Treatment of cancer with oral drugs: a position statement by the Spanish Society of Medical Oncology

Cancer treatment involves the participation of multiple medical specialties and, as our knowledge of the disease increases, this fact becomes even more apparent. The degree of multidisciplinarity is determined by several factors, which include the severity and type of disease, the increasing diversity in the available pharmacological and non-pharmacological therapies, and the range of specialists involved in cancer therapy, such as medical oncologists, radiotherapists, gynecologists, gastroenterologists, urologists, surgeons, and pneumologists, among others. Across Europe, the situation of cancer care can be variable due to the diversity of health systems, differences in drug reimbursement, and the degree of establishment of Medical Oncology as a medical specialty in the European Union states.

Venäjään liittyvän markkinatutkimustiedon markkinapotentiaali Suomessa

Tämän diplomityön tavoitteena on tehdä markkinatutkimus suomalaisista yrityksistä, jotka toimivat tai aikovat lähiaikoina aloittaa toiminnan Venäjän markkinoilla. Tutkimus tehdään kaksiosaisena kyselytutkimuksena ja sen avulla selvitetään, minkälaisia Venäjään liittyviä tietotarpeita eri toimialojen yrityksillä on. Tuloksien avulla työn teettäjä Tutkimus- ja Analysointikeskus TAK Oy pystyy kartoittamaan potentiaalisia uusia asiakasyrityksiä. Diplomityön alussa tutustutaan markkinatutkimukseen ja luodaan katsaus Venäjän markkinoiden erikoispiirteisiin sekä esitellään TAK Oy. Tämän jälkeen läpikäydään vaiheittain markkinatutkimus, jonka toteutus perustuu diplomityön alussa esiteltyihin taustatietoihin. Työn lopussa kerrotaan tutkimuksen tulokset sekä niiden pohjalta tehdyt johtopäätökset ja suositukset TAK Oy:lle. Viimeisenä osana tässä työssä on yhteenveto tutkimuksen keskeisimmistä asioista. Diplomityön tuloksena saatiin aikaiseksi tutkimus suomalaisten yritysten Venäjän kauppaan kohdistuvasta kiinnostuksesta ja Venäjän markkinoihin liittyvistä tietotarpeista. Lisäksi tutkimuksien perusteella saatiin laadittua lista yrityksistä, jotka voisivat olla kiinnostuneita TAK Oy:n tuottamista tutkimuspalveluista.

Käänteinen arvonlisäverotus rakennustoimialan näkökulmasta

Tutkielman tavoitteena on selvittää käänteisen arvonlisäverotuksen mahdollisen käyttöönoton vaikutuksia suomalaisille rakennusyrityksille. Käänteinen arvonlisäverotus liittyy rakennusalalla ilmenevän harmaan talouden hillitsemiseen. Vastaavanlainen menettely on käytössä muutamissa Euroopan maissa, joista verrokkimaaksi työhön valikoitui Ruotsi. Tutkielmassa on käyty läpi talousrikollisuutta rakennusalalla, rakennusalan erityispiirteitä, Suomen ja Ruotsin arvonlisäverojärjestelmiä sekä käännetyn menettelyn käytöstä saatuja kokemuksia. Lisäksi haluttiin selvittää ruotsalaisten tekemiä lainsäädännöllisiä valintoja sekä niiden vaikutuksia. Tutkielman empiirinen aineisto kerättiin haastatteluin sekä Suomesta että Ruotsista. Tutkimuksen tuloksena voidaan sanoa, että menettely aiheuttaa yrityksille ylimääräistä hallinnollista taakkaa, mutta siitä huolimatta sen käyttöönottoon on suhtauduttu Ruotsissa melko positiivisesti. Tutkimuksessa havaittiin myös, että yksityiskohdilla ja säännöksillä on huomattavan suuri merkitys käännetyn menettelyn yrityksille aiheuttamaan kuormitukseen.

O químico e naturalista luso-brasileiro Alexandre Antonio Vandelli

Alexandre Vandelli was the heir of two illustrious scientific traditions in the Luso-Brazilian world of the late eighteenth and early nineteenth centuries, that of his father, the celebrated Italian-Portuguese naturalist and chemist Domingos (Domenico) Vandelli, and that of his father-in-law, that protean figure in several scientific specialties as well as in politics, José Bonifácio de Andrada e Silva, who in later life was of paramount importance in the process of Brazilian independence from Portugal. The younger Vandelli followed their footsteps but soon engaged in a multiple career, at first in Portugal and later in Brazil, of which little is known and is here presented for the first time.

PERFIL DOS BOLSISTAS DE PRODUTIVIDADE EM PESQUISA NAS SUBÁREAS DA QUÍMICA DO CNPq

The profile analysis of CNPq Research Productivity Fellows (PQ) in the four subfields of chemistry and in their respective specialties highlighted particularities with regard to the indicators related to the judging criteria established by the Chemistry Advisory Committee. The curricula of all 727 PQ fellows with active grants in 15/03/2013 were analyzed spanning the past10 years (2003-2013). Out of all PQ-1 fellows, researchers in the subfield of Organic Chemistry had the highest median number of articles published per year. The subfield of Analytical Chemistry qualifies a higher number of postgraduate level students in comparison to other Chemistry subfields. Furthermore, this subfield had the highest average Hirsch index among PQ-1A and PQ-1B fellows. On the other hand, Inorganic Chemistry had the highest average number of patent applications per researcher, while Physical Chemistry had the specialties with the highest citation rates per paper and the highest average impact factors per journal. In all subfields, women made up a low proportion, especially at the highest levels of PQ fellowships. Although quantitative differences in scientific output were observed among the subfields, qualitative evaluation of science output was not carried out.

High-speed solid-rotor induction machine – calculation program

The aim of this thesis is to utilize the technology developed at LUT and to provide an easy tool for high-speed solid-rotor induction machine preliminary design. Computer aided design tool MathCAD has been chosen as the environment for realizing the calculation program. Four versions of the design program have been made depending on the motor rotor type. The first rotor type is an axially slitted solid-rotor with steel end rings. The next one is an axially slitted solid-rotor with copper end rings. The third machine type is a solid rotor with deep, rectangular copper bars and end rings (squirrel cage). And the last one is a solid-rotor with round copper bars and end rings (squirrel cage). Each type of rotor has its own specialties but a general thread of design is common. This paper follows the structure of the calculating program and explains some features and formulas. The attention is concentrated on the difference between laminated and solid-rotor machine design principles. There is no deep analysis of the calculation ways are presented. References for all solution methods appearing during the design procedure are given for more detailed studying. This thesis pays respect to the latest innovations in solid-rotor machines theory. Rotor ends’ analytical calculation follows the latest knowledge in this field. Correction factor for adjusting the rotor impedance is implemented. The purpose of the created design program is to calculate the preliminary dimensions of the machine according to initial data. Obtained results are not recommended for exact machine development. Further more detailed design should be done in a finite element method application. Hence, this thesis is a practical tool for the prior evaluating of the high-speed machine with different solid-rotor types parameters.

Realidade virtual e robótica em cirurgia: aonde chegamos e para onde vamos?

Minimally Invasive Surgery, Telesurgery, Robotics and Virtual Reality represent the technological frontiers that have revolutionized operating practices nowadays. These new technologies aim at improving the quality of assistance offered to patients; thus, they demand from the medical staff more effective measures as far as scientific research, training and expenditure of time and financial resources are concerned. In the past, surgeons have led several medical revolutions, such as the use of antiseptic surgical methods by Semelweiss, the use of anesthesia by Warren, antibiotic therapy, the transplants and the onset of the minimally invasive surgery by Mouret and Perissat. The objective of this article is to present the outreach of this new technology which comprises minimal access, computing, robotics and teletransmission. We have concluded that the new technologies developed in the medical field in the last decades, will offer new options and challenges for the treatment of the surgical patient, leading the scientific knowledge to a new era, the one of the virtual environment.

Plastic surgery in chest wall reconstruction: relevant aspects - case series

Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

Cost-effectiveness analysis in South Karelia Central Hospital

The target organization of this study, otherwise South-Karelia Social and Health Care District (Eksote) provides health, senior, family and social welfare services. South Karelia Central Hospital provides special health care and offers health services from all of the most important medical specialties. Eksote has in use 15D instrument to measure the health-related quality of life (HRQoL) of their patients before and after their interventions for observing the health effects of the medical care. Furthermore, 15D allows measuring the effectiveness and cost-effectiveness of health care when comparing these before and after results of the 15D measurements and adding the costs of the interventions into this research. The main purposes of this study were to analyze the effectiveness and cost-effectiveness of medical care in South Karelia Central Hospital by using the gathered 15D data to calculate effectiveness and cost-effectiveness ratios and to analyze the reliability and availability of the data. Study has been conducted using literature review and quantitative research methods. The results indicate that from the patients within the eight units selected to this study the 15D change information was available from the 52 %, the 15D change and the cost information from 38 % and the information of quality-adjusted life years (QALYs) produced and the cost information from 35 %. The effectiveness and cost-effectiveness of medical care were greatest at the units of Pain Outpatient Clinic and Rheumatic Diseases Outpatient Clinic. The most effective medical care is given in the unit where the average price of one produced QALY is the highest (Orthopedics). However, the calculated standard deviations pointed out that there are great variances in the effectiveness and cost-effectiveness within the units also.

Brazilian medical publications: citation patterns for Brazilian-edited and non-Brazilian literature

Today, the quality of a scientific article depends on the periodical in which it is published and on the number of times the article is cited in the literature. In Brazil, the criteria for the evaluation of this scientific production are improving. However, there is still some resistance, with authors arguing that Brazilian publications must be preferentially addressed to the national readers and, therefore, they should ideally be written in Portuguese. In order to determine the kind of scientific journals cited in the reference lists of articles published in medical periodicals edited in Brazil, in the present study we determine the rate of Portuguese/English citations. Three issues of 43 periodicals (19 indexed in SciELO, 10 in PubMed, 10 in LILACS, and 4 in the ISI-Thompson base) of different medical specialties were analyzed, and the number of both Portuguese and English citations in the reference list of each article was recorded. The results showed that in Brazilian-edited journals the mean number of citations/article was 20.9 ± 6.9 and the percentage of citations of international non-Brazilian periodicals was 86.0 ± 11.2%. Of the latter, 94.4 ± 7.0 are indexed by ISI-Thompson. Therefore, we conclude that Brazilian medical scientists cite the international non-Brazilian periodicals more than the national journals, and most of the cited papers are indexed by ISI-Thompson.

Adoption and Usability of Online Pharmacies for Purchasing Prescription Medicines

The study examines customers’ perceptions of purchasing prescription medicine from online pharmacies. The main purpose is to find determinants affecting the adoption of online pharmacies, and to consider the role of usability in the adoption process. The theoretical part of the paper provides the overlook on adoption constructs and their relations. In addition, usability factors used in prior studies are presented, as well as how they have been connected to IS adoption research. The specialties of Finnish pharmacy business and the requirements set to online pharmacies are also discussed. The empirical part of the study is conducted with the qualitative approach. Four respondents were interviewed and observed while they tried online pharmacies. The data gathered indicates respondents’ initial beliefs toward the service, perceptions of the usability, and the changes in the perceptions and beliefs after using online pharmacies. The results indicate that usability factors and adoption determinants are interrelated. Usability influences perceived ease of use, which affects both perceived usefulness and behavioral intention. Regulations restrict the design of online pharmacies, which has affect on the both the perceived ease of use and perceived usefulness, and thus the whole adoption process.

Rittermere Farm Craft Studio Fonds, 1951-2006

During the 1950’s, the Rittenhouse family of Vineland in the Niagara Peninsula opened a craft store and studio. Within a short period of time, they realized that resources for the craft of rug hooking were in demand and they began to build their business around this niche. Edna Rittenhouse, the mother, was the wool dyer; Margaret Rowan, the daughter, was the pattern designer; Ted Rowan, the son-in-law, changed careers and became the manager of the family business. The 1960’s were a prosperous time, not only in the Niagara Peninsula, but also for the Rittenhouse business. Edna Rittenhouse had been hooking rugs for decades but she and her family worked at developing and sharing newer techniques with newer materials. Shading manuals were authored and published; students became teachers; creativity abounded in the demand for and the creation of new designs. Instead of using woolen yarn, they were using pure woolen fabric; instead of using a standard cutter, they began using a uniquely designed cutter; instead of using frames, they employed a table top method. The new material and technique resulted in a rug with a smooth, uniform texture and a soft nap. Since many crafters belonged to crafters guilds, Margaret and Ted Rowan began promoting the idea of a guild for rug hookers and in time the Ontario Hooking Craft Guild was also a reality. A joint project between Chatelaine magazine and the Rittermere studio for Canada’s centennial year of 1967 was extremely well received within the circle of hooking crafters and the Rittermere Farm Craft Studio became a North American landmark for crafters. From this point onward the studio had a large customer base not only in North America but also overseas. The studio remained popular until 1984 when Margaret and Ted Rowan decided to retire. The Rittermere name has been preserved in the name of Rittermere-Hurst-Field which is a similar business located in Aurora which is just north of Toronto.

Construction d'une échelle décrivant les niveaux de compétence de collaboration, à partir d'indicateurs validés par des enseignants cliniciens en médecine

La collaboration est une compétence essentielle que les futurs médecins doivent développer. La détermination des niveaux de compétence est cruciale dans la planification de cet apprentissage. Les échelles descriptives suscitent un intérêt croissant, car elles décrivent en termes qualitatifs les performances attendues. Nous inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration: 1) formulation d’une liste d’indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d’éducateurs (n=7), leaders pédagogiques possédant une expertise pour la compétence de collaboration; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de 118 indicateurs, auprès d’enseignants cliniciens représentant les différentes spécialités (n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux questionnaires appariés par calibration concurrente; 4) détermination des niveaux des indicateurs par les éducateurs et les chercheurs; et 5) rédaction de l’échelle à partir des indicateurs de chaque niveau. L’analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l’échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L’échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d’une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendus à la fin de chaque niveau et est utile à la planification de l’apprentissage et de l’évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l’analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d’adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l’efficacité de la méthodologie de Blais (2009) dans un contexte de compétence transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d’autres compétences.

L’évaluation du raisonnement clinique des résidents en hématologie par l’approche de concordance de script

La pratique de l’hématologie, comme celle de toute profession, implique l’acquisition d’un raisonnement adéquat. Se basant sur une théorie de psychologie cognitive, le test de concordance de script (TCS) a été développé et validé comme un instrument permettant d’évaluer le raisonnement clinique dans diverses spécialités médicales. Le but de cette étude était d’examiner l’utilité et les paramètres psychométriques d’un TCS en hématologie. Nous avons construit un TCS composé de 60 questions que nous avons administré à 15 résidents juniors (R1 à R3 en médecine interne), 46 résidents séniors (R4, R5 et R6 en hématologie) et 17 hématologues à travers le Canada. Après optimisation, le TCS comptait 51 questions. Sa consistance interne mesurée par le coefficient de Cronbach alpha était 0.83. Le test était en mesure de discriminer entre les résidents selon leur niveau de formation. Les questions contenant des images (n=10) semblaient avoir un potentiel discriminatoire plus élevé. Les scores obtenus par les résidents séniors corrélaient modéremment avec ceux obtenus à un test conventionnel d’hématologie composé de questions à choix multiples et à courte réponse (r de Pearson = 0.42; p=0.02). Le TCS a été complété en 36 minutes en moyenne et a été bien reçu par les participants. Le TCS est un instrument d’évaluation utile et valide en hématologie. Il peut être utilisé à des fins formatives en aidant au suivi de la progression des résidents. Il pourrait aussi être combiné à d’autres instruments d’évaluation à des fins sanctionnelles, ou encore, en éducation médicale continue.

Les facilitateurs et les solutions à la pratique optimale des médecins dans le traitement de l’asthme

OBJECTIF : Déterminer les principales solutions qui facilitent la pratique optimale des médecins dans le traitement de l’asthme, incluant la prescription d’un médicament de contrôle à long terme et l’utilisation de plans d’action écrits. MÉTHODOLOGIE: Des entrevues individuelles semi-structurées ont été menées avec des médecins de différentes spécialités (médecins de famille, pédiatres, urgentologues, pneumologues et allergologues). Ces entrevues ont été transcrites puis analysées qualitativement de manière indépendante par deux chercheures qualifiées. RÉSULTATS : Quarante-deux médecins ont été interviewés. Un total de 867 facilitateurs et solutions ont été exprimés, répondant à trois de leurs besoins: (1) avoir du soutien dans la prestation de soins optimaux, (2) être habileté à aider et motiver les patients à suivre leurs recommandations et (3) avoir l’opportunité d’offrir des services efficients. À partir de ces données, une taxonomie de facilitateurs et de solutions comprenant dix catégories a également été développée. CONCLUSION : Les médecins ont proposé une multitude de facilitateurs et de solutions pour soutenir la pratique optimale. Ils varient essentiellement selon la spécialité et le comportement visé (prescription de médicaments de contrôle à long terme, utilisation de plans d’autogestion écrits et la gestion générale de l’asthme). Cela fait ressortir l’importance d’effectuer le choix des interventions en étroite collaboration avec les utilisateurs de connaissances afin d’obtenir des solutions qui soient perçues comme faisables et applicables, ayant ainsi potentiellement plus de chances de mener à un changement de pratique. La nouvelle taxonomie offre la possibilité d’utiliser un langage commun pour classifier les facilitateurs et les solutions.