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The purpose of NCDP policy was to reduce the price of drugs. However, it is unclear that a reduction in the price of a single antibiotic will lead to an increase in other alternatives, which is crucial for antibiotic management. The aim of this study was to evaluate the impact of policy on the consumption of policy-related antibiotic. Quasi-experimental interrupted time series methods were used to assess the effects of the policy. After the implementation of the policy, the consumption of the winning products increased rapidly, with a significant difference in growth (β2 = 88.03). For nonwinning products, the level of purchase volume decreased (β2=-22.83) in the intervention group, and after adding the comparison group, this number fell further in statistical significance (β2=-114.53). Among all the nonwinning products, the level of purchase volume (β2=-73.59) and expenditures (β2=-346.71) of the generic drugs that passed the conformance evaluation decreased significantly after the policy in the difference model. The purchase volume of J01DC, J01DD and total antibiotics significantly increased in control group compared with the intervention. The implementation of the volume-based procurement policy promoted the use of winning products and decreased the usage of its alternative watch antibiotics. [ABSTRACT FROM AUTHOR]

When a mixed-model assembly line (MAL) is balanced, it is generally assumed that the variants of a task over different models should be assigned to an identical station. In this study, this restriction is relaxed and the variants of a task over different models can be duplicated on two adjacent stations (referred to as adjacent task duplication) to improve the MAL’s efficiency. The adjacent task duplication incurs few additional training and tool duplication costs as each task is duplicated on at most two stations. Moreover, for each task, the assembly part storage is not duplicated as it can be shared by the two adjacent stations. The mathematical model of this problem is formulated and some important properties are characterised. A branch, bound and remember algorithm is then developed to solve the problem. The performance of the proposed algorithm is tested on 900 representative instances, of which 889 instances are optimally solved. The experimental results show that the use of the adjacent task duplication policy effectively reduces the number of stations, especially when the WEST ratios are small. [ABSTRACT FROM PUBLISHER]

Antimicrobial resistance is one of the most significant challenges of the twenty-first century, and the illegal sale of antimicrobial drugs at community pharmacies is a driver of antimicrobial resistance. This study explores the knowledge, attitudes, and practices (KAP) of pharmacy staff toward antimicrobial stewardship programs (ASPs). We conducted a descriptive cross-sectional study among community pharmacy staff in Northeastern China, from April 1 to 31 May 2019, using a self-administered KAP questionnaire comprising 20 items. The data analysis was carried out by employing Mann-Whitney and Kruskal-Wallis tests. A response rate of 98.5% (394/400) was obtained. The majority of participants (94.9%) demonstrated a good understanding of antimicrobial use, but they lacked an adequate understanding of ASPs. Nearly half of the participants (40.6%) reported that they sold antimicrobials to patients without a prescription. Education level, age, occupation, and experience were all significantly associated (P < 0.05) with participants' median ASPs scores. Besides, the presence of a licensed pharmacist (OR 46.327, 95% CI 2.443–878.451, P = 0.011) was the main factor associated with the pharmacy staff's understanding of antimicrobial use policies. The participants' knowledge of antimicrobials was good, and their attitudes regarding ASPs were positive, but their practices regarding ASPs were poor. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to explore the knowledge, attitudes, and practices concerning antibiotic prescriptions to children with URTIs among pediatricians and to identify barriers to appropriate antibiotic prescription among pediatricians. Methods: An online-based survey was conducted among pediatricians in Shaanxi province, western China, with a population of 38.35 million and an area of 205,600 square kilometers. Results: A total of 472 pediatricians completed this survey, with the response rate of 26.0%. The theoretical knowledge about antibiotics was excellent, with a median score of 8(0-8). However, 30.1% of the respondents still believed that antibiotics are anti-inflammatory drugs. The pediatricians' age, education level, and monthly income and whether had ever received training had significant associations with their knowledge level. The attitude scores were 41.1 ± 3.6, with a ranged of 29-52 points (total score of 55), indicating that most respondents had positive attitudes toward antibiotics. However, 22.7% of the respondents still preferred to use antibiotics for URTIs. It was found that uncertain diagnosis, parent requirements and insufficient time were barriers to appropriate antibiotic prescription. The indiscriminate prescription of antibiotics to children with URTIs was prevalent among pediatricians. Conclusion: Effective integrated interventions should be developed to promote the prudent use of antibiotics among pediatricians. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance (AMR) is a major threat to global health and antimicrobial stewardship programs (ASPs) are useful to limit the momentum of AMR. This study was intended to determine the attitudes of clinicians about AMR, ASP strategies, and their readiness to participate in ASPs. Methods: A cross-sectional survey was carried out among clinicians working in teaching hospitals of Punjab between August and November 2018. A multistage sampling method was used. Descriptive statistics and Kruskal-Wallis tests were employed for data analysis. Results: A response rate of 77.9% (670 ⁄ 859) was achieved. Most of the physicians (n = 302, 71.7%) compared to surgeons (n = 134, 70.9%) and anesthetists (n = 25, 41.7%) considered AMR as a serious health problem in Pakistani hospitals (p < 0.001). Clinicians were agreed that hospital audit and feedback (n = 434, 64.8%), restriction of certain antibiotics (n = 424, 63.3%), readily accessible microbiological data (n = 453, 67.6%), and regular educational sessions (n = 496, 74.0%) are imperative approaches to implement ASPs. Median ASP and AMR scores were significantly associated with age, experience, and types of clinicians (p < 0.05). Conclusions: Despite poor previous knowledge of ASPs, all clinicians showed a positive attitude towards hospital ASPs. Several approaches suggested by clinicians will be helpful to implement hospital ASPs in Pakistan. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) has a very high prevalence and poses a huge financial encumbrance on patients. This study aimed to evaluate the cost of diabetes care among patients with type 2 diabetes in private clinics of southern Punjab, Pakistan. Research design and methods: This was a descriptive, cross-sectional, prevalence-based, cost-of-illness (COI) study conducted in six private clinics of southern Punjab from July to September 2016, using a pretested questionnaire. Study participants were recruited using a random selection method. Continuous variables, including direct and indirect costs, were summarized using descriptive statistics. Inferential statistics were also used to analyze the correlation between the variables and cost. Results: The mean annual direct cost per patient with diabetes was estimated to be 332 USD. Medications accounted for the largest share (60.4%) of this cost. Age, locality, high socioeconomic status, and prolonged disease duration were significantly associated with the direct costs of illness (p < 0.05). Moreover, 19% of total earnings among very low-income patients were spent on diabetes care. Conclusions: A substantial proportion of patients’ income is spent on diabetes care in Punjab. Our findings support the substantial individual and societal burden caused by diabetes. [ABSTRACT FROM AUTHOR]

Background: Non-prescription use of antibiotics in children is an important public health problem. We aimed to investigate primary caregivers' knowledge, attitudes, and practices of antibiotics use among children in urban China.Methods: Knowledge, attitudes, and practices regarding antibiotics use in children were assessed through a cross-sectional questionnaire survey of 4200 caregivers of children under-7 years from three cities in China. Data were analyzed using descriptive statistics and multivariate analysis.Results: Caregivers' knowledge gaps and undesirables attitudes regarding appropriate use of antibiotics were identified. 48.2% of respondents reported non-prescription use of antibiotics for children in the past 6 months. The most common sources of antibiotics used without a prescription are community pharmacies and leftovers. Storing antibiotics at home and caregivers' supportive attitude were positively and significantly associated with non-prescription use of antibiotics in children, while significant inverse associations were found for caregiver's knowledge of prescription-only regulation on antibiotics sales at community pharmacies.Conclusions: There was a high proportion of primary caregivers self-medicate antibiotics for children in urban China, despite their insufficient knowledge about antibiotic use. Public health initiatives are needed such as public education campaigns and stricter government regulation of antibiotic use and availability in community pharmacies. [ABSTRACT FROM AUTHOR]

Abstract We conducted a qualitative study to examine the enablers and barriers influencing the implementation of medical cannabis from the perspectives of practicing doctors and pharmacists within the African context. Interviews were conducted to investigate medical professionals’ perceptions and concerns regarding medicinal cannabis. Three major themes were identified: beliefs about consequences, optimism, and environmental resources and context. Depending on the context of use, medical professionals described cannabis as potentially useful as an adjunct medicine and yet problematic owing to knowledge and social barriers, particularly religion. Implementation strategies tailored to address structural and social concerns to providing optimal care are needed to ensure that medical professionals are well versed in policy and clinical aspects. [ABSTRACT FROM AUTHOR]