Pain Management Policy Formulation at a Tertiary Care Teaching Institute in India: A Prospective Observational Study

Background: Access to pain management has been recognized as a fundamental human right. Inadequate pain relief hampers the quality of life and has a physiological and psychosocial impact on the patient and caregivers. Inadequate pain relief remains the leading cause of suffering in hospitalized patients worldwide. Objective: The objective of this article is to provide adequate pain relief to hospitalized patients through proper assessment, treatment, and monitoring of pain by the trained health-care workers through a sustainable and effective institutional pain management policy. Methods: The formulation of pain management policy at a tertiary care teaching institute was conducted in three phases – Phase 1: need assessment by an open?label, uncontrolled, prospective observational study over 1 month period, Phase 2: teaching, training, and awareness of health?care workers, and Phase 3: constitution of the committee at the institute level with the formation of pain resource teams. Results: An open?label, prospective observational study conducted over 1 month revealed that among 814 hospitalized patients, 108 out of 235 (46%) patients in medical and 385 out of 579 (66.5%) patients in the surgical cohort had NRS score of ?3, implying an inadequate pain relief even at 24 h following medical or surgical intervention, respectively. Conclusion: The provision of effective and adequate pain relief to hospitalized patients requires trained health-care workers and a uniform and structured pain management policy at the institutional level. Recognition and addressal of the barriers and challenges while framing an institutional pain policy is of utmost importance.

Tramas en la construcción de la intersectorialidad para atender la primera infancia / Framework of intersectionality construction for early childhood assistance / Tramas na construção da intersetorialidade para atender a primeira infância

Resumen (analítico) Se presentan los resultados de una investigación cualitativa realizada desde una perspectiva interpretativa-histórica, para comprender la construcción de relaciones intersectoriales en el programa de atención a la primera infancia de Medellín entre el 2004 y el 2014. Se recurrió al análisis documental y a la observación participante en espacios de gestión de políticas públicas y se implementaron entrevistas semiestructuradas a funcionarios gubernamentales y no gubernamentales. La información se analizó desde tres dimensiones interdependientes: ideológica, política y administrativa. Según los resultados, las acciones intersectoriales se ven favorecidas por la adopción del enfoque de derechos, la implementación de instrumentos de política pública y la búsqueda del posicionamiento de los servicios en la comunidad; sin embargo, estos aspectos están atravesados por tensiones derivadas del intento de articular diferentes miradas, relaciones de poder y acciones administrativas.

Abstract (analytical) His paper presents the results of qualitative research carried out from an interpretative-historical perspective, to understand the construction of intersectoral relationships in the program of early childhood care in Medellin between 2004 and 2014. Documentary analysis and participant observation were used in public policy management spaces, and semi-structured interviews with government and non-government officials were implemented. The data was analyzed from three interdependent dimensions: ideological, political, and administrative. According to the results, intersectoral actions are favored by the adoption of the rights approach, the implementation of public policy instruments, and the search for the positioning of services in the community. However, these aspects are traversed by tensions derived from the attempt to articulate different views, power relations, and administrative actions.

Resumo (analítico) Este artigo apresenta os resultados da pesquisa qualitativa realizada desde uma perspectiva interpretativa-histórica, para entender a construção de relações intersetoriais no programa da atenção à primeira infância de Medellín entre o 2004 e o 2014. Recorreu-se à análise documental e à observação participante em espaços de gestão de políticas públicas e implementaram-se entrevistas semiestruturadas a funcionários governamentais e não governamentais. A informação foi analisada desde três dimensões interdependentes: ideológica, política e administrativa. Segundo os resultados, as ações intersetoriais se veem favorecidas pelo uso do enfoque de direitos, a implementação de instrumentos de política pública e a procura do posicionamento dos serviços na comunidade; mesmo assim, estes aspectos estão atravessados por tensões derivadas da tentativa de articular diferentes olhares, relações de poder e ações administrativas.

Quantitative Evaluation of Chronic Disease Management Policy in China Based on PMC Index Model / 中国药房

OBJECTIVE：To su mmarize the achievements and shortcomings of chronic disease management policies in China ， and to provide reference for the formulation and improvement of the policy. METHODS ：Totally 109 documents related to chronic disease management issued by the State Council and various ministries and commissions from 2009 to 2020 were processed by text mining method. PMC index evaluation model of chronic disease management policy was established. Sixteen typical chronic disease management policies were quantitatively evaluated and analyzed by 10 first-level indicators and 40 second-level indicators. RESULTS：Among the 16 policies，10 were of excellent level and 6 were of acceptable level. The average PMC score was 7.243， which was generally acceptable level but still had large room for improvement. By comparing two representative policies ，it was found that the main reasons for the policies with low scores were the lack of long-term development planning ，the absence of “Internet + chronic disease management ”new model and other contents ，and the lack of talent incentive and legal guarantee measures. CONCLUSIONS ：Chronic disease management policy has been improved ，and it can be further improved from the aspects of policy prescription ，policy content and incentive mode.

Abordagens do trabalho no setor público de saúde: uma revisão narrativa da literatura / Enfoque del trabajo en el sector público de salud: una revisión narrativa de la literatura / Approaches of work in the public health sector: a narrative review of literature

Resumo Trata-se de revisão narrativa de literatura para identificar diferentes abordagens teóricas que vêm sendo utilizadas na discussão sobre o trabalho em saúde. Nosso objetivo foi atualizar o conhecimento sobre essa temática pelo mapeamento das diferentes estratégias metodológicas. Organizou-se a bibliografia segundo três perspectivas de análise: mercado - os sujeitos do trabalho vistos como força produtiva; Estado - os sujeitos do trabalho entendidos como elo entre o Estado e a sociedade; e atividade - a dimensão subjetiva do trabalho. Tal estratégia possibilitou uma visão integrada do campo, apontando os diferentes, porém complementares, caminhos metodológicos para a análise do trabalho no setor público de saúde.

Abstract This is a narrative review of literature identifying different theoretical approaches that have been used in the discussion about health work. Our objective was to update the knowledge about this theme by mapping the different methodological strategies. The bibliography was organized according to three diferents perspectives of analysis: Market — the subjects of labor seen as a productive force, State — the subjects of labor understood as the link between State and Society, and Activity — the subjective dimension of work. This strategy made possible an integrated vision of the field, pointing out the different but complementary methodological paths for the analysis of work in the public health sector.

Resumen Este artículo es una revisión narrativa de literatura identificando diferentes enfoques teóricos que se han utilizado en la discusión sobre el trabajo en salud. Nuestro objetivo es actualizar el conocimiento sobre esta temática, mapeando las diferentes estrategias metodológicas. La bibliografía fue organizada según tres perspectivas de análisis: mercado - los sujetos del trabajo vistos como fuerza productiva, Estado - los sujetos del trabajo entendidos como vínculo entre Estado y sociedad, y actividad - la dimensión subjetiva del trabajo. Esta estrategia permitió una visión integrada del campo, señalando los diferentes, pero complementarios caminos metodológicos para el análisis del trabajo en el sector público de salud.

Study on the Purchase Management of Priority Reviewed Drugs in China / 中国药房

OBJECTIVE： To provide reference for improving the purchase management policy of priority reviewed drugs in China. METHODS： Based on the purchase management policy of priority reviewed drugs in China， priority reviewed drugs approved for market by the end of 2017 were sorted out； the priority reviewed drugs that had been purchased in a clear way were selected and classified according to the reasons for their inclusion in the priority review. The procurement methods of different categories of priority reviewed drugs in different provinces were compared in order to find out the shortcomings of priority reviewed drug procurement management and put forward related suggestions. RESULTS & CONCLUSIONS： By the end of 2017， 56 priority reviewed drugs achieved marketing authorization， 16 of which were purchased through provincial drug procurement platforms. Among the 16 drugs mentioned above， there were 13 priority reviewed drugs of which purchase methods were specific， including direct online purchase， price-limited online purchase， bidding purchase， price-negotiated purchase， bidding purchase and record purchase. And the direct online purchase was used the most frequently. According to the reasons included in the priority review， above 13 drugs with specific purchase methods were divided into 5 categories such as new drugs with obvious clinical value， urgent medical needed drugs， pediatric drugs， first generic drugs， the drugs which had passed investigational new drug application. China’s purchase management policy of priority reviewed drugs still had shortcomings through three aspects， including the system design， purchase method and management procedure. There is no sufficient connection between the registration review policy and the procurement policy. In addition to the clinical badly-needed priority reviewed drugs， the procurement methods of priority reviewed drugs in the remaining categories was not uniform， and the regional difference was large. And the utilization degree of pharmacoeconomic evaluation during the drug purchasing process needed to be improved. It is suggested to make the category of drug purchase more detailed combining with the classification of drug registration， unify the method of drug purchase to make the purchase way of each kind of priority reviewed drugs explicit， standardize the management of drug purchase and improve the attention and utilization of pharmacoeconomic evaluation， so as to improve the accessibility of priority reviewed drugs in China.

Discussion on management policy of National Scientific Research Funds in recent years / 中华医学科研管理杂志

Objective Through combing the existing problems in the management policy of scientific research funds,this paper puts forward some constructive suggestions in reality.Methods Summarize the characteristics of scientific research fund management policies in related documents published in recent years,and systematically analyze the problems encountered in practical work.Resuits This paper points out some problems that will be encountered when carrying out the management policies of scientific research funds,further putting forward the policy suggestions.Conclusions Regulations of management for scientific research projects at the national level keep pace with times and are of great significance.In the process of implementation,it will be more scientific,reasonable and effective if there were more specific policy guidance,fully consideration on the mental labor value of scientists and wide application of information technology.

Study on the Management Policy Situation of the Re-use of Single-use Device at Home and Abroad / 中国药房

OBJECTIVE:To provide reference for the management of re-use of single-use devices (SUDs) in China. METH-ODS:The management situation of SUDs use in China and the management policy of SUDs re-use in America and Germany were introduced,the published literature of SUDs re-use was researched and the safety and ethicality were analyzed and discussed. RE-SULTS:China had no regulation for the clear definition of the range,standards and requirements of SUDs re-use;America and Germany had well-management for the SUDs re-use with different modes. Literature analysis showed that there were 3 results for the SUDs re-use,including supporting,opposition and classified management. In terms of safety,SUDs re-use needs the base of specific species and disinfection operations;in terms of ethicality,SUDs re-use should focus on the right to know of patients and the effects on cost savings and environment. CONCLUSIONS:China should establish and improve the management policy of SUDs re-use,develop the classification assessment of re-use,encourage third-party organizations participating in the recycling of SUDs and strengthen the monitoring of adverse reactions,etc.