ABSTRACT
BACKGROUND: A prescribing monitoring policy (PMP) was implemented in November 2015 in Anhui province, China, the first province to pilot this policy to manage the use and costs of select drugs based on their large prescription volumes and/ or costs in hospitals. This study evaluated the impact of PMP on the use and expenditures of different drugs in three tertiary hospitals in Anhui. METHODS: We obtained monthly drug use and expenditures data from three tertiary hospitals in Anhui (November 2014 through September 2017). An interrupted time series (ITS) design was used to estimate changes in defined daily doses (DDDs per month) and drug expenditures (dollars per month) of policy-targeted and non-targeted drugs after PMP implementation. Drugs were grouped based on whether they were recommended (recommended drugs) by any clinical guidelines or not (non-recommended drugs), or if they were potentially over-used (proton pump inhibitors, PPIs). RESULTS: After PMP, DDDs and costs of the targeted PPIs (omeprazole) declined while use of non-targeted PPIs increased correspondingly with overall sustained declines in total PPIs. The policy impact on recommended drugs varied based on whether the targeted drugs have appropriate alternatives. The DDDs and costs of recommended drugs that have readily accessible appropriate alternatives (atorvastatin) declined, which offset increases in its alternative non-target drugs (rosuvastatin), while there was no significant change in those recommended drugs that did not have appropriate alternative drugs (clopidogrel and ticagrelor). Finally, the DDDs and costs of non-recommended drugs decreased significantly. CONCLUSION: PMP policy impact was not the same across different drug groups. PMP did help contain the use and costs of potentially over-used drugs and non-recommended drugs. PMP did not seem to reduce the use of first-line therapeutic drugs recommended by clinical treatment guidelines, especially those lacking alternatives; such drugs are unlikely appropriate candidates for PMP.
Subject(s)
Health Expenditures , Proton Pump Inhibitors , Humans , Interrupted Time Series Analysis , Proton Pump Inhibitors/therapeutic use , Omeprazole/therapeutic use , Policy , China , Drug CostsABSTRACT
Aim: The aim of this study was to assess the association between PEAR1 polymorphisms and ischemic clinical outcomes. Materials & methods: We searched the electronic database for articles on the relationship of PEAR1 SNPs and ischemic events in patients with coronary artery disease (CAD) up to October 2020. Results: A total of 9914 patients with CAD from six studies focusing on 12 SNPs of PEAR1 were included in this study. The A allele of rs12041331 were associated with ischemic events (odds ratio: 1.40; 95% CI: 1.04-1.88; p = 0.03). The AA homozygotes of rs2768759 was related to a higher risk of ischemic events than carriers of the C allele (odds ratio: 2.08; 95% CI: 1.09-3.97; p = 0.03). Conclusion: PEAR1 rs12041331 and rs2768759 are significantly associated with ischemic events in patients with CAD.
Subject(s)
Coronary Artery Disease/drug therapy , Coronary Artery Disease/genetics , Genetic Variation/genetics , Myocardial Ischemia/genetics , Receptors, Cell Surface/genetics , Cohort Studies , Dual Anti-Platelet Therapy/adverse effects , Dual Anti-Platelet Therapy/methods , Genetic Variation/drug effects , Humans , Myocardial Ischemia/drug therapy , Treatment OutcomeABSTRACT
In this study, the mechanism for converting citrus peel wastes (CPW) into bioflocculants using Alcaligenes faecalis subsp. phenolicus ZY-16 was analysed. The results demonstrated that the ZY-16 strain could produce various lignocellulolytic enzymes, containing cellulase, hemicellulase, pectinase, protease, and ligninase, enhancing the hydrolysis of citrus peel wastes. Molecular distillation removes antimicrobial limonene, which could inhibit bioflocculant production. The optimal fermentation conditions with the highest bioflocculant yield (3.49 g/L) were 38.79 g/L of CPW, 35.54 °C, and pH 4.48. Furthermore, the bioflocculant was used to eliminate microcystins for the first time, and the highest removal efficiency (90.05%) was achieved at a pH of 3.0, after 800 mg/L of bioflocculant was added into the microcystins solution (10 mg/L) for 60 min. Therefore, this paper demonstrated that CPW could be a cost-effective feedstock for the production of bioflocculants, which have potential application in microcystin removal.
