Ledelsesmodeller i danske virksomheder

I de seneste årtier er der opstået flere og flere ledelsesmodeller (kvalitetsprismodeller, ISO 9000, Balanced Scorecard etc.) som virksomheder kan anvende til at opnå en konkurrencemæssig fordel gennem forbedring af forretningsgangene. Rationalet bag de fleste af modellerne er, at der er en årsagssammenhæng mellem stakeholdertilfredshed (medarbejdere, kunder, ejere etc.) og virksomhedens finansielle resultater, og at modellen kan hjælpe virksomheden med at kapitalisere sammenhængen. Artiklen fokuserer på en sammenligning mellem virksomheder, der anvender en given ledelsesmodel, og de virksomheder der ikke gør. I den empiriske del indledes med en beskrivelse af udviklingen i anvendelsen af ledelsesmodeller i den private sektor i Danmark baseret på data fra Dansk Excellence Index. Denne beskrivelse fokuserer på den overordnede udvikling i anvendelse samt eventuelle forskelle med hensyn til branche og virksomhedsstørrelse. Desuden omhandler artiklen konsekvenserne af en række øvrige virksomhedskarakteristika (eksportandel, børsnotering m.v.). Artiklen antyder til slut hvilken effekt, det har at anvende en ledelsesmodel ved at rapportere forskelle i selvrapporterede resultater mellem virksomheder, der henholdsvis anvender/ikke anvender en given ledelsesmodel

The influence of geographical and clinical factors on decisions to use surgical mesh in operations for pelvic organ prolapse

Background: Surgical mesh can reinforce damaged biological structures in operations for genital organ prolapse. The first mesh products were cleared by the U.S. Food and Drug Administration in 2002. In contrast to stringent requirements for the development of pharmaceuticals, there was never a systematic scientific evaluation of mesh products. Purpose: We examined whether Swedish gynecological surgeons have transformed increasing amounts of scientific information into common learning, resulting in a convergent and consistent pattern of mesh use. Methods: Based on data from the Swedish National Quality Register of Gynecological Surgery, registered from 2010 to 2016, we examined changes in decisions to use mesh in a largely uniform group of 2864 recurrence patients operated by 455 surgeons, where surgical mesh was used in 1435 patients (50.1%). By means of logistic regression, we explained decisions to use mesh by clinical risk factors, an FDA warning, year of surgery, type of hospital, and geographical factors. Results: The use of mesh in Sweden varied extensively, by a range from 7% to 93% on county level. These disparities were maintained between the entities over time. Different groups of decision makers had drawn different conclusions from the available information. Geography was the most important parameter in explaining decisions to use mesh. Conclusion: Mounting scientific information has had no measurable impact on decision-making, and has not led to a more consistent decision pattern. Early decisions have led to obvious ‘communities of practice’ at county and region levels. Swedish surgeons, unaltered through 7 years, have made mesh decisions in a clearly biased fashion, highly influenced by geographical factors, and with no measurable change towards national consensus

Response evaluation of the neck in oropharyngeal cancer:Value of magnetic resonance imaging and influence of p16 in selecting patients for post-radiotherapy neck dissection

<div><p>ABSTRACT</p><p><b>Background.</b> Residual neck disease after radiotherapy in advanced oropharyngeal squamous cell carcinoma (OPSCC) is associated with increased mortality, and some patients may benefit from post-radiotherapy neck dissection (PRND). The aim of the present study was to assess the value of magnetic resonance imaging (MRI) and other clinical characteristics in selecting patients for PRND.</p><p><b>Materials and methods.</b> Retrospective cohort study. Consecutive patients with N+ OPSCC were included. Medical records, pathology reports and imaging reports were reviewed. Pre- and post-therapeutic imaging was re-evaluated.</p><p><b>Results.</b> A total of 100 consecutive patients from a three-year period were included. Neck response was evaluated with MRI two months after treatment. Sixty patients were suspicious for residual neck disease, and were offered surgery; seven of these patients had histologic evidence of carcinoma. Cumulative neck failure after three years was 14% (8.4–24%), and did not differ significantly among patients with positive compared to negative MRI (radiologist's initial description; p = 0.47, log-rank test). Applying neck failure as gold standard, sensitivity and specificity of MRI was 69% and 41%, respectively; positive and negative predictive value was 15% and 90%. Patients with p16 + disease had significantly larger lymph nodes after treatment, and imaging based on lymph node size resulted in many false positives. Analysis of receiver operating characteristic curves in 191 individual lymph nodes showed that a short axis ≥ 10 mm should be classified as suspicious. Furthermore, T-stage and p16-status were associated with increased risk of neck recurrence. Salvage was successful in four patients with early detected nodal recurrence.</p><p><b>Conclusion.</b> These results suggest that lymph node size, T-stage and p16 status could be used in selecting patients for PRND in OPSCC. Yet, early anatomical imaging may be inappropriate for evaluating neck response in patients with p16 + disease as enlarged lymph nodes often do not indicate residual neck disease.</p></div

Response evaluation of the neck in oropharyngeal cancer: Value of magnetic resonance imaging and influence of p16 in selecting patients for post-radiotherapy neck dissection

Background. Residual neck disease after radiotherapy in advanced oropharyngeal squamous cell carcinoma (OPSCC) is associated with increased mortality, and some patients may benefit from post-radiotherapy neck dissection (PRND). The aim of the present study was to assess the value of magnetic resonance imaging (MRI) and other clinical characteristics in selecting patients for PRND. Materials and methods. Retrospective cohort study. Consecutive patients with N+ OPSCC were included. Medical records, pathology reports and imaging reports were reviewed. Pre- and post-therapeutic imaging was re-evaluated. Results. A total of 100 consecutive patients from a three-year period were included. Neck response was evaluated with MRI two months after treatment. Sixty patients were suspicious for residual neck disease, and were offered surgery; seven of these patients had histologic evidence of carcinoma. Cumulative neck failure after three years was 14% (8.4–24%), and did not differ significantly among patients with positive compared to negative MRI (radiologist's initial description; p = 0.47, log-rank test). Applying neck failure as gold standard, sensitivity and specificity of MRI was 69% and 41%, respectively; positive and negative predictive value was 15% and 90%. Patients with p16 + disease had significantly larger lymph nodes after treatment, and imaging based on lymph node size resulted in many false positives. Analysis of receiver operating characteristic curves in 191 individual lymph nodes showed that a short axis ≥ 10 mm should be classified as suspicious. Furthermore, T-stage and p16-status were associated with increased risk of neck recurrence. Salvage was successful in four patients with early detected nodal recurrence. Conclusion. These results suggest that lymph node size, T-stage and p16 status could be used in selecting patients for PRND in OPSCC. Yet, early anatomical imaging may be inappropriate for evaluating neck response in patients with p16 + disease as enlarged lymph nodes often do not indicate residual neck disease