The Relationship Between Class Size and Student Achievement

Few issues in education have continued to receive as much attention as the topic of class size and its effect on student achievement. Frequent studies on this issue have produced an immense body of related literature

Increased Porphyrins in Primary Liver Cancer Mainly Reflect a Parallel Liver Disease

Hepatic porphyries have been associated with an increased risk of primary liver cancer (PLC), which on the other hand may cause an increased porphyrin production. To evaluate the role of an underlying liver disorder we analyzed porphyrins in patients with hepatocellular carcinoma (HCC) (n = 65), cholangiocellular carcinoma (n = 3), or suspected PLC, which turned out to be metastases (n = 18) or a benign disorder (n = 11). None of the patients had a family history of porphyry or clinical signs of porphyry. Increased aminolevulinic acid or porphyrin values were common not only in patients with PLC (43%) but also in metastatic (50%) and benign (64%) liver disorders. The corresponding proportion for HCC patients with liver cirrhosis (55%) was higher (P < .05) than in those without cirrhosis (17%). We conclude that symptomatic porphyries are unusual in PLC, whereas elevated urinary and/or faecal porphyrins are common, primarily reflecting a parallel liver disease and not the PLC

Outcomes after surgical treatment of localized prostate cancer with focus on urinary incontinence and short term complications

Background: Urinary incontinence is a significant long-term complication after radical prostatectomy. The aim was to evaluate clinically significant definitions of urinary incontinence and to investigate its potential predictors. Robot-assisted radical prostatectomy has become a widespread surgical technique in prostate cancer despite the lack of randomised trials showing its superiority compared to open surgery. A further aim was to compare shortterm results three months after the two surgical techniques. Material and methods: Data for this thesis derives from two sources. The first cohort is a consecutive series of 1411 men who underwent radical prostatectomy at Karolinska University Hospital from 2002 to 2006 and completed a study-specific validated questionnaire. The second cohort derives from the LAPPRO study, a multicentre, prospective controlled trial of men who underwent radical prostatectomy between 2008 and 2011 (n=4003). Data was collected prospectively with validated patient questionnaires and case report forms which were completed by health-care personnel. Results: Urinary leakage as a long-term side effect after radical prostatectomy proved to cause the patient a lot of bother. Even a proportion of those who had occasional leakage reported significant bother. Increased age at surgery increases the risk of urinary incontinence one year after surgery and this increases exponentially with age. Furthermore patients with preoperative urinary leakage have an increased risk of postoperative incontinence. When evaluating short-term outcomes and comparing open radical prostatectomy to robot-assisted radical prostatectomy, re-operation during initial hospital stay was more frequent after open surgery. Men operated by open surgery also sought medical care more frequently compared to men operated by robot-assisted surgery within three months after surgery. Men who underwent lymph-node dissection proved to have an increased risk for readmission as well as a greatly increased risk for thromboembolic events, such as deep venous thrombosis and pulmonary embolism. Regardless of whether lymph-node dissection was preformed or not, men who underwent open prostatectomy appeared to have an increased risk of thromboembolic events compared to those who had robot-assisted surgery. Conclusions: If the definition of continence consists of the use of pads, a certain number of men that are bothered significantly by urinary leakage will be defined as continent. When planning a patient for radical prostatectomy, one must take age and preoperative urinary leakage into consideration as risk factors for postoperative incontinence. The robot-assisted radical prostatectomy is a safe procedure and has some short-term advantages compared to open surgery. Lymph-node dissection during radical prostatectomy increases the risk for thromboembolic events, the risk is higher in open surgery compared to robot-assisted surgery

Drug Treatment in Older People before and after the Transition to a Multi-Dose Drug Dispensing System - A Longitudinal Analysis

Tverrsnittstudie, undersøker assosiasjonen mellom multidose og polyfarmasi hos eldre.Background: an association has been found between multi-dose drug dispensing (MDD) and use of many drugs. The aim of this study was to investigate the nature of this association, by performing a longitudinal analysis of the drug treatment before and after the transition to MDD. Methods: inclusion critera in this register-based study were inhabitants in Region Västra Götaland, Sweden, who, at ≥65 years of age and between 1st July 2006 and 30th June 2010, filled their first MDD prescription. For each individual, prescribed drugs were estimated at three month intervals before and after (maximum 3 years, respectively) the first date of filling an MDD prescription (index date). Results: a total of 30,922 individuals matched the inclusion criteria (mean age: 83.2 years; 59.9% female). There was a temporal association between the transition to MDD and an increased number of drugs: 5.463.9 and 7.563.8 unique drugs three months before and after the index date, respectively, as well as worse outcomes on several indicators of prescribing quality. When either data before or after the index date were used, a multi-level regression analysis predicted the number of drugs at the index date at 5.76 (95% confidence limits: 5.71; 5.80) and 7.15 (7.10; 7.19), respectively, for an average female individual (83.2 years, 10.8 unique diagnoses, 2.4 healthcare contacts/three months). The predicted change in the number of drugs, from three months before the index date to the index date, was greater when data before this date was used as compared with data after this date: 0.12 (0.09; 0.14) versus 0.02 (20.01; 0.05). Conclusions: after the patients entered the MDD system, they had an increased number of drugs, more often potentially harmful drug treatment, and fewer changes in drug treatment. These findings support a causal relationship between such a system and safety concerns as regards prescribing practices

Impact of information letters on the reporting rate of adverse drug reactions and the quality of the reports: a randomized controlled study

BACKGROUND: Spontaneous reporting of adverse drug reactions (ADRs) is an important method for pharmacovigilance, but under-reporting and poor quality of reports are major limitations. The aim of this study was to evaluate if repeated one-page ADR information letters affect (i) the reporting rate of ADRs and (ii) the quality of the ADR reports. METHODS: All 151 primary healthcare units in the Region Västra Götaland, Sweden, were randomly allocated (1:1) to an intervention (n = 77) or a control group (n = 74). The intervention consisted of one-page ADR information letters administered at three occasions during 2008 to all physicians and nurses in the intervention units. The number of ADR reports received from the 151 units was registered, as was the quality of the reports, which was defined as high if the ADR was to be reported according to Swedish regulations, that is, if the ADR was (i) serious, (ii) unexpected, and/or (iii) related to the use of new drugs and not labelled as common in the Summary of Product Characteristics. A questionnaire was administered to evaluate if the ADR information letter had reached the intended recipient. RESULTS: Before the intervention, no significant differences in reporting rate or number of high quality reports could be detected between the randomization groups. In 2008, 79 reports were sent from 37 intervention units and 52 reports from 30 control units (mean number of reports per unit ± standard deviation: 1.0 ± 2.5 vs. 0.7 ± 1.2, P = 0.34). The number of high quality reports was higher in intervention units than in control units (37 vs. 15 reports, 0.5 ± 0.9 vs. 0.2 ± 0.6, P = 0.048). According to the returned questionnaires (n = 1,292, response rate 57%), more persons in the intervention than in the control group had received (29% vs. 19%, P &lt; 0.0001) and read (31% vs. 26%, P &lt; 0.0001) an ADR information letter. CONCLUSIONS: This study suggests that repeated ADR information letters to physicians and nurses do not increase the ADR reporting rate, but may increase the number of high quality reports

Impact of information letters on the reporting rate of adverse drug reactions and the quality of the reports: a randomized controlled study

BACKGROUND: Spontaneous reporting of adverse drug reactions (ADRs) is an important method for pharmacovigilance, but under-reporting and poor quality of reports are major limitations. The aim of this study was to evaluate if repeated one-page ADR information letters affect (i) the reporting rate of ADRs and (ii) the quality of the ADR reports. METHODS: All 151 primary healthcare units in the Region Västra Götaland, Sweden, were randomly allocated (1:1) to an intervention (n = 77) or a control group (n = 74). The intervention consisted of one-page ADR information letters administered at three occasions during 2008 to all physicians and nurses in the intervention units. The number of ADR reports received from the 151 units was registered, as was the quality of the reports, which was defined as high if the ADR was to be reported according to Swedish regulations, that is, if the ADR was (i) serious, (ii) unexpected, and/or (iii) related to the use of new drugs and not labelled as common in the Summary of Product Characteristics. A questionnaire was administered to evaluate if the ADR information letter had reached the intended recipient. RESULTS: Before the intervention, no significant differences in reporting rate or number of high quality reports could be detected between the randomization groups. In 2008, 79 reports were sent from 37 intervention units and 52 reports from 30 control units (mean number of reports per unit ± standard deviation: 1.0 ± 2.5 vs. 0.7 ± 1.2, P = 0.34). The number of high quality reports was higher in intervention units than in control units (37 vs. 15 reports, 0.5 ± 0.9 vs. 0.2 ± 0.6, P = 0.048). According to the returned questionnaires (n = 1,292, response rate 57%), more persons in the intervention than in the control group had received (29% vs. 19%, P &lt; 0.0001) and read (31% vs. 26%, P &lt; 0.0001) an ADR information letter. CONCLUSIONS: This study suggests that repeated ADR information letters to physicians and nurses do not increase the ADR reporting rate, but may increase the number of high quality reports