Characterization of thrombin derived from human recombinant prothrombin.

Thrombin (FIIa) is the key enzyme in haemostasis and acts on several substrates involved in clot formation, platelet activation and feed-back regulation of its own formation. During activation of blood coagulation, FIIa is formed by proteolytic cleavage of prothrombin (FII). In the production of recombinant human FII (rhFII), a key question is whether the thrombin formed has the same properties as endogenous thrombin. We have investigated whether FIIa formed from rhFII and plasma-derived human FII (pdhFII) have the same enzymatic and haemostatic properties against a number of substrates and the same haemostatic capacity in plasma, whole blood and on platelets. Pure FIIa was isolated from rhFII and pdhFII cleaved by recombinant ecarin, and analytical methods were developed to compare the activity of FIIa against different substrates. FIIa derived from rhFII and pdhFII were found to have very similar properties in activating FVIII, FXIII, protein C, platelet aggregation and plasma or whole blood coagulation. Further, the same turnover for S-2366 was found with similar KM. However, activation of FV with rhFIIa was approximately 25% more effective than with pdhFIIa and heparin-enhanced inhibition of rhFIIa by antithrombin was significantly more efficient compared with pdhFIIa with 10% higher inhibition both at steady state and at initial rate conditions. Although differences between the two FIIa preparations using ecarin cleavage were observed, FIIa derived from rhFII administered to human would likely be very similar in activity and function as FIIa formed from endogenous FII.

Priority setting in Swedish health care: are the politicians ready?

BACKGROUND: Resource allocation in public health care principally involves politicians, administrators, and physicians. They all have their different roles, agendas and ambitions when it comes to how public health care resources should be spent. Previous studies on attitudes among health-care stakeholders have mainly focused on views and preferences among clinical decision-makers, while less attention has been paid to the views of health care politicians. AIM: The study aimed to investigate if the health care politicians' views on priority setting and decision-making in health care differed from other stakeholder groups. METHOD: The study was based on a questionnaire conducted among health care politicians, administrators, and physicians in four county councils in Southern Sweden. RESULTS: The findings show significant differences between the politicians and the other two groups in their views on health-care resources, financing, priority setting and decision-making. CONCLUSIONS: The findings could, at least partly, be explained by the special situation it means for the politicians to be forced to be re-elected every fourth year to stay in power.

Public dialogue on healthcare prioritisation.

The Swedish public healthcare sector is administered by county councils or regions with their own power of taxation. These authorities are facing difficult times as the gap between demand and healthcare resources is widening and the option to further increase county council taxes is not politically tempting. It is becoming ever more apparent that, sooner or later, limits to the public healthcare commitment must be set. In the north-western district of Region Skåne, the district board determined to initiate a public dialogue on prioritisation with local residents. Annual surveys were sent to 1% of the population ( approximately 2500 individuals) during the period 2002-2004. The addressees were also asked if they wanted to participate in public meetings with the healthcare politicians. This study investigates what happened to the preferences and attitudes of the interest group when the participants were not only offered an opportunity to enter into a dialogue with their peers and representatives, but also received information on prioritisation matters. After the intervention, which consisted of two public meetings with politicians and five information booklets on prioritisation issues, the study group was asked to participate in a second survey. At the follow-up, 20% fewer thought that one should always have a right to public healthcare, even if troubles were trivial. Eighty four percent in the study group thought that the general public should participate in prioritisation discussions while only 64% in the control group agreed to this. Eighty two percent of the study group marked the dialogue project "good" or "very good". The results indicate an increased acceptance for reallocations, a strengthened will to participate and more confidence in the politicians and their work. The study is descriptive and designed to make long-term follow-ups possible.

Opinions of Swedish citizens, health-care politicians, administrators and doctors on rationing and health-care financing.

OBJECTIVE: To compare the views of citizens and health-care decision-makers on health-care financing, the limits of public health-care, and resource allocation. DESIGN: A postal survey based on a randomized sample of adults taken by the national registration and stratified samples of health-care politicians, administrators, and doctors in five Swedish counties. PARTICIPANTS: A total number of 1194 citizens (response rate 60%) and 427 decision-makers (response rate 69%). RESULTS: The general public have high expectations of public health-care, expectations that do not fit with the decision-makers' views on what should be offered. To overcome the discrepancy between demand and resources, physicians prefer increased patient fees and complementary private insurance schemes to a higher degree than do the other respondents. Physicians take a more favourable view of letting politicians on a national level exert a greater influence on resource allocation within public health-care. A majority of physicians want politicians to assume a greater responsibility for the exclusion of certain therapies or diagnoses. Most politicians, on the other hand, prefer physicians to make more rigorous decisions as to which medical indications should entitle a person to public health-care. CONCLUSIONS: The gap between public expectations and health-care resources makes it more important to be clear about who should be accountable for resource-allocation decisions in public health-care. Significant differences between physicians' and politicians' opinions on financing and responsibility for prioritization make the question of accountability even more important.