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There is growing evidence that young tourists at nightlife resorts have a propensity for risk-taking. Based on ethnographic fieldwork at an international nightlife resort in Bulgaria, this article examines how guides help tourists lower their inhibitions and reach states of collective effervescence. Focus is on young guides and tourists from Denmark. The article argues that the guides use four basic techniques to stir up effervescence: body techniques, speech and sound effects, crowd effects and alcohol. 相似文献
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《Journal of medical economics》2013,16(3):576-585
AbstractObjective:This study was designed to evaluate the cost utility of tocilizumab in rheumatoid arthritis (RA) patients, with inadequate responses to traditional disease-modifying anti-rheumatic drugs (tDMARDs) from a payer’s perspective in Italy.Methods:An individual patient simulation model was used to project lifetime medical costs (payer’s perspective) and quality-adjusted life-years (QALYs). Treatment sequences starting with tocilizumab or the most commonly prescribed biologics (etanercept, adalimumab, or infliximab) were compared. The addition of tocilizumab to standard of care, without the replacement of anti-tumor necrosis factor (TNF)-α treatments, was also evaluated. Patient characteristics, treatment efficacy, and quality-of-life data were based on three phase 3 tocilizumab clinical trials (TOcilizumab Pivotal Trial in Methotrexate Inadequate respONders [OPTION], Tocilizumab in cOmbination With traditional DMARD therapy [TOWARD], and TociLIzumab Safety and THE Prevention of Structural Joint Damage [LITHE]). Mixed-treatment comparison was used to estimate response probabilities. Resource utilization, treatment acquisition, administration, and monitoring costs were estimated using Italian secondary sources. Uncertainty in model parameters was evaluated by probabilistic sensitivity analysis.Results:Replacement of anti-TNF-α treatments with tocilizumab reduced total costs over a patient’s lifetime (base-case analysis: tocilizumab sequence, €141,100 vs standard of care sequence, €143,500). Patients receiving tocilizumab realized more QALYs than patients receiving standard of care (9.8881 vs 9.3502 QALYs). Therefore, according to the base-case analysis, the tocilizumab sequence dominated the standard of care. In a sensitivity analysis, the model base-case result was robust to input changes. When tocilizumab was added to standard of care, without replacing anti-TNF-α treatments, the incremental cost-effectiveness ratio was €17,100 per QALY.Conclusion:The analysis demonstrates that, in Italy, replacing another biologic DMARD with tocilizumab or adding tocilizumab to the current standard of care is a cost-effective strategy in the treatment of RA patients with inadequate responses to tDMARDs. 相似文献
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目的探讨伊曲康唑对合用药物药代动力学的影响机制,为临床上安全合理地利用合成药物提供依据。方法利用健康成人的肝细胞微粒体,将其分为加入不同浓度伊曲康唑的10个小组,浓度梯度为0.0、0.4、0.8、1.6、3.2μg/ml,每组做5个平行组,之后在其中五组加入肝细胞微粒体细胞色素的P450的同功酶1A2的底物非那西丁,在另外五组中加入同工酶3A4的底物睾酮,测量不同伊曲康唑下的同功酶1A2和3A4的相对活性。结果各浓度伊曲康唑组对同功酶1A2作用效果无明显差异,各浓度伊曲康唑组对同功酶3A4的作用较明显,同功酶3A4的活性随着伊曲康唑的浓度增大而减小,其减小到本实验的最大活性一半时的伊曲康唑的浓度为0.7μg/ml。结论伊曲康唑对健康成年人肝细胞微粒体细胞色素酶同功酶1A2的活性无显著影响;但是它对同功酶3A4的活性有明显抑制作用,极大地影响了同功酶3A4对合用药物药代动力学的各种参数。 相似文献
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鉴于当前基药配送中的关键问题,提出了优化方案。方案中,针对某一区域各基层对基药差异悬殊的需求量,进行了配比,一次配送和二次配送结合下实现了路径的优化,运输模型的建立和求解实现了成本的最低,有效地提高了医药物流企业基药配送的既得利润和行业积极性,对省内“统一配送”基药模式的改革和创新具有参考意义。 相似文献
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目的了解和分析2010年我院抗菌药物不良反应情况,为临床合理、安全用药提供依据。方法汇总2010年收集到的抗菌药物不良反应报告,按药物不良反应因果关系判断标准进行分析、评价、分级、统计。结果抗菌药物不良反应报告共计188例,排名前三位的分别是头孢菌素类药物(29.647%)、喹诺酮类药物(22.22%)、青霉素类(22.22%)。结论抗菌药物不良反应与药物性质、临床使用量、个体因素等密切相关。 相似文献
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Steven R. Feldman Jashin J. Wu Shipra Rastogi Brandy Menges Melissa Lingohr-Smith Jay Lin 《Journal of medical economics》2018,21(5):537-541
Introduction: Brodalumab is a new biologic approved by the US Food and Drug Administration in 2017 for the treatment of moderate-severe psoriasis. This study evaluated the impact of the introduction of brodalumab on the pharmacy budget on US commercial health plans.Methods: An Excel-based health economic decision analytic model with a US health plan perspective was developed. The model incorporated published moderate-to-severe psoriasis prevalence data; market shares of common biologic drugs, including adalimumab, ustekinumab, secukinumab, ixekizumab, and etanercept, used for the treatment of moderate–severe psoriasis; 2017-year Wholesale Acquisition Costs for the biologic drugs; drug dispensing fee; patient co-pay; and drug contracting discount. Total annual health plan costs for the biologic drugs were estimated. Scenarios with different proportions of patients treated with brodalumab were compared to a control scenario when no brodalumab was used.Results: In a hypothetical commercial health plan covering two million members, 7,038 moderate-to-severe psoriasis patients were estimated to be eligible for treatment with brodalumab. Prior to brodalumab approval, the proportions of patients treated by other biologics were estimated at 50.8% for adalimumab, 13.5% for ustekinumab, 14.1% for secukinumab, 4.4% for ixekizumab, and 17.2% for etanercept. With a 20% drug price discount applied to all biologics, the annual health plan costs for brodalumab, adalimumab, ustekinumab, secukinumab, ixekizumab, and etanercept were estimated at $37,224, $49,166, $55,084, $56,061, $64,396, and $57,170, respectively. When no brodalumab is used, the total annual pharmacy budget for the biologics used among these patients was estimated at $414,362,647. Among scenarios where the proportions of brodalumab usage were 3%, 8%, 16%, and 30%, the total annual pharmacy cost was estimated to be reduced by $3,698,129, $9,861,677, $19,723,355, and $36,981,290, respectively.Conclusion: Based on the economic model, brodalumab has the potential to substantially reduce pharmacy expenditures for the treatment of patients with moderate-to-severe plaque psoriasis in the US. 相似文献
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