The New Orleans Athletic Club, founded in 1872, is one of the oldest athletic clubs in the United States that still operates today. After the boom of the 1920s and increased revenues, the club was forced to confront the Great Depression and shift its emphasis on the "strenuous life" to the "social life" to survive. The club had capitalized on the popularity of boxing during the 1920s and just finished constructing a lavish new club house when the stock market crashed in 1929. With members losing their jobs, the popularity of boxing waning, and the club in dire financial straits, the club looked for alternative strategies to survive. Its "social life" strategy relied on the club's various political ties to cut expenses and increased incentives for membership, which led to a larger, albeit, limited presence of women at the club.

In my thesis, in the theoretical part I deal with atrial fibrillation. I also deal with management of atrial fibrillation treatment. In the paper I explain the basic principles of pharmaco-economic evaluation in the Czech Republic, on the basis of which laws these pharmacological interventions are evaluated and who are in the Czech Republic. In the work I present cost breakdown and what are the most commonly used pharmaco-economic analyzes. In the practical part I will apply the theoretical knowledge. I have developed cost utility analysis based on available clinical evidence - randomized clinical trials ARISTOTLE (Granger, 2011), RE-LY (Connolly, 2009), ROCKET AF (Patel, 2011). I made an indirect comparison of the total benefits of NOACs. In the baseline scenario, I have calculated QALY to evaluate the benefits of effectiveness, safety and reduction of mortality. I have also dealt with a bleeding-related scenario. The ICER's greatest contribution to the public healthcare system has shown the active substance apixaban in both scenarios. I added the results and confirmed the clinical results of a recent, robust, retrospective study by Mayo Clinic (Yao, 2016).

ABSTRACTBackground: Determination of blood loss can be a crucial factor at surgical procedures, especially when the amount of blood is small and mixed with other fluids. The existing methods to measure this are still not supported with evidence enough.Aim: To validate the accuracy of the HemoCue® system (HemoCue, Ängelholm, Sweden) at estimation of blood loss in a setup where blood is mixed with saline and saliva.Materials and methods: The haemoglobin concentration of defibrinated horse blood was measured using the haematology analysers Hemocue® 201+ and Hemocue Plasma/Low Hb Photometer. Series of non-diluted blood (control) and blood diluted with saline and saliva (test) were conducted to mimic a clinical situation at oral and maxillofacial surgical treatment. Following each dilution, a new measurement of the haemoglobin concentration was performed using the appropriate haematology analyser to measure the blood loss.Results: There were no statistically significant differences regarding the measured Hb concentration in relation to the degree of dilution. The accuracy of measured blood volume in the diluted and non-diluted blood (control) was within a level of ± 11,5%.Conclusion: The measurement of haemoglobin concentrations in a mixture of blood, saline, and saliva, proved to be accurate when compared to non-diluted blood. It is suggested that the HemoCue® system can be applied in the field of oral and maxillofacial surgery to improve the accuracy of the blood loss measurement.

Introduktion: På senare tid har en ny generation av antikoagulantia (NOAK) uppkommit. NOAK kommer med fördelar då tidigare antikoagulantia behandling krävt täta läkarkontroller, reglering av dosering och hänsyn till kost. Tidigare antikoagulantia som warafarin och hepariner inhiberar flera koagulationsfaktorer. Medan Edoxaban som tillhör NOAK endast hämmar fria faktor Xa och protrombinaktivitet. Som följd av detta har Edoxaban en bättre effekt och ger ett mer säkert resultat vid korrekt ordination. Eftersom Edoxaban elimineras via njurar är det viktigt med njurfunktionskontroller som görs via estimerat glomerulär filtrationshastighet (eGFR). Kreatininbaserad eGFR gjordes med Lund-Malmö-formeln (LM) som är anpassad för den svenska populationen. Cystatin-C-baserad eGFR beräknas via Caucasian-Asian-pediatric-and-adult-cohorts-formeln (CAPA) där endast ålder tas hänsyn, till skillnad från LM-formeln där fler faktorer spelar roll. Syftet: Undersöka korrelationen mellan kreatininbaserade eGFR formeln LM och cystatin-C-baserad eGFR formeln CAPA. Metod: Blodprov togs från 43 Edoxabanbehandlade patienter i Karlstad Centralsjukhus. Patienternas eGFR beräknades via CAPA- respektive LM-formel. Faktorer som vikt, längd och ålder togs till hänsyn. Resultat: LM- och CAPA-eGFR visar en stark korrelation. Slutsats: LM-eGFR påverkas av fler faktorer och som följd fungerar bäst för patienter med balanserad längd och vikt samt stabil kost. Medan CAPA-eGFR, som påverkas av färre faktorer är anpassade för patienter som är över- och underviktiga med mycket varierad kost. / Introduction: A new generation of anticouagulants has emerged called NOAC. NOAC comes with benefits that have previously been problematic for patients treated with anticouagulants such as regular check-ups and dose regulation. Previous anticouagulants, warafarin and heparins, inhibits multiple coagulation factors. While NOAC only inhibits select few factors. For example, Edoxaban only inhibits free factor Xa and prothrombin activity. As result, Edoxaban has a better effect with proper prescription. Edoxaban eliminates through the kidneys which makes renal function tests important – eGFR. Creatinine-based eGFR is calculated via LM-formula which is adapted for the Swedish population. Cystatin-C-based eGFR is calculated via CAPA formula where only age is taken into account whereas the LM-formula relies on multiple factors. Aim: The purpose of the study is to understand the correlation between creatinine- and cystatin-C-based eGFR. Method: blood samples were taken from 43 patient treated with Edoxaban at Karlstad Hospital. eGFR were calculated via CAPA and LM formula. Weight, age and height were taken into account.  Result: A strong correlation shows in LM- and CAPA-eGFR. Conclusion: LM-eGFR is affected by several factors therefore works best for patients with balanced height and weight as well as a stable diet. Patients who are overweight, underweight or has a very varied diet is best fit for CAPA-eGFR which is unaffected by these factors.

Apixaban och lågmolekylärt heparin (LMH) är antikoagulantia som förhindrar blodproppsbildning genom att hämma faktor Xa. Allt mer patienter använder apixaban och LMH, vilket gör att laboratoriemedicin på länssjukhuset Ryhov är i behov av att utvärdera analysmetoder för apixaban och LMH för att kunna implementera analyserna i klinisk rutin. Syftet med studien var att utvärdera analysmetoden för bestämning av anti-FXa aktivitet i plasma hos patienter behandlade med apixaban eller LMH med hjälp av kromogen substratmetod. Metodutvärderingen bestod av fyra steg: repeterbarhet, mellanliggande precision, överensstämmelse med validerad metod och analys av normalpopulation. Utvärderingen genomfördes med hjälp av Sysmex CS-2100 där det analyserades 20 respektive 40 patientprover för apixaban och LMH samt 10 normalprover. Aktivitet av faktor Xa bestämdes kvantitativt med användning av ljusabsorption vid 405 nm. Repeterbarhet och mellanliggande precision visade låg CV. Patientprover visade överensstämmande resultat med referensvärden från andra laboratorium där r2 för apixaban och LMH var 0,95. Avvikande resultat kan bero på mätfel eller förväxling mellan prover. Analys av normalpopulation visade att värden låg under det lägsta tillförlitliga värdet. Utvärdering av analysmetoden apixaban och LMH på Ryhovs laboratorium visade goda resultat vilket bekräftar att analysmetoden kan användas i klinisk rutin. / Introduction: Apixaban and low molecular weight heparin (LMWH), are anticoagulants that prevent clot formation by inhibiting factor Xa. Increasingly more patients use apixaban and LMWH, for this reason the laboratory medicine at the county hospital Ryhov needs to evaluate methods of analysis for apixaban and LMWH to be able to implement the analyzes in clinical routine. Aim: The purpose of the study was to evaluate the assay method for determining anti-FXa activity in plasma in patients treated with apixaban or LMWH using chromogenic substrate method. Method: The method evaluation consisted of four steps: repeatability, intermediate precision measures, compliance with validated method and analysis of normal population. The evaluation was performed using Sysmex CS-2100 where 20 respective 40 patient samples were analyzed for apixaban and LMWH as well as 10 normal population samples. Factor Xa activity was quantitatively determined using light absorption at 405 nm.Result and discussion: Repeatability and intermediate precision showed low CV. Patient samples showed consistent results with reference values from other laboratories where r2 for apixaban and LMWH were 0.95. Deviant results may be due to measurement errors or confusion between samples. Analysis of normal population showed that values were below the lowest reliable value. Conclusion: Evaluation of the analysis method apixaban and LMWH at Ryhov's laboratory showed good results, which confirms that the assay method can be used in clinical routine.