Аналіз тенденцій рівня розвитку економічних процесів підприємства

Подано методичні розробки щодо визначення ймовірної зміни рівнів розвитку економічних процесів машинобудівних підприємств залежно від рівня ефективності матеріальної мотивації персоналу на період 2010 р. Імовірну зміну рівня розвитку економічного процесу визначено за допомогою ланцюгів Маркова, що передбачає реалізацію шести послідовних етапів. Ключові слова: підприємства машинобудування, ланцюги Маркова, економічні процеси.Представлены методические разработки по определению вероятного изменения уровня развития экономических процессов предприятий машиностроения в зависимости от уровня эффективности материальной мотивации персонала на период 2010 г. Вероятное изменение уровня развития экономического процесса определено с помощью цепей Маркова, что предусматривает реализацию шести последовательных этапов. Ключевые слова: предприятия машино-стро¬ения, цепи Маркова, экономические процессы.The paper presents methodical developments on determination of probable changes in the level of machine-build enterprises’ economic processes development depending on the level of personnel’s material motivation efficiency for the period of 2010. Probable changes in the level of economic processes development are determined by using Markov’s chains which provide six stages. Keywords: machine-building enterprises, Markov chains, economic processes

Intrahepatic cholangiocarcinoma: Current perspectives

Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy arising from the liver. ICC makes up about 10% of all cholangiocarcinomas. It arises from the peripheral bile ducts within the liver parenchyma, proximal to the secondary biliary radicals. Histologically, the majority of ICCs are adenocarcinomas. Only a minority of patients (15%) present with resectable disease, with a median survival of less than 3 years. Multidisciplinary management of ICC is complicated by large differences in disease course for individual patients both across and within tumor stages. Risk models and nomograms have been developed to more accurately predict survival of individual patients based on clinical parameters. Predictive risk factors are necessary to improve patient selection for systemic treatments. Molecular differences between tumors, such as in the epidermal growth factor receptor status, are promising, but their clinical applicability should be validated. For patients with locally advanced disease, several treatment strategies are being evaluated. Both hepatic arterial infusion chemotherapy with floxuridine and yttrium-90 embolization aim to downstage locally advanced ICC. Selected patients have resectable disease after downstaging, and other patients might benefit because of postponing widespread dissemination and biliary obstruction

Uncertainty in Medical Decision Making: knowing how little you know

Making decisions about the care of individual patients is fundamental to health care. For each patient, many decisions have to be made. In the emergency room, for example, a doctor should decide which patient to see first, decide whether an x-ray should be made of an injured ankle, and decide how this specific ankle fracture of this specific patient should be treated. Medical training is focused on acquiring the knowledge and experience to make such decisions. Other factors that are essential for patient care, including empathy and technical abilities, also involve decision making. For example, in the outpatient clinic, a trade-off is needed when one patient needs more time and empathy, but the waiting room is packed and the physician is an hour behind schedule. In the operating room, a surgeon must decide whether to proceed with a complicated laparoscopic procedure to remove a gall bladder, to convert to an open procedure, or to ask a more experienced surgeon for help

A preliminary prediction model for potentially guiding patient choices between breast conserving surgery and mastectomy in early breast cancer patients; a Dutch experience

Purpose: To guide early stage breast cancer patients to choose between breast conserving surgery (BCS) and mastectomy (MST) considering the predicted cosmetic result and quality of life (QoL). Methods: A decision model was built to compare QoL after BCS and MST. Treatment could result in BCS with good cosmesis, BCS with poor cosmesis, MST only, and MST with breast reconstruction. QoL for these treatment outcomes were obtained from a previous study and the literature and translated into EuroQoL-5D derived utilities. Chance of good cosmesis after BCS was predicted based on tumor location and tumor/breast volume ratio. The decision model determined whether the expected QoL was superior after BCS or MST based on chance of good cosmesis. Results: The mean utility for the treatments such as BCS with good cosmesis, BCS with poor cosmesis, MST only, and MST with breast reconstruction were 0.908, 0.843, 0.859, and 0.876, respectively. BCS resulted in superior QoL compared to MST in patients with a chance of good cosmesis above 36%. This 36% threshold is reached in case the tumor is located in the upper lateral, lower lateral, upper medial, lower medial, and central quadrant of the breast with a tumor/breast volume ratio below 21.6, 4.1, 15.1, 3.2, and 14.7, respectively. Conclusions: BCS results in superior QoL in patients with tumors in the upper breast quadrants or centrally and a tumor/breast volume ratio below 15. MST results in superior QoL in patients with tumors in the lower breast quadrants and a tumor/breast volume ratio above 4