• Refine Query
  • Source
  • Publication year
  • to
  • Language
  • 165
  • 158
  • 63
  • 51
  • 19
  • 18
  • 14
  • 7
  • 7
  • 6
  • 6
  • 6
  • 5
  • 4
  • 4
  • Tagged with
  • 602
  • 44
  • 41
  • 40
  • 37
  • 35
  • 35
  • 34
  • 32
  • 32
  • 29
  • 29
  • 27
  • 27
  • 26
  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
551

Povinnosti společníků společnosti s ručením omezeným / Duties of members of a Limited Liability Company

Dulačková, Kristína January 2014 (has links)
The topic of Limited Liability Company is a popular issue among the professional public due to the fact that Limited Liability Company belongs to the most favourite and the most widespread companies. This thesis comprehensively explains duties of members of Limited Liability Company in terms of Business Corporations Act and, where appropriate, compares them with those contained in the Commercial Code. After the brief discourse about Limited Liability Company, its nature and its position among the business corporations, the thesis provides characteristics of a share with emphasis on its qualitative aspect. In the second chapter the schemes of duties of members in works of various authors are first of all compared and critically assessed, and subsequently the own division of duties of members is created. A criterion for the division of duties is the fact, whether they are governed by general or special regulation and in the latter whether the duties arise on the basis of the act, or the Memorandum of Association. The characteristics of duties itself is included in the third to sixth chapters, which successively explain the duty of loyalty, the contributory duty, the liability duty, the duty of additional contribution, the duty of personal participation on a company, the duty to contribute to the...
552

Humor při výuce francouzského jazyka / Humour during the French classes

Hanzlíková, Dana January 2012 (has links)
anglicky : Title of the thesis : Humour during the French classes Keywords : Comic, irony, humour, laughter, Henri Bergson, Louis Cazamian, gelotology, gélothérapie, sense of humour, French as a foreign language, school class, word play, joke, riddle, tongue twister, didactical sheet. Abstract : The thesis aims to provide a comprehensive description of possible use of humour in teaching the French language. In the theoretical section, it defines humour as a form of comic, deals with the influence of humour and laughter on health and describes the advantages and difficulties of integrating humour into school teaching. In the practical part, it analyses the humour in French textbooks, proposes a typology of humour in teaching materials and presents finally didactical sheets to teach French at all language levels. These exercises and activities are dedicated to all speech and language skills. They are focused on different themes to captivate the target age category and meet the requirements to be fun for students. The thesis should become aid and inspiration for those teachers, who decide to incorporate humour and laughter in the teaching of French.
553

Novos resultados nas caminhadas deterministas parcialmente autorepulsivas em meios aleatórios obtidos com o gerenciamento numérico da memória dos caminhantes / New Results in Random Media of the deterministic partially self-avoiding walk, obtained with memory numerical management of the walkers.

Oliveira, Wilnice Tavares Reis 29 April 2010 (has links)
Podemos considerar a caminhada determinista do turista como um processo do tipo dinâmico, que ocorre sobre uma rede composta por N pontos. Os pontos são gerados de maneira aleatória, no espaço euclidiano d dimensional. Um caminhante, partindo de um ponto qualquer do meio desordenado, se movimenta seguindo uma regra determinista de ir para o ponto mais próximo que não tenha sido visitado nos últimos ?= µ - 1 passos. Cada uma das trajetórias geradas através dessa dinâmica possui uma parte inicial não periódica de t passos, denominada transiente, e uma parte final, periódica, de p passos, denominada atrator. Devido ao custo computacional de memória, só é possível simular sistemas com N ? O(103) e µ << N. Neste estudo uma nova implementação na estrutura de armazenamento de dados, no modelo numérico do turista, nos permitiu obter algumas distribuições estatísticas para a caminhada, com valores de memória µ ? O(N). Com estes resultados verificamos a eficiência da estrutura proposta e avançamos no conhecimento acerca do comportamento do turista em caminhadas com memória da ordem de N. Também neste trabalho, obtivemos resultados numéricos interessantes, que serviram para explicar a formação de atratores com determinados períodos na caminhada determinista do turista unidimensional, bem como a não formação de atratores com períodos 2µ+1, 2µ+2 e 2µ+3.não são constituídos. Também neste trabalho, uma nova implementação na estrutura de armazenamento de dados, no modelo numérico do turista, nos permitiu obter algumas distribuições estatísticas para a caminhada, com valores de memória ? muito acima do que se tinha alcançado anteriormente. Com estes resultados verificamos a eficiência da estrutura proposta, e avançamos o conhecimento a cerca do comportamento do turista em sistema da ordem de N. / We may consider the deterministic tourist walk as a dynamic process performed over a landscape of N points. These points are randomly spread on a d dimensional euclidean space. A walker leaves from any point of that landscape and moves according to the deterministic rule of going to the nearest point that has not been visited in the last ?= µ - 1 steps. Each trajectory generated by this dynamics has an initial non-periodic part of t steps, called transient, and a final periodic one of p steps, called attractor. Due to computational costs of memory usage, it is possible to simulate only small sistems, with N ? O(103) and µ << N. In this work, we propose a new implementation of the structure for data storage. The numerical model of the tourist walk, allowed us to obtain some statistical distributions for the walk with a memory value µ ? O(N). Moreover, in this study we obtain interesting and useful numerical results to explain the presence of some specific attractors in deterministic walk in one-dimensional space and the absence of attractors with periods 2µ+1, 2µ+2 and 2µ+3. are not made. In this work, we propose a new implementation of the structure for storing data, the numerical model of the tourist, has allowed us to obtain some statistical distributions for the walk with a memory value ? over and above what had been achieved previously. With these results, we verifed the efficiency of the HL structure proposed, and advance knowledge about the behavior of the tourist walk in the order of N.
554

Novos resultados nas caminhadas deterministas parcialmente autorepulsivas em meios aleatórios obtidos com o gerenciamento numérico da memória dos caminhantes / New Results in Random Media of the deterministic partially self-avoiding walk, obtained with memory numerical management of the walkers.

Wilnice Tavares Reis Oliveira 29 April 2010 (has links)
Podemos considerar a caminhada determinista do turista como um processo do tipo dinâmico, que ocorre sobre uma rede composta por N pontos. Os pontos são gerados de maneira aleatória, no espaço euclidiano d dimensional. Um caminhante, partindo de um ponto qualquer do meio desordenado, se movimenta seguindo uma regra determinista de ir para o ponto mais próximo que não tenha sido visitado nos últimos ?= µ - 1 passos. Cada uma das trajetórias geradas através dessa dinâmica possui uma parte inicial não periódica de t passos, denominada transiente, e uma parte final, periódica, de p passos, denominada atrator. Devido ao custo computacional de memória, só é possível simular sistemas com N ? O(103) e µ << N. Neste estudo uma nova implementação na estrutura de armazenamento de dados, no modelo numérico do turista, nos permitiu obter algumas distribuições estatísticas para a caminhada, com valores de memória µ ? O(N). Com estes resultados verificamos a eficiência da estrutura proposta e avançamos no conhecimento acerca do comportamento do turista em caminhadas com memória da ordem de N. Também neste trabalho, obtivemos resultados numéricos interessantes, que serviram para explicar a formação de atratores com determinados períodos na caminhada determinista do turista unidimensional, bem como a não formação de atratores com períodos 2µ+1, 2µ+2 e 2µ+3.não são constituídos. Também neste trabalho, uma nova implementação na estrutura de armazenamento de dados, no modelo numérico do turista, nos permitiu obter algumas distribuições estatísticas para a caminhada, com valores de memória ? muito acima do que se tinha alcançado anteriormente. Com estes resultados verificamos a eficiência da estrutura proposta, e avançamos o conhecimento a cerca do comportamento do turista em sistema da ordem de N. / We may consider the deterministic tourist walk as a dynamic process performed over a landscape of N points. These points are randomly spread on a d dimensional euclidean space. A walker leaves from any point of that landscape and moves according to the deterministic rule of going to the nearest point that has not been visited in the last ?= µ - 1 steps. Each trajectory generated by this dynamics has an initial non-periodic part of t steps, called transient, and a final periodic one of p steps, called attractor. Due to computational costs of memory usage, it is possible to simulate only small sistems, with N ? O(103) and µ << N. In this work, we propose a new implementation of the structure for data storage. The numerical model of the tourist walk, allowed us to obtain some statistical distributions for the walk with a memory value µ ? O(N). Moreover, in this study we obtain interesting and useful numerical results to explain the presence of some specific attractors in deterministic walk in one-dimensional space and the absence of attractors with periods 2µ+1, 2µ+2 and 2µ+3. are not made. In this work, we propose a new implementation of the structure for storing data, the numerical model of the tourist, has allowed us to obtain some statistical distributions for the walk with a memory value ? over and above what had been achieved previously. With these results, we verifed the efficiency of the HL structure proposed, and advance knowledge about the behavior of the tourist walk in the order of N.
555

Cache-conscious off-line real-time scheduling for multi-core platforms : algorithms and implementation / Ordonnanceur hors-ligne temps-réel et conscient du cache ciblant les architectures multi-coeurs : algorithmes et implémentations

Nguyen, Viet Anh 22 February 2018 (has links)
Les temps avancent et les applications temps-réel deviennent de plus en plus gourmandes en ressources. Les plate-formes multi-cœurs sont apparues dans le but de satisfaire les demandes des applications en ressources, tout en réduisant la taille, le poids, et la consommation énergétique. Le challenge le plus pertinent, lors du déploiement d'un système temps-réel sur une plate-forme multi-cœur, est de garantir les contraintes temporelles des applications temps réel strict s'exécutant sur de telles plate-formes. La difficulté de ce challenge provient d'une interdépendance entre les analyses de prédictabilité temporelle. Cette interdépendance peut être figurativement liée au problème philosophique de l'œuf et de la poule, et expliqué comme suit. L'un des pré-requis des algorithmes d'ordonnancement est le Pire Temps d'Exécution (PTE) des tâches pour déterminer leur placement et leur ordre d'exécution. Mais ce PTE est lui aussi influencé par les décisions de l'ordonnanceur qui va déterminer quelles sont les tâches co-localisées ou concurrentes propageant des effets sur les caches locaux et les ressources physiquement partagées et donc le PTE. La plupart des méthodes d'analyse pour les architectures multi-cœurs supputent un seul PTE par tâche, lequel est valide pour toutes conditions d'exécutions confondues. Cette hypothèse est beaucoup trop pessimiste pour entrevoir un gain de performance sur des architectures dotées de caches locaux. Pour de telles architectures, le PTE d'une tâche est dépendant du contenu du cache au début de l'exécution de la dite tâche, qui est lui-même dépendant de la tâche exécutée avant et ainsi de suite. Dans cette thèse, nous proposons de prendre en compte des PTEs incluant les effets des caches privés sur le contexte d’exécution de chaque tâche. Nous proposons dans cette thèse deux techniques d'ordonnancement ciblant des architectures multi-cœurs équipées de caches locaux. Ces deux techniques ordonnancent une application parallèle modélisée par un graphe de tâches, et génèrent un planning statique partitionné et non-préemptif. Nous proposons une méthode optimale à base de Programmation Linéaire en Nombre Entier (PLNE), ainsi qu'une méthode de résolution par heuristique basée sur de l'ordonnancement par liste. Les résultats expérimentaux montrent que la prise en compte des effets des caches privés sur les PTE des tâches réduit significativement la longueur des ordonnancements générés, ce comparé à leur homologue ignorant les caches locaux. Afin de parfaire les résultats ainsi obtenus, nous avons réalisé l'implémentation de nos ordonnancements dirigés par le temps et conscients du cache pour un déploiement sur une machine Kalray MPPA-256, une plate-forme multi-cœur en grappes (clusters). En premier lieu, nous avons identifié les challenges réels survenant lors de ce type d'implémentation, tel que la pollution des caches, la contention induite par le partage du bus, les délais de lancement d'une tâche introduits par la présence de l'ordonnanceur, et l'absence de cohérence des caches de données. En second lieu, nous proposons des stratégies adaptées et incluant, dans la formulation PLNE, les contraintes matérielles ; ainsi qu'une méthode permettant de générer le code final de l'application. Enfin, l'évaluation expérimentale valide la correction fonctionnelle et temporelle de notre implémentation pendant laquelle nous avons pu observé le facteur le plus impactant la longueur de l'ordonnancement: la contention. / Nowadays, real-time applications are more compute-intensive as more functionalities are introduced. Multi-core platforms have been released to satisfy the computing demand while reducing the size, weight, and power requirements. The most significant challenge when deploying real-time systems on multi-core platforms is to guarantee the real-time constraints of hard real-time applications on such platforms. This is caused by interdependent problems, referred to as a chicken and egg situation, which is explained as follows. Due to the effect of multi-core hardware, such as local caches and shared hardware resources, the timing behavior of tasks are strongly influenced by their execution context (i.e., co-located tasks, concurrent tasks), which are determined by scheduling strategies. Symetrically, scheduling algorithms require the Worst-Case Execution Time (WCET) of tasks as prior knowledge to determine their allocation and their execution order. Most schedulability analysis techniques for multi-core architectures assume a single WCET per task, which is valid in all execution conditions. This assumption is too pessimistic for parallel applications running on multi-core architectures with local caches. In such architectures, the WCET of a task depends on the cache contents at the beginning of its execution, itself depending on the task that was executed before the task under study. In this thesis, we address the issue by proposing scheduling algorithms that take into account context-sensitive WCETs of tasks due to the effect of private caches. We propose two scheduling techniques for multi-core architectures equipped with local caches. The two techniques schedule a parallel application modeled as a task graph, and generate a static partitioned non-preemptive schedule. We propose an optimal method, using an Integer Linear Programming (ILP) formulation, as well as a heuristic method based on list scheduling. Experimental results show that by taking into account the effect of private caches on tasks’ WCETs, the length of generated schedules are significantly reduced as compared to schedules generated by cache-unaware scheduling methods. Furthermore, we perform the implementation of time-driven cache-conscious schedules on the Kalray MPPA-256 machine, a clustered many-core platform. We first identify the practical challenges arising when implementing time-driven cache-conscious schedules on the machine, including cache pollution cause by the scheduler, shared bus contention, delay to the start time of tasks, and data cache inconsistency. We then propose our strategies including an ILP formulation for adapting cache-conscious schedules to the identified practical factors, and a method for generating the code of applications to be executed on the machine. Experimental validation shows the functional and the temporal correctness of our implementation. Additionally, shared bus contention is observed to be the most impacting factor on the length of adapted cache-conscious schedules.
556

Teoretická východiska tvorby a hodnocení pracovních listů pro výuku cizích jazyků se zaměřením na španělský jazyk / Theoretical basis of developing and evaluating worksheets for foreign language teaching with a focus on the Spanish language

Kupka, Tomáš January 2019 (has links)
The author of this doctoral thesis Theoretical basis of developing and evaluating worksheets for foreign language teaching with a focus on the Spanish language attempts to describe the current situation regarding the creation of worksheets. He highlights the fact that there is no theoretical basis for their production, and no evaluation of the quality and application of these worksheets in the teaching of Spanish. He also outlines ways how to solve this deficit and potential problems in the process of investigation into this topic. The main aim of this dissertation is to analyse the worksheets as a supplementary teaching material and to describe the whole process of their adoption, adaptation, creation, usage, evaluation, revision and actualization. Although the teachers usually complement their usual textbook with autonomous supplementary materials, the lack of methodology or empirical research on this topic is evident. In theoretical part of this doctoral thesis all available sources will be analysed and the emphasis will be put on comparing rules of the textbooks creation to worksheets creation in order to put together relevant information. The similar principles will be highlighted and also differences will be mentioned. Moreover, methods of creating and evaluating worksheets will be...
557

Five year analysis of the eurotransplant senior program

Nöldeke, Jana 28 November 2005 (has links)
Das zunehmende Durschnittsalter unserer Gesellschaft und der Mangel an Spenderorganen stellen bedeutende Herausforderungen für die Organtransplantation dar. Organe, die früher als "marginal" galten, werden heute routinemässig transplantiert. Gleichzeitig mit der Zunahme älterer Patienten auf der Warteliste steigt das Interesse an der Entwicklung von speziellen Allokations-Strategien. Basierend auf dem Konzept der Abstimmung des metabolischen Bedarfs des älteren Empfängers und der Kapazität der älteren Spenderniere entwickelte Eurotransplant daher das Eurotransplant Senior Program (ESP), welches im Januar 1999 gestartet wurde. Im Rahmen dieses Programms werden Nieren von über 65 Jahre alten Spendern lokal auf eine selektierte Gruppe über 65 Jahre alter, nicht immunisierter Empfänger übertragen. Das Ziel dieser 5-Jahres Analyse war es herauszufinden, ob das ESP erfolgreich seine Ziele erreicht hat, Organe von älteren Spendern optimal zu nutzen und die Zeit auf der Warteliste für ältere Empfänger zu verkürzen. Als Basis dienten Daten des Eurotransplant Information Systems (ENIS). Zusätzliche Informationen wurden für die ESP Patienten und zwei Kontrollgruppen mit entweder annähernd vergleichbarem Alter des Spenders (Kontrolle 1) oder des Empfängers (Kontrolle 2) erfasst. Insgesamt zeigt diese Auswertung, dass die Ziele des ESP erreicht wurden. Die Verfügbarkeit von älteren Spenderorganen wurde von 162 (10%) im Jahre 1998 auf 239 (fast 15%) im Jahre 2004 gesteigert. Die Wartezeit für ältere Empfänger verkürzte sich signifikant im Vergleich zu vor der Einführung des ESP und weiter im Verlauf der ersten 5 Jahre auf deutlich unter 4 Jahre, während sich die Wartezeit für Patienten in den Kontrollen die über ETKAS transplantiert wurden um bis zu einem Jahr verlängerte. Die kalte Ischämiezeit für ESP Patienten war signifikant kürzer mit etwa 12 im Vergleich zu ca. 17 Stunden für beide Kontrollen.Das Patienten- und Transplantatüberleben der Empfänger von Organen von über 65-jähriger Spendern wurde durch die ESP-Allokation, trotz 5-10% höherer Abstossungraten, nich negativ beeinflusst. Die Analyse der unabhängigen Risikofaktoren für akute Abstoßungsreaktionen weist darauf hin, dass ein verbessertes HLA matching unter Beibehaltung kurzer Ischämiezeiten möglicherweise von Vorteil wäre. / The aging society and the shortage of organs impose significant challenges to organ transplantation. As a result, organs previously considered marginal are now routinely used. At the same time, an increase in the number of elderly patients on renal transplant waiting lists has heightened interest in the development of special allocation strategies for these patients. As a result, Eurotransplant started the Eurotransplant Senior Program (ESP) in January 1999, an allocation scheme based on the concept of matching the metabolic demand of the recipient and the excretory capacity of the donor. The program obtaines kidneys from donors over 65 years and locally allocates them to a selected group of non-immunized patients in the same age group. The main objective of this evaluation was to find out if the allocation scheme is effective in using kidneys from elderly donors and if it shortens the waiting time for elderly patients. The Eurotransplant database was used as a starting point, and data added to the database by collecting additional information on the ESP patients, and on two control groups. The controls were observed over the same time period as the ESP patients, and matched them for either donor age (Control 1) or recipient age (Control 2). Overall, this 5-year analysis of the ESP shows that the objectives of the program have been met. The availability of elderly donors increased from 169 (10%) in 1998 to 239 (almost 15%) in 2004. The waiting time for elderly recipients transplanted within the ESP was successfully reduced compared to the waiting time before introduction of ESP and is now below 4 years, while waiting time in both control groups has increased by up to one year. The cold ischemia time for ESP patients was significantly shorter, with a mean of approximately 12 hours compared with over 17 hours in both control groups. Graft and patient survival in recipients of organs from donors age over 65 were not negatively impacted by the ESP allocation despite 5-10% higher acute rejection rates.Based on an analysis of independent risk factors the use of HLA matching instead of waiting time should be considered as an allocation criterion while maintaining a short cold ischemia time.
558

On unequal probability sampling designs

Grafström, Anton January 2010 (has links)
The main objective in sampling is to select a sample from a population in order to estimate some unknown population parameter, usually a total or a mean of some interesting variable. When the units in the population do not have the same probability of being included in a sample, it is called unequal probability sampling. The inclusion probabilities are usually chosen to be proportional to some auxiliary variable that is known for all units in the population. When unequal probability sampling is applicable, it generally gives much better estimates than sampling with equal probabilities. This thesis consists of six papers that treat unequal probability sampling from a finite population of units. A random sample is selected according to some specified random mechanism called the sampling design. For unequal probability sampling there exist many different sampling designs. The choice of sampling design is important since it determines the properties of the estimator that is used. The main focus of this thesis is on evaluating and comparing different designs. Often it is preferable to select samples of a fixed size and hence the focus is on such designs. It is also important that a design has a simple and efficient implementation in order to be used in practice by statisticians. Some effort has been made to improve the implementation of some designs. In Paper II, two new implementations are presented for the Sampford design. In general a sampling design should also have a high level of randomization. A measure of the level of randomization is entropy. In Paper IV, eight designs are compared with respect to their entropy. A design called adjusted conditional Poisson has maximum entropy, but it is shown that several other designs are very close in terms of entropy. A specific situation called real time sampling is treated in Paper III, where a new design called correlated Poisson sampling is evaluated. In real time sampling the units pass the sampler one by one. Since each unit only passes once, the sampler must directly decide for each unit whether or not it should be sampled. The correlated Poisson design is shown to have much better properties than traditional methods such as Poisson sampling and systematic sampling.
559

An analysis of the usage of antibiotics in the private health care sector : a managed health care approach / Renier Coetzee

Coetzee, Renier January 2004 (has links)
The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. However, health care expenditure is a great cause for concern and many nations around the world struggle to contain rising health care costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR) and disease management have emerged as control tools to ensure cost effective selection and use of medicine. These managed care instruments are often used to determine whether new strategies or interventions, such as the implementation of a managed medicine reference price list, are appropriate and have "value". The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in the private health care sector of South Africa. The research design used in this study was retrospective, non-experimental and quantitative. The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31 April 2003) from the central medicine claims database of Medschem&. Data was analysed according to prevalence, cost and original (innovator) or generic medicine items. For the purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and "others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations, quinolones, chloramphenicol and aminoglycosides. The results of the empirical investigation showed the total number of medicine items claimed during the study period amounted to 49098736 medicine items having a total expenditure of R7150344897.00. There was a decrease in the prevalence of original (innovator) products during the two-year period. The prevalence of generic products increased from 25.87% to 32.47%. A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43 representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original (innovator) products contributed 62.32% and generic products 37.68% to the total cost of all antibiotics claimed. It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed (n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43) for the two-year period. The average cost of beta-lactam items ranged between R112.88 * 69.95 and R122.18 + 81.42. The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved. Cost analysis indicated that it is possible to reduce health care costs by implementing strategies with the aim to reduce medicine cost. Further research, however, is necessary and in this regard recommendations for further research were formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.
560

An analysis of the usage of antibiotics in the private health care sector : a managed health care approach / Renier Coetzee

Coetzee, Renier January 2004 (has links)
The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. However, health care expenditure is a great cause for concern and many nations around the world struggle to contain rising health care costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR) and disease management have emerged as control tools to ensure cost effective selection and use of medicine. These managed care instruments are often used to determine whether new strategies or interventions, such as the implementation of a managed medicine reference price list, are appropriate and have "value". The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in the private health care sector of South Africa. The research design used in this study was retrospective, non-experimental and quantitative. The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31 April 2003) from the central medicine claims database of Medschem&. Data was analysed according to prevalence, cost and original (innovator) or generic medicine items. For the purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and "others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations, quinolones, chloramphenicol and aminoglycosides. The results of the empirical investigation showed the total number of medicine items claimed during the study period amounted to 49098736 medicine items having a total expenditure of R7150344897.00. There was a decrease in the prevalence of original (innovator) products during the two-year period. The prevalence of generic products increased from 25.87% to 32.47%. A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43 representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original (innovator) products contributed 62.32% and generic products 37.68% to the total cost of all antibiotics claimed. It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed (n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43) for the two-year period. The average cost of beta-lactam items ranged between R112.88 * 69.95 and R122.18 + 81.42. The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved. Cost analysis indicated that it is possible to reduce health care costs by implementing strategies with the aim to reduce medicine cost. Further research, however, is necessary and in this regard recommendations for further research were formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

Page generated in 0.0418 seconds