Saturday, October 31, 2015

Billion Bill for new cancer drugs – Bergens Tidende

Hospitals peaks have notified the Ministry of Health that new, expensive cancer medicines will crack hospitals economy.

– It is entitled and simply happened a miracle, says Ingolf Skadberg (66) and smiles happy.

For eighteen years ago fisherman from Egersund confirmed lung cancer that has spread. Operation was no use, and chemotherapy proved ineffective.

So did Skadberg offer to test a new drug, which should speed up the body’s own immune defenses. After half a year with immunotherapy the tumor in the lung shrunk to far less than half. The spread is the only remnants left.



Promising new treatment

PD1 inhibitors. You might as well learn name, you’ll hear it often in the future. PD1 inhibitors are drugs that help the body’s own immune system to fight cancer. Immunotherapy is promising new cancer treatment.

The medication Skadberg have tested, is one of two new PD1 inhibitors that are appropriate to impose against lung cancer has spread.

  • Immunotherapy is the treatment of cancer in which the body’s immune system will help to self-dealing and kill cancer cells. Some medicines (as PD1) inhibitors block the brake pads between cancer cells and the immune system. This means that cancer cells can not evade the immune cells and cancer cells are attacked and die.
  • Decision Forum has twice said no to the introduction of PD1 inhibitor nivolumab against lung cancer has spread before the impact is assessed against the award.
  • Two large studies show that nivolumab gives median patient three months extra life. About one fifth achieve prolonged survival, ie two years or more. It’s better numbers than treatment with chemotherapy.

The problem is the price of these new medicines. Treatment with new PD1 inhibitors costing 1.1 million annually. Most recently this week said Decision Forum refusal to introduce PD1 inhibitor nivolumab before Medicines Agency has considered whether the effect is good enough to justify the high price.

Also read: Immunotherapy tested at Haukeland

The professionals in the Norwegian Lung Cancer Society believes that the results for nivolumab is so good, that the medication immediately should be used.

In Decision Forum sitting directors of the four health regions. In September the forum to ask the Ministry of Health involved in the question of how hospitals to deal with the galloping rise in drug spending.



Price: Three billion

technical director Baard-Christian the Scheme in Health Vest has a note warned their counterparts in Decision Forum that several similar cases are underway. PD1 inhibitors may be appropriate for 20 different cancers.

PD1 inhibitors will cost the Norwegian health care between 2.5 and 3 billion annually, given that these medicines administered to 3,000 patients annually, it says in the note .

Lung cancer is a large group of patients. As many as 1,500 lung cancer patients annually are appropriate for PD1-treatment. The medication these patients are currently costs 10,000 kroner annually.

– These new medicines represents a wonderful and very welcome development, but we can not confirm that they are used, without regard to the consequences, says the Scheme.

– Dramatic consequences

Decision Forum is the national body that make new medicines and methods standard in Norwegian hospitals. Schem recalls that the forum is required to be neutral in relation to the diagnosis.

– We can not concern ourselves with what disease the medicine is working towards. Our goal should be that the funds we get from our politicians should provide the greatest possible benefit to the entire population, and be most fairly distributed among populations, he said.



Read also: Price to Bergen cancer researcher

To increase spending on a range means cuts on others.

– To say yes to new billion spending overnight will have dramatic consequences for other patient groups, he added.

– Hopes for better and longer life

Section Chief Øystein Fløtten at Haukeland University Hospital has no trouble seeing the high price makes the introduction of PD1 inhibitors to a dilemma.

Medical is immune therapy a major advance.

– For cancer patients, these new medications hope for a better and longer life, he said.

– Can they be completely healthy?

– I think we really do not. But for a small proportion of patients the effect is good and stays throughout the observation period, which currently is two years, says Fløtten.

When it comes nivolumab is NOMA started with the systematic review, which is expected around year end. When the question comes up again in Decision Forum.



Paying yourself

Some do not have time to wait so long. TV 2 has a series of stories told about Svein Ulset from Bergen who are now paying for nivolumab treatment at private clinic Aleris.

– For me it is an unacceptable question in the sense that they should spend time to find this out, I’ll die in the meantime. I will not survive a year or half a year, he said to TV 2.



– You know me fine

Ingolf Skadberg have plans that extend far into the future. Fishing does he continued, and in the winter there will be another trip to Gran Canaria.

– I have not taken time to think much of life expectancy and such. The days at sea has been busy, he said.

– You know you well?

– I’ve been short of breath, especially in the past, but now receive medicines to help prevent it . Otherwise I feel absolutely fine, says Skadberg.



Høie requires industry

Health and Human Services Bent Høie see that many hospitals are struggling when new and expensive drugs are approved and should be offered patients. This has led to a greater burden on hospitals economy than population trends would imply.

– This drives costs up, and it’s one of the reasons why we have chosen to increase hospitals’ budgets in recent years, says Høie.



Read also: When the principal got cancer

He is keen to set standards for the pharmaceutical industry.

– The pharmaceutical industry will not be able to dictate prices. We should be able to negotiate the price and know that the treatment effect is documented before taking new medications in use, says Høie.

It should also be equal treatment by all the country’s hospitals.



White Paper

After Christmas he will deliver a white paper, where these priorities are included.

– There is no doubt that medical breakthroughs can treat patients and provide better results than before. Especially new medicines that provide life-prolonging treatment to cancer patients, says Høie.

Haukeland University Hospital has seen medicine expenditure increase for several years. New cancer drugs are costly, but also other biological agents weigh in the accounts.



More expensive medicines

For nearly 10 years ago, hospitals are required to pay for a variety of biological drugs that patients use without to be admitted. H-prescription scheme concerned first new rheumatic drugs and was then expanded to apply multiple drugs against MS and 2014 some cancer drugs.

The costs have exploded. Last year H-prescriptions almost half of hospitals’ expenses for medicines. When cost H-prescriptions hospitals two billion crowns.

Also read: Høie opened prostate center

Haukeland University estimate that the final bill for H-prescription schemes in the year ending in just under 190 million . Last year it sounded at 170 million.

– A conservative estimate says that the new PD1 inhibitors against lung cancer will cost us 30 million annually, says technical director Alf Henrik Andreassen.

– How handles hospital such an expense?

– Should we use 30 million for new cancer drugs, we must give priority to other areas of hospital operations or other patient groups. Naturally we will deal loyally with national decisions, but such decisions must come along with money to take costs, Andreassen says.

LikeTweet

Friday, October 30, 2015

Billion Bill for new cancer drugs – Bergens Tidende

Hospitals peaks have notified the Ministry of Health that new, expensive cancer medicines will crack hospitals economy.

– It is entitled and simply happened a miracle, says Ingolf Skadberg (66) and smiles happy.

For eighteen years ago fisherman from Egersund confirmed lung cancer that has spread. Operation was no use, and chemotherapy proved ineffective.

So did Skadberg offer to test a new drug, which should speed up the body’s own immune defenses. After half a year with immunotherapy the tumor in the lung shrunk to far less than half. The spread is the only remnants left.



Promising new treatment

PD1 inhibitors. You might as well learn name, you’ll hear it often in the future. PD1 inhibitors are drugs that help the body’s own immune system to fight cancer. Immunotherapy is promising new cancer treatment.

The medication Skadberg have tested, is one of two new PD1 inhibitors that are appropriate to impose against lung cancer has spread.

  • Immunotherapy is the treatment of cancer in which the body’s immune system will help to self-dealing and kill cancer cells. Some medicines (as PD1) inhibitors block the brake pads between cancer cells and the immune system. This means that cancer cells can not evade the immune cells and cancer cells are attacked and die.
  • Decision Forum has twice said no to the introduction of PD1 inhibitor nivolumab against lung cancer has spread before the impact is assessed against the award.
  • Two large studies show that nivolumab gives median patient three months extra life. About one fifth achieve prolonged survival, ie two years or more. It’s better numbers than treatment with chemotherapy.

The problem is the price of these new medicines. Treatment with new PD1 inhibitors costing 1.1 million annually. Most recently this week said Decision Forum refusal to introduce PD1 inhibitor nivolumab before Medicines Agency has considered whether the effect is good enough to justify the high price.

Also read: Immunotherapy tested at Haukeland

The professionals in the Norwegian Lung Cancer Society believes that the results for nivolumab is so good, that the medication immediately should be used.

In Decision Forum sitting directors of the four health regions. In September the forum to ask the Ministry of Health involved in the question of how hospitals to deal with the galloping rise in drug spending.



Price: Three billion

technical director Baard-Christian the Scheme in Health Vest has a note warned their counterparts in Decision Forum that several similar cases are underway. PD1 inhibitors may be appropriate for 20 different cancers.

PD1 inhibitors will cost the Norwegian health care between 2.5 and 3 billion annually, given that these medicines administered to 3,000 patients annually, it says in the note .

Lung cancer is a large group of patients. As many as 1,500 lung cancer patients annually are appropriate for PD1-treatment. The medication these patients are currently costs 10,000 kroner annually.

– These new medicines represents a wonderful and very welcome development, but we can not confirm that they are used, without regard to the consequences, says the Scheme.

– Dramatic consequences

Decision Forum is the national body that make new medicines and methods standard in Norwegian hospitals. Schem recalls that the forum is required to be neutral in relation to the diagnosis.

– We can not concern ourselves with what disease the medicine is working towards. Our goal should be that the funds we get from our politicians should provide the greatest possible benefit to the entire population, and be most fairly distributed among populations, he said.



Read also: Price to Bergen cancer researcher

To increase spending on a range means cuts on others.

– To say yes to new billion spending overnight will have dramatic consequences for other patient groups, he added.

– Hopes for better and longer life

Section Chief Øystein Fløtten at Haukeland University Hospital has no trouble seeing the high price makes the introduction of PD1 inhibitors to a dilemma.

Medical is immune therapy a major advance.

– For cancer patients, these new medications hope for a better and longer life, he said.

– Can they be completely healthy?

– I think we really do not. But for a small proportion of patients the effect is good and stays throughout the observation period, which currently is two years, says Fløtten.

When it comes nivolumab is NOMA started with the systematic review, which is expected around year end. When the question comes up again in Decision Forum.



Paying yourself

Some do not have time to wait so long. TV 2 has a series of stories told about Svein Ulset from Bergen who are now paying for nivolumab treatment at private clinic Aleris.

– For me it is an unacceptable question in the sense that they should spend time to find this out, I’ll die in the meantime. I will not survive a year or half a year, he said to TV 2.



– You know me fine

Ingolf Skadberg have plans that extend far into the future. Fishing does he continued, and in the winter there will be another trip to Gran Canaria.

– I have not taken time to think much of life expectancy and such. The days at sea has been busy, he said.

– You know you well?

– I’ve been short of breath, especially in the past, but now receive medicines to help prevent it . Otherwise I feel absolutely fine, says Skadberg.



Høie requires industry

Health and Human Services Bent Høie see that many hospitals are struggling when new and expensive drugs are approved and should be offered patients. This has led to a greater burden on hospitals economy than population trends would imply.

– This drives costs up, and it’s one of the reasons why we have chosen to increase hospitals’ budgets in recent years, says Høie.



Read also: When the principal got cancer

He is keen to set standards for the pharmaceutical industry.

– The pharmaceutical industry will not be able to dictate prices. We should be able to negotiate the price and know that the treatment effect is documented before taking new medications in use, says Høie.

It should also be equal treatment by all the country’s hospitals.



White Paper

After Christmas he will deliver a white paper, where these priorities are included.

– There is no doubt that medical breakthroughs can treat patients and provide better results than before. Especially new medicines that provide life-prolonging treatment to cancer patients, says Høie.

Haukeland University Hospital has seen medicine expenditure increase for several years. New cancer drugs are costly, but also other biological agents weigh in the accounts.



More expensive medicines

For nearly 10 years ago, hospitals are required to pay for a variety of biological drugs that patients use without to be admitted. H-prescription scheme concerned first new rheumatic drugs and was then expanded to apply multiple drugs against MS and 2014 some cancer drugs.

The costs have exploded. Last year H-prescriptions almost half of hospitals’ expenses for medicines. When cost H-prescriptions hospitals two billion crowns.

Also read: Høie opened prostate center

Haukeland University estimate that the final bill for H-prescription schemes in the year ending in just under 190 million . Last year it sounded at 170 million.

– A conservative estimate says that the new PD1 inhibitors against lung cancer will cost us 30 million annually, says technical director Alf Henrik Andreassen.

– How handles hospital such an expense?

– Should we use 30 million for new cancer drugs, we must give priority to other areas of hospital operations or other patient groups. Naturally we will deal loyally with national decisions, but such decisions must come along with money to take costs, Andreassen says.

LikeTweet

Warning ophthalmologic – immediate assistance by synsfelttap connection. stroke … – Health Authority

Norwegian Board determines each year a significant number of supervisory issues facing healthcare professionals and businesses in the health service based on information on individual events. Some of these will be published on this website in anonymous form. The cases are intended as such matters for the businesses and personnel to benefit from them and to inform them about our business and not as an aid to identification of individual cases and individual personnel.

The public demands for transparency in individual cases are handled through that anyone can request access to individual documents, based on publicly available mailing lists.

Exempt from public disclosure pursuant to offline a. § 13 cf. PAA. § 13, first paragraph. 1

Procedural process

The subject matter

Your statements to the case

Norwegian Board of Health reviews

About the concept of responsibility and diligent care

Emergency

Review

Norwegian Board of Health has decided to give you a warning under the Health § 56, first paragraph. We have concluded that you have violated the requirements for proper care and diligent care of the same Act § 4, and the duty to provide immediate assistance in § 7.

You can complain the decision within three – 3 – weeks of receiving this letter.

Procedural process

Norwegian Board received from the County of XXXXXX submitted two audits matters relating to your business as ophthalmologist by letter dated XXXXXX and XXXXXX.

Supervision cases concerning your treatment respectively XXXXXX, born XXXXXX (hereinafter patient 1) and XXXXXX, born XXXXXX (hereinafter patient 2).

We oriented you by letter dated XXXXXX that we would consider giving you a warning. You stated you to this by letter dated XXXXXX.

The subject matter

You are a graduate of the University of XXXXXX XXXXXX in, and received authorization as a doctor in Norway the XXXXXX, HPR no. XXXXXX. You were approved ophthalmologists in Norway the XXXXXX. At the time of the relevant events were you in private practice specialist with agreement with XXXXXX RHF (75%) and employed at XXXXXX HF (25%). You are now working in 100% position at XXXXXX.

Norwegian Board has considered the matter on the basis of the documents you’ve got submitted earlier in the proceedings. Below is a discussion of the factors that have had an impact on our rating.

Patient 1 ( XXXXXX , born XXXXXX )

The patient was at the time of consultation with you the XXXXXX a fresh woman on XXXXXX years.

Journal Notes from consultations

Of journal memo dated XXXXXX stated that the patient came to you as immediate help, because she in the morning the same day had suddenly Class for blindness in the right visual field (right-sided hemianopsia) combined with easy left-sided headaches. Furthermore, it says that the patient did not enter anything diplopia, and that she smoked. It is stated that the patient had no known diseases. She had been examined by ophthalmologist in XXXXXX because she had discomfort in left øyeblokk sometimes, without it ever was made some discoveries.

Upon examination of the visual field (Donders method), it was found homonym right-sided hemianopsia. The sight in his right eye and left eye was set to be 0.8. Upon examination of eye grounds, it was found pale eye grounds with clear lenses and “ neat ” optic nerve heads (papillae) although they were a little reddish (hyperemic). There were no signs that the optic nerve head was protruding (congestion). Furthermore, it was found “ pretty ” yellow vision spot (macula) of the retina and dense crossing phenomena. In parentheses is the noted “ smoking, hypertension .”

At the end of the journal paper says it indicated that the patient be referred to MRI of the brain and the eye socket (orbit) at XXXXXX HF, radiology department, considering the tumor in the left hemisphere (hemisphere).

The patient was then to consultation with you the XXXXXX. By preliminary examination of visual field with Donders method, did you right-sided hemianopsia, and upon examination of the peripheral visual field (perimetry) did you right-sided, incomplete hemianopsia in both eyes with deeper loss in the left eye. Journal memo states that you recommended control of the visual field about four months. It is further stated that the patient had preliminary lane ban, and that the family doctor did follow up the patient for driving license. At the end of the journal paper stated the following: “ The patient even seen not satisfied out today too (she has written appeal to the County Governor of XXXXXX XXXXXX about 1 survey) .

Patient complaints

The patient has complained about the treatment she received from you in two letters to the County , dated XXXXXX and XXXXXX.

The patient indicates in his letter of XXXXXX that she was referred to an ophthalmologist after being on XXXXXX emergency. She was told that the doctor did not come before 09.00, but that she was referred to akuttime so she would be add quickly.

The patient waited in the waiting room, and noon. 9:00 gave the receptionist message to the waiting that ophthalmologist would be delayed. You arrived at closer. 09:30. The patient heard when she was mentioned as acute patient, and it was questioned whether you could inflow her first. You came looked and shouted two other patients. Time passed, and the next time you came out into the waiting room, you cried a third patient. The patient then contacted the emergency room again and wondered if it was not like that she should be checked by an ophthalmologist. Patient states that it seems like it then was given new messages, and she came in to you about kl. 10.50.

After you had examined the patient, she was reportedly told that she had lost 50% of vision in both eyes, but that there were eyes there was something wrong with. Vision loss could be due to a tumor or something else neurological. She was told that you had sent a referral to XXXXXX HF, and that you could not specify when she would get an appointment – she had to eventually turn to the hospital to know this. Further indicating the patient that she was told to go home and wait for the request.

The patient indicates that she was very distraught over this, and she tried to get reconsideration of emergency and their GP. The patient and her husband feared that there could be a blood clot, and they insisted that the patient was going to hospital for radiography. About. kl. 16.00 she was sent in ambulance to XXXXXX and around kl. 19.00 was taken a CT which showed an ischemic stroke.

In the appeal of XXXXXX stated that the patient felt that she was greeted by a “ very cross and person ” when she was back to consultation with you the XXXXXX. The patient indicates that you scolded her and accused her of having treated you badly. The fact that she felt badly treated by previous consultation, you should have brushed aside with the patient to understand that you were in a hurry as ophthalmologist. You should also have stated that you did something reprehensible during the consultation.

You did then new patient assessment. When the patient asked about the survey results, you should have said that she had to discuss this with your GP. The patient stood up then and left the office.



Your statements to the case

You have stated you matter in a letter dated XXXXXX, XXXXXX and XXXXXX.

From the statement of XXXXXX stated that you usually start your practice at. 8:30, but that you were delayed because XXXXXX. You indicate that you first saw an urgent care patient with questions about visual disturbance / visual field defect when you arrived at the office. 09:30. Then sow you the first two patients in your work list since they had waited for about five months to get to the hour. You show that immediate aid patients in addition to conventional patients on the list and that some doctors put them up at the end of the day.

You further indicates that you did a thorough eye examination of the patient, and immediately sent reference to the radiology department at XXXXXX hospital with ophthalmologist note. You emphasize that there is no “stroke unit” in XXXXXX, and that one does not have MR / CT in the radiology department, so that one can not make the correct diagnosis.

In the statement of XXXXXX indicates that you were not rude during the last consultation with the patient. What you said was that you thought that the appeal was unfair, and that you were disappointed because you always seek to do your best. Regarding the outcome of the investigations that were done, you say that the patient was explained this. She was told that she still did not fulfill the requirements for driving, and she got a printout of the results of the field survey. The patient seemed frustrated by this, and you said that further follow-up in terms of driving licenses had to be done by your GP, or neurologist. You mean you were professional and courteous and you regret that the patient was not happy, but believes that this does not excuse the false accusations against you.

In the statement of XXXXXX type that you usually had 1-2 immediate -help-patients daily in your practice in XXXXXX. You point out that you received the referral for emergency care when you arrived the office XXXXXX, but that there was no information in the citation that indicated that it was urgent “to the minute”; there were questions about visual disturbance and visual field defect. After the examination the patient was told that everything was normal with the eyes, and that the symptoms were caused by illness / injury to the visual pathway in the head. You deeply regret that you have not personally contacted the referring duty doctor.

When it comes to the patient’s other complaint, write the patient received explained the outcome of the investigation, and she received a copy of the current perimetry (visual field control) so all your patients get. This is also recognized in the discharge summary. You affirm that you appeared calm, professional and polite, but you apologize for that she has felt badly treated.

Patient 2 ( XXXXXX , born XXXXXX )

The patient is a woman with long-standing hypertension and poorly regulated diabetes mellitus type 2, chronic kidney disease with excretion of protein in the urine and two previous stroke.

Consultation with you that XXXXXX

The patient was his first consultation with you the XXXXXX. Journal memo stated that the patient had insulin-dependent diabetes type 2. The sight was set to 0.9 in the right eye and 0.2 on the left eye. The pressure was measured to be 17 mmHg on both eyes. The thickness of the cornea (pakymetri) was measured at 512. Upon examination of the eyes, it was clear media, neat optic nerve heads (papillae) and crossover phenomena. The yellow spot (macula) of the right eye was “ OK “, while the macula on the left side had laser brands. There was no sign of karnydanning (proliferations) or other forms of retinal disease caused by diabetes (diabetic retinopathy). Furthermore, it says that it was taken, and that the patient should be checked in XXXXXX. The diagnosis was stated to be E10.3 Diabetes mellitus type 1 with ophthalmic complications.

Consultation with you that XXXXXX

The XXXXXX was patient to its second consultation with you. Journal memo stated that the patient had insulin-dependent diabetes mellitus type 2 since XXXXXX age with previous heart attacks, two strokes and arthritis. The sight was stated to be “ +, 9 ed ” on the right eye and 0.15 in the left eye. The pressure was measured at 18 mm Hg in both eyes. About examination of both eyes says: “ Pale. Peaceful. Clear lenses “. Furthermore, it was “ pretty ” yellow spot (macula) of the right eye and laser marks left macula and the temple of the macula. It was not found karnydanning (proliferation), but I’ve found some mikroutposninger (microaneurysms) on the small arteries (arterioles) and tight crossover phenomena. Furthermore, it says that the patient had mild retinal disease due to diabetes. The diagnosis was stated to be E10.3 Diabetes mellitus type 1 with ophthalmic complications.

Consultation with you that XXXXXX

By Journal note states that XXXXXX. The note says that the patient had insulin-dependent diabetes and elevated blood pressure, and that she at last examination of eyesight (with glasses) at your substitute the XXXXXX, had had sight of 0.4 in the right eye and 0.2 on the left eye. It is further stated that the patient had had a stroke in XXXXXX and XXXXXX and that she had received preventive laser treatment for diabetes retinopathy. It is also indicated that the patient’s vision by examination (with glasses) with you in November 2011 was 0.9 in the right eye and 0.2 on the left eye.

In the current study was the vision (with glasses) considered to be 1.0 in the right eye and 0.2 on the left eye. The examination of the peripheral visual field showed deep and large loss in the temporal lower field on the right eye and deep loss towards the nose on your left. The pressure was measured to be 18 mmHg in both eyes.

Upon further examination of the eye found you pale, clear lens, pretty papilla and mild to moderate diabetic retinopathy in the right eye combined with dry macula. On the left eye there were similar conditions, with the exception of laser marks in the macula and temporal side of the macula. Furthermore, it says: “ Enlarge the OCT “. Finally states argued that considering that the patient does not meet the requirements for driving, and the patient should be checked in six months with regard to diabetic retinopathy. As diagnosis is indicated E11.3 Diabetes mellitus type 2 with ophthalmic complications.

Your statements

You have stated you matter in a letter dated XXXXXX and XXXXXX.

In the statement of XXXXXX specify that the patient was examined by you and an ophthalmologist substitute in the period after XXXXXX. Furthermore, you indicate that it was not made findings that were notifiable to the authorities before you examined the patient the XXXXXX. You write that the patient was referred to you the first time in XXXXXX considering the care of the diabetic retinopathy. You specify that such supervision does not involve assessment of vision. Furthermore, you claim that it was the special circumstances after XXXXXX, that made you also conducted field survey the XXXXXX.

In the statement of XXXXXX type that it is not normal in Norway to do perimetry (visual field control) by diabetes control. You also indicate that the patient after the controls with you in XXXXXX and XXXXXX was investigated, examined and treated by several doctors and ophthalmologists without her being deprived of license. XXXXXX. As XXXXXX, you found it reasonable to do perimetry in addition to the regular surveys. The results of the surveys indicated that the patient did not fulfill the requirements to hold a driver’s license, and this was reported to the police and GPs. You are now reading the CMO supervisor about guidelines for the counties in the treatment of a driving license issues, and you will strongly regret that the discharge summary of XXXXXX was not sent to the County of XXXXXX. You mean you acted properly, but this experience has made you even more aware of the symptoms in diabetics with regard to driving.



Norwegian Board of Health reviews

Norwegian Board of Health has assessed following:

  • if you gave patient 1 proper diagnosis and treatment at the first consultation, ref. the Health § 4
  •  

  • if you by not inflow patient 1 with once broke immediate aid duty in Health § 7
  •  

  • if you gave patient 1 caring help at the second consultation, ref. the Health § 4
  •  

  • if you gave patient 2 proper treatment, ref. the Health § 4
  •  

Below we list the relevant provisions.

The Health § 4, first paragraph:

health professionals must perform their work in accordance with the requirements of professional responsibility and diligent care that can be expected based on their qualifications, the nature of work and the situation in general.

The Health § 7:

Health personnel shall immediately notify the health care they abilities when it must be assumed that aid is urgently needed. With the limitations imposed by the patient and user Rights Act § 4-9, necessary health care is provided even if the patient is unable to consent, and even if the patient objects to such care.

If doubts about health care is of vital importance, health personnel carry out the necessary investigations.

The obligation does not apply to the extent that other qualified health provider assumes responsibility for providing health care.

If the concept of responsibility and diligent care

In the specific assessment of whether the way you act in the matter was proper, take the State Board of Health based on the general description of what should could be expected from professional practice. In determining what constitutes good practice, emphasis will be placed on current professional guidelines and / or guidelines.

What is justifiable is determined by an assessment of each case, and not on how the healthcare ideal should have behaved. By proper proportionality assessment we look to action alternatives in the current situation. Further emphasis will be placed on how great a risk of damaging a deviation will be associated with. The contents of the acceptability requirements tightened if there is great risk of serious injury if done incorrectly. Not any deviation from good practices considered as unjustifiable. There must be a relatively clear deviation from good practice before the action is indefensible.

Caring assistance is about the way patients are met at, and that she or he appears respect and empathy. Specifically, this gives manifested in the way healthcare is acting opposite and communicate with the patient. Caring health care requires that health professionals providing health care must be confident way. Patients are in a dependent relationship with healthcare providers provide health care, and must therefore have confidence in health services and health personnel. In a treatment situation are those professionals that sets the conditions and the patient is entitled to security in the treatment situation. Such confidence is partly dependent on the healthcare professional actor, with the ability to show care and respect in the face of the patient.

A doctor must therefore be conscious of their appearance and demeanor. It is also expected that the doctor is clearly in its communication with the patient so that situations not be misunderstood. Inadequate communication with patients can inflict the patients stress in that situation might be misunderstood, the diagnosis may be incomplete, and the treatment and follow-up of the patient may be indefensible.

Your diagnosis and treatment of patient 1

Good practices for assessment of patients with acute homonym hemianopsia

Homonym hemianopsia involves the loss of the right (or left) halves of sight in both eyes. Such Class for synsfelttap can be transient or persistent.

The most common cause of persistent homonym hemianopsia in adults, vascular conditions, such as for example stroke, and then follow the conditions as brain tumors, trauma, surgery and other diseases central nervous system.

An important difference between the homonym hemianopsia caused by cerebral infarction, and homonym hemianopsia caused by a brain tumor, is the time it takes for symptoms to occur. By homonym hemianopsia due to ischemic stroke, vision loss come acute, while the homonym hemianopsia due to brain tumor, vision loss occur gradually over time.

National technical guideline for treatment and rehabilitation for stroke (IS-1688) , indicating that patients with symptoms of acute stroke, immediately be admitted hospital with stroke unit for diagnostics, emergency care and rehabilitation. Furthermore, it is stated that patients with symptoms of acute stroke, immediately should be examined with CT or MRI.

Consultation no. 1

Despite the fact that the patient had acute encountered visual field defect, it appears that you suspected a brain tumor, and referred the patient to MR with this in mind. The fact that the patient homonym hemianopsia occurred acutely, however spoke against this patient’s visual field defect was caused by a brain tumor. Given that stroke is also a far more common cause of homonym hemianopsia, it should have been obvious to you that the stroke was a more likely diagnosis than gliomas, and the urgency of getting examined patient. The patient smoked, made it more likely that the patient’s visual field defect could be caused by a stroke.

You have indicated that there are no MRI or CT in the radiology department at XXXXXX. This suggests that it was urgent the more to get the patient to a hospital where the patient could get quick diagnosis and treatment for acute ischemic stroke.

We consider it as serious that you sent the patient home after the discovery of acute occurred homonym hemianopsia, without ensuring patient rapid diagnosis and treatment. The fact that you are not referring the patient to the immediate aid assessment and treatment in hospitals, increased risk that the patient could obtain permanent synsfelttap.

You have maintained that the patient was assessed adequately, assume that was no information in the citation or signs of the patient that would suggest that it was urgent “to the minute”, such as bleeding, pain, deconditioning, etc.. State Board of Health will again point out that emergency occurred homonym hemianopsia usually caused by disease, and that it urgent to get explored such a condition. We consider it seriously that you still do not seem to take this inward you.

Norwegian Board of Health finds that your diagnosis and treatment of patient 1 was academically indefensible, and a breach of the Health Personnel § 4.



Emergency

The provision of Health § 7 instant support triggers a duty to provide assistance for caregivers, and requires that health professionals act quickly where this is urgently needed. Assessments must be given to whether there is a risk to life or risk of serious deterioration of the health condition.

You sow ordinarily referred patients before this patient, but there is no proof that it was urgent to see these patients. You exposed to inflow patient despite the fact that she was referred to urgent care and it was reported from XXXXXX emergency that she had vision outcomes. As there are long distances to hospitals and the lack of CT / MR in XXXXXX, should the patient become add to you faster. The fact that you do not quickly sow patient who was referred as urgent care, and sow ordinarily referred patients before her, violations of the Health § 7.

Consultation no. 2

When it comes to your behavior towards the patient at the second consultation it

XXXXXX indicates the patient in her complaint that she felt like a very sour and cross-person and that you accused her of having treated you badly through its appeal for you to the County. In your medical record, you have indicated that the patient seemed satisfied by this consultation, and you have also noted that the patient had written a complaint to the County on your first examination of her. In your statement of XXXXXX specify that you felt unfairly treated by the patient, but that you were not rude.

In part you have recorded that the patient had complained about your treatment of her, and you have specified in your statements that you felt treated unfairly. Norwegian Board of Health therefore assumed that you were indignant over the patient’s complaint when you re so patient, and this may have influenced how you behaved towards her.

Norwegian Board of Health pointed out that the doctor is very important to behave professionally in such a situation, and the physician must treat the patient in a caring way even if the patient has sent a complaint on one. The patient is in a more vulnerable position than the doctor, which is the professional party in the relationship. Professional Conduct will also prevent the appearance of doctor weaken further.

Based on information in the case, adding Norwegian Board assumed that during the second consultation with the patient acted in such a way that the patient did not diligent care and that a breach of the Health Personnel § 4.

Your follow-up and treatment of patient 2

Good practice for diagnosis and treatment of eye disease in diabetes

Øyemanifestasjoner of diabetes mellitus is common, and diabetes is partly associated with retinal disease ( diabetic retinopathy), fluid retention and swelling in the “yellow spot” of the retina (macula edema), premature “cataracts” (cataract) and increased incidence of “glaucoma” (glaucoma). Diabetes is still a leading cause of vision loss and blindness in the industrialized world.

There is a clear correlation between poor glycemic control and risk of developing diabetic retinopathy in patients with diabetes. CMO national professional guidelines for prevention, diagnosis and treatment of diabetes (IS-1694) , entered earlier that long-term blood glucose (HbA1c) should be under 7%. This target was revised in October 2012 to HbA1c below or equal to 6.5%. It is also specified that patients with type 2 diabetes from the time of diagnosis should be checked annually; possibly less frequently with stable blood glucose control and the absence of retinopathy. Regular eye examina- is important for time to treat retinopathy.

A general eye examination will be so extensive that disease and conditions that may threaten the patient’s vision and other health being diagnosed. Such studies usually include the following:

  • inspection of the eyelids, cilia (cilia) and lacrimal system
  •  

  • biomicroscopy of conjunctiva, sclera, iris and lens
  •  

  • direct and indirect ophthalmoscopy
  •  

  • reflecting position, rent, mobility, pupils action, convergence
  •  

  • vision with best correction
  •  

  • Near Vision / lesesyn if necessary
  •  

  • pressure in the eye (intraocular pressure)
  •  

  • field (Donders method), or screening with perimetry
  •  

Eye examination for diabetic retinopathy should always be performed on both eyes and dilated pupils. Ophthalmologist performs its survey by ophthalmoscopy (direct and indirect) and with biomicroscopy (slit lamp and contact glass). Visusundersøkelse with best refraction and pressure measurement is a matter of course. Intravenous fluorescein angiography is usually indicated for anticipated treatment possible macular edema, and may be indicated by some other retinopatiformer such as threatening macular edema, preproliferative retinopathy and proliferative retinopathy. OCT (optical coherence tomography) is today taken routinely to follow the development of macular edema and OCT can complement and often replace fluorescein angiography.

It is important to note that stroke, and laser treatment for diabetic retinopathy, can cause visual field defects.

evaluation

It appears from the record that by consultations with the patient the XXXXXX and XXXXXX, indicated that the patient had insulin-dependent diabetes mellitus type 2 while the diagnosis is specified as type 1 diabetes mellitus with ophthalmic complications. Upon consultation XXXXXX, you specified that the patient had a diagnosis of type 2 diabetes mellitus with ophthalmic complications. We will initially emphasize that diabetes mellitus type 1 and 2 are two different diseases with different causes and treatments.

The fact that the patient had undergone two previous stroke and had undergone laser treatment, did the patient was exposed to could get visual field defect. The fact that you were familiar with these risk factors, did you should have examined the patient’s field of view closer.

In your statements you stated that it does not belong to the eye examination of diabetic patients to examine patient’s field of vision. In Norwegian Ophthalmological Society (NOF) its Quality Manual, states explicitly that it should be done examination of vision in patients with diabetes, but the investigating field belong to a regular eye exam.

The fact that you have not conducted examination of the visual field by some of your two consultations with the patient in XXXXXX and XXXXXX, despite the fact that you in XXXXXX was aware that the patient had ophthalmic complications related to his diabetes and was formerly laser treated in the retina and that, in XXXXXX was aware that she in addition also had had two strokes in the past, considered academically indefensible.

In both your statements to the case set the examination of visual field are not part of the examination of patients with eye complications due to diabetes. After the State Board of Health assessment suggests a lack of insight and recognition of the importance of field studies in diabetic patients with ophthalmic complications that have previously undergone stroke and laser treatment of the retina. This case shows the importance of such inquiries to be made.

About notification on driving licenses by Health § 34

Norwegian Board of Health will also attach some comments to the notification requirement for a driving license for Health § 34. In accordance with the regulation on the provision (regulations on physician notification that the holder of a pilot’s license or driver’s license does not satisfy health requirements) , the doctor finds that a patient does not meet the health requirements to hold a driver’s license, encourage the patient to hand their driver’s license if the condition is expected to last for less than six months. If your doctor is in doubt, or deems that the condition will last beyond six months, the doctor shall in writing notify the patient and to public authorities.

LikeTweet

Indicted dentist: – Life was totally chaotic after newspaper reports – NRK

The man in the 50s acknowledged partial guilt for tax evasion, but thought the amount was 7.9 million. He testified in court on Thursday and had trouble explaining why it was not filed tax returns or paid taxes.

– Negative newspaper articles meant I lost patients and got financial problems, explained the defendant was honest that the family had high living standards including big house and expensive car.

The defendant dentist began his statement by reading from a note he had written before the trial to try to explain why things was that they were.

Can not remember

He explained how it all started with a patient who complained about the treatment, which eventually ended with several articles in the local newspaper in 2010 where he and dental clinic was identified.



District Court: The prosecutor in the case is police lawyer Richard Roed and man defender Tore M. Fame Location.

Photo: Linda Vespestad / NRK

– Life went from being happy to hell, said the dentist.

He reads quickly and must occasionally take breaks to wipe the tears and accumulate. He told how family life, economics, his career and clinic collapsed after newspaper headlines, and that everything was chaos. Much of the period is a fog and I can not remember so much of the time, explained the defendant.



You mean he owned apartment

He is charged bounndragelse in connection with the settlement after one of his companies went bankrupt. He should not have told the trustee that the company owned a property in Spain, and tried thus evading NOK 3.2 million.

The liquidator discovered this and took the seizure of property, according to the indictment. This denied the defendant guilty for. He explained in court that he and his wife had bought the apartment from the company in 2012, and that therefore there were those who owned the place and not the company.

Prosecutor Richard Roed wondered why police thus not found purchase contract under raid summer 2013, but it did not know the accused.

Did not contract

When he was asked what he owned and what the company owned in police interview in 2013, he said on two occasions that it was the company.

– Why did you say that the company owned the apartment, if it was you who owned it? You explained the right when it mattered car and liabilities, wondered prosecutor Roed on.

– I do not know, I was in shock. Everything was chaotic. I do not remember everything I said. Most of police interviews is just a fog, explained dentist.

– Did you purchase to the trustee?

– No, he threatened me quickly with bounndragelse. I was completely run down.

Both tax authorities and trustee explained in court that they are confident that it was the company that owned the apartment.



Expensed horse

He is also accused of having expensed for much of the firm. Including mobile to a family member or rental of stall for horses.

– There and then I thought that stall rent was good for health. It allowed me to do my job well and that therefore there was just expensing it. When it comes to mobile, so it was not I who brought the vouchers. I see now that I had a responsibility to follow as head of the firm, said the defendant dentist in his testimony.

It has been announced that two insurance companies will request a refund of sickness benefits.

LikeTweet

Thursday, October 29, 2015

Expect dividend party in Gjensidige – was publicly rocket – E24

int forsikring Butikk drive Skal du, du vil være underlagt in Rekke reguleringer. Det veto Gjensidige Sjef Helge Leiro Baastad high-om.

– Det be ut til den at regulatoriske usikkerheten avtagende er, have healthy and Gjensidige til dag på kvartalspresentasjonen.

Da MENERS have to IOVENE og ikke at Gjensidige reglene Må forholde seg til lish Faeries, men tydeligere, slik at enklere er til å forholde sec.

Til Tross for you finansresultat we first Revet and son sammenlignet med SAMME period and fjor, sier Baastad at den reduserte risikoen knyttet til reguleringer vile komme til å påvirke utbyttepolitikken.

– Dette er noe We vil være positivt med Tanke på kapitalposisjonen til Gjensidige, og dermed også fremtidig utbyttekapasitet, healthy Gjensidige-Toppen og mente med det at det blir mer hanging Rutte med and tiden we kommer.

Lesogså: Gjensidige-konsernet leverte and dag nok et rekordresultat for skadeforsikringsvirksomheten and selskapet.

Redusert Behovia in stor for pengesekk

Det vært knyttet usikkerhet har om til Kapital Naturskadefondet and Gjensidige har til å kan Bruker inngå and we kapitaldekningen oppfylle skal til Solvens kravene II-direktivet, we implemented 1.januar
2016.

And I noticed Brother Finanstilsynet 19.juni and fjor fra det å lese sto at midlene of Fondet ikke til we avsettes kunne medregnes inn under “solvenskapital.” Na was dette ut til å være endret.

– Vi har levd med in usikkerhet rundt naturskadepoolen, og det be ut til å bli avklart Na sier Baastad – we forventer in endelig og positiv avklaring int utgangen BC earrings.

selskapets presentasjon and Schweigaardsgate gikk På det også FREM at risikoen knyttet til I skatt redusert for selskapet.

– Wine presenterte in “worst-case” -effekt på 1,4 milliard Kroner and forrige Kvartal, sier Baastad og sier videre at forventningsnivået nå ligger på 900 Millioner Kroner, men at ta lang tid för det vil selskapet do in avklaring.

Skattesaken dreier verdivurdering av seg om såkalte Tekniske provisjoner. Etter tredje Kvartal forventer Altså Gjensidige et mer enn positivt utfall and Saken Forster antatt.

I Dermed behovet for in større pengesekk blitter mindre.

The også: Nordea med ferske kvartalstall: – Innskuddsmarginene er under press

– Det kan være ekstraordinære utbytter fremover

– Vi skal skape positiv utbyttevekst fremover, Baastad sier til E24.

– Kapitalreservene selskapet and Stig are Folge av det reduserte behovet for strategisk kapitalbuffer. Pareto Kallis det in kjempemulighet, DNB and spekulerer OKT utbytte. Hva skal dere bruke pengene useful?

– Det er ikke noe enkelt svar på det, sier Baastad Forster.

– Det vi har sagt er at wine føler bones trygge, og det Henger Sammi med et systematisk og kontinuerlig forbedringsarbeid of Siste 10 Arene.

Forsikringssjefen viser til at selskapet er godt posisjonert and forhold til å Holde Kunda, Vinne Kunda og skape vekst fremover and markedene opererer and Gjensidige.

I fjor klarte of å dele ut til sine hele 8.4 milliard Kroner eiere. Det tilsvarte 70.4 Pros BC selskapets result etter skatt. Det langsiktige suitcases and den finansielle Strategien er 70 Pros.

– Vi er and situasjon Hvor vi ikke har Behovia for a bygge unødvendig kapitalbuffere – we også betyr at det kan være ekstraordinære utbytter fremover, sier Gjensidige-Sjef we dermed langt på seen antyder, men ikke besluttsomt Svara på om aksjonærene skal forvente sec ekstraordinære utbytter.

Skyter fart på Oslo Stock

Gains aksje landet and tredje Kvartal landet på 1.2 forsikringsgiganten Kroner for a word in forventing fra på 0.9 markedet Krones aksje.

DNB Markets Skriv at det reduserte behovet for strategisk buffer ved årsslutt vile kunne g forventinger om ekstraordinært utbytte int utgangen BC earrings.

Gjensidige-aksjen skjøt fredag ​​and været . Da Oslo Bors stengte, var aksjen opp 12.28 Pros and dag har skutt and været. Tidligere opp på dagen var den NESTA 15 Pros. Aksjen har dermed hentet inn – og så det veil – and nedturen hittil år.

også: Sjefstrateg tror Oslo Bors skal opp: – Vi har lagt krisetiden bak oss

Redusert vekst and Norsk Økonomi

Økningen and forsikringsresultatet ble in premievekst Drevet av på hele 5.1 Pros.

– Justerer for man valutaeffekter oppkjøp og er premieveksten langt lava enn 5,1 prose Baastad og sier til at viser den underliggende veksten and premiene for private henholdsvis – og er næringslivssegmentet 1.7 og 3.2 Pros.

Gjensidige-Sjef forventer in vekst and forsikringspremiene lik BNP-vekst.

– Hva er forventingene til BNP-veksten fremover?

– Det er et godt spørsmål, sier Baastad – sier for at vi vil have done in avkjøling and Norsk Økonomi.

& lt; b & gt; FLOMAT: & lt; / b & gt ; Leirsund and Skedsmo Kommune var et av Flere sted We ble utsatt for FLOMAT and september. The tone flommene and Norge and september p & # xE5; virket kostnadene & # xA0; til Gjensidige med 80 Millioner Kroner.
FLOMAT: and Leirsund Skedsmo Kommune var et av sted Flere we utsatt ble for FLOMAT and september. Flommene tone and påvirket kostnadene september til Norge and Gjensidige med Millioner 80 Kroner.

– Jeg tror det kan bli noe verre enn det vi har sett og lest av prognosene så langt, og trekker FREM DNB are and sine analyzer ikke be lys and for tunnel Norsk næringsliv for and 2018.

også: 26,000 oljejobber Borte: – det vil komme Flere Kutta

ekstremvær Mer

Selskapet leverte nok et rekordresultat int skadeforsikringsvirksomheten for tredje Kvartal. Det Gode resultatet ble Delva motvirket BC OKT storskadeinnslag. To flommer and Norge and september påvirket kostnadene med 80 Millioner Kroner.

– Forventer du mer ekstremvær fremover?

– Ja, det gjør jeg faktisk. Gjør det jeg. Jeg forventer Vatter og Vilt Klima sier Sjef and I av Norges største forsikringsselskap.

– Alle mediene Skriv om at nå lish det veldig mye verre til neste år, og earrings etter der igjen, forklarer Baastad og MENERS at det på lang sikt er mer interesting HVA are skjer.

– I Arene jeg har igjen her, så kommer tilfeldighetene til å SLA Trend understreker Baastad – og Peker muntert og fornøyd ett år på den yngre informasjonsdirektøren and selskapet Når have forklarer HVA have MENERS sikt lang med.

Believes animal cancer medicine to the hospitals’ finances to collapse – Dagbladet.no

The directors of the health regions have notified the Ministry that new, expensive cancer medicines will crack hospitals economy.

Immunotherapy with so-called PD1 inhibitors, which help the body’s own immune system to fight cancer has shown promising results. The problem is that medicine is so expensive that it is uncertain whether the effect is good enough to justify the price, type Bergens Tidende.

Norwegian Lung Cancer Society believes treatment should be used immediately, while Decision Forum – where the directors of the four health regions sitting – have said no. NOMA has not considered the matter yet.

With a price of 1.1 million per patient per year, the new treatment may cost several billion for health regions, says technical director Bård-Christian in the Scheme Health west in a note. 1,500 lung cancer patients are current PD1 receivers. Today they get prescribed medication that costs a fraction of immune therapy: NOK 10,000 per year.

In addition, PD1 inhibitors be appropriate for a variety of other cancers.

The forum will ask the Ministry of Health involved in the question of how the galloping expenses should be handled. Health Bent Høie (H) says the hospitals’ budgets have increased in recent years to meet increased costs, but adds that the pharmaceutical industry should not get to dictate prices.

(NTB)

LikeTweet

Tuesday, October 27, 2015

The municipality will not pay the politicians voted yes to – Varden

Dette er inkludert i alle abonnement

Full tilgang til alt vårt digitale innhold på varden.no, og eAvisen.

Abonnenter kan på Minside gratis og enkelt dele sin digitale tilgang med inntil 4 personer i samme husstand.

Last ned gratis app til mobilen. Få push-varslinger umiddelbart med de viktigste nyhetsoppdateringene.

Du sparer raskt inn abonnementet med Varden Pluss, eksklusive tilbud på opplevelser, reiser, bilvask, restauranter, og mye annet

Alt dette får du som abonnent

LikeTweet

The government will allow e-cigarettes with nicotine. – Aura Avisa

The government opens to allow the sale of nicotine e-cigarettes in Norway – but will prohibit the use in non-smoking areas.

Consumers will thus avoid having to buy electronic cigarettes with nicotine on the web if Conservatives and the Progress Party gets what they want.

Approximately 50,000 Norwegians smoke today e-cigarettes, according to a note about the tobacco directive as Tuesday to be sent out for consultation. Many people use it as an aid for quitting with regular cigarettes.

But the government will put an end to that e-cigarette smokers can steam on their nozzles in places where smoking ban applies. Today it is up to the owner of the premises to allow or prohibit smoking of e-cigarettes.

The background is a report from the Public Health showing that the nicotine-related dangers of passive damping is the same as for passive tobacco smoking especially for people with cardiovascular disease, children and pregnant women.

– We propose a number of amendments to the Tobacco Act as a result of new EU tobacco directive. This, we are required to follow, said health Bent Høie said.

The directive does not apply to e-cigarettes. Approximately 50,000 Norwegians smoke today e-cigarettes, and many use it as an aid to quit smoking.

– Here we have chosen to propose that both the sale and use of e-cigarettes regulated in the same way as regular smoking tobacco, except when it comes to display ban and standardization of tobacco packets, says Høie.

Cancer Society is wary to allow e-cigarettes with nicotine, partly because it can create nicotine addiction.

– And we know too little about the health consequences in the long term, said Deputy Secretary General of the Cancer Society, Ole Alexander Opdalshei, to TV 2.

Meanwhile, stricter rules for labeling tobacco products. Hereafter warnings cover half of the surface of packs of cigarettes, rolling tobacco and water pipe tobacco. For other tobacco products shall warning covering one third of the surface.

In addition to the usual warning that smoking kills, will all smoking tobacco hereinafter also indicated that “tobacco smoke contains over 70 carcinogen.” (AFP)

LikeTweet

Want to buy medicine at the hospitals – the newspaper Bergens Tidende

– Cancer patients should get to get to his regular hospital doctor and be treated with the medication they buy with their own money, says the Secretary General of the Cancer Society.

The expensive cancer medicines were subjects in health debate at Litteraturhuset Monday night.

BT and other media have in recent weeks told about the new immune preparations are medically approved but not yet cleared for use in Norwegian hospitals.

Meanwhile, people flock to two private clinics, where treatment can be purchased for 100,000 crowns a month.

Read

– People should not have to go to Aleris Oslo for this treatment. Instead they should charge for medication and take it to their regular doctor at Haukeland, says Anne Lise Ryel, Secretary General of the Cancer Society.

– Your regular doctor knows your medical history and know what you can tolerate and not tolerate, points out Ryel.

Ryel get a nod from Lars A. Akslen, cancer researcher at the Centre for biomarkers (CCBIO) at UiB and Haukeland University Hospital.

Asked by BT says Akslen that he is positive to the input from the Cancer Society.

– Now do not treat I patients themselves, but many colleagues would probably set positively to this, he said.

– Packet Flow for bureaucrats

Today there Decision Forum that says yes or no to introducing new drugs and methods at Norwegian hospitals. In Decision Forum has the directors of the four health regions to vote.

This fall Decision Forum twice said no to PD1 inhibitor nivolumab of lung cancer patients with metastatic disease, before Medicines Agency has assessed the impact on the price. Probably, it takes up to six months before the case is back in Decision Forum.

  • Decision Forum, where the directors of the regional health authorities meet, has twice refused to introduce immune preparation nivolumab against lung cancer with metastasis, before the impact is assessed against the award. 3000 Norwegians get lung cancer each year, 2,000 die from the disease.
  • Nivolumab is one of several new so-called PD1 inhibitors, which helps the body’s immune system to fight the cancer and shows promise results. Median patient live three months longer and fifth are alive two years after starting treatment.
  • More PD1 inhibitors and other immune preparations are underway for several types of cancer.
  • In a note to Decision Forum says that the new PD1 inhibitors can cost Norwegian hospital 2.5 to 3 billion a year if given to 3,000 cancer patients a year. In Norway these costs PD1 inhibitors 1.1 million for a year’s treatment.

Akslen believes that several matters to discuss around the Decision Forum . One is the democratic issue, because the process is so closed until the decision is made.

The second is timeliness.

– Maybe we should introduce a package stream for health bureaucrats, says Akslen, with reference to the health bureaucrats have made strict deadlines for hospitals dealing with cancer patients.

Want cancer fund

Akslen and Ryel is also agreed that Norway should create a fund to finance expensive drugs in the intervening period from the medically approved to Decision Forum is finished decided.

– Such a fund would loose many of today’s problem issues, they say both.

For the protesting professor Ole Frithjof Norheim, former head of the Priorities Committee.

– In the UK there such a fund. It has blown the budget, says Norheim.



– Brenner for justice

The overarching theme of the debate was the health priorities in the future. Norheim oriented about mindset in Priorities The Commission’s proposal, while Professor Bertil Tungodden at NHH reminded that people are concerned with justice, not efficiency.

– Everyone will have an effective healthcare system with minimal bureaucracy and unnecessary treatment. The difficult discussions about justice and this is what people are passionate about, he said.

LikeTweet

Agri Analysis Memo 2-2015: Is TTIP solution to the crisis? – No to the EU

Handels- og statsavtaler er viktige for mange næringers og staters utvikling, noe vi kjenner godt fra diskusjoner om EEC-, EF- og EU-medlemskap i Norge. Stadig tilbakevendende diskusjoner om globale handelsavtaler først gjennom GATT, så WTO og nå regionale handelsavtaler, skaper høy temperatur, og disse har også potensielt stor innflytelse i de land som inngår avtalene. ‘

Norge følger nøye med på hva som foregår internasjonalt når det gjelder mellomstatlige avtaler; for å holde seg oppdatert om utviklingen i egen region, for å utvikle vårt forhold til nære allierte og handelspartnere, og ikke minst for å være oppdatert på utvikling i handelsregelverk generelt. Forholdet til vår store handelspartner EU er for tiden regulert gjennom EØS, mens vi ikke har noen spesiell avtale med vår allierte nabo USA. Det er også høyst uvisst om vi trenger en avtale med USA, selv om EU og USA blir enige om partnerskapsavtalen.

Rapporten er skrevet av Margaret Eide Hillestad og Christian Anton Smedshaug og utgitt av Agri Analyse

LikeTweet

Monday, October 26, 2015

The government will allow e-cigarettes with nicotine – ABC News

Consumers will thus avoid having to buy electronic cigarettes with nicotine on the net, if the Conservatives and the Progress Party gets what they want.

Approximately 50,000 Norwegians smoke today e-cigarettes, according to a note about the tobacco directive as Tuesday to be sent out for consultation. Many people use it as an aid for quitting with regular cigarettes.

See also: WHO to fight against e-cigarettes

Same smoking

But the government will put an end to that e-cigarette smokers can steam on their nozzles in places where smoking ban applies. Today it is up to the owner of the premises to allow or prohibit smoking of e-cigarettes.

The background is a report from the Public Health showing that the nicotine-related dangers of passive damping is the same as for passive tobacco smoking especially for people with cardiovascular disease, children and pregnant women.

In addition, health authorities point that some e-cigarettes are very similar to cigarettes, and that it can be difficult to tell the difference between smoke and vapor a local, making regulatory authority’s work more difficult.

Cancer Society is wary to allow e-cigarettes with nicotine, partly because it can create nicotine addiction.

– And we also know little about health consequences in the long term, said Deputy Secretary General of the Cancer Society, Ole Alexander Opdalshei, to TV 2.

See also: Passive smoking by e-cigarettes provide health risk
>

Larger warnings

Meanwhile, stricter rules on labeling of tobacco products. Hereafter warnings cover half of the surface of packs of cigarettes, rolling tobacco and water pipe tobacco. For other tobacco products shall warning covering one third of the surface.

In addition to the usual warning that smoking kills, will all smoking tobacco hereinafter also indicated that “tobacco smoke contains over 70 carcinogen.”

See also: Belief in a tobacco world by 2040

LikeTweet

Saturday, October 24, 2015

Cargiants throttle on Wall Street – Manager

Promotion med annonselenker

GM opp på solide tall. Knallstart for børsdebutanten Ferrari.

Pilene pekte mot en positiv start på amerikanske børser onsdag etter en ny runde selskapsresultater, mens investorene også retter blikket mot en av årets største børsnoteringer.

I tidlig handel er Dow Jones-indeksen opp 0,28 prosent, S&P 500 stiger 0,21 prosent og Nasdaq er opp 0,31 prosent.

Bilprodusenten General Motors stiger over fire prosent etter å ha rapportert et nettoresultat på 1,4 milliarder dollar for tredje kvartal, på linje med tredje kvartal i fjor. Det justerte resultatet på 1,50 dollar per aksje overgår imidlertid forventningene på 1,12 dollar i en FactSet-undersøkelse.

Tar Ferrari på børs
Onsdag er også første handelsdag for luksusbilprodusenten Ferrari på New York-børsen, som naturlig nok har fått tickeren «RACE».

Dagen starter med full gass for aksjen, som sendes opp over 13 prosent.

- Begeistring over Ferraris børsnotering hjelper amerikanske aksjer mot en positiv åpning, bemerker CMC Markets-analytiker Jasper Lawler i et notat, ifølge Marketwatch.

I forkant av børsnoteringen har Ferrari hentet 893 millioner dollar i et aksjesalg, ifølge Financial Times. Kursen i tilbudet på 52 dollar verdsetter bilprodusenten til 9,8 milliarder dollar, tilsvarende nær 80 milliarder dollar.

Prisingen er også i den øvre enden av det forespeilede intervallet, noe som indikerer sterk interesse fra investorene.

Ferrari spinnes ut fra Fiat Chrysler, som selger en eierandel på rundt 10 prosent. Den resterende eierandelen på 80 prosent planlegger Fiat å dele ut til egne investorer neste år, ifølge Bloomberg.

Samtidig vil grunnleggeren Enzo Ferrari sin sønn Piero Ferrari beholde et eierskap på 10 prosent.

I fjor produserte Ferrari 7.255 biler og hadde en omsetning på 2,8 milliarder euro.

Børsnoteringen er den fjerde største hittil i 2015, et år som har vært det svakeste for amerikanske nye børsnoteringer siden 2010.

Resultatskred
I tillegg leveres det en rekke selskapsresultater for tredje kvartal. Både General Motors og Coca-Cola er blant de 32 S&P 500-selskapene som legger frem tall i dag.

Coca-Cola faller derimot 1 prosent etter at nettoresultatet falt til 1,45 milliarder dollar i tredje kvartal, fra 2,11 milliarder dollar i tilsvarende kvartal i fjor.

Lik NA24 her og få flere ferske økonominyheter!

LikeTweet

Expect dividend growth in Gjensidige – were rocket on a stock exchange – E24

int forsikring Butikk drive Skal du, du vil være underlagt in Rekke reguleringer. Det veto Gjensidige Sjef Helge Leiro Baastad high-om.

– Det be ut til den at regulatoriske usikkerheten avtagende er, have healthy and Gjensidige til dag på kvartalspresentasjonen.

Da MENERS have to IOVENE og ikke at Gjensidige reglene Må forholde seg til lish Faeries, men tydeligere, slik at enklere er til å forholde sec.

Til Tross for you finansresultat we first Revet and son sammenlignet med SAMME period and fjor, sier Baastad at den reduserte risikoen knyttet til reguleringer vile komme til å påvirke utbyttepolitikken.

– Dette er noe We vil være positivt med Tanke på kapitalposisjonen til Gjensidige, og dermed også fremtidig utbyttekapasitet, healthy Gjensidige-Toppen og mente med det at det blir mer hanging Rutte med and tiden we kommer.

Lesogså: Gjensidige-konsernet leverte and dag nok et rekordresultat for skadeforsikringsvirksomheten and selskapet.

Redusert Behovia in stor for pengesekk

Det vært knyttet usikkerhet har om til Kapital Naturskadefondet and Gjensidige har til å kan Bruker inngå and we kapitaldekningen oppfylle skal til Solvens kravene II-direktivet, we implemented 1.januar
2016.

And I noticed Brother Finanstilsynet 19.juni and fjor fra det å lese sto at midlene of Fondet ikke til we avsettes kunne medregnes inn under “solvenskapital.” Na was dette ut til å være endret.

– Vi har levd med in usikkerhet rundt naturskadepoolen, og det be ut til å bli avklart Na sier Baastad – we forventer in endelig og positiv avklaring int utgangen BC earrings.

selskapets presentasjon and Schweigaardsgate gikk På det også FREM at risikoen knyttet til I skatt redusert for selskapet.

– Wine presenterte in “worst-case” -effekt på 1,4 milliard Kroner and forrige Kvartal, sier Baastad og sier videre at forventningsnivået nå ligger på 900 Millioner Kroner, men at ta lang tid för det vil selskapet do in avklaring.

Skattesaken dreier verdivurdering av seg om såkalte Tekniske provisjoner. Etter tredje Kvartal forventer Altså Gjensidige et mer enn positivt utfall and Saken Forster antatt.

I Dermed behovet for in større pengesekk blitter mindre.

The også: Nordea med ferske kvartalstall: – Innskuddsmarginene er under press

– Det kan være ekstraordinære utbytter fremover

– Vi skal skape positiv utbyttevekst fremover, Baastad sier til E24.

– Kapitalreservene selskapet and Stig are Folge av det reduserte behovet for strategisk kapitalbuffer. Pareto Kallis det in kjempemulighet, DNB and spekulerer OKT utbytte. Hva skal dere bruke pengene useful?

– Det er ikke noe enkelt svar på det, sier Baastad Forster.

– Det vi har sagt er at wine føler bones trygge, og det Henger Sammi med et systematisk og kontinuerlig forbedringsarbeid of Siste 10 Arene.

Forsikringssjefen viser til at selskapet er godt posisjonert and forhold til å Holde Kunda, Vinne Kunda og skape vekst fremover and markedene opererer and Gjensidige.

I fjor klarte of å dele ut til sine hele 8.4 milliard Kroner eiere. Det tilsvarte 70.4 Pros BC selskapets result etter skatt. Det langsiktige suitcases and den finansielle Strategien er 70 Pros.

– Vi er and situasjon Hvor vi ikke har Behovia for a bygge unødvendig kapitalbuffere – we også betyr at det kan være ekstraordinære utbytter fremover, sier Gjensidige-Sjef we dermed langt på seen antyder, men ikke besluttsomt Svara på om aksjonærene skal forvente sec ekstraordinære utbytter.

Skyter fart på Oslo Stock

Gains aksje landet and tredje Kvartal landet på 1.2 forsikringsgiganten Kroner for a word in forventing fra på 0.9 markedet Krones aksje.

DNB Markets Skriv at det reduserte behovet for strategisk buffer ved årsslutt vile kunne g forventinger om ekstraordinært utbytte int utgangen BC earrings.

Gjensidige-aksjen skjøt fredag ​​and været . Da Oslo Bors stengte, var aksjen opp 12.28 Pros and dag har skutt and været. Tidligere opp på dagen var den NESTA 15 Pros. Aksjen har dermed hentet inn – og så det veil – and nedturen hittil år.

også: Sjefstrateg tror Oslo Bors skal opp: – Vi har lagt krisetiden bak oss

Redusert vekst and Norsk Økonomi

Økningen and forsikringsresultatet ble in premievekst Drevet av på hele 5.1 Pros.

– Justerer for man valutaeffekter oppkjøp og er premieveksten langt lava enn 5,1 prose Baastad og sier til at viser den underliggende veksten and premiene for private henholdsvis – og er næringslivssegmentet 1.7 og 3.2 Pros.

Gjensidige-Sjef forventer in vekst and forsikringspremiene lik BNP-vekst.

– Hva er forventingene til BNP-veksten fremover?

– Det er et godt spørsmål, sier Baastad – sier for at vi vil have done in avkjøling and Norsk Økonomi.

& lt; b & gt; FLOMAT: & lt; / b & gt ; Leirsund and Skedsmo Kommune var et av Flere sted We ble utsatt for FLOMAT and september. The tone flommene and Norge and september p & # xE5; virket kostnadene & # xA0; til Gjensidige med 80 Millioner Kroner.
FLOMAT: and Leirsund Skedsmo Kommune var et av sted Flere we utsatt ble for FLOMAT and september. Flommene tone and påvirket kostnadene september til Norge and Gjensidige med Millioner 80 Kroner.

– Jeg tror det kan bli noe verre enn det vi har sett og lest av prognosene så langt, og trekker FREM DNB are and sine analyzer ikke be lys and for tunnel Norsk næringsliv for and 2018.

også: 26,000 oljejobber Borte: – det vil komme Flere Kutta

ekstremvær Mer

Selskapet leverte nok et rekordresultat int skadeforsikringsvirksomheten for tredje Kvartal. Det Gode resultatet ble Delva motvirket BC OKT storskadeinnslag. To flommer and Norge and september påvirket kostnadene med 80 Millioner Kroner.

– Forventer du mer ekstremvær fremover?

– Ja, det gjør jeg faktisk. Gjør det jeg. Jeg forventer Vatter og Vilt Klima sier Sjef and I av Norges største forsikringsselskap.

– Alle mediene Skriv om at nå lish det veldig mye verre til neste år, og earrings etter der igjen, forklarer Baastad og MENERS at det på lang sikt er mer interesting HVA are skjer.

– I Arene jeg har igjen her, så kommer tilfeldighetene til å SLA Trend understreker Baastad – og Peker muntert og fornøyd ett år på den yngre informasjonsdirektøren and selskapet Når have forklarer HVA have MENERS sikt lang med.