Objective To investigate the situation of supplemental drugs to the national essential medicines list (EML) in primary health care facilities. Methods Supplemental essential medicine lists published by provincial governments around our country were identified. Characteristics of categories, names and quantities of the supplemental drugs were extracted and compared. Results Supplemental lists issued by 13 provinces were included. The number of the supplemental drugs of four provinces including Jiangsu, Guangdong, Inner Mongolia and Shandong surpassed 200. All the included lists contained chemicals and traditional Chinese medicine, as well as nine categories mentioned in the EML. The frequency of 17 drugs in the supplemental lists was over 10. Specific paediatrics drugs and antitumor drugs were considered by several provinces. Conclusion At present, EML cannot meet the requirements of the primary healthcare. Selection and amendment of EML may refer to the supplemental lists which reflect the demands of essential drugs in every area in our country.
Objective To analyze chemical drugs included in the National Essential Medicines List (EML) of China, to provide reference on how to improve the selection criteria and strengthen management and supply of essential medicines. Methods Dosage form, specification and manufacturers of 201 kinds of chemical drugs included in the EML were retrieved through SFDA website, data collection and analysis were conducted using Excel software. Results Domestic chemical drugs in EML involved 24 kinds of dosage forms, 644 kinds of specifications, 37 854 kinds of drugs for sales, and 2 908 manufacturers. Imported chemical drugs in EML involved 12 kinds of dosage forms, 43 kinds of specifications, 113 kinds of drugs for sales, and 53 manufacturers. Included drugs were primarily normal dosage forms while chemical drugs had many different specifications. Medicines duplication in production was serious and the distribution in market was unbalanced. The sole and exclusive dosage form variety lacked of effective evidence. Selection mechanism and reevaluation needed to be developed. Conclusion It is suggested to include drug specification in EML, and refer to spectrum of diseases for detailed selection mechanism of essential drugs, reevaluation of the listed drugs and formulate strict drug bidding rules so as to optimize EML.
Thisstudyisbasedonaretrospectivereviewof48patientswithechinococcosisofliverwithemphasisonthedifferentialdiagnosisandtheselectionofsurgery.Causesofmisdiagnosisandtheevaluationofavariousoperationsonthisdiseasewerediscussed.Results:Thecommonmisdiagnosiswasduetoobscurehistoryandsymptoms,errorsonimmunologicaltests,lackofspecificmanifestationonradiologicalexaminationandtheforemostsymptomsofcomplications.Theoperativewaysmustbechoseninaccordancewitheachindividualdisease.Theimprovementofoperativetechniquessuchas“tumorfree”operation,irrigationwithhypertonicsalinesolution,infillingwithgreateromentum,applicationofbiojellycanincreasethetherapeuticeffectofoperation.Conclusion:Thekeypointofdifferentialdiagnosisistorecognizetheatypicalcases.Rationalselectionofoperationsandimprovementofoperativetechniquesandmethodsarethecrucialtoincreasethetherapeuticeffectofthisdisease.
OBJECTIVE: To investigate the selection and identification of human keratinocyte stem cells(KSC) in vitro. METHODS: According to the characteristics of KSC which can adhere to extracellular matrix very fast, we selected 3 groups of different time(5 minutes, 20 minutes and 60 minutes) and unselected as control group. And the cells were identified by monoclone antibody of beta 1-integrin and cytokeratin 19 (Ck19), then the image analysis was done. Furthermore we analyzed the cultured cells with flow cytometer(FCM) and observed the ultrastructure of the cell by transmission electron microscope(TEM). RESULTS: The cell clones formed in all groups after 10 to 14 days, while the cells of 5 minute group grew more slowly than those of the other groups, however, the clones of this group were bigger. The expression of beta 1-integrin and Ck19 were found in all groups. The positive rate of beta 1-integrin was significant difference between 5 minute group and the other groups (P lt; 0.05). And the expression of Ck19 was no significant difference between 5 minute group and 20 minute group(P gt; 0.05), and between 60 minute group and control group. But significant difference was observed between the former and the later groups(P lt; 0.05). The result of FCM showed that most cells of the 5 minute group lied in G1 period of cell cycle, which was different from those of the other groups. At the same time, the cells of 5 minute group were smaller and contained fewer organelles than those of the other groups. CONCLUSION: The above results demonstrate that the cells of 5 minute group have a slow cell cycle, characteristics of immaturity, and behaving like clonogenic cells in vitro. The cells have the general anticipated properties for KSC. So the KSC can be selected by rapid attachment to extracellular matrix and identified by monoclone antibody of beta 1-integrin and Ck19.
Objectives To analyze the development and implementation of the national drug policy in order to provide decision-making for the establishment of the Chinese national drug policy. Methods Nineteen electronic databases, the WHO, the World Bank, and governmental websites were included in this study. A pre-designed data extraction form was used to collect information. The data were analyzed and described by a pre-designed analytic framework. Result A total of 182 studies were included in this review. The main points of common concern in the national drug policy were: drug regulation and quality assurance, rational use of drugs, drug supply, the selection of essential drugs, human resource development and training, traditional medicine, drug financing and affordability, drug research, monitoring and assessment of the nation drug policy, technical cooperation, and the national pharmaceutical industry. The selection of essential drugs, quality assurance, supply, pricing, and supply of traditional medicine were gradually carried out in China. Pharmaceutical research, monitoring and evaluation, as well as the development of pharmaceutical industry and technical cooperation within it should be further strengthened. Conclusion China should establish related organizations and working procedures; speed up the implementation of the legislation of national drug policy; integrate the mechanism of essential drugs selection and supply system; regulate the order of medicine production and regulation; establish scientific and reasonable pricing mechanisms for drugs and assessment systems; strengthen the monitoring and evaluation of national drug policy and update and improve the national drug policy.
Objective To compare the national essential medicines list (EML) and national essential insurance medicine list (EIML) of China with that of the WHO, so as to provide reasonable evidence for the adjustment of new EML and EIML of China. Methods The similarities and differences in the selection, updating, categories, subcategories and the amounts of medicines in the EML and EIML of China and the WHO EML were compared and analyzed. Results There are some differences among the three lists in selecting principles, updating of medicines .The latest version of WHO EML (version in 2007) has 27 categories, including 340 medicines; China EML (version in 2004) has 23 categories and 773 western medicines, containing 23 categories and 225 (66.17%) similar medicines of WHO EML, which accounts for 29.11% of EML of China. China EIML (version in 2005) has 23 categories and 1 031 western medicines, containing 22 categories and 227 (66.76%) of WHO EML, which accounts for 22.02% of EIML of China. China EIML was developed based on China EML. There is little difference in selecting, updating, categories of medicines. Conclusion The difference was obviously found in medicine selection, updating and categories between China EML, EIML and WHO EML. We suggested that our national EML and EIML should be more reasonably selected and updated base on the principals of WHO EML.
The steps of searching evidence were introduced. How to select computer retrieval systems and searching engines were discussed including evidence retrieval systems and other medical information retrieval systems, bibliography systems and full-text systems, metasearch engine systems and single search engine systems, as well as the engines for evaluating information and the general medical search engines.
ObjectiveTo explore the selection problem of independent variables and stepwise regression method for multiple logistic regression analysis. MethodsAccording to the data of the case-control investigation for coronary heart disease, age (X1), hypertension history (X2), hypertension family history (X3), smoking (X4), hyperlipidemia history (X5), animal fat intake (X6), weight index (X7), type A personality (X8), and coronary heart disease (CHD, Y) were analyzed by SPSS 18.0 software. The multiple logistic regression analysis was done and the differences of risk factors were compared among 6 kinds stepwise regression variable selection method. ResultsThe univariate analysis showed that no difference was found between CHD group and non-CHD group in age distribution (P=0.116). But the multivariate logistic regression analysis showed that, comparing to population over 65 years old, age was a protective factor on the low age groups (OR< 45=0.100, 0.000 to 0.484, P=0.020; OR45-54=0.051, 0.003 to 0.975, P=0.048). If the age was defined as categorical variable, the risk factors for coronary heart disease were animal fat intake (X6), type A personality (X8), hypertension history (X5) and age (X1), respectively (P < 0.05). If the age was defined as a continuous variable, the effect of age (X1) was not statistically significant (P=0.053). The common risk factors were intake of animal fat (X6) and type a personality (X8) by six kinds method of stepwise variable selection. In addition, the risk factor also included hyperlipidemia history (X5) (forward-condition, forward-LR, forward-wald), hypertension family history (X3), age (X1) (backward-condition, backward-LR) and hypertension history (X2) (backward-wald). ConclusionStepwise regression method should be used to analyze all the variables, including no statistically significant independent variables in univariate analysis. If the categorical variable is regarded as continuous variables, some information may be lost, and even the risk factors may be missed. When the risk factors are not the same by several stepwise regression variable selection method, it should be combined with clinical and epidemiological significance, as well as biological mechanisms and other professional knowledge.
ObjectiveTo analyze the current status of the application of randomization methods in randomized controlled trials (RCTs) which have been published in New England Journal of Medicine (NEJM).MethodsRCTs published by NEJM in 2018 were searched and collected. The characteristics of clinical trial design elements and the application status of randomization methods were comprehensively analyzed to distinguish blind trial and non-blind trial, and characteristics of application of randomization methods and selection of allocation concealment mechanisms of non-blind trials were summarized.ResultsA total of 151 RCTs were published in NEJM in 2018, in which blinded trials and non-blinded trials accounted for 75 (49.67%) and 76 (50.33%), respectively. 34 (22.52%) RCTs did not report specific randomization methods, and the remaining 117 (77.48%) reported. Among the latter, stratified block randomization accounted for the main body (72.65%), followed by block randomization (11.11%), minimization method (9.40%), simple randomization method (4.27%) and the others. There was no significant difference in the proportion of reporting or using randomization methods between blind and non-blind trials (P>0.05). In 76 non-blind trials, 38 (50.00%) clearly reported the concealment method of random allocation, among which 37 used the central randomization (97.37%) and 1 used envelope method (2.63%).ConclusionsThe current RCTs published in NEJM still have problems in the selection of randomization methods to be optimized and the transparency of randomization reporting to be improved.
Pragmatic randomized controlled trials can provide high-quality evidence. However, pragmatic trials need to frequently encounter the missing outcome data due to the challenges of quality assurance and control. The missing outcome could lead to bias which may misguide the conclusions. Thus, it is crucial to handle the missing outcome data appropriately. Our study initially summarized the bias structures and missingness mechanisms, and then reviewed important methods based on the assumption of missing at random. We referred to the multiple imputations and inverse probability of censoring weighting for dealing with missing outcomes. This paper aimed to provide insights on how to choose the statistical methods on missing outcome data.