Efficacy of Endovascular Treatment for Acute Cerebral Large-Vessel Occlusion: Analysis of Nationwide Prospective Registry

BackgroundThe aim of this nationwide, prospective registry of acute cerebral large-vessel occlusion was to assess the efficacy of endovascular treatment (EVT) on outcome in the “real-world” settings.MethodsMedical information of the patients was anonymized and registered prospectively through a Web site from 84 medical centers in Japan. Reperfusion of the affected arteries was evaluated by the Thrombolysis in Cerebral Infarction grade on cerebral angiography or by the modified Mori grade on magnetic resonance angiography. Clinical outcome was evaluated by modified Rankin Scale (mRS) at 90 days after onset. Symptomatic intracranial hemorrhage and procedure-related complications were also analyzed.ResultsAmong intravenous tissue plasminogen activator (IV t-PA)–failed patients, no significant difference in favorable outcome was seen with or without EVT overall (41.7% versus 36.8%, P = .55). However, EVT significantly increased favorable outcomes (mRS score 0-2) in patients with internal carotid artery (ICA)/middle cerebral artery M1/basilar artery (BA) occlusion (41.3% versus 20.5%, P = .019). In contrast, among t-PA–ineligible patients, EVT significantly increased favorable outcomes overall (29.1% versus 19.5%; odds ratio, 1.70; P = .007). Furthermore, favorable outcomes were more common in patients with ICA/M1/BA occlusion (29.0% versus 10.3%; odds ratio, 3.56; P < .0001). Multivariate analysis also confirmed the efficacy of IV t-PA, EVT, and their combination for favorable outcome.ConclusionsEVT significantly improved clinical outcomes in IV t-PA–failed and t-PA–ineligible patients with ICA/M1/BA occlusion. These findings support the introduction of EVT for acute proximal artery occlusion

Cost-effectiveness Analysis of Apixaban against Warfarin for Stroke Prevention in Patients with Nonvalvular Atrial Fibrillation in Japan

Abstract Purpose The aim of this study was to evaluate the cost-effectiveness of apixaban compared with to warfarin, current standard of care, for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in Japan. Methods A previously published lifetime Markov model was adapted to evaluate the cost-effectiveness of apixaban compared with warfarin in patients with NVAF in Japan. In the same model, the costs associated with each clinical event and background mortality were replaced with Japanese data. Whenever available, some of the utility parameters were derived from Japanese published literature. Lifetime horizon was selected to evaluate the value of the treatment benefit (stroke prevention) against potential risks (such as major bleedings) among patients with NVAF. Direct medical cost, long-term care cost, and quality-adjusted life years (QALYs) were calculated from the payers' perspective. Findings Compared with warfarin, treatment with apixaban was estimated to increase life expectancy by 0.231 year or 0.240 QALYs while treatment cost increased by ¥511,692 (US $5117 at an exchange rate of US$1 = ¥100). The incremental cost-effectiveness ratio was ¥2,135,743 per QALY (US $21,357 per QALY). On the basis of the results of the probabilistic sensitivity analysis, when the willingness-to-pay threshold was set at approximately ≥¥2,250,000 (US$22,500) per QALY, the probability of apixaban being cost-effective was ≥50%. Assuming a willingness-to-pay threshold of ¥5,000,000 (US $50,000) and ¥6,700,000 (US$67,000) in Japan, the probability of apixaban being cost-effective was 85% and 91%, respectively. Conclusion Although most participants in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial used for the efficacy data of apixaban in the model were non-Japanese patients, the impact of the limitations on our results was considered small, and our results were deemed robust because of the additional effect in Japanese patients compared with that in the global population according to the subanalysis of Japanese patients in the trial. Therefore, based on an adaptation of a published Markov model, apixaban is a cost-effective alternative to warfarin in Japan for stroke prevention among patients with NVAF

Study on effective instruction method for student teaching (I) : Analysis of the trips in when the student teacher make a teaching plan

広島大学附属福山中・高等学校において実施されている教育実習をより充実させるために，教育実習指導Ｂと中高実習Ⅰ・Ⅱの効果的な指導方法を，３か年にわたり研究していく。この研究を行うことで，今まで指導教員の経験と直感に頼っていた実習生の取組課題に系統性を与えるとともに，指導教員の評価や助言も効果的なものにできると考える。１年次は，教育実習指導Ｂを受講した実習生が指導案作成のどの場面でつまづいているのかを調査するため，実習生へのアンケートをおこない，実習生が作成した指導案を分析した。その結果，多くの実習生が，教材研究の段階でつまづいていることが，明らかになった。また，実習Ｂの指導により，教材研究の段階から授業構成の段階へと，つまづき場面が変化していることも分かった。こうしたつまづきを克服するための，効果的な指導・助言といった手立ての研究をおこない体系化することが，今後の課題である。It lasts for three years and studies an effective instruction method of student teaching instruction B and training I, II to expand student teaching carried out in a high school in Fukuyama attached to Hiroshima University more. I performed the questionnaire to a trainee to investigate it which scene of the teaching plan making the trainee who attended student teaching instruction B tripped in 1 annual and analyzed the teaching plan that a trainee made. As a result, it was revealed that many trainees tripped at the stage of the teaching materials study. In addition, I understood that I tripped from the stage of the teaching materials study on a stage of the class constitution, and a scene changed by instruction of training B

Development of unit for elective subject from fifth to ninth grade to improve cooperative creation (3)

本研究は, 「21世紀型の教科学力」の新たな観点としての「協同的創造力」の育成をめざして, 自分たちで新たな文化を創造する子どもを育てる協同的創造学習のあり方について実証的に研究を進め, 単元モデルと評価方法を開発することを目的としている。そこで, 教科学習を「協同的創造学習」としてとらえ直すとともに, 中学校での従来の選択教科の時間に加えて, 小学校第5・6学年合同の選択教科の時間を新設して「協同的創造力」を特化して育むことにし, 本年度は, 選択教科の単元モデルの充実・改善と評価方法の確立に取り組んだ。その結果, 選択教科において, これまで開発した単元モデルをより充実させたり, 新たな単元モデルを開発したりすることができた。また, 評価の観点を整理し, 子どもの意識調査やカリキュラム評価に継続して取り組むことによって, 子どもの思いを汲み取り単元を見直していくことができた。今後も必修教科と選択教科のつながりや関連性, 各学年の系統性を整理するとともに, 協同的創造力育成の手だてを整理し, 来年度に向けて, これまで培ったものを生かす新たな学習開発を模索していきたいと考えている