One year cost effectiveness of sirolimus eluting stents compared with bare metal stents in the treatment of single native de novo coronary lesions: an analysis from the RAVEL trial

OBJECTIVE: To assess the balance between costs and effects of the sirolimus eluting stent in the treatment of single native de novo coronary lesions in the RAVEL (randomised study with the sirolimus eluting Bx Velocity balloon expandable stent in the treatment of patients with de novo native coronary artery lesions) study. DESIGN: Multicentre, double blind, randomised trial. SETTING: Percutaneous coronary intervention for single de novo coronary lesions. PATIENTS: 238 patients with stable or unstable angina. INTERVENTIONS: Randomisation to sirolimus eluting stent or bare stent implantation. MAIN OUTCOME MEASURES: Patients were followed up to one year and the treatment effects were expressed as one year survival free of major adverse cardiac events (MACE). Costs were estimated as the product of resource utilisation and Dutch unit costs. RESULTS: At one year, the absolute difference in MACE-free survival was 23% in favour of the sirolimus eluting stent group. At the index procedure, sirolimus eluting stent implantation had an estimated additional procedural cost of 1286. At one year, however, the estimated additional cost difference had decreased to 54 because of the reduction in the need for repeat revascularisations in the sirolimus group (0.8% v 23.6%; p < 0.01). After adjustment of actual results for the consequences of angiographic follow up (correction based on data from the BENESTENT (Belgium Netherlands stent) II study), the difference in MACE-free survival was estimated at 11.1% and the addit

Health and prolonging working lives: an advisory report of the Health Council of The Netherlands

Objective This paper summarizes the main findings and recommendations of an advisory report on health and prolonging working life, which was requested by the Dutch Minister of Social Affairs and Employment. Methods The advisory report was compiled by a multidisciplinary committee of ten scientists appointed by the Health Council of The Netherlands. The committee's aims were to (i) describe the health of the ageing population, (ii) describe how prolonging working life influences health, (iii) describe determinants, besides health, for prolonging working lives, and (iv) review the literature on interventions aimed at retaining or improving employability of older workers. Results The report was presented to the Minister on 26 June 2018. As the likelihood of health problems increases with age, prolonging working life may be difficult. In general, life expectancy increases and gains in life years and health seem mainly attributable to people aged >75 years. Work is good for mental health. However, it may be beneficial for mental health to stop working around the retirement age. Besides health, financial factors, lifestyle, motivation to work, and working conditions play a role in prolonging working life. A systematic review of the evidence indicated that interventions such as worksite health promotion or career development workshops can support older workers in this matter. Conclusions The Health Council advised the Dutch Government to focus on worksite health promotion and career development interventions as well as the improvement of their implementation. This requires a tailored approach as there is a large diversity in health among older workers and particularly between low- and higheducated people. With this in mind, it was further recommended to explore whether flexible pension schemes might better suit this diversit

Jan Swammerdam als microscopist

Jan Swammerdam as microscopist Contrary to the usual opinion, Jan Swammerdam, after the period of mysticism, resumed his scientific work. He worked very hard during the last period of his life (1676-80), though he was no more fit for field research. He now collected and enlarged his manuscripts and made them ready for press; they were published by Boerhaave as the Biblia Naturae (1737-38). Moreover in these years he applied himself in particular to microscopical examinations. In his earlier days he had used a magnifying glass made by Van Musschenbroek. but now he made his simple microscopes himself after a method he had learnt from Joh. Hudde. They were, in fact, very small glass globules which also later have been shown by P. Harting to have a great magnifying power (800 - 2200 x). They enabled Swammerdam to study the inner structure of insects and, in 1678, the red blood cells (already observed by Leeuwenhoek some years previously) and their oval form. Furthermore he describd the spermatozoa in a dog some months after Leeuwenhoek had studied them first. He recognized Leeuwenhoek's priorities, but the two naturalists had too little appreciation for each other's merits

Anton de Heide als proefondervindelijk onderzoeker

Anton de Heide as an experimental investigator Anton de Heide, a Middelburg doctor, who discovered the ciliar motion in mussels, also made original experimental research in the field of physiology and pathology. Some of these observations are briefly discussed. With his microscopes he studied the movement of the blood in a capillary net of the inner side of the skin of a frog, as well as the effect of punctures of small veins and arteries. Further he studied the behaviour of human blood in small glass tubes, and the blood of some animals by preventing coagulation, or adding chemical substances. Finally he made an experimental study of the formation of callus in the broken bones of the legs of frogs