Processamento de linguagem natural não supervisionado na identificação de pacientes suspeitos de infecção por COVID-19 / Procesamiento del lenguaje natural no supervisado para identificar a los pacientes sospechosos de infección por COVID-19 / Unsupervised natural language processing in the identification of patients with suspected COVID-19 infection

Os pacientes com síndrome pós-COVID-19 se beneficiam de programas de promoção de saúde e sua rápida identificação é importante para a utilização custo efetiva desses programas. Técnicas tradicionais de identificação têm fraco desempenho, especialmente em pandemias. Portanto, foi realizado um estudo observacional descritivo utilizando 105.008 autorizações prévias pagas por operadora privada de saúde com aplicação de método não supervisionado de processamento de linguagem natural por modelagem de tópicos para identificação de pacientes suspeitos de infecção por COVID-19. Foram gerados seis modelos: três utilizando o algoritmo BERTopic e três modelos Word2Vec. O modelo BERTopic cria automaticamente grupos de doenças. Já no modelo Word2Vec, para definição dos tópicos relacionados a COVID-19, foi necessária análise manual dos 100 primeiros casos de cada tópico. O modelo BERTopic com mais de 1.000 autorizações por tópico sem tratamento de palavras selecionou pacientes mais graves - custo médio por autorizações prévias pagas de BRL 10.206 e gasto total de BRL 20,3 milhões (5,4%) em 1.987 autorizações prévias (1,9%). Teve 70% de acerto comparado à análise humana e 20% de casos com potencial interesse, todos passíveis de análise para inclusão em programa de promoção à saúde. Teve perda importante de casos quando comparado ao modelo tradicional de pesquisa com linguagem estruturada e identificou outros grupos de doenças - ortopédicas, mentais e câncer. O modelo BERTopic serviu como método exploratório a ser utilizado na rotulagem de casos e posterior aplicação em modelos supervisionados. A identificação automática de outras doenças levanta questionamentos éticos sobre o tratamento de informações em saúde por aprendizado de máquina.

Los pacientes con síndrome pos-COVID-19 pueden beneficiarse de los programas de promoción de la salud. Su rápida identificación es importante para el uso efectivo de estos programas. Las técnicas de identificación tradicionales no tienen un buen desempeño, especialmente en pandemias. Se realizó un estudio observacional descriptivo, con el uso de 105.008 autorizaciones previas pagadas por un operador de salud privado mediante la aplicación de un método no supervisado de procesamiento del lenguaje natural mediante modelado temático para identificar a los pacientes sospechosos de estar infectados por COVID-19. Se generaron 6 modelos: 3 con el uso del algoritmo BERTopic y 3 modelos Word2Vec. El modelo BERTopic crea automáticamente grupos de enfermedades. En el modelo Word2Vec para definir temas relacionados con la COVID-19, fue necesario el análisis manual de los primeros 100 casos de cada tema. El modelo BERTopic con más de 1.000 autorizaciones por tema sin tratamiento de palabras seleccionó a pacientes más graves: costo promedio por autorizaciones previas pagada de BRL 10.206 y gasto total de BRL 20,3 millones (5,4%) en 1.987 autorizaciones previas (1,9%). Además, contó con el 70% de aciertos en comparación con el análisis humano y el 20% de los casos con potencial interés, todos los cuales pueden analizarse para su inclusión en un programa de promoción de la salud. Hubo una pérdida significativa de casos en comparación con el modelo tradicional de investigación con lenguaje estructurado y se identificó otros grupos de enfermedades: ortopédicas, mentales y cáncer. El modelo BERTopic sirvió como un método exploratorio para ser utilizado en el etiquetado de casos y su posterior aplicación en modelos supervisados. La identificación automática de otras enfermedades plantea preguntas éticas sobre el tratamiento de la información de salud mediante el aprendizaje de máquina.

Patients with post-COVID-19 syndrome benefit from health promotion programs. Their rapid identification is important for the cost-effective use of these programs. Traditional identification techniques perform poorly especially in pandemics. A descriptive observational study was carried out using 105,008 prior authorizations paid by a private health care provider with the application of an unsupervised natural language processing method by topic modeling to identify patients suspected of being infected by COVID-19. A total of 6 models were generated: 3 using the BERTopic algorithm and 3 Word2Vec models. The BERTopic model automatically creates disease groups. In the Word2Vec model, manual analysis of the first 100 cases of each topic was necessary to define the topics related to COVID-19. The BERTopic model with more than 1,000 authorizations per topic without word treatment selected more severe patients - average cost per prior authorizations paid of BRL 10,206 and total expenditure of BRL 20.3 million (5.4%) in 1,987 prior authorizations (1.9%). It had 70% accuracy compared to human analysis and 20% of cases with potential interest, all subject to analysis for inclusion in a health promotion program. It had an important loss of cases when compared to the traditional research model with structured language and identified other groups of diseases - orthopedic, mental and cancer. The BERTopic model served as an exploratory method to be used in case labeling and subsequent application in supervised models. The automatic identification of other diseases raises ethical questions about the treatment of health information by machine learning.

A entrada do capital estrangeiro no sistema de saúde no Brasil / The entry of foreign capital into the health system in Brazil / La entrada de capital extranjero en el sistema de salud en Brasil

O estudo descreve o histórico da legislação, analisa a trajetória e dimensiona o capital estrangeiro no sistema de saúde no Brasil. A Lei Orgânica da Saúde restringiu a participação do capital estrangeiro, legislações setoriais permitiram o posterior ingresso na assistência médica suplementar e, em 2015, uma nova lei promoveu a abertura irrestrita, inclusive em hospitais e serviços de saúde. O estudo analisou documentos, legislação e dados de bases secundárias públicas ou obtidos via Lei de Acesso à Informação. Foram considerados investimentos diretos e atos de fusões e aquisições no setor privado da saúde. Foram identificadas cinco fases: ordenamento inaugural, expansão regulada, restrição legal, liberação setorizada e abertura ampliada. De 2016 a 2020, ingressaram no país quase dez vezes mais recursos estrangeiros em serviços de saúde que no quinquênio anterior. Foram identificadas 13 empresas ou fundos, a maioria originária dos Estados Unidos. Normas que permitiram a abertura do capital estrangeiro foram antecedidas por lobbies empresariais e interações público-privadas que podem afetar a qualidade das políticas públicas e a integridade do processo legislativo. O capital aportado busca empresas já constituídas e mais rentáveis, em diversos segmentos de atividade. O ingresso ocorre em redes assistenciais privadas não universais, que atendem clientelas específicas, concentradas geograficamente. Conclui-se que o capital estrangeiro, elemento do processo de financeirização da saúde, se expressa como possível vetor da ampliação de desigualdades de acesso da população aos serviços de saúde e como um obstáculo adicional à consolidação do Sistema Único de Saúde.

The study describes the history of legislation, analyzes the trajectory and the amount of foreign capital in the Brazilian health system. The Organic Health Law restricted the participation of foreign capital; sectoral legislation, however, allowed its subsequent entry into supplementary medical care and, in 2015, a new law promoted unrestricted openness, including in hospitals and healthcare services. Our study analyzes documents, legislation, and data obtained from secondary public bases or via the Law on Access to Information. Direct investments and merger and acquisition acts in the private health sector were considered. Five phases were identified: inaugural planning, regulated expansion, legal restriction, sectorized release, and expanded opening. From 2016 to 2020, the amount of foreign resources entering the country's healthcare services was almost ten times more than the previous five-year period. Thirteen companies or funds were identified, most of them from the United States. Regulation allowing for the opening of foreign capital were preceded by business lobbies and public-private interactions that can affect the quality of public policies and the integrity of the legislative process. The invested capital seeks established and profitable companies in various segments of activity. Admission occurs in non-universal private care networks, which serve specific, geographically concentrated clientele. We conclude that foreign capital, an element of health financialization process, is expressed as a possible vector of the expansion of inequalities in the population's access to health services and as an additional obstacle to the consolidation of the Brazilian Unified National Health System.

Este estudio describe la historia de la legislación, analiza la trayectoria y dimensiona el capital extranjero en el sistema de salud en Brasil. La Ley Orgánica de Salud restringió la participación de capital extranjero, las legislaciones sectoriales permitieron el posterior ingreso a la asistencia médica complementaria y, en el 2015, una nueva ley promovió la apertura sin restricciones, incluso en hospitales y servicios de salud. El estudio analizó documentos, legislación y datos de bases públicas secundarias u obtenidos por medio de la Ley de Acceso a la Información. Se consideraron inversiones directas y actos de fusiones y adquisiciones en el sector privado de la salud. Se identificaron cinco etapas: ordenamiento inaugural, expansión regulada, restricción legal, liberación sectorizada y apertura ampliada. Del 2016 al 2020 ingresaron al país casi diez veces más recursos extranjeros en servicios de salud que en el quinquenio anterior. Se identificaron 13 empresas o fondos, la mayoría con origen en los EE.UU. Las reglas que permitieron la apertura al capital extranjero fueron precedidas por cabildeos empresariales e interacciones público-privadas que pueden afectar la calidad de las políticas públicas y la integridad del proceso legislativo. El capital aportado busca empresas ya consolidadas y más rentables, en diversos segmentos de actividad. El ingreso se da en redes asistenciales privadas no universales, que atienden a una clientela específica y geográficamente concentrada. Se concluye que el capital extranjero, elemento del proceso de financiarización de la salud, se expresa como un posible vector de la ampliación de desigualdades en el acceso de la población a los servicios de salud y como un obstáculo adicional para la consolidación del Sistema Único de Salud.

Perception of the healthcare accreditation system in Colombia / Percepción del sistema de acreditación sanitaria en Colombia

Abstract Introduction: Accreditation is an external, systematic, periodic, and voluntary evaluation process to which health care institutions submit themselves in order to demonstrate compliance with superior levels of quality of care. The Icontec, through an evaluative model, accredits the quality of health institutions in Colombia. Methods: Descriptive cross-sectional study following the recommendations of the survey study report. Using an electronic format, 22 health institutions with experience in the Icontec accreditation process were surveyed. The instrument evaluated three thematic axes of the process: added value provided by the accreditation process, evaluation process and final report. The measurement was carried out using a Likert-type scale and a descriptive statistical analysis to establish the perception of the phases of the process. Results: the items with the best perception were the humanization of care (86.4%) followed by patient safety and teamwork (81.8%). After accreditation, the quality of the processes improved (77.4%), infection prevention and control (68.1%) and physician commitment (63.6%). 54.6% felt that evaluators use different methods of evaluation. 63.6% of the respondents considered that Icontec does not comply with the times defined for the delivery of the report. Conclusion: the Icontec accreditation system adds value to health institutions in most of the thematic areas evaluated, especially in the humanization of care and patient safety. The lowest perception is presented in the increase of physicians' commitment.

Resumen Introducción: la acreditación es un proceso de evaluación externo, sistemático, periódico y voluntario al que se someten instituciones de salud para demostrar el cumplimiento de niveles superiores de calidad en la atención. El Icontec, Instituto colombiano de normas técnicas, es la organización colombiana no gubernamental designada por el Ministerio de Salud para ser la entidad que acredita la calidad de las instituciones de salud en Colombia. El objetivo del presente estudio fue evaluar la percepción del valor que agrega la acreditación a la calidad de la atención en clínicas y hospitales en Colombia. Métodos: estudio transversal observacional. Se encuestaron 22 profesionales con experiencia en el proceso de acreditación Icontec. El instrumento evaluó tres ejes temáticos del proceso: valor agregado que aporta el proceso de acreditación, proceso de evaluación e informe final. La percepción de las fases del proceso fue medida a través de una escala tipo Likert y un análisis estadístico descriptivo. Resultados: los ítems con mejor percepción fueron la humanización de la atención (86.4%), la seguridad de los pacientes y el trabajo en equipo (81.8%). Laacreditación mejora la calidad de los procesos (77.4%), la prevención y el control de infecciones (68.1%) y el compromiso de los médicos (63.6%). El 54.6% consideró que los evaluadores utilizan métodos diferentes de evaluación. Conclusión: el sistema de acreditación Icontec en Colombia, agrega valor a las instituciones de salud en la mayoría de los ejes temáticos evaluados. La percepción más baja se presenta en el incremento de compromiso de los médicos.

Research advances of Zaoren Anshen prescription preparations / 中国中药杂志

Zaoren Anshen prescription preparations(ZRASs), which are prepared from three traditional Chinese herb medicines, namely fried Zizyphi Spinosae Semen, Salvia Miltiorrhizae Radix et Rhizoma and vinegar-processed Schisandrae Chinensis Fructus, are a series of proprietary Chinese medicines for the treatment of insomnia, amnesia and dizzy in clinic. In recent years, pharmacodynamic effect, chemical constituents and quality control of ZRASs had been extensively studied for the purpose of ensuring their safety, efficacy and stability, and a great progress had been made. However, there is no review of the research advance of ZRASs up to date. The present review summarized the research advance of ZRASs in quality control standards, chemical constituents, pharmacodynamic effects, and chemical analysis for the first time, with the aim to provide a reference for further studies on the effective constituents and quality control of ZRASs.

O conflito público-privado no SUS: a atenção ambulatorial especializada no Paraná / The public-private conflict in SUS: specialized outpatient care in Paraná

RESUMO O conflito fundamental da saúde em sociedades capitalistas - direito social versus mercadoria - também se expressa no interior do Sistema Único de Saúde (SUS). Este trabalho analisou a relação público-privado na oferta de serviços ambulatoriais especializados pelo SUS no estado do Paraná, no período de 1995 a 2015, em comparação com a realidade nacional. Realizou-se um estudo descritivo, com procedimentos selecionados, a partir da coleta de dados no Sistema de Informações Ambulatoriais (SIA), por meio da plataforma do Datasus Tabnet On-line nos anos de 1995, 1999, 2003, 2007, 2011 e 2015. Os resultados demonstram que a atenção ambulatorial especializada, secundária e terciária, sofreu ampliação nas duas décadas, acompanhando a expansão do SUS. O percentual de participação privada é, em geral, minoritária nos serviços de média complexidade e majoritária nos de alta complexidade, sendo que, no Paraná, o grau de privatização é consideravelmente maior que no âmbito nacional. Assim, diferentemente do preconizado constitucionalmente, em vários serviços e áreas do SUS, o público é que assume o papel de complementar ao privado. Discutem-se os possíveis impactos da privatização interna do SUS sobre seus limites em se constituir como sistema universal, integral e igualitário.

ABSTRACT The fundamental conflict of health in capitalist societies – social right versus commodity – is also expressed within the Unified Health System (SUS). This research analyzed the public-private relationship in the provision of specialized outpatient services by the SUS in the state of Paraná, from 1995 to 2015, in comparison with the national reality. A descriptive study was carried out, with selected procedures, with data collected in the Outpatient Information System (SIA) through the Datasus Tabnet On-line platform in the years 1995, 1999, 2003, 2007, 2011 and 2015. The results demonstrate that specialized outpatient care, secondary and tertiary, has expanded over the past two decades, following the expansion of SUS. The percentage of private participation is, in general, minority in the medium complexity services and majority in the high complexity services, and in Paraná the degree of privatization is considerably higher than at the national scope. Thus, differently from what is constitutionally recommended, in various services and areas of the SUS, it is the public that assumes the role of complementing the private. The possible impacts of the internal privatization of SUS on its limits on constituting itself as a universal, comprehensive and equal system are discussed.

Análisis del subsidio a la demanda para atención de salud y su relación con los holdings de empresas en Chile. Modalidad libre elección en prestadores privados (2000-2018) / Analysis of health care demand subsidies and the role of private health care corporations

This work analyzes the demand subsidies to access health care and their relationship with large private corporations in Chile, through the transfer of public funds through the modality of freedom of choice (MLE) from 2000 to 2018. Therefore, we analyzed the expansion of the health market and the strengthening of health care corporations, identifying the distribution of resources according to type of health provider. We reviewed the annual reports of private health care corporations. We also analyzed billing data according to the provider through the freedom of choice modality from the year 2000 to the year 2018. We identified an increasing transformation of medical work from free exercise to become dependent on private health corporations, and an increase in public dependence on private providers to meet health demands. There is a growing capture of public funds by these holdings, using the strategy of increasing provider property concentration and a trans nationalization of the health market in Chile.

Limitation standard of toxic aconitines in proprietary Chinese medicines using on-line extraction electrospray ionization mass spectrometry

Development of rapid analytical methods and establishment of toxic component limitation standards are of great importance in quality control of traditional Chinese medicine. Herein, an on-line extraction electrospray ionization mass spectrometry (oEESI-MS) coupled with a novel whole process integral quantification strategy was developed and applied to direct determination of nine key aconitine-type alkaloids in 20 proprietary Chinese medicines (APCMs). Multi-type dosage forms (, tablets, capsules, pills, granules, and liquid preparation) of APCM could be determined directly with excellent versatility. The strategy has the characteristics of high throughput, good tolerance of matrix interference, small amount of sample (∼0.5 mg) and reagent (∼240 μL) consumption, and short analysis time for single sample (<15 min). The results were proved to be credible by high performance liquid chromatography-mass spectrometry (LC-MS) and electrospray ionization mass spectrometry, respectively. Moreover, the limitation standard for the toxic aconitines in 20 APCMs was established based on the holistic weight toxicity (HWT) evaluation and the severally, and turned out that HWT-based toxicity evaluation results were closer to the real clinical applications. Hence, a more accurate and reliable APCM toxicity limitation was established and expected to play an important guiding role in clinics. The current study extended the power of ambient MS as a method for the direct quantification of molecules in complex samples, which is commonly required in pharmaceutical analysis, food safety control, public security, and many other disciplines.

Knowledge, attitude and practice regarding generic drugs and branded drugs: a cross sectional study

Background: Medicines play a main role in the process of human development. The rational utilization of medicines can decrease morbidity and mortality as well as improve quality of life. In an era of steeply rising health care expenses, generic medicines provide a less expensive alternative to branded medicines. Use of generic drugs can contribute to substantial savings in medicines expenditure and the issue of access and affordability is thus addressed.Methods: A sample of 500 patients selected from out patient department was randomly selected. A self-instructed questionnaire was used for the study for the duration of 1 month. Data was analyzed using IBM SPSS statistics Version 20 New York, United States. Summary statistics were expressed using mean and standard deviation (SD) for numerical variables (median and interquartile ranges [IQRs] when skewed) and counts and percentages for categorical variables.Results: Participants reported with 17.23% knowledge score, 40.65% attitude score, and 7.96% attitude score.Conclusions: In the study it was found that there is significant correlation between knowledge and attitude whereas no correlation was found between knowledge and practice regarding usage of generic drugs.

Exploration of the Method of Developing Core Data Sets for Post-marketing Clinical Safety Evaluation of Chinese Proprietary Medicine / 世界科学技术-中医药现代化

The insufficient reporting of adverse reactions of Chinese proprietary medicines is common. In addition, there is a lack of safety information in the specifications of Chinese proprietary medicines, which led to less evidence for clinical safety of Chinese proprietary medicines in clinical practice. It is urgent to carry out post-marketing clinical safety re-evaluation of Chinese proprietary medicine. Developing a clinical safety evaluation data set for Chinese proprietary medicine may reduce the insufficient reporting of safety information and the inconsistency of data reporting in similar studies, as well as include more studies in systematic reviews, so that they can provide higher-level evidence for clinical safety of Chinese proprietary medicine. This paper proposes a method for developing core data set of clinical safety evaluation of Chinese proprietary medicine: firstly, the application scope of core data set for clinical safety evaluation was determined according to the characteristics of diseases, population, research objectives, administration methods, evaluation methods, etc. Systematic reviews and semi-structured interviews should be conducted to develop the list of original items for clinical safety evaluation. Based on the list, Delphi surveys can be developed in different stakeholders. Then the final core data set can be developed via consensus meetings.

Información de la escuela de enfermería de prelicenciatura previo accesible: un calidad proyecto de mejoría utilizando conocimientos al marco de acción / Accessible pre-licensure nursing school information: a quality improvement project using knowledge to action framework

En respuesta a la escasez de enfermería proyectada, legisladores de la Florida hicieron modificaciones a la ley de 2009 que cambió la Junta de enfermería aprobación y control de proceso para los programas de Educación de enfermería. Como resultado, el número de programas de enfermería aprobado en la Florida aumento de 171 a 350 (105%), que dio lugar a la proliferación de programas de enfermería pobres con baja graduación y bajo porcentaje de aprobación del NCLEX. Los estudiantes tienen el reto de distinguir programas de enfermería de buena reputación comparada a las instituciones problemáticas. La finalidad de este proyecto era crear una plataforma centralizada basada en web y evaluar la capacidad de la plataforma para incrementar el conocimiento en estudiantes de programas de enfermería posibles, en cuanto a programas de enfermería creíble. El proyecto fue implementado usando el conocimiento para la acción de marco de trabajo. Para probar el aumento de eficacia y conocimiento, estudiantes de enfermería potenciales de veintisiete acordaron examinar todos los componentes de la Página Web. Basado en el análisis, el post cuestionario partituras general fueron superiores a puntajes del cuestionario previo que demostró un aumento en el conocimiento. En el futuro, el proyecto podría ampliarse para incluir clases en línea gratuitas como terminología médica, error médico y mantenerse saludable a través de la escuela de enfermería.

In response to the projected nursing shortage, Florida law makers made modifications to the law in 2009 that changed the Board of Nursing's approval and monitoring process for nursing education programs. As a result, the number of approved nursing programs in Florida increased from 171 to 350 (105%) which resulted in the proliferation of poor nursing programs with low graduation and NCLEX pass rates. Prospective students are challenged to distinguish reputable nursing programs from problematic institutions. The purpose of this project was to create a centralized web-based platform and evaluate the ability of the platform to increase knowledge in prospective nursing students, regarding credible nursing programs. The project was implemented using the Knowledge to Action Frame Work. To test the effectiveness and knowledge gain, twenty seven prospective nursing students agreed to examine all components of the website. Based on the analysis, post questionnaire scores were overall higher than pre-questionnaire scores which showed an increase in knowledge. In the future, the project could expand to include free online classes such as, medical terminology, medical error, and staying healthy through nursing school.

Calidad de control metabólico en pacientes ambulatorios con diabetes tipo 2 atendidos en una clínica privada / Quality of metabolic control in outpatients with type 2 diabetes seen in a private clinic

Objetivo: Evaluar la calidad de control metabólico en pacientes ambulatorios con diabetes mellitus tipo 2 (DM2) de una clínica privada en Lima, Perú. Materiales y métodos: Estudio de corte transversal en la consulta externa del Servicio de endocrinología de una clínica privada de Lima, Perú. Se recolectó información socio demográfica, historia de enfermedad, autorreporte de complicaciones y comorbilidades, medidas antropométricas y presión arterial. Además, se tomó muestras de sangre para análisis de prueba rápida de glucosa, hemoglobina glicosilada (HbA1c) y perfil lipídico. Se consideró pobre control metabólico si el participante tenía HbA1c >7%, colesterol LDL (LDL-c) =100 mg/dl, y presión arterial =130/80 mmHg. Se aplicaron cuestionarios adicionales, para medir la adherencia al tratamiento, actividad física, calidad de vida, autoeficacia y depresión. Resultados: Se incluyó a 60 participantes, 53,3% (32/60) fueron de sexo femenino y la media de edad fue 63,1 ±13,2 años. Se encontró pobre control metabólico en 85% (51/60) de los participantes; presión arterial controlada en 71,2% (42/60), LDL-c controlado en 10% (6/60) y HbA1c controlado en 48,3% (29/60) de los participantes respectivamente. Complicaciones crónicas como retinopatía se autorreportó en el 3,3% (2/60) participantes, neuropatía en 10% (6/60), nefropatía en 1,7% (1/60), presión arterial alta en 30% (18/60) y enfermedad cerebro vascular en 5% (3/60) de los participantes. Conclusión: La prevalencia de control metabólico no controlado es elevada, a pesar del contexto de atención en una clínica privada. Regulación y medidas para mejorar el control en centros privados es necesario

Objective: To assess the quality of metabolic control among outpatients with type 2 diabetes mellitus (DM2) in a private clinic in Lima, Peru. Materials and methods: This is a cross-sectional study in the outpatient endocrinology service of a private clinic in Lima, Peru. Socio-demographic information, history of diabetes, self-report of complications and comorbidities, anthropometric measures and blood pressure data were collected. Blood samples were taken for assessing fasting blood glucose, glycated hemoglobin (HbA1c) and lipid profile. A poor metabolic control was considered if the participant had HbA1c >7%, LDL cholesterol (LDL-c) =100 mg/dl, and blood pressure =130/80 mmHg. Additional questionnaires were administered for measuring adherence to therapy, physical activity, quality of life, self-efficacy and depression. Results: Sixty participants were included; 53.3% (32/60) were female and their mean age was 63.1 ±13.2 years. Poor metabolic control was found in 85% (51/60) of all participants; controlled blood pressure in 71.2% (42/60), controlled LDL-C levels in 10% (6/60), and controlled HbA1c values in 48.3% (29/60) participants, respectively. Chronic complications such as retinopathy were found in 3.33% (2/60) participants, neuropathy in 10% (6/60), nephropathy in 1.7% (1/60), high blood pressure in 30% (18/60) and cerebrovascular disease in 5% (3/60) of all participants. Conclusion: There is a high prevalence of poor metabolic control in patients with type 2 diabetes, despite being taken care of in a private clinic. It is necessary to take actions in order to improve the metabolic control in patients with type 2 diabetes attending the private health care sector

Evolution of the registration regulations for proprietary Chinese medicines in China / 中国天然药物

In this review, we provide a comprehensive overview on the registration of proprietary Chinese medicines (PCMs) in China over the past century by examining published literature and historical data. We will examine this evolving administrative practice for PCMs registration in China, which is divided to the following five stages: (1) initial measures (1915-1948); (2) early development (1949-1965); (3) provincial approval and trial implementation of the "approval number" system (1966-1984); (4) legislation and cleanup (1985-1999); and (5) centralized national approval (2000 until now), offering a panoramic view on the characteristics of PCMs registration management in China.

Investigation and Analysis on Clinical Application of Proprietary Chinese Medicine by Clinicians in Integrat-ed Medical Institutions / 中国药房

OBJECTIVE:To understand the application of proprietary Chinese medicine by clinicians in integrated medical insti-tutions,and provide reference for its rational use. METHODS:The questionnaire was designed,including related issues of proprie-tary Chinese medicine clinical application(such as medication basis of proprietary Chinese medicine,combined medication,clini-cal efficacy and its influencing factors,medication for special groups and so on)and suggestions;the questionnaires were delivered to the clinicians who worked in some second and third grade of integrated medical institutions located in southwestern regions and Chengdu,and the questionnaires was in the form of an anonymous;relevant data of available questionnaire were collected statisti-cally;the application situation of proprietary Chinese medicines and the existence question were analyzed,and suggestions were put forward. RESULTS:Totally 300 questionnaires were sent out,264 were effectively received,with effective rate of 88.0%. The clinicians involved in investigation were mainly in undergraduate,mostly the resident physicians and attending physician;only 6.8%of the physicians received the training of basic theory of traditional Chinese medicine after work;36.4%physicians often pre-scribe proprietary Chinese medicines,and the medication basis was mainly in package insert (64.0%) and clinical experience (55.3%);51.1% thought unclear indications affected the application of proprietary Chinese medicines,64.0% thought package in-sert can not meet clinical needs. In terms of answers in brief questions,the surveyed clinicians generally considered the package in-sert was too simple,which needed further perfected. CONCLUSIONS:The problems in clinical application of proprietary Chinese medicines should not be ignored. The relevant departments should strengthen the supervision of clinical application of proprietary Chinese medicines,and strengthen the re-evaluation of proprietary Chinese medicines market,as to provide data support for the continuous improvement of package insert. Medical institutions should carry out training timely for the physicians who prescribe pro-prietary Chinese medicines,the pharmacists should strengthen checking of proprietary Chinese medicines prescription and special prescription comment,and ensure prescription checking and comment play a active role in promoting rational drug use based on“proprietary Chinese medicines clinical application guiding principle”“prescription management method”.

Teaching of chronic renal failure in a reasonable application of proprietary Chinese medicines / 中国医学装备

Chronic kidney disease has become a global public health problem, and a new pandemic, which seriously endanger people's health and life. With the gradual increase in kidney disease treatment of traditional Chinese medicine, western medicine doctors to rational use of Chinese patent medicine is also worthy of attention and discussion. In this research, we discussed the reliability of traditional Chinese medicine in chronic renal failure with practicability, to the analysis of the current status of Chinese patent medicine in General hospital, and summarizes the effect of traditional Chinese medicine in the treatment of renal diseases and analyzed the disadvantages. Finally, from the clinical research, we concluded that the reasonable application of traditional Chinese medicine in chronic renal failure has a long way to go and we need to make unremitting efforts.

Literary analysis of the adverse reactions of Niuhuang-Jiedu pill / 国际中医中药杂志

Objective To Summariz and discuss the adverse reactions of Niuhuang-Jiedu pill (NJP) in the treatment.Methods Retrieved ADR report literatures through Chinese Medical Journal Database (CMJD) and WANFANG DATA from 1970 to 2012 with NJP as the key words,got and analyzed datas including patient age,gender,dosage,medication time and ADR type.Results Sixty-eight literatures with seventy-seven ADR report cases were retrieved.Adverse action induced by NJP was mainly allergic response,including arseniasis,gastrointestinal,uropoiesis reactions.Among 77 ADR cases,47 cases were considered as allergic response,61.0％ of the total,one death and thirteen shock cases were included.The number of arseniasis,gastrointestinal,uropoiesis reactions cases were respectively 14.3％,11.7％,6.5％ of the total.Conclusion The ADR of NJP should not be ignored.Allergy history,dosage and medication time should be pay more attention to to prevent the ADR of NJP to the fullest extemt.

The Problems of Nonproprietary Names Prescription

The government is now operating a pilot project of generic prescription in the National Medical Center and planning to execute it after analyzing the results. The aims of changing Brand Name Prescription (Proprietary Names Prescription) to Generic Prescription (Nonproprietary Names Prescription) are to reduce medical expenses, to increase patient's conveniences and rights, and to strengthen pharmaceutical companies' internal competitiveness. However, we doubt whether these goals can be reached by the execution of the Generic Prescription. More important is that Korea is not well prepared with the medicine bioequivalent experiments, which can be potentially harmful to patients. If the government should carry out this plan just because the pilot project involving some relatively safe medicines does not show problems, it will confront with big damages. Namely, carrying out the Generic Prescription in an unprepared condition will not benefit but will cause a big damage to the patients.

Analysis of Adverse Drug Reactions Associated with Proprietary Chinese Medicine from 2002 to 2006 in Beijing Hospital / 药物流行病学杂志

Objective:To analyze adverse drug reactions(ADRs)associated with proprietary Chinese medicine occurring in Beijing Hospital.Method:The ADRs associated with proprietary Chinese medicine between 2002 and 2006 were collected and the associated information was retrospectively analyzed.Result:a total of 179 ADRs were analyzed. Most of them occurring in women patients(76.1%)with hyperplasia of mammary glands who took Xiaojin pills and Xi- huang pills(22.1% & 12%).The herbal medicine injections were the other most associated ones.The clinical appearances of ADRs were rash and bodily manifestation of hypersensitiveness.Condusion:The investigation of Chinese medicine ADR plays a very important role in the modernization of Chinese medicine.

Legal Aspects of Medical Records / 医学教育

This paper discusses medical records, which are often disputed during lawsuits and play an important role in the factfinding process. There have been no published reports of problems related to medical records or concrete measures to deal with these problems on the basis of a review of judicial precedents. To avoid lawsuits, medical records should be considered in the context of judicial precedents (previous court rulings). The present paper therefore analyzes basic matters related to medical records that were disputed during lawsuits, in relation to judgments obtained in previous court rulings, to determine the judicial role of medical records and their ownership. Although the ownership of medical records is unclear, we believe that patients have some ownership rights over their medical records, that hospitals are responsible for the control of the records, and that physicians have the obligation to use and prepare them. Therefore, medical records can be seen as being jointly owned by the medical care provider and the patient. Analysis of relevant judicial precedents has also allowed us to clarify essential points related to avoiding lawsuits.

Clinical Evaluation of Arsenical Keratosis / 대한피부과학회지

BACKGROUND: Arsenics have been used for various medical purposes. These arsenics can cause different kinds of cutaneous and internal malignancies. The arsenic-induced malignancies can be fatal or cause severe morbidity. OBJECTIVE: For early detection and prevention of the arsenic-induced malignancies, the authors analyzed the clinical characteristics of arsenic-induced skin diseases. METHODS: Medical records of 15 patients(10 males, 5 females) with arsenical keratosis(AK) during a period from September 1994 to October 1999 were reviewed. Interview, physical examinations, skin biopsy, and laboratory tests were performed. RESULTS: 14 patients used Korean proprietary pills(KPP, "Hwan-Yak"), which were suspected to contain certain amount of arsenics, as a drug for treatment of certain diseases such as vitiligo(4 patients, 26.7%), laceration, syphilis, etc. The other formulation of medication was Salvarsan injection. Age at KPP or Salvarasan medication was from seven to thirty-five years old. Duration of medication was from one month to four years. Bowen's disease(BD), squamous cell carcinoma(SCC) and basal cell carcinoma(BCC) were detected in ten(66.7%), three(20%) and one(6.7%) patients, respectively. One(6.7%) patient had lung cancer. Sites of predilection were palmoplantar area(100%) for AK, trunk(60%) for BD and lower extremities(45%) for SCC and BCC. CONCLUSION: Chronic exposure to arsenic can induce the cutaneous and systemic malignancies. To prevent these malignancies, strict managements and supervising programs on certain arsenic-containing drugs(probably KPPs) are required, and regular cutaneous and systemic examinations for the patients with AK should be performed.

A prescrição racional em medicina veterinária e os nomes dos fármacos dos medicamentos alopáticos / Rational prescription in veterinary medicine and the names of active substances of alopatic medicines

Este artigo revisa a questão da prescrição dos medicamentos, no exercício da clínica veterinária, ressaltando as dificuldades e/ou problemas que podem resultar da existência de diversos nomes atribuídos a um mesmo fármaco. Os fármacos tem várias denominações: o nome químico, os nomes genéricos e o nome comercial. Cada fármaco pode estar presente em mais de uma especialidade farmacêutica produzida pelas diversas indústrias farmacêuticas e recebe uma denominação comercial distinta. Uma portaria ministerial aprovou as Denominações Comuns Brasileiras baseadas na terminologia recomendada pela Organização Mundial da Saúde para o nome genérico dos fármacos. mas parte da indústria farmacêutica de medicamentos de uso médico veterinário ainda não emprega a denominação recomendada em seus produtos. A multiplicidade resultante cria dificuldades e pode induzir o médico-veterinário a erros no momento da prescrição ou utilização de medicamentos além de obrigá-lo a freqüentes consultas a compêndios a procura da sinonímia mais conhecida para exercer uma terapêutica racional. Por outro lado, o intercâmbio comercial decorrente do acordo Mercosul, se incluir a comercialização de medicamentos veterinários, pode gerar dificuldades adicionais caso não sejam adotadas normas uniformes na denominação das substâncias ativas entre os países signatários do acordo.

Drugs can be designed by their chemical name, by their generic (or non proprietary) names and by the commercial (or proprietary) name. Drugs can be marketed by more than one company and can have several proprietary or trademark names. In Brazil pharmaceutical companies which produce veterinary drugs use different chemical or generic names to designe the active drug of medicines. This clearly create difficulties for veterinarians inducing errors andmisuses. Medicines for human use on the other hand have a offïcial generic (non-proprietary) name known as Denominações Comuns Brasileiras (Brazilian Common Denomination) which were adopted in accordance with the World Health Organization recomendations. It is stressed that Brazilian Oficial non-proprietary names should also be adopted by manufacturers of veterinary drugs. This would either help to eliminate the necessity for memorizing multiple chemical and generic drug names as been as reduce the possibility of misunderstanding and errors. If veterinary medicines would be marketed in various South-American countries, as a result from the Mercosul comercial agreement, the existence of many names for the same drug can result in an even more conjuse situation. This article deals with this problem and calls for attention for the uniformity of drug nomes.