Objectives: For drugs reimbursed with limited evidence of patient benefits, confirmatory evidence of overall survival (OS) and quality of life (QoL) benefits is important. For QoL data to serve as valuable input to patients and decision-makers, it must be measured and analyzed using appropriate methods. We aimed to assess the measurement and analyses of post-reimbursement QoL data for cancer drugs introduced in Swedish healthcare with limited evidence at the time of reimbursement. Methods: We reviewed any published post-reimbursement trial data on QoL for cancer drugs reimbursed in Sweden between 2010 and 2020 with limited evidence of improvement in QoL and OS benefits at the time of reimbursement. We extracted information on the instruments used, frequency of measurement, extent of missing data, statistical approaches, and the use of pre-registration and study protocols. Results: Out of 22 drugs satisfying our inclusion criteria, we identified published QoL data for 12 drugs in 22 studies covering multiple cancer types. The most frequently used QoL instruments were EORTC QLQ-C30 and EQ-5D-3/5L. We identified three areas needing improvement in QoL measurement and analysis: (i) motivation for the frequency of measurements, (ii) handling of the substantial missing data problem, and (iii) inclusion and adherence to QoL analyses in clinical trial pre-registration and study protocols. Conclusions: Our review shows that the measurements and analysis of QoL data in our sample of cancer trials covering drugs initially reimbursed without any confirmed QoL or OS evidence have significant room for improvement. The increasing use of QoL assessments must be accompanied by a stricter adherence to best-practice guidelines to provide valuable input to patients and decision-makers. 

Open Networked Learning (ONL) is a collaborative open online course for higher education educators worldwide, focusing on open education, collaborative learning, and course design. The interorganizational course welcomes both institutional and open learners from around 30 nations. Delivered 17 times since 2014 with up to 120 participants in each session, ONL employs problem-based learning to foster digital competencies and strengthen community development. Rooted in the European Framework for Digital Competence of Educators (DigCompEdu), a study involving 48 participants revealed statistically significant, across-the-board competence enhancement post-course, affirming ONL’s efficacy. The article also summarizes our experiences and learnings from participating in and organising the course over the past ten years. 

We study how much regional variation in healthcare spending is driven by place- and patient-specific factors using a random sample of 53,620 regional migrants in Sweden. We find notable differences depending on the category of care, with place-specific factors having a significantly larger impact on specialized outpatient care compared to inpatient and pharmaceutical care. The place effect is estimated to 75% of variation in specialized outpatient care, but 26% or less in variations in inpatient care, and 5% in prescription drug spending. We also find that the empirical estimator has a substantial impact on the estimates of the place-specific effect. The results based on the traditional approach in the literature with two-way fixed effects and event-study models produce much larger estimates of the place-specific effect compared to results based on recently developed heterogeneity-robust models. For total healthcare spending, the traditional two-way fixed effects model estimates a place effect of 78%, while the heterogeneity-robust estimator finds a place effect around 10%. This finding indicates that previous results in this literature, all based on traditional two-way fixed-effects regressions, should be interpreted with care. 

On 20 November 2020, the government of Sweden banned on-premise alcohol sales after 10:30 p.m. and then after 8 p.m. on December 24. This study aims to estimate the impact of earlier pub closing hours on emergency calls to the police. We use a quasi-experimental hybrid differences-in-differences design, drawing on data for emergency calls in Sweden. The primary outcome measure is the daily number of emergency calls to the police in Sweden 70 days before the intervention and 70 days after the intervention. The primary control series is the daily number of emergency calls to the police in Sweden during the preceding year, 70 days before the intervention and 70 days after the intervention. We fail to find an effect on daily emergency calls, or nighttime emergency calls to the police, from the restrictions on the sale of alcohol. There is, however, some evidence indicating that weekend emergency calls may have been affected, but that potential effect does not translate into an overall effect. While our study is limited in its focus, it contributes to using a wide range of time windows and a large geographical area (the whole of Sweden) to inform on displacement effects, as well as in considering a broader set of robustness checks. We suggest that our results and future work should be seen in light of our limitations and our contribution, respectively.

Class demonstrations where the lecturer’s hand motor actions are observable generally have a positive effect on the learning of motor skills because they trigger an effortless process of embodied simulations. Whether the learning of cognitive skills is likewise affected by such visualisations is yet to be investigated and might depend on the learning content as well as other factors. This study aimed to investigate whether showing the lecturer’s hand via a document camera during an introductory financial accounting class affects student learning (transfer performance), cognitive load responses, and note-taking behaviour compared to a writing pad where the lecturer’s hand is not visible. The study utilised a quasi-experimental design in an in-person setting, with a pre-test and post-test comparison of two groups of participants: one group that viewed a lecture video without the lecturer’s hand being visible (n = 509), and another group that viewed the same lecture with the lecturer’s hand being visible (n = 571). The results showed that the with-hand group had a significantly higher increase in test scores compared to the without-hand group. However, the visibility of the hand did not significantly impact cognitive load or note-taking behaviour. The findings have important practical implications for education, as incorporating non-verbal cues such as the lecturer’s hand may effectively enhance learning cognitive skills.

I föreliggande rapport kan du ta del av sju olika utvecklingsprojekt inom undervisning och examination vid Karlstads universitet. Samtliga bidrag i rapporten har utvecklats från projekt som presenterats vid enhetens universitetspedagogiska konferens.

I årets upplaga kan du bland annat läsa om en ny typ av tentamen, en klimatutmaning. Vad händer när studenter uppmanas att under en månads tid göra något annorlunda i sin vardag, så som att resa med cykel eller buss istället för bil? I en annan studie undersöker författarna huruvida det är någon skillnad för studenterna om läraren använder läsplatta eller dokumentkamera i inspelade föreläsningar.

Du får även en inblick i hur flexibla nätbaserade kurser för yrkesverksamma, i samverkan med företag och organisationer, kan bidra till det livslånga lärandet, och inte minst vilken roll sociala medier kan få när en kurs om vetenskaplig metod plötsligt ställs om till distans i pandemitider. 

Publicerade texter i rapportserien kan ligga till grund för pedagogisk meritering vid ansökan om att bli meriterad eller excellent inom undervisning och examination vid Karlstads universitet.

Background and ObjectiveCancer drug costs have increased considerably within healthcare systems, but many drugs lack quality-of-life (QoL) and overall survival (OS) data at the time of reimbursement approval. This study aimed to review the extent of subsequent literature documenting improvements in OS and QoL for cancer drug indications where no such evidence existed at the time of reimbursement approval.MethodsDrug indications with claims of added therapeutical value but a lack of evidence on OS and QoL that were reimbursed between 2010 and 2020 in Sweden were included for review. Searches were conducted in PubMed and ClinicalTrial.gov for randomized controlled trials examining OS and QoL.ResultsOf the 22 included drug indications, seven were found to have at least one trial with conclusive evidence of improvements in OS or QoL after a mean follow-up of 6.6 years. The remaining 15 drug indications either lacked subsequent randomized controlled trial data on OS or QoL (n = 6) or showed no statistically significant improvements (n = 9). Only one drug demonstrated evidence of improvement in both OS and QoL for its indication.ConclusionsA considerable share of reimbursed cancer drug indications continue to lack evidence of improvement in both OS and QoL. With limited healthcare resources and an increasing cancer burden, third-party payers have strong incentives to require additional post-reimbursement data to confirm any improvements in OS and QoL.

I en tidigare studie (Rahnert, 2022a) har distansundervisningens utmaningar med att presentera exempel eller övningar på elektroniska motsvarigheter till en whiteboardtavla belysts. I två synkrona redovisningskurser undersöktes om studenters upplevda lärande underlättas när bokföringsövningar presenteras med hjälp av en dokumentkamera som synliggör lärarens hand och det läraren skriver, eller en skrivplatta som enbart synliggör det läraren skriver. Studien visade att dokumentkameran underlättar studenters upplevda lärande avsevärt mer än skrivplattan.Denna studie bygger vidare på den tidigare genom att undersöka huruvida val av presentationsverktyg har betydelse för redovisningsstudenters faktiska lärande. I ett experiment fick slumpmässigt valda studenter i en kurs i grundläggande redovisning antingen se en övning som presenterades med hjälp av en dokumentkamera (lärarens hand synlig) eller en skrivplatta (lärarens hand inte synlig). Studenters lärande mättes med hjälp av tester före och efter övningen (pre- och post-tester). Resultaten visar att den genomsnittliga andelen korrekta svar ökade något mer från pre- till post-testerna för de studenter som hade sett övningen som presenterades med hjälp av dokumentkameran. Dock var skillnaderna mellan grupperna inte statistiskt signifikanta, varför försiktighet med att argumentera för dokumentkameran bör iakttas.

To combat the increasing incidence of telephone scams targeting the elderly, the Swedish Police initiated an informational campaign in 2023. This campaign involved distributing educational postcards to households with at least one resident aged 70 or older. We assess the effectiveness of the postcard intervention by comparing the change in the outcome variable (number of plaintiffs) among individuals aged 70 and above to those below 70. Despite the campaign’s aim to increase awareness and offer practical advice for avoiding scams, our analysis reveals no impact on the number of plaintiffs exposed to fraud. Our study did not identify any significant effects, adding to the existing body of literature on the effectiveness of information in influencing crime-related behaviors, where findings have been inconclusive.