Change a Way Forward: An interpretative and qualitative study examining an organizational change initiative

Title: Change – A way forward: An interpretative and qualitative study examining an organizational change initiative. Seminar date: May 28th 2013 Course: BUSN49 - Degree Project in Managing People, Knowledge and Change - Master Level Authors: Lena Ytterberg, Susanna Hallner Advisors: Stefan Sveningsson Department of Business Administration Lund University School of Economics and Management, Sweden. Key words: IKEA Industry, Organizational Change Management, Cultural change, Sense Making, Symbolic Leadership, Organizational Identification, Zero Defect Culture, Quality Thesis purpose: The main purpose with this thesis is, with an interpretative perspective, examine a change initiative. Methodology: The research is conducted from a qualitative and interpretative perspective taking a reflexive standpoint. Theoretical Perspective: The thesis is examined based on existing literature regarding organizational change management, sense making, symbolic leadership and organizational identification. Through our findings we aim to extend existing theories. Empirical Foundation: The research is based on a case study of a company within the furniture production industry. The main findings were collected and provided by interviews with managers from the organization. Conclusions: Employees interpret change initiatives in multiple ways. Therefore managers have an important role to create meaning behind reasons of why change needs to be done. The importance for employees to identify with the organization is one vital factor for a change to proceed

Use of health services in people with multiple sclerosis with and without depressive symptoms: a two-year prospective study

BACKGROUND: To organize tailored healthcare for people with multiple sclerosis (MS), knowledge about patterns in the use of healthcare among subgroups, such as those with depressive symptoms, is essential. Thus, the purpose of this study was to explore and compare the use of health services in people with MS and depressive symptoms, and without depressive symptoms over a period of 30 months. METHODS: Data on the use of health services by 71 people with MS and depressive symptoms, and 102 with no depressive symptoms were collected from a computerised register and by interview, then categorized with regard to disease severity (Expanded Disability Status Scale). RESULTS: People with EDSS mild and depressive symptoms used more outpatient and inpatient care compared to those with no depressive symptoms. Furthermore, they received more unsalaried informal care as well as intense rehabilitation periods. CONCLUSIONS: The issues underlying the differences in the use of healthcare need to be explored further, as well as the plausible implications for the organization of healthcare services for people with MS and depressive symptoms. Furthermore, the life situations of caregivers of people with MS and depressive symptoms should be considered, and appropriate interventions supplied in order to diminish caregiver burden

Venous Thromboembolism and Cerebrovascular Events in Patients with Giant Cell Arteritis: A Population-Based Retrospective Cohort Study

To investigate the incidence of venous thromboembolism (VTE) and cerebrovascular events in a community-based incidence cohort of patients with giant cell arteritis (GCA) compared to the general population. METHODS: A population-based inception cohort of patients with incident GCA between January 1, 1950 and December 31, 2009 in Olmsted County, Minnesota and a cohort of non-GCA subjects from the same population were assembled and followed until December 31, 2013. Confirmed VTE and cerebrovascular events were identified through direct medical record review. RESULTS: The study population included 244 patients with GCA with a mean ± SD age at diagnosis of 76.2 ± 8.2 years (79% women) and an average length of follow-up of 10.2 ± 6.8 years. Compared to non-GCA subjects of similar age and sex, patients diagnosed with GCA had a higher incidence (%) of amaurosis fugax (cumulative incidence ± SE: 2.1 ± 0.9 versus 0, respectively; p = 0.014) but similar rates of stroke, transient ischemic attack (TIA), and VTE. Among patients with GCA, neither baseline characteristics nor laboratory parameters at diagnosis reliably predicted risk of VTE or cerebrovascular events. CONCLUSION: In this population-based study, the incidence of VTE, stroke and TIA was similar in patients with GCA compared to non-GCA subjects

Services for reducing duration of hospital care for acute stroke patients

<p>Background: Stroke patients conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed which offer patients in hospital an early discharge with rehabilitation at home (early supported discharge (ESD)).</p> <p>Objectives: To establish the effects and costs of ESD services compared with conventional services.</p> <p>Search methods: We searched the trials registers of the Cochrane Stroke Group (January 2012) and the Cochrane Effective Practice and Organisation of Care (EPOC) Group, MEDLINE (2008 to 7 February 2012), EMBASE (2008 to 7 February 2012) and CINAHL (1982 to 7 February 2012). In an effort to identify further published, unpublished and ongoing trials we searched 17 trial registers (February 2012), performed citation tracking of included studies, checked reference lists of relevant articles and contacted trialists.</p> <p>Selection criteria: Randomised controlled trials recruiting stroke patients in hospital to receive either conventional care or any service intervention which has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care.</p> <p>Data collection and analysis: The primary patient outcome was the composite end-point of death or long-term dependency recorded at the end of scheduled follow up. Two review authors scrutinised trials and categorised them on their eligibility.We then sought standardised individual patient data from the primary trialists. We analysed the results for all trials and for subgroups of patients and services, in particular whether the intervention was provided by a co-ordinated multidisciplinary team (co-ordinated ESD team) or not.</p> <p>Main results: Outcome data are currently available for 14 trials (1957 patients). Patients tended to be a selected elderly group withmoderate disability. The ESD group showed significant reductions (P = 0.0001) in the length of hospital stay equivalent to approximately seven days. Overall, the odds ratios (OR) (95% confidence interval (CI)) for death, death or institutionalisation, death or dependency at the end of scheduled follow-up were OR 0.91 (95% CI 0.67 to 1.25, P = 0.58), OR 0.78 (95% CI 0.61 to 1.00, P = 0.05) and OR 0.80 (95% CI 0.67 to 0.97, P = 0.02) respectively. The greatest benefits were seen in the trials evaluating a co-ordinated ESD team and in stroke patients with mild to moderate disability. Improvements were also seen in patients’ extended activities of daily living scores (standardised mean difference 0.12, 95% CI 0.00 to 0.25, P = 0.05) and satisfaction with services (OR 1.60, 95% CI 1.08 to 2.38, P = 0.02) but no statistically significant differences were seen in carers’ subjective health status, mood or satisfaction with services. The apparent benefits were no longer statistically significant at five-year follow-up.</p> <p>Authors’ conclusions: Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as reducing the length of hospital stay. We observed no adverse impact on the mood or subjective health status of patients or carers.</p&gt

Нравственное воспитание будущих врачей при обучении их русскому языку как иностранному

НРАВСТВЕННОЕ ВОСПИТАНИЕРУССКИЙ ЯЗЫК КАК ИНОСТРАННЫЙВОСПИТАНИЕ СТУДЕНТОВОБУЧЕНИЕИНОЯЗЫЧНОЕ ОБРАЗОВАНИЕИНОСТРАННЫЕ СТУДЕНТ

Heightened immune response to autocitrullinated porphyromonas gingivalis peptidylarginine deiminase: a potential mechanism for breaching immunologic tolerance in rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is characterised by autoimmunity to citrullinated proteins, and there is increasing epidemiologic evidence linking Porphyromonas gingivalis to RA. P gingivalis is apparently unique among periodontal pathogens in possessing a citrullinating enzyme, peptidylarginine deiminase (PPAD) with the potential to generate antigens driving the autoimmune response. Objectives: To examine the immune response to PPAD in patients with RA, individuals with periodontitis (PD) and controls (without arthritis), confirm PPAD autocitrullination and identify the modified arginine residues. Methods: PPAD and an inactivated mutant (C351A) were cloned and expressed and autocitrullination of both examined by immunoblotting and mass spectrometry. ELISAs using PPAD, C351A and another P gingivalis protein arginine gingipain (RgpB) were developed and antibody reactivities examined in patients with RA (n=80), individuals with PD (n=44) and controls (n=82). Results: Recombinant PPAD was a potent citrullinating enzyme. Antibodies to PPAD, but not to Rgp, were elevated in the RA sera (median 122 U/ml) compared with controls (median 70 U/ml; p<0.05) and PD (median 60 U/ml; p<0.01). Specificity of the anti-peptidyl citrullinated PPAD response was confirmed by the reaction of RA sera with multiple epitopes tested with synthetic citrullinated peptides spanning the PPAD molecule. The elevated antibody response to PPAD was abolished in RA sera if the C351A mutant was used on ELISA. Conclusions: The peptidyl citrulline-specific immune response to PPAD supports the hypothesis that, as a bacterial protein, it might break tolerance in RA, and could be a target for therapy

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ABSTRACT. Objective. To determine the incidence and prevalence of sporadic inclusion body myositis (sIBM) and polymyositis (PM) in a population-based study. Methods. Charts of patients with myositis in Olmsted County, Minnesota, USA, from 1981 to 2000 were reviewed. Results. For sIBM, the age-and sex-adjusted incidence rates per 100,000 were 0.79 (95% confidence interval = 0.24-1.35), and for PM, 0.41 (95% CI 0.08-0.73). The age-and sex-adjusted prevalence rates per 100,000 were 7.06 (95% CI 0.87-13.24) for sIBM and 3.45 (95% CI 0.00-7.35) for PM. Conclusion. The incidence and prevalence rates for sIBM are higher than previously reported