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1. Time trends and regional variations in prices of anticancer medicines in China

Author: Jinwei Zhang, Shuchen Hu, Xingyu Liu, Xiaoyong Liu, Jieqiong Zhang, Caijun Yang, and Yu Fang
Subjects: cancer, medicine price, time trends, regional variation, China, Therapeutics. Pharmacology, RM1-950
Abstract: IntroductionHigh prices, as a main factor, contributed to the lack of adequate access to essential anticancer medicines, especially for patients in developing countries. The Chinese Government has introduced a series of policies to control the prices of medicines during the last decade, but the effect on anticancer medicine is not yet clear.MethodsTo evaluate the time trends and regional variation in the price of essential anticancer medicines in China, we used the procurement data of anticancer medicines from 2015 to 2022. We selected 29 anticancer medicines from the 2018 Chinese National Essential Medicines List. To measure the cost of a medicine, we used defined daily dose cost -the cost per defined daily doses. At national level, we focused on the price changes over time and compared the price between medicine categories. At provincial level, we assessed price variation among provinces over time.ResultsFor prices at the national level, all 6 targeted medicines exhibited a continuous decrease trend in price. Out of 23 non-targeted medicines, 4 (17·39%) experienced continuous increases in prices, and 9 (39·13%) showed price decreases from 2015 to 2019 and then an upward trend during 2019–2022; Of the remaining non-targeted medicines, 7 (30·43%) had continuous price decreases and 3 (13.04%) had price increases followed by decreases. For prices at the provincial level, provincial price variation became smaller for almost all targeted medicines, except rituximab; for 11 out of 23 non-targeted medicines, provincial price variations became larger. During the study period, the proportion of price-increased medicines in each province was geographically correlated, and no significant relationship between prices and GDP per capita was observed for both targeted and non-targeted anticancer medicines.ConclusionThe prices and regional disparity of most targeted anticancer medicines were decreasing, while for nearly half of the non-targeted anticancer medicines, the prices were increasing and the regional disparity became wider, which may lead to compromised access to these essential anticancer medicines and raise inequity health outcome among regions.
Published: 2024
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2. Dispensing of antibiotics for tuberculosis patients using standardized patient approach at community pharmacies: results from a cross-sectional study in Pakistan

Author: Ali Hassan Gillani, Hafsa Arshad, Hasan Mujtaba, Muhammad Farooq Umer, Sen Xu, Wenjing Ji, Kamran Bashir, Jie Chang, Caijun Yang, and Yu Fang
Subjects: dispensing of antibiotics, tuberculosis patients, dispensing practices, simulated client approach, community pharmacies, Public aspects of medicine, RA1-1270
Abstract: BackgroundPakistan is among top countries for antibiotic consumption around the globe and patients often receive antibiotics directly from community pharmacies. Thus, our aim was to assess the drug dispensing practices of pharmacies for presumed and confirmed tuberculosis by using standardized patients’ method in Pakistan.MethodsIn this cross-sectional study, we adopted two standardized patient cases in pharmacies of three cities of Punjab. The first case involved a presumed tuberculosis patient presenting with 2–3 weeks of cough and fever (Case-1), and the second case involved a confirmed tuberculosis patient carrying microbiologically confirmed tuberculosis results (Case-2). The ideal management for Cases-1 and Case-2 is referral of standardized patients to a healthcare provider without dispensing antibiotics or steroids, or both. The differences in antibiotic use, steroid use, and the number of medicines dispensed in referred and non-referred patients between Case-1 and Case-2 were analyzed using descriptive statistics.ResultsBetween April 1, 2020, and July 31, 2020, standardized patients completed 575 out of 598 interactions among community pharmacies in Lahore, Rawalpindi, and Sialkot. We recorded ideal management in 115 (37.7%) of the 305 Case-1 interactions and 130 (48.1%) of the 270 Case-2 interactions. Antibiotic dispensing was higher in Case-1, with 71 out of 305 instances (23.3%), than in Case-2 interactions, with 27 out of 270 instances (10.0%). Anti-tuberculosis drugs were dispensed to 1 patient in Case-1 (0.3%) and to 19 patients (7.0%) in Case-2.ConclusionSlightly more than one-third of pharmacies in Punjab, Pakistan, ideally managed patients with presumed tuberculosis, but almost half of them ideally managed cases of confirmed tuberculosis. The presence of confirmed diagnosis slightly changes the behavior in the correct management of patients.
Published: 2024
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3. The impact of drug shortages on drug prices: evidence from China

Author: Shuchen Hu, Jinwei Zhang, Jianwei Li, Jieqiong Zhang, Mengyuan Pan, Cheng Xiang, Chintan V. Dave, Caijun Yang, and Yu Fang
Subjects: drug shortage, drug price, mixed-effects model, drug policy, subgroup analysis, Public aspects of medicine, RA1-1270
Abstract: IntroductionDrug shortages pose a serious global public health challenge, affecting China and other countries. Evidence from USA shows that short-supplied drugs demonstrated a very high price growth during and after a shortage. However, the effect of shortages on drug prices in China remains unknown. This paper aims to understand the impact of drug shortages on prices and explore implications for shortage prevention policy.MethodsWe collected the purchase prices and delivery rates of 120 drugs from April 2019 to December 2021 across whole China. We examined price progression of affected drugs using linear mixed-effects models and performed subgroup analyses based on the number of manufacturers and the severity of shortage.ResultsNon-shortage cohort had an annual price growth of 11.62% (95% confidence interval [CI] 8.34 to 14.98). Shortage cohort demonstrated an annual price growth of 8.08% (95%CI 0.12 to 16.77) in the period preceding a shortage, 27.57% (95%CI 6.17 to 52.87) during a shortage, and 9.38% (95%CI −12.64 to 36.39) in the post-shortage period. Drug shortages’ impact on prices varied across subgroups. Compared with that of drug markets supplied by a single manufacturer, the price growth rate of markets supplied by more than one manufacture declined more after the shortage resolution.ConclusionShortages resulted in significant price increases of study markets, especially the low-priced markets, while the shortage resolution slowed the growth. The primary shortage driver has shifted from the low price to others drivers, such as unavailability of active pharmaceutical ingredients. For currently sole-supplied drugs, the expedited review of applications from other manufacturers should be considered.
Published: 2023
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4. Pharmacists’ approach to oncology medicine shortages: results of a cross-sectional survey in Pakistan

Author: Caijun Yang, Faiz Ullah Khan, Yu Fang, Sundus Shukar, Muhammad Hassaan Shahid, Jinwei Zhang, and Shayan Muhammad Din
Subjects: Medicine
Abstract: Objectives The study estimated the shortages of oncology medicines in Pakistan, their causes, impacts, mitigation strategies, and possible interventions.Design Cross-sectional survey.Setting Oncology pharmacists working at 43 oncology settings (out of 80) from five regions of Pakistan (four provinces (Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan) and one federal territory (Islamabad)) were approached.Participants Oncology pharmacists with more than 1 year of experience were selected using stratified random sampling, and data were collected using a questionnaire from September 2021 to January 2022.Primary and secondary outcome measures To estimate the prevalence of oncology medicine shortages in Pakistan and establish recommendations to overcome them.Results Of 167 responded pharmacists, 87% experienced shortages in their practice. Most respondents (50%) experienced both oncology and support agent shortages. It was a current problem in hospitals (58%) and increased with time, but the situation varied across regions (p=0.007). Mainly shortages occur half-yearly (p=0.001) and last for
Published: 2023
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5. Evaluation of the effect of managing oxycodone/acetaminophen as a psychotropic medicine: An interrupted time-series study

Author: Cheng Xiang, Sha Li, Jinwei Zhang, Jieqiong Zhang, Shuchen Hu, Mengyuan Pan, Caijun Yang, and Kanghuai Zhang
Subjects: Oxycodone/acetaminophen, policy, clinical effect, psychotropic medicine, interrupted time series, Therapeutics. Pharmacology, RM1-950
Abstract: Background: Oxycodone/acetaminophen has been reported for misuse for many times in China. To cope with that, Chinese national authorities jointly issued a policy, requiring that oxycodone/acetaminophen should be managed as a psychotropic medicine starting 1 September 2019. This paper aimed to evaluate the effect of this policy in medical institutions.Methods: We used interrupted time-series analysis to examine the immediate level and slope changes in the mean number of tablets prescribed, proportion of oxycodone/acetaminophen prescription exceeding 30 pills, days supplied per prescription and the proportion of days supplied exceeding 10 days with prescription data from 5 tertiary hospitals in Xi’an city between 1 January 2018 and 30 June 2021 (42 months). We divided the prescriptions into two groups, one for long-term drug users, and the other for short-term drug users.Results: In total, 12,491 prescriptions were included in the final study, with 8,941 and 3,550 prescriptions for the short-term and long-term drug users, respectively. Significant differences in the proportion of prescriptions issued by various departments, were observed between pre- and post-implementation of the policy for both short-term and long-term drug users (p < 0.001). For short-term drug users, the policy implementation was only associated with an immediate level decrease in proportion of prescriptions exceeding 30 tablets (−4.09%, p < 0.001). For long-term drug users, after the policy, the mean number of tablets prescribed and the mean proportion of prescriptions exceeding 30 tablets experienced a level decrease of 22.96 tablets (p < 0.001) and a level decrease of 41.13% (p < 0.001), respectively; the mean number of days supplied showed a significant level decrease (6.88 days per prescription) and slope increase (0.19 days per month), and the mean proportion of days supplied exceeding 10 days showed a significant level decrease (−10.51% per prescription) and a slope increase (0.27% per month).Conclusion: Implementation of stricter management for oxycodone/acetaminophen achieved its goal of reducing the risk of misuse in short-term drug users. For those long-term drug users, policy needed to be strengthened as the prescription exceeding 10 days was still at a high level after the intervention. Policies targeting patients with different drug demands are needed. Many other strategies can be implemented, including establishing specific guidelines/principles and conducting training programs.
Published: 2023
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6. Current situation and future development of the biopharmaceutical industry in China: A mixed-method study

Author: Ruomeng Yang, John Alimamy Kabba, Xuelin Yao, Caijun Yang, Jie Chang, Wenjing Ji, Minghuan Jiang, Mingyue Zhao, Jun Wen, and Yu Fang
Subjects: biopharmaceutical, biotechnology, biosimilars, China, innovation, biological medicine, Therapeutics. Pharmacology, RM1-950
Abstract: Introduction: The biomedical industry has grown significantly both globally and in China; however, there are still challenges. This study aimed at evaluating the biopharmaceutical sector of China, in terms of ability to innovate, current sales volume, investment, and R&D expenditure, as well as providing a case study detailing the progress and challenges of the industry in Shaanxi province.Method: A cross-sectional mixed-method study design was used to generate a comprehensive profile of the nature of biopharmaceutical innovation capacity and development in China by triangulating country-wide survey and interview data from Shaanxi province. Only biopharmaceutical companies that are currently marketing or conducting research and development were eligible for inclusion, and Shaanxi province was selected for conducting the interviews. Categorical and continuous variables were analyzed descriptively. Interviews were thematically analyzed by using NVivo version 12.Results: The analysis includes responses from 77 biopharmaceutical enterprises; the majority (36, 46.8%) are in Eastern China, followed by 26 (33.8%) in Central China. In 2018, the total sales of biological products amounted to 26.28 billion yuan, and in 2019, a slight increase was observed (30.34 billion); the amount doubled in 2020 to about 67.91 billion yuan. The top three biopharmaceutical products on sale in 2020 were Camrelizumab (5.14 billion yuan), human albumin (4.56 billion yuan), and human immunoglobulin for injection (3.78 billion yuan). Expenditure on R&D has also increased; it amounted to 1657.7 million yuan in 2018, which more than doubled in 2019 to 3572.1 million yuan and further increased to 5857.7 million yuan in 2020. Nonetheless, the progress is not uniform across all provinces, as shown from the results from Shaanxi province, because of lack of local government policies that will impact on the funding, incentives, and market share that motivate the producers.Conclusion: China’s biopharmaceutical industry has expand significantly. The increase in sales indicates that there is an increase in demand for biologicals; moreover, R&D funding is increasing. These are key indicators that influence innovation and development. However, the sector’s capacity to innovate and develop needs to be improved, particularly in the western region, where research and production are relatively weak.
Published: 2022
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7. Access to Insulin Products in Pakistan: A National Scale Cross-Sectional Survey on Prices, Availability, and Affordability

Author: Amna Saeed, Krizzia Lambojon, Hamid Saeed, Zikria Saleem, Naveed Anwer, Muhammad Majid Aziz, Wenjing Ji, Wenchen Liu, Chen Chen, Caijun Yang, Yu Fang, and Zaheer-Ud-Din Babar
Subjects: insulin, price, availability, affordability, Pakistan, Therapeutics. Pharmacology, RM1-950
Abstract: Background: Diabetes is among the top ten most prevalent diseases in Pakistan, and the availability of medicines to treat the disease is vital for a great percentage of the country’s population. Insulin was discovered a century ago; however, its access in several parts of the globe remains an issue. This study aims to evaluate prices, availability, and affordability (access components) of insulin and five comparator medicine access in Pakistan.Methods: A nationwide cross-sectional survey was conducted to evaluate the access to insulin and some comparator medicines in eight cities of Pakistan, using a modified WHO/HAI methodology. The survey included 80 medicine outlets, i.e., 40 private pharmacies and 40 public hospitals. Data for every unique insulin product available in the Pakistani market were obtained, including five comparator medicines. Percentage availability, median unit prices (MUPs), and affordability (the number of days’ wages (NDWs) required for a month’s course by the lowest-paid unskilled government worker) of all products were calculated, including originator brands (OBs) and biosimilar (BS) products.Results: Of all insulin products surveyed (n = 320), 87.5% were manufactured by foreign multinational companies (MNCs). None of the insulin products had an ideal availability of 80% in any of the surveyed health facilities. In the public sector, none of the insulin products had an availability of more than 50%. In the public sector, the overall availability of human insulin was 70% (including OB and BS). While in the private sector, the overall availability of human insulin was 90% and that of analog insulin was 62.5%. The analog insulin products were 72.8% costlier than the human insulin products. The median prices of BS insulin were 25.4% lower than the OB products, indicating that almost one-fourth of the cost could be saved by switching to BS human insulin from OB human insulin. All oral anti-diabetic medicines were found to be affordable, whereas none of the insulin was affordable. The NDWs for human and analog insulin were 1.38 and 5.06.Conclusion: In Pakistan, the insulin availability falls short of the WHO’s benchmark of 80%. Insulin continues to be unaffordable in both private and government sectors. To increase insulin access, the government should optimize insulin procurement at all levels, promote local production, enforce biosimilar prescribing, and provide financial subsidies for these products.
Published: 2022
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8. Impact of the Expert Consensus on Carbapenem Consumption Trends and Patterns in Public Healthcare Institutes: An Interrupted Time Series Analysis, 2017–2020

Author: Dan Ye, Caijun Yang, Wenjing Ji, Jie Zheng, Jingyi Zhang, Runqing Xue, Jianli Gu, Minchun Chen, Kangkang Yan, and Yongzhong Liu
Subjects: antibacterial consumption, carbapenem, interrupted time series, expert consensus, China, Therapeutics. Pharmacology, RM1-950
Abstract: Background: Carbapenems are considered the last line of defence against bacterial infections, but their high consumption and the resulting antibacterial resistance are an increasing global concern. In this context, the Chinese health authority issued an expert consensus on the clinical applications of carbapenems. However, the long- and short-term effects of the expert consensus on carbapenem use are not clear.Methods: This study was conducted in Shaanxi, a northwest province of China. We collected all available carbapenem procurement data between January 2017 and December 2020 from the Provincial Drug Centralized Bidding Procurement System. A quasi-experimental interrupted time series analysis was used to evaluate the longitudinal effectiveness of expert consensus by measuring the change in the Defined Daily Dosesper 1,000 inhabitants per day (DID), the percentage of carbapenem expenditures to total antimicrobial expenditure, the total carbapenem expenditure, and the defined daily cost (DDDc). We used Stata SE version 15.0 for data analysis, and p < 0.05 was considered statistically significant.Results: After the distribution of the expert consensus, the level (p = 0.769) and trend (p = 0.184) of DID decreased, but the differences were not statistically significant. The percentage of carbapenem expenditures to total antimicrobial expenditure decreased abruptly (p < 0.001) after the intervention, but the long-term trend was still upward. There was no statistically significant relationship between the release of the expert consensus and carbapenem expenditure in the long term, but there was a decreasing trend (p = 0.032). However, the expert consensus had a positive impact on the economic burden of carbapenem usage in patients, as the level (p < 0.001), and trend (p = 0.003) of DDDc significantly decreased.Conclusion: The long-term effects of the distribution of the expert consensus on the use and expenditure of carbapenems in public health institutions in Shaanxi Province were not optimal. It is time to set up more administrative measures and scientific supervision to establish a specific index to limit the application of carbapenems.
Published: 2022
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9. Drug Shortage: Causes, Impact, and Mitigation Strategies

Author: Sundus Shukar, Fatima Zahoor, Khezar Hayat, Amna Saeed, Ali Hassan Gillani, Sumaira Omer, Shuchen Hu, Zaheer-Ud-Din Babar, Yu Fang, and Caijun Yang
Subjects: medicine shortage, drug shortage, definitions, causes, impacts, mitigation strategies, Therapeutics. Pharmacology, RM1-950
Abstract: Drug shortage is a global issue affecting low, middle, and high-income countries. Many countries have developed various strategies to overcome the problem, while the problem is accelerating, affecting the whole world. All types of drugs, such as essential life-saving drugs, oncology medicines, antimicrobial drugs, analgesics, opioids, cardiovascular drugs, radiopharmaceutical, and parenteral products, are liable to the shortage. Among all pharmaceutical dosage forms, sterile injectable products have a higher risk of shortage than other forms. The causes of shortage are multifactorial, including supply issues, demand issues, and regulatory issues. Supply issues consist of manufacturing problems, unavailability of raw materials, logistic problems, and business problems. In contrast, demand issues include just-in-time inventory, higher demand for a product, seasonal demand, and unpredictable demand. For regulatory issues, one important factor is the lack of a unified definition of drug shortage. Drug shortage affects all stakeholders from economic, clinical, and humanistic aspects. WHO established global mitigation strategies from four levels to overcome drug shortages globally. It includes a workaround to tackle the current shortage, operational improvements to reduce the shortage risk and achieve early warning, changes in governmental policies, and education and training of all health professionals about managing shortages.
Published: 2021
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10. Patients’ perception of the outpatient pharmaceutical service quality in hospital pharmacies with auditable pharmaceutical transactions and services in Ethiopia: a cross-sectional study

Author: Khezar Hayat, Caijun Yang, Yu Fang, Desalegn Gebrehaweria Kassa, Cheng Xiang, Shuchen Hu, and Amanuel Kidane Andegiorgish
Subjects: Medicine
Abstract: Objective To ensure the availability of quality pharmaceutical products and effective pharmaceutical services, a package of interventions named auditable pharmaceutical transactions and services (APTS), was implemented in the tertiary and secondary hospitals across Ethiopia since 2014. This study aimed to evaluate outpatients’ perception of pharmaceutical service quality in hospitals with APTS in Ethiopia.Design Cross-sectional study.Setting Seven hospitals of Tigray, Ethiopia.Participants 794 patients coming for pharmaceutical services.Main outcome measures SERVQUAL instrument was employed to collect the patient’s perception of pharmaceutical services. The mean perception score of pharmaceutical service quality was the main outcome measurement.Results Out of 810 patients approached, 794 participated in the study (response rate of 98.02%). Overall, the mean perception score of the service quality was 3.1 of 5. Among the five dimensions of SERVQUAL, dimension of empathy achieved the highest result with a mean score of 3.71, and tangibility was the second (3.19), followed by responsiveness (3.08), assurance (2.87) and reliability (2.81). The perception of patients in tertiary hospitals of service quality was more positive compared with patients in secondary hospitals (3.265>3.011, p=0.04). However, the difference was only significant in the dimension of assurance when considering the five dimensions separately. Respondents who were older, widowed, illiterate, farmer, retired or Orthodox were found to have better quality service experience compared with others (p=0.001).Conclusion Generally, outpatients’ perception of pharmaceutical service quality was positive. However, two dimensions of the service quality (assurance and reliability) were negatively perceived. To improve the service quality, we recommended the following: (1) managers should provide more training for pharmacists to strengthen their professional knowledge and encourage them to cooperate with other professionals; (2) the government needs to develop guidelines on information provided to patients and train the pharmacists to follow them; (3) hospitals can apply various procurement methods and efficient inventory management methods.
Published: 2021
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11. Impact of the Low-Price Medicine Policy on Medicine Supply in China: An Interrupted Time-Series Analysis

Author: Mingyue Zhao, Ali Hassan Gillani, Duan Ji, Zhitong Feng, Yu Fang, and Caijun Yang
Subjects: medicine supply, interrupted time series analysis, low‐price medicine policy, medicine price, medicine shortage, Therapeutics. Pharmacology, RM1-950
Abstract: Objectives: The primary objective of the study was to assess the impact of the Low-Price Medicine Policy (LPMP) on the supply of low-price medicines (LPMs) in China. The secondary objective of the study was to describe the supply situation of LPMs from 2005 to 2018.Methods: The LPMP was launched in the third quarter of 2014 (2014Q3). An interrupted time series analysis was used to evaluate the impact of LPMP on the supply of LPMs in China. Ordinary least squares and Poisson regression models were utilized to estimate the effect of LPMP on LPMs’ supply growth rate and the number of supplied LPMs. All the LPMs were divided into two subgroups: intermittent supply and continuous supply. The trend and level changes of the quarterly average growth rate and number of quarterly supplies for different LPM groups were analyzed from 2005 to 2018.Findings: For the quarterly average growth rate, before the intervention, a significant increasing trend was observed in the total group and the continuous supply subgroup; after the introduction of LPMP, the increasing trend was ceased and a significant decrease in the trend and level was noted for both the total group (trend coefficient: β3= −0.0132, p < 0.01; level coefficient: β2 = −0.1510, p < 0.05) and the continuous supply subgroup (trend coefficient: β3 = −0.0133, p < 0.01; level coefficient: β2 = −0.1520, p < 0.05); whereas it had no significant effect for intermittent supply subgroup. For the number of quarterly supplies, after the intervention of LPMP, decline of the supply number was observed (trend coefficient: β3 = −0.0027, p < 0.001; level coefficient: β2 = −0.0584, p < 0.001); whereas the LPMP was associated with an upward trend and level (trend coefficient: β3 = 0.0715, p < 0.001; level coefficient: β2 = 0.174) for the intermittent supply subgroup.Conclusion: For most of the LPMs, LPMP did not meet the goal of stimulating LPM production. However, for severely shortage medicines (the intermittent supply subgroup), the effect of LPMP was positive. Comprehensive policies rather than just deregulating medicine price should be introduced to alleviate the situation of medicine shortage in China.
Published: 2021
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12. Access to Essential Cardiovascular Medicines in Pakistan: A National Survey on the Availability, Price, and Affordability, Using WHO/HAI Methodology

Author: Amna Saeed, Faria Saeed, Hamid Saeed, Zikria Saleem, Caijun Yang, Jie Chang, Minghuan Jiang, Mingyue Zhao, Muhammad Saqlain, Wenjing Ji, Muhammad Majid Aziz, Krizzia Lambojon, Ali Hassan Gillani, Khezar Hayat, Sabiha Gul, Yu Fang, and Zaheer-Ud-Din Babar
Subjects: cardiovascular drugs, access to medicines, medicines policy, essential medicines, non-communicable diseases, Therapeutics. Pharmacology, RM1-950
Abstract: Objective: This national survey was aimed at measuring the access to cardiovascular disease (CVD) medicines in terms of their availability, price, and affordability in Pakistan. This was done by using the standard WHO/Health Action International (HAI) methodology.Methods: The price and availability data for 18 CVD medicines were collected from public sector hospitals (n = 40) and private sector retail pharmacies (n = 40) in eight cities of Pakistan. The outcome measures were availability (calculated as percentage of health facilities stocked with listed medicines), medicine price to the international reference price ratio (i.e., median price ratio (MPR)), and affordability (calculated as number of days’ wages (NDWs) of the lowest paid unskilled government worker required to afford one-month treatment of a chronic disease). The affordability of standard treatment in Pakistan with four CVD drugs was compared with data from six other low and middle income countries (LMICs) using HAI database.Findings: The mean percent availability of CVD medicines was significantly low (p < 0.001) in the public sector as compared to the private sector, that is, 25.5% vs. 54.6% for originator brands (OBs) and 30.4% vs. 34.9% for lowest price generics (LPGs), respectively. For all OBs and LPGs, the inflation-adjusted mean MPR was 2.72 and 1, respectively. CVD medicines were found to be unaffordable with average NDWs of 6.4 and 2.2 for OBs and LPGs, respectively, that is, NDWs of more than 1. In international comparison with countries such as Sudan, Lebanon, Egypt, India, Afghanistan, and China, the affordability of standard treatment with selected CVD medicines (atenolol, amlodipine, captopril, and simvastatin) in Pakistan was found to be low. Overall, all four OBs and three out of four LPGs of selected CVD drugs were found unaffordable in Pakistan.Conclusion: This data indicated that the availability of selected CVD medicines was low in both public and private sector medicine outlets. Both OBs and LPGs were found unaffordable in the private sector, necessitating the redressal of pricing policies, structuring, and their implementation.
Published: 2021
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13. Evaluating Price and Availability of Essential Medicines in China: A Mixed Cross-Sectional and Longitudinal Study

Author: Caijun Yang, Shuchen Hu, Dan Ye, Minghuan Jiang, Zaheer-Ud-Din Babar, and Yu Fang
Subjects: medicine price, pharmaceutical policy, equitability, China, availability, Therapeutics. Pharmacology, RM1-950
Abstract: Objectives: To evaluate the price and availability of medicines in China.Methods: A standard methodology developed by WHO and Health Action International was used to collect medicine price and availability data. We obtained cross-sectional data for 48 medicines from 519 facilities (280 public hospitals and 239 private retail pharmacies) in five provinces in China in 2018. We also collected longitudinal data for 31 medicines in Shaanxi Province in 2010, 2012, 2014, and 2018. Medicine price was compared with the international reference price to obtain a median price ratio (MPR). The availability and price in five provinces were compared in matched sets. We used general estimating equations to calculate differences in availability and median prices from 2010 to 2018.Findings: Mean availability of surveyed medicines in five provinces was low in both public (4.29–32.87%) and private sectors (13.50–43.75%). The MPR for lowest priced generics (LPGs) was acceptable (1.80–3.02) and for originator brands (OBs) was much higher (9.14–12.65). The variation was significant for both availability and price of medicines across provinces. In Shaanxi Province, the availability of medicines decreased between 2010 and 2018, but this was not significant in the public or private sector. Compared with 2010, the median adjusted patient price was significantly lower in 2018 for nine OBs (difference −22.4%; p = 0.005) and 20 LPGs (−20.5%; p = 0.046) in the public sector and 10 OBs (−10.2%; p = 0.047) in the private sector.Conclusion: Access to medicines was found to be poor and unequal across China in 2018. Future interventions are needed, and possible strategies include effective and efficient procurement, promoting the development of retail pharmacies and increasing medicine price transparency.
Published: 2020
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14. Perspective of Key Healthcare Professionals on Antimicrobial Resistance and Stewardship Programs: A Multicenter Cross-Sectional Study From Pakistan

Author: Khezar Hayat, Meagen Rosenthal, Ali Hassan Gillani, Jie Chang, Wenjing Ji, Caijun Yang, Minghuan Jiang, Mingyue Zhao, and Yu Fang
Subjects: antimicrobial resistance, antimicrobial stewardship programs, antibiotic resistance, healthcare professionals, Pakistan, physicians, Therapeutics. Pharmacology, RM1-950
Abstract: Background: Antimicrobial resistance (AMR) is an increasing global threat, and hospital-based antimicrobial stewardship programs (ASPs) are one of the effective approaches to tackle AMR globally. This study was intended to determine the attitude of key healthcare professionals (HCPs), including physicians, nurses, and hospital pharmacists, towards AMR and hospital ASPs.Methods: A cross-sectional study design was used to collect data from HCPs employed in public teaching hospitals of Punjab, Pakistan, from January 2019 to March 2019. A cluster-stratified sampling method was applied. Descriptive statistics, Mann Whitney and Kruskal Wallis tests were used for analysis.Results: A response rate of 81.3% (881/1083) for the surveys was obtained. The majority of the physicians (247/410, 60.2%) perceived AMR to be a serious problem in Pakistani hospitals (p < 0.001). Most of the HCPs considered improving antimicrobial prescribing (580/881, 65.8%; p < 0.001) accompanied by the introduction of prospective audit with feedback (301/881, 75.8%; p < 0.001), formulary restriction (227/881, 57.2%; p = 0.004) and regular educational activities (300/881, 75.6%; p = 0.015) as effective ASP methods to implement hospital ASPs in Pakistan. A significant association was found between median AMR and ASP scores with age, years of experience, and types of HCPs (p < 0.05).Conclusions: The attitude of most of the HCPs was observed to be positive towards hospital-based ASPs regardless of their poor awareness about ASPs. The important strategies, including prospective audit with feedback and regular educational sessions proposed by HCPs, will support the initiation and development of local ASPs for Pakistani hospitals.
Published: 2020
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15. The Effects of a New Public Medicine Procurement Policy on Medicine Price in Shaanxi Province, Western China: An Interrupted Time Series Analysis

Author: Shuchen Hu, Chen Chen, Shengfang Yuan, Fei Xue, Li Shi, Yu Fang, and Caijun Yang
Subjects: medicine price, interrupted time series analysis, medicine procurement policy, policy effect, China, Therapeutics. Pharmacology, RM1-950
Abstract: Objectives: To assess the effects on medicine price, a new public medicine procurement policy (NPMPP) undertaken in western China in 2015.Methods: An interrupted time series analysis was used to evaluate the impact of NPMPP on the prices of emergency medicines, gynaecological medicines, and paediatric medicines in Shaanxi Province, western China. Based on the procurement records in all the public health institutions in Shaanxi Province, we built three regression models. The monthly average price growth rate of the three categories of medicines was analysed covering the period 2015 to 2017.Findings: Before the intervention, there was an increasing trend in the monthly average growth rate of the three categories of medicines, but significant only in emergency medicines and paediatric medicines. After the introduction of NPMPP, the increasing trend was accelerated for both the emergency medicines (coefficient = 0.114, P < 0.001) and gynaecological medicines (coefficient = 0.078, P < 0.05), whereas the increasing trend for paediatric medicines was slowed down after the intervention (coefficient = −0.024, P < 0.05).Conclusion: Using interrupted time series analysis, we identified a statistically significant increase in the price growth rate of emergency medicines and gynaecological medicines, but a statistically significant decrease in the price growth rate of paediatrics, following the introduction of NPMPP. The impact of NPMPP on emergency medicines was greater than that on gynaecological medicines. To inhibit the growth trend of drug price, effective policies need to be introduced.
Published: 2019
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16. Evaluating access to oral anti-diabetic medicines: A cross-sectional survey of prices, availability and affordability in Shaanxi Province, Western China.

Author: Caijun Yang, Shuchen Hu, Yanbing Zhu, Wenwen Zhu, Zongjie Li, and Yu Fang
Subjects: Medicine, Science
Abstract: OBJECTIVES:To assess the availability and affordability of oral anti-diabetic medicines in Shaanxi Province, Western China. METHODS:In 2015, the prices and availability of 8 anti-diabetic medicines covering 31 different dosage forms and strengths were collected in six cities of Shaanxi Province. A total of 72 public hospitals and 72 private pharmacies were sampled, using a modified methodology developed by the World Health Organization (WHO) and Health Action International (HAI). Medicine prices were compared with international reference prices to obtain a median price ratio. For urban residents, affordability was assessed as the lowest-paid unskilled government workers to purchase cost of standard treatment in days' wages; for rural residents, days' net income was used. RESULTS:The mean availabilities of originator brands (OBs) and generics were 34.3% and 28.7% in public hospitals, and 44.1% and 64.4% in the private pharmacies. OBs and the lowest priced generics (LPGs) were procured at 12.38 and 4.52 times the international reference price in public hospitals, and 10.26 and 2.81 times the international reference prices in private pharmacies. Treatments with OBs were unaffordable even for urban residents. The affordability of the LPGs was good, except for acarbose, repaglinide and pioglitazone. CONCLUSIONS:Most anti-diabetic medicines cannot met the WHO's availability target (80% availability) in Shaanxi Province. The high prices of OBs had severely influenced the affordability of medicines, especially for the rural residents. Effective policies should be initiated to ensure the Chinese people a better access to more affordable anti-diabetic medicines.
Published: 2019
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17. Knowledge, Attitude, and Practices of Antibiotics and Antibiotic Resistance Among Chinese Pharmacy Customers: A Multicenter Survey Study

Author: Pengchao Li, Khezar Hayat, Li Shi, Krizzia Lambojon, Amna Saeed, Muhammad Majid Aziz, Tao Liu, Shiyu Ji, Yilin Gong, Zhitong Feng, Minghuan Jiang, Wenjing Ji, Caijun Yang, Jie Chang, and Yu Fang
Subjects: antibiotics, antibiotic resistance, knowledge, community pharmacy, China, Therapeutics. Pharmacology, RM1-950
Abstract: Background: Resistance to antibiotics is one of the major global health challenges. An adequate understanding of the public regarding rational antibiotic use is a prerequisite to limit progression in antibiotic resistance. This study aimed to investigate the knowledge, attitude, and practices (KAP) of antibiotics and antibiotic resistance among customers visiting community pharmacies. Methods: This study was undertaken in three capital cities in China during March 2019 and July 2019 by using a questionnaire of 28 items. The questionnaire had four parts, including sociodemographic characteristics, KAP about antibiotics, and antibiotic resistance. A systematic random sampling approach was used to recruit the participants. Kruskal–Wallis and Mann–Whitney tests were carried out for data analysis. Results: The response rate was 66.7% (1800/2700). Out of the total, only 9.7% of the customers had good knowledge about antibiotics. Nearly half of the participants were unable to differentiate between antibiotics, and anti-inflammatory drugs (n = 820, 45.6%, Median = 2, IQR = 1). Most of the customers were of the view that the use of over the counter antibiotics in pregnant women is unsafe (n = 1307, 72.6%, Median = 2, IQR = 0). Almost half of the participants disagreed that costly antibiotics are more effective and have fewer side effects (n = 897, 49.9%, Median = 3, IQR = 1). Only 22.3% of participants said that they always finish the course of antibiotic treatment (n = 401, 22.3%, Median = 3, IQR = 1). Conclusion: The knowledge of Chinese pharmacy consumers was inadequate, and a lack of good attitudes and practices in certain aspects of antibiotic use was observed. Educational interventions are needed to increase public knowledge of antibiotics.
Published: 2020
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18. Dispensing Antibiotics without a Prescription for Acute Cough Associated with Common Cold at Community Pharmacies in Shenyang, Northeastern China: A Cross-Sectional Study

Author: Li Shi, Jie Chang, Xiaoxi Liu, Panpan Zhai, Shuchen Hu, Pengchao Li, Khezar Hayat, John Alimamy Kabba, Zhitong Feng, Caijun Yang, Minghuan Jiang, Mingyue Zhao, Hao Hu, and Yu Fang
Subjects: nonprescription antibiotic dispensing, pharmacy service practice, community pharmacy, acute cough, standardized client study, Therapeutics. Pharmacology, RM1-950
Abstract: The inappropriate use of antibiotics is a major health issue in China. We aimed to assess nonprescription antibiotic dispensing and assess pharmacy service practice at community pharmacies in Shenyang, northeastern China, and to compare these practices between pediatric and adult cases. A cross-sectional study was performed from March to May 2018 using the standardized client method. Two different simulated scenarios were presented at pharmacies, namely, pediatric and adult acute cough associated with a common cold. Of 150 pharmacy visits, 147 visits were completed (pediatric case: 73, adult case: 74). A total of 130 (88.4%) community pharmacies dispensed antibiotics without a prescription, with a significant difference between pediatric and adult cases (pediatric case, 79.5% versus adult case, 97.3%, p = 0.005). Symptoms were asked in most visits (pediatric case: 82.2%, adult case 82.4%). Patients’ previous treatment and history of allergies were both inquired more frequently in the pediatric cases than in the adult cases. Medication advice was provided more often in the adult cases than in pediatric cases. Antibiotics were easily obtained without a prescription in Shenyang, especially for adult patients. Adequate inquiries and counseling had not occurred in most pharmacies.
Published: 2020
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19. Antibiotic prescribing practices in secondary and tertiary hospitals in Shaanxi province, western China, 2013-2015.

Author: Kangkang Yan, Meiling Xue, Dan Ye, Caijun Yang, Jie Chang, Minghuan Jiang, Mingyue Zhao, Hongli Zhang, and Yu Fang
Subjects: Medicine, Science
Abstract: IntroductionThe irrational use of antibiotics is a major driver of antimicrobial resistance. This study aimed to explore how antibiotics were used in secondary and tertiary hospitals in Shaanxi Province, western China from 2013 to 2015.MethodA retrospective study was conducted with a sample of 16 hospitals in Shaanxi Province (2 tertiary and 14 secondary hospitals; 8 public and 8 private hospitals) using a stratified random sampling method. All of the macro data from these hospitals from 2013 to 2015 were analyzed. All collected data were double-entered and analyzed using Excel 2007.ResultsThe percentage of injectable antibiotic prescriptions was 26.6% of all of the antibiotic prescriptions in the secondary hospitals and 14.2% in the tertiary hospitals. Injectable antibiotic prescriptions in private tertiary hospitals (enter %) were more than two times that of public tertiary hospitals (enter %). In both tertiary and secondary hospitals, the percentage of antibiotic prescriptions for outpatients, emergency patients and inpatients were within the scope of the national standards, while the intensity of antibiotic use was higher than the national standard of 40 DDD/100 bed-days. The prophylactic antibiotic use rate in clean surgery was 40.4% in tertiary hospitals and 60.7% in secondary hospitals, which were both higher than the national standard of 30%. The preventive use rate of antibiotics in private tertiary hospitals (55.00%) was more than two times that of public tertiary hospitals (25.90%), and the rate was also higher in private secondary hospitals (61.50%) than in public secondary hospitals (59.70%).ConclusionsSubstantial antibiotic abuse occurred in the sample Chinese hospitals, especially in secondary hospitals. The government should continue to strengthen the administration of antimicrobial use in hospitals. At the same time, medical professional training and interventions for physicians should be conducted to fundamentally reduce the irrational use of antibiotics.
Published: 2018
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20. The current status and effects of emergency drug shortages in China: Perceptions of emergency department physicians.

Author: Caijun Yang, Wenfang Cai, Zongjie Li, Amy Theresa Page, and Yu Fang
Subjects: Medicine, Science
Abstract: OBJECTIVES:The shortage of emergency drugs in China is severe. This study aimed to characterize emergency drug shortages in China and to measure their effects. METHODS:An online questionnaire based on a literature review was sent to emergency department physicians in Chinese secondary and tertiary hospitals from November 2016 to February 2017. The survey asked physicians questions about their experiences with emergency drug shortages. RESULTS:In total, 236 physicians from 29 provinces participated in the survey. According to their responses, 90.7% of the respondents experienced drug shortages during the last year. More than half of the physicians (65.7%) reported that drug shortages occurred at least once a month. Hospitals in the eastern and western regions of China had more emergency drugs in shortage than hospitals in central China, especially those with many inpatient beds (≥800). In addition, the shortage situation was more serious in secondary hospitals than in tertiary hospitals. More respondents agreed that original medicines, injections, essential medicines, medicines without alternative agents and cheap medicines were more susceptible to shortages than generics, oral medicines, nonessential medicines, medicines with alternative agents and expensive medicines, respectively. Most respondents thought that drug shortages always, often or sometimes affected patients [delayed therapy (62.6%), longer rescue and recovery times (58.9%) and higher costs (58.7%)] and physicians [inconvenience (81.0%), higher pressure (76.5%) and harm to patient-doctor relationships (72%)] and compromised hospital reputations (55.1%). CONCLUSIONS:The shortage of emergency drugs in China is serious, especially in secondary hospitals located in eastern and western China. Emergency drug shortages have significant effects on patients and physicians.
Published: 2018
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21. Current Situation, Determinants, and Solutions to Drug Shortages in Shaanxi Province, China: A Qualitative Study.

Author: Caijun Yang, Lina Wu, Wenfang Cai, Wenwen Zhu, Qian Shen, Zongjie Li, and Yu Fang
Subjects: Medicine, Science
Abstract: Drug shortages were a complex global problem. The aim of this study was to analyze, characterize, and assess the drug shortages, and identify possible solutions in Shaanxi Province, western China.A qualitative methodological approach was conducted during May-June 2015 and December 2015-January 2016. Semi-structured interviews were performed to gather information from representatives of hospital pharmacists, wholesalers, pharmaceutical producers, and local health authorities.Thirty participants took part in the study. Eight traditional Chinese medicines and 87 types of biologicals and chemicals were reported to be in short supply. Most were essential medicines. Five main determinants of drug shortages were detected: too low prices, too low market demands, Good Manufacturing Practice (GMP) issues, materials issues, and approval issues for imported drugs. Five different solutions were proposed by the participants: 1) let the market decide the drug price; 2) establish an information platform; 3) establish a reserve system; 4) enhance the communication among the three parties in the supply chain; and 5) improve hospital inventory management.Western China was currently experiencing a serious drug shortage. Numerous reasons for the shortage were identified. Most drug shortages in China were currently because of "too low prices." To solve this problem, all of the stakeholders, especially the government, needed to participate in managing the drug shortages.
Published: 2016
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22. Research on the Funding Effectiveness of National Major Scientific Research Instrument Development Projects Based on Literature Big Data Analysis.

Author: Yitong Liu, Xueshen Shang, Xiaomeng Li, Caijun Yang, Lili Wang, Yu Zhang 0180, Feng Pan, and Liu Li
Published: 2023
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23. Study on the Construction of Metrology Thesaurus System in Digital Age.

Author: Caijun Yang, Yao Wu, and Yitong Liu
Published: 2019
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24. The impacts of the national centralized drug procurement policy on the use of policy-related antibiotic agents: the case of Shaanxi province, China

Author: Caijun Yang, Dan Ye, Kangkang Yan, Cheng Xiang, Shengyuan Liu, Jianli Gu, Yongzhong Liu, and Yu Fang
Subjects: Microbiology (medical), Infectious Diseases, Virology, Microbiology
Published: 2023

25. Procurement of medicines to treat cancer, 2015–2020, China

Author: Mengyuan, Pan, Shuchen, Hu, Jieqiong, Zhang, Cheng, Xiang, Zaheer-Ud-Din, Babar, and Caijun, Yang
Subjects: China, Policy, Neoplasms, Public Health, Environmental and Occupational Health, Humans, Drugs, Essential
Abstract: To assess the procurement of medicines to treat cancer in China.We conducted a descriptive analysis of the national procurement data for 20 anti-cancer medicines in China from 2015 to 2020. We estimated the number of defined daily doses procured per year in three areas of China for essential medicines and medicines for targeted therapies. We adjusted the data by the number of cancer patients in each region for each year.Between 2015 and 2020, the number of defined daily doses per patient decreased from 40.87 to 35.86 (-12.27%) for essential medicines, while the number increased from 0.85 to 12.52 (1381.15%) for target medicines. The procurement of three out of 10 essential medicines decreased, whereas procurement of all 10 targeted medicines increased. In 2020, the eastern area procured the most essential medicines (44.98 doses per patient) and targeted medicines (16.55 doses per patient), but had the smallest relative change in procurement of both essential medicines (-22.76%) and targeted medicines (978.16%). The central area had the largest increase in procurement of both essential medicines (9.64%; from 25.25 to 27.68 doses per patient) and targeted medicines (4587.81%; from 0.23 to 10.64 doses per patient).Procurement of anti-cancer medicines varied across regions. Specific policies are needed at the national level to eliminate inequalities in access to these medicines. Two issues that need attention are the lower access to many essential anti-cancer medicines in some provinces and the increase in use of targeted medicines.Évaluer l'approvisionnement en médicaments pour traiter le cancer en Chine.Nous avons réalisé une analyse descriptive des données d'approvisionnement nationales pour 20 médicaments contre le cancer en Chine, entre 2015 et 2020. Nous avons estimé le nombre de doses quotidiennes définies achetées chaque année dans trois régions du pays, aussi bien de médicaments essentiels comme de médicaments destinés à des thérapies ciblées. Nous avons ajusté ces données en tenant compte du nombre de patients atteints d'un cancer chaque année dans chacune des régions.Entre 2015 et 2020, le nombre de doses quotidiennes définies par patient a décliné, passant de 40,87 à 35,86 (−12,27%) pour les médicaments essentiels, tandis que ce nombre a augmenté de 0,85 à 12,52 (1381,15%) pour les médicaments ciblés. L'acquisition de trois des dix médicaments essentiels a diminué; en revanche, les dix médicaments ciblés ont tous connu une hausse en matière d'approvisionnement. En 2020, c'est la région orientale qui s'est procuré le plus de médicaments essentiels (44,98 doses par patient) et ciblés (16,55 doses par patient), bien qu'elle affiche la plus petite variation relative dans l'achat de médicaments essentiels (−22,76%) et ciblés (978,16%). La région centrale, elle, a enregistré la plus importante augmentation dans l'acquisition de médicaments essentiels (9,64%; de 25,25 à 27,68 doses par patient) et ciblés (4587,81%; de 0,23 à 10,64 doses par patient).L'approvisionnement en médicaments contre le cancer diffère d'une région à l'autre. Des mesures spécifiques sont nécessaires à l'échelle nationale pour mettre un terme aux inégalités dans l'accès à ces traitements. Deux problèmes en particulier doivent être examinés: l'accès plus limité à de nombreux médicaments essentiels contre le cancer dans certaines provinces, ainsi que l'utilisation accrue de médicaments ciblés.Evaluar la adquisición de medicamentos para tratar el cáncer en China.Se realizó un análisis descriptivo de los datos de adquisición nacional de 20 medicamentos contra el cáncer en China de 2015 a 2020. Se calculó la cantidad de dosis diarias definidas adquiridas por año en tres regiones de China para medicamentos esenciales y medicamentos para tratamientos dirigidos. Asimismo, se ajustaron los datos en función de la cantidad de pacientes con cáncer en cada región para cada año.Entre 2015 y 2020, la cantidad de dosis diarias definidas por paciente disminuyó de 40,87 a 35,86 (-12,27 %) para los medicamentos esenciales, mientras que la cantidad aumentó de 0,85 a 12,52 (1381,15 %) para los medicamentos dirigidos. La adquisición de tres de los 10 medicamentos esenciales disminuyó, mientras que la adquisición de los 10 medicamentos dirigidos aumentó. En 2020, la región oriental adquirió la mayor cantidad de medicamentos esenciales (44,98 dosis por paciente) y de medicamentos dirigidos (16,55 dosis por paciente), pero tuvo el menor cambio relativo en la adquisición tanto de medicamentos esenciales (-22,76 %) como de medicamentos dirigidos (978,16 %). La región central es la que más ha aumentado la compra de medicamentos esenciales (9,64 %, de 25,25 a 27,68 dosis por paciente) y de medicamentos dirigidos (4587,81 %, de 0,23 a 10,64 dosis por paciente).La adquisición de medicamentos contra el cáncer varía según las regiones. Se necesitan políticas específicas a nivel nacional para eliminar las desigualdades en el acceso a estos medicamentos. Dos temas que requieren atención son el menor acceso a muchos medicamentos esenciales contra el cáncer en algunas provincias y el aumento del uso de medicamentos dirigidos.تقييم شراء الأدوية لعلاج السرطان في الصين.قمنا بإجراء تحليل وصفي لبيانات المشتريات الوطنية لعدد 20 دواءً مقاومًا للسرطان في الصين خلال الفترة من 2015 إلى 2020. وقد قدرنا عدد الجرعات اليومية المحددة التي يتم شراؤها كل عام في ثلاث مناطق بالصين للأدوية الأساسية، وأدوية العلاجات المستهدفة. قمنا بتعديل البيانات حسب عدد مرضى السرطان في كل منطقة لكل عام.بين عامي 2015 و2020، انخفض عدد الجرعات اليومية المحددة لكل مريض من 40.87 إلى 35.86 (−%12.27) للأدوية الأساسية، بينما ارتفع العدد من 0.85 إلى 12.52 (%1381.15) للأدوية المستهدفة. انخفض شراء ثلاثة من كل 10 أدوية أساسية، في حين زاد شراء جميع الأدوية الـ 10 المستهدفة. في عام 2020، اشترت المنطقة الشرقية الأدوية الأساسية جداً (44.98 جرعة لكل مريض)، والأدوية المستهدفة (16.55 جرعة لكل مريض)، ولكن كان لها أقل تغيير نسبي في شراء كل من الأدوية الأساسية (%22.76)، والأدوية المستهدفة (%978.16). شهدت المنطقة المركزية أكبر زيادة في شراء كل من الأدوية الأساسية (%9.64؛ من 25.25 إلى 27.68 جرعة لكل مريض)، والأدوية المستهدفة (%4587.81؛ من 0.23 إلى 10.64 جرعة لكل مريض).اختلفت مشتريات الأدوية المكافحة للسرطان عبر المناطق. هناك حاجة إلى سياسات محددة على المستوى الوطني للقضاء على حالات عدم المساواة في الحصول على هذه الأدوية. هناك مسألتان تحتاجان إلى الاهتمام، وهما الحصول المتدني على العديد من الأدوية الأساسية المكافحة للسرطان في بعض المقاطعات، والزيادة في استخدام الأدوية المستهدفة.旨在评估中国癌症治疗药物的采购情况。.我们对中国 2015 年至 2020 年 20 种抗癌药物的国家采购数据进行了描述性分析。我们估计了中国三个地区每年采购的基本药物和靶向治疗药物的日规定剂量。我们根据每个地区每年的癌症患者数量对数据进行了调整。.在 2015 年至 2020 年期间，每名患者服用的基本药物的日规定剂量从 40.87 剂下降到 35.86 剂 (-12.27%)，靶向药物从 0.85 剂增加到 12.52 剂 (1381.15%)。十分之三的基本药物的采购量有所下降，然而，所有 10 种靶向药物的采购量均有所增加。2020 年，东部地区对基本药物（每名患者 44.98 剂）和靶向药物（每名患者 16.55 剂）的采购量最多，但对基本药物 (−22.76%) 和靶向药物 (978.16%) 的采购量的相对变化最小。中部地区对基本药物（9.64%；每名患者从 25.25 剂增加到 27.68 剂）和靶向药物（4587.81%；每名患者从 0.23 剂增加到 10.64 剂）的采购量增福最大。.各地区抗癌药物的采购量存在差异。需要在国家层面制定具体政策，以消除在这些药物的获得性方面的差距。需要注意两个问题，在一些省份，许多基本抗癌药物的获得性较低，并且靶向药物的使用量有所增加。.Оценить закупки препаратов для лечения рака в Китае.В период с 2015 по 2020 год был проведен описательный анализ данных о национальных закупках 20 противораковых препаратов в Китае. Было подсчитано количество установленных суточных доз основных лекарственных средств и лекарственных препаратов для таргетной терапии, закупаемых в год в трех районах Китая. Данные были скорректированы по количеству пациентов с онкологическими заболеваниями в каждом регионе за каждый год.В период с 2015 по 2020 год количество установленных суточных доз на одного пациента снизилось с 40,87 до 35,86 (–12,27%) для основных лекарственных средств, в то время как для лекарственных препаратов для таргетной терапии это количество увеличилось с 0,85 до 12,52 (1381,15%). Закупки трех из 10 основных лекарственных средств снизились, при этом закупки всех 10 препаратов для таргетной терапии увеличились. В 2020 году в восточном регионе было закуплено больше всего основных лекарственных средств (44,98 дозы на пациента) и лекарственных препаратов для таргетной терапии (16,55 дозы на пациента), однако относительное изменение закупок как основных лекарственных средств (–22,76%), так и препаратов для таргетной терапии (978,16%) было наименьшим. В центральном регионе наблюдался наибольший рост закупок как основных лекарственных средств (9,64%; с 25,25 до 27,68 дозы на пациента), так и лекарственных препаратов для таргетной терапии (4587,81%; с 0,23 до 10,64 дозы на пациента).Закупки противораковых препаратов различались по регионам. Для устранения неравенства в доступе к этим лекарственным препаратам необходимы конкретные меры на национальном уровне. Две требующие внимания проблемы – это снижение доступности многих основных противораковых препаратов в некоторых провинциях и увеличение использования препаратов для таргетной терапии.
Published: 2022

26. Dispensing of antibiotics for tuberculosis patients using standardized patient approach at community pharmacies: results from a cross-sectional study in Pakistan.

Author: Gillani, Ali Hassan, Arshad, Hafsa, Mujtaba, Hasan, Umer, Muhammad Farooq, Sen Xu, Wenjing Ji, Bashir, Kamran, Jie Chang, Caijun Yang, and Yu Fang
Published: 2024
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27. Clinical Consumption of Compound Opioid Analgesics in China: A Retrospective Analysis of National Data 2015–2018

Author: Zhitong Feng, Shuchen Hu, Qinqin Feng, Cheng Xiang, Mengyuan Pan, Qian Shen, and Caijun Yang
Subjects: China, Pharmaceutical Science, Drug Prescriptions, History, 21st Century, Toxicology, Retrospective analysis, Humans, Pain Management, Medicine, Practice Patterns, Physicians', National data, Acetaminophen, Retrospective Studies, Pharmacology, Consumption (economics), Geography, Codeine, business.industry, General Medicine, Drug Utilization, Analgesics, Opioid, Drug Combinations, Defined daily dose, Southern china, business, Opioid analgesics, Oxycodone
Abstract: Compound opioid analgesics (COA) are widely used for cancer pain relief, but few studies investigated the use of that. We aimed to report the characteristics and trend of COA consumption in different regions and health facilities in China. The procurement data of two types of COA, compound codeine phosphate (CCP) and oxycodone and acetaminophen (OAA), in all medical institutions of 20 provinces from 2015 to 2018 were used. Data were presented as Defined Daily Dose for Statistical purpose (SDDD) and expenditures per million inhabitants per day. The annual consumption of COA and ratio of two combinations were compared among regions and institutions. We found, during 2015 - 2018, COA consumption increased at an average rate of 7.32% in SDDD and 19.19% in expenditures, while OAA accounted for most of the consumption. Highest COA consumption appeared in Northern China, with 121.72 SDDD and 1689.87 RMB (2015), whereas the lowest COA consumption was only 11.28 SDDD appearing in Southern China. The ratio of OAA and CCP (in SDDD) was highest in Southern China (53.14 in 2018), whereas lowest in West North (0.37 in 2018). In terms of institutions, tertiary had the highest COA consumption, with 16.74 SDDD and 292.73 RMB (2018). The SDDD of OAA was 27.44 times of that of CCP in tertiary, while it was only 0.11 in primary. Overall, COA consumption is on an upward trend and different among regions and health institutions in either amount or types of COA. These findings call for establishment of COA management regulations.
Published: 2021

28. A Generic Approach for Leather Nesting.

Author: Yuping Zhang and Caijun Yang
Published: 2009
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29. Anti-cancer medicine shortages in an oncology tertiary hospital of Pakistan: A five-year retrospective study

Author: Sundus Shukar, Caijun Yang, Shahbaz Ahmad Khan, and Omar Akhlaq Bhutta
Subjects: Oncology, Pharmacology (medical)
Abstract: Objective Anti-cancer medicine shortages are advancing challenges for patients and hospitals. This study aims to evaluate anti-cancer and supportive medicine shortages in a tertiary hospital in Pakistan and propose solutions. Method A retrospective observational research was performed in a tertiary care hospital in Pakistan from 2016 to 2020. Data was retrieved from the hospital database using a questionnaire regarding short medicines’ generic name, brand, dosage, source, total source, frequency, causes, impact, management, and analyzed by Microsoft Excel 2013. Results Between January 2016 and December 2020, 43 individual medicine shortages were observed, with an average of 8.6 shortages per year. There were shortages of 22 medicines, including 8 anti-cancer (36.4%) and 14 supportive agents (63.6%). Total shortage days were 27,100, with an average of 1232 days (SD 757) per medicine. Supportive medicines’ shortages were frequent, but oncology agents’ shortages were constant. The most affected dosage form was injection. Cardiovascular drugs and alkylating agents were the most affected class in supportive and anti-cancer medicines, respectively. The use of “alternative medicine” and “patient needs based importation” were the most common mitigation strategies. Conclusion Shortages of oncology medicines are challenging in Pakistan. The most prominent causes are the lack of updated governmental regulations, registration, and import issues. The tertiary care hospital has very few sources of supply, so it imports these drugs on a need basis to manage the shortages. But it is still concerning because of the huge financial burden on patients and institutions due to expensive import, and therapy become delayed as the import process takes time. Moreover, the most affected drug class was alkylating agents, and dosage was both injectable and oral medicines.
Published: 2022

30. Anticancer medicines in Pakistan: An analysis of essential medicines lists

Author: Sundus Shukar, Rehan Anjum, Jinwei Zhang, Zaheer-Ud-Din Babar, Iqra Mobeen, and Caijun Yang
Subjects: Oncology, Pharmacology (medical)
Abstract: Objective The lack of anticancer drugs for curative and supportive purposes is the critical reason for the low survival rate in low-and-middle-income countries. This study aims to analyze whether the National Essential Medicines List (NEML) and Registered Essential Medicines List (REML) are in concordance with the World Health Organization (WHO) Essential Medicines List (EML) and whether the formularies prevalent in the country are parallel to each other and to the NEML. Method An observational study design was used in which antineoplastic drugs from the 2021 NEML and REML were compared with 2021 WHO EML to evaluate their availability in Pakistan. Market access was determined. Moreover, the formularies of six different hospital types were compared with each other and with the NEML, and REML to estimate the availability within hospitals. Results There were 66 anticancer drugs in 2021 WHO EML and all were found in Pakistan's 2021 NEML but only 48 drugs (73%) were found in the REML. Hydroxycarbamide and dasatinib were two registered drugs absent in all hospitals’ formularies. The market access for anticancer medicines was 73% (48 of 66). Semigovernment hospital (86%) has the highest availability, followed by the government hospital (80%). All the hospitals have unregistered drugs including bortezomib, lenalidomide, and mesna. Conclusion Pakistan's NEML adopts WHO EML abruptly but all medicines are not registered. The hospitals are trying their best to increase availability but optimum drug regulations to revise NEML based on the country's requirements and emphasizing registration of anticancer medicines are needed to improve the country's availability of antineoplastic agents.
Published: 2023

31. Prescribing for Patients Seeking Maternal and Child Healthcare in Sierra Leone: A Multiregional Retrospective Cross-Sectional Assessments of Prescribing Pattern Using WHO Drug Use Indicators

Author: Chenai Kitchen, Yu Fang, Zongjie Li, Mingyue Zhao, Minghuan Jiang, Caijun Yang, Christian Hanson, John Alimamy Kabba, Peter James, and Jie Chang
Subjects: Drug, medicine.medical_specialty, media_common.quotation_subject, Pharmacy, Essential medicines, Sierra leone, Sierra Leone, 03 medical and health sciences, 0302 clinical medicine, Health care, Medicine, free healthcare, 030212 general & internal medicine, Medical prescription, prescribing pattern, media_common, Original Research, Risk Management and Healthcare Policy, rational drug use, Under-five, Ms excel, business.industry, 030503 health policy & services, Health Policy, Public Health, Environmental and Occupational Health, Family medicine, drug utilisation, 0305 other medical science, business
Abstract: John Alimamy Kabba,1– 3 Peter Bai James,4,5 Zongjie Li,1– 3 Christian Hanson,6,7 Jie Chang,1– 3 Chenai Kitchen,1– 3 Minghuan Jiang,1– 3 Mingyue Zhao,1– 3 Caijun Yang,1– 3 Yu Fang1– 3 1Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an, People’s Republic of China; 3Shaanxi Center for Health Reform and Development Research, Xi’an, People’s Republic of China; 4Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; 5Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia; 6Pharmacy Board, Ministry of Health and Sanitation New England, Freetown, Sierra Leone; 7Pharmacy Department, Well Star Atlanta Medical Centre South, East Point, GA, USACorrespondence: Yu FangDepartment of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, #76 Yanta West Road, Xi’an 710061, People’s Republic of ChinaTel +86 29 82655132Email yufang@mail.xjtu.edu.cnPurpose: Rational use of medicines is a necessary constrict towards increasing access for those that desperately need them in society. In this study, we assess medicines prescribing patterns in healthcare facilities implementing free healthcare policy for pregnant women, lactating mothers and children under the age of five in Sierra Leone.Materials and Methods: Using WHO drug use indicators, we evaluated prescription records from the pharmacies of four hospitals; one from each of the four regions in Sierra Leone. To study prescribing indicators, we systematically sampled 1200 prescriptions overall (300/hospital) retrospectively spanning a year, from June 2017 to July 2018. In evaluating patients care indicators, we randomly sampled 120 (30/hospital) patients encounter prospectively. We used MS Excel 2016 and IMB SPSS in data analysis, and p< 0.05 was considered significant for associational analysis.Results: The average drug per prescription was 3.6 (SD=1.3) overall, 3.5 (1.3) for children under five and 3.4 (1.4) for pregnant women/lactating mothers. Eighty-seven percent of prescriptions for under-five children contains antibiotics as opposed to 68.4% of prescriptions for pregnant women/lactating mothers. More injections were prescribed per encounter for pregnant women/lactating mothers 23.2% than for children under five 18.1%. Overall, generic prescribing and prescribing from the National Essential Medicines List were 74.9% and 73.8%, respectively. None of the studied health facilities dispensed all of the prescribed medicines. The most prescribed pharmacological class of drugs were antibiotics, and paracetamol was the most commonly prescribed drug.Conclusion: Following WHO drug use indicators used in this study, drugs were irrationally prescribed within government hospitals providing free healthcare in Sierra Leone. Sustainability of the free healthcare scheme will require efficient medicine supply and management strategies. Therefore, the formulation of stewardship programs and/or an active Drug and Therapeutics Committee may be necessary to optimise drug use in these hospitals.Keywords: prescribing pattern, rational drug use, drug utilisation, free healthcare, Sierra Leone
Published: 2020

32. A survey of knowledge, attitudes and practices concerning antibiotic prescription for upper respiratory tract infections among pediatricians in 2018 in Shaanxi Province, China

Author: Wenjing Ji, Hongli Zhang, Dan Ye, Yu Fang, Caijun Yang, Minghuan Jiang, Mingyue Zhao, Kangkang Yan, and Shengyuan Liu
Subjects: Adult, Male, 0301 basic medicine, Microbiology (medical), China, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, genetic structures, medicine.drug_class, 030106 microbiology, Antibiotics, Microbiology, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Virology, medicine, Humans, Pediatricians, 030212 general & internal medicine, Practice Patterns, Physicians', Medical prescription, Respiratory Tract Infections, Respiratory tract infections, business.industry, Age Factors, Middle Aged, Antibiotic prescription, Anti-Bacterial Agents, Cross-Sectional Studies, Infectious Diseases, Family medicine, Income, Educational Status, Female, business
Abstract: 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...
Published: 2020

33. Perceptions of Cannabis in sub-Saharan Africa: Findings from a general population survey in six African countries with different Cannabis policies

Author: Chenai Kitchen, John Alimamy Kabba, Tonny Ssekamatte, Ediomo-Ubong Nelson, Samuel Adu-Gyamfi, Molewane Mametja, Caijun Yang, Jie Chang, and Yu Fang
Abstract: Background Recently, legislative shifts in cannabis regulation away from exclusively prohibitionist controls have been seen in sub-Saharan African countries. However, the extent to which public perceptions are aligned with policy trends is unclear. Given that views concerning cannabis may be influenced by associated legislation we aimed to compare public opinion towards cannabis amongst countries with legislatively different cannabis policies. Methods We conducted an online survey of the general adult population in six purposively selected countries representative of maximum policy variation across sub-Saharan Africa i.e., Ghana, Nigeria, Sierra Leone, South Africa and Zimbabwe. Survey questions covered perceptions towards users, risks and benefits, regulations and public health impacts as well as sociodemographic characteristics. Chi square tests were used to analyse the association between categorical variables and explore country level differences. Results Totally 1216 responses were received. Large variations were noted in responses towards user stereotypes, risks and preferred legislation. In relation to users being honest (X2=43.316, P), most in Sierra Leone(52.9%), Nigeria (45.6%) and Uganda(48.6%) disagreed whereas in Ghana(39.4%), South Africa(43.3%) and Zimbabwe(40.1%) most agreed. Differences in smoking cannabis and smoking tobacco products(X2= 27.712, P=0.002) saw respondents from Ghana(51.4%), Nigeria(58.8%), Uganda(50.9%) and Zimbabwe(46.8%) agreeing that smoking cannabis is more harmful to health, whereas majorities in Sierra Leone(45.7%) and South Africa(49.8%) disagreed. Apart from South Africa were the greater proportion opted to allow cannabis for all purposes(28.8%), majorities in other countries supported only medicinal legalisation(X2= 96.631, P). Conclusion Dependent upon the question of focus, at the liberal end of the policy spectrum are Ghana, South Africa and Zimbabwe whilst Nigeria, Sierra Leone and Uganda were more conservative. Responses tended to reflect the policy position of respective countries, however our findings suggest overall increasing medicinal cannabis support. Greater understanding of policy dynamics may help create frameworks for countries contemplating reforms.
Published: 2022

34. Perceptions of pharmacists towards drug shortages in the healthcare system of Pakistan and its impact on patient care: findings from a cross-sectional survey

Author: Sumaira Omer, Mengyuan Pan, Salamat Ali, Sundus Shukar, Yu Fang, and Caijun Yang
Subjects: health services administration & management, health policy, General Medicine, Pharmacists, quality in health care, Cross-Sectional Studies, general medicine (see internal medicine), Humans, Pakistan, Health Services Research, Patient Care, Delivery of Health Care
Abstract: ObjectiveThis study aimed to explore pharmacists’ perceptions on drug shortages and its impingement on the Pakistani healthcare system, in particular on patient care.DesignOnline questionnaire survey.Setting and participantsHospital pharmacists from five out of seven regions of Pakistan were approached; including the federal territory (Islamabad) and four provinces (Khyber Pakhtunkhwa, Balochistan, Punjab and Sindh).Primary and secondary outcome measuresPrevalence and type of shortages were identified along with strategies to reduce its effect on patient care.MethodA validated questionnaire was distributed through various online platforms to 800 registered hospital pharmacists. A convenience sampling technique was used to obtain information on drug shortages, the reporting system for shortages, the impact on patients and policy solutions for managing drug shortages.ResultsOut of 800 hospital pharmacists, 708 completed the questionnaire (response rate: 88.5%). Of these hospital pharmacists, 47% came from hospitals of Punjab, 26% from Khyber Pakhtunkhwa, 13% from Sindh, 11% from Balochistan and 4% from Islamabad; 72% and 28% worked in tertiary and secondary hospitals, respectively. The majority (32%) interacted with shortages daily. The top three drug categories reported in shortage were oncology drugs (54%), cardiovascular drugs (53%) and antimicrobials (42%). 58% of the respondents have seen care delayed as a negative consequence of shortages. ‘Creating new communication system’ (65%) and ‘readjust budget plans’ (41%) were the two most frequently indicated recommendations for shortages management at hospital, while ‘circulars or alerts from the regulatory authority’ (60%) and ‘time to time directives from local health statuaries’ (48%) were two most widely suggested policy solutions.ConclusionDrug shortage is a serious concern in Pakistani hospitals, experienced on a daily basis endangering patients’ health. Enhanced communication is required, connecting the key stakeholders. Health policies should be reviewed; adequate funds should be allocated to the health sector preventing future shortages.
Published: 2021

35. Access to Insulin Products in Pakistan: A National Scale Cross-Sectional Survey on Prices, Availability, and Affordability

Author: Amna Saeed, Krizzia Lambojon, Hamid Saeed, Zikria Saleem, Naveed Anwer, Muhammad Majid Aziz, Wenjing Ji, Wenchen Liu, Chen Chen, Caijun Yang, Yu Fang, and Zaheer-Ud-Din Babar
Subjects: Pharmacology, Pharmacology (medical)
Abstract: Background: Diabetes is among the top ten most prevalent diseases in Pakistan, and the availability of medicines to treat the disease is vital for a great percentage of the country’s population. Insulin was discovered a century ago; however, its access in several parts of the globe remains an issue. This study aims to evaluate prices, availability, and affordability (access components) of insulin and five comparator medicine access in Pakistan.Methods: A nationwide cross-sectional survey was conducted to evaluate the access to insulin and some comparator medicines in eight cities of Pakistan, using a modified WHO/HAI methodology. The survey included 80 medicine outlets, i.e., 40 private pharmacies and 40 public hospitals. Data for every unique insulin product available in the Pakistani market were obtained, including five comparator medicines. Percentage availability, median unit prices (MUPs), and affordability (the number of days’ wages (NDWs) required for a month’s course by the lowest-paid unskilled government worker) of all products were calculated, including originator brands (OBs) and biosimilar (BS) products.Results: Of all insulin products surveyed (n = 320), 87.5% were manufactured by foreign multinational companies (MNCs). None of the insulin products had an ideal availability of 80% in any of the surveyed health facilities. In the public sector, none of the insulin products had an availability of more than 50%. In the public sector, the overall availability of human insulin was 70% (including OB and BS). While in the private sector, the overall availability of human insulin was 90% and that of analog insulin was 62.5%. The analog insulin products were 72.8% costlier than the human insulin products. The median prices of BS insulin were 25.4% lower than the OB products, indicating that almost one-fourth of the cost could be saved by switching to BS human insulin from OB human insulin. All oral anti-diabetic medicines were found to be affordable, whereas none of the insulin was affordable. The NDWs for human and analog insulin were 1.38 and 5.06.Conclusion: In Pakistan, the insulin availability falls short of the WHO’s benchmark of 80%. Insulin continues to be unaffordable in both private and government sectors. To increase insulin access, the government should optimize insulin procurement at all levels, promote local production, enforce biosimilar prescribing, and provide financial subsidies for these products.
Published: 2021

36. A branch, bound, and remember algorithm for the simple disassembly line balancing problem

Author: Chengbin Chu, Jinlin Li, Caijun Yang, Xiaohong Chen, and Zhanguo Zhu
Subjects: 0209 industrial biotechnology, 021103 operations research, General Computer Science, Branch and bound, Heuristic, Computer science, 0211 other engineering and technologies, 02 engineering and technology, Management Science and Operations Research, 020901 industrial engineering & automation, Exact algorithm, Modeling and Simulation, Line balancing, Graph (abstract data type), Integer programming, Algorithm
Abstract: In this paper, we deal with a disassembly line balancing problem (DLBP), using an AND/OR graph (AOG) to represent the precedence relations between tasks. The decision maker needs to select a proper processing alternative and assign the corresponding tasks among stations to minimise the number of stations, without violating the cycle time constraint and the precedence relations. The problem was first formulated by Koc et al. (2009) and is denoted as type 1 simple DLBP (SDLBP-1) in this study. We prove that an SDLBP-1 with no parallel tasks is polynomially solvable and develop a branch, bound, and remember (BB&R) algorithm for the general SDLBP-1 with parallel tasks. Moreover, two lower bounding schemes, a strengthened Koc's integer programming (IP) model and a new benchmark instance generation scheme are proposed. Computational results show that the BB&R algorithm is the state-of-the-art exact algorithm for SDLBP-1, and that it can be easily truncated into a state-of-the-art heuristic which optimally solves most instances in very short time. In addition, the lower bounds and the strengthened IP model are also demonstrated to be effective.
Published: 2019

37. Clinical Study on Electronic Medical Neuroelectric Stimulation Based on the Internet of Things to Treat Epilepsy Patients with Anxiety and Depression

Author: Caijun Yang, Shaoping Li, Shenguo Wang, Lantian Wang, Weijie Wang, Bo Zhang, and Mingchao Liu
Subjects: medicine.medical_specialty, Medicine (General), Deep brain stimulation, Vagus Nerve Stimulation, Article Subject, medicine.medical_treatment, Internet of Things, Biomedical Engineering, Health Informatics, Stimulation, 02 engineering and technology, Anxiety, 03 medical and health sciences, Epilepsy, 0302 clinical medicine, R5-920, Quality of life, 0202 electrical engineering, electronic engineering, information engineering, medicine, Medical technology, Humans, R855-855.5, Depression (differential diagnoses), business.industry, Depression, Therapeutic effect, 020206 networking & telecommunications, medicine.disease, Treatment Outcome, Physical therapy, Quality of Life, Surgery, medicine.symptom, Electronics, business, 030217 neurology & neurosurgery, Vagus nerve stimulation, Biotechnology, Research Article
Abstract: With the continuous development and improvement of the level of medical technology in our country in recent years, the treatment of epilepsy has been constantly updated and developed. Nerve electrical stimulation is considered to be a very effective method for treating epilepsy with anxiety and depression. There are many traditional methods for the treatment of epilepsy. For example, vagus nerve stimulation (VNS) has been applied earlier, and the therapeutic effect has been confirmed, but it will cause serious complications and is easier to be uncomfortable; deep brain stimulation for epilepsy is still in the immature stage, and there is no final conclusion. Therefore, this article proposes a clinical study on the treatment of patients with epilepsy with anxiety and depression based on the electronic medical nerve stimulation of the Internet of Things. First of all, this article uses the literature method to study the causes of epilepsy and previous treatment methods. Then, we designed an experimental study of epilepsy with depression based on the Internet of Things electronic medical neuroelectric stimulation therapy and selected the core quality of life questionnaire, SDS, and SAS as observation indicators. Finally, the comparison of epilepsy symptoms and depression and anxiety between the control group and the observation group before and after treatment was analyzed. The results of the experiment showed that, among the 50 subjects in the study, the observation group that used electrical nerve stimulation therapy had 5 people who stopped seizures after treatment, accounting for 10%, while in the control group of traditional drug treatment methods, after treatment, only one person stopped the seizure, accounting for 2%. In addition, the SAS and SDS scores of the observation group were also lower than those of the control group. Therefore, the use of nerve electrical stimulation to treat epilepsy with anxiety and depression symptoms has better performance and can help patients recover as soon as possible.
Published: 2021
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38. Trends in Consumption of Quinolones in Chinese Healthcare Institutions: Results of National Procurement Data Analysis (2015–2018)

Author: Mingyue Zhao, Chen Chen, Yu Fang, Jie Chang, Khezar Hayat, Wenchen Liu, Sen Xu, Minghuan Jiang, Ali Hassan Gillani, Wenjing Ji, and Caijun Yang
Subjects: Consumption (economics), Procurement, Public economics, business.industry, Health care, Business
Abstract: BackgroundThere is widespread use of quinolones to treat various infectious diseases due to their broad-spectrum nature and optimal pharmacokinetic characteristics. Nevertheless, the risk of bacterial resistance has also amplified as a consequence of their judicial use in hospitals and the community. The current study investigated the consumption and expenditure of quinolone antibiotics during 2015–2018 in various health settings in China.MethodsWe used the China Drug Supply Information Platform (CDSIP) to analyze the drug procurement data of national healthcare institutions, focusing on determining the trend and pattern of quinolone consumption. The standard Anatomical Therapeutic Chemical (ATC)/Defined daily dose (DDD) methodology was opted to quantify antibiotic usage.ResultsA slight decrease in J01M antibiotics consumption (25.7% to 23.5%) was observed over four years (2015–2018). The use of quinolones was significantly higher in rural primary health centers (53.9%) and tertiary hospitals (22.1%). In 2017, levofloxacin (61.4%) was the most commonly consumed quinolone, followed by norfloxacin (27.1%) and moxifloxacin (4.1%). The total spending on J01M antibiotics gradually increased from 21.4% in 2015 to 27.9% in 2018. ConclusionsFrom 2015 to 2018, the general use of J01M antibiotics decreased marginally, but the use of the paternal type of J01M and its expenditure is continuously growing. There is a need to enforce stringent antibiotic management programs to restrict the irrational use of antibiotics.
Published: 2020

39. Impact of the zero-mark-up drug policy on drug-related expenditures and use in public hospitals, 2016–2018: an interrupted time series study in Shaanxi

Author: Dan Ye, Mingyue Zhao, Shengyuan Liu, Caijun Yang, Kangkang Yan, Minghuan Jiang, Yu Fang, Hongli Zhang, and Jie Chang
Subjects: Drug, China, media_common.quotation_subject, drug expenditure, Psychological intervention, Context (language use), zero mark-up drug policy, Drug Costs, Interrupted Time Series Analysis, Environmental health, Medicine, Humans, Medical prescription, hospital, media_common, drug use, Government, business.industry, Hospitals, Public, Health Policy, Interrupted time series, Retrospective cohort study, General Medicine, Pharmaceutical Preparations, Health Expenditures, business
Abstract: ObjectiveThe aim of this study was to measure the impact of zero-mark-up drug policy (ZMDP) on drug-related expenditures and use in urban hospitals.DesignThis was a retrospective observational study of trends in drug expenses and use in the context of the ZMDP using an interrupted time series analysis.SettingTwelve hospitals (three tertiary hospitals and nine secondary hospitals) in Xi’an, which is the capital of Shaanxi Province in Western China.Data and participantsThe prescription information for all outpatients and inpatients in the study hospitals from January 2016 to April 2018 was used in this study.InterventionsThe Chinese government announced the policy intervention measure of the ZMDP, which was implemented in all public hospitals as of 1 April 2017.Primary measuresMonthly drug expenditures, monthly medical expenditures, the percentage of drug expenditures among total medical expenditures, the average outpatient drug expenditure per visit, the percentage of prescriptions that include an injection and the percentage of prescriptions that include an antibiotic.ResultsMonthly total medical expenses increased in both tertiary and secondary hospitals after the ZMDP was implemented. In tertiary hospitals, the average outpatient drug expenditures per visit showed a slow decreasing trend before the intervention and an increasing trend after the intervention, with statistically significant changes in both the level (pConclusionsThe effect of the ZMDP on drug-related expenditures and use in Chinese public hospitals was not substantially evident. Future pharmaceutical reform measures should give more consideration to physician prescription behaviours.
Published: 2020

40. Impact of National Drug Pricing Policy 2018 on access to medicines in Lahore division, Pakistan: a pre-post survey study using WHO/HAI methodology

Author: Amna Saeed, Zikria Saleem, Mingyue Zhao, Yu Fang, Hamid Saeed, Faiz Ullah Khan, Muhammad Aziz, Zaheer-Ud-Din Babar, Naveel Atif, Minghuan Jiang, Caijun Yang, Ali Hassan Gillani, and Wenjing Ji
Subjects: health services administration & management, Pharmacy, World Health Organization, Essential medicines, Drug Costs, Health Services Accessibility, Environmental health, Medicine, health economics, Humans, Pakistan, Health policy, health care economics and organizations, Government, Health economics, business.industry, Public sector, health policy, General Medicine, Private sector, Pharmacology and Therapeutics, Cross-Sectional Studies, Costs and Cost Analysis, Survey data collection, pharmacology, business, Drugs, Essential
Abstract: ObjectiveTo evaluate the impact of new National Drug Pricing Policy (NDPP) 2018 on access to medicines in terms of prices, availability and affordability.DesignTwo cross-sectional surveys were undertaken before and after the launch of NDPP 2018, using a modified WHO/Health Action International (WHO/HAI) methodology.SettingFour districts of Lahore division, Pakistan.Participants16 public sector hospitals and 16 private sector retail pharmacies.MeasuresThe pre and post survey data on prices and availability of lowest price generics (LPGs) and originator brands (OBs) of 50 medicines were obtained by visiting the same public and private sector health facilities (n=32). Out of 50, 46 surveyed medicines were from the National Essential Medicines List. Inflation-adjusted median unit prices (MUPs) and median price ratios (MPRs) from 2019 were used for price comparison. Affordability was calculated in terms of number of days’ wages required to get a standard treatment by the lowest paid unskilled government worker.ResultsThe overall mean percent availabilities remained poor in both years, that is, far less than 80%. In the public sector, the mean percent availability of OBs improved from 6.8% to 33.1%, whereas, in the case of LPGs, it was reduced from 35.1% to 9%. In the private sector, the mean percent availability of both OBs and LPGs demonstrated slight improvements in 2019, that is, 55.0%–58.3% and 20.3%–32.3%. The adjusted MUPs and MPRs of OBs significantly increased by a median of 4.29% (Wilcoxon test p=0.001, p=0.0001), whereas the adjusted MUPs and MPRs of LPGs increased by a median of 15.7% (p=0.002, p=0.0002). Overall, the affordability of many medicines for common ailments was reduced significantly in 2019.ConclusionsThe availability of medicines slightly improved, except in the case of LPGs, which was reduced in the public sector. The implementation of NDPP 2018 led to increase in drug prices, making the standard treatment for some of the most prevalent ailments unaffordable. So verily, the drug pricing policy must be reviewed to ensure access to essential medicines.
Published: 2020

41. Knowledge, attitude, and practices of community pharmacy staff toward antimicrobial stewardship programs: a cross-sectional study from Northeastern China

Author: Caijun Yang, Yu Fang, Minghuan Jiang, Li Shi, Zhitong Feng, Khezar Hayat, Jie Chang, Zhe Huang, Yilin Gong, Wenjing Ji, Pengchao Li, Mingyue Zhao, and Cheng Xiang
Subjects: 0301 basic medicine, Microbiology (medical), Adult, Male, China, Health Knowledge, Attitudes, Practice, Cross-sectional study, Attitude of Health Personnel, 030106 microbiology, Community Pharmacy Services, Pharmacists, Microbiology, 03 medical and health sciences, Antimicrobial Stewardship, Young Adult, 0302 clinical medicine, Antibiotic resistance, Anti-Infective Agents, Virology, Environmental health, Surveys and Questionnaires, Antimicrobial stewardship, Humans, 030212 general & internal medicine, Community pharmacies, Middle Aged, Antimicrobial, Infectious Diseases, Cross-Sectional Studies, Community pharmacy, Female, Business
Abstract: 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.
Published: 2020

42. Knowledge, Attitude, and Practices of Healthcare Professionals on COVID-19 and Risk Assessment to Prevent the Epidemic Spread: A Multicenter Cross-Sectional Study from Punjab, Pakistan

Author: Naveel Atif, Furqan Khurshid Hashmi, Yu Fang, Fahad Saleem, Hamid Saeed, Muhammad Islam, Caijun Yang, Minghuan Jiang, Usman Rashid Malik, and Mingyue Zhao
Subjects: Adult, medicine.medical_specialty, Health Knowledge, Attitudes, Practice, Coronavirus disease 2019 (COVID-19), Cross-sectional study, Health, Toxicology and Mutagenesis, Health Personnel, education, Pneumonia, Viral, lcsh:Medicine, Risk management tools, 01 natural sciences, Risk Assessment, Article, 03 medical and health sciences, Betacoronavirus, Young Adult, 0302 clinical medicine, Epidemic spread, medicine, Humans, Pakistan, 030212 general & internal medicine, 0101 mathematics, Pandemics, Emergency management, Health professionals, business.industry, SARS-CoV-2, lcsh:R, 010102 general mathematics, Public Health, Environmental and Occupational Health, Outbreak, COVID-19, healthcare professionals, Cross-Sectional Studies, Family medicine, KAP, Risk assessment, business, Coronavirus Infections
Abstract: In the current outbreak of novel coronavirus (COVID-19), healthcare professionals (HCPs) have a primary role in combating the epidemic threat. HCPs are at high risk of not only contracting the infection but also spreading it unknowingly. It is of utmost importance to evaluate their knowledge, attitudes, and practices (KAP) and the ability to assess the risks associated with the outbreak. A cross-sectional online survey involving physicians, pharmacists, and nurses was conducted. A 39-itemed questionnaire based on the World Health Organization (WHO)COVID-19 risk assessment tool was shared with healthcare professionals in three purposively selected key divisions of Punjab province. Out of 500 healthcare professionals, 385 responded to the survey. The majority (70%) were aged 22&ndash, 29 years, 144 (37.4%) physicians, 113 (29.4%) nurses, and 128 (33.2%) pharmacists completed the survey. Overall, 94.8% of healthcare professionals scored adequately (&gt, 14) for COVID-19-related knowledge, 97.9% displayed an optimistic attitude (&gt, 42) and 94.5% had an adequate practice score (&gt, 28). Kruskal&ndash, Wallis and Jonckheere&ndash, Terpstra tests showed significant differences (p &lt, 0.05) in KAP and risk assessment scores among groups, physicians and nurses scored higher as compared to pharmacists. Further research and follow-up investigations on disaster management and risk assessment can help policy-makers better tackle future epidemics.
Published: 2020

43. Knowledge, Attitude, and Practices of Antibiotics and Antibiotic Resistance Among Chinese Pharmacy Customers: A Multicenter Survey Study

Author: Caijun Yang, Tao Liu, Li Shi, Yu Fang, Muhammad Aziz, Shiyu Ji, Khezar Hayat, Amna Saeed, Krizzia Lambojon, Yilin Gong, Wenjing Ji, Pengchao Li, Zhitong Feng, Minghuan Jiang, and Jie Chang
Subjects: 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, knowledge, China, antibiotic resistance, medicine.drug_class, 030106 microbiology, Antibiotics, Pharmacy, Biochemistry, Microbiology, Article, antibiotics, 03 medical and health sciences, 0302 clinical medicine, Antibiotic resistance, medicine, Global health, community pharmacy, Pharmacology (medical), 030212 general & internal medicine, General Pharmacology, Toxicology and Pharmaceutics, Response rate (survey), business.industry, lcsh:RM1-950, Systematic sampling, Infectious Diseases, lcsh:Therapeutics. Pharmacology, Family medicine, Multicenter survey, Over-the-counter, business
Abstract: Background: Resistance to antibiotics is one of the major global health challenges. An adequate understanding of the public regarding rational antibiotic use is a prerequisite to limit progression in antibiotic resistance. This study aimed to investigate the knowledge, attitude, and practices (KAP) of antibiotics and antibiotic resistance among customers visiting community pharmacies. Methods: This study was undertaken in three capital cities in China during March 2019 and July 2019 by using a questionnaire of 28 items. The questionnaire had four parts, including sociodemographic characteristics, KAP about antibiotics, and antibiotic resistance. A systematic random sampling approach was used to recruit the participants. Kruskal&ndash, Wallis and Mann&ndash, Whitney tests were carried out for data analysis. Results: The response rate was 66.7% (1800/2700). Out of the total, only 9.7% of the customers had good knowledge about antibiotics. Nearly half of the participants were unable to differentiate between antibiotics, and anti-inflammatory drugs (n = 820, 45.6%, Median = 2, IQR = 1). Most of the customers were of the view that the use of over the counter antibiotics in pregnant women is unsafe (n = 1307, 72.6%, Median = 2, IQR = 0). Almost half of the participants disagreed that costly antibiotics are more effective and have fewer side effects (n = 897, 49.9%, Median = 3, IQR = 1). Only 22.3% of participants said that they always finish the course of antibiotic treatment (n = 401, 22.3%, Median = 3, IQR = 1). Conclusion: The knowledge of Chinese pharmacy consumers was inadequate, and a lack of good attitudes and practices in certain aspects of antibiotic use was observed. Educational interventions are needed to increase public knowledge of antibiotics.
Published: 2020

44. Pharmaceutical Policy and Practice Research: A Review of Studies in China

Author: Khezar Hayat, Amna Saeed, Yu Fang, Caijun Yang, Krizzia-Mae Lambojon, and Ali Hassan Gillani
Subjects: Procurement, Health facility, business.industry, Accounting, Business, China, Essential medicines, Pharmaceutical policy, Profit (economics), Practice research
Abstract: The Pharmaceutical policy in China has changed greatly since the National Essential Medicines Program (NEMP) introduced the health system reform in 2009. A National Essential Medicine List (NEML) was issued in 2009, with 307 medicines. The second edition of NEML with 520 medicines was issued in 2012, and the third edition with 685 medicines in 2018. Other matching policies were introduced consequently, such as Zero Mark-up (essential medicines are sold to patients for procurement price plus a fixed distribution cost, with no profit for the sale to the health facility), province-based medicine, competitive-bidding system and so on. The Center of Drug Safety and Policy (CDSP), situated in Xi’an Jiaotong University (XJTU) and founded in 2014, is working on pharmaceutical policy issues and providing the necessary evidence showing the efficiency of these policies. The results of these studies are reported in this chapter.
Published: 2020

45. A Qualitative Study Exploring the Management of Medicine Shortages in the Community Pharmacy of Pakistan

Author: Yu Fang, Caijun Yang, Sundus Shukar, Salamat Ali, Sumaira Omer, and Ali Hassan Gillani
Subjects: Attitude of Health Personnel, Health, Toxicology and Mutagenesis, Psychological intervention, Distribution (economics), Pharmacy, essential medicines, Community Pharmacy Services, Pharmacists, Article, Essential medicines, qualitative interviews, Professional Role, community setting, Humans, Pakistan, Pharmacies, Consumption (economics), Medical education, business.industry, Public Health, Environmental and Occupational Health, Bulk purchasing, Medicine, Business, Thematic analysis, shortages, Qualitative research
Abstract: Managing medicine shortages consumes ample time of pharmacists worldwide. This study aimed to explore the strategies and resources being utilized by community pharmacists to tackle a typical shortage problem. Qualitative face-to-face interviews were conducted. A total of 31 community pharmacists from three cities (Lahore, Multan, and Dera Ghazi Khan) in Pakistan were sampled, using a purposive approach. All interviews were audio taped, transcribed verbatim, and subjected to thematic analysis. The analysis yielded five broad themes and eighteen subthemes. The themes highlighted (1) the current scenarios of medicine shortages in a community setting, (2) barriers encountered during the shortage management, (3) impacts, (4) corrective actions performed for handling shortages and (4) future interventions. Participants reported that medicine shortages were frequent. Unethical activities such as black marketing, stockpiling, bias distribution and bulk purchasing were the main barriers. With respect to managing shortages, maintaining inventories was the most common proactive approach, while the recommendation of alternative drugs to patients was the most common counteractive approach. Based on the findings, management strategies for current shortages in community pharmacies are insufficient. Shortages would continue unless potential barriers are addressed through proper monitoring of the sale and consumption of drugs, fair distribution, early communication, and collaboration.
Published: 2021

46. How does the general public view antibiotic use in China? Result from a cross-sectional survey

Author: Dan Ye, Kangkang Yan, Wenjing Ji, Caijun Yang, Ali Hassan Gillani, Jie Chang, Muhammad Aziz, and Yu Fang
Subjects: Adult, Male, China, Health Knowledge, Attitudes, Practice, Adolescent, medicine.drug_class, Cross-sectional study, 030231 tropical medicine, Antibiotics, Population, Pharmaceutical Science, Pharmacy, Self Medication, Toxicology, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Antibiotic resistance, Environmental health, Global health, Humans, Medicine, Pharmacology (medical), 030212 general & internal medicine, education, Respiratory Tract Infections, Aged, Pharmacology, Response rate (survey), education.field_of_study, business.industry, Middle Aged, Anti-Bacterial Agents, Cross-Sectional Studies, Public Opinion, Female, business, Self-medication
Abstract: Background Resistance to antibiotics is a major threat to global health and general public play a significant role in the fight against antimicrobial resistance. Objective The present study aimed to identify the knowledge, attitudes, and practice of the general public towards antibiotic use in China. Setting Randomly selected parks in three cities of western, central and eastern China: Xi'an, Changsha, and Nanjing. Method A cross-sectional survey was conducted on a sample of 1400 residents, from January to June 2015. Main outcome measures Knowledge, attitudes and practices scores toward self-medication with antibiotics and compliance with antibiotic regimens. Results The response rate was 86.0% (n = 1204). Only 192 (19.5%) respondents gained a score of 3 or above, and the maximum score of 4, reflecting poor knowledge towards antibiotics. Just over half (54.8%) of respondents incorrectly believed antibiotics were effective against viral infections and only one-third (34.3%) knew that antibiotics were not anti-inflammatories. Nearly half of the respondents (49.0%) had changed the dosage when taking antibiotics, 35.6% switched to another class, 33.4% had not finished the full treatment course and over 60.0% kept leftover antibiotics for future use. Almost half of the respondents (45.7%) stated they had used antimicrobials during the last 6 months and 64.4% of them had self-medicated. Conclusion This study identified serious misconceptions regarding antibiotics use in the Chinese general public. Effective interventions should be developed to provide practical and appropriate advice to effect behaviour change within this population.
Published: 2017

47. Attitude of clinicians towards hospital-based antimicrobial stewardship programs: a multicenter cross-sectional study from Punjab, Pakistan

Author: Jie Chang, Meagen Rosenthal, Shan Zhu, Mingyue Zhao, Yu Fang, Minghuan Jiang, John Alimamy Kabba, Alemtsehay Adam Bogale, Ali Hassan Gillani, Caijun Yang, and Khezar Hayat
Subjects: 0301 basic medicine, Microbiology (medical), Adult, Male, Cross-sectional study, Attitude of Health Personnel, 030106 microbiology, Microbiology, 03 medical and health sciences, Antimicrobial Stewardship, Young Adult, 0302 clinical medicine, Antibiotic resistance, Virology, Environmental health, Physicians, Surveys and Questionnaires, Global health, Antimicrobial stewardship, Medicine, Humans, Pakistan, 030212 general & internal medicine, Hospitals, Teaching, health care economics and organizations, business.industry, Drug Resistance, Microbial, Hospital based, Infectious Diseases, Cross-Sectional Studies, Female, business
Abstract: 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 deter...
Published: 2019

48. Patients’ Anticipation for the Pharmacies of Rural Communities: A Qualitative Study from Pakistan

Author: Minghuan Jiang, Yu Fang, Muhammad Ali Raza, Wenjing Ji, Muhammad Aziz, Zhu Shan, Caijun Yang, Imran Masood, and Jie Chang
Subjects: Semi-structured interview, Adult, Counseling, Male, medicine.medical_specialty, Referral, Adolescent, Health, Toxicology and Mutagenesis, Staffing, qualitative study, lcsh:Medicine, Pharmacy, Community Pharmacy Services, Article, Nonprobability sampling, Interviews as Topic, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Professional Role, medicine, community pharmacies, First Aid, Humans, Pakistan, 030212 general & internal medicine, patients’ anticipation, rural population, Qualitative Research, Quality of Health Care, business.industry, 030503 health policy & services, lcsh:R, Public Health, Environmental and Occupational Health, Middle Aged, Family medicine, Pharmacy practice, Female, Business, Rural area, 0305 other medical science, Qualitative research
Abstract: Background: Community pharmacies are an integrated part of healthcare systems worldwide. In low and middle income countries like Pakistan, the paradigm of pharmacy practice is shifting from dispensing medicines to clinical activities. There are disparities in these practices according to location. Pharmacies in urban localities are better than those in rural areas. This qualitative study was conducted to explore patients&rsquo, expectations and current practices in rural pharmacies. Methods: A cohort of adult pharmacy visitors (aged &gt, 18 years) that reside in rural community was selected. Consenting participants were recruited by purposive sampling technique until thematic saturation level was achieved. A total of 34 patients were interviewed. Face-to-face interviews were conducted using a semi structured interview guide. All the data were transcribed and used to originate the themes. Results: On analysis, a total of 20 themes were obtained. Sixteen themes pronounced the current provided services. Four themes provided some suggestions for the development of better pharmacies. On call services to provide medicines, limited free extended pharmacy services, interest in patients&rsquo, wellbeing, appropriate referral, vaccination, free medical camp, medical services at home, first aid, and counseling were appreciated by patients. Patients stated that medicines are inappropriately stored in unhygienic conditions, prices of medicines are comparatively high, and medicines are substandard. Unavailability of medicines, inept dispensing, limited staffing with poor knowledge, limited working hours, and quackery promotion are challenges in rural pharmacy practice. Patients say that non marginal pricing, informative services, new legislation, and proper vigilance by officials can improve the pharmacy services in rural communities. Conclusions: Patients alleged that rural pharmacies perform deprived practices. To improve service, new legislation and the proper implementation of existing law is needed.
Published: 2019

49. Antibiotics (Macrolides and Lincosamides) Consumption Trends and Patterns in China’s Healthcare Institutes. Based on a 3 Year Procurement Records, 2015–2017

Author: Sen Xu, Wenchen Liu, Jie Chang, Minghuan Jiang, Wenjing Ji, Chen Chen, Ali Hassan Gillani, Mingyue Zhao, Caijun Yang, and Yu Fang
Subjects: trends, China, medicine.drug_class, Health, Toxicology and Mutagenesis, Antibiotics, lcsh:Medicine, Erythromycin, lincosamides, 010501 environmental sciences, Azithromycin, 01 natural sciences, Article, antibiotic use, 03 medical and health sciences, 0302 clinical medicine, Antibiotic resistance, Environmental health, medicine, patterns, 030212 general & internal medicine, 0105 earth and related environmental sciences, Consumption (economics), Lincosamides, macrolides, business.industry, lcsh:R, Public Health, Environmental and Occupational Health, Clindamycin, Drug Utilization, Anti-Bacterial Agents, Defined daily dose, business, Delivery of Health Care, medicine.drug
Abstract: In this study, we investigated the trends and patterns of antibiotic consumption (macrolides and lincosamides) in China&rsquo, s healthcare institutions from 2015 to 2017. The China Drug Supply Information Platform (CDSIP) was officially launched in 2015. We collected records from this national centralized bidding procurement system between 2015 and 2017. The use of J01F antibiotics (macrolides or lincosamides) was calculated in a defined daily dose per 1000 inhabitants per day (DID).Purchase data from 70,366 national medical facilities included in the CDSIP were collected. The procurement data of 66,007 medical facilities have not changed over 3 years. There is a slight decline in the consumption of J01F antibiotics, which decreased from 3.03 DID in 2015 to 2.91 DID in 2017. Azithromycin (20.6%) was the most commonly used antibiotic in 2017 among all classes, followed by clindamycin (17.9%) and erythromycin (13.7%). Parenteral antibiotics accounted for 32.0% of total antibiotic consumption and 59.6% of total antibiotics expenditure in 2017. The overall consumption of most antibiotics decreased slightly over the 3-yearstudy period. This may be owing to China&prime, s health-related policies in the past few years. A gap still exists in antibiotic use between regions and dosage forms. Further studies are needed to optimize antibiotic prescribing and reduce antibiotic resistance.
Published: 2020

50. Balancing mixed-model assembly lines using adjacent cross-training in a demand variation environment

Author: Jie Gao and Caijun Yang
Subjects: 0209 industrial biotechnology, Mathematical optimization, 021103 operations research, Cross-training, Layoff, General Computer Science, Operations research, Computer science, 0211 other engineering and technologies, Volume (computing), 02 engineering and technology, Variation (game tree), Management Science and Operations Research, Task (project management), 020901 industrial engineering & automation, Modeling and Simulation, Line (geometry), Benchmark (computing), Production (economics)
Abstract: The internationalization of markets and increased sophistication of consumers have led to an increase in the variety and uncertainty of products demand. It spurs the wide use of flexible production systems in producers. In this study, we aim to present a flexible mixed-model assembly line with adjacent workforce cross-training policy to account for this issue. With the adjacent cross-training, the skill of each task can be learned by two workers in adjacent stations and then task reallocation is possible when demand varies. Whenever the production volume or product mix changes, the only modification of the line is shifting some tasks to the adjacent stations where the workers can deal with. In this way, the line can achieve quick response to demand variation with high efficiency without additional trainings or great changes (such as: employment or layoff). The problem is formulated and some important properties are characterized. Then, a branch, bound and remember (BB&R) algorithm is developed to solve the problem. The efficiency and effectiveness of the proposed algorithm and this policy are tested on 450 representative instances, which are randomly generated on the basis of 25 well-known benchmark problems. This paper presents a contribution related to a straight-paced MAL with adjacent cross-training to meet the variation in production demand.With adjacent cross-training, tasks can be reallocated to adjacent stations where workers can deal with when demand changes. The assembly line can achieve quick response to the new demand without too many changes.For all the 450 instances, our algorithm can find the optimal solution for 388 instances in 100s, and the gaps between the obtained objective values and the lower bounds are 1.62 for the remaining 62 instances on average.In total, 83 out of the 388 instances use fewer stations with the adjacent cross-training policy than without the policy.
Published: 2016

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