Categories Of Medicines Research Articles

A concept analysis of ‘trial recruitment’ using the hybrid model – Phase 1 findings

Background: The International Committee of Medical Journal Editors (ICMJE) requires trials submitted for publication to be registered before enrolment of the first participant; however, there is ambiguity around the definition of recruitment and in anchoring the trial start date, end date, recruitment and enrolment, temporally to trial processes. There is potential for variation in how recruitment is reported and understood in trial protocols and trial reports. We report on Phase 1 of a concept analysis of 'trial recruitment' and develop a preliminary operational definition of 'trial recruitment'. Methods: A concept analysis using the hybrid model. We searched randomised and non-randomised trial reports published between January 2018 and June 2019. Included studies were sourced from the five top journals in the category of medicine with the highest impact factor. We examined how recruitment was defined temporally to four time points; screening, consent, randomisation, and allocation. Results: Of the 150 trial reports analysed, over half did not identify a clear time point of when recruitment took place in relation to any of screening/consent/randomisation/allocation. The majority of the assessed trials provided a time frame in relation to the trial (i.e. start/end date), the process that this time frame referred to differed between studies. There was variation across studies in the terminology used to describe entry to the trial and often multiple terms were used interchangeably. Conclusion: There is ambiguity around temporal descriptions of 'trial recruitment' in health care journals. Informed by the findings of Phase 1, we developed a preliminary temporal operational definition of trial recruitment based on i) trial recruitment of an individual or cluster and ii) the trial recruitment period. In Phase 2 this definition will be discussed in focus groups with healthcare workers involved in designing/implementing/reporting on trials; to contribute to the final phase (analytical phase) of this concept analysis.

Background styles in systematic review articles are not related to the publication in high-impact-factor journals: A meta-epidemiological study.

To clarify the styles used in background sections of systematic reviews (SR) and to identify which styles if any were related to the publication in high-impact-factor (HIF) medical journals. This was a cross-sectional study for original SR articles published in top 50 journals in MEDICINE, GENERAL & INTERNAL category in Journal Citation Reports 2018. We randomly included 90 articles from top 10 HIF journals and 90 from others, respectively. We conducted a content analysis to classify the background styles. We assessed the factors associated with the publication in HIF journals. We found 6 categories. We defined 6 categories as follows: Update of prior SR, New in scope than prior SR, Higher quality than prior SR, Completely new SR, Limitations of primary studies only, and Not presenting unknown in prior SR or primary studies. All 6 categories were not related to the publication in HIF journals. We found 6 categories of styles in background sections of SR, none of which however were related to publication in HIF journals. SR authors may wish to use any of these categories to communicate the importance of their research questions.

Determination and Comparison of Trace Elements in Various Parts of Eichhornia crassipes by a Validated Method using Inductively Coupled Plasma Mass Spectrometry and Atomic Emission Spectrometry

Objective : In this study, we have evaluated trace element concentration of various parts of Eicchornia crassipes, collected from three different lakes in Pune district, India.Methods : The dried segregated parts of Eicchornia crassipes were subjected to microwave digestion, followed by measurement with Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES) and Inductively Coupled Plasma-Mass Spectroscopy (ICP-MS). Optimization and validation of the method was performed for determining the minor and trace element concentrations of Co, I, Ni, Cu, Mn, Zn, Fe in roots, petiole and leaves of the plant. NIST Standard reference material SRM 1547 (Peach leaves) was used for establishing accuracy of the analytical method. Rhodium was used an internal standard for correcting matrix effects.Results and Discussion : A validated ICP-OES and ICP-MS method was established for determining the minor and trace element concentrations of Co, I, Ni, Cu, Mn, Zn, Fe in roots, petiole and leaves of the plant. Levels of all elements were found to be higher in roots, followed by petiole and leaves. Except for Zn and Fe, where concentration in leaves was found to be higher than in petiole. Of all the measured elements, total concentration of Mn was found to be highest (566 mg kg-1), followed by Fe (341 mg kg-1), Zn (40.26 mg kg-1), Cu (28.04 mg kg-1), Ni (9.54 mg kg-1), Co (4.33 mg kg-1) and I (0.94 mg kg-1). A surprising finding was the presence of iodine in the plant, despite its non-marine source.Conclusion : Plant-derived products form an important category in alternative medicine that is often used for treatment of several disorders. Eicchornia crassipes (water hyacinth), considered as the world’s worst weed, has been used in folk medicine, with very little evidence-based data to support its potential medicinal value. Here we report the trace element profile of Eicchornia crassipes. Insight into the trace element profile of various parts of the plant can perhaps be harnessed to postulate the rationale behind the use of specific parts of the weed in traditional medicine.

Medicinal ethnobotany of wild plants: a cross-cultural comparison around Georgia-Turkey border, the Western Lesser Caucasus

BackgroundThe Mountains of the Western Lesser Caucasus with its rich plant diversity, multicultural and multilingual nature host diverse ethnobotanical knowledge related to medicinal plants. However, cross-cultural medicinal ethnobotany and patterns of plant knowledge have not yet been investigated in the region. Doing so could highlight the salient medicinal plant species and show the variations between communities. This study aimed to determine and discuss the similarities and differences of medicinal ethnobotany among people living in highland pastures on both sides of the Georgia-Turkey border.MethodsDuring the 2017 and 2018 summer transhumance period, 119 participants (74 in Turkey, 45 in Georgia) were interviewed with semi-structured questions. The data was structured in use-reports (URs) following the ICPC classification. Cultural Importance (CI) Index, informant consensus factor (FIC), shared/separate species-use combinations, as well as literature data were used for comparing medicinal ethnobotany of the communities.ResultsOne thousand five hundred six UR for 152 native wild plant species were documented. More than half of the species are in common on both sides of the border. Out of 817 species-use combinations, only 9% of the use incidences are shared between communities across the border. Around 66% of these reports had not been previously mentioned specifically in the compared literature. Only 33 species have similar use reports in both countries, most important of which are Plantago major, Urtica dioica, Picea orientalis, Anthemis spp., Sambucus ebulus, Achillea millefolium, Helichrysum rubicundum, Mentha longifolia, Pinus sylvestris var. hamata, Hypericum perforatum, Tussilago farfara, Helichrysum plicatum, Rumex crispus, Berberis vulgaris, and Origanum vulgare. More than half of species reported in each country were found to have more than one part of the plant valued for medicinal use. The most common way of using plants medicinally in both countries is drinking the water infusion of aerial parts with flowers. Based on CI index value, two-thirds of the salient 15 genera in both countries have use reports in at least seven medicinal use categories. While the most cited category with highest FIC is digestive in Georgia, it is skin category in Turkey. Patterns of medicinal plant knowledge among studied communities appear to be connected with more than one cultural factor, in particular ethnolinguistic diversity, cultural background, and access to multilingual written folk and scientific literature, or probably a combination of various factors.ConclusionConsidering the regions’ floral similarity, common historical-cultural contact, and similar livelihood strategies of the communities, shared ethnomedicinal knowledge across the Georgia-Turkey border is quite low. Even though the impacts of accessing multilingual folk and scientific literature are likely to be significant, the factors that shape the medicinal plant knowledge patterns of the communities are shown to be variable among species, needing further research into intracultural diversity and socio-economical conditions, as well as the political history across the border.

\u201cPeruvian balsam\u201d: an example of transoceanic transfer of medicinal knowledge

BackgroundConnections between China and the new Spanish colonies in America are known for an exchange of silver for silks and porcelains. That also medicinal drugs and medicinal knowledge crossed the Pacific Ocean is hardly known or discussed. Myroxylon balsamum (L.) Harms var. pereirae (Royle) Harms (“New World“ or “Peruvian balsam“) is a botanical balsam that has a long history of medicinal use, particularly as antiseptic and for wound healing. Except for a Chinese article discussing the reception of balsam in China and Japan, no scientific studies on its impact in China and Japan and the channels of transfer from the Americas to Asia exist.MethodsDescription: (1) This section provides a general introduction into Commiphora gileadensis (“Old World” balsam) as a medicinal category and discusses the specific medicinal properties of Myroxylon balsamum (L.) Harms var. pereirae (Royle) Harms. The section “Historical research and uses” provides a brief survey on some historical analyses of balsam. Aim, design, setting: (2) Applying a comparative textual and archaeological analysis the article critically examines Chinese and Japanese sources (texts, maps) to show (i) what Chinese and Japanese scholars knew about balsam, (ii) where and how it was used, and (iii) to identify reasons why the “digestion” of knowledge on balsam as a medicinal developed so differently in China and Japan.Results and discussionThis chapter discusses the introduction of “Peruvian balsam” into, its uses as a medicinal as well as its scholarly reception in early modern China and Japan and introduces the channels of transmission from Spanish America to Asia. It is shown that Myroxylon balsamum (L.) Harms var. pereirae (Royle) Harms was partly a highly valued substance imported from the Americas into China and Japan. But the history of the reception of medicinal knowledge on Peruvian balsam was significantly different in China and Japan.ConclusionsIn Japan, the knowledge on Myroxylon balsamum was continuously updated, especially through mediation of Dutch physicians; Japanese scholars, doctors and pharmacists possessed a solid knowledge on this balsam, its origin and its medicinal uses. In China, on the contrary, there was no further “digestion” or development of the knowledge on either Myroxylon balsamum (L.) Harms var. pereirae (Royle) Harms or Commiphora gileadensis. By the late nineteenth century, related medicinal and even geographic knowledge had mostly been lost. The interest in “balsam” in late Qing scholarship was pure encyclopaedic and philosophic.

Emerging trends from COVID-19 research registered in the Clinical Trials Registry - India.

Since the beginning of the year, the deadly coronavirus pandemic, better known as coronavirus disease 2019 (COVID-19), brought the entire world to an unprecedented halt. In tandem with the global scenario, researchers in India are actively engaged in the conduct of clinical research to counter the pandemic. This review attempts to provide a comprehensive overview of the COVID-19 research in India including design aspects, through the clinical trials registered in the Clinical Trials Registry - India (CTRI) till June 5, 2020. One hundred and twenty two registered trials on COVID-19 were extracted from the CTRI database. These trials were categorized into modern medicine (n=42), traditional medicine (n=67) and miscellaneous (n=13). Of the 42 modern medicine trials, 28 were on repurposed drugs, used singly (n=24) or in combination (n=4). Of these 28 trials, 23 were to evaluate their therapeutic efficacy in different severities of the disease. There were nine registered trials on cell- and plasma-based therapies, two phytopharmaceutical trials and three vaccine trials. The traditional medicine trials category majorly comprised Ayurveda (n=45), followed by homeopathy (n=14) and others (n=8) from Yoga, Siddha and Unani. Among the traditional medicine category, 31 trials were prophylactic and 36 were therapeutic, mostly conducted on asymptomatic or mild-to-moderate COVID-19 patients. This review would showcase the research being conducted on COVID-19 in the country and highlight the research gaps to steer further studies.

Solving the problem of access to cardiovascular medicines: revolving fund pharmacy models in rural western Kenya

Availability of medicines for treatment of cardiovascular disease (CVD) is low in low-income and middle-income countries (LMIC). Supply chain models to improve the availability of quality CVD medicines in LMIC...

Study on mechanism of Tibetan medicine Zuomua Decoction in treatment of hypertension based on network pharmacology and molecular docking technology

Hypertension is a kind of chronic cardiovascular system disease caused by a series of factors and carriers dysfunction, which belongs to the category of Tibetan medicine "Chalong disease", and has a high rate of disability and mortality. Zuomua Decoction is a classical Tibetan medicine for Chalong disease, but its mechanism is not clear. Therefore, in this paper we explored the multi-components, multi-targets and multi-channels mechanism of Zuomua Decoction in the treatment of hypertension based on network pharmacology and molecular docking technology. First of all, the chemical components of Zuomua Decoction were obtained in the retrieval of traditional Chinese medicine systems pharmacology database(TCMSP), China National Knowledge Infrastructure(CNKI) and Wanfang database. The potential targets of Zuomua Decoction were predicted by BATMAN-TCM database, and the targets of hypertension were obtained by using DisGeNET database. The intersection of these two targets set was taken to obtain the potential targets of Zuomua Decoction in the treatment of hypertension, and then the chemical compositions-targets network was constructed. Secondly, the intersection targets were imported into STRING database to obtain the interaction relationship of intersection targets, and the protein interaction network of Zuomua Decoction in the treatment of hypertension was constructed in Cytoscape. Topological, GO, and KEGG enrichment analysis were used to construct the key targets-signal pathways-biological processes network diagram and explore the mechanism of Zuomua Decoction in the treatment of hypertension. Finally, the key targets were selected to construct the pharmacodynamic identification models to verify the effect mode of Zomua Decoction in treating hypertension. The results showed that there were 61 chemical components and 90 potential targets in the compounds-targets network. We obtained 21 key targets, 154 signal pathways, and 382 biological processes in topological, GO, and KEGG enrichment analysis of the protein interaction network, and in the comprehensive analysis, it was found that Zuomua Decoction could reduce blood pressure by regulating renin angiotension aldosterone system, balancing the concentration of intracellular calcium and sodium ions and regulating vasoconstriction and relaxation. ACE, AGTR1, and ADRB2 were used as the carriers for molecular docking study on the components of Zuoma Decoction, and the results showed that the chemical components of Zuomua Decoction had a good binding activity with key targets. The purpose of this study is to provide ideas for the in-depth study of Zuoma Decoction in the treatment of hypertension, and provide scientific basis for its clinical rational application.

Association between faecal occult bleeding and medicines prescribed for chronic disease: a data linkage study

AimsThe presence of detectable faecal haemoglobin (f-Hb) has been shown to be associated with all-cause mortality and with death from a number of chronic diseases not known to cause gastrointestinal...

Increase in public interest concerning alternative medicine during the COVID-19 pandemic in Indonesia: a Google Trends study

Background: The COVID-19 pandemic has triggered individuals to increase their healthy behaviour in order to prevent transmission, including improving their immunity potentially through the use of alternative medicines. This study aimed to examine public interest on alternative medicine during the COVID-19 pandemic using Google Trends in Indonesia. Methods: Employing a quantitative study, the Spearman rank test was used to analyze the correlation between Google Relative Search Volume (RSV) of various search terms, within the categories of alternative medicine, herbal medicine and practical activity, with COVID-19 cases. In addition, time lag correlation was also investigated. Results: Public interest toward alternative medicine during COVID-19 pandemic in Indonesia is dramatically escalating. All search term categories (alternative medicine, medical herbal, and alternative medicine activities) were positively associated with COVID-19 cases (p<0.05). The terms ‘ginger’ (r=0.6376), ‘curcumin’ (r=0.6550) and ‘planting ginger’ (0.6713) had the strongest correlation. Furthermore, time lag correlation between COVID-19 and Google RSV was also positively significant (p<0.05). Conclusion: Public interest concerning alternative medicine related terms dramatically increased after the first COVID-19 confirmed case was reported in Indonesia. Time lag correlation showed good performance using weekly data. The Indonesian Government will play an important role to provide and monitor information related to alternative medicine in order for the population to receive the maximum benefit.

Systematic Review of Transgender-Related Research in Radiology Over a Decade: There Is Work to Be Done.

The ACR has established that diversity and inclusion are central to its mission of excellence in the radiologic professions; therefore, radiologists have a responsibility to serve the imaging needs of the transgender community. To understand radiologists' current knowledge of transgender topics, the authors performed a systematic review of publications from radiology journals. A lexicon of 14 transgender-related terms was created and expanded through a PubMed keyword search. From the 129 journals from the radiology, nuclear medicine, and medical imaging category of Journal Citation Reports, 106 journals met the inclusion criteria, including English translation and Scopus data for the study period. Using the Scopus advanced search feature, articles with titles, abstracts, Medical Subject Headings terms, or key words including 1 of 14 transgender terms were identified and analyzed. Of the more than 200,000 articles published by the 106 journals from January 2008 to July 2019, 29 relevant articles were identified. Only 14 of the 106 journals published any transgender-related topics. The volume of articles has increased over time. The largest proportion of articles was published under the "general radiology" subsection, with the majority of these being editorials (6 of 10). Most of the original research was published under "neuroradiology" (7 of 13). Use of nonpreferred language, such as "transsexual" and "natal sex" was present through2019. Publication on transgender-related topics was uncommon among radiology journals. It is important to encourage further research and publication on transgender topics, as well as use of respectful, accepted language in radiology journals.

Population-Based Registry Analysis of Antidiabetics Dispensations: Trend Use in Spain between 2015 and 2018 with Reference to Driving.

Insulins and some oral antidiabetics are considered to be driving-impairing medicines (DIM) and they belong to the Driving under the Influence of Drugs, alcohol, and medicines (DRUID) category I (minor influence on fitness to drive). The trend of antidiabetics use in Castilla y León from 2015 to 2018 is presented through a population-based registry study. Treatment duration with these medicines and the concomitant use of other DIMs were observed. An adjustment method was used with information from the drivers’ license census. For all calculations, age and gender were taken into account. 3.98% of the general population used at least one antidiabetic, as well as 2.92% of drivers. The consumption of antidiabetics in men was higher than in women (4.35% vs. 3.61%, p = 0.001), and the use increases with age, especially from 35–39 years to 75–79 years in men and 85–89 years in women. Antidiabetics were consumed chronically, specifically 100% in the case of insulins and 95% in the case of oral antidiabetics. In addition to antidiabetics, 2.5 ± 1.86 DIMs were consumed, mainly anxiolytics (25.53%), opioids (23.03%), other analgesics and antipiretics (19.13%), and antidepressants (17.73%). Collaboration between pharmacists and physicians is a priority to clearly transmitting risks to patients. It is necessary that the health authorities include information on DIMs, such as the DRUID classification, in the prescription and dispensing software.

Analytical investigation of ternary mixture of phenylephrine hydrochloride, dimetindene maleate and benzalkonium chloride using validated stability indicating HPLC-DAD method

A stability-indicating high performance liquid chromatography method with diode array detection (HPLC-DAD) was developed and validated for simultaneous determination of phenylephrine hydrochloride (PHR), dimetindene maleate (DMD) and benzalkonium chloride (BZM) in nasal drops and gel dosage forms. Effective liquid chromatographic separation was accomplished by employing Venusil XBP Cyano column (4.6 × 250 mm, 5 µm particle size) with gradient elution of the mobile phase consisting of buffer solution of potassium dihydrogen phosphate (0.025 M) and sodium 1-butane sulfonate (SBS) (0.025 M) (adjusted to pH 6.0) and acetonitrile. Peak areas of PHR, DMD and BZM at 271, 256 and 206 nm, respectively were measured and correlated to their concentrations. Peaks of PHR and DMD eluted at retention times 3.76 and 9.06 min, respectively, while BZM eluted as a couple of peaks at 11.88 and 12.51 min. The proposed HPLC procedure was carefully validated in terms of system suitability, linearity, ranges, precision, accuracy, specificity, robustness, detection and quantification limits. The linearity range for both PHR and BZM was 10–400 μg/mL and DMD was 5–300 μg/mL with correlation coefficients >0.9999. The studied compounds were subjected to stress conditions of neutral, acidic and alkaline hydrolysis, oxidation and thermal degradation. Good resolution of the three compounds from their forced degradation products proves specificity and stability-indicating merits of the proposed method. In addition, resolution of the three drugs under investigation from some pharmaceutical compounds of different medicinal categories showed the high specificity of the described method.

Explaining the Process of Spiritual healing of Critically-ill Patients: A Grounded Theory Study.

Spiritual healing is one of the most intriguing category of alternative and complementary medicine. The aim of this study was to explain the process of spiritual healing in patients with refractory diseases in Iran. This grounded theory study was conducted in Iran from 2018 to 2019. The participants were 14 patients with refractory diseases and 4 healers whom were first selected through purposeful and then theoretical sampling. Semi-structured interviews were used to collect data on patients and healers. All the interviews were transcribed verbatim. Data were coded and grouped under specific categories and analyzed using the Strauss and Corbin's approach (2008). Four main categories emerged from data analysis including: I) frustration to initial acceptance II) disbelief to trust III) evaluation to action and IV) doubt to certainty. The results of our study provide context-specific factors affecting the complex and multifactorial nature of spiritual healing process in patients with refractory diseases. Health care professional can use these findings in designing and implementing appropriate interventions to integrate spiritual healing into their holistic practices of care.

Ethnomedicinal Plant Knowledge of the Karen in Thailand.

The Thai Karen, the largest hill-tribe in Thailand, guard substantial ethnomedicinal plant knowledge, as documented in several studies that targeted single villages. Here, we have compiled information from all the reliable and published sources to present a comprehensive overview of the Karen ethnomedicinal plant knowledge. Our dataset covers 31 Karen villages distributed over eight provinces in Thailand. We used the Cultural Importance Index (CI) to determine which species were the most valuable to the Karen and the Informant Consensus Factor (ICF) to evaluate how well distributed the knowledge of ethnomedicinal plants was in various medicinal use categories. In the 31 Karen villages, we found 3188 reports of ethnomedicinal plant uses of 732 species in 150 plant families. Chromolaena odorata, Biancaea sappan, and Tinospora crispa were the most important medicinal plants, with the highest CI values. The Leguminosae, Asteraceae, Zingiberaceae, Euphorbiaceae, Lamiaceae, Acanthaceae, Apocynaceae, and Menispermaceae were the families with the highest CI values in the mentioned order. A high proportion of all the 3188 Karen use reports were used to treat digestive, general and unspecified, musculoskeletal, and skin disorders.

The Effects of Probiotics and Prebiotics on Mental Disorders: A Review on Depression, Anxiety, Alzheimer, and Autism Spectrum Disorders.

Probiotics and their nutrient sources (prebiotics) have been shown to have positive effects on different organs of the host. The idea of their potential benefits on Central Nervous Systems (CNS) and the incidence of Anxiety, Schizophrenia, Alzheimer, Depression, Autism, and other mental disorders has proposed a new category of medicines called "psychobiotic" which is hoped to be of low-side effect anti-inflammatory, antidepressant, and anti-anxiety constitutes. In the current review, we present valuable insights into the complicated interactions between the GI microbiota (especially in the colon), brain, immune and central nervous systems and provide a summary of the main findings of the effects of pro- and prebiotics on important mental disorders from the potential mechanisms of action to their application in clinical practice. Google Scholar, Pub Med, Scopus, and Science Direct databases were searched using following key words: "probiotics", "prebiotics", "mental disorders", "psychological disorders", "depression", "anxiety", "stress", "Alzheimer" and "autism spectrum". The full text of potentially eligible studies was retrieved and assessed in detail by the reviewers. Data were extracted and then summarized from the selected papers. The results of the provided evidence suggest that probiotic and prebiotics might improve mental function via several mechanisms. The beneficial effects of their application in Depression, Anxiety, Alzheimer and autism spectrum diseases have also been supported in clinical studies. Pro and prebiotics can improve mental health and psychological function and can be offered as new medicines for common mental disorders, however, more clinical studies are necessary to conduct regarding the clinical significance of the effects and their bioequivalence or superiority against current treatments.

How well does Malaysia achieve value for money in public sector purchasing of medicines? Evidence from medicines procurement prices from 2010 to 2014

BackgroundMalaysia’s public healthcare sector provides a greater volume of medicines at lower overall cost compared to the private sector, indicating its importance in providing access to medicines for Malaysians. However, the Ministry of Health (MOH) has concerns about the continuous increase in the public sector medicines budget, and achieving efficiencies in medicines procurement is an important goal. The objectives of this study were to assess the overall trend in public sector pharmaceutical procurement efficiency from 2010 to 2014, and determine if the three different ways in which MOH procures medicines influence efficiency.MethodsWe matched medicines from the public sector procurement report by medicine formulation to medicines with a Management Sciences for Health (MSH) International Reference Price (IRP) for each year. Price ratios were calculated, and utilizing the information on quantity and expenditure for each product, summary measures of procurement efficiency were reported as quantity- and expenditure-weighted average price ratios (WAPRs) for each year. Utilizing MOH procurement data to obtain information on procurement type, a multiple regression analysis, controlling for factors that can influence prices, assessed whether procured efficiency (relative to IRPs) differed by MOH procurement type.ResultsMalaysia’s public sector purchased medicines at two to three times the IRP throughout the study period. However, procurement prices were relatively stable in terms of WAPRs each year (2.2 and 3.2 in 2010 to 1.9 and 2.9 in 2014 for quantity and expenditure WAPRs, respectively). Procurement efficiency did not vary between the three different methods of MOH procurement. Procurement efficiency of both imported originators and imported generics were significantly lower (P < 0.001 and P < 0.01) than local generic products, and medicine source and category influenced the procurement efficiency of each MOH procurement mechanism.ConclusionThe design of different medicines procurement mechanisms, along with the balance between ensuring competitive procurement prices and adhering to national industry and procurement policies, have not been able to achieve lower public sector medicines procurement prices (relative to IRP). Introducing pooled procurement options along with continuous monitoring of procurement efficiency and exploring ways to improve price competition among local and foreign suppliers is recommended.

Managing access to advanced therapy medicinal products: Challenges for NHS Wales.

Advanced Therapy Medicinal Products (ATMPs), which include gene, somatic cell therapies and tissue-engineered medicines, have the potential to transform current care pathways by offering durable and potentially curative outcomes. However, they are exceptionally expensive, with prices exceeding £1m per patient in some cases. With an expectation that a large number of ATMPs will soon gain marketing authorisation (global market is estimated to reach £9bn to £14bn by 2025), healthcare payers and providers face a number of challenges to facilitate patient access to this new category of medicines. This viewpoint reflects on the experience of introducing ATMPs into the National Health Service in Wales where £1 in every £200 spent on medicines (2019/2020) is expected to be on ATMPs for just 20 patients. Evidence to date makes it apparent that decisions regarding clinical and cost-effectiveness and the scale of the budget impact of implementing ATMPs create both financial and health service risks. Consequently, there are significant policy implications. A critical examination is made of the approaches taken for the health technology assessment and appraisal of ATMPs, the methods of payment and service impacts of these medicines, and the approach taken to horizon scanning and subsequent modelling of the financial impact over the next 10 years.

Ethno-medicinal and bio-cultural importance of aloes from south and east of the Great Rift Valley floristic regions of Ethiopia

There are 46 Aloe species identified from Ethiopia out of which 67.3% are endemics but comprehensive data on their ethno-medicinal and bio-cultural values are lacking. Interview, focus group discussion (FGD), and guided field walks were conducted with 210 respondents (152 men and 58 women). Relative frequency of citation (RFCs), informants' consensus factor (Fic), use value (UVs), relative importance index (RIs), and cultural value index (CV) were analyzed. Non-parametric Kruskal Wallis and Wilcoxon tests were performed using R software. Twenty-three Aloe species were recorded in the study areas with 196 use-reports and 2158 citations, grouped into six major use categories (NUC = 6). Medicinal use categories accounted for 149 use-reports (76%) with 1607 citations. The species with the highest numbers of use-reports were Aloe megalacantha subsp. alticola, A. trichosantha subsp. longiflora and A. calidophila of which 87, 75 and 61.1% respectively were medicinal uses. Aloe calidophila has highest values in all indices UV (11.72), RFC (0.68), RI (0.89), and CV (6.2). Among Aloe parts, leaf exudate accounted for 111 use-reports (49.1%) of which 92.9% were used for medicinal purposes. Aloe retrospiciens and A. ruspoliana were reported poisonous to carnivores. Fic values of the six major use categories ranged from 0.86 to 0.22. Elderly people (>60) had more knowledge than 25–40 and 41–60 age groups (Kruskal-Wallis chi-squared = 12.17, df = 3, p = 0.006), which is significant difference in depth of ethno-medicinal knowledge. Men had more knowledge of medicinal uses than women (Wilcoxon test, p = 0.002) significantly different, while women were knowledgeable than men for cultural uses like, cosmetic (Wilcoxon test, p = 0.06), not significantly different. The ways in which aloes are used and valued have implications for their future medicinal utility, which instigate detailed phytochemical and pharmacological studies.

The Emergency Medicine Facing the Challenge of Open Science

(1) Background: The availability of research datasets can strengthen and facilitate research processes. This is specifically relevant in the emergency medicine field due to the importance of providing immediate care in critical situations as the very current Coronavirus (COVID-19) Pandemic is showing to the scientific community. This work aims to show which Emergency Medicine journals indexed in Journal Citation Reports (JCR) currently meet data sharing criteria. (2) Methods: This study analyzes the editorial policies regarding the data deposit of the journals in the emergency medicine category of the JCR and evaluates the Supplementary material of the articles published in these journals that have been deposited in the PubMed Central repository. (3) Results: It has been observed that 19 out of the 24 journals contained in the emergency medicine category of Journal Citation Reports are also located in PubMed Central (PMC), yielding a total of 5983 articles. Out of these, only 9.4% of the articles contain supplemental material. Although second quartile journals of JCR emergency medicine category have quantitatively more articles in PMC, the main journals involved in the deposit of supplemental material belong to the first quartile, of which the most used format in the articles is pdf, followed by text documents. (4) Conclusion: This study reveals that data sharing remains an incipient practice in the emergency medicine field, as there are still barriers between researchers to participate in data sharing. Therefore, it is necessary to promote dynamics to improve this practice both qualitatively (the quality and format of datasets) and quantitatively (the quantity of datasets in absolute terms) in research.