Evaluation of success of mergers and acquisitions – Case Finnish forest companies

Tutkimuksen tavoitteena oli selvittää mitkä asiat vaikuttavat fuusioiden menestykseen, millaisia menetelmiä fuusioiden menestyksen mittaamiseen on ja mitä menetelmiä suomalaisessa metsäteollisuudessa käytetään ja kuinka systemaattista menestyksen mittaaminen on. Lisäksi arvioitiin kahden suomalaisen metsäteollisuuden fuusion kannattavuutta. Fuusioita koskevan kirjallisuuden perusteella luotiin haastattelurunko, jonka pohjalta saatiin suomalaisen metsäteollisuuden näkemys fuusioiden menestyksen mittaamisesta. Kirjallisuudessa esitettyjä menestyksen mittareita on osittain sovellettu laskentaosuudessa ja niiden avulla arvioitu fuusioiden kannattavuutta. Tärkeimmät fuusioihin vaikuttavat tekijät olivat haastattelujen perusteella toimialan konsolidoituminen ja yrityksen oma strategia. Fuusioiden menestyksen mittaaminen koettiin ongelmalliseksi, eikä mitään yhtenäistä käytäntöä ole. Stora Enson ja UPM-Kymmenen fuusioita voidaan pitää empiriaosuudessa esitettyjen laskelmien perusteella menestyksekkäinä.

Available evidence and outcome of off-label use of rituximab in clinical practice

Purpose: To analyze the therapeutic indications for off-label use of rituximab, the available evidence for its use, the outcomes, and the cost. Methods: This was a retrospective analysis of patients treated with rituximab for off-label indications from January 2007 to December 2009 in two tertiary hospitals. Information on patient characteristics, medical conditions, and therapeutic responses was collected from medical records. Available evidence for the efficacy of rituximab in each condition was reviewed, and the cost of treatment was calculated. Results: A total of 101 cases of off-label rituximab use were analyzed. The median age of the patients involved was 53 [interquartile range (IQR) 37.5-68.0] years; 55.4 % were women. The indications for prescribing rituximab were primarily hematological diseases (46 %), systemic connective tissue disorders (27 %), and kidney diseases (20 %). Available evidence supporting rituximab treatment for these indications mainly came from individual cohort studies (53.5 % of cases) and case series (25.7 %). The short-term outcome (median 3 months, IQR 2-4 months) was a complete response in 38 % of cases and partial response in 32.6 %. The highest short-term responses were observed for systemic lupus erythematosus and membranous glomerulonephritis, and the lowest was for neuromyelitis optica, idiopathic thrombocytopenic purpura, and miscellaneous indications. Some response was maintained in long-term follow-up (median 23 months IQR 12-30months) in 69.2%of patients showing a short-term response. Median cost per patient was 5,187.5 (IQR 5,187.5-7,781.3). Conclusions: In our study, off-label rituximab was mainly used for the treatment of hematological, kidney, and systemic connective tissue disorders, and the response among our patient cohort was variable depending on the specific disease. The level of evidence supporting the use of rituximab for these indications was low and the cost was very high. We conclude that more clinical trials on the off-label use of rituximab are needed, although these may be difficult to conduct in some rare diseases. Data from observational studies may provide useful information to assist prescribing in clinical practice.

Key elements for, and indicators of, a successful transition: an international Delphi study.

PURPOSE: The purpose of this study was to reach an international consensus to determine what key elements should be part of a transition program and what indicators could be used to assess its success. METHODS: For this purpose, a Delphi study including an international panel of 37 experts was carried out. The study consisted of three rounds, with response rates ranging from 86.5% to 95%. At each round, experts were asked to assess key elements (defined as the most important elements for the task) and indicators (defined as quantifiable characteristics). At each round, panelists were contacted via e-mail explaining them the tasks to be done and giving them the Web link where to complete the questionnaire. At Round 3, each key element and indicator was assessed as essential, very important, important, accessory, or unnecessary. A 70% agreement was used as cutoff. RESULTS: At Round 3, more than 70% of panelists agreed on six key elements being essential, with one of them (Assuring a good coordination between pediatric and adult professionals) reaching an almost complete consensus (97%). Additionally, 11 more obtained more than 70% agreement when combined with the Very important category. Among indicators, only one (Patient not lost to follow-up) was considered almost unanimously (91%) as essential by the panelists and seven others also reached consensus when the Very important category was included. CONCLUSIONS: Using these results as a framework to develop guidelines at local, national, and international levels would allow better assessing and comparing transition programs.

Gonalgies: que faire en médecine de premier recours [Knee pain in ambulatory practice].

Knee pain is a frequent complaint in ambulatory practice. Because of its complexity, the knee is prone to trauma, arthritis and the impact of aging. Septic arthritis is an emergency and has to be suspected when important knee pain is associated with fever, an alteration of the general condition, or in a particular social context. In most cases the clinical examination can identify the type of pathology. Conservative treatment is beneficial in most cases and physiotherapy a major component of the prognosis.

Trace element monitoring in the ICU: quality and economic impact of a change in sampling practice.

BACKGROUND & AIMS: Trace elements (TE) are involved in the immune and antioxidant defences which are of particular importance during critical illness. Determining plasma TE levels is costly. The present quality control study aimed at assessing the economic impact of a computer reminded blood sampling versus a risk guided on-demand monitoring of plasma concentrations of selenium, copper, and zinc. METHODS: Retrospective analysis of 2 cohorts of patients admitted during 6 months periods in 2006 and 2009 to the ICU of a University hospital. INCLUSION CRITERIA: to receive intravenous micronutrient supplements and/or to have a TE sampling during ICU stay. The TE samplings were triggered by computerized reminder in 2006 versus guided by nutritionists in 2009. RESULTS: During the 2 periods 636 patients met the inclusion criteria out of 2406 consecutive admissions, representing 29.7% and 24.9% respectively of the periods' admissions. The 2009 patients had higher SAPS2 scores (p = 0.02) and lower BMI compared to 2006 (p = 0.007). The number of laboratory determinations was drastically reduced in 2009, particularly during the first week, despite the higher severity of the cohort, resulting in à 55% cost reduction. CONCLUSIONS: The monitoring of TE concentrations guided by a nutritionist resulted in a reduction of the sampling frequency, and targeting on the sickest high risk patients, requiring a nutritional prescription adaptation. This control leads to cost reduction compared to an automated sampling prescription.

Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice.

Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. In order for TBS to usefully add to bone mineral density (BMD) and clinical risk factors in osteoporosis risk stratification, it must be independently associated with fracture risk, readily obtainable, and ideally, present a risk which is amenable to osteoporosis treatment. This paper summarizes a review of the scientific literature performed by a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. Low TBS is consistently associated with an increase in both prevalent and incident fractures that is partly independent of both clinical risk factors and areal BMD (aBMD) at the lumbar spine and proximal femur. More recently, TBS has been shown to have predictive value for fracture independent of fracture probabilities using the FRAX® algorithm. Although TBS changes with osteoporosis treatment, the magnitude is less than that of aBMD of the spine, and it is not clear how change in TBS relates to fracture risk reduction. TBS may also have a role in the assessment of fracture risk in some causes of secondary osteoporosis (e.g., diabetes, hyperparathyroidism and glucocorticoid-induced osteoporosis). In conclusion, there is a role for TBS in fracture risk assessment in combination with both aBMD and FRAX.

Human Capital Questionnaire (PHCQ): Assessment of European nurses' perception as indicators of human capital quality

Healthcare accreditation models generally include indicators related to healthcare employees' perceptions (e.g. satisfaction, career development, and health safety). During the accreditation process, organizations are asked to demonstrate the methods with which assessments are made. However, none of the models provide standardized systems for the assessment of employees. In this study, we analyzed the psychometric properties of an instrument for the assessment of nurses' perceptions as indicators of human capital quality in healthcare organizations. The Human Capital Questionnaire was applied to a sample of 902 nurses in four European countries (Spain, Portugal, Poland, and the UK). Exploratory factor analysis identified six factors: satisfaction with leadership, identification and commitment, satisfaction with participation, staff well-being, career development opportunities, and motivation. The results showed the validity and reliability of the questionnaire, which when applied to healthcare organizations, provide a better understanding of nurses' perceptions, and is a parsimonious instrument for assessment and organizational accreditation. From a practical point of view, improving the quality of human capital, by analyzing nurses and other healthcare employees' perceptions, is related to workforce empowerment.

Venttiili- ja toimilaitetehtaan tuotannon suunnittelu

Venttiili- ja toimilaitetehtaassa kokoonpannaan erilaisia venttiilityyppejä sekä toimi- laitteita. Koko Metso Automationin Helsingin tehtaiden tuotantotilanteen muuttuessa käynnistettiin kehitysprojekti, jonka tarkoituksena oli uudenaikaistaa venttiilien ja toimilaitteiden valmistus vastaamaan nykypäivän vaatimuksia. Laajamittaisen osa- valmistuksen ulkoistuksen ja tuotteiston muutoksen vuoksi tuotannon uudelleen- järjestäminen oli välttämätöntä. Diplomityön tarkoituksena oli suunnitella venttiili- ja toimilaitetehtaan layout sekä uutta tuotantotilannetta vastaavat toimintatavat. Haasteena oli kolmen hyvin erilailla toimivan tuotetehtaan yhdistäminen yhdeksi kokonaisuudeksi, jossa kunkin tehtaan parhaat toimintatavat yhdistyvät. Nykyinen tuotanto ja valmistusmäärät kartoitettiin ja analysoitiin, minkä jälkeen tuotannon suunnittelu uusiin tiloihin käynnistettiin. Työ jaettiin järjestelmällisesti osiin teorian ja käytännön osuuksien kesken siten, että teoria tukee työn käytännön- osuutta. Apuna käytettiin useita erilaisia materiaalivirtojen kartoitusmenetelmiä, lukuisia mittareita, selvityksiä, ennusteita ja erilaisia malleja tulevasta tuotannosta. Layout suunniteltiin käytössäolevaan tehdashalliin, mikä aiheutti runsaasti haasteita ja rajoitteita. Aikataulu tehtiin tarkasti siten, että muuttojärjestys lyötiin lukkoon, mutta kuormitustilanne ja koneiden siirrot aiheuttivat muutoksia aikataulussa. Tavoite tuotannon häiriöttömyydestä toteutui hyvin aikataulun kustannuksella. Käytännönosuudessa tarkasteltiin erityisesti kapasiteetin joustavuutta kuormituksen vaihdellessa sekä kehitettiin toimintatavat, joilla se hallitaan. Lisäksi tutkimuksen aikana käynnistettiin useita kehitysprojekteja työn tulosten pohjalta. Näitä olivat erilaiset varaston hallintaan sekä solujen itseohjautuvuuteen liittyvät asiat. Diplomityön tuloksena saatiin uusi layout sekä sitä tukeva uusi toimintatapa, solujen itseohjautuvuuden kehittäminen käynnistettiin, varastojen hallinnan osittainen ulkoistaminen aloitettiin. Lisäksi tuotannolle kehitettiin lukuisia seurantamittareita. Layoutprojekti toteutettiin loppuun diplomityön aikana

Teknologiayrityksen laajentuminen epävarmassa tilanteessa – reaalioptiolähtöinen kannattavuustarkastelu

Investoinnit ovat välttämättömiä, jotta yritys voi parantaa asemaansa toimintaympäristössään ja ylläpitää saavutettua kilpailuetua. Siksi investointien kannattavuuden tutkiminen on tärkeää. Reaalioptioiden avulla voidaan hyödyntää tulevaisuuden mahdollisuuksia ja vähentää uhkia, jolloin kannattavuuslaskentaan saadaan uusia näkökulmia. Reaalioptiot ovat strategisen suunnittelun työkaluja. Työssä tutkittiin reaalioptioiden mahdollisuuksia teknologiayrityksen päätöksenteon tukena. Tarkastelu tehtiin kohdeyrityksen näkökulmasta keskittyen informaation tuottamiseen ja reaalioptioiden soveltamiseen kerätyssä aineistossa. Reaalioptiot ovat tärkeitä riskienhallintavälineitä, joiden avulla tulevaisuuden muutokset voidaan ottaa muuttujiksi investointeja arvotettaessa. Reaalioptioiden soveltava käyttö on ollut vielä vähäistä niiden monimutkaisuudesta ja muuttujien hallinnan vaikeudesta johtuen. Reaalioptioita on tutkittu tieteellisessä kirjallisuudessa jo merkittävästi. Suomessa käytännön sovellukset ovat olleet vähäisiä. Reaalioptioiden strategisesta luonteesta johtuen tulokset ovat usein myös salaisia. Tässä työssä käytetään kohdeyrityksen pyynnöstä Case-osuudessa kohteista muutettuja nimiä ja arvoja.

Prevalence of Ischemic Heart Disease and Management of Coronary Risk in Daily Clinical Practice: Results from a Mediterranean Cohort of HIV-Infected Patients

There are conflicting data on the prevalence of coronary events and the quality of the management of modifiable cardiovascular risk factors (CVRF) inHIV-infected patients. Methods.We performed a retrospective descriptive study to determine the prevalence of coronary events and to evaluate the management of CVRF in a Mediterranean cohort of 3760 HIV-1-infected patients from April 1983 through June 2011. Results.We identified 81 patients with a history of a coronary event (prevalence 2.15%); 83% of them suffered an acute myocardial infarction. At the time of the coronary event, CVRF were highly prevalent (60.5% hypertension, 48% dyslipidemia, and 16% diabetes mellitus).OtherCVRF, such as smoking, hypertension, lack of exercise, and body mass index, were not routinely assessed. After the coronary event, a significant decrease in total cholesterol ( � = 0.025) and LDLcholesterol ( � = 0.004) was observed. However, the percentage of patients whomaintained LDL-cholesterol > 100mg/dL remained stable (from 46% to 41%, � = 0.103). Patients using protease inhibitors associated with a favorable lipid profile increased over time ( � = 0.028). Conclusions.The prevalence of coronary events in our cohort is low. CVRF prevalence is high and theirmanagement is far from optimal. More aggressive interventions should be implemented to diminish cardiovascular risk in HIV-infected patients.

Establishment of a Representative Practice-based Research Network (PBRN) for the Monitoring of Primary Care in Switzerland.

Data are urgently needed to better understand processes of care in Swiss primary care (PC). A total of 2027 PC physicians, stratified by canton, were invited to participate in the Swiss Primary care Active Monitoring network, of whom 200 accepted to join. There were no significant differences between participants and a random sample drawn from the same physician databases based on sex, year of obtaining medical school diploma, or location. The Swiss Primary care Active Monitoring network represents the first large-scale, nationally representative practice-based research network in Switzerland and will provide a unique opportunity to better understand the functioning of Swiss PC.