A technological approach to “Reaching the Unreached” – Leveraging teleophthalmology services in Rural Gujarat

Purpose: Early detection of sight?threatening disorders by technological applications like teleophthalmology and prompt treatment can help decrease visual impairment. This study evaluated the role of teleophthalmology in underserved rural areas along with cost?saving estimates for the end user. Methods: A prospective, observational, cross?sectional hospital?based study was conducted over 3 months. First 1000 teleconsultations were included. None of the patients denied providing informed consent. The patients were consulted at the eight vision centers and three satellite centers of the hospital in the nearby rural and tribal regions closer to their residential places. These vision and satellite centers were connected to the base hospital like a hub and spoke model with a teleophthalmology network. Results: Cataract (n = 301, 30.1%) and refractive error (n = 290, 29%) were the most common diagnosis. 42.1% of patients were referred to base hospital for further evaluation. Thus, a total of 57.9% of patients were not required to visit the base hospital for initial consultation, saving time and money. Furthermore, 15.1% of patients were provided medical treatment at the vision center and satellite center, which helped in making teleophthalmology cost?saving for the patients. An average of Rs. 621/? were saved per patient for the community in our study. Conclusion: Networked teleophthalmology model can be an affordable and feasible tool for providing eye care delivery services in rural and tribal regions of Gujarat and the whole country, especially for the end user. Thus, it may be a workable model in ophthalmology practice with substantial cost saving to the community.

Growth-of-shgs-and-empowerment-of-women

Micro finance through Self Help Group (SHG) has been recognized internationally as the modern tool to combat poverty and for rural development. Micro finance and SHGs are effective in reducing poverty, empowering women and creating awareness which finally results in sustainable development of the nation. Micro finance define as efforts to improve poor people's access to loans and saving services may be the fastest growing and most widely recognized anti-poverty too. Micro finance includes basic financial services including small loans, savings accounts, funds transfers and insurance. A long side non-financial service such as business training Micro finance assists people living in poverty who wouldn't usually qualify for regular banking services because they have no form of collateral or formal identification. An attempt is made here to examine the impact of the microfinance on the development of the Self-Help Groups in India. The total number of self-help groups which have maintained savings with banks is 100 lakhs during 2018-19 but only 26.98 lakhs i.e 26.95 percent of the SHGs have obtained credit from the financial institutions. Out of 74.62 lakh SHGs, only 11.96 lakhs i.e. 16.03 percent of the SHGs have got micro-credit from the institutional credit agencies during 2010-11. The above analysis indicates that the number of SHGs which got micro credit has increased from 16 percent to 27 percent i.e only 11 percentage points increased in 2018-19 over 2010-11. About 73 percent of the SHGs are out of the purview of the public financial institutions. Majority of the women members of SHGs are away from the institutional credit agencies. These marginalized women have to depend on informal financial services for their credit needs. So that the financial informal sector (mostly moneylenders)has continued to rule in the rural economy. There is a need to break the monopoly of door step availability of credit to these marginalized sections by the informal sources of credit. The credit needs of the women members have enormously increasing for the last two decades. The average loan disbursement per SHG has increased from Rs.1.22 lakhs during 2010-11 to Rs.2.16 lakhs during 2018-19. This is inadequate to meet the credit requirements of the members in the SHGs. Hence it should be made four to five times of the micro credit per SHGs. The bank loans are not regularly paid by the members of the SHGs. Hence, the amount of loan outstanding has continuously increased since 2010-11. It is evident from the fact that the average outstanding bank loans against SHGs shows higher level. The average outstanding per SHG has increased from Rs.65, 224 during 2010-11 to Rs.171543 during 2018-19, shows two and half-fold increase. As a result of it the overall NPA rate in bank loan to SHGs is steadily increasing since 1910-11. However, the overall NPA rate in bank loan to SHG is 5.19 percent as on 31-03-2019 registering a fall of 93 basis points from the previous level of 6.12 percent. The above analysis reveals that the steady declining the rate of NPA is indicating the recovery of loans made of SHGs is improving during the last few years.

Preliminary study on the block-based charging model for neonatal medication in pharmacy intravenous admixture service / 中华医院管理杂志

Objective:To explore the block-based charging method for centralized dispensing of neonatal drugs in pharmacy intravenous admixture service (PIVAS), analyze its effect on drug savings and inpatient drug cost, so as to provide the reference for the appropriate charging method of neonatal drugs.Methods:According to the balance quantity and amount of neonatal intravenous drugs that were centrally allocated by the PIVAS of our hospital, refer to the doctor′s orders, the dosage per dose as well as the number of patients per dose were analyzed, then the drug types and plans for block-based charging were formulated. Before and after the implementation of the plan, the monthly average drug balance quantity and amount, the average number of drug charges for the neonates, the average daily drug cost, and the adverse events of related drugs were used as the indicators to be investigated to clarify the implementation effect of the block-based charging mothod.Results:Fourteen medicines were charged by block-based, including 4 antibiotics, 2 ordinary infusion preparations, and 8 parenteral nutrition solution preparations. The monthly average drug balance quantity was reduced from 5 047±541 to 1 856±225, and the monthly average balance amount was reduced from 65 811±10 265 yuan to 20 659±6 002 yuan. The average drug dosage for children in the trial drug was significantly reduced with a decrease range of 39.2% to 90.1%. Both the inpatient daily drug cost of neonatus and the daily average antibacterial drug cost was decreased. During the centralized dispensing of neonatal drugs, no related adverse drug events occurred.Conclusions:The block-based charging method of centralized drug distribution can improve the utilization rate of drugs, reduce drug waste, reduce the cost of inpatient medicines the financial burden on children′s families, which is worthy of further promotion and implementation.

Analysis of the use of insulin products in our hospital after centralized volume-based procurement / 中国药房

OBJECTIVE To analyze the implementation of insulin centralized volume-based procurement policy （hereinafter referred to as “centralized procurement”） in our hospital and its effect on the use of insulin products in clinical. METHODS The manufacturer， specifications， usage， sales amount and agreed purchase volume of insulin products in our hospital before （July 4， 2021 to January 3， 2022） and after （July 4， 2022 to January 3， 2023） the centralized procurement were collected. The defined daily dose （DDD） method was used to calculate defined daily doses （DDDs）， defined daily cost （DDC）， the progress of procurement completion and actual cost saving. RESULTS After the centralized procurement， the number of insulin products had increased from 20 to 29 in our hospital； except for the Insulin degludec/aspart injection in our hospital’s original insulin catalog that had not been centrally purchased， all other existing varieties had been included in centralized procurement catalog. The use of Insulin aspart 30 injection produced by Novo Nordisk （China） Pharmaceutical Co.， Ltd. always ranked the first place in the list of usage and DDDs before and after the centralized procurement. The sales amount of Insulin glargine injection produced by Ganli Pharmaceutical Co.， Ltd. and Tonghua Dongbao Pharmaceutical Co.， Ltd. increased significantly due to the significant increase in usage. The centralized procurement of Degu insulin injection from Novo Nordisk （China） Pharmaceutical Co.， Ltd. had achieved a relatively high completion rate in our hospital’s original insulin catalog， while the completion rate for new varieties was low. After the centralized procurement， our hospital actually saved a total of 1 388 582.66 yuan in expenses. CONCLUSIONS After the centralized procurement， the selection and usage of insulin varieties in our hospital are reasonable， which saves patients’ insulin treatment costs， and reduces economic pressure on patients and society.

Patrones de ahorro y freno inhibitorio: un estudio desde la neuroeconomía conductual / Saving patterns and inhibitory control: a study within behavioral neuroeconomics / Padrões de economia e de frenagem inibitória: um estudo de neuroeconomia comportamental

La neuroeconomía es una de las neurociencias con base cognitiva ­ comportamental que ha experimentado un crecimiento teórico, metodológico y experimental bastante amplio en los últimos 20 años. Su capacidad de combinar elementos de salud cerebral como por ejemplo el adecuado freno inhibitorio que repercute necesariamente en una capacidad amplia de posponer la recompensa con comportamientos de base económica concretos como el ahorro puede implicar un nuevo eje de desarrollo de la salud mental en los estudiantes de psicología de la Universidad Mayor de San Andrés en la ciudad de La Paz, Bolivia. De hecho, existe amplia evidencia documentada de que la capacidad de posponer la recompensa inmediata por un bien mayor constituye un gran predictor del rendimiento académico al mismo tiempo que deriva en habilidades positivas a lo largo de la vida. Este estudio constituye el primero en su naturaleza y área en la carrera de Psicología de la UMSA y constituye un aporte directo a la planificación de la salud mental de los estudiantes de la carrera.

Neuroeconomics is one of the cognitive and behavioral based neurosciences that has undergone a substantial growth in experimental, theoretical and methodological terms within the last 20 years. Its capacity to combine brain health factors such as an adequate inhibitory control (that necessarily will influence gratification delay) with economic-related behaviors such as saving, may generate a new axis of development of the mental health in psychology students of the Higher University of San Andres in La Paz, Bolivia. As a matter of fact, there is robust evidence that gratification delay executed in order to get a greater good constitutes in and on itself an accurate predictor of academic performance as well as positive life skills. This study is the first to be conducted on this area in the psychology undergraduate program and could be a potential contribution to the enhancement of the psycho-emotional health of the students who participated in it.

A Neuroeconomia é uma das neurociências de base cognitivo-comportamental que experimentou um amplo crescimento teórico, metodológico e experimental nos últimos 20 anos. Sua capacidade de combinar elementos de saúde cerebral, como o freio inibitório apropriado que necessariamente afeta uma ampla capacidade de adiar a recompensa com comportamentos de base econômica específicos, como poupança, pode implicar em um novo eixo de desenvolvimento da saúde mental em alunos de psicologia da Universidad Mayor de San Andrés na cidade de La Paz, Bolívia. Na verdade, há ampla evidência documentada de que a capacidade de adiar a recompensa imediata por um bem maior é um forte indicador de desempenho acadêmico, ao mesmo tempo que leva a habilidades positivas ao longo da vida. Este estudo é o primeiro em sua natureza e área na carreira de Psicologia da UMSA e constitui uma contribuição direta para o planejamento da saúde mental dos alunos da carreira.

Clinical efficacy of laparoscopic modified Parks operation on the ultra-low rectal cancer / 中南大学学报(医学版)

OBJECTIVES@#To investigate the clinical efficacy of laparoscopic modified Parks operation on the patients with ultra-low rectal cancer.@*METHODS@#According to the preoperative stage and intraoperative anastomotic position, 98 patients with ultra-low rectal cancer above T2 stage underwent laparoscopic Dixon operation, modified Parks operation and Miles operation, respectively. All patients were divided into 3 groups: a Dixon operation group (@*RESULTS@#The patients were more obese, the distance between tumor and anal margin was closer, and the operation time was longer in the modified Parks operation group than those in the Dixon operation group (all @*CONCLUSIONS@#Laparoscopic modified Parks operation is a safe, economical and effective anus preservation operation, which can not only save the anus for some patients who had to perform Miles operation, but also recover better and faster after operation. Although the early anal function of patients performed with the modified operation is poor, it can gradually recover to the same level as the patients performed with the Dixon operation.

Evaluation of the effect of the water-saving irrigation project on Oncomelania hupensis control in hilly regions of Yixing City, Jiangsu Province / 中国血吸虫病防治杂志

Objective To evaluate the effect of the water-saving irrigation project on Oncomelania hupensis snail control in hilly regions of Yixing City, Jiangsu Province. Methods A retrospective survey combined with cross-sectional investigation was employed. The implementation of the water-saving irrigation development project in Yixing City from 2005 to 2007 was retrospectively collected, and the snail status was collected in regions where the water-saving irrigation project was located and the project-affected regions from 2003 to 2018, to examine the effect of the project on snail control. In addition, a cross-sectional survey was performed to investigate the destruction of the water-saving irrigation project in 2018. Results A total of 22 water-saving irrigation projects were implemented in 5 townships in hilly regions of Yixing City from 2005 to 2007, where snail habitats were treated covering 266.97 hm2. Before the implementation of the project from 2003 to 2006, cumulative 47.87 hm2 snail habitats were detected in regions where the project was located, and no snails were found in regions where the project was located from the implementation of the project in 2006 to 2018. However, a few snails were found in the project-affected regions in 2017 and 2018. In addition, there were problems found in the later-stage maintenance and management of the project. Conclusions The water-saving irrigation projects shows a high efficiency on snail control in hilly regions of Yixing City. The later-stage maintenance of the project and monitoring of snails remain to be intensified to enhance the snail control efficiency of the water-saving irrigation project.

Generic prescribing in India: a stumbling block

In India, there is 62% out-of-pocket health expenditure per capita and only 15% are covered by health insurance. The use of generics can save a lot of money which can be used for other health issues. But lack of knowledge about cost effectiveness of generic medicines among various health-care professionals had led to a low rate of generic medicine prescription in India. This review aims to identify the barriers in adoption of generic prescribing in clinical practice in India. A systematic literature review was conducted using various healthcare databases such as PubMed and google scholar. The literature search using various combination of keywords retrieved 2360 articles. After excluding duplicates, articles in languages other than English and based on relevance to subject only 15 articles were selected. The barriers to generic prescribing identified from reported literature can be broadly classified based on stakeholders of healthcare setting such as physicians, patients, pharmacist and government policies. The major barriers to generic prescribing identified were negative perception of various stakeholders, lack of awareness of regulatory standards, maturity of health care system, vulnerability of patients, lack of standard guidelines in brand substitution, incentives and influence of drug advertisements. In Indian set up, studies on impact evaluation of generic prescription, emphasizing the quality and cost saving by their use in clinical practice should be conducted. This evidence will help to build the confidence of various stakeholders towards implementing generic prescribing in clinical practice.

Anestesia en el angiofibroma juvenil: un reto al anestesiólogo / Anesthesia in juvenile angiofibroma: an challenge for the anesthesiologist

Introducción: La anestesia para el angiofibroma juvenil es una de las intervenciones más complejas dentro de la otorrinolaringología, pues el sangramiento incoercible causa hipovolemia aguda la cual se produce en un breve período y lleva al shock hipovolémico y a la muerte de no tratarse adecuadamente. Objetivo: Realizar una actualización sobre el perioperatorio de la anestesia en el angiofibroma juvenil. Desarrollo: Se debe minimizar las pérdidas sanguíneas a toda costa. La mejor asociación fue la hipotensión inducida, la hemodilución hipovolémica y el predepósito de sangre autóloga, con la angiografia y embolización arterial selectiva del tumor. Conclusiones: La exéresis quirúrgica del angiofibroma juvenil es una intervención de alto riesgo. El equipo de trabajo constituye un elemento primordial. La asociación de hipotensión inducida, hemodilución hipovolémica y predepósito de sangre autóloga son los pilares fundamentales para la mejor evolución de estos pacientes(AU)

Introduction: Anesthesia for juvenile angiofibroma is one of the most complex interventions within otolaryngology, since incoercible bleeding causes acute hypovolemia, which occurs in a short period and leads to hypovolemic shock and death if not treated properly. Objective: To carry out an update about the perioperative period of anesthesia in juvenile angiofibroma. Development: Blood losses must be minimized at all costs. The best association was induced hypotension, hypovolemic hemodilution, and autologous blood predeposit, with angiography and selective arterial embolization of the tumor. Conclusions: Surgical removal of juvenile angiofibroma is a high-risk intervention. The work team is an essential element. The association of induced hypotension, hypovolemic hemodilution, and autologous blood predeposit are the fundamental pillars for the best evolution of these patients(AU)

Programa nacional que incentive el ahorro para acceder a la educación superior privada en México / National program that incentive savings to access private higher education in Mexico

RESUMEN Actualmente, las familias mexicanas utilizan créditos educativos para acceder a la educación superior privada, porque no cuentan con los ingresos suficientes para costear las matrículas y los gastos adicionales o si los tienen, habiendo educación pública gratuita, consideran un lujo educarse en universidades privadas. El objetivo de esta reflexión fue buscar una opción que incentive el ahorro y promueva la profesionalización de los jóvenes, sin necesidad de endeudarse. Para esto, se recolectó información secundaria y se desarrolló un modelo de regresión, con el fin de establecer qué variables son significativas para las familias mexicanas y, de esta forma, poder plantear una propuesta de ahorro. Una familia de escasos recursos difícilmente puede exhibir las garantías económicas de un crédito y, apenas, puede ahorrar lo suficiente para realizar estudios universitarios, cuando tiene necesidades básicas por cubrir. Por este motivo, se propone un programa nacional de ahorro educativo, que permita a las familias planear, a largo plazo, la captación de capital para la profesionalización de sus hijos, destinando una fracción de sus ingresos, desde que sus hijos son pequeños para que, al iniciar sus estudios universitarios privados no requieran pagar tasas de interés, que reduzcan su poder adquisitivo en el futuro.

ABSTRACT Currently, Mexican families use educational credits to access private higher education because they do not have enough income to pay tuition and additional expenses, or if they do, since there is free public education, they consider it a luxury. The objective of this article is to look for an option that encourages savings and promotes the professionalization of young people without entering debt. For this, secondary information was collected and a regression model was developed in order to establish which variables are significant for Mexican families and thus be able to propose a savings proposal. Households with low economic resources can hardly access the economic warrants from a credit and can hardly save enough to have higher educational degrees, when they have basic necessities to fulfill. For this reason, a national educational savings program is proposed that allows families to plan long-term capital raising for the professionalization of their children, allocating a fraction of their income since their children are small so that when they go to make their University studies do not require paying interest rates that reduce your purchasing power in the future.

Aproveitamento de água pluvial e sua relação com ações de conservação de água: estudo de caso em hospital universitário, São Carlos (SP) / Rainwater harvesting and its relationship with water conservation actions: case study in a universitary hospital, São Carlos, São Paulo, Brazil

RESUMO A implantação de sistemas de aproveitamento de águas pluviais (SAAPs) em edificações com alto consumo de água, como estabelecimentos hospitalares, pode trazer benefícios tanto econômicos aos usuários como ambientais. No entanto, é considerada por alguns como a última ação a implementar na conservação da água nessas instituições, recomendando-se, em um primeiro momento, ações de diminuição de consumo. Por isso, este trabalho teve como objetivo avaliar o potencial de economia de água decorrente da implantação de um SAAP como alternativa de abastecimento de água e estabelecer comparações com ações de diminuição de consumo, tendo como objeto de estudo o Hospital Universitário (HU), da Universidade Federal de São Carlos, São Paulo. Para tanto, foi adotada uma metodologia baseada no balanço hídrico em função das demandas de água para diferentes usos no HU e em relação às edificações atualmente em funcionamento e ampliações futuras, previstas em dos fases; análises do tamanho ótimo de armazenamento e avaliação da redução de consumo com um maior controle das perdas e a substituição de tecnologias existentes por dispositivos economizadores nos mesmos períodos. Com a determinação da relação oferta-demanda, a implantação do SAAP evidenciou um potencial de economia de água de 57% do consumo com as instalações atualmente em funcionamento e de 19% do consumo final projetado para o final das ampliações, enquanto as ações de diminuição apontaram valores de 37 a 24% para os mesmos cenários. Procedimentos combinados de aproveitamento de águas de chuva e diminuição de consumo de água podem economizar entre 71% do consumo atual e 39% no final de projeto, níveis considerados significativos e que refletem a necessidade do gerenciamento estratégico da água que promovam benefícios financeiros, ambientais e sociais.

ABSTRACT The implementation of rainwater harvesting systems (RWHS) in buildings with significant water consumption, such as hospitals, can bring both economic and environmental benefits to users. However, it is considered by some the last action to be implemented in the conservation of water in these institutions, recommending at a first moment actions to reduce consumption. That is why the purpose of this study was to evaluate the potential of water saving by means of the implementation of a RWHS as an alternative of water supply and to establish comparisons with water uses conservations actions, having as an object of study the University Hospital of the Federal University of São Carlos - SP (UH). This was determined by a methodology based on the water balance as a function of the water demands for different uses in the UH and in relation to the buildings currently in operation and future extensions, planned in the phases; optimal storage size analysis and consumption reduction assessment with greater loss control and replacement of existing technologies with cost-saving devices over the same periods. With the determination of the supply - demand relationship, RWHS's implementation showed a water saving potential of 57% of the current consumption and 19% of the projected end, while the decreasing actions indicated values of 37 to 24% for the same scenarios. Combined actions for rainwater harvesting and reducing water consumption can save between 71% of current consumption and 39% at the end of the project, which are considered to be significant levels and reflect the needs of strategic water management with financial, environmental and social benefits.

Economic impact of the clinical pharmacist interventions in the pediatric intensive care unit

Clinical pharmacists in intensive care units are involved in patient safety, technical guidance and cost saving with rational use of medicines. This study aimed to estimate the cost saving of clinical pharmacist interventions in pediatric intensive care units (PICU). This was a retrospective, observational study. Savings were measured for three months based on (1) Clinical pharmacist interventions from prescription analysis, (2) Individualized doses of four antibiotics, (3) Comparison of drugs dispensing systems before and after the decentralization of pharmacy services. The main outcome is costs saving with strategic planning of medication use based on local reality. A number of 73 clinical pharmacist interventions were made, from which 13 allowed the calculation of economic impact, saving US$ 633.38/year. Cost saving from individualized doses of four antibiotics was US$ 8,754.46/year. The decentralization of pharmacy services saved US$ 28,770.52/year. The evaluated interventions were successful. Clinical pharmacist interventions, individualized antimicrobials doses and decentralization of pharmacy services reduce costs in the hospital.

Impact of “4+7” City Drug Centralized Procurement Program on the utilization of original and generic cardiovascular drugs in a tertiary hospital / 药学实践杂志

Objective To analyze the impact of “4+7” City Drug Centralized Procurement Program on the utilization of cardiovascular medicines, and to provide a reference for optimizing the policy of generic medicines as substitutes for original medicines. Methods Eleven drugs, both generic and original were selected for treatment of cardiovascular diseases in an outpatient clinic of a tertiary hospital in Shanghai. The proportion of use of generic drugs and original drug, ratio of used amount, daily cost ratio, and potential cost savings rate of replacement of original drug by generic drug were analyzed before the “4+7” (2018.04.01-2018.09.30) and after the “4+7” (2019.04.01-2019.09.30). Results After the “4+7”, the proportion of the original research drug used decreased from 84.32% to 58.12%, and the ratio of amount of used money decreased from 86.02% to 78.16%; the proportion of generic medicines used increased from 15.68% to 41.88%, and the ratio of amount used increased from 13.98% to 21.84%; the daily cost ratio of generic medicine to original medicine decreased from 0.87 to 0.39. Under the same condition, the potential cost savings of replacing the original drug with generic drugs before and after the “4+7” were RMB 3.703 million and RMB 3.399 million, respectively, and the cost saving rate was 35% and 61%, respectively. Conclusion The “4+7” City Drug Centralized Procurement Program significantly increase the use of cardiovascular generic drugs and significantly reduce the cost of drugs; however, it has a small impact on the quantity and amount of generic drugs used. There is still a significant potential for cost saving. It is recommended to further increase the publicity of the policy on the substitution of original drug by generic, expedite the consistency evaluation process of generic drugs and take measures to avoid the widening of the price gap between original drugs and generics.

Discussion on Energy Consumption Management and Green Development of Medical Electrical Equipment / 中国医疗器械杂志

Facing the new situation of national green development, energy conservation and environmental protection, this study systematically expounds the energy consumption management of medical electrical equipment in USA, Europe and China, and puts forward suggestions on green development of medical electrical equipment in China.

Cerebellar infarction complicated with acute hydrocephalus

Acute hydrocephalus is a rare manifestation of posterior circulation strokes. Clinical worsening and coma may occur in addition to these symptoms of cerebellar dysfunction. Timely and careful approach will certainly prove to be life saving when deciding for a shunt procedure in a patient developing obstructive hydrocephalus following cerebellar infarct. The case presented here is a reminder for both this rare complication, and the treatment approach. We present a patient with cerebellar infarct and secondary obstructive hydrocephalus. Forty three year old male patient was brought to the emergency room in our hospital with unconsciousness, before that patient with suddenly developing dizziness, loss of balance and vomiting. His neurological examination showed that he was coma. The patient's brain computed tomography scan showed severe third and lateral ventricular dilation suggestive of obstructive hydrocephalus. Following shunt placement and suboccipital decompression, the patient recovered and was able to walk without assistance. Cerebellar infarcts may cause death as a result of pressure increase in the posterior fossa and pressure on the brain stem due to edema. Moreover, the aquaductus or the fourth ventricle may close because of edema and cause obstructive hydrocephalus and acute intracranial pressure increase. Temporary external ventricular drainage or permanent shunt systems and surgical decompression of the posterior fossa may be considered to prevent progressive neurologic worsening. In conclusion, we wished to point out that a timely surgical procedure in a cerebellar infarct case where acute hydrocephalus developed could be life saving.

Evaluation of a Carbapenem-Saving Strategy Using Empirical Combination Regimen of Piperacillin-Tazobactam and Amikacin in Hemato-Oncology Patients

We implemented a carbapenem-saving strategy in hemato-oncology patients from 2013, using an empirical combination of piperacillin-tazobactam and amikacin for high-risk hemato-oncology patients with febrile neutropenia, who remain hemodynamically unstable > 72 hours despite initial cefepime treatment. All-cause mortality was not different between the two periods (6.54 and 6.57 deaths per 1,000 person-day, P = 0.926). Group 2 carbapenem use significantly decreased after strategy implementation (78.43 vs. 67.43 monthly days of therapy, P = 0.018), while carbapenem-resistant gram-negative bacilli did not show meaningful changes during the study period. Our carbapenem-saving strategy could effectively suppress carbapenem use without an increase of overall mortality.

Utilization Analysis of the Original and Generic Drugs for Hypertension and Diabetes in a Tertiary Public Hospital in Jiangsu Province / 中国药房

OBJECTIVE： To provide evidence support for the economic benefits of generic drugs as substitutes for original drugs， and to provide suggestions for promoting the use of generic drugs. METHODS： Twelve kinds of drugs with both original and generic versions for treating hypertension and diabetes were selected from a tertiary public hospital in Jiangsu province. The proportion of usage quantity， the ratio of amount， price ratio were analyzed quarterly during 2017-2018. RESULTS： From the first quarter of 2017 to the fourth quarter of 2018， the ratio of quantity of original drugs increased from 24.53％ to 39.12％， while that of generic drugs decreased from 75.47％ to 60.88％； the ratio of amount of original drugs increased from 39.45％ to 61.47％， while that of generic drugs decreased from 60.55％ to 38.53％； the price ratio of generic drug to original drug decreased from 0.50 to 0.40. With the same efficacy， the cost of generic drugs replacing original drugs in 2018 could save 622，100 yuan， and the cost savings rate could be 47.65％. CONCLUSIONS： Drug expenditure could be reduced by substituting original drug with generics， but the useage quantity and amount ratio of generic drug in this hospital is gradually declining. So， in order to save drug experditure， it is necessary to speed up the process of conformity evaluation and clinical equivalence study of generic drugs， increase the education and publicity of generic prescriptions and rational use， so as to improve doctors’ and patients’ recognition of the quality and efficacy of generic drugs， cooperate with the centralized procurement policy to encourage the purchase and use of generic drugs.

Design, integration, and application of special membrane materials and equipment for new separation process in Chinese materia medica industry / 中草药

The development of human society is mainly marked by materials. “Academic Leadership Series, National Science Think Tank, Development Strategies of Chinese Disciplines in the Next 10 Years: Material Science” points out that: Material science has become the essential link for the development and deepening of modern science and technology, and plays a basic and leading role in the development of science and technology; The emergence of a new type of material can also drive the birth of an industry. The excessive consumption of resources and energy by process industry and the pollution of environment have become bottlenecks restricting the sustainable development of human society. Chemical engineering has always been important to achieve efficient transformation of materials and effective utilization of energy. In the 21st century, the objectives of chemical engineering have been transformed into: Relying on superior performance, friendly environment, and fully function, new structural and functional materials with good and complete functions to develop new process industrial technology and form new process flow and integration technology in order to achieve the goal of high efficiency, low consumption, and pollution-free. Membrane technology, with advanced separation materials as carriers, can achieve separation of substances and molecules at mild and low cost conditions. It is especially suitable for the needs of modern industry for energy saving, recycling of low-grade raw materials, and eliminating environmental pollution. It has become key technologies to solve the major problems in the fields of energy, water resources and environment. The application of membrane materials and equipment to the Chinese materia medica (CMM) industry can significantly improve the production efficiency. In this paper, through the analysis of the application of membrane materials and technology in foreign and domestic pharmaceutical industries, facing the industrial upgrading and green development of the application process of CMM industry, it is proposed to introduce the theory and method of material chemical engineering into the field of CMM, to carry out original research with independent intellectual property rights, and to construct a new membrane-based approach. The new separation procedure, separation process and exclusive equipment with separation technology as the core realize energy saving and emission reduction in the production process of CMM. Through expatiating on the basic research and engineering application of industrialization of separation process of CMM and its complex systems such as water extraction system and oil-water mixture system in the past 20 years, the project team provides theoretical basis and application demonstration for the design, integration, and application of new separation process of CMM based on special membrane technology.

Actitud hacia el consumo, ahorro y endeudamiento en titulados de una universidad pública del sur de Chile / Attitudes toward purchase, saving and indebtedness in university graduates from a public university of southern Chile

La presente investigación tiene por objeto comparar las actitudes hacia el ahorro, consumo y endeudamiento en titulados de una universidad pública del sur de Chile, a partir de su género, nivel socioeconómico y facultad de procedencia. Cuenta con un diseño cuantitativo, no experimental, ex post facto, de alcance descriptivo-correlacional y de tipo transversal. Se administraron la Escala de Actitudes hacia el Endeudamiento, la Escala de Actitudes hacia el Ahorro, la Escala de Actitudes hacia la Compra y la Escala de Evaluación del Nivel Socioeconómico ESOMAR. Además, se aplicó un cuestionario de preguntas de clasificación sociodemográfica, que fue respondido por 120 titulados universitarios de una universidad pública del sur de Chile contactados mediante el método bola de nieve. Se realizaron análisis descriptivos, pruebas de comparación de medias y medianas para dos muestras independientes para las comparaciones según género, nivel socioeconómico y facultad de procedencia (pruebas t para muestras independientes y pruebas U de Mann-Whitney),y pruebas de correlación r de Pearson para identificar posibles asociaciones entre las distintas escalas y subescalas. Los resultados permiten concluir un perfil esperable en cuanto a actitudes hacia el ahorro, endeudamiento y la compra, en titulados universitarios. En relación a las comparaciones, si bien se encontraron algunas diferencias significativas en cuanto a género y nivel socioeconómico de los participantes, resultaron más bien bajas. Finalmente, se hallaron asociaciones entre actitudes hacia el ahorro con austeridad y con racionalidad en la compra. También se encontraron asociaciones entre compulsividad en la compra con austeridad (inversamente) y con impulsividad en la compra, lo que apunta a una coherencia teórica de los constructos y sus dimensiones. Limitaciones del estudio incluyen el uso de medidas de autorreporte, lo que restringe la extrapolación de resultados a contextos fuera del presente estudio. Otra limitación corresponde al método de muestreo utilizado (bola de nieve) y tamaño muestral, lo que no permitiría generalizar los resultados a la población. A partir de los hallazgos y limitaciones, se realizan sugerencias para futuras investigaciones en alfabetización económica.

Since the decade of 1970 onward in Chile, there has been a substantial change in terms of economic behaviour, which stems mainly from the installation of a neoliberal socioeconomic model. The profound consequences of this change for the Chilean society can be seen to this day, 40 years later, and these consequences include: broader access to goods and services for segments of the population that were previously excluded and/or that were a privilege of the economic elites; the assignation of new meanings to the concepts of purchase; and saving and indebtedness. These are all key concepts for the development and comprehension the neoliberal model. Complementary, the study of university graduates' behaviour is especially relevant in this area, considering that higher education is often thought to play a substantial role in social mobility. In the Chilean context, the transformations of the educational system have favoured the expansion of the admission numbers up to the point that seven of ten Chileans that pursue a graduate degree are the first members of their family to reach this educational level. Considering the above, the present study aims to compare attitudes towards purchase, saving and indebtedness in graduates from a university in southern Chile, by gender, socioeconomic level and faculty. The study follows a quantitative, cross-sectional, non-experimental, ex-post-facto design, with a descriptive-correlational scope. A questionnaire was completed by 120 participants contacted via snowball method. The questionnaire included: the Attitudes toward Indebtedness Scale; Attitudes toward Saving Scale; and Attitudes toward Purchase Scale, a scale that evaluates the participants' socioeconomic level and other sociodemographic information to help describe the sample. Descriptive analyses were carried out, along with mean and median comparisons for gender, socioeconomic level and faculty (t tests for independent samples and Mann-Whitney U tests). Finally, correlation tests with Pearson's r test were carried out to test associations between the scales and subscales. Results showed a profile that is desirable in university graduates in terms of attitudes towards saving, indebtedness and purchase, that is: favourable attitudes toward saving, austerity (a subscale of attitudes toward indebtedness) and rationality (a subscale of attitudes toward purchase), as well as negative attitudes toward hedonism (a subscale of attitudes toward indebtedness), and compulsivity and impulsivity (subscales of attitudes toward purchase). In terms of comparison, differences were found when comparing participants by gender in terms of attitudes toward compulsivity, and by their socioeconomic level by attitudes toward austerity in the indebtedness. Both these differences, although significant, were low when considering their effect size. No differences were found when comparing the faculty to which participants belonged in terms of attitudes toward saving, indebtedness and purchase. Finally, results showed associations between attitudes toward saving and austerity and with rationality, and between compulsivity and austerity (inversely) and with impulsivity. These results highlight the need to strengthen the attitudinal aspect in higher education environments where economic literacy is carried out, aiming to prepare students for their insertion into the workforce and their role as active citizens. Limitations of this study include the subjective self-report measurements used, which are susceptible to the effect of social desirability. This limitation hinders the extrapolation of the results in terms of attitudes into actual behaviour in the real world. Another limitation comes from the sampling method used (snowball) and sample size, which does not allow to generalize the results to the population. Drawing from both findings and limitations, suggestions for future research in the subject of economic literacy and related issues are outlined.