广东廉价基药招标竞质不竞价

广东省卫生厅近日公布基本药物低价药品目录,目录内的药品招标将不再竞争价格,以避免低价药"中标死"。?2011年,广东省政府办基层医疗卫生机构基本药物集中采购实施方案首次制订了基本药物低价药品目录。进入目录的首先是基层医疗卫生机构临床常用、招标价格相对稳定     

《国家基本药物手册》（基层医疗卫生机构配备使用部分）出版上市

《国家基本药物手册》（基层医疗卫生机构配备使用部分）是由上海市执业药师协会、上海市中西医结合学会组织编写,由上海交通大学出版社于2009年11月底正式出版发行。该书收载了《国家基本药物目录（基层医疗卫生机械配备使用部分）》（2009版）所列入的全部药品共351个品种。     

国家基本药物目录中化学药品种与上市情况分析

目的分析我国《国家基本药物目录》中的化学药品种及其获准上市状况,为进一步完善《国家基本药物目录》遴选标准,加强基本药物的生产供应管理提供参考。方法检索国家食品药品监督管理局官方网站,对《国家基本药物目录·基层医疗卫生机构配备使用部分》（2009版）中201种化学药的获准上市药品的剂型、规格、生产企业逐项统计。结果《国家基本药物目录》化学药中的国产药品共有24种剂型、644种规格,涉及上市药品37854个、生产企业2908家;进口药品共有12种剂型,涉及品种43个,上市药品113个、生产企业53家。目录品种以常规剂型为主,规格繁多;重复生产严重,市场分布不均衡;独家品种和独家剂型品种的纳入缺乏有效证据;药品遴选机制尚待完善。结论建议将药品规格纳入基本药物目录;细化目录遴选机制,参照疾病谱合理遴选基本药物;基于上市药品再评价,制定严格的药品招标采购标准;优化基本药物目录。     

成都市三圈7个乡镇和社区卫生服务机构药品使用现况调查——三圈七院六站预调查报告之三

目的通过预调查了解成都市基层医疗卫生机构用药和合理用药情况，为进一步全面调查和循证制定成都市基层基本药物目录制度提供证据，促进合理用药。方法收集成都市7个城乡基层卫生机构最近一个年度的用药记录，包括药品种类、品种数、金额和使用量。采用描述性分析和ABC分类法统计药物信息，计算基层卫生机构实际用药占WHO基本药物示范目录、医保目录和国家基本药物目录的比例。结果成都市一圈乡院／中心用药品种数是二，三圈乡院的4倍，二、三圈使用品种数最多的三类西药为抗感染药、消化系统用药、维生素类药、矿物质与微量元素；使用品种数最多的中成药分别是内科类、外科类、妇科类。总金额西药约占60％，中成药占40％。乡院／中心不合理用药表现为：过度使用注射剂、过度使用药品和抗生素不合理使用。结论建议循证筛选并缩减国家基本药物目录收录的药物品种，根据不同地区的疾病负担、支付水平和用药需求制订区域性基本药物目录，再将地区目录与药品报销目录整合，有利于提高基本药物的使用率。控费重点是金额比例较高的药物。合理用药监测重点是使用频度比例较大的药物。应成都市卫生局资助项目成立药物与治疗学委员会，围绕基本药物目录的建设、使用、报销和患者满意度开展动态监测、教育、评价和持续改进。     

我国基本药物目录、基本医疗保险药物目录和WHO基本药物目录比较

目的比较我国《基本药物目录》、《国家基本医疗保险药物目录》与世界卫生组织（WHO）《基本药物目录》的异同,为调整我国新的《基本药物目录》和《国家基本医疗保险药物目录》提供科学依据：方法比较分析我国《基本药物目录》、《国家基本医疗保险药物目录》和WHO《基本药物目录》在药物遴选、标准和方法更新及所包含的药物种类、亚类、具体收录药物等方面的异同。结果我国《基本药物目录》、《国家基本医疗保险药物目录》与WHO《基本药物目录》在药物遴选与更新方面存在较大差异。WHO最新《基本药物目录》（2007年版）收录27个种类,共340种药物;我国最新《基本药物目录》（2004年版）收录23个种类,共773种药物,其中包含WHO基本药物23个种类,重合225种药物,重合率66．17％,占我国《基本药物目录》的29．11％;我国《国家基本医疗保险药物目录》（2005年版）收录23个种类,共1031种药物,其中包含WHO基本药物22个种类,重合227种药物。重合率66．76％,占我国《国家基本医疗保险药品目录》的22．02％。我国《国家基本医疗保险药物目录》以我国《基本药物目录》为指导,两者在药物遴选、更新和具体药物收录方面差异较小。结论我国《基本药物目录》、我国《国家基本医疗保险药品目录》与WHO《基本药物目录》在药物遴选、更新、具体药物收录等方面有较大差异,建议以WHO《基本药物目录》为指导,进一步完善药物目录的遴选原则和更新程序,科学合理地收录基本药物。     

国家基本药物目录最晚明年调整

在2011年10月12日召开的新闻发布会上,卫生部药政司司长郑宏表示,最晚不迟于2012年,国家基本药物目录将进行调整。新的目录将不再区分基层机构和大医院版本。基本药物制度实施已近3年,各地对基本药物目录调整的呼声也日渐增高。从实施情况看,基层版的基本药物目录对其他基     

我国2009版基本药物目录（基层）与WHO2010版儿童基本药物示范目录比较分析

目的比较2009版我国《基本药物目录（基层医疗机构配备使用部分）》和世界卫生组织（WHO）儿童基本药物示范目录（EMLc）的异同,为循证制订我国儿童基本药物目录提供参考。方法采用描述性分析的方法比较上述两种目录在内容组成、药物种类、具体药物、药物剂型和使用标识说明等方面的异同。结果①WHO儿童基本药物示范目录由核心目录和补充目录两部份组成,我国基本药物目录（基层）无此分类;②我国基本药物目录（基层）与WHO儿童基本药物示范目录有20个分类重合,但未包含WHO儿童目录的抗肿瘤药、血液制品、消毒剂、腹膜透析液和新生儿用药;③两目录的品种重合数与WHO儿童目录重合率平均为52.61%,15类（占75%）在20%～80%,较高;与我国目录重合率平均为44.19%,11类（占55%）在20%～50%,达最高;品种重合率超过80%的仅有调节水、电解质及酸碱平衡药,耳鼻喉用药重合率为0%;④我国基本药物目录（基层）无药物规格和儿童用药标识,无药物年龄限制和说明,药物剂型缺少适合儿童的混悬液、糖浆剂、滴剂、颗粒剂、刻痕片剂等。结论我国2009版基本药物目录（基层）尚不适合儿童。WHO儿童基本药物示范目录基于全球儿童的疾病负担,直接套用于我国存在安全隐患。建议借鉴WHO制订EMLc的标准和方法,循证制订适合我国儿童疾病负担和临床需求的儿童基本药物目录,促进儿童合理用药。     

编前寄语

"2020年人人享有基本医疗卫生服务"是我国政府对民众和全世界的承诺。在国家"保基本、强基层、建机制"的新医改方针指导下,基于基层主要疾病负担,为基层疗机构遴选安全、有效、价廉、可及的基本药物成为重要而紧迫的任务。在由南昌大学牵头,并与山东省医学科学院和     

山西医疗机构乱收费责任人将予以5倍罚款

国务院深化医药卫生体制改革领导小组办公室日前启动和部署国家基本药物制度工作。根据实施规划,建立国家基本药物制度的工作目标任务是：到2011年,初步建立国家基本药物制度;到2020年,全国实施规范的覆盖城乡的国家基本药物制度。今年的工作任务和目标是：每个省（区、市）在30％的政府举办城市社区卫生服务机构和县（基层医疗卫生机构）实施基本药物制度,     

北京居民健康档案5年建立完成

2010年12月16日首都医药卫生协调委员会第二次全体会议透露,自2011年1月1日起,北京市将用5年时间完成全体居民电子病历和居民健康档案建设。北京市已在所有政府举办的社区卫生服务机构建立了国家基本药物制度,全部共计519种药物实施零差率销售。北京市将在政府举办的基层医疗卫生机构以外的医疗卫生机构,把基本药物作为首选药物,并达到一定的使用比例。针对看病难、看病贵问题,明年北京市将研究推进改革药品和医疗服务价格形成机制。按计划分步骤、有升有降地进行医疗服     

Safety in the use of compressed air versus oxygen for the ophthalmic patient

Oxygen, routinely administered during surgery to avoid hypoxia, poses risks including increased likelihood of surgical room fires and predisposition to retinal phototoxicity in patients. Compressed air to supplement ventilation may be safer than oxygen. The purpose of this study was to determine whether hypoxia occurs more frequently when compressed air replaces supplemental oxygen during ophthalmic surgery. A convenience sample of 111 patients was randomly assigned to receive supplemental oxygen (group 1) or compressed air (group 2). Patients with serious cardiac or pulmonary disease were excluded. Blood oxygen levels were monitored during surgery by pulse oximetry. Oxygen was administered to all group 2 patients whose oxygen saturation fell to less than 90% or by more than 5% below baseline. No differences were observed between groups in age, ASA classification, type of surgery, or anesthetic drugs or doses. Minor, but statistically higher oxygen values were observed in group 1. The frequency with which oxygen saturation decreased below 90% or below 5% of baseline was similar in both groups. Supplemental oxygen is not required routinely in selected patients undergoing ophthalmic surgery. By using compressed air, the risk of operating room fires and retinal phototoxicity may be reduced.     

Oxygen therapy and exercise response in lung disease

Lung disease affects exercise performance through a number of mechanisms, including hypoxemia, abnormal ventilatory mechanics, abnormal ventilatory muscles, abnormal ventilatory patterns, abnormal right heart function and subjective dyspnea. Supplemental oxygen improves hypoxemia and thus improves exercise impairment resulting from hypoxemia-related reductions in oxygen delivery. Supplemental oxygen also reduces exercise ventilation. This, in turn, reduces ventilatory muscle work, and the concomitant permissive hypercapnia may have beneficial effects at the cellular level. Additionally, in obstructive disease patients, an improved ventilatory pattern may reduce air trapping. Supplemental oxygen may also improve right ventricular dysfunction in patients with underlying right ventricular dysfunction. Finally, supplemental oxygen may reduce dyspnea caused by oxygen-related carotid body activity. Important questions remain. First, is long-term oxygen use of benefit in patients with only exercise hypoxemia? Second, is exercise conditioning possible in patients with exercise hypoxemia? Third, does supplemental oxygen enhance exercise conditioning efforts in those patients with CLD but without exercise hypoxemia? If the answer to this last question is yes, what selection criteria should be used to identify those who would benefit? The answers to all of these questions will have enormous impact on our approach to the optimal management of CLD patients.     

Has oxygen administration delayed appropriate respiratory care? Fallacies regarding oxygen therapy

Modern clinical use of supplemental oxygen supposes that: (1) exposure to F(IO)(2) < or = 60% is without adverse effects, (2) an individual at risk of developing arterial hypoxemia can be protected by administering high F(IO)(2), and (3) routine administration of supplemental oxygen is useful, harmless, and clinically indicated. There is now substantial evidence that none of those 3 suppositions are correct, and, on the contrary, supplemental oxygen is actually detrimental to many of the patients who receive it. Supplemental oxygen is much overused and its use should be limited to the few conditions and situations in which it is truly effective, useful, and non-detrimental.     

Supplemental oxygen is not required in trauma patients treated with IV opiates

The risk of respiratory depression can prevent the proper use of opioids in trauma patients and lead to use of supplemental oxygen. However, high FiO(2) might contribute to atelectasis formation and consequently to relative hypoxia. Supplemental oxygen also can cause a risk of fire. In a randomized, controlled study we evaluated the need and effects of supplemental oxygen in 13 patients with extremity trauma who were treated pain-free with an intravenous opioid, oxycodone (dose range 6.75-13.6 mg). After opioid injection, 7 patients received 40% supplemental oxygen and 6 were breathing room air. Pulse oxygen saturation (SpO(2)), arterial blood gases, and hemodynamic parameters were monitored for 30 minutes. Atelectasis formation was evaluated with a computed tomography scan. No hypoxia, hypoventilation, or significant atelectasis formation was detected in any of the patients. Accordingly, routinely given supplemental oxygen was not considered necessary in these patients because no complications were seen.     

Supplemental perioperative oxygen for reducing surgical site infection: a meta-analysis

Objective  To assess the efficacy of supplemental perioperative oxygenation for prevention of surgical site infection (SSI).
Data sources  Computerized PUBMED and MEDLINE search supplemented by manual searches for relevant articles.
Study selection  Randomized, controlled trials evaluating efficacy of supplemental perioperative oxygenation versus standard care for prevention of SSI in patients' undergoing colorectal surgery.
Data synthesis  Data on incidence of SSI were abstracted as dichotomous variables. Pooled estimates of the relative risk (RR) and 95% confidence interval (CI) were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenzel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I².
Results  Four randomized controlled trials met the inclusion criteria. Supplemental perioperative oxygenation resulted in a reduced incidence of SSI [RR 0.70 (95% CI 0.52–0.94), P  = 0.01], using a fixed effects model. Using the more conservative random effects model, the point estimate was similar [RR 0.74 (95% CI 0.39–1.43), P  = 0.37], but the results failed to achieve statistical significance. The I² test showed moderate heterogeneity.
Conclusions  Our analysis showed that supplemental perioperative oxygenation is beneficial in preventing SSI in patients undergoing colorectal surgery. Because of heterogeneity in study design and patient population, additional randomized trials are needed to determine whether this confers benefit in all patient populations undergoing other types of surgery. Supplemental perioperative oxygenation is a low-cost intervention that we recommend be implemented in patients undergoing colorectal surgery pending the results of further studies. Further research is needed to determine whether or not supplemental hyperoxia may cause unanticipated adverse effects.     

Effects of intercessory prayer on patients with rheumatoid arthritis

BACKGROUND: Many individuals pray during times of illness, but the clinical effects of prayer are not well-understood. METHODS: We prospectively studied a cohort of 40 patients (mean age, 62 years; 100% white; 82% women) at a private rheumatology practice. All had class II or III rheumatoid arthritis and took stable doses of antirheumatic medications. All received a 3-day intervention, including 6 hours of education and 6 hours of direct-contact intercessory prayer. Nineteen randomly selected sample patients had 6 months of daily, supplemental intercessory prayer by individuals located elsewhere. Ten arthritis-specific outcome variables were measured at baseline and at 3-month intervals for 1 year. RESULTS: Patients receiving in-person intercessory prayer showed significant overall improvement during 1-year follow-up. No additional effects from supplemental, distant intercessory prayer were found. CONCLUSIONS: In-person intercessory prayer may be a useful adjunct to standard medical care for certain patients with rheumatoid arthritis. Supplemental, distant intercessory prayer offers no additional benefits.     

Therapy of the acute porphyrias

In the management of acute porphyria it is essential to be aware of the potential for many drugs to induce porphyrin synthesis and thus precipitate the acute porphyric crisis. In this review, lists of drugs unsafe and safe for use in the porphyrias are presented. In addition, therapeutic regimens are described which are appropriate to the porphyric subject. These include the use of high carbohydrate intake and the intravenous infusion of haem arginate.     

不完全川崎病与脓毒症患儿AHA推荐实验室指标的比较分析

目的探讨美国心脏病学会(AHA)推荐的8项实验室指标在不完全川崎病(iKD)早期诊断中的临床意义。方法回顾性分析了2006年1月至2010年12月间36例住院iKD患儿的临床资料,以45例脓毒症患儿作为对照组,比较分析了两组患儿AHA推荐的8项iKD诊断增补实验室指标的检测结果。结果①iKD和脓毒症两组间在外周血WBC、PLT、Hb的定量比较中无差异(P均>0.05),而在CRP、ESR、ALB、ALT定量比较的t检验中有统计学意义(P均<0.05);②iKD组ESR异常升高及≥3项指标异常的几率明显高于脓毒症组,且有统计学意义(P均<0.05)。结论 AHA推荐的8项实验室指标,有助于iKD和脓毒症的鉴别诊断,对于早期诊断iKD有一定的临床意义。     

Total parenteral nutrition in critically ill surgical patients: fixed vs tailored caloric replacement

In critically ill patients accurate measurement of total energy expenditure (TEE) is possible by means of continuous indirect calorimetry. Since in many ICUs the necessary equipment is not available, the Harris-Benedict formula (HB) is frequently used to calculate TEE. Supplemental application of a clinical correction factor (HBc) has been advised. In this study we assessed the reliability of both methods of calculation and of a standard nutritional regimen, all three compared to the calorimetrically measured TEE (gold standard). Although the basic HB-formula did not perform better than the standard regimen, significantly better results were obtained by supplemental application of the clinical correction factor (HBc). It is left undecided, whether or not indirect calorimetry is actually to be preferred in daily clinical practice.