The NEMS included policies targeting drug selection, production, procurement, distribution, pricing, use and reimbursement. The core of the program was the National EssentialMedicine List, which included 205 Western medicines and 102 traditional Chinese medicines (TCMs) . To address local needs, the central government gave authority to provincial governments to supplement the list according to their economic situation and specific needs. Another key policy element of the NEMS was a zero markup policy under which essential medicines were sold to patients at the procurement price, with no profit to healthcare facilities for the sale. Province-based bidding and centralized procurement for essential medicines were developed to simplify the supply chain and strengthen market competition, which were effective in achieving the lowest possible drug prices.
20 loss of the essentialmedicine perspective. An EML is a compass for many other health policies and industrial policies, that must be in alignment to produce better health outcomes . Reducing the importance of the essential medicines concept has consequences on financing and on local production and in a certain way eliminates a crucial axis on which may revolve regulation and priority decisions for all policies and for health innovation . Recently an example of fast change, not exactly compatible with the traditional EM concept [8, 51], and with consequences for health outcomes, was the rapid incorporation of telaprevir and boceprevir, new DAAs for Hepatitis C. At the time this was perceived as a correct choice, due to existing evidence . However, after very serious adverse effects were identified, these medicines were also rapidly disenfranchised – but with serious health consequences remaining, as well as considerable costs for the country and a difficult, if not impossible, delisting, due to social pressures . Delisting or moving to second generation DAAs is now taking place across countries, including Brazil. The country, faced with growing litigation, has also advanced in forging a disinvestment protocol, fuelled by Conitec [18,52,53] .
In 2009, increasing concerns regarding the appropriate- ness of medicinal drug use and access to safe and effective essential medicines led the Chinese government to intro- duce the National EssentialMedicine System (NEMS) for public primary health care facilities, with the intention of extending it to private providers and hospitals. This pro- gram was a new policy in China and advocated prioritizing the use of essential medicines and the rational use of essen- tial medicines. The program’s key objectives included re- moving the profit link between health institutions, doctors, and medicines and the improvement of medicine use. The core of the program was the Essential Drug List (EDL), which included selected low-cost medicines for common treatable diseases affecting vast numbers of people. The list for primary health care facilities contained 307 generic medicines (205 Western medicines and 102 traditional Chinese medicines). All public primary health care set- tings were required to stock and prescribe only drugs from the EDL and to sell them at cost (zero-profit drug policy). Clinical treatment guidelines and formulas for the administration of essential medicines were developed to regulate the behavior of health workers. Local social health insurance programs (including the New Rural Cooperative Medical Scheme) covered all essential medi- cines and provided a higher reimbursement for listed drugs than for non-listed drugs. However, different provinces var- ied in terms of the reimbursement rate.
In conclusion, irrespective of the high markup of medicine prices, medication remains largely affordable. However, despite the affordability of generic medicines, certain inno- vator medicines remain too expensive for a majority of the population. This is particularly a concern for essential medi- cines, crucial drugs in managing both patients as well as the general population. Indeed, one way to ensure affordability is educating the public on the use of generic medicines, which in turn can reduce out-of-pocket expenses. However, it should be noted that calculating affordability on the basis of the wages of unskilled government workers may lead to optimistic results since a portion of the population may earn a lot less. Nonetheless, the current work suggests that prices of essential medicines need to be fixed in order to keep them at reasonable levels. There is also a need for a national medicine pricing policy to review and regulate essential medicines, in order to ensure both generic and innovator medicine prices are capped. This may help keep out-of-pocket expenses, particularly in middle-income countries such as Malaysia, at a minimal in the private sector.
We found one pharmacoeconomic study by Robber- stad et al. on Zinc as adjunct therapy which reported it to be cost-effective in Tanzania . Tanzania adopted the new diarrhoea treatment guidelines which incorpo- rated the use of Zinc in July 2007  followed by its listing in the national essentialmedicine list the same year . Our review of documents revealed that a task force committee which was composed of representatives from the government, WHO, UNICEF, and non- governmental organization was formed to advocate for adoption of Zinc . However there is no evidence of whether economic evaluation was among the criteria on which the local decision was based apart from the WHO/UNICEF recommendation.
From Table 2, however, out of the 131 respondents, 106 (80.9%) were from HC IIs and IIIs which uses the push system of essentialmedicine supply system. Furthermore, the health center IVs in Gulu District which receives essential medicines supplies through the pull system had, 25 (19.1%) respondents included in the study. Nineteen out of the 131 (15%) of respondents reported full time availability hence no stock out of essential medicines in their unit out but, the majority (9.2%) were from the HC IVs and only 5.3% from the HC IIs and IIIs. On comparing HC IIs/IIIs and HC IVs, the most frequently out of stock combination was quinine and oral rehydration salt (ORS) 22.1% vs 0%, followed by quinine and measles vaccine (3.8% vs 0%) respectively. The single most frequently out of stock medicine was quinine (13% vs 1.5%; HC II & IIIs and HC IVs respectively), followed by measles vaccine (4.6% vs 0%) respectively. It can be inferred therefore that the HC IIs and IIIs which uses the push method of supply have more stock out of essential medicines compared with HCIVs that uses the pull system.
a) Rational FDCs: FDCs which matched exactly with those given in either EML of WHO or NLEM of India were considered rational. Those FDCs which contained either a substitute of essentialmedicine or other identical drug from the group and met the above six criteria were also considered as rational E.g: FDC of ampicillin with sulbactam is though not listed in either of the above two lists, it was considered rational since ampicillin is a substitute of amoxicillin (aminopanecillin) and sulbactam is that of clavulanic acid (beta lactamase inhibitor) and this FDC meets all the above five criteria.
This study is based on the analysis of real-world drug utilization data, and the purpose is to define the links and influence of the specific roles of the drug policy and whether the impact of these affecting factors and modes of action on clinical drug use is in line with policy expec- tations. For the EssentialMedicine Policy, many publica- tions are focused on methods of evaluating institutional performance with primary hospitals as the research object [7–9]. However, in the new situation of urban public hos- pital reform, there is limited research on the operating mechanism and how to implement the EssentialMedicine Policy at senior medical institutions. This topic starts with research on the status quo of implementation of the Es- sential Medicine Policy in county-level public hospitals to determine if the trend of changes in drug utilization and whether essential drugs can be prioritized in comprehen- sive public hospitals. In select samples and as a pilot city of public hospital reform in Anhui Province, the imple- mentation of medical reform evaluation and development trend of research have a certain representation.
CMS: Council for Medical Schemes; COMED: Central Procurement Agency for medicines in South Africa; EML: EssentialMedicine List; ERP: External Reference Price; HAI: Health Action International; IRP: Internal Reference Price; ITS: Interrupted Time Series; LMICs: low to middle-income countries; MCC: Medicine Control Council; NAPPI: National Pharmaceutical Product Index; NDP: National Drug Policy; NHA: National Health Accounts; NHI: National Health Insurance; No-POS: Complimentary Health Plan of Colombia; OECD: Organisation for Economic Co-operation and Development; POS: Compulsory Health Plan of Colombia; SEP: Single Exit Price;
In this study, we used only 9.7 % of overall patients’ data. Although it is uncommon, we provided the baseline charac- teristics of participants not only about eligible patients but also ineligible patients. Our data were primarily obtained from female patients, and this sex difference is common in Japanese Kampo clinics [21, 22]. This is because some Kampo formulas, including kamishoyosan and keishibukur- yogan, are especially used for female patients. These Kampo formulas are originally designed for perimenopausal or post- partum women, respectively. We could obtain similar results using only data from female patients. When we excluded male patients, female sex was disappeared from the table of important variables but the other variables had almost the same rank with same value of importance (Data not shown). Our results suggested that a greater number of candidate Kampo formulas led to a worse discriminant rate. Specific- ally, the DSS could only handle around two or three fre- quently used Kampo formulas, even though there are far more officially approved formulas in Kampo medicine. In- deed, upon including a fourth Kampo formula, keishibu- kuryogan, the discriminant rate dropped by approximately 30 %. This was likely because it was difficult to differentiate between the second Kampo formula, kamishoyosan, and the fourth, keishibukuryogan (data not shown). Our data suggest that differences between the top three Kampo for- mulas were rather large, whereas the differences between Table 3 Top 30 most important variables for predicting top 3
plementary and alternative medicine (CAM) has increased significantly over the past few years. In this context, it is necessary to develop information to meet the needs of consumers. Inequities in availability, accessibility and affordability of health care have increased, between as well as within populations the world over. In the recent past there has been a growing interest in Traditional medicine/Complementary and Alternative Medicine (TCAM) and their veloping countries. Diversity, flexibility, easy accessibility, broad continuing acceptance in developing countries and increasing popularity in developed countries, relative low cost, low levels of technological input, relative low side effects and g economic importance are some of the positive features of traditional medicine (WHO 2002). According to WHO some of the major policy challenges include safety, efficacy, quality and rational paper will give an overview on herbal medicines, which are the most influential traditional medicine systems to improve public health
Many natural compounds from various plant extracts have been investigated for their chemopreventive effects. 30 Extracts from the essential oils contain a wide range of saturated and unsaturated hydrocarbons and gas chromato- graphy has turned out to be the best-suited separation process for multicomponent analysis. 31 The peak area % obtained indicated cuminaldehyde to be a major contribu- tor to the biological properties of cumin seed oil extract. Characterisation studies were conducted to establish a preferred cumin nanoemulsion formulation in order to substantiate the idea of antiproliferative and anti-bacterial effects of the chemo-preventive agents affecting multiple pathways. The cumin nanoemulsion was prepared using cumin seed oil, water and Tween 80 owing to its low polarity, high solubilization capacity, and lesser molecular weight. 32 The colour change observed on visual inspection is attributable to Rayleigh scattering effect from nanoe- mulsions with minimized droplet size diameter. 33 The contribution of the surfactant in stabilizing and controlling the droplet size diameter is pivotal for the formulation of nanoemulsions. 34 The formulation process is termed to be non-spontaneous in nature as the Gibbs free energy for the formation of cumin nanoemulsion is positive. The surfac- tant signi ﬁ cantly reduces the free energy utilized in nanoe- mulsion formulation. 35 The ultrasonication technique generated small droplets. A lower polydispersity index of these droplets was indicative of the homogeneity and stability of the formulations. 36
Medicine dispensing for the essential medicines will primarily be through the mail. A supply of medicines that are needed for acute care (eg, antibiotics) will be stocked at each clinic study site and available for on-site dispensing by the clinician, and dispensing records will be kept to prevent contamination. For all other medicines covered by the list, the research pharmacist who will have direct access to patient electronic medical records and prescriptions will dispense these medicines as prescribed. Medicines can be delivered to a study participant within the expected geographical regions in Ontario within 1 day. Controlled substances (eg, opioids, sedatives and stimulants) will not be included in the intervention for safety reasons, and patients will access these medicines in the usual fashion and not through the research study.
Although the charred bodies are generally not completely destroyed, it remains a difficult and challenging task for the forensic physician who is expected to determine: the identity of the victim, the presence or absence of essential signs that could indicate whether the deceased was alive or not when the fire broke out, the cause of death, potential poisoning or intoxication (carbon monoxide, alcohol, drugs, etc.), the possibility of a third party intervention and of potential criminal involvement.
Available Online at www.ijpret.com 1543 for application development and includes services for building GUI applications, data access, and other component types. The framework is designed to simplify the reuse and integration of components. Android apps are built using a mandatory XML manifest file. The manifest file values are bound to the application at compile time. This file provides essential information to an Android platform for managing the life cycle of an application. Examples of the kinds of information included in a manifest file are descriptions of the app’s components among other architectural and configuration properties.
Professionalism is the foundation of trust on which the doctor-patient relationship is built. This study was performed to measure professionalism in Iranian physical medicine and rehabilitation residents as a baseline assessment tool for future studies. This was a descriptive study. The Persian version of the American Board of Internal Medicine (ABIM) questionnaire was distributed among all the second and third-year residents of the medical state universities of Iran (n=43). Data were summarized as mean (SD), and independent samples t-test was used for comparison of means between genders, and also between the second and third-year residents.
Comparison of the public hospitals procurement prices, retail private pharmacies and ADDO`s patient prices and NHIF patient prices for medicines in the health facilities showed that public hospitals procurement prices were 0.7591 times the international reference prices for 10 LPGs. This means that public hospitals procure medicines through MSD at a price below the available international market. NHIF patient prices for the lowest price of generic drugs were more (177.74%) than those in the public hospital procurement prices (Table 6). The NHIF patient prices were slightly higher compared to patient prices in the ADDO’s and retail pharmacies for the medicines. This shows that private medicine outlets will still make reasonable profits by providing services to NHIF beneficiaries who may have missed the drugs in the public hospitals. In addition, the availability of essential antibiotics was slightly higher (80%) in the retail pharmacies compared to ADDO’s (70%). However, the differences in availability of essential antibiotics between ADDO’s and retail pharmacies were not statistically significant (Table 6).
End of life: a source of ethical tension Progress in sci- ence and technology in recent decades, such as that made in medicine, has helped considerably to improve the living conditions and health of the populations of the industrialised countries, enabling people to reach a greater age and to live longer, quite often in full posses- sion of their physical and cognitive faculties. Yet this progress has not intrinsically altered our perception of death, except to make it more unacceptable. Although death is seen as a natural phenomenon, part of the nor- mal order of things, it is often an ordeal and a tragedy for those who witness it, as death is not merely the end of a life, but also the end of an existence, the loss of a unique individual who is special and irreplaceable. Death is thus experienced sometimes as an injustice, an out- rage, whatever ideas, representations, and beliefs are held on what happens to the person after death, whether death is seen as annihilation or not, as an enigma, a mystery, a passage, a metamorphosis… For many people, whether or not death has meaning depends more on the sense, or lack of it, accorded to life, in accordance with their religious, spiritual or philosophical views. The perception of death differs according, for example, to whether life is held to have no meaning unless it is lived with full possession of all physical and mental faculties, or rather that it is part of a greater whole that includes, for example, an afterlife, which gives transcendent mean- ing to the hardships of the life that is coming to an end. It is the tension between the natural side of death and what death contributes to the meaning of life that is today at the heart of debates in France on the end of life. Medicine obviously is not immune to this tension. It re- sponds to the tension through a form of prudential wisdom. Because medicine above all relates to human existences prey to diseases that may be seriously debili- tating, life-threatening or life-ending. In the struggle for life, it is medicine’s task to preserve the conditions of a life sufficiently viable to give rise to a veritable existence, and not to seek to avoid death indifferent to the condi- tions of the existence that ensues. It was in this spirit that the SRLF made its recommendations of 2002 on the withholding and withdrawal of treatment in intensive care . These recommendations were updated in 2009  and were fundamental in the drawing up of Leonetti’s law on the rights of patients and the end of life (No. 2005–370 of 22 April 2005). In 2010 an end-of-life is- sues group was tasked, among other things, with review- ing the state of knowledge on end-of-life conditions and related healthcare practices and with bringing to the public debate objective and reliable data on the reality of end-of-life situations in France. Once again it was the
All five libraries had comparable strong subjects in basic sciences and clinical medicine, which shows similarities in their collection priorities. However, the libraries had different weak areas. Due to budget limitations, it may difficult to develop all weak areas at once. Thus, one library might choose to develop one area, while other libraries might strengthen another area. These differences in weak areas could be considered a driving force for forming