiu principal que persegueix aquest projecte, és definir un sistema de gestió que permeti a l’empresa conduir les seves activitats de forma simplificada i ordenada, i que alhora faciliti la informació necessària per a corregir i millorar les activitats. Un altre objectiu que pretén aconseguir aquest projecte, és el de dissenyar un SGI que aprofiti les sinèrgies generades en els diferents àmbits de la pròpia empresa i fomenti les interaccions entre els diferents nivells de l’organització. En conseqüència, millorarà de forma important els fluxos d’informació dins de l’empresa minimitzant els esforços i la pèrdua d’informació. El mètode escollit per a la implantació del SGI, ha estat la Gestió per Processos, la qual es basa en la definició i seguiment dels processos de l’empresa, partint de les necessitats del client i acabant quan aquestes estan satisfetes. En conclusió, a la finalització del present projecte s’obtindrà un SGI, amb tots els processos de l’empresa definits i implantats, que doni compliment a les normes UNEEN-ISO 9001:00, UNE-EN-ISO 14001:04 i OHSAS 18001:07. Aquest SGI, que s’ha realitzat des d’un punt de vista documental i teòric, suposarà una millora de l’eficàcia operativa dels processos i una important millora competitiva de l’empresa.

Realització d'una aplicació de gestió de xarxes per a la xarxa sensefils de Manresa GuifiBages

En els últims anys, la popularitat de les xarxes sensefils (WIFI) ha anat en augment a un ritme incansable. Des de petits aparells instal•lats a les cases amb aquesta tecnologia com a complement dels routers d’accés a internet instal•lats per diverses companyies, fins a empreses fent petits desplegaments per comunicar entre si les seves seus. Al marge d’aquests escenaris, s’ha produït un fenomen social d’acolliment d’aquesta tecnologia a nivell mundial, en forma del que coneixem com a xarxes ciutadanes / xarxes lliures / xarxes socials. Aquestes xarxes han estat possibles gràcies a diverses raons que han fet assequible a col•lectius de persones, tant els aparells com els coneixements necessaris per dur a terme aquestes actuacions. Dintre d’aquest marc, al Bages, concretament a Manresa, es va començar a desenvolupar una d’aquestes xarxes. Les decisions d’aquesta xarxa d’utilitzar exclusivament hardware i software de codi obert, i determinats aspectes tècnics de la xarxa, ha comportat que la xarxa fos incompatible amb algunes de les aplicacions de gestió de xarxes existents desenvolupades per comunicats com gufi.net a Osona. És per això que per garantir el creixement, la supervivència i l’èxit d’aquesta xarxa en el temps, és indispensable poder comptar amb una eina de gestió que s’adigui a les característiques de GuifiBages. L’objectiu principal d’aquest treball és dotar a la xarxa GuifiBages de les eines necessàries per poder gestionar tota la informació referent a l’estructura de la seva xarxa, tant per facilitar l’accés a nous usuaris sense molts coneixements tècnics, com per facilitar nous desplegaments / reparacions / modificacions de la xarxa d’una manera automàtica. Com a conclusió d’aquest treball, podem afirmar que les avantatges que proporciones tecnologies com Plone, faciliten enormement la creació d’aplicacions de gestió de continguts en entorn web. Alhora, l’ús de noves tècniques de programació com AJAX o recursos com els que ofereix Google, permeten desenvolupar aplicacions web que no tenen res a envejar al software tradicional. D’altra banda, voldríem destacar l’ús exclusiu de programari lliure tant en els paquets de software necessaris pel desenvolupament, com en el sistema operatiu i programes dels ordinadors on s’ha dut a terme, demostrant que es poden desenvolupar sistemes de qualitat sense dependre de programari privatiu.

Analítica preoperatoria

Antes de cualquier intervención quirúrgica podológica, es imprescindible el realizar una analítica de control. El perfil de esta analítica será relativo a la idiosincracia de cada paciente, dependiendo de su patología, medicación que esté tomando o factores de riesgo.

Luottamuksen ilmeneminen alueellisissa yhteistyöverkostoissa

Appearance of trust in regional, co-operative networks In our times, the value of social networks has been widely acknowledged. One can say that it is important for private persons to get networked, whilst it is even a must for companies and organizations in business life. This doctor's thesis examines three co-operative regional networks. Networks are located in Western Uusimaa (Länsi-Uusimaa) region in southernmost Finland, and they had both public organizations and private companies as participants (later called ‘players’). Initially, all of them were co-financed from public funds, and two of them are still operational while writing this. The main target of these networks has been to act as learning networks. The learning network stands for an ensemble of research and development units and workplaces constituting a common forum for learning. The main focus in this study has been on qualitative and structural characteristics of the networks, and how they are relating with intrinsic trust. In addition to the development of trust, it has been studied, at what level organizational learning within the networks takes place, and lastly, what kind of factors facilitate the development of social capital. The theoretical framework for the study is built on analysing trust and social capital. It is a 'mission impossible' to find single definitions for such major concepts. In this study, from the research questions' point of view it has been more relevant to concentrate on the aspects of networking and the relationships between the participating organizations. The total view in this study is very network-centric, and therefore those theories which have similar point of view have been prioritized. Such is the theory about structural holes by Ronald S. Burt (1992). It has been widely applied; especially his views on constraints affecting players in networks. The purpose of this study has not been to create new theories or to analyse and compare thoroughly the existing theoretical trends. Instead, the existing theories have provided the study with conceptual tools, which have been utilized for supporting the empirical results. The aim has been to create an explanatory case study consisting relevant discussion on the relationship between the network characteristics and the appearance of trust. The conceptual categorization for confidence vs. trust created by Niklas Luhmann (1979) is another important theoretical building block. In most cases, co-operation in networks is initiated by people already trusting in each other and willing to work together. However, personal trust is not sufficient in the long run to sustain the co-operation within the network: more abstract systemic trust described by Luhmann must also emerge. In the networks with different structures and at different development phases, these forms of trust appear at different levels. In this study, Luhmann’s systemic trust as a term has been replaced by the concept of 'trust in network as a system'. Structural characteristics of a network (density, centrality, structural holes etc.) have been selected to explain the creation of social capital and trust. The ability to adapt new information is essential for the development of social capital. Qualitative analysis for development phase has been used, and the Learning Network Maturity Test by Leenamaija Otala (2000) and her work have been applied. Thus, the qualitative characteristics and the structural characteristics of the networks are utilized together, when the creation of social capital and appearance of trust are assessed. Social Network Analysis, questionnaires and interviews have been the research methods. Quantitative and qualitative data have been combined. There is a similarity in viewpoints to research data with Extensive Case Study method, in which different cases are searched by exploring various cases and comparing certain common features between them and generic models. Development of trust, social capital and organizational learning has been explained in the study by comparing the networks in hand. Being a case study, it doesn't have targets to provide with general results and findings like conventional surveys. However, in this work phenomena and mechanisms related to them are interpreted from the empirical data. Key finding of this study is that the networks with high structural equality and clear target setting enable building trust to the network as a system. When systemic trust is present, e.g. changes in personnel involved in the co-operation won't hinder the network from remaining operational. On the other hand, if the players are not well motivated to co-operate, if the network is extremely centralized structurally, or if the network has players holding very much more beneficial position compared to the others, systemic trust won't develop: trust tends to remain at the personal level, and is directed to some players only. Such networks won't generate results and benefits to its players, and most probably they won’t live very long. In other words, learning networks cannot solely be based on willingness to learn, but also on willingness to co-operate.

Developing the Sourcing with the Purchasing Tool in the Chemical Company

The aim of this research was to investigate Tikkurila Oyj's Vantaa factories' current status in procurement and to develop the reporting of purchases and purchase warehouses, and to measure the activities during the implementation of the new purchasing tool. The implemented purchasing tool was based on ABC-analysis. Based on its reports the importance of performance measurements for the operations of the company, and the purpose of getting transparency to the company's supply chain on the part of purchasing were examined. A successful purchase- and material operation calls for accurate knowledge and professional skills. The research proved that with a separate purchasing tool, that analyses the existing information of the company's production management system, it is possible to get added value to whole supply chain's needs. The analyses and reports of the purchasing tool enable a more harmonized purchasing process at the operative level, and create a basis for internal targets and to their follow-up. At the same time the analyses clarify the current status and development trends of procurement fresh to the management. The increase of the possibilities of exploitation of information technology enables a perfect transparency to the case company's purchase department.

Materiaalitoimintojen kehittäminen kokoonpano-osastolla

Työn tavoitteena oli yhtenäisen toimintamallin luominen kohdeyrityksen materiaalitoiminnoille tuotannon kokoonpano-osastolla ja kokoonpanoa palvelevissa varastoissa. Toimintamallin tuli kattaa nimikkeiden siirrot ja siirtoihin liittyvät toimet toiminnanohjausjärjestelmässä. Lisäksi toimintamallin tuli vähentää saldovirheitä ja niistä johtuvia osapuutteita ja inventaarioepäselvyyksiä. Nykytilan kartoituksella yksilöitiin oleellisimmat kehityskohteet saldovirheiden eliminoimiseksi. Myös yrityksen lean-implementoinnin vaatimukset materiaalitoimintojen luotettavuudelle oli huomioitava. Kehityskohteiden tehostustoimista luotiin materiaalitoimintojen malli, joka yhtenäistää käytäntöjä ja vähentää operatiivisia saldojen hallinnan haasteita.

Distribution development in global business environment

The purpose of this master’s thesis was to analyze a case company’s distribution and its elements. With different distribution structure options a customer can be served with different ways. However, cost elements and service elements create different trade-offs. In this work the case company’s distribution’s present state was analyzed and conclusions were made. Based on these conclusions different alternatives for distribution were created. These different alternatives were analyzed through simulations and with more traditional calculations to compose the total operative costs of each alternative. Also other aspects were considered, such as required organizational changes and the possible better customer service. With the suggested 3-stock distribution structure shorter delivery times and possibly more punctual deliveries for products kept in stock could be achieved with the same operative costs as in current direct delivery model. Also, similar benefits could be achieved with other products with the 3-stock model.