Clinical and economic benefits of extended treatment with apixaban for the treatment and prevention of recurrent venous thromboembolism in Canada

Background and objective Venous thromboembolism (VTE) is associated with long-term clinical and economic burden. Clinical guidelines generally recommend at least 3 months of anticoagulation, but, in clinical practice, concerns over bleeding risk often limit extended treatment. Apixaban was studied for extended VTE treatment in the AMPLIFY-EXT trial, demonstrating superiority to placebo in VTE reduction without increasing risk of major bleeding. This study assessed the long-term clinical and economic benefits of extending treatment with apixaban when clinical equipoise exists compared to standard of care with enoxaparin/warfarin and other novel oral anti-coagulants (NOACs) for the treatment and prevention of recurrent VTE in Canada.

Methods A Markov model was developed to follow patients with VTE over their lifetimes. Efficacy and safety for apixaban and enoxaparin/warfarin were based on AMPLIFY and AMPLIFY-EXT, while relative efficacy to other NOACs was synthesized by network meta-analysis (NMA). Dosages for NOACs and enoxaparin/warfarin were based on their respective trials and were given up to 18 months and up to 6 months, followed by no treatment, respectively. Patient quality adjusted life years (QALYs) were based on published studies, and costs for resource utilization were from a Ministry of Health perspective, expressed as 2014 CAD ($).

Results Extended treatment with apixaban compared to enoxaparin/warfarin resulted in fewer recurrent VTEs, VTE-related deaths, and bleeding events, but at slightly increased cost. The incremental cost-effectiveness ratio was $4828 per QALY gained. Compared to other NOACs, apixaban had the fewest bleeding events, similar recurrent VTE events, and the lowest overall cost, which was driven by the strong bleeding profile. In scenario analyses of acute and lifetime treatments, apixaban was cost-effective against all strategies.

Conclusions Extended treatment with apixaban can offer substantial clinical benefits and is a cost-effective alternative to enoxaparin/warfarin and other NOACs.     

高职高专英语口语常见错误分析及对策

本文通过对高职高专学生英语口语中常见错误的分析,应用Corder的错误分析理论,结合教学实践,提出了若干具体可行的提高高职高专英语口语教学的纠错方法,以提高英语口语课堂教学的高效性。     

文化导向型模拟法在大学英语口语中的应用

针对我国大学英语口语教学的现状,教学模式改革势在必行。文化导向型模拟法,作为一种新型的互动式教学模式,通过有效的途径加大目的语文化输入,非常符合口语课程的特点,将其应用于大学英语口语的教学实践中将大大提升课程的教学效果。     

Branding with the in–out effect: The impact of consonantal articulation on brand evaluation

Recent research has shown that mouth movements, produced even during silent reading, can affect stimulus evaluation. Words featuring systematic wanderings of consonantal stricture spots ranging from the front to the rear of the mouth (inward) are preferred to words with wanderings in the opposite direction (outward). In four experiments, the authors extended this in–out effect from a basic laboratory setting to a more ecologically relevant domain and examined the boundary conditions of possible applications to marketing. In this research, the inward/outward words presented were embedded in common brand imagery such as labels, logos, and product packages. Either with plain graphic information or with more visually informative packaging, inward names were always preferred (all p‐values < 0.001). These results indicate that concurrent information that competitively feeds into the preference judgment did not have diagnostic value when compared to the articulation direction. Such prevalence of the effect even when embedded in more complex stimulus emphasizes the relevance of investigating oral kinematics effects and the need to further research other sensorimotor phenomena in consumer behavior.     

基于Krashen监察模式的公安英语口语教学改革研究

为积极响应教育部加强大学英语教学改革的号召,进一步加快公安院校行业英语口语教学的改革步伐以提升公安院校学生听说能力,以Krashen监察模式理论为研究视角深入剖析公安英语教学的现状,从教改目标、思路及实施方法三方面论述了进行公安英语口语教学改革的可行性和实效性。     

高职院校旅游专业学生口语交际能力评价研究

评价高职旅游专业学生的口语交际能力,要制定出一套科学的评价体系,应建立知识与能力,过程与方法,情感、态度与价值观三维交融的立体评价体系。评价时要遵循一定的评价原则,力求做到评价内容全面性、评价标准个性化、评价方法多样性。     

A note on videos and accounting education

Doctoral students are often uncomfortable making oral presentations before their peers and the instructor. This paper describes a recent innovation employed in the doctoral programme of a major university which we feel has been useful not only in increasing the communication skills of our doctoral students, but has also enhancing the quality of doctoral students' dissertations as well as the teaching and presentation skill of staff involved in the programme.     

边疆少数民族地区高职高专英语口语教学实践研究

本文通过对边疆少数民族地区高职高专英语口语教学现状的调查与分析,从实际出发,采取相应的措施,探索出一条适合边疆少数民族地区高职高专学生的有效的口语教学模式。目的是提高学生的英语口语水平,以适应社会发展的需要。     

Costs of hospital visits among patients with deep vein thrombosis treated with rivaroxaban and LMWH/warfarin

Background:

For many years, the standard of care for patients diagnosed with deep vein thrombosis (DVT) has been low-molecular-weight heparin (LMWH) bridging to an oral Vitamin-K antagonist (VKA). The availability of new non-VKA oral anticoagulants (NOAC) agents as monotherapy may reduce the likelihood of hospitalization for DVT patients.

Objective:

To compare hospital visit costs of DVT patients treated with rivaroxaban and LMWH/warfarin.

Methods:

A retrospective claim analysis was conducted using the MarketScan Hospital Drug Database for care provided between January 2011 and December 2013. Adult patients using rivaroxaban or LMWH/warfarin with a primary diagnosis of DVT during the first day of a hospital visit were identified (i.e., index hospital visit). Based on propensity-score methods, historical LMWH/warfarin patients (i.e., patients who received LMWH/warfarin before the approval of rivaroxaban) were matched 4:1 to rivaroxaban patients. The hospital-visit cost difference between these groups was evaluated for the index hospital visit, as well as for total hospital-visit costs (i.e., including index and subsequent hospital visit costs).

Results:

All rivaroxaban users (n?=?134) in the database were well-matched with four LMWH/warfarin users (n?=?536). The mean hospital-visit costs were $5257 for the rivaroxaban cohort and $6764 in the matched-cohort of patients using LMWH/warfarin. The $1508 cost difference was statistically significant between cohorts (95% CI?=?[?$2296; ?$580]; p-value?=?0.002). Total hospital-visit costs were lower for rivaroxaban compared to LMWH/warfarin users within 1, 2, 3, and 6 months after index visit (significantly lower within 1 and 3 months, p-values <0.05)

Limitations:

Limitations were inherent to administrative-claims data, completeness of baseline characteristics, adjustments restricted to observational factors, and lastly the sample size of the rivaroxaban cohort.

Conclusion:

The availability of rivaroxaban significantly reduced the costs of hospital visits in patients with DVT treated with rivaroxaban compared to LMWH/warfarin.     

对外汉语初级阶段口语课教学现状调查及教学对策

作为对外汉语教学实践中最基础的课程之一,对外汉语口语课在教学实践中有着特殊的地位。在教师和学生心目中也有着特殊的地位,通过分析比对,发现了对外汉语初级阶段口语课的教学现状及存在的问题,并根据存在的问题,提出了相应的教学对策：把握好口语课课型;坚持课堂语言的规范性;选择好口语课教材;运用多种教学方法,将任务型语言教学法融入课堂中。