Length of stay and economic consequences with rivaroxaban vs enoxaparin/vitamin K antagonist in patients with DVT and PE: findings from the North American EINSTEIN clinical trial program

Objective:

Venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [(PE]) represents a substantial economic burden to the healthcare system. Using data from the randomized EINSTEIN DVT and PE trials, this North American sub-group analysis investigated the potential of rivaroxaban to reduce the length of initial hospitalization in patients with acute symptomatic DVT or PE.

Methods:

A post-hoc analysis of hospitalization and length-of-stay (LOS) data was conducted in the North American sub-set of patients from the randomized, open-label EINSTEIN trial program. Patients received either rivaroxaban (15?mg twice daily for 3 weeks followed by 20?mg once daily; n?=?405) or dose-adjusted subcutaneous enoxaparin overlapping with (guideline-recommended ‘bridging’ therapy) and followed by a vitamin K antagonist (VKA) (international normalized ratio?=?2.0–3.0; n?=?401). The open-label study design allowed for the comparison of LOS between treatment arms under conditions reflecting normal clinical practice. LOS was evaluated using investigator records of dates of admission and discharge. Analyses were carried out in the intention-to-treat population using parametric tests. Costs were applied to the LOS based on weighted mean cost per day for DVT and PE diagnoses obtained from the Healthcare Cost and Utilization Project dataset.

Results:

Of 382 patients hospitalized, 321 (84%), had acute symptomatic PE; few DVT patients required hospitalization. Similar rates of VTE patients were hospitalized in the rivaroxaban and enoxaparin/VKA treatment groups, 189/405 (47%) and 193/401 (48%), respectively. In hospitalized VTE patients, rivaroxaban treatment produced a 1.6-day mean reduction in LOS (median?=?1 day) compared with enoxaparin/VKA (mean?=?4.5 vs 6.1; median?=?3 vs 4), translating to total costs that were $3419 lower in rivaroxaban-treated patients.

Conclusion:

In hospitalized North American patients with VTE, treatment with rivaroxaban produced a statistically significant reduction in LOS. When treating DVT and PE patients, clinicians should consider newer anti-coagulants with less complex treatment regimens.     

"Bet You Can't Eat Just one"-

Household and food store manager perceptions of the acceptance of four means of reducing the incidence and severity of food safety hazards were estimated using a mail survey in early 1992. Households gave limited acceptance to use of vacuum packaging, irradiation, organic production and pesticide-free production as means of reducing food safety hazards. Education of the household head was the only socioeconomic characteristic statistically impacting household acceptance of these four activities. Store manager perceptions of their customers' reactions to these procedures were statistically less favorable than those of the households.     

Negotiating in Latin America

Abstract

The emerging role of Latin America in the global marketplace suggests that understanding and managing cross-cultural negotiations will become increasingly important between Latin America and the rest of the world, including and especially the United States and Canada. While North America and Latin America were colonized at about the same time, different historical development, economic conditions, and cultures influence their approaches to negotiation. This paper examines what we know about negotiating in Latin America, based on anecdotal and empirical evidence, and what aspects of negotiation behavior require further study and elucidation.

Resumen

La nueva y creciente posición de América Latina en los mercados globales hará que el entendimiento y la administración de los procesos de negotiatíon inter-culturales entre América Latina y el resto del mundo, con especial énfasis en Estados Unidos y Canadá, adquiera mucha mayor importancia. Norte y Latino América fueron colonizadas en épocas aproximadamente similares, sin embargo, los procesos requeridos para negociar con cada uno de ellos han sido influenciados por diferentes desarrollos históricos, condiciones económicas y aspectos culturales. Este artículo examina a través de evidencia anecdótica y empírica los aspectos de negociaión en América Latina ya conocidos y aquellos que requieren investigación adicional.

Resumo

O papel emergente da América Latina no mercado global sugere que o entendimento e a gerêntia de negociações inter-culturais se tornará cada vez mais importante entre a América Latina e o resto do mundo, destacando-se os Estados Unidos e o Canadá. Apesar de a América do Norte e a América Latino terem sido colonizados em torno da mesma época, diferentes desenvolvimentos históricos, condições econômicas e culturas influenciaram a sua forma de negociar. Esse artigo examina o que nós sabemos a respeito de negocição na América Latina, baseado em evidências casuals ou empíricas, e que aspectos do comportamento de negociação requerem estudos mais aprofundados ou maior elucidação.     

美、法国有企业改革对我国国有企业发展转型的启示

改革开放以来,随着社会主义市场经济的迅猛发展,对国有企业的改革要求也越来越高;另外,国有企业的改革也极大地促进了社会主义市场经济的发展。但是,也应该看到:我国的国有企业体制仍然存在着很多问题,和社会主义市场经济的发展存在着一定的冲突。本文以美国和法国这两个西方发达国家为参照,从改革历程、手段等方面全面分析两个国家的国有企业改革并总结其中经验,尝试对我国未来的国有企业改革提出一些建议。     

Teaching Media and Methods in Marketing: European and North American Universities

This article aims to examine the most widely used teaching media and methods in university education. To achieve this objective, international research has been carried out among 135 marketing teachers from North American and European universities. The study shows that North American teachers use more traditional media and participatory methods than European teachers.     

Book Review

The diffusion of the Internet is becoming a central policy issue for developing countries, being identified by scholars as a key driver of knowledge, innovation and development. Remarkably, the related literature is scarce and fragmented. In order to contribute to fill this gap, we analyse Internet access and usage patterns in seven Latin American countries. In addition to the traditional socio-economic determinants of Internet access, the results also suggest an important role for network effects, presence of students at households and complementarities in Internet use at different locations. Concerning usage, estimations show that Internet access does not translate automatically into usage. In particular, females are found to be less likely to use the Internet, even once access is provided. Finally, the evidence suggests that while technological skills are necessary to fully exploit Internet potentialities, individuals located in rural areas are more likely to use the Internet for education purposes, confirming the potential connectivity impact on human capital.     

Call for papers: Special Issue of International Journal of HRM

Though women remain under-represented among expatriate managers due to a range of organisational and cultural barriers in selection and individual relocation concerns, they have begun to pursue alternative routes towards a global career such as frequent travel and undertaking domestic positions with international development and community development responsibilities. In this paper, we explore the perceptions that Middle Eastern and North American women have of traditional and new trajectories in global work and careers and conclude that increased flexibility allows women to pursue global development opportunities differently throughout their lifetime careers, permitting them to adapt to work–life circumstances. Thus, our research provides new insights into the nature and dynamic of the nature of women's global work and careers.