Evolution in the profile of thyroid cancer cases treated in an oncology reference service: what changed in the last 20 years

Objective: To evaluate the characteristics of thyroid carcinoma cases treated at a reference hospital for cancer between 2008 and 2010.Methods: we studied 807 cases and analyzed the following clinicopathologic variables: symptoms, risk factors, diagnostic tests, staging, histological type, treatment performed and complications.Results: Females were more affected, with 660 cases (82%). The average age at diagnosis was 44.5 years. Prior exposure to ionizing radiation was reported by 22 (3%) patients, a family history of thyroid cancer by 89 (11%), and 289 (36%) individuals reported other types of cancer in the family. The fine needle aspiration biopsy was the main parameter for surgical indication and was suggestive of carcinoma in 463 patients (57%). Papillary carcinoma was the most common histological type, with 780 cases (96.6%). There were 728 (90%) total thyroidectomies, 43 (5.3%) reoperations or partial thyroidectomies followed by totalization, 23 (2.8%) extended thyroidectomies and only 13 (1.6%) partial thyroidectomies (lobectomy with isthmectomy). Neck dissection associated with thyroidectomy was done in 158 patients (19.5%). We observed a predominance of tumors classified as T1 in 602 (74.6%) patients. Transient hypocalcemia was the most frequent complication.Conclusion: The results show that the worldwide increase in the incidence of thyroid cancer has changed the profile of patients seen at a referral service. In addition, there were changes in the type of surgical treatment used, with increased use of total thyroidectomy in relation to partial and subtotal ones, and decreased use of elective neck dissections.

Aplication of videothoracoscopy in trauma - experience of a service

Objective: To evaluate patients with chest trauma submitted to videothoracoscopy during hospitalization. In 2007, the Trauma Surgery Group was created in the General Surgery Department of the Hospital Municipal Lourenço Jorge of Rio de Janeiro-RJ, and started following all trauma victims who were admitted to the Hospital. Methods : We conducted a retrospective analysis of patients submitted to thoracoscopy from July 2007 to May 2015, based on a database started at the beginning of this period and on data collection from patients who underwent thoracoscopy. We evaluated the following parameters: procedure effectiveness, indication of the procedure, conversion rate, complications and mortality. We included patients who presented post-traumatic pleural collections, such as retained hemothorax and pleural empyema, and penetrating injury in the thoracoabdominal transition. All patients were hemodynamic stable and signed an informed consent. Results: In the analyzed period 53 patients were submitted to videothoracoscopy; 24 had penetrating trauma (45.3%) and 29, blunt (54.7%), with a predominance of males (75.5%). The procedure was performed in 26 cases of retained hemothorax (49%), 14 cases of empyema (26.5%) and in 13 patients for evaluation of injury in the thoracoabdominal transition (24.5%). The thoracoscopy was effective in resolution of 36 cases (80%), without need for further procedure. There was a conversion rate of 15.5% and 3 procedure complications related (6.6%). Mortality was nil. Conclusion: In this series, videothoracoscopy proved that this diagnostic and therapeutic procedure is safe and effective, if performed by a surgeon with appropriate training, especially when it is indicated in cases of retained hemothorax and evaluation of penetrating thoracoabdominal trauma.

IT service catalog : a case study of the implementation need in a Pan-Nordic Insurance Company

IT service catalog is an increasingly important issue as many IT organizations have been realizing it as a central communication and visualization tool to bridge the gap between IT and the business. This study reviews relevant literature on IT service catalog and related issues on IT services delivery. Furthermore, the study shows how IT service catalog can enhance IT effectiveness as well as provide more benefits when integrating with Configuration Management Database. In order to analyze whether IT service catalog is needed to be implemented in a Pan-Nordic Insurance Company, this study also investigates the current IT services delivery of a case study. The findings of the study show the problems in the current situation of IT services delivery in the case. The characteristics of IT service catalog are recommended in order to help with the mentioned flaws.

Transfer of Administrative HR Services to Global Service Center in Poland

Liiketoimintaa tukevien palvelujen etätuotanto edustaa uutta kansainvälistymisen muotoa. Kehittyvien markkinoiden nousu yhdistettynä yritysten arvoketjutoimintojen kansainvälistymiseen on luonut yrityksille kasvavan paineen etsiä parasta sijaintia toiminnoilleen. Monikansalliset yritykset ovat yhä useammin korvanneet paikallisia henkilöstöpalvelujaan siirtymällä globaaliin malliin jaettujen palvelujen tuotannossa. Tämä diplomityö on toteutettu tukeakseen UPM:n henkilöstöhallintoa globaalin palvelukeskuksen perustamisessa Puolaan. Tutkimuksen tavoitteena on laajentaa käsitystä henkilöstöpalvelujen tarjontamallin uudistamiseen johtaneista tekijöistä ja motiiveista. Empiirisen tutkimuksen tärkein tavoite on tukea rekrytoinnin hallinnollisten töiden siirtoa globaaliin palvelukeskukseen palvelun laadun säilyessä vähintään aikaisemmalla tasolla. Tutkimuksen tulokset painottavat strategista näkökulmaa muutokseen. Strategiset syyt UPM:n henkilöstöhallinnon globaalin palvelukeskuksen perustamiselle sisältävät ylikapasiteetin ja päällekkäisten toimintojen vähentämisen eri maissa. Muutos lisää palvelun joustavuutta sekä edesauttaa toiminnan läpinäkyvyyttä, ennustettavuutta ja kustannusten valvontaa. Onnistuneesti toteutetut jaetut palvelut voivat toimia hyvänä lähtökohtana tehokkaiden henkilöstöpalvelujen tuottamiselle.

Developing customer need based services in personal security service industry

The purpose of this thesis is to examine how services can be developed and how the voice of the customer can be incorporated to the strategic planning of services. Furthermore, the objective is to investigate the methods of customer need analysis and service bundling. The data is collected from secondary and primary sources by reviewing the existing academic literature and by conducting in-depth interviews and surveys. The main findings of this research indicate that the service development in personal security service industry should be conducted through a formalized process and the process should begin with setting the strategic objectives. Moreover, the voice of the customer should be incorporated into all stages of the development process, especially into the front-end of the process. Furthermore, the information on customer needs should be gathered in a manner tailored for the purposes of service development.

The Impact of Service Quality and Relationship Quality on Customer Loyalty in Business-to-Business Context

The main objective of this Master’s Thesis was to examine the interrelations of service quality and relationship quality (customer satisfaction, trust and commitment), and find out are they antecedents for customer loyalty in business-to-business context. Literature review revealed some research gaps concerning these focal concepts, which should be studied more closely. The theoretical basis for this research was collected for evaluating a strategic increase of customer’s perceptions of service quality and relationship quality as well as customer loyalty in business-to-business environment, and it was tested empirically in a sample of 164 corporate customers, who responded to the Internet-based survey. The measures, used in the survey, were first assessed by using confirmatory factor analysis (CFA), and then the hypothesized relationships were further verified using structural equation modeling (SEM) in LISREL 8.80. There was found support for a half of the hypothesized construct relations. The results of the research confirm the direct influence of trust and commitment on customer loyalty. Also, service quality turned out to have an indirect impact on customer loyalty through trust. No support, however, was offered for the proposed impact of customer satisfaction on loyalty in this case. The research provides managerially relevant and actionable results that may help service providers execute more specific customer relationship quality strategies that lead to higher customer loyalty.

Toimintaohjeita Standard service-asemien palveluskunnalle

kuv., 21 x 27 cm

Shell service

kuv., 15 x 22 cm

Shell service

kuv., 15 x 22 cm

Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil

PURPOSE: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. METHODS: A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. RESULTS: The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm², respectively, versus 12.4 cm² in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). CONCLUSION: Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.

Ford service certificat

kuv., 9 x 18 cm

Ford service certifikat

kuv., 10 x 18 cm

Ford service certifikat

kuv., 10 x 18 cm

Quality Indicators of Cervical Cytopathology Tests in the Public Service in Minas Gerais, Brazil

Objective The objective of this study is to assess the performance of cytopathology laboratories providing services to the Brazilian Unified Health System (Sistema Único de Saúde - SUS) in the State of Minas Gerais, Brazil. Methods This descriptive study uses data obtained from the Cervical Cancer Information System from January to December 2012. Three quality indicators were analyzed to assess the quality of cervical cytopathology tests: positivity index, percentage of atypical squamous cells (ASCs) in abnormal tests, and percentage of tests compatiblewith high-grade squamous intraepithelial lesions (HSILs). Laboratories were classified according to their production scale in tests per year≤5,000; from 5,001 to 10,000; from 10,001 to 15,000; and 15,001. Based on the collection of variables and the classification of laboratories according to production scale, we created and analyzed a database using Microsoft Office Excel 97-2003. Results In the Brazilian state of Minas Gerais, 146 laboratories provided services to the SUS in 2012 by performing a total of 1,277,018 cervical cytopathology tests. Half of these laboratories had production scales≤5,000 tests/year and accounted for 13.1% of all tests performed in the entire state; in turn, 13.7% of these laboratories presented production scales of > 15,001 tests/year and accounted for 49.2% of the total of tests performed in the entire state. The positivity indexes of most laboratories providing services to the SUS in 2012, regardless of production scale, were below or well below recommended limits. Of the 20 laboratories that performed more than 15,001 tests per year, only three presented percentages of tests compatible with HSILs above the lower limit recommended by the Brazilian Ministry of Health. Conclusion The majority of laboratories providing services to the SUS in Minas Gerais presented quality indicators outside the range recommended by the Brazilian Ministry of Health.