Kundelønnsomhetsanalyser i Norge : en studie av bruksgrad og nytteverdi

I senere tid har interessen for kundelønnsomhetsanalyser vært økende. Fagområdet har utviklet seg mye de siste tiårene, men mye er fortsatt uutforsket. Denne studien er den første i Norge til å se på utbredelsen av ulike former for kundelønnsomhetsanalyser. En slik kartlegging bidrar til mer nyansert innsikt i fagområdet. Vi har gjennomført en kvantitativ undersøkelse av de største selskapene i Norge (etter driftsinntekter 2010). Datamaterialet har blitt hentet inn gjennom utsendelse av et elektronisk spørreskjema til CFO-er, økonomi-, regnskaps- og markedssjefer. Den første problemstilling vi ønsker å finne svar på, er: I hvilken grad bruker norske selskap kundelønnsomhetsanalyser, og hvordan oppleves nytteverdien av disse? Funnene våre viser at mange selskap bruker, og har nytte av kundelønnsomhetsanalyser. Videre viser resultatene at potensiell nytte overstiger nåværende nytte av kundelønnsomhetsanalyser. Av de fire ulike formene for kundelønnsomhetsanalyser (lønnsomhetsanalyse av enkeltkunder, lønnsomhetsanalyse av kundesegment, enkeltkunders livsløpsverdi og verdivurdering av enkeltkunder) finner vi at den minst ressurskrevende analyseteknikken, lønnsomhetsanalyse av kundesegment, har høyest bruksgrad og nytteverdi. Analyseteknikken gir hovedsakelig et oversiktsbilde av kundelønnsomhet for kundesegment, og gir ikke detaljkunnskap om lønnsomhetsforskjeller mellom enkeltkunder. Videre tyder funnene på at de to fremtidsrettede analyseteknikkene (enkeltkunders livsløpsverdi og verdivurdering av enkeltkunder) er lite utbredt, og at kunnskapen om slike analyseteknikker er lav. Den andre problemstillingen vi ønsker å finne svar på, er: Påvirker bruksgrad av aktivitetsbaserte estimeringsmetoder og grad av markedsorientering bruksgrad og nytte av kundelønnsomhetsanalyser? Funnene våre viser at høyere bruksgrad av aktivitetsbaserte estimeringsmetoder øker bruksgraden av noen former for kundelønnsomhetsanalyser. Dette kan skyldes at de selskapene som bruker aktivitetsbaserte estimeringsmetoder tar i bruk andre avanserte økonomistyringsverktøy, noe kundelønnsomhetsanalyser kan klassifiseres som. Videre finner vi at høyere grad av markedsorientering tilsier høyere bruksgrad og nytte av noen former for kundelønnsomhetsanalyser. Med andre ord tyder det på at markedsorienterte selskap i større grad enn andre utfører kunderelaterte analyser

MOBILE and the provision of total joint replacement

Modern joint replacements have been available for 45 years, but we still do not have clear indications for these interventions, and we do not know how to optimize the outcome for patients who agree to have them done. The MOBILE programme has been investigating these issues in relation to primary total hip and knee joint replacements, using mixed methods research

Exploring Different Peripheral Nociceptive Input Underlying Ongoing and Movement Evoked Cancer-Induced Bone Pain

Cancer-induced bone pain is reported to be one of the most detrimental aspects of the disease, often broadly categorized into two separate pain phenomena. Patients experience ongoing pain, a dull achy persistent background pain that worsens as disease progresses which is currently treated with around the clock mu opioid receptor (MOR) agonists such as morphine. Patients also report transient episodes of severe pain that is spontaneous but often triggered by movement that “breaks through” around the clock medication. Breakthrough pain is treated with additional rapid onset MOR agonists that are hindered by dose-limiting side effects and often misalign with treatment for patients. The failure of current medications to effectively treat patients and undesirable side effects of MOR agonists highlights the need to develop novel treatments. We examined the hypothesis that ongoing pain and breakthrough pain are mitigated by unique populations of sensory afferents. Utilizing a rat model of cancer-induced bone pain (CIBP) that implants MATBIII adenocarcinoma cells into the tibia of Fischer rats, we demonstrate that IB4-binding fibers play a critical role in transducing breakthrough pain, whereas TRPV1 expressing fibers do not. Limitations of the chemo-ablative approach used to target these neurons directed work to a mouse model of CIBP that relies on implantation of Lewis lung carcinoma cells into the femur of C57BL/6 mice. Utilizing Nav1.8-Cre and MrgD-Cre-ERT2 mouse lines, targeted expression of the light sensitive proton pump ArchT allowed for the inhibition of neurons in animals with CIBP. Using conditioned place preference to pain relief, we demonstrate that inhibition of Nav1.8 fibers relieves ongoing pain, and silencing MrgD fibers in tumor-bearing animals results in conditioned place preference. We also describe a potential approach to measure breakthrough pain in the mouse, but did not characterize it. This work provides evidence to target these populations of sensory neurons to develop treatments in an effort to reduce and treat cancerinduced ongoing and breakthrough pain. The implication of non-peptidergic neurons to convey components of cancer-induced bone pain is a novel finding and distinguishes them for a unique role in CIBP from other work in the pain field

Is there evidence for accelerated polyethylene wear in uncemented compared to cemented acetabular components? A systematic review of the literature

Joint arthroplasty registries show an increased rate of aseptic loosening in uncemented acetabular components as compared to cemented acetabular components. Since loosening is associated with particulate wear debris, we postulated that uncemented acetabular components demonstrate a higher polyethylene wear rate than cemented acetabular components in total hip arthroplasty. We performed a systematic review of the peer-reviewed literature, comparing the wear rate in uncemented and cemented acetabular components in total hip arthroplasty. Studies were identified using MEDLINE (PubMed), EMBASE and the Cochrane Central Register of Controlled Trials. Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The search resulted in 425 papers. After excluding duplicates and selection based on title and abstracts, nine studies were found eligible for further analysis: two randomised controlled trials, and seven observational studies. One randomised controlled trial found a higher polyethylene wear rate in uncemented acetabular components, while the other found no differences. Three out of seven observational studies showed a higher polyethylene wear in uncemented acetabular component fixation; the other four studies did not show any differences in wear rates. The available evidence suggests that a higher annual wear rate may be encountered in uncemented acetabular components as compared to cemented components

Total hip replacement. Results of a postal survey of current practice on the cement fixation of the acetabular cup in the UK

Previous finite element studies and laboratory investigations on reconstructed acetabulum joints show that long-term fixation of the acetabular cup in total hip replacements (THRs) is influenced by surgical fixation techniques. The aim of this study is to determine and understand the reasons of current practice in the cement fixation of the acetabular cup in THRs in the UK. Following a pilot study, a postal survey was carried out among 1350 orthopaedic consultants. Response rate was 40% and data obtained from the returned questionnaires provided information about the current practice of 431 consultants with an average of 16.5 years of experience and who perform an average of 55 cemented THR operations annually. The survey showed wide variations in the fixation methods of the acetabular component. 95% of the respondents use cement to fix the acetabular cup, 46% maintain the subchondral bone and 63 % use a flanged acetabular cup. The numbers of anchorage holes drilled vary from zero to thirty-six and drill diameters vary from 2 to 15 mm. Anchorage hole depths vary from 3 to 20 mm. Given the variability of surgical fixation methods, further studies need to be carried out to determine how fixation techniques could be improved to increase the longevity of the acetabular component in THRs. Further investigations could lead to a better understanding of the factors that contribute to the stability of THRs

Countrywise results of total hip replacement. An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database

Background and purpose: An earlier Nordic Arthroplasty Register Association (NARA) report on 280,201 total hip replacements (THRs) based on data from 1995–2006, from Sweden, Norway, and Denmark, was published in 2009. The present study assessed THR survival according to country, based on the NARA database with the Finnish data included. Material and methods: 438,733 THRs performed during the period 1995–2011 in Sweden, Denmark, Norway, and Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities with 95% confidence interval (CI). Cox multiple regression, with adjustment for age, sex, and diagnosis, was used to analyze implant survival with revision for any reason as endpoint. Results: The 15-year survival, with any revision as an endpoint, for all THRs was 86% (CI: 85.7–86.9) in Denmark, 88% (CI: 87.6–88.3) in Sweden, 87% (CI: 86.4–87.4) in Norway, and 84% (CI: 82.9–84.1) in Finland. Revision risk for all THRs was less in Sweden than in the 3 other countries during the first 5 years. However, revision risk for uncemented THR was less in Denmark than in Sweden during the sixth (HR = 0.53, CI: 0.34–0.82), seventh (HR = 0.60, CI: 0.37–0.97), and ninth (HR = 0.59, CI: 0.36–0.98) year of follow-up. Interpretation: The differences in THR survival rates were considerable, with inferior results in Finland. Brand-level comparison of THRs in Nordic countries will be required

Utenlandske leger og sykepleiere i Norge

Leger Tallet på utenlandske leger som kommer til Norge for å arbeide, har økt jevnt fra 1995 til 1998, bortsett fra en mindre nedgang i 1996. Økningen var særlig kraftig fra 1998 til 1999, noe som først og fremst gjaldt danske og svenske leger med et såkalt D-nummer som identifikasjon i personregisteret. Personer som tildeles D-nummer planlegger å ikke bli lenger enn 6 måneder i Norge. Tallet på tyske leger økte markant fra 1995 til 1998, men gikk kraftig ned i 1999. I større grad enn leger fra andre europeiske land har tyske leger vanlig fødselsnummer, noe som indikerer at de planlegger å bli i Norge lenger enn 6 måneder. Svenske leger er relativt sett de minst stabile, men likevel den største gruppen av utenlandske leger i Norge. Aldersmessig er det flest leger fra utlandet i gruppen 40-54 år. Blant dem som er tildelt vanlig fødselsnummer, i motsetning til D-nummer, er likevel aldersgruppen 30-39 den største. Det betyr at yngre personer er mer stabile og blir værende i flere år enn de som er eldre. Leger som kommer fra Sverige og Danmark er stort sett eldre enn tyske leger. Sykepleiere Fra 1995 til 1996 var det en dobling av antall sykepleiere som kom til Norge for å ta seg arbeid. Deretter var det en liten nedgang fra 1997 til 1998, og nær en halvering fram til 1999. Det var i hovedsak svenske sykepleiere som stod for den sterke økningen fra 1995 til 1996. I de etterfølgende år gikk tallet på svenske sykepleiere ned, mens tallet på finske sykepleiere økte kraftig, og stabiliserte seg på et høyt nivå. Forskjellen på svenske og finske sykepleiere er at de finske som får autorisasjon, i større grad faktisk kommer og tar arbeid i Norge. Den kraftige nedgangen fra 1998 til 1999 skyldes en nedgang i svenske og danske sykepleiere som får autorisasjon

The Nordic Arthroplasty Register Association: A unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs

Background and purpose The possibility of comparing results and of pooling the data has been limited for the Nordic arthroplasty registries, because of different registration systems and questionnaires. We have established a common Nordic database, in order to compare demographics and the results of total hip replacement surgery between countries. In addition, we plan to study results in patient groups in which the numbers are too small to be studied in the individual countries

Turvallinen aikuinen ja sen merkitys nuoren arjessa

Opinnäytetyön tarkoituksena oli kartoittaa nuorten näkökulmia turvallisesta aikuisesta ja sen merkityksestä heidän arjessaan. Tavoitteena oli selvittää, millaisena nuoret kokevat turvallisen aikuisen ja miten turvallisen aikuisen läsnäolo vaikuttaa heidän elämäänsä osana arkea. Tutkimus toteutettiin yhteistyössä Etelä-Pohjanmaalla sijaitsevan yläkoulun kanssa. Yhteistyötahon kautta tutkimukseen saatiin vastaajajoukko koulun yhdeksäsluokkalaisista. Tutkimustuloksista saatua tietoa voidaan hyödyntää osana nuorten näkökulmien ymmärtämistä ammattilaisten ja vanhempien kanssa esimerkiksi vanhempainilloissa. Teoriaosuudessa käsitellään kiintymyssuhteita sekä niiden merkitystä lapsuudessa ja nuoruudessa, nuoruutta elämänvaiheena, nuoruuden eri sosiaalisten suhteiden merkitystä sekä turvallisuutta käsitteenä ja kokemuksena. Opinnäytetyö toteutettiin laadullisena, eli kvalitatiivisena tutkimuksena, jossa aineisto kerättiin Webropol-kyselyn muodossa. Yhdeksäsluokkalaiset vastasivat kyselyyn opinto-ohjaajan tunnilla syyskuussa 2024. Kyselyä lähdettiin rakentamaan tutkimuskysymysten pohjalta. Kyselyssä käytettiin avoimia sekä monivalintakysymyksiä. Tutkimuksen tuloksien analysoinnissa käytettiin menetelmänä teemoittelua. Kyselyyn vastasi 42 oppilasta. Opinnäytetyössä saatujen tulosten mukaan suuri osa nuorista kokee turvallisen aikuisen ymmärtäväisenä, rauhallisena sekä luotettavana henkilönä, joka osaa kuunnella ja antaa neuvoja päätöksenteossa sekä vaikeissa hetkissä. Vastauksista nousi esille turvallisuus ja aikuisen väkivallattomuuden tärkeys. Tutkimus osoitti, että arjessa nuorelle on tärkeää tulla kuulluksi ja nähdyksi