Trends of self-reported non-adherence among type 2 diabetes medication users in the United States across three years using the self-reported Medication Adherence Reasons Scale

Background & aimsTo determine the trends of self-reported non-adherence rates among adults taking Type 2 medicines (T2D) medicines between 2017 and 2019 and to identify the patterns for the frequently reported reasons for non-adherence in the United States.Methods & resultsData from the National Health and Wellness Survey, a self-administered, internet-based cross-sectional survey of US adults from 2017 to 2019 was used. Non-adherence was measured using the self-reported Medication Adherence Reasons Scale (MAR-Scale). Frequencies were used to identify the reasons for non-adherence for insulin and non-insulin therapies for T2D.Data were obtained from 2983 respondents in 2017, 5416 in 2018, and 5268 in 2019. Based on the MAR-Scale, the self-reported medication non-adherence rate was 25% in 2017, 21% in 2018, and 27% in 2019. The most common reason for non-adherence across all the three years was simple forgetfulness, yet patients reported the lowest mean number of days missing medication for that reason. Though less frequently reported, non-adherence lasted longer when patient did not know how to take their medicines, cost was a reason, or had concerns about the long term effects of the medicines.ConclusionsWith no significant improvement in adherence with T2D medicines over time, regardless of better awareness and extensive diabetes education, focus should be on individualized non-adherence reasons-based interventions.     

Real-World Impact of Transferring the Dispensing of Hospital-Only Medicines to Community Pharmacies During the COVID-19 Pandemic

ObjectivesIn Portugal, the dispensing of most outpatient specialty medicines is performed exclusively through hospital pharmacies and totally financed by the National Health Service. During the COVID-19 first wave, the government allowed the transfer of the dispensing of hospital-only medicines (HOMs) to community pharmacies (CPs). This study aimed to measure the value generated by the intervention of CP in the dispensing of HOM.MethodsA single-arm, before-and-after study with 3-month follow-up was conducted enrolling a randomly selected sample of patients or caregivers with at least 1 dispensation of HOM through CP. Data were collected by telephone interview. Main outcomes were patients’ self-reported adherence (Measure Treatment Adherence), health-related quality of life (EQ-5D 3-Level), satisfaction with the service, and costs related to HOM access.ResultsOverall 603 subjects were recruited to participate in the study (males 50.6%) with mean 55 years old (SD = 16). The already high mean adherence score to therapy improved significantly (P < .0001), and no statistically significant change (P > .5757) was found in the mean EQ-5D score between baseline (0.7 ± 0.3) and 3-month follow-up (0.8 ± 0.3). Annual savings account for €262.1/person, arising from travel expenses and absenteeism reduction. Participants reported a significant increase in satisfaction levels in all evaluated domains—pharmacist’s availability, opening hours, waiting time, privacy conditions, and overall experience.ConclusionsChanging the dispense setting to CP may promote better access and satisfaction. Moreover, it ensures the persistence of treatments, promotes savings for citizens, and reduces the burden of healthcare services, representing a crucial public health measure.     

Out of the boxes,out of the silos: The need of interdisciplinary collaboration to reduce poor-quality medical products in the supply chain

In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area.     

本草类书籍与《滇南本草》历代药图演变评述*

本草学是东方医药学的重要标志。在生境中辨识药用植物是本草学的重点，本草著作在对药用植物进行描述的同时，基于知识传授的实际需要，会配以药图帮助学者掌握该药材的特点以方便识别。药图在发展过程中逐渐从本草著作的附属成为独立的册页，其科学和艺术价值也日益凸显，然而其重要性并没有被太多研究者重视，尤其将药图研究的视野从传统医药扩展至文化史、艺术史、美学和文化资源学等领域的研究成果更是鲜有。本文从本草学和本草图谱的演变发展历史为线索，以云南地域本草的杠鼎之作《滇南本草》各时期版本中代表性药图作为研究对象，对比《本草纲目》等几种代表性本草著作中的药图，结合文化和艺术史相关知识，初步梳理《滇南本草》各历史时期药图的特点，分析其演变原因和具体社会条件，尝试从历史角度理解和归纳这些不同时期和版本药图的发展变化呈现的特点并揭示我们今天研究和利用中国传统药图这一重要文化资源的意义和价值。     

针对目前已注册的上市中成药治疗新型冠状病毒肺炎临床研究分析＊

本研究系统分析了中成药治疗新型冠状病毒肺炎临床研究方案注册信息，以提高相关临床研究设计质量，以及为中成药上市后评价提供参考和建议。对中国临床试验注册中心网站（www.chictr.org.cn）和美国临床试验注册中心网站（clinicaltrials.gov）进行检索，以新型肺炎、COVID-19、中成药等为检索词，检索新型冠状病毒肺炎中成药相关临床研究方案。按照纳排标准筛选临床研究，并提取注册号、研究题目、研究设计及类型、干预措施等数据，采用描述性分析方法对纳入研究的注册信息进行分析。共纳入新型冠状病毒肺炎中成药相关研究方案35个，其中涉及的8种中成药是新冠肺炎诊疗方案（第七版）中所推荐使用的药物。评价的干预措施共涉及23种中成药（如血必净注射液、喜炎平注射液、连花清瘟胶囊/颗粒等）。主要疗效指标以退热时间、疾病痊愈时间/有效率等为主。结果显示：中成药治疗新冠肺炎的临床研究响应快速，目前已注册多个临床研究，包括疾病诊治、预防全过程。但也存在问题，如研究人群不明确、评价指标代表性差等，相关研究设计和实施尚有待优化，以进一步提高临床试验研究的可行性，以期为当前和后续更多的临床研究方案提供参考。     

Experimental and In Silico Analysis of Cordycepin and its Derivatives as Endometrial Cancer Treatment

The aim of this study was to investigate the inhibition effects of cordycepin and its derivatives on endometrial cancer cell growth. Cytotoxicity MTT assays, clonogenic assays, and flow cytometry were used to observe the effects on apoptosis and regulation of the cell cycle of Ishikawa cells under various concentrations of cordycepin, cisplatin, and combinations of the two. Validated in silico docking simulations were performed on 31 cordycepin derivatives against adenosine deaminase (ADA) to predict their binding affinities and hence their potential tendency to be metabolized by ADA. Cordycepin has a significant dose-dependent inhibitory effect on cell proliferation. The combination of cordycepin and cisplatin produced greater inhibition effects than did cordycepin alone. Apoptosis investigations confirmed the ability of cordycepin to induce the apoptosis of Ishikawa cells. The in silico results indicate that compound MRS5698 is least metabolized by ADA and has acceptable drug likeness and safety profiles. This is the first study to confirm the cytotoxic effects of cordycepin on endometrial cancer cells. This study also identified cordycepin derivatives with promising pharmacological and pharmacokinetic properties for further investigation in the development of new treatments for endometrial cancer     

中草药种植品质知识图谱的构建

科学合理地种植中草药是解决中药资源紧缺、保障中药质量的根本方法。中草药品质受种子种苗、种植措施、土壤状况等多种因素影响，各影响因素对中草药品质产生不同的作用，但迄今为止并没有通过调控中草药种植因素分析中药材品质的模型和方法。因此，本研究通过文献调研结合专家种植经验，综合分析影响中草药种植指标的复杂因素，以提高中药材品质为目标，基于图数据库的方法构建影响不同中草药种植品质的知识图谱，探讨中草药种植因素与指标之间的关系，通过调节影响中药材品质的因素，为中草药种植以及提高中药品质提供依据。     

Impact of pharmaceutical price controls on the cost of cardiovascular drugs: does essentiality matter?

ABSTRACT

Background

With the goal of improving the affordability of medicines, governments across the globe have instituted various forms of price controls. Since 2013, India has been regulating the prices of drugs included in its national list of essential medicines (NLEM). Here we evaluate the cost variations among available cardiovascular drugs and perform cost-analysis comparing essential and non-essential drugs.     

中西医结合治疗新型冠状病毒肺炎100例疗效及肝损伤情况分析

目的回顾性分析100例上海地区新型冠状病毒肺炎(简称"新冠肺炎")患者中西医结合治疗后的临床疗效及肝损伤情况。方法收集2020年1月22日至2020年2月10日上海市公共卫生临床中心收治的100例新冠肺炎患者的出入院临床资料及治疗方案信息,观察舌象、脉象、中医证候及肝损伤情况、临床结局与转归,比较临床症状、炎症及免疫相关指标的变化情况。结果①本研究中新冠肺炎患者的中医证型主要以热毒闭肺型、湿毒郁肺型、肺脾气虚型三型为主;实证明显偏多,虚证主要为肺脾气虚,气阴两虚偏少。②入院时无任何症状者有43例(占43.0%);服用中药汤剂以后,52例有症状患者的发热、咳嗽、咳痰、纳差、腹泻等主要症状均有不同程度改善。③中药汤剂治疗前与治疗1周后比较,患者的血清白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)等炎症指标及CD4~+等免疫指标差异有统计学意义,均得到明显改善(P0.05)。④中药汤剂治疗前,共有16例患者已存在轻度肝损伤;将服中药治疗前及治疗1周后的肝功能指标进行比较,发现治疗后其中有2例患者的肝功能恢复正常,其余14例仍存在肝损伤、但均为轻度,且治疗前后肝功能各项指标差异无统计学意义(P0.05);其余84例患者在中药汤剂治疗前及治疗1周后肝功能各项指标均在正常范围内。⑤本研究中,共有81例(81.0%)患者病愈出院,19例(19.0%)患者仍在治疗中,病死率为0%。出院患者的平均住院时间为(16.0±5.8)d。5例重型患者中有3例病愈出院,剩余2例病情转轻,未向危重型发展,危重症转化率为0%。⑥81例出院患者中,仅有5例(6.2%)患者胸部CT提示肺炎感染病灶完全吸收,剩余76例(93.8%)患者胸部CT仍提示存在不同程度的异常病变。结论中西医结合治疗,特别是辨证应用中药汤剂治疗可明显减轻新冠肺炎患者的发热、咳嗽、纳差、腹泻等主要临床症状,改善体内炎症反应及免疫失调,降低病死率及危重症转化率,且不会造成药物性肝损伤。     

中药雾化吸入联合常规疗法与护理措施干预甲状腺癌术后声音嘶哑效果分析

目的:观察在常规治疗与护理基础上加用中药雾化吸入治疗甲状腺癌术后声音嘶哑的效果。方法:纳入120例气阴两虚型甲状腺癌术后声音嘶哑患者,应用随机数字表法分为2组各60例,2组均采用常规治疗与护理措施干预,观察组加用中药雾化吸入治疗,2组疗程均为1个月。治疗前后评价2组患者的声音嘶哑情况评分,评价患者在观察期的用药依从性,出院前评价护理满意度,并比较2组的治疗效果。结果:治疗1个月后,观察组临床疗效优于对照组,差异有统计学意义(P<0.05)。观察组患者的用药依从性情况较好,绝大多数患者能够按时按量用药,不受症状波动的影响,2组比较,差异有统计学意义(P<0.05)。观察组护理满意度高于对照组,差异有统计学意义(P<0.05)。结论:在常规治疗与护理基础上加用中药雾化吸入干预甲状腺癌术后声音嘶哑,可有效改善声音嘶哑、提高疗效,提高患者的用药依从性和对护理措施的满意度。