Avaliação Económica de Ticagrelor em Prevenção Secundária Pós Síndroma Coronária Aguda

INTRODUCTION AND OBJECTIVES: To estimate the cost-effectiveness and cost-utility of ticagrelor in the treatment of patients with acute coronary syndromes (unstable angina or myocardial infarction with or without ST-segment elevation), including patients treated medically and those undergoing percutaneous coronary intervention or coronary artery bypass grafting. METHODS: A short-term decision tree and a long-term Markov model were used to simulate the evolution of patients' life-cycles. Clinical effectiveness data were collected from the PLATO trial and resource use data were obtained from the Hospital de Santa Marta database, disease-related group legislation and the literature. RESULTS: Ticagrelor provides increases of 0.1276 life years and 0.1106 quality-adjusted life years (QALYs) per patient. From a societal perspective these clinical gains entail an increase in expenditure of €610. Thus the incremental cost per life year saved is €4780 and the incremental cost per QALY is €5517. CONCLUSIONS: The simulation results show that ticagrelor reduces events compared to clopidogrel. The costs of ticagrelor are partially offset by lower costs arising from events prevented. The use of ticagrelor in clinical practice is therefore cost-effective compared to generic clopidogrel

Cost-effectiveness of ticagrelor plus aspirin versus aspirin in acute ischaemic stroke or transient ischaemic attack: an economic evaluation of the THALES trial

Health economics; StrokeEconomía de la salud; IctusEconomia de la salut; IctusObjective THALES demonstrated that ticagrelor plus aspirin reduced the risk of stroke or death but increased bleeding versus aspirin during the 30 days following a mild-to-moderate acute non-cardioembolic ischaemic stroke (AIS) or high-risk transient ischaemic attack (TIA). There are no cost-effectiveness analyses supporting this combination in Europe. To address this, a cost-effectiveness analysis was performed. Methods Cost-effectiveness was evaluated using a decision tree and Markov model with a short-term and long-term (30-year) horizon. Stroke, mortality, bleeding and EuroQol-5 Dimension (EQ-5D) data from THALES were used to estimate short-term outcomes. Model transitions were based on stroke severity (disabling stroke was defined as modified Rankin Scale >2). Healthcare resource utilisation and EQ-5D data beyond 30 days were based on SOCRATES, another trial in AIS/TIA that compared ticagrelor with aspirin. Long-term costs, survival and disutilities were based on published literature. Unit costs were derived from national databases and discounted at 3% annually from a Swedish healthcare perspective. Results One-month treatment with ticagrelor plus aspirin resulted in 12 fewer strokes, 4 additional major bleeds and cost savings of €95 000 per 1000 patients versus aspirin from a Swedish healthcare perspective. This translated into increased quality-adjusted life-years (0.04) and reduced societal costs (−€1358) per patient over a lifetime horizon. Key drivers of cost-effectiveness were number of patients experiencing subsequent disabling stroke and degree of disability. Findings were robust over a range of input assumptions. Conclusion One month of treatment with ticagrelor plus aspirin is likely to improve outcomes and reduce costs versus aspirin in mild-to-moderate AIS or high-risk TIA.AstraZeneca funded the THALES trial and the cost-effectiveness analysis of this study

Cost-Effectiveness of Ticagrelor Plus Aspirin Versus Aspirin in Acute Ischaemic Stroke or Transient Ischaemic Attack: An Economic Evaluation of the THALES Trial

OBJECTIVE: THALES demonstrated that ticagrelor plus aspirin reduced the risk of stroke or death but increased bleeding versus aspirin during the 30 days following a mild-to-moderate acute non-cardioembolic ischaemic stroke (AIS) or high-risk transient ischaemic attack (TIA). There are no cost-effectiveness analyses supporting this combination in Europe. To address this, a cost-effectiveness analysis was performed. METHODS: Cost-effectiveness was evaluated using a decision tree and Markov model with a short-term and long-term (30-year) horizon. Stroke, mortality, bleeding and EuroQol-5 Dimension (EQ-5D) data from THALES were used to estimate short-term outcomes. Model transitions were based on stroke severity (disabling stroke was defined as modified Rankin Scale \u3e2). Healthcare resource utilisation and EQ-5D data beyond 30 days were based on SOCRATES, another trial in AIS/TIA that compared ticagrelor with aspirin. Long-term costs, survival and disutilities were based on published literature. Unit costs were derived from national databases and discounted at 3% annually from a Swedish healthcare perspective. RESULTS: One-month treatment with ticagrelor plus aspirin resulted in 12 fewer strokes, 4 additional major bleeds and cost savings of €95 000 per 1000 patients versus aspirin from a Swedish healthcare perspective. This translated into increased quality-adjusted life-years (0.04) and reduced societal costs (-€1358) per patient over a lifetime horizon. Key drivers of cost-effectiveness were number of patients experiencing subsequent disabling stroke and degree of disability. Findings were robust over a range of input assumptions. CONCLUSION: One month of treatment with ticagrelor plus aspirin is likely to improve outcomes and reduce costs versus aspirin in mild-to-moderate AIS or high-risk TIA. TRIAL REGISTRATION NUMBER: NCT03354429

Dosimetry tools and techniques for IMRT

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98734/1/MPH001313.pd

Fritidspedagogen som försvann eller Vem bryr sig om fritids?

GÖTEBORGS UNIVERSITET Institutionen för pedagogik och didaktik ABSTRACT Titel: Fritidspedagogen som försvann eller Vem bryr sig om fritids? Författare: Carina Brockmar, Susanne Rikner Handledare: Mikael Nilsson Examinator: Owe Stråhlman Typ av arbete: Examensarbete 10 p Program och kurs: Lärarprogrammet med inriktning mot yngre åldrar, LAU 350 Antal sidor: 26 Datum: 5 juni, 2006 _________________________________________________________________________ Inledning: Fritidshemmet och fritidspedagogerna har ställts inför stora förändringar de senaste femton åren. Lärarutbildningen har också förändrats och få studenter väljer inriktning mot yngre åld-rar och fritidshem. Vi ville veta mer om hur det blivit så här och varför fritidshemmet blivit så osynligt i utbildningarna. Syfte: Syftet med examensarbetet är att sätta fokus på fritidshemmet och läraren med inriktning mot fritidshem samt ställa utvecklingen i utbildningen i relation till situationen ute i arbetslivet. Vi vill problematisera resultatet av utvecklingen och undersöka om utvecklingen är önskvärd eller beror på okunskap. Metod: Vi har använt oss av halvstrukturerade intervjuer och litteraturstudier som metod Resultat: Intervjuerna uttrycker och bekräftar vår oro inför utvecklingen. Kunskapen om yrket och verksamheterna är låg. Litteraturen bekräftar att det är skolan som gjort de största vinsterna av utvecklingen, då fritidshemmen integrerats i skolan och samverkan utvecklas mellan verk-samheterna. Många utttrycker ett ”osynliggörande” av yrkesidentitet och verksamhet. Konse-kvenserna av de dubbla yrkesrollerna som pedagogerna mot yngre åldrar skulle få är dåligt belyst, och resultatet av förändringarna i utbildningen tenderar att sänka statusen på dessa inriktningar. Diskussion: Vår oro inför yrkets framtid och verksamheten fritidshem har genom litteraturstudier och in-tervjuer bekräftats. Skolans kultur dominerar kunskapssyn samt ofta även verksamhet och pedagoger i fritidshem efter fritidshemmets integration i skolan. Kunskapen om verksamheten och yrket är lågt både hos studenter såväl som lärarutbildare och allmänhet. Kunskapen om och användningen av styrdokumentet Allmänna råd för fritidshem är låg. Mer kunskap behövs om vad som går förlorat i den utveckling som nu sker. Sökord: Fritidshem, fritidspedagog, Lärare med inriktning mot yngre åldrar, Allmänna råd för fritids-hem, fritidspedagogi

Arvet & miljöns betydelse för missbruk. Före detta missbrukares tankar om orsaken till missbruk.

  I denna studie har fem personer, tre män och två kvinnor intervjuats. Alla är idag nyktra missbrukare. Studiens syfte har varit att försöka ta reda på vilka uppfattningar och tankar före detta missbrukare har om arvet respektive miljöns påverkan för risken att utveckla missbruk. För att kunna belysa och beskriva tankar kring denna fråga har ett kvalitativt angreppssätt med fem semistrukturerade intervjuer använts som bearbetats utifrån en hermeneutisk ansats. I dessa intervjuer har det försökts att fånga upplevelser och förstå hur före detta missbrukares känner och tänker om arvet respektive miljön har haft betydelse för deras fall eller i någon annans utveckling av missbruk. I studien framkommer att både f.d. missbrukare och litteraturen menar att arv och miljö spelar roll för om och hur ett missbruk kommer att utveckla sig.   De nyckelord som använts i intervjuerna varit: familjesituation, uppväxtförhållanden, eget bruk/missbruk, arv & miljö. Som Svenska sökord som använts vid sökning av litteratur har varit: arv, miljö, missbruk och de engelska har varit abuse, family situation och dysfunctional

Waldorf Teachers and Environmental Issues : - Behavior, Values, Attitudes and Feelings of Responsibility

Today it has become critical that people adapt their behavior and lifestyles to environmental constraints. Teachers are supposed to teach pupils to accept personal responsibility in regard to these problems. The pedagogies of Waldorf and public schools have different outlooks on nature, hence it was hypothesized that Waldorf and public teachers would differ in regard to pro-environmental behavior and factors explaining such actions. An e-questionnaire measuring pro-environmental behavior, biospheric and altruistic values, feelings of personal responsibility, and pro-environmental attitudes was filled out by 68 Waldorf teachers and 73 public teachers from different municipalities in Sweden. The results suggest that Waldorf teachers report higher biospheric values (partial eta2 = .46, p < .001), more pro-environmental behavior (partial eta2 = .39, p < .001), more feelings of personal responsibility, (partial eta2 = .32, p < .001), and higher altruistic values (partial eta2 = .12, p < .001), than public school teachers do. There were a few limitations in reliability and possibly with social desirability. However, the present study paves the way for an understanding of how pedagogy can be of help in preventing further environmental problems

To build on cultural heritage – discourse about Liljevalchs art gallery and its annex

This thesis is about Liljevalchs art gallery in Stockholm and its intended annex, which is now under construction and will be completed in 2021. The purpose of the thesis is to identify different kinds of discourse regarding both Liljevalchs art gallery and the annex. This is done through a discourse analysis of different types of texts about Liljevalchs, written by art historians, Stockholm City Museum and Stockholm Planning Office. Texts from the architectural competition of the annex, describing the annex as well as the original art gallery, are also analyzed. In discourse analysis, language is thought not only to play a significant part in constructing the environment, but also in shaping our opinions about it. The thesis aims to make the different discourses visible, so that they can be examined and analyzed regarding their consequences, especially for the cultural heritage. Liljevalchs art gallery was built between 1914 and 1916, and was designed by the Swedish architect Carl Bergsten (1879-1935). It was the first independent, public museum for contemporary art in Sweden. In the 1980’s it was appointed as a building of particularly high cultural value by the Stockholm City Museum. It is described, both in the discourses of architectural history and cultural history, as a pioneering work in Swedish architecture as one of the first modernistic buildings in Sweden. It is especially valued for its sculpture hall, its atrium, its main entrance and also its interior. The discourse of cultural history values Liljevalchs long tradition as an important institution in the Swedish art society, as well as the fact that its interior and exterior are well-preserved. The architects behind the winning entry in the architectural competition of the annex, Wingårdhs Arkitektkontor, emphasize the similarities between the original art gallery and the annex in their description of it. However, the pictures of their entry shows an annex which differs from its main building. The jury in the competition praises the annex as a playful addition to Liljevalchs, and connects it to Liljevalchs folksy spirit rather than to Bergstens iconic building. If this discourse about the annex will remain will be a question for future research.Uppsats för avläggande av filosofie kandidatexamen med huvudområdet kulturvård med inriktning mot bebyggelseantikvarisk verksamhet 2020, 180 hp Grundnivå 2020:1