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- Aasa, Mikael, et al.
(författare)
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Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction-Results of the Swedish Early Decision reperfusion Study (SWEDES) trial.
- 2010
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Ingår i: American heart journal. - : Elsevier BV. - 1097-6744 .- 0002-8703. ; 160:2, s. 322-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. METHODS: Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. RESULTS: Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group ($4,602 vs $3,807; P = .047), as well as the cost of drugs ($1,309 vs $1,202; P = .001), whereas the cost of hospitalization was lower ($7,344 vs $9,278; P = .025). The cost of investigations, outpatient care, and loss of production did not differ significantly between the 2 treatment arms. Total cost and quality-adjusted survival were $25,315 and 0.759 vs $27,819 and 0.728 (both not significant) for the primary PCI and thrombolysis groups, respectively. Based on the 1-year follow-up, bootstrap analysis revealed that in 80%, 88%, and 89% of the replications, the cost per health outcome gained for PCI will be <$0, $50,000, and $100,000 respectively. CONCLUSION: In a 1-year perspective, there was a tendency toward lower costs and better health outcome after primary PCI, resulting in costs for PCI in comparison to thrombolysis that will be below the conventional threshold for cost-effectiveness in 88% of bootstrap replications.
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| 2. |
- Aasa, Mikael, et al.
(författare)
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Risk Reduction for Cardiac Events After Primary Coronary Intervention Compared With Thrombolysis for Acute ST-Elevation Myocardial Infarction (Five-Year Results of the Swedish Early Decision Reperfusion Strategy [SWEDES] Trial).
- 2010
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Ingår i: The American journal of cardiology. - : Elsevier BV. - 1879-1913 .- 0002-9149. ; 106:12, s. 1685-91
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Tidskriftsartikel (refereegranskat)abstract
- Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction compares favorably to thrombolysis. In previous studies the benefit has been restricted to the early postinfarction period with no additional risk decrease beyond this period. Long-term outcome after use of third-generation thrombolytics and modern adjunctive pharmaceutics in the 2 treatment arms has not been investigated. This study was conducted to compare 5-year outcome after updated regimens of PPCI or thrombolysis. Patients with ST-elevation myocardial infarction were randomized to enoxaparin and abciximab followed by PPCI (n = 101) or enoxaparin followed by reteplase (n = 104), with prehospital initiation of therapy in 42% of patients. Data on survival and major cardiac events were obtained from Swedish national registries after 5.3 years. PPCI resulted in a better outcome with respect to the composite of death or recurrent myocardial infarction (hazard ratio 0.54, confidence interval 0.31 to 0.95) compared to thrombolysis. This was attributed to a significant decrease in cardiac deaths (hazard ratio 0.16, confidence interval 0.04 to 0.74). The difference evolved continuously over the 5-year follow-up. After adjustment for covariates, a significant benefit remained with respect to cardiac death or recurrent infarction but not for the composite of total survival or recurrent myocardial infarction (p = 0.07). The observed differences were not seen in patients in whom therapy was initiated in the prehospital phase. In conclusion, PPCI in combination with enoxaparin and abciximab compares favorably to thrombolysis in combination with enoxaparin with a risk decrease that stretches beyond the early postinfarction period. Prehospital thrombolysis may, however, match PPCI in long-term outcome.
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| 5. |
- Abdon, NJ, et al.
(författare)
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Peripartumcardiomyopathi an often mised diagnosis
- 2013
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 110:23-24, s. 1152-1154
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Tidskriftsartikel (refereegranskat)abstract
- Peripartumkardiomyopati är en sällsynt form av hjärtsvikt. Diagnostiska kriterier är nytillkommen hjärtsvikt från sen graviditet och upp till fem månader efter förlossning, avsaknad av annan förklaring till hjärtsvikt och nedsatt systolisk vänsterkammarfunktion Orsaken till tillståndet tros vara omvandling av prolaktin till en kardiotoxisk variant. Terapin är den etablerade, men ACE-hämmare och ARB får inte ges till ammande mödrar. Hjärttransplantation har tillgripits. Maligna hjärtarytmier har krävt behandling med implanterbar defibrillator och pacemaker. Hämning av produktionen av prolaktin med bromokriptin har gett goda resultat i en liten studie. Resultaten har inte bekräftats.
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| 8. |
- Abraham, Getahun Yacob
(författare)
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Critical Pedagogy: Origin, Vision, Action & Consequences
- 2014
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Ingår i: KAPET. - Karlstad : Karlstads universitet. - 1653-4743. ; 10:1, s. 90-98
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Critical pedagogy is a transformation-based approach to education. The aim of this article is to introduce the origin, vision, action and consequences of critical pedagogy. It also aims on finding out about educators’ possibility of actualising it in their practice. As a source materials articles, book chapters and books are used. The literature shows that critical pedagogy has its origin in the tradition of critical theory of the Frankfurt School and the work of the Brazilian pedagog Paulo Freire. According to the literature, its major theses is that education should go beyond transfer of knowledge and training the future labour force; to help developing critical consciousness, which leads to transformation of the individual, learning environment and society at large. Critical pedagogy is criticised for a focus on macro level system, for not having a model for classroom implementation and for being abstract. Despite some critics, I argue that critical pedagogy has still the potential to empower those in the field of education to increase their consciousness about the injustice in their society and to involve in transforming it. Keywords: Critical pedagogy, critical thinking, critical theory, dialogue, Frankfurt School, transformation.
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| 10. |
- Abraham, Getahun Yacob
(författare)
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Democratic Values in the Comprehensive Schools Curricula of the Nordic Countries.
- 2013
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Konferensbidrag (refereegranskat)abstract
- Democratic values in the comprehensive schools curricula of the Nordic countries. The major focus of this paper is to find out which aspects of democratic values are emphasised in the comprehensive schools curricula of the five Nordic countries. It is also an intention of the paper to find out similarities and differences in emphasis and if available data allows to further investigate the reasons for differences and similarities.Major sources for the work were curricula of comprehensive schools from the different Nordic countries. Each countries current curriculum was closely read to understand their contents and to undertake comparative analysis. Text analysis was used as a major tool to look closely at the text and context. For further knowledge journals on curriculum studies and other relevant materials were consulted.A preliminary review of the general section of comprehensive schools curricula of these countries show:In the Danish curriculum participation, responsibility and understanding rights and duties are emphasised.The Finnish curriculum raises issues on human rights, equality, natural diversity, preservation of environment and multiculturalism. Responsibility, a sense of community and respect for the right and freedom of the individual are emphasised. General diversity and gender equality are given significant attention.In the Icelandic curriculum the major focus is human rights, collective responsibility, participation, influencing, and respect. Concern for people, animal and the environment are included in the curriculum. Critical thinking and reflection, active cooperation & collective responsibility are also emphasised.The Norwegian curriculum mentions understanding, cooperation, independence, individual freedom and tolerance as important issues.Swedish curriculum raises issues on respect for human rights, respect for persons and the environment. It considers inviolability of human life, individual freedom and integrity, equality between women and men, solidarity with the weak and vulnerable as crucial points. Sense of justice, generosity of spirit, tolerance and responsibility, well-being and development of the individual, no discrimination and personal responsibility were among the areas the curriculum lifted up.The curricula in these five countries give room for democratic values. There are some variations on emphasises on specific issues. But all the curricula include issues of rights and responsibilities.Keywords: curricula, democratic values, Nordic countries
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