Free Medicine Research Articles

Out-of-pocket payment and catastrophic health expenditure of tuberculosis patients in accessing care at public-private mix clinics in Myanmar, 2022

BackgroundThe financial burden of tuberculosis (TB) can hinder patients and their families, creating obstacles throughout the care cascade, despite TB prevention and control being provided free of charge. In Myanmar, patients can visit private providers operating under public-private mix (PPM) schemes, where TB services (diagnosis and treatment) are typically offered at no cost. The study focused on quantifying the financial burden faced by TB patients seeking care from Myanmar's PPM providers.MethodsThis cross-sectional telephone survey included 695 adults seeking TB treatment [drug-susceptible TB (DS-TB) and retreatment TB] from various private providers in four states and regions with high TB burden in Myanmar. Telephone interviews were conducted in May and June 2022. Both direct and indirect costs incurred from the patient and their household perspective were valued in 2022 and estimated throughout pre- and post-TB treatment episodes. The TB-affected households were defined as experiencing catastrophic health expenditure if their expenditure due to TB exceeded 20% of their capacity to pay, as recommended by the World Health Organization. All cost data were collected in Myanmar Kyats (MMK) and converted to USD (1 USD = 1850 MMK as of July 20, 2022). Logistic regression analysis was done to identify the determinants of catastrophic health expenditure.ResultsThe findings showed patients made a median of 7 times for clinic visits throughout their treatment, with the median total cost for the entire TB treatment being 53.4 US dollars (USD), including direct medical and testing costs (11.9 USD) and direct non-medical patient expenditure (11.6 USD). Pre-treatment costs were higher compared to post-treatment costs (the intensive phase and continuation phase). During the intensive phase, TB care cost was nearly free, but during the continuation phase, it was a median of 2.6 USD. About 34.5% of patients experienced catastrophic health expenditure due to TB treatment, with expenses exceeding 20% of their capacity to pay. Multivariate regression analysis revealed that patients with a history of hospitalization (aOR = 14.84; P < 0.01), seeking care from regions other than Yangon (aOR = 2.6; P < 0.01), and using coping strategies (aOR = 12.53; P < 0.01), were more likely to face catastrophic financial burdens. Higher monthly household income (over 162 USD) was associated with a decreased risk of incurring catastrophic health expenditure (aOR = 0.38; P < 0.01).ConclusionsTB patients and their households in Myanmar faced risk of catastrophic costs, even when treated in the private sector with free diagnostic charges and anti-TB medicine. The study highlighted the need for additional strategies or policies to make TB care affordable and mitigate the financial burden of TB-affected households.Graphical

The perception of Ukrainians about political life in the post-war period and the prospects for the spread of populism

The non-acceptance by the majority of the population of Ukraine of the idea of elections during a full-scale war is a forced prolongation of the legitimacy of existing state institutions. Ukrainians understand all the risks of such elections for the political system under martial law, agreeing to the norms of legislation and compliance with democratic procedures. At the same time, a sufficiently significant number of the population is forming, which does not share the monopolization of power during the war by one political force. Accumulation of political issues, which will be expressed in the post-war period, will become a significant challenge for the political class of Ukraine. The low level of trust in existing political parties and the growing demand for new political forces can become a favorable background for the spread of anti-elitist ideas of populism. In public opinion, there is a demand mostly for politicians from the military environment and to a lesser extent from expert and civil sectors, intelligentsia, and volunteers. Reconstruction of the post-war economy will require non-standard solutions, in particular, optimization of expenditures in the social sphere and maximum liberalization. Several innovations will not have support in the mass consciousness. In particular, Ukrainians are mostly in favor of free medicine and education, a ban on the sale of land to foreigners, and assigning responsibility for increasing people’s incomes to the state, not to the individual. The lack of financial resources after the end of the war can accelerate the growing social deprivation. The combination of these potentially conflicting attitudes with a high level of antagonism and intolerance to a different political point of view can be skilfully «warmed up» by populist forces.

Research trends and hotspots of ferroptosis in neurodegenerative diseases from 2013 to 2023: A bibliometrics study

BackgroundWith the aging population, the incidence of neurodegenerative diseases increases yearly, seriously impacting human health. Various journals have published studies on the pathogenesis of ferroptosis in neurodegenerative diseases. However, bibliometric analysis in this field is still lacking. The study aims to visually analyze global research trends in this field over the past decade. MethodsThe articles and reviews regarding ferroptosis in neurodegenerative diseases were retrieved from the Web of Science on September 1, 2023. Citespace [version 6.2. R4 (64-bit)] and VOSviewer (version 1.6.18) were used to conduct the bibliometric and knowledge-map analysis. ResultsIn total, 370 studies were included in the paper and ranked by their citation frequency. Many articles on ferroptosis in neurodegenerative diseases have been published in the past decade. The country, institution, author, and journal with the highest publications were China, Guangzhou Medical University, Maher, Pamela, and Free Radical Biology And Medicine, respectively. The analysis of keyword co-occurrence indicated that research frontiers were molecular mechanisms of ferroptosis in neurodegenerative diseases, especially a few key pathways that triggered ferroptosis in these diseases, including lipid peroxidation signaling, iron metabolism, and GSH/GPX4 signaling. In addition, ferroptosis inhibitors such as liproxstatins and ferrostatins had protective effects in animal models of neurodegenerative diseases. Therefore, future attention should also be focused on therapeutic drugs that target ferroptosis. ConclusionThis study comprehensively analyzed the publications on ferroptosis in neurodegenerative diseases from a bibliometric perspective. Research on this topic is currently expanding at a rapid pace, and the China holds a leading position in this field by its scientific achievements and productivity. Moreover, the research frontiers were molecular mechanisms of ferroptosis in neurodegenerative diseases and developing targeted therapeutic drugs. In summary, our results showed an all-sided overview of the knowledge atlas and a valuable reference for the future research in this field.

“Зеленые” против бедных: противоречия левого энвайронментализма

The article examines the prospects of an alliance between the ideology of environmentalism and left-wing ideological trends aimed at solving the problems of the poor and socially vulnerable. It is noted that although the “greens” have often been criticized for their focus on the interests of the middle class and ignoring the material problems of the social “grassroots”, modern left-wing theorists increasingly associate the solution to the problem of global warming with the struggle for the material interests of the “exploited and oppressed” (representatives of the working class, precarious workers, poor residents of developing countries, minorities, etc.). It is assumed that the richest, not the poor, should pay for the energy transition; many jobs will be needed for such a transition; serious material climate damage will be prevented; residents of the poorest countries will benefit from the fight against global warming, because they are most vulnerable to droughts, floods and other potential catastrophic events. Today, it is also increasingly noted that “green” energy has already become competitive, and the main problem is in the selfish interests of capitalists. Nevertheless, as the author shows, despite the attempts of the “greens” to get closer to the “reds”, objective realities indicate a fundamental difference between the interests of environmentalists and those who today need basic material goods at present. “Green” energy has not become cheaper than fossil fuels, and attempts to radically accelerate the energy transition can lead to an economic, not a climatic, catastrophe. Moreover, it is impossible to solve all the problems at once: a choice is inevitable between urgent investments in the energy transition and the achievement of other socially significant goals: affordable education, free and high-quality medicine, housing construction for all those in need, and much more.

Research progress of ferroptosis in Parkinson's disease: a bibliometric and visual analysis.

In recent years, the role of ferroptosis in Parkinson's disease (PD) has become a research hotspot based on evidence of abnormal iron deposition and lipid peroxidation damage in the brains of PD patients. This study aims to examine the relevant research on ferroptosis and PD from a bibliometric perspective. Original research and review articles related to ferroptosis and PD were retrieved from the Web of Science Core Collection (WOSCC) database. Statistical analysis and visualization of information including countries, institutions, authors, journals, and keywords of the included studies were conducted using the R software package "bibliometrix." A total of 414 articles met the inclusion criteria, averaging 37.86 citations per article. From 2012 to 2022, the average annual growth rate of research in this area was 63.44%. The corresponding authors of published articles were mainly affiliated with institutions in China, the United States, and Australia. Shanghai Jiao Tong University in China and the University of Melbourne in Australia emerged as the most active and influential institutions. The journal with the highest H-index and publication output was Free Radical Biology and Medicine. "Ferroptosis," "immunotherapy," "prognosis" and "microenvironment" were identified as high-frequency keywords, indicating current and future research directions in this field. This bibliometric study provides insights into current research hotspots and emerging trends in the growing field of ferroptosis research related to PD. The high-frequency keywords identified highlight active areas of investigation involving methods, mechanisms, and populations of interest.

Trends and hotspots of publications on ferroptosis: A 10 Year overview

BackgroundFerroptosis was proposed to be a type of programmed cell death in 2012. Ferroptosis plays a significant role in a variety of illnesses. ObjectiveTo better understand the direction of future research, we performed a bibliometric analysis to identify research hotspots with a focus on ferroptosis. MethodsThe search terms [TI = “ferroptosis” OR (“GSH” AND “GPX4”) OR “lipid peroxidation” OR “iron homeostasis” OR “iron metabolism”] AND [PY = “2012–2022”] AND [DT = “Article OR Review”] AND [LA = “English”] were used to retrieve publications related to ferroptosis for a bibliometric analysis. We utilized Microsoft Excel to calculate the frequency and proportion of the published articles, VOSviewer to perform a co-occurrence analysis and for visualizing the data, CiteSpace to obtain a timeline of keywords and institutions, and RStudio to calculate citation metrics. As indicated by the analysis, indicators such as the number of publications, the most productive authors and coauthorship status, the distribution of publications by country, favoured journals, the most influential institutions and the most frequently cited documents are reported in this article. ResultsA total of 8009 publications were retrieved from the WOS core collection, and 197 papers published in 2023 were removed from this analysis. The remaining 7812 papers, which included 118 in the WOS collection, were incorporated into the bibliometric study. ConclusionThe number of annual scientific publications on ferroptosis have been increasing each year. The academic communities represented by Tang, Daolin, Stockwell, Brent R., Wang, Fudi, and Conrad, Marcus were the most authoritative. China, USA, and Germany were the front-runners in the field of ferroptosis. Free Radical Biology and Medicine was the largest contributor of ferroptosis-related research, and Cell and Nature were the most influential journals to publish articles on ferroptosis. Columbia Univ and Univ Pittsburgh were the institutions that received the most attention. Recent research on ferroptosis has been focused on molecular mechanisms, particularly those in the contexts of various diseases, which will be a hotspot of future research. In addition, interdisciplinary ferroptosis and big-data research is expected to be a new frontier.

A scientometrics and visualization analysis of oxidative stress modulator Nrf2 in cancer profiles its characteristics and reveals its association with immune response

BackgroundNrf2, an essential and fascinating transcription factor, enjoys a dual property in the occurrence and development of inflammation and cancer. For over two decades, numerous studies regarding Nrf2 in cancer have been reported, whereas there is still a lack of a scientometrics and visualization analysis of Nrf2 in cancer. Hence, a scientometric study regarding the oxidative stress modulator Nrf2 was implemented. MethodsAfter the quality screening, we defined 7168 relevant studies from 2000 to 2021. CiteSpace, VOSviewer, R software, and GraphPad Prism were used for the following scientometric study and visualization analysis, including field profiles, research hotspots, and future predictions. ResultsThe total number of publications and citations are 1058 and 54,690, respectively. After polynomial fitting curve analysis, two prediction functions of the annual publication number (y = 3.3909x2 - 13585x + 1 E+07) and citation number (185.45x2 - 743669x + 7 E+08) were generated. After scientometric analysis, we found that Biochemistry Molecular Biology correlates with Nrf2 in cancer highly, and Free Radical Biology and Medicine is a good choice for submitting Nrf2-related manuscripts. The current research hotspots of Nrf2 in cancer mainly focus on cancer therapy and its cellular and molecular mechanisms. “antioxidant response element (87.5)", “gene expression (43.98)", “antioxidant responsive element (21.14)", “chemoprevention (20.05)", “carcinogenesis (19.2)", “cancer chemoprevention (18.45)", “free radical (17.15)", “response element (14.17)", and “chemopreventive agent (14.04)" are important for cancer therapy study. In addition, “glutathione-S-transferase (47)", “keap1 (15.39)", and “heme oxygenase 1 gene (24.35)" are important for inflammation and cell fate study. More interestingly, by performing an “InfoMap” algorithm, the thematic map showed that the “immune response” is essential to oxidative stress modulator Nrf2 but not well developed, indicating it deserves further exploration. ConclusionThis study revealed field profiles, research hotspots, and future directions of oxidative stress modulator Nrf2 in inflammation and cancer research, and our findings will offer a vigorous roadmap for further studies in this field.

Effect of Free Medicine Distribution on Health Care Costs in Canada Over 3 Years

Few interventions are proven to reduce total health care costs, and addressing cost-related nonadherence has the potential to do so. To determine the effect of eliminating out-of-pocket medication fees on total health care costs. This secondary analysis of a multicenter randomized clinical trial using a prespecified outcome took place across 9 primary care sites in Ontario, Canada (6 in Toronto and 3 in rural areas), where health care services are generally publicly funded. Adult patients (≥18 years old) reporting cost-related nonadherence to medicines in the past 12 months were recruited between June 1, 2016, and April 28, 2017, and followed up until April 28, 2020. Data analysis was completed in 2021. Access to a comprehensive list of 128 medicines commonly prescribed in ambulatory care with no out-of-pocket costs for 3 years vs usual medicine access. Total publicly funded health care costs over 3 years, including costs of hospitalizations. Health care costs were determined using administrative data from Ontario's single-payer health care system, and all costs are reported in Canadian dollars with adjustments for inflation. A total of 747 participants from 9 primary care sites were included in the analysis (mean [SD] age, 51 [14] years; 421 [56.4%] female). Free medicine distribution was associated with a lower median total health care spending over 3 years of $1641 (95% CI, $454-$2792; P = .006). Mean total spending was $4465 (95% CI, -$944 to $9874) lower over the 3-year period. In this secondary analysis of a randomized clinical trial, eliminating out-of-pocket medication expenses for patients with cost-related nonadherence in primary care was associated with lower health care spending over 3 years. These findings suggest that eliminating out-of-pocket medication costs for patients could reduce overall costs of health care. ClinicalTrials.gov Identifier: NCT02744963.

Technical expertise and behavior of the doctor- a major determinant of waiting time of OPD patients

Background: The study was conducted to understand various factors affecting waiting time spent by the patients in outpatient department (OPD) and to provide recommendations for reducing the waiting time in OPD of the selected hospital. Methods: It was a descriptive cross-sectional pretested questionnaire-based study involving all new 100 consenting patients at OPD recruited into the study using a systematic sampling technique after calculating the sampling interval. Results: The study indicates that 70% of patients were satisfied and only 30% were dissatisfied with the attention given by the OPD staff, cleanliness, attentiveness of doctor but shows great dissatisfaction regarding the waiting time spent by them in the outpatient department. Most of the subjects gave the reason for their satisfaction despite more time because of expertise of the doctor, behavior of the doctor, association of hospital with non-government organizations and insurance companies for free medicine and surgery. The dissatisfaction was not because of lack of administration but because of low level of awareness amongst patients attending the OPD about internet booking of appointment, COVID protocols, priorities given to recommendations given by other doctors/VIPs and walk in OPDs attended without prior appointment. Conclusions: A very important observation which evolved from the study was the version of patients that waiting time does not matter because they want to be treated from same doctor due to his/her expertise. Second important observation was that the addressing and greeting of patient by his/her name gave a great satisfaction and level of comfort to patients and affects the waiting time.

Impact of COVID-19 on cardiovascular clinics: Are we ready for telemedicine?

The need for telemedicine was felt more than ever during the COVID-19 pandemic, which impacted health care worldwide. Therefore, this study aimed to determine the difficulties faced by patients in visiting the cardiac outpatient department during COVID-19, along with assessing the awareness and acceptability of telemedicine. In this cross-sectional study, selected patients presenting to outpatient department of a tertiary care cardiac hospital were interviewed regarding the difficulties faced by patients in visiting the outpatient department during COVID-19 and their awareness and acceptability of telemedicine using a self-designed structured questionnaire. Of the 403 patients, 58.3% were male, the mean age was 53.04 ± 11.73 years, and most (77.7%) were urban residents. Ischemic heart disease was present in 69.5%, followed by hypertension (38.7%) and heart failure (29.3%). A total of 26.6% required emergency room visits. Limited appointments (55.6%) was the most common problem faced by patients during COVID-19, followed by financial issues (17.1%), fear of acquiring infection (13.4%), and limited mobility due to lockdown (22.6%). Only 12.2% were aware of telemedicine, 4.5% had previously used it, and 41.2% were willing to opt for telemedicine in the future. No internet access (39.2%) was the key barrier to the usage of telemedicine, followed by a lack of free medicine (39%) and a lack of a smart device (31.5%). Limited appointments due to COVID-19 restrictions has made it difficult for patients to visit the clinics, which has led to increased emergency room visits. Telemedicine awareness was found to be limited; however, many patients were willing to adopt it provided their limitations could be overcome.

Effect of free medicine distribution on ability to make ends meet: post hoc quantitative subgroup analysis and qualitative thematic analysis

ObjectivesOut-of-pocket medication costs can contribute to financial insecurity and many Canadians have trouble affording medicines. This study aimed to determine if the effect of eliminating out-of-pocket medication costs on individual’s...

A Collaborative Approach: Clinical Pathway for Gastrointestinal Bleeding When Transfusion Is Not an Option

Introduction: With a high risk of morbidity and mortality, gastrointestinal bleeding (GIB) is a common cause of hospitalization, with transfusion considered the standard of care. Urgent treatment of a GIB can be challenging for many patients, such as Jehovah's Witnesses, who cannot accept transfusion of red blood cells due to religious convictions. We developed a clinical pathway to manage GIB in patients in whom transfusion is not an option, with hematologists providing a crucial role in managing anemia, coagulopathies, and reversal agents. Our Transfusion Free Medicine (TFM) Program at Pennsylvania Hospital sees 1200 Jehovah's Witness patients annually. We were asked to develop a clinical pathway to share throughout the University of Pennsylvania health system due to our 100% survival rate with GIB in Jehovah's Witnesses spanning two decades. The pathway we created incorporates basic patient blood management strategies focusing on rapid interventions to control ongoing blood loss, correcting coagulopathies, and the utilization of pharmacologic agents to enhance hemostasis. Methods: A multidisciplinary team of specialists, including physicians, advanced practice providers from hematology, gastroenterology, cardiology, interventional radiology, and members of the TFM program, was convened. Practicing Jehovah's Witness coordinators were specifically included to educate and counsel patients and providers on medical practices acceptable to Jehovah's Witness. A literature review was performed to collate evidence-based practices for managing GIB. The review informed the development of the clinical pathway. Dissemination and access to the pathway included uploading a schematic onto a shared health system clinical care platform (Dorsata). The tool provides clinical decision support to providers by standardizing the approach to triage, navigation, and multi-modality treatment. The pathway structure is based on either upper or lower gastrointestinal bleeding. Implementation included clinical decision support built within the electronic medical records platform (EPIC) using smart phrases. These interventions facilitated gastroenterology, hematology, interventional radiology cardiology, and transfusion-free medicine referrals. Results: The developed clinical pathway for upper GIB is depicted below with plans to track patient outcomes as it is used more frequently throughout the health system. Conclusion: We developed and piloted a clinical care pathway to manage GI bleeding in patients who can not be transfused by leveraging expertise from a multidisciplinary team. Differences from the standard GI pathway where transfusion support is recommended include the essential role of the hematologist, cardiologist, interventional radiologist, and gastroenterologist to advise alternatives. The Cardiologist's role was essential to assist with reversal agents and determine the modification or withholding of cardiac medications when profound anemia occurs. These simple patient blood management strategies in the pathway have been successful, so much so that we believe they can be utilized in all patients with GIB. This pathway may also eliminate or reduce the need for unnecessary transfusion support, improve patient outcomes and create a more collaborative approach to treating gastrointestinal bleeding when transfusion is not an option. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

ПЛАТНЫЕ И БЕСПЛАТНЫЕ МЕДИЦИНСКИЕ УСЛУГИ: ИСТОРИЧЕСКИЕ ПАРАЛЛЕЛИ РАЗВИТИЯ

One of the most pressing issues has always been the question of the cost of medical care. The article shows that different periods of history were characterized by different costs of medical care. The history of the ancient world and the Middle Ages was characterized by both free medicine and paid in the form of products or material values. It was shown how Russian healthcare system and the formation of the cost of medical services are reflected in different periods of history. It has been noted that the need of all social strata and rulers for medical services since ancient times has turned medical service into an important component of society’s life. Therefore, medicine inevitably interacted with various social spheres. Throughout history, this relationship has depended on many factors. Many patients believe that medical care should be free, some argue that free care is ineffective, and that is why it is necessary to introduce paid medicine. It has been revealed that so far the balance between paid and free medicine in the world has not been reached.

The research landscape of ferroptosis in the brain: A bibliometric analysis.

Background: Ferroptosis is a newly proposed concept of programmed cell death and has been widely studied in many diseases during the past decade. However, a bibliometric study that concentrates on publication outputs and research trends of ferroptosis related to the brain is lacking. Methods: We retrieved publication data in the field of ferroptosis in the brain from the Web of Science Core Collection on 31 December 2021. A bibliometric analysis was performed using VOSviewer and CiteSpace software. Results: Six hundred fifty-six documents focusing on ferroptosis in the brain were published from 2012 to 2021. The number of publications in this field has shown a steady increase in recent years. Most publications were from China (338) and the United States (166), while the most productive organizations were at the University of Melbourne (34) and University of Pittsburgh (23). Ashley I. Bush was the most productive author, while Scott J Dixon was the most co-cited author. The journal Free Radical Biology and Medicine published the most articles in this field, while Cell was the most cited journal. Among 656 publications, top 10 cited documents were cited at least 300 times. Among the top 20 references with the strongest citation bursts, half of the papers had a burst until 2021. The keywords analysis suggests that the top 20 keywords appeared at least 40 times. Additionally, "amyloid precursor protein" was the keyword with strongest bursts. Conclusion: Research on ferroptosis in the brain will continue to be highly regarded. This study analyzed the research landscape of ferroptosis in the brain and offers a new reference for researchers in this field.

AB0674 Providing patients with systemic sclerosis by medical care in Russia: the first data from Moscow Register of Systemic Sclerosis

BackgroundSystemic sclerosis (SSc) is a multisystem, connective tissue disease characterized by fibrosis of the skin and internal organ involvement, which can influence quality-of-life and functional capacity. 1 The mortality rate is increasing in the United States and Europe; as many as 3.08 persons are affected per 1 million. Changes in lungs and heart, pulmonary hypertension are the most significant reasons of death in patients with systemic sclerosis.2ObjectivesTo estimate quality and completeness of medical care in patients with systemic sclerosis in Russia.Methods66 patients included in the study. 61 female and 5 male (mean age: 62,48 ± 10,1), among which there were 24 limited SSc (lSSc) and 42 diffuse SSc (dSSc). All patients fulfilled the ACR/EULAR classification criteria. We estimated percentage of patients, who were examined by basic studies: capillaroscopy, functional lung tests, echocardiography, HRCT, fully immunologic study and right heart catheterization etc. and try to understand reasons of incompleteness of these assessments.ResultsDespite the presence of Raynaud’s phenomenon in 85% of patients, capillaroscopy was performed only in 65.21% of them, examination of the esophagus was performed in only 22.92% of patients, with development of dysphagia in 50% of patients. HRCT was performed in 54.71% (25.76% NSIP, 9.09% UIP), right heart catheterization in 4.17% (signs of pulmonary hypertension according to ECHO detected in 42.86% of patients). FLT were performed in mostly patients (86.34%), but it wasn`t fully: measuring of DLCO was realized only in patients with severe desease (22.92% оf patients). That explains its low mean level (61.37% from normal) as opposed to mean FEV1 (90.7% from normal) and FVC (89.47% from normal) level. Fully immunologic study was performed in 35.42% of patients, despite the fact that different autoantibodies showed up in 72.92% of patients (the most common were: antiScl70 41,67%, ACA 22,92%, ANF 52,08%).ConclusionAccording to the results of the study, we have identified a significant decrease in the quality of medical care despite the clinical recommendations and generally accepted standards. We suppose. that the main reasons for this situation are the complex healthcare problems: insufficient competence of doctors, lack of collaboration between related specialties, unavailability of a number of studies within the framework of free medicine and high cost of these studies for the patients themselves, and the lack of time for communication between the doctor and the patient to explain the seriousness of the disease and the nescessity of all parts of examination and treatment.

Factors Associated with Free Medicine Use in Patients with Hypertension and Diabetes: A 4-Year Longitudinal Study on Full Coverage Policy for Essential Medicines in Taizhou, China.

Full coverage policies for medicines have been implemented worldwide to alleviate medicine cost burden and promote access to medicines. However, few studies have explored the factors associated with free medicine use in patients with chronic diseases. This study aimed to analyze the utilization of free medicines by patients with hypertension and diabetes after the implementation of the full coverage policy for essential medicines (FCPEM) in Taizhou, China, and to explore the factors associated with free medicine use. We conducted a descriptive analysis of characteristics of patients with and without free medicine use and performed a panel logit model to examine factors associated with free medicine use, based on an electronic health record database in Taizhou from the baseline year (12 months in priori) to three years after FCPEM implementation. After FCPEM implementation, the proportion of patients without any free medicine use decreased from 31.1% in the baseline year to 28.9% in the third year, while that of patients taking free medicines rose from 11.0% to 22.8%. Patients with lower income or education level, those with agricultural hukou, patients aged 65 and above, married patients, and patients in the Huangyan district were more likely to take free medicines. In conclusion, FCPEM contributed to improved medicine access, especially in vulnerable populations. Local policy makers should consider expanding the coverage of FCPEM to other types of medicines and cultivate the potential of social supports for patients to enhance the effectiveness of FCPEM policies.

Preoperative Hemoglobin Optimization in Jehovah's Witness Cardiovascular Surgery Patients with Anemia and Barriers to Care

Cardiac surgery has a risk for extensive blood loss which poses a particular challenge in individuals refusing blood transfusions. Additionally, preoperative anemia with a hemoglobin (Hb) below 13 g/dL in men and 12 g/dL in women is associated with increased short and long-term complications and mortality and increases the need for blood transfusion support. The current guidelines for perioperative anemia management recommend optimizing hemoglobin levels prior to surgery and utilizing blood conservation techniques during the procedure. At present red blood cell (RBC) transfusions during cardiac surgery are usually recommended when Hb levels are below 7-8 g/dL a restrictive transfusion strategy to reduce complications. However, the use of any RBC transfusions is associated with worse outcomes in cardiac surgery compared with those who do not receive transfusions.We have found that JW seek out quality health care and accept the vast majority of medical treatments once they are educated. The Transfusion Free Medicine Coordinator's role in the Anemia Clinic is to endorse clinical strategies for managing hemorrhage and anemia without blood transfusion. They educate and counsel the patients so they can decide as to what blood fractions and cell salvage techniques they will accept. We have found that some Health Care Providers are unaware that ESAs also contain albumin so JW patients may be given this product without that knowledge. The vast majority of patients will accept the use of ESAs but find the cost prohibitive.Jehovah's Witness patients have provided a natural case study for examining how well adjuvant therapies can improve preoperative anemia without transfusions and continue with good outcomes. Hb optimization is achieved through the use of intravenous iron and, if needed, erythropoiesis stimulating agents (ESAs). In Table 1 we highlight our single center data in which all cardiovascular surgeries were performed by a surgeon experienced in blood-conservation strategies. Our thirty-day re-admission rates for all patients was zero percent, compared to state-specific data, which estimates about an 11.7% rate of re-admission. The data illustrate the need to have a target Hb 13 or above to allow for the decline that may occur during the hospital stay. Of note no thromboembolic events have occurred with the use of an ESA in this group.Although ESAs are approved to optimize Hb in orthopedic surgery, they are not covered for cardiac surgery which has presented a significant challenge to patients who can not safely proceed to surgery until a target Hb between 13 to 15 g/dL is achieved.These data highlight the utility and safety associated with the use of ESAs for patients who do not accept blood products at an experienced Center for Transfusion-Free Medicine, such as ours. At this time, since insurance companies do not cover the cost of ESAs for patients needing life-saving cardiovascular operations, cost is a prohibitive barrier for patients. Unfortunately, it is not uncommon for patients to have to borrow money from others or set up payment plans. We hope that analyses like ours will help drive changes in reimbursement policies, particularly for patients who based on religious convictions, cannot receive blood products, and thus for whom pre-operative hemoglobin optimization is of utmost importance. [Display omitted] DisclosuresNo relevant conflicts of interest to declare. OffLabel Disclosure:Erythropoiesis-stimulating agent (ESA) are indicated for the treatment of anemia due to Chronic Kidney Disease in patients on dialysis and not on dialysis, Zidovudine in patients with HIV-infection, anemia due to myelosuppressive chemotherapy and reduction of allogeneic RBC transfusions in patients undergoing elective, noncardiac, nonvascular surgery

Use of an Antifibrinolytic Agent and Vitamin K As Alternative to Platelet Transfusions in Autologous Hematopoietic Cell Transplantation

BackgroundManaging thrombocytopenia with a prophylactic strategy was previously recommended for patients with impaired bone marrow function, hematological malignancies, and recipients of HCT when platelet counts declined to under 10,000/uL. However, the updated 2018 ASCO guidelines now suggest a place for a therapeutic i.e., after a bleeding event rather than a prophylactic platelet transfusion strategy for patients with hematologic malignancies undergoing autologous HCT. Studies show a lack of significant difference between trial groups in hemostatic outcomes, such as the number of WHO grade 2-4 bleeds, and number of days with bleeding events. Platelet transfusions increase risks of infectious and non-infectious complications as well as inducing a platelet refractory state. Our Transfusion Free Medicine Program has now performed over 200 autologous hematopoietic stem cell transplants (HCT) in Jehovah's Witnesses who due to religious convictions, do not accept red cell or platelet transfusions.Vitamin K is a fat-soluble vitamin that is required for normal blood clotting. Autologous HCT patients are at risk for vitamin K deficiency from multiple reasons including malnutrition, frequent use of antibiotics, chemotherapy induced gastrointestinal toxicity leading to malabsorption and colitis. The prothrombin test lacks the sensitivity and specificity to detect mild deficiency. A mild vitamin K deficiency may be underdiagnosed in our transplant patients adding to bleeding risk. With the effective use of antifibrinolytic agents and Vitamin K as an alternative to platelet transfusions we believe this may enhance hemostasis and prove a valuable adjunct to a therapeutic approach.MethodsPatients in our study were those who were of the Jehovah's Witness faith undergoing autologous HCT for Multiple Myeloma and Lymphoma. Patients received aminocaproic acid as an alternative to platelet transfusion to enhance hemostasis at a dose of 1 g every 4 hours or prophylactically for platelet counts less than 30,000 /uL. Titration to 4 g every 4 hours intravenously was required for platelet counts less than 10,000/ul or clinical bleeding. Vitamin K 10 mg orally or subcutaneous was also started at this time.ResultsTable 1 illustrates the low number of bleeding events especially grade 3 or 4 that occurred. There were no Grade 3 or 4 bleeding events in patients with platelet counts above 5000/uL. No patient had residual long term effects nor was there an increase in thromboembolic events.ConclusionsThese data add to the body of literature supporting a therapeutic platelet transfusion strategy in an experienced center for autologous HCT patients and challenges the prophylactic platelet count of 10,000 /uL suggesting instead 5000/uL. The safety and efficacy of antifibrinolytic agents and Vitamin K as an alternative to platelet transfusions to enhance hemostasis in autologous stem cell transplant patients may prove beneficial not only in JW patients but also in those transplant centers wishing to offer a therapeutic platelet transfusion approach and as a strategy to manage platelet refractoriness. [Display omitted] DisclosuresNo relevant conflicts of interest to declare. OffLabel Disclosure:Aminocaproic Acid is an antifibrinolytic agent approved for treatment of bleeding in surgical patients and hematological bleeding disorders. Vitamin K is approved for use in reversal of anticoagulation from Warfarin, vitamin K deficiency without liver disease and in the newborn.

Morphological and Microscopical Characteristics of Murdannia bracteata (C.B.Clarke) J.K.Morton ex D.Y.Hong

Morphological and microscopical characteristics of “Co ruoi la bac” collected in Nam Dinh province were studied. Results have identified the scientific name of the plant as Murdannia bracteata (family Commelinaceae). Besides, the microscopical characteristics and powder microscopy of leaf and stem of M. bracteata species were established. Specifically, the plant’s leaf and stem are characterized by pale violet corolla, oval bracts and needle shape calcium oxalate crystals converging or single in the soft tissue of the leaf; the herbal powder has twisted vascular grafts, unicellular hairs,…&#x0D; Keywords:&#x0D; Murdannia bracteata, M. bracteata, Murdannia bracteata (C.B.Clarke) J.K.Morton ex D.Y.Hong, Commelinaceae, morphological characteristics, microscopical characteristic&#x0D; References&#x0D; [1] M. D. O. Pellegrini, R. B. Faden, R. F. D. Almeida, Taxonomic Revision of Neotropical Murdannia Royle (Commelinaceae), PhytoKeys, Vol. 74, 2016, pp. 35-78, https://doi.org/10.3897/phytokeys.74.9835.[2] R. B. Faden, K. E. Inman, Leaf Anatomy of The African Genera of Commelinaceae: Anthericopsis and Murdannia, The Biodiversity of African Plants, 1996, pp. 464-471, https://doi.org/10.1007/978-94-009-0285-558.[3] M. C. Naik, B. R. P. Rao, A New Species of Dewflower Murdannia Sanjappae (Commelinaceae) from Andaman Islands, India, Journal of Threatened Taxa, Vol. 9, No. 11, 2017, pp. 10909-10913, http://doi.org/10.11609/jott.3341.9.11.10909-10913.[4] V. V. Chi, Dictionary of Medicinal Plants in Vietnam, Medical Publishing House, Hanoi, 2012 (in Vietnamese).[5] P. H. Ho, An Illustrated Flora of Vietnam, Youth Publishing House, Ho Chi Minh City, 2003 (in Vietnamese).[6] M. Betti, A. Minelli, B. Canonico, P. Castaldo, S. Magi, M. Aisa, F. Galli, Antiproliferative Effects of Tocopherols (Vitamin E) on Murine Glioma C6 Cells: Homologue-specific Control of PKC/ERK and Cyclin Signaling, Free Radical Biology and Medicine, Vol. 41, No. 3, 2006,pp. 464-472, http://doi.org/10.1016/j.freeradbiomed.2006.04.012.[7] N. N. Thin, Plant Research Methods, Education Publishing House, Hanoi, 2006 (in Vietnamese).[8] V. D. Loi, L. T. T. Huong, Texbook: Practical Botany - Pharmacognosy - Traditional Medicine, Hanoi National University Publishing House, Hanoi, 2017 (in Vietnamese).

The history of IUBMB Life (1980-2020).

The history of IUBMB Life (1980-2020).