Individual and combined impact of heart failure and atrial fibrillation on ischaemic stroke outcomes: a prospective hospital register cohort study

Background and Purpose— We aimed to determine individual and combined effects of atrial fibrillation (AF) and heart failure (HF) on acute ischemic stroke outcomes: in-hospital mortality, length-of-stay, and poststroke disability; long-term mortality and stroke recurrence. Methods— Prospective cohort study of patients with acute ischemic stroke admitted to a UK center with a catchment population of ≈900 000 between 2004 and 2016. Exposure groups were patients with neither AF nor HF (reference group), those with AF but without HF, those with HF but without AF, and those with AF+HF. Logistic and Cox regressions were used to model in-hospital and long-term outcomes, respectively. Results— A total of 10 816 patients with a mean age±SD =77.9±12.1 years, 48% male were included. Only 30 (4.9%) of the patients with HF but not AF were anticoagulated at discharge. Both AF (odds ratio, 1.24 [95% CI, 1.07–1.43]), HF (odds ratio, 1.40 [1.10–1.79]), and their combination (odds ratio, 2.23 [1.83–2.72]) were associated with increased odds of in-hospital mortality. All 3 exposure groups were associated with increased length-of-stay, while only AF predicted increased disability (1.36 [1.12–1.64]). Patients were followed for a median of 5.5 and 3.7 years for mortality and recurrence, respectively. Long-term mortality was associated with AF (hazard ratio, 1.45 [95% CI, 1.33–1.59]), HF (2.07 [1.83–2.36]), and their combination (2.20 [1.96–2.46]). Recurrent stroke was associated with AF 1.50 (1.26–1.78), HF (1.33 [1.01–1.75]), and AF with HF (1.62 [1.28–2.07]). Conclusions— The AF-associated excess risk of stroke recurrence was independent of comorbid HF. HF without AF was also associated with a significant risk of recurrence. Anticoagulation for secondary stroke prevention in patients with HF without AF may require further evaluation in a clinical trial setting

HAMK Kaupallisten tapahtumien liiketoimintamalli

Tämän opinnäytetyön toimeksiantajana toimii Hämeen ammattikorkeakoulun Työelämän lähipalvelut. Opinnäytetyön tavoitteena oli määritellä Työelämän lähipalveluiden kaupallisten tapahtumien liiketoimintamalli. Liiketoimintamallin tavoitteena on toimia kaupallisten tapahtumien tuotantoprosessin tukena. Liiketoimintamalli havainnollistetaan Business Model Canvas-työkalua hyväksi käyttäen. Työn teoriaosuus koostuu liiketoimintamallista, liiketoimintamallin rakentamisesta ja tapahtumatuotannosta. Liiketoimintamallin teoriaa avataan käyttäen Business Model Canvas-työkalun kokonaisuuksia hyväksi käyttäen. Työhön on tehty teemahaastattelu, jossa haastateltiin kolmea henkilöä jotka toimivat tapahtumatuotannon asiantuntijoina. Haastattelun avulla selvitettiin Työelämän lähipalveluiden kaupallisten tapahtumien nykytilannetta ja tulevaisuuden mahdollisuuksia. Haastattelun tulokset on huomioitu liiketoimintamallia rakentaessa. Opinnäytetyön tuloksena on syntynyt kaupallisten tapahtumien liiketoi-mintamalli. Liiketoimintamalli havainnollistaa kaupallisten tapahtumien asiakaskuntaa, myyntiä, tapahtumatuotantoa ja kustannustehokasta ajattelua. Opinnäytetyön loppuun on koottu kehitysehdotukset. Kehitysehdotuksissa käydään läpi kokonaisuuksia, jotka saattaisivat parantaa kaupallisten tapahtumien tuotantoprosessia.This thesis was commissioned by the Business Services of Häme Univer-sity of Applied Sciences. The subject of this thesis was to make a business model of the commercial events of the Business Services. The business model is made to be part of the commercial events’ production process. The business model is illustrated by using the Business Model Canvas tool. The theoretical part of the thesis deals with the parts of the business model, how to build a business model and the event production. The business model itself is opened by using the Business Model Canvas tool. The thesis uses a qualitative research method. The study was made by in-terviewing three professional event organizers. The point of the interview was to clarify the current status of the Business services’ commercial events and the possibilities of the future. The results of the interviews were used when creating the actual business model. As the result of this thesis, the business model was created for the Business Services. The business model elaborates customer markets, sales, event production and cost-efficiency approach of commercial events. The final part of the thesis compiles the development points, which could help the production process of the commercial events