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The article presents the author's views on policy decisions and research in economics and industrial relations. A decision maker must take into account all the major considerations that may influence the outcome and consequences of a decision and be prepared to take and live with the pressures that are generated. The decision cannot abstract from institutions, people, and public processes. The time perspectives of decision makers may be very different from those of analysts. Labor economists seem to have no difficulty in understanding that the findings of natural scientists should not automatically determine, for instance, occupational health policy, but they have much more trouble seeing that their own analytical and quantitative work is no more decisive. The author's assessment of the Phillips Curve literature for public policy has been considered. It was not calculations of an aggregative Phillips Curve that led economic advisers in 1966 to be concerned about inflation prospects and to urge a tax increase, and no quantification of aggregate wage employment relations could have been imaginably useful in that decision.

Background: Direct oral anticoagulants (DOACs) have expanded the armamentarium for antithrombotic therapy. Although DOAC-related major bleeding was associated with favorable outcomes compared with warfarin in clinical trials, warfarin effects were reversed in < 40% of cases, raising concerns about the generalizability of this finding.Methods: Consecutive patients ≥ 66 years presented to five tertiary care hospitals across three cities in Ontario, Canada from October 2010 to March 2015 with diagnoses that included hemorrhage. Charts were screened for association with DOAC or warfarin use; eligible cases were abstracted and linked to administrative databases.Results: Among 19,061 records screened, 2,002 (460 receiving DOAC, 1,542 receiving warfarin) were eligible. Reversal agents (72.9% vitamin K, 40.7% prothrombin complex concentrates) were frequently used in warfarin bleeding events. Red blood cell transfusions occurred more often in DOAC bleeding events than in warfarin events (52.0% vs 39.5%; adjusted relative risk [aRR], 1.32; 95% CI, 1.19-2.47). However, units of blood products transfused were not different between the two groups. Thirty-four DOAC cases (7.4%) received activated prothrombin complex concentrates or recombinant factor VIIa. In-hospital mortality was lower following DOAC bleeding events (9.8% vs 15.2%; aRR, 0.66; 95% CI, 0.49-0.89), although differences in 30-day mortality did not reach statistical significance (12.6% vs 16.3%; aRR, 0.79; 95% CI, 0.61-1.03).Conclusions: In this unselected cohort of patients with oral anticoagulant-related hemorrhage with high rates of warfarin reversal, in-hospital mortality was lower among DOAC-associated bleeding events. These findings support the safety of DOACs in routine care and present useful baseline measures for evaluations of DOAC-specific reversal agents. [ABSTRACT FROM AUTHOR]

Chronic non-cancer pain is a debilitating condition associated with high individual and societal costs. While opioid treatment for pain has been available for centuries, it is associated with high variability in outcome, and a considerable proportion of patients is unable to attain relief from symptoms while suffering adverse events and developing medication dependence. We performed a review of the efficacy of pharmacogenomic markers and their abilities to predict adverse events, dependence, and associated economic costs, focusing on two genes: OPRM1 and CYP2D6. Data sources were articles indexed by PubMed on or before August 6, 2013. Articles were first selected after review of their titles and abstracts, and full papers were read to confirm eligibility. Initially, fifty-two articles were identified. Of these, 17 were relevant to biological actions of pharmacogenomic markers and their effect on therapeutic efficacy, 16 to adverse events, 15 to opioid dependence, and eight to economic costs. In conclusion, increasing costs of opioid therapy have made the advances in pharmacogenomics an attractive solution to personalize care with unclear repercussions related to the impact on costs, morbidity, and outcomes. This intersection of pharmacoeconomics and pharmacogenomics presents a unique platform to further examine current advances in clinical medicine and their utility in cost-effective treatment of chronic pain. [ABSTRACT FROM AUTHOR]

Ankle sprains are common soft-tissue injuries that are often treated in emergency departments. These injuries can have significant consequences for the patient, including long-term morbidity and loss of productivity. The objective of this study was to examine the direct and indirect health resource utilization associated with ankle sprains. 296 adult patients with acute ankle sprains participated in the study in Kingston, Ontario, Canada. Data were collected using a one-month productivity questionnaire. Overall, 11% (95% CI, 8-15%) of the participants visited a physician following the initial emergency department visit. Almost all (95%; 95% CI, 92-97%) of the participants used medications or supportive treatments and 55% (95% CI, 50-61%) reported taking time off from work, school, or housework. The use of unpaid assistance was indicated by 56% of the participants (95% CI, 50-62%). Findings from this analysis highlight the significant patient-related and health care system burden of acute ankle sprains. [ABSTRACT FROM AUTHOR]

The Canadian health care system is a publicly financed system administered by ten provincial and three territorial governments. The purpose of this article is to provide an overview of the universal health care system in Canada, including its history, the health status of Canadians, health care funding and spending, and health research and data collection. Health care spending in Canada amounts to 11.6% of the country's gross domestic product and is estimated to have been $200.5 billion Canadian dollars in 2011. Hospitals account for the largest source of health care spending (29%), followed by drugs (16%) and physician spending (14%). Of the total health care spending, 70% is paid for by the public system. Due to the Canadian population being covered by the universal health care system, health data are being collected and can be used to monitor the health care system and inform evidence-based medicine. [ABSTRACT FROM AUTHOR]