统计指标在控制药品费用中的作用

目的：探讨统计指标在控制药品费用中的作用。方法：采用门诊人均药费、门诊人均医疗费、住院日均药费、住院日均医疗费等4个指标，制定调控值，并辅以相应的奖惩措施对药品费用进行控制。结果：门诊人均药费同比下降38％，住院日均药费下降46％，全院药费占医疗费比例由43.4％下降到27％。结论：统计指标在控制药品费用中有实用价值。     

我院实施药品集中供应后对医疗总费用的影响分析

目的:了解药品集中供应对医疗总费用的影响,对解决老百姓"看病贵"问题提供有效可行的建议。方法:利用PASW Statistics 18统计软件对我院药品集中供应改革前、后1年的门诊次均费用、门诊次均药费、住院次均费用、住院次均药费、平均床日费用等指标进行比较和统计学分析。结果:与改革前比较,改革后门诊次均费用降低13·58%、门诊次均药费降低24·50%、住院次均费用降低5·09%、住院次均药费降低8·91%、平均床日费用降低10·92%(P<0·05)。结论:药品集中供应能够通过降低门诊和住院次均药费从而降低患者医疗总费用。     

医院药品费用的控制措施探讨

控制医疗费用的快速增长是国务院2012年印发的第11号文件《“十二五”期间深化医药卫生体制改革规划暨实施方案》中的重要内容之一。2012年,我国医院门诊药费占门诊医药费的50．3％,住院药费占住院医药费的41．1％［1］,可见药品费用仍占医院业务收入的一半左右,故控制好了医院药品费用,对控制我国医疗费用的快速增长有显著的意义。近年来,我国医院药品费用一直处于快速上升趋势。据卫生部统计的一组数据显示［2］,我国综合医院门诊患者人均药品费用由2007年的68．0元逐渐增至2011年的92．4元,增加了35．8％,出院患者人均药品费用由2007年的2148．9元逐渐增至2011年的2939．7元,增长了36．8％。药品费用的快速增长有合理因素和不合理因素,其不合理因素主要是现行医疗体制的弊端、医院“以药养医”的经营模式、对处方者用药监管的松懈［3,4］等。目前,以破除医院“以药养医”机制为关键环节,一系列控制医院药品费用的政策和措施已出台并实施,医院作为药品的主要销售与使用端,在药品费用的控制中有着举足轻重的地位,医院应在明确政府和市场行为的基础上［5］,以患者为中心,积极响应国家政策,主动探索控制药品费用不合理增长的措施和方法,以缓解患者“看病贵”的问题。本文主要从医院临床管理方面对医院药品费用的控制措施予以总结。     

解决药价虚高又有新动作 中国即将掀起药品降价风暴

为落实温家宝总理知识精神切实解决群众看病难、看病贵问题和“药价虚高”问题,国家发改委酝酿再次对药品实施大幅度降价。参加降价专家论证会的中国医药商业协会副会长朱长浩日前透露:将对22种抗感染类药品实行降价,最高降幅达90％,平均降幅达60％,最低降幅为20％,其中专利药将降价30％。     

制药企业承受之重

近年来国家为了规范医药市场，解决老百姓看病难、看病贵的问题，出台了一系列的制度和政策：药品分类管理、医药购销领域治理商业贿赂、规范药品名称管理、药品降价等等，而药品降价是其中的主旋律。2006年8月22日，国家发改委发出了对青霉素等99种抗微生物药物的零售价格进行调整的通知，共涉72．400多个剂型规格，平均降价幅度30％，最大降幅达到76．8％，降价金额为434亿元。这是国家发改委继2006年6月份出台抗肿瘤药物价格调整方案之后的又一次药品调价措施。     

用系统观点认识“看病贵”与“药价高”的关系

目的:促进我国药品价格的合理确定和调整,对“看病贵”问题的有效解决提供参考。方法:分析“药价高”与“看病贵”的实质,以及决定药品费用高低的关键要素,用系统观点分析药品价格与药品费用之间的内在关系。结果与结论:我国目前采取的药品降价措施难以奏效;从药品价格入手解决“看病贵”问题的关键在于改革现行的药品定价方法,合理确定所有药品特别是具有可替代性药品间的差比价。     

普药难以背负降价之重——业界期待新的药品调价机制尽快建立

为解决群众“看病贵、看病难”的问题,到目前为止,国家对药品已经进行18次降价,降价金额超过400亿,可看病贵的问题至今仍然没有得到有效解决;与此同时,许多制药企业的利润在不断减少,行业亏损面在不断扩大。对如何破解这一难题,业内人士普遍认为,药品价格不能只降不升,药品定价应该在消费者利益、企业利益、国家利益和社会责任之间找到平衡点。     

对当前医药行业几个热点问题的思考

自1997年以来,尽管国家已先后实行了16次药品强制降价,“看病难,看病贵”反而愈演愈烈,但有关部门仍然乐此不疲,执着坚定地实行了第17次药品强制降价。一时间,舆论的焦点集中指向了“药价虚高”。刚刚经过以“GMP”、“GSP”认证为标志的行业调整,喘息未定、负重前行的医药行业成了众矢之的。似乎老百姓看不起病的原因都是因为医药行业唯利是图,追求暴利所致。我国的医疗体制改革总体上是不成功的,这说明当前出现的群众“看病难,看病贵”问题是有深层次原因的,一味打击医药行业,是无助于问题的解决的,甚至可能适得其反。“看病难,看病贵…     

取消药品加成政策在某县级公立医院的实施效果评价

目的:了解取消药品加成政策在某县级公立医院的实施效果及其影响。方法:对某县级公立医院取消药品加成政策实施前后的同期数据进行比较和分析。结果:取消药品加成政策实施后,住院药占比由44.11%降至35.67%,门诊药占比由49.50%降至38.84%,差异均有统计学意义(P<0.05);住院人均费用及住院人均药费、门诊人均费用及门诊人均药费均显著降低,差异有统计学意义(P<0.05),其中住院人均药费平均降幅为25.5%,门诊人均药费平均降幅为32.1%;但出院人次、门诊诊疗人次和人均住院日无明显变化。结论:取消药品加成政策能够减轻患者医疗费用负担。由此对医院收入产生的影响,一方面需财政合理补偿,另一方面还需医院自身通过提高医疗水平、调整和合理分配收入以充分体现医疗技术劳务价值、用优质的服务吸引患者等途径达到社会公益和医院效益"双赢"的状态。     

如何把药价降下来

<正> 在看病贵中,药物贵是最大的一块。那么,如何能把虚高的药价降下来?是否可以由政府来统制药价且实行降价?自1998年以来,政府有关机构已有过19次“药品降价令”,但效果并不明显。第18次药品降价,估计110个品种降幅25％,部分廉价药首次升价5％～10％。前17次降价的效果之所以不明显,问题在于,利益驱动之下,所降价的药品或称“普药”几乎进不了城市的大医院,而是很快被驱赶到乡间,甚至渐渐被驱赶出市场。今天我们在城里已经很难见到几分钱一粒的阿司匹林或者几块钱一支的青霉素     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.