Pharmaceutical Input Research Articles

Smartphone apps pertaining to aquaculture sector in Bangladesh: Current status and future potentials

In recent years, the aquaculture sector in Bangladesh has experienced significant technological advancements, notably the adoption of smartphone applications. This empirical study evaluates the current status of smartphone apps available in the aquaculture industry of the country using data obtained from the internet and field surveys. The study identified 41 smartphone apps currently used in the sector, where 58.53 % are related to pond-based aquaculture, 14.63 % are designed for biofloc system, 4.87 % pertain to cage aquaculture and 4.87 % marketing-aided corporate-related apps, 9.75 % focus on disease and treatment-related, and 7.31 % fall into miscellaneous categories. The “Poultry Animals and Aqua Index (PAAI)" app, which addresses aquaculture pharmaceutical inputs and fish disease treatment guidelines, emerged as the most downloaded app in this domain. Pearson correlation analysis indicated that app size or user ratings did not influence app downloads. The study also found that approximately 57.66 % of fish farmers are aware of these smartphone apps. Private fisheries professionals were the main driving forces behind the use of these apps, accounting for 52 % of the information spread. Despite mixed levels of satisfaction among farmers, about 25 % expressed a positive experience. Most of the farmers (57.66 %) acknowledged the awareness and beneficial impacts of using these apps in aquaculture. This study enhances the understanding of smartphone apps usage in Bangladesh to promote the aquaculture industry, highlighting its potential to promote industry growth, alleviate poverty, and contribute to economic development.

The impact of centralized band purchasing of pharmaceuticals on innovation of Chinese pharmaceutical firms: an empirical study based on double difference models.

In 2018, China began to gradually promote the pilot policy of centralized band purchasing of medicines. Implementing this policy has resulted in a significant decrease in drug prices. However, there needs to be a clear consensus on the impact and mechanism of action on the innovation of pharmaceutical companies. Therefore. Taking the data of Chinese Shanghai and Shenzhen A-share pharmaceutical listed companies from 2016 to 2022 as a sample, this paper empirically investigates the impact of the centralized banded purchasing policy of drugs on the innovation of pharmaceutical enterprises by using a double difference model and further analyzes the mechanism of its action. The results show that implementing the centralized banded purchasing policy can promote pharmaceutical enterprises' innovation input and output, which is robust under the parallel trend and placebo tests. Further exploring the impact mechanism of the centralized band purchasing policy on pharmaceutical enterprises' innovation, it can be found that it promotes innovation inputs through three channels: government subsidies, enterprise profits, and operating income. In addition, the impact of centralized band purchasing on enterprise innovation is heterogeneous in terms of region, enterprise nature, and scale. Therefore, the positive effects of the centralized band purchasing policy on promoting innovation in pharmaceutical enterprises should be fully recognized, and enterprise heterogeneity should be taken into account when implementing the policy. This study provides empirical evidence on the implementation effect of the centralized banded purchasing policy and provides lessons for continuously optimizing the policy to promote the high-quality development of pharmaceutical enterprises.

Does China's national volume-based drug procurement policy promote or hinder pharmaceutical innovation?

The national volume-based drug procurement policy initiated in China since 2018 represents a significant reform in China's pharmaceutical distribution system. It has largely squeezed out the price bubble of low-end generic drugs, making competition in the pharmaceutical sales segment more intense and transparent. This policy intervenes in the distribution link of the pharmaceutical industry by intensifying market competition, thereby enhancing the innovation willingness and R&D capabilities of pharmaceutical companies. Taking the national volume-based drug procurement policy as the policy shock, we used the multi-period difference-in-difference method to study the impact of the policy on innovation input, innovation output quantity and innovation output quality of listed pharmaceutical companies and its impact mechanism. We found that the volume-based policy can significantly promote the pharmaceutical companies' innovation input and the innovation output quality, but significantly reduced the innovation output quantity. For innovative and generic drug companies, this policy has limited impact on innovative drug companies, but force generic drug companies to pay more attention to cost control and market positioning, and the quality and cost-effectiveness of R&D output to ensure competitiveness in the market. For bid-winning and non-winning companies, the policy has a greater innovation incentive for non-winning companies than winning companies, by imposing greater survival pressure on non-winning companies, forcing them to increase R&D investment intensity and adopt the innovation strategy of preferring quality to quantity. The results show that the national volume-based drug procurement policy should be expanded to lower drug prices and lighten the medical burden on patients, with enhanced quality and safety supervision. Additionally, it suggests cautious application of such policies to innovative and high-end generic drugs to encourage continued pharmaceutical innovation and industry advancement.

Changing Dynamics of Trade Balance of Therapeutic, Prophylactic Uses of Medicaments in Pakistan.

This paper aims to present structural changes and trade competitiveness in Pakistan’s pharmaceutical and biotechnology industries. Trade of pharmaceutical inputs including therapeutic and prophylactic uses of medicaments were analysed to improve their exports. The data was collected for exports and imports of therapeutic, prophylactic uses of Medicaments for Pakistan and major export destinations (China, Germany, South Africa and India) for the period 2003-2020. The normalized RCA (NRCA) index was calculated as an alternative measure of comparative advantage and trade competitiveness of the country and for forecasting, the ARMA model was applied. Results revealed that the trade of therapeutic, prophylactic uses of Medicaments was increasing with time. Pakistan is now well known for its export of pharmaceutical products. This study will help policymakers and planners for improving the trade of therapeutic, prophylactic uses of Medicaments in Pakistan.

Data processing of the Brazilian National System of Controlled Product Management for drug utilization research with antimicrobials

The Brazilian National System of Controlled Product Management (SNGPC) stores data on the dispensing of manufactured and compounded drugs and pharmaceutical inputs, whether controlled and antimicrobial, based on the records of private pharmacies and drugstores. This study assessed the quality of SNGPC data from the dispensing records of manufactured antibiotics, aiming to propose their use in drug utilization researchs (DURs), with a descriptive and retrospective design, analyzing the raw dataset of the SNGPC from January 2014 to December 2020. A total of 475,805,207 drug-dispensing records were collected. On average, antibiotics corresponded to 54.5% of the total records. The quality dimension "unreported" was systematically identified in the variables "active ingredient", "sex", "age" and "ICD-10". The amount of vials/bottles and packages ranged from one to 536 units and the amount of pharmaceutical inputs dispensed, from one to 7,500 units. Results show that 25% of the records exceed an individual therapy and the SNGPC has no critical mechanism to avoid dispensations outside the therapeutic standard for the class. Despite vulnerabilities due to data quality, which can be overcome, the SNGPC allows for the construction of different analytical plans, involving time and other aggregations, in the analysis of community use of antimicrobials and controlled drugs, which makes it a powerful source of data for DUR.

“Penciclovir”

“Penciclovir”

Exploring elderly patients’ perspectives on deprescribing: a qualitative study interim analysis

Abstract Introduction The ageing population has caused an increase in polypharmacy, multimorbidities and complexity of patients (1). Polypharmacy increases the likelihood of Adverse Drug Reactions, particularly in elderly patients due to functional/cognitive changes (1). Current research investigating views on deprescribing has shown that patients are often willing to undertake deprescribing, however qualitative research in elderly populations is sparse (1). Aim This study aimed to explore elderly patients’ perspectives on deprescribing and pharmaceutical input into their care. Methods Semi-structured interviews were undertaken with a purposive sample of elderly (>65 years) inpatients with multiple morbidities and/or frailty and were taking at least one regular medicine, at two English NHS hospital Trusts. The interview guide was developed with public contributions, aligned with the study aim and informed by the Theoretical Framework of Acceptability (TFA)(2). The TFA was used because it was developed for assessing the acceptability of healthcare interventions (2). The interview guide included a distress protocol because the patient cohort was vulnerable. Interviews were conducted face-to-face, audio-recorded, transcribed verbatim and analysed using the Framework Analysis approach, with a priori categories informed by the TFA. Results Interviews were conducted with 8 participants (2 male,6 female), aged 67-89 and taking 3-9 pre-admission medicines. Most participants seemed to understand that deprescribing may become appropriate and trusted their doctor to initiate discussion when deprescribing is appropriate. However, participants reported wanting to know the rationale for deprescribing (TFA domain: affective attitude): “…why was I taking it in the first place if I don’t need it now?”. Most participants wanted deprescribing discussions to start with the rationale and some said medicines should be stopped gradually with regular reviews (TFA domain: affective attitude, ethicality). Most participants referred to pharmacists having a small role in their healthcare and none mentioned pharmacists stopping medicines (TFA domain: affective attitude): “… they sort all the drugs out don’t they, that they’re ordered…”. Access to GPs was commonly reported as a burden (TFA domain: burden). Some participants reported not feeling confident to ask their GP questions and some said they had not established trust due to not seeing a regular doctor (TFA domain: burden and opportunity costs): “I’ve gotta get my confidence in them…”. Several participants reported having taken medicines for years and said that they thought the medicines were beneficial, whilst other participants said that if they could take fewer medicines they would (TFA domain: ethicality and perceived effectiveness). Some participants understood that deprescribing required weighing up risks and benefits (TFA domain: intervention coherence): “…consider the benefits and the possibility of side effects”. Conclusion This study adds insights from qualitative research, but these may not be widely transferrable. Whilst these are interim analysis findings that may be further refined, they suggest that deprescribing is likely to be acceptable to patients when conducted by healthcare professionals they trust and who provides the rationale for deprescribing. Patients’ awareness of who can deprescribe would benefit from being increased, since participants did not cite pharmacists as experts who can deprescribe. Future research could explore how to do so. References (1) Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Br J Clin Pharmacol. 2014 Oct;78(4):738-47. (2) Sekhon M, Cartwright M, Francis J. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res, 2017; 17: 88.

Clean vs dirty labels: Transparency and authenticity of the labels of Ceylon cinnamon.

Ceylon cinnamon, which was regarded as a luxury spice during ancient times, has been consumed for its medicinal properties and health benefits for thousands of years. For centuries, Arabian traders controlled the European cinnamon trade through limited supplies from a country which they did not reveal. Content marketing analysis and chemical profiling of value-added products of Ceylon cinnamon in the global marketplace are proposed to investigate the clean status of the product labels. In the present study, a mixed-method approach was employed to investigate the labels of 6 types of value-added forms of cinnamon; i.e. quills, powder, tea, breakfast cereals, confectionery and bakery and nutraceuticals which are used in USA, UK, Mexico, Japan and products of Sri Lankan cinnamon exporters. Two hundred and seventy-six labels were analyzed to find out the aspects of clean status, transparency and authenticity. Key label claims of the cinnamon products lie within the bounds of cleaner, healthy, nutritional and sustainable attributes. Consumer perception lies within ingredients, nutritional value, country of origin and claim on safety and quality standards and certification. The value chain transparency, ethical rules (species mislabeling), and chemical profile of the pharmaceutical, confectionery and fragrance industry inputs were ignored. The best claim and competitive advantage of the Ceylon cinnamon; an ultra-low level (<0.01 mg/g Dry Weight) of Coumarin, were rarely indicated in labels. Lack of clean labels and traceability lagged Ceylon cinnamon in the 40 international markets while Cassia cinnamon (Coumarin content 2.23 mg/g DW), a major competitor of Ceylon cinnamon appears in the market with dirty labels. Millennials and upper-middle-class female consumers in their active ages, place a high demand on Ceylon cinnamon. Today's tech-savvy global consumers of Ceylon cinnamon use market intelligence frequently for identifying product authenticity. Well equipped clean labels were found to be demanded by the modern cinnamon consumers.

HIV-antiretrovirals in river water from Gauteng, South Africa: Mixed messages of wastewater inflows as source

South Africa has the highest number of people living with the human immunodeficiency virus (HIV). High usage of HIV-antiretroviral drugs (ARVs) for the treatment of the acquired immunodeficiency syndrome (AIDS) leads to the presence of ARVs in the environment. Wastewater is a major contributor of pharmaceuticals in surface and drinking water as wastewater treatment plants (WWTPs) are not designed to remove these compounds. Pharmaceuticals in the environment pose risks and the effects of ARVs on non-target organisms are largely unknown. The concentrations of ARVs in surface water upstream and downstream from WWTPs in rivers were determined. The samples were extracted by solid-phase extraction and analysed by using liquid chromatography coupled with a quadrupole time-of-flight mass spectrometer. Five ARVs were quantified, mostly in downstream samples of the WWTPs, indicating wastewater as a source of ARVs, but this was not apparent in all cases. Nevirapine, lopinavir, and efavirenz were frequently detected; the highest concentrations being lopinavir and efavirenz at 38 μg/L and 24 μg/L, respectively. Aquatic ecosystems are at risk due to the constant input of pharmaceuticals that include large amounts of everyday use and the release of ARVs. This study highlights the potential of increased water pollution worldwide should more people consume increased quantities of pharmaceuticals.

Produção pública de medicamentos no Brasil no contexto da pandemia da COVID-19

No Brasil, o Sistema Único de Saúde foi instituído nas bases da Constituição Federal de 1988, que estabeleceu, dentre outros campos de atuação, a sua participação na produção de medicamentos e na promoção do desenvolvimento científico e tecnológico e a inovação em saúde. Este ensaio discute a produção pública de medicamentos no âmbito dos laboratórios oficiais e seus desafios no contexto da pandemia de COVID-19, utilizando-se como base os medicamentos do estudo Solidarity. O Brasil conta com 20 laboratórios oficiais que juntos possuem 289 medicamentos aprovados, compostos por 169 fármacos, em diferentes apresentações, além de 86 Parcerias para o Desenvolvimento Produtivo vigentes que envolvem o desenvolvimento e transferência de tecnologias de outros 55 medicamentos. Nos últimos anos, diversas políticas desenvolvidas no Brasil promoveram o desenvolvimento e a produção de medicamentos estratégicos para a população, reduzindo a dependência produtiva e tecnológica e contribuindo para a diminuição da vulnerabilidade do SUS. Contudo, desafios como a deficiência de infraestrutura e de competências técnicas e gerenciais dos laboratórios públicos, dependência externa de insumos farmacêuticos e políticas recentes de austeridade fiscal, fragilizam o País para o enfrentamento da pandemia.

Tucumã (Astrocaryum vulgare) fat: an Amazonian material as a pharmaceutical input for lipid nanoparticle production

Native Amazon palm trees have been target of research and product development especially because of their oil and fat. Tucuma-do-Para (Astrocaryum vulgare) is a palm tree from which is possible to extract fruit seed fat. This article studied its physico-chemical characterization and analyzed its feasibility of use as raw material for nanostructured lipid nanoparticle (NLC) in pharmaceuticals. Through acidity, refraction and iodine indexes it was possible to determine that the fat has good quality and is in accordance with the literature. Ultraviolet spectrum scanning did not show peaks in region of dienes and trienes, compounds which appear when fat is decomposing. Infrared spectra and nuclear magnetic resonance determined spectral identity of the fat, confirming it is composed mainly by saturated groups. Fatty acid profile by gas chromatography coupled to mass spectrometer evidenced components in greater quantity: lauric and myristic acids in saturated part and oleic acid in unsaturated part. These acids have pharmacotechnical importance as permeation agents of active substances. Tucuma fat has thermal stability up to 350 °C and melting point of 35 °C. To reach nanostructured lipid carriers preparation it was necessary to increase its melting point by mixing it with carnauba wax. Through X-ray diffraction in crystallized tucuma fat/carnauba wax mixture it was possible to identify stable β′-form which is the ideal form for production of stable nanostructured lipid carriers. From this lipidic mixture of tucuma fat/carnauba wax in 1:1 ratio, 9 formulations of nanostructures lipid carriers were prepared, from which 3 formulations were distinguished by their excelente particle size and polydispersity index values.

Autocuidado e percepção do tratamento para o diabetes por pessoas em uso de insulina

Objetivo: apreender a percepção de pessoas com Diabetes Mellitus em uso de insulina sobre seu autocuidado e repercussão do tratamento em seu cotidiano. Método: pesquisa descritiva exploratória de natureza qualitativa, realizada em município de médio porte da região Sul do Brasil, com 16 pessoas em uso de insulina que faziam acompanhamento na Atenção Primária. Os dados foram coletados no período de maio a julho de 2017, por meio de entrevista semiestruturada e submetidos à Análise temática. Resultados: emergiram três categorias que abordam as dificuldades em mudar hábitos de vida, as repercussões do uso de insulina na vida cotidiana e os entraves vivenciados na aquisição dos insumos farmacêuticos para o tratamento. Conclusão: a prática do autocuidado, por pessoas com Diabetes Mellitus em uso de insulina, é permeada por diversas dificuldades, e a principal delas é a necessidade de mudanças no estilo de vida.

An Approach to Drug Stability Studies and Shelf-life Determination

The main objective of carrying out stability studies of the drug product is to establish shelf life of drug during storage. Stability of drug is defined as “The capability of a particular formulation in a specific container/closed system, to remain within its physical, chemical, microbiological, therapeutic, and toxicological specifications throughout its shelf life”. As mentioned in the International Conference on Harmonization (ICH) guideline Q1A (R2), stability studies are commonly the activity on the critical path to regulatory filing and approval. Stability studies are of different types and different methods are useful for the determination of stability like real-time stability testing, accelerated stability testing, retained sample stability testing and cyclic temperature stress testing. pH and temperature are the main factors influencing the stability of the drug. The pH-rate profile (log(k)vs pH) is the pH dependence of the specific rate constant of degradation of compounds. Forced degradation includes deterioration of new drug substances and products at more severe conditions than the accelerated conditions and it indicates the accuracy of stability-indicating methods. The different conditions applied during the forced degradation include hydrolytic, oxidation, photolytic and thermal stress etc. The techniques utilized for evaluation of stability studies can be LC-MS/MS, HPLC-DAD, HPLC-MS, HPLC-UV, HPTLC, TLC, LC-NMR etc. amongst them some techniques shows high sensitivity and resolution power to establish more effective stability-indicating method while for shelf life estimation of drugs and products the different methods mentioned are FDA’s method, the direct method, inverse method, simulation results and Garret and Carper method. Thus stability testing of pharmaceutical products inputs specific scheme in the evolution of a new drug as well as new formulation.

Plasma fresco congelado: insumo farmacêutico para produção de medicamentos hemoderivados

Introduction: In Brazil, hemotherapy was started as a medical specialty in the 1940s in the Rio de Janeiro and Sao Paulo axis with the inauguration of the first Blood Bank at the Fernandes Figueira Institute. As a governmental initiative, Law n. 1,075/1950/MS, which provides for the voluntary donation of blood, was promulgated, culminating with the Law n. 10,205/2001, which regulated paragraph 4 of article 199 of the Federal Constitution, regarding collection, processing, storage, distribution and application of blood and its components. Among the components obtained in the Hemotherapy Services, we can highlight the frozen fresh plasma (FFP) that can be transfused and, when becoming a surplus of the therapy, continue to be used to produce industrialized blood products. Objective: This study intends to demonstrate the most relevant aspects regarding the recovery of factor VIII content, in the FFP units collected in 72 Hemotherapy Services visited in the country, aiming at its safe and effective use both for therapeutic use and as a pharmaceutical input in the production of blood products. Method: The methodology adopted included five steps: Elaboration and validation of the questionnaire applied; Selection of Hemotherapy Services to be visited; Analysis of quality indicators according to the Donabedian Triad; Collection, packaging and transport of FFP units; Analysis of the Factor VIII content in the FFP units collected during the technical visit during the period from 2013 to 2015. Results: Among the results obtained, it is important to highlight the concentration of factor VIII (IU/mL), in the FFP units, with the following results: mean 0.68; standard deviation 0.32; coefficient of variation 47.1%, confidence interval 0.64 to 0.71. Conclusions: factor VIII content greater than or equal to 0.70 IU/mL was found in 38.5% of FFP units, as specified in the Brazilian Pharmacopoeia, which can and should be used as a pharmaceutical input in the production of blood products. It was also found a disposal of approximately 500 million IU/mL of factor VIII, which represents 83.0% of the annual acquisition by the Ministry of Health of Concentrate of factor VIII for medical uses. Such use could generate significant savings in public coffers.

Condutas em Atenção Primária: desenvolvendo um sumário online, em português, de prática clínica baseada em evidências

Introdução: Embora existam internacionalmente diversos sumários online baseados em evidências, a maioria é de língua inglesa, pago ou com restrições de acesso internacional. Desta forma, estamos desenvolvendo um sumário de prática clínica baseado em evidências, em português, gratuito, transparente e livre de insumos da indústria farmacêutica. Métodos: Selecionamos 28 tópicos para a primeira fase do projeto. Estes tópicos compõem problemas que abrangem 50% da demanda em atenção primária, são desenvolvidos sob a metodologia de revisões rápidas e submetidos à revisão por pares. A busca por evidência é realizada de forma discricionária, dando preferência às revisões sistemáticas. O website é financiado pelos autores, os quais não possuem conflitos de interesse. O conteúdo do site está sob licença Creative Commons BY-NC-SA. Resultados: Criamos um manual para o desenvolvimento dos tópicos e o site www.condutas.com.br está disponível para acesso, com três tópicos desenvolvidos: resfriado comum, hipertensão arterial e pré-natal. Conclusão: O Condutas em Atenção Primária possui qualidade editorial e metodologia baseada em evidências adequada, se comparada a outros sumários online, o que é um avanço para a prática clínica nacional. Seu perfil inovador democratiza o acesso a informações atuais, consistentes e diversas, antes restritas ao leitor de língua inglesa, contudo, ao mesmo tempo enfrenta as limitações por seu pioneirismo e inerente amadorismo.

Análise dos pedidos de patente de insulina depositados no Brasil

Entre os medicamentos biotecnológicos, a insulina tem um papel extremamente significativo, pois no ranking mundial de medicamentos ocupa um lugar entre os mais comercializados e, no Brasil, é o insumo farmacêutico que gera mais gastos com importação. A insulina é um dos principais medicamentos utilizados para o diabetes, doença que acomete 415 milhões de pessoas e consome 12% das despesas mundiais de saúde. O objetivo do presente estudo consiste em analisar a atual situação no ranking de depósitos de pedidos de patente de insulina no Brasil. A busca dos documentos de patentes foi realizada utilizando a base de dados Orbit Intelligence®. Os resultados observados demonstram a ausência no Brasil de indústrias nacionais inovando, por meio de patentes, nessa área biotecnológica, deixando o país dependente de aquisição da insulina no mercado externo, o que pode acarretar um desabastecimento nacional. Dos três países estudados, somente os Estados Unidos apresenta índices de patenteamento que demonstram avanço e investimento em pesquisa e desenvolvimento. É necessário aumentar o investimento em P&amp;D e criar políticas públicas que incentivem a inovação do estudo na área biotecnológica no Brasil.

Occurrence and risk assessment of antidepressants in Huangpu River of Shanghai, China.

Antidepressants are gaining public attention because of increasing reports of their occurrence in environment and their potential impact on ecosystems and human health. Continuous input of pharmaceuticals into rivers, through psychiatric hospital or wastewater treatment plant (WWTPs) effluent, may cause adverse effects on the aquatic ecosystems of the receiving water bodies. This work investigates the occurrence and sources of 8 antidepressants in main stream and tributaries of Huangpu River in Shanghai. The detected concentrations of the selected antidepressants ranged from low nanogram per liter to 42.9ngL-1 (fluoxetine) in main stream and ranged from low nanogram per liter to 33.7ngL-1 (fluoxetine) in tributaries. To study the effect of hospital or wastewater treatment plants (WWTPs) on environment, the upstream and downstream samples were analyzed. Generally, antidepressants had greater concentrations in downstream than that in upstream of the WWTPs or hospitals. It is suggesting that WWTPs and hospitals may introduce pollution into water environment. A preliminary risk assessment was conducted: none of the eight target compounds yielded risk quotient (RQ) values more than 0.1, thus indicating that no adverse effect is expected in water environment. These results will provide background data for future antidepressants pollution control and management in Shanghai, China.

Are exposure predictions, used for the prioritization of pharmaceuticals in the environment, fit for purpose?

Prioritization methodologies are often used for identifying those pharmaceuticals that pose the greatest risk to the natural environment and to focus laboratory testing or environmental monitoring toward pharmaceuticals of greatest concern. Risk-based prioritization approaches, employing models to derive exposure concentrations, are commonly used, but the reliability of these models is unclear. The present study evaluated the accuracy of exposure models commonly used for pharmaceutical prioritization. Targeted monitoring was conducted for 95 pharmaceuticals in the Rivers Foss and Ouse in the City of York (UK). Predicted environmental concentration (PEC) ranges were estimated based on localized prescription, hydrological data, reported metabolism, and wastewater treatment plant (WWTP) removal rates, and were compared with measured environmental concentrations (MECs). For the River Foss, PECs, obtained using highest metabolism and lowest WWTP removal, were similar to MECs. In contrast, this trend was not observed for the River Ouse, possibly because of pharmaceutical inputs unaccounted for by our modeling. Pharmaceuticals were ranked by risk based on either MECs or PECs. With 2 exceptions (dextromethorphan and diphenhydramine), risk ranking based on both MECs and PECs produced similar results in the River Foss. Overall, these findings indicate that PECs may well be appropriate for prioritization of pharmaceuticals in the environment when robust and local data on the system of interest are available and reflective of most source inputs. Environ Toxicol Chem 2017;36:2823-2832. © 2017 SETAC.

Urinary catheter-related visits to the emergency department and implications for community services.

to conduct a service review of catheterised patients attending the ED of a large London hospital; to describe incidence, reasons for attendance and cost to inform future planning for out-of-hospital care. a catheter collaborative, consisting of multidisciplinary health professionals and patients, formulated survey questions. Patients were identified from the electronic patient record by searching for the code 'urological complaint'. One month of clinical records were retrospectively reviewed and analysed using descriptive statistics. 287 patients attended the department with urological complaints: 41 (14%) had urinary catheter problems, of these 24 (59%) patients were discharged and 17 (41%) were admitted for further treatment. Stays in ED varied from 1 hour 13 minutes to 17 hours (mean = 4.8 hours). A total of 9 patients (38%) were sent home during antisocial hours (9 pm to 7 am), 4 patients were discharged between midnight and 2 am. Patients admitted had mean stays of 4.11 days. Most admissions were short term for intravenous (IV) treatments; 3 patients were hospitalised for 20 days. A total of 14 patients (34%) were diagnosed with catheter-related infections: 11 (79%) had bladder infections and 3 (21%) had septicaemia. All 14 patients (100%) had urine-culture-confirmed infections, mainly from coliform, proteus and pseudomonas species. A total of 20 patients (49%) received antibiotic treatment. The majority of patients received an initial IV dose followed, where required, by oral treatment on discharge. many catheterised patients had complex needs with high rates of urinary infections and admissions for urosepsis. High attendance related less to old age but more to complexity of history, such as neurological conditions and disability. Only a proportion of these patients could be safely treated by district nurse teams. A significant proportion would require more responsive community services with several spells of short-term input (e.g. daily or more than once-daily visits) and access to diagnostics, microbiology, pharmaceutical input and IV treatments.

A judicialização da saúde: as decisões do Supremo Tribunal Federal frente ao princípio da separação dos poderes

Resumo: Introdução: A Constituição Federal de 1988, ao qualificar a saúde como um direito fundamental, de acesso universal e igualitário, e dever do Estado, e ao estabelecer a participação do poder judiciário diante de ameaça ou lesão ou aos direitos fez surgir a chamada judicialização da saúde: a interferência desse poder em questões que, primariamente, seriam da competência dos poderes executivos e legislativos. O artigo objetivou identificar o posicionamento do Supremo Tribunal Federal (STF) quanto à interferência do Judiciário diante do princípio da separação dos poderes. Metodologia: Tratou-se de pesquisa qualiquantitativa, de caráter descritivo e analítico, das decisões judiciais proferidas pelo STF, de junho de 2009 a junho de 2015, em sede recursal, de ações cujos objetos pleiteados versavam sobre ações ou serviços de saúde. Resultados e discussão: A análise das decisões demonstra: aumento das demandas de saúde levadas à Suprema Corte em 2014 e 2015; predominância de demandas de assistência farmacêutica e insumos; tendência do Estado de alegar como razões do recurso a violação da separação dos poderes e grave lesão à ordem pública; o entendimento pacificado do STF quanto à matéria. Conclusão: Para o STF a intervenção do Judiciário nas políticas públicas de saúde não fere o princípio da separação dos poderes, nem gera lesão à ordem pública, pois a garantia e efetivação do direito à saúde é responsabilidade do Estado, seja qual for a esfera e a abrangência de suas funções, sendo inadmissível, dentro do modelo constitucional adotado, qualquer dos poderes eximir-se dessa obrigação.