E-procurement in Public Organization

Tampereen kaupungin kokonaishankinnoista vain kaksi prosenttia tehtiin toiminnanohjausjärjestelmällä vuonna 2013. Järjestelmän matalasta käyttöasteesta johtuen hankintatiedot puuttuvat järjestelmästä, mikä hankaloittaa hankintojen strategista johtamista. Työn taustalla on tarve tehostaa toimintoja ja saada aikaan kustannussäästöjä sekä saada hankinnoista enemmän tietoa niiden tehokkaammaksi johtamiseksi. Tutkimuksen tarkoituksena oli tunnistaa keinoja, joiden avulla Tampereen kaupungin ostamista voidaan kehittää sähköisellä ostojärjestelmällä. Päätavoitteena oli kaupungin ostamisen nykytilan selvittäminen ja siihen soveltuvan sähköisen ratkaisun vaatimusten määrittely. Tässä työssä keskityttiin työn toimeksiantajan Tampereen Logistiikan valitsemien Tampereen kaupungin yksiköiden Infran, Kotihoidon ja Tilakeskuksen ostamisen kehittämiseen. Tutkimus toteutettiin laadullisena monimenetelmäisenä tapaustutkimuksena. Aineistona käytettiin kirjallisuutta, vanhoja Tampereen kaupungin selvityksiä sekä kohdeyksiköiden ja muiden kaupunkien hankinnoista vastaavien henkilöiden haastatteluja. Aikaisempi kirjallisuus on käsitellyt ostamisen suhdetta hankintoihin ja toimitusketjuun sekä tarkastellut sähköistä ostamista keinona tehostaa hankintoja. Tutkimuksen empiriaosuus esittelee ensin havaintoja aikaisemmista tutkimuksista sekä muiden kaupunkien benchmark-analyysistä. Toisessa osassa käsitellään ostotoimintaa ja sen kehitysmahdollisuuksia kohdeorganisaation valikoiduissa yksiköissä. Aineistoanalyysin tuloksena tunnistettiin ostamisen ongelmaksi kirjavat ostoprosessit sekä niistä aiheutuvat prosessikustannukset. Tuloksina saatiin ostamisen asettamia vaatimuksia ostojärjestelmälle, joita ovat noutojen kirjaus ja mobiilikäyttömahdollisuus. Ratkaisuehdotuksena annettiin malli uudesta prosessista, johon sitoutuu vähemmän työaikaa aikaisempaan verrattuna sekä ehdotettiin katalogien käyttöönottamista kaupungin omassa järjestelmässä

Identification of 18 High Risk F8 Mutations for Inhibitor Development in 2,700 Non-Severe Hemophilia A Patients

Clinical epidemiolog

Identification of 18 High Risk F8 Mutations for Inhibitor Development in 2,700 Non-Severe Hemophilia A Patients

Clinical epidemiolog

Factor VIII gene (F8) mutation and inhibitor development in non-severe hemophilia A

Background: The development of neutralizing antibodies (inhibitors) towards factor VIII is a major complication in non-severe hemophilia A, profoundly aggravating the bleeding pattern. Identification of high risk patients is hampered by lack of data on the association between factor VIII gene (F8) mutations and the development of inhibitors that take exposure days to therapeutic factor VIII concentrates into account. Aims: To determine the risk of inhibitor development in patients with non-severe hemophilia A and to analyze the association with F8 mutation, taking exposure days to therapeutic factor VIII concentrates into account. Methods: The study population was derived from a source population of 2711 non-severe hemophilia A patients (factor VIII 2-40%), treated in 34 hemophilia treatment centers in Europe and Australia (the INSIGHT consortium). The association between F8 mutation and inhibitor development was assessed in 1112 patients, only recruited from centers that had genotyped at least 70% of their patients. Inhibitor risk was calculated as Kaplan-Meier incidence with cumulative number of exposure days as time variable. Thus, risk was calculated as the proportion of patients that developed an inhibitor after a certain number of exposure days (e.g. 20 or 50) to therapeutic factor VIII concentrates. Results: During 44,800 exposure days (median 24 exposure days per patient; Inter Quartile Range (IQR), 7-90), 59 of the 1112 patients developed an inhibitor; cumulative incidence of 5.3% (95% confidence interval (CI), 4.0-6.6) after a median of 28 exposure days (IQR, 12- 71). The inhibitor risk at 50 exposure days was 6.7% (95% CI, 4.5- 8.9) and at 100 exposure days this risk was further increased to 13.3% (95% CI, 9.6-17.0). Among a total of 221 different F8 point mutations 19 were associated with inhibitor development. The inhibitor risk was highest for R593C, D2074G, R2159C and W2229C, reaching 19%, 21%, 39% and 42%, respectively, at 50 exposure days. Conclusion: Among a total of 221 different point mutations, 19 mutations were associated with inhibitor development. Longitudinal analysis revealed that the inhibitor incidence in non-severe hemophilia A patients with certain F8 mutations approaches the incidence observed in patients with severe hemophilia. These results emphasize the importance of F8 genotyping in non-severe hemophilia A. New preventive and therapeutic approaches in this patient group are urgently needed

Factor VIII gene (F8) mutation and inhibitor development in non-severe hemophilia A

Clinical epidemiolog

Inhibitor development and mortality in non-severe hemophilia A

BackgroundThe life expectancy of non-severe hemophilia A (HA) patients equals the life expectancy of the non-hemophilic population. However, data on the effect of inhibitor development on mortality and on hemophilia-related causes of death are scarce. The development of neutralizing factor VIII antibodies in non-severe HA patients may dramatically change their clinical outcome due to severe bleeding complications. ObjectivesWe assessed the association between the occurrence of inhibitors and mortality in patients with non-severe HA. MethodsIn this retrospective cohort study, clinical data and vital status were collected for 2709 non-severe HA patients (107 with inhibitors) who were treated between 1980 and 2011 in 34 European and Australian centers. Mortality rates for patients with and without inhibitors were compared. ResultsDuring 64200 patient-years of follow-up, 148 patients died (mortality rate, 2.30 per 1000 person-years; 95% confidence interval (CI), 1.96-2.70) at a median age of 64years (interquartile range [IQR], 49-76). In 62 patients (42%) the cause of death was hemophilia related. Sixteen inhibitor patients died at a median age of 71years (IQR, 60-81). In ten patients the inhibitor was present at time of death; seven of them died of severe bleeding complications. The all-cause mortality rate in inhibitor patients was >5 times increased compared with that for those without inhibitors (age-adjusted mortality rate ratio, 5.6). ConclusionInhibitor development in non-severe hemophilia is associated with increased mortality. High rates of hemophilia-related mortality in this study indicate that non-severe hemophilia is not mild at all and stress the importance of close follow-up for these patients

Clinical presentation of inhibitor development in non-severe hemophilia A: half of patients have high titer inhibitors and present with bleeding complications

Clinical epidemiolog