Clinical Consumption of Compound Opioid Analgesics in China: A Retrospective Analysis of National Data 2015-2018.

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.

Was William Harvey's commitment to experimentation reflected in his clinical practice?

The physician and physiologist Dr William Harvey is known for having discovered that the heart pumps arterial blood round the whole body and receives venous blood from the periphery, which it forwards to the lungs for reoxygenation. Harvey's discovery was based on anatomical and physiological evidence and experiments using ligatures of varying tensions. As a clinician, however, Harvey does not appear to have appreciated the value of experiments in assessing treatment effects. Although he criticised Galenic views about the clinical value of experience and authority in the absence of accompanying empirical evidence, two handwritten prescriptions that he wrote for his friend and future biographer John Aubrey provide evidence that he conformed with Galenic theory when it came to drug therapy in clinical practice. This was consistent with his senior position in the College of Physicians, whose Pharmacopoeia Londinensis was based on Galenic principles, an appreciation of which was required for entry into the College. Harvey's prescriptions reflect this and open a window onto 17th-century therapeutic practice and the personal elements on which such practice was sometimes based.

The doctor and his patients: the intergenerational dispute concerning the ideal physician, the Czech Lands 1840s-1890s

In the second half of the 19th century, the professionalization of the medical field took place in the Czech Lands, then part of Austria-Hungary. The physicians’ aim was to elimi-nate their rivals, such as charlatans, folk healers, and other alternative healers, but they also strove to regulate competition among colleagues. In this period, which can be described as a period of therapeutic nihilism, a new generation of physicians emerged in the Czech Lands who tried to promote and apply new medical knowledge to everyday practice in the medical market. In practice, however, it was very hard for this innovative group of young medics to defend their scientific approach and their professional honor from the demands of patients, on whose monetary reward they and their families depended. The article argues that there was a dispute between the older and younger generations of physicians over the ideal of the physician and his honor. This hypothesis is based on a discursive analysis of medical manuals for laymen penned mostly by physicians, so-called «house physicians», and of articles in profes-sional journals published by local physicians in the Czech language. The conflict is illustrated by examples of bloodletting and drug prescriptions (AU)

The British Pharmacological Society's WDM Paton Memorial Lecture 2019: How doctors were informed about pharmaceutical products through advertising in the British Medical Journal from 1955/6 to 1985/6.

We have reviewed pharmaceutical advertisements in every available issue of the British Medical Journal (BMJ) in 12-month periods during 1955/6, 1965/6, 1975/6, and 1985/6. We have determined the amount of advertising, the therapeutic areas covered, and whether adverts reflected the large number of New Chemical Entities (NCEs) launched during that time. For each product we recorded the therapeutic indications, the marketing company, and the number of adverts appearing. The total number of products advertised fell from 340 in 1955/6 to 260 in 1965/6, 70 in 1975/6, and 16 in 1985/6. Advertisement numbers and companies advertising also fell. Antimicrobial drugs and cardiovascular drugs were the top products advertised over the 30 years, with respiratory, analgesic, and gastrointestinal drugs also in the top five. The number of different drugs advertised by individual companies fell from around eight per company in 1955/6 to one or two in 1985/6. There was good concordance between the most advertised therapeutic areas and NCEs entering the market. From the 1950s to the 1980s prescribers were extensively informed about pharmacological advances in therapeutics through BMJ advertisements. Many novel drugs that were advertised proved to be of lasting value. The Medicines Act 1968 introduced product licensing, regulations requiring demonstration of quality, efficacy, and safety, and restrictions on advertising. Subsequently many companies reduced their advertising or stopped altogether. Since advertising influences prescribing, and since antimicrobial drugs were the most commonly advertised products during 1955-86, we speculate that advertising, resulting in excess use, may have, at least partly, driven bacterial drug resistance.

La prescripción enfermera. Historia de un eufemismo / Nursing prescription. The story of a euphemism

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Antibiotic resistance and antibiotic prescribing by dentists in England 2007-2016.

The early prescribers of penicillin realised that antibiotics should be used wisely and as an adjunct to traditional surgical provision. They predicted that inappropriate use would increase sensitisation to the drug. National Health Service dentists prescribed almost 10% of antibiotics issued in NHS general practice in 2016 and an audit shows that many of these may have been prescribed inappropriately. One of the causes of antimicrobial resistance is over prescription of the drugs. This paper recalls the recommendations of some early users of penicillin, reports on the current prescription patterns of dentists in England, describes the mechanism of acquisition of anti-microbial resistance and discusses dentists' role in attempting to reduce the problem.

Does the doctrine of double effect apply to the prescription of barbiturates? Syme vs the Medical Board of Australia.

The doctrine of double effect (DDE) is a principle of crucial importance in law and medicine. In medicine, the principle is generally accepted to apply in cases where the treatment necessary to relieve pain and physical suffering runs the risk of hastening the patient's death. More controversially, it has also been used as a justification for withdrawal of treatment from living individuals and physician-assisted suicide. In this paper, I will critique the findings of the controversial Victorian Civil and Administrative Tribunal (VCAT) hearing Syme vs the Medical Board of Australia In that hearing, Dr Rodney Syme, a urologist and euthanasia advocate, was defending his practice of prescribing barbiturates to terminally ill patients. Syme claimed that he prescribed the drugs with the intention of relieving their existential suffering and not to assist in suicide; he argued that the DDE could be applied. Pace VCAT, I argue that this is an illegitimate application of DDE. I argue that a close scrutiny of Syme's actions reveals that, at the very least, he intended to give patients the option of suicide. He furthermore used what on a traditional definition of DDE would be considered a 'bad' means-the prescription of Nembutal-to achieve a 'good' end-the relief of suffering. The case demonstrates the crucial importance of analysing an agent's 'intention' and the 'effects' of their actions when applying DDE. Ethicists and, indeed, the judiciary need to attend to the ethical complexities of DDE when they assess the applicability of DDE to end of life care. If they fail to do this, the doctrine risks losing its legitimacy as an ethical principle.

La farmacia del hospital Nuestra Señora de Gracia de Zaragoza: la importancia histórica de un legado / The pharmacy of the Nuestra Señora de Gracia Hospital in Zaragoza: the historical importance of a legacy

Las farmacias de hospital han tenido a lo largo de los siglos una importancia relevnate dentro del desarrollo global de la farmacia, tanto desde el aspecto profesional, como en el científico y el artístico. En España han sido destacables las aportaciones y la historial de la farmacia del Hospital de la Santa Creu de Barcelona, de la que se tienen datos desde la fundación del Hospital en 1404 y las de los hospitales General de Valencia y el de Madrid. En Aragón el Hospital de Nuestra Señora de Gracia de Zaragoza ha sido durante siglos su principal centro sanitario. De su botica tenemos conocimiento desde tiempos de Fernando el Católico y su importancia está avalada por documentos y estudios de distintas épocas. Trasladado el Hospital a su actual emplazamiento, tras la destrucción del primitivo en 1808, la farmacia sufrió varias remodelaciones, la más importante se realizó poco después de hacerse cargo la Diputación Provincial de Zaragoza del funcionamiento del centro en el último tercio del siglo XIX. En este trabajo pretendemos exponer el funcionamiento del Hospital Nuestra Señora de Gracia de Zaragoza y especialmente de su farmacia en el último tercio del siglo XIX describiendo sus funciones, la importancia de los farmacéuticos que trabajaron ella y la renovación de sus estructura en 1881 que se ha conservado en su esencia hasta el presente

Over centuries hospital pharmacies have played an important role in the global development of Pharmacy, as much from the professional as scientific and artistic aspects. In Spain, the contribution and history of the pharmacy of the Hospital de Santa Creu in Barcelona, with data from its foundation in 1404, and those of the General hospitals of both Valencia and Madrid, have been outstanding. In Aragon, Zaragoza's Nuestra Señora de Gracia Hospital has been the main health centre. We have knowledge from its pharmacy dating from the time of Fernando the Catholic and its importance is backed by documents and studies from different periods. The Hospital was moved to its current localtion after the original was destroyed in 1808, the pharmacy underwent several restructurings with the most important was done shortly after the Diputación Provincial de Zaragoza took over its running in the last third of the XIXth century. This work intends to show how Zaragoza's Nuestra Señora de Gracia hospital worked and, in particular, its pharmacy in the last third of the XIXth century, describing its functions, the importance of the pharmacists working there and the renewal of its structure in 1881, which have been maintained in essence until the present day

Uriach 180 años fragmentos de una historia / No disponible

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[Criticism of physicians by Johannes Gregorius Macer Szepsius (1530-after 1579)]. / Johannes Gregorius Macer Szepsius (1530-1579 után) kritikája az orvosokról.

Humanist author J. G. Macer Szepsius (1530-after 1579) born in Szepsi, Upper Hungary (today Slovakia, Moldava and Bodvou) lived in Krakow and was a typical author of Latin occasional poetry. In a part of his work De vera gloria libellus (Booklet on the true glory) published in 1562 he deals with certain professions and criticizes them. Physicians are described as being garrulus (loquacious), mendicus (beggar), and having a big belly due to a luxury. The Physician doesn´t read books, is lazy and not characterized by his knowledge, but rather by ignorance, arrogance and pride. Physicians prescribe medications without knowing their effects. Such a criticism is surprising, because Macer Szepsius was probably closely related to medicine.

The medical treatment of Maria, Dowager Empress of the Russian Empire: an analysis of her prescription book from 1807 and 1808.

This study analyzes the medicines that were used to treat the Dowager Russian Empress Maria, widow of Tsar Paul I, and describes the doctors who cared for her health in 1807 and 1808. The source for this research was the imperial court pharmacy prescription book 1807-1811. Hypotheses about the diseases and medical problems of the Empress and how treatment for her differed according to circumstances, particularly after the loss of her granddaughter Princess Elizabeth, have been made based on the prescriptions recorded in the book. The content of the prescriptions suggests that the Empress suffered from gastrointestinal tract disorders, skin and eye diseases, neuralgic pains and insomnia. Foreign physicians educated in European universities worked at the imperial court and implemented European medical traditions. They took high positions in the administration and the medical education system, and gradually spread their experience and modern knowledge to Tsarist Russian society.

Mistress Joyce Jeffreys and her physician, Dr Bridstock Harford (1607-1695).

The notebooks of Joyce Jeffreys, a wealthy Hereford businesswoman in the mid-17th century, provide information about the medicines she purchased and the fees she paid to her medical advisors. Her physician, Dr Bridstock Harford, was a successful doctor but a troublesome neighbour, who was often the subject of litigation. As an ardent parliamentarian, he held public offices during the Commonwealth. Later his opinions mellowed and he ended his days as a loyal subject of the king and a benefactor to his city.

[Removal of weremit from the abdomen. Interpretation and efficacy of an ancient Egyptian prescription by the newest scientific results]. / A weremit kiuzése a hasból. Óegyiptomi recept hatásosságának értelmezése az újabb kutatási eredmények alapján.

Significant percentage of today's knowledge of ancient Egyptian medicine has been acquired from papyri left behind from various periods of Egyptian history. The longest and the most comprehensive is the Ebers papyrus, kept at the University Museum of Leipzig, which was written more than one thousand years before Hippocrates (c. 460-377 BC). One of the riddles among the prescriptions of the Ebers papyrus Eb20 has been used in order to remove the so called "wemyt" weremit from the abdomen with the help of a drink, which consists of "jnnk", Conyza dioscoridis in milk or sweet beer. The authors assume that the disease could be an infection of Schistosoma haematobium and/or Schistosoma mansoni. Nowadays the tea of Conyza dioscoridis is widely used as an important part of traditional medicine against rheumatism, intestinal distention and cramps, as well as an antiperspirant, and with external use for wound healing. The authors' intent is to interpret the efficacy of the above-mentioned ancient prescription with the help of modern medical and pharmaceutical knowledge.

[Mining analysis on composition and medication of menstruation prescriptions in Fu Qingzhu's Obstetrics and Gynecology].

In this paper, menstruation prescriptions were selected from "Fu Qingzhu's Obstetrics and Gynecology" and analyzed by using GRI algorithm, correlation analysis, hierarchical clustering method through SPSS, Clementine and traditional Chinese medicine (TCM) inheritance auxiliary systems, in order to screen out 15 menopathy prescriptions, which involve 45 traditional Chinese medicine herbs. In the study, blood-tonifying and qi-tonifying herbs were found to be frequent in the prescriptions. The most frequent single herb was white paeony root, accounting for 9.6% in the total number of prescriptions; The most frequent herb pairs were white paeony root-radix rehmanniae preparata and paeony root-angelica sinensis. Among Fu Shan's menopathy prescriptions, 61 herbal pairs showed a correlation coefficient exceeding 0.05, which evolved into 16 pairs of core combinations. The analysis showed that menopathy prescriptions in volume 1 of "Fu Qingzhu's Obstetrics and Gynecology" focused on tonic traditional Chinese medicines involving liver, spleen and kidney and were adjusted according to changes in qi, blood, cold, hot and wet, which could provide a specific reference for further studies on Fu Shan's academic thoughts and traditional Chinese medicine clinical treatment of menopathy.

Evaluación de la conciliación de la medicación en una Unidad de Traumatología / Evaluation of medication reconcilliation in a Trauma Unit

Introducción: El objetivo del estudio fue evaluar la tasa de discrepancias en la conciliación de la medicación realizada al ingreso de los pacientes en una Unidad de Traumatología, identificando los posibles factores de riesgo asociados a los errores de conciliación. Material y métodos: Se trata de un estudio observacional transversal realizado en un hospital de tercer nivel durante el periodo comprendido entre el 1 de mayo y el 16 de julio del 2012, en el que se elaboró un listado del tratamiento domiciliario del paciente contrastándose con la historia farmacoterapéutica recogida al ingreso en dicha unidad, para identificar los errores de conciliación. Estos se clasificaron en función del tipo y la relevancia de la discrepancia. Se realizó un análisis estadístico por regresión logística, utilizando como variable dependiente la existencia de discrepancias. Resultados: Ciento sesenta y cuatro pacientes fueron incluidos en el estudio, hallándose errores de conciliación en el 48,8%, de las cuales el 14,4% fueron considerados muy relevantes. De los pacientes ingresados de forma urgente, el 66,7% presentó discrepancias frente al 44,8% en pacientes programados. En total, se identificaron 153 errores de conciliación, siendo el tipo más frecuente el de omisión de algún medicamento (72%). Se detectó que por cada fármaco añadido al tratamiento domiciliario habitual el riesgo de presentar discrepancias aumenta en un 33%. Conclusión: Este estudio pone en evidencia la falta de exhaustividad en la recogida de la historia farmacoterapéutica de los pacientes al ingreso en la Unidad de Traumatología (AU)

Introduction: The aim of this study was to assess the rate of discrepancies in medication reconciliation on admission patients in a trauma unit, and identifying potential risk factors associated with these discrepancies. Material and methods: A cross-sectional, observational study was carried out to identify reconciliation errors in a tertiary hospital during the period from May 1 to July 16 of 2012. Medication history of the patient was compared with home medication data collected on admission, to identify reconciliation errors. These were classified according to the type and severity of the discrepancies. Statistical analysis by logistic regression was performed, using the presence of discrepancies as dependent variable. Results: The study included 164 patients, and reconciliation errors were found in 48.8%, of which 14.4% were considered highly relevant. Around two-thirds (66.7%) of the patients admitted to the emergency department showed unjustified discrepancies compared to 44.8% in scheduled patients. In total, 153 reconciliation errors were identified, being omitted drug the most frequent type of discrepancie (72%). The risk of discrepancies increases by 33% for each drug added to the usual home treatment. Conclusion: This study demonstrates the lack of quality in home medication recording in patients admitted to the trauma unit (AU)

Breve reseña de la presentación del libro: Formulario cirujano para uso del Hospital Militar de Mahón / No disponible

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Hospital Militar de San Miguel (1838-1839) / Hospital Militar em San Miguel (1838-1839) / Military Hospital of San Miguel (1838-1839)

En el año 1838 el Capitán General decide instalar en la ciudad de Trujillo un hospital militar debido al asentamiento de varios regimientos de Infantería y Caballería en dicha zona. El hospital se ubicó en el convento de San Miguel, aprovechando que este se encontraba vacío. Prestarían servicio en el mismo los tres médicos, el boticario y el practicante de la cuidad y fueron contratados tres enfermeros que se encargarían de atender a los militares enfermos. La Diputación Provincial de Cáceres fue la encargada de suministrar parte de los recursos materiales, lencería, ropa para los militares. Siendo el Ayuntamiento de la cuidad el que debía sufragar el resto de gastos que ocasionara el mismo, personal, víveres, medicinas, entre otros. En el hospital, según los registros encontrados en el archivo, se atendieron a un total de 93 militares y un preso, en un período de unos tres meses, que originaron unos 1714 días de ingreso. El hospital de San Miguel estuvo en funcionamiento por un período de unos dos años, el cierre del mismo que se estableció a finales del mes de octubre de 1839, pudo deberse al excesivo gasto que suponía mantener tal infraestructura o al desacuerdo entre el Capitán General y la Corporación Local. Los objetivos del presente trabajo son: conocer la dotación de personal de dicha institución, centrándonos en la figura del personal de enfermería; exponer los recursos materiales con los que contaban el personal asistencial para dar dicha atención y describir la atención prestada a los militares enfermos que estaban ingresados en dicho hospital. Para ello se ha realizado un estudio histórico-documental, durante los años 2013-2014, de los legajos que se encuentran depositados en el Archivo Municipal de Trujillo. Tras esta investigación podemos concluir que la figura del personal de enfermería era clave dentro del funcionamiento del Hospital Militar de San Miguel, pues es este colectivo el encargado de prestar los cuidados necesarios a los militares enfermos en pro de su recuperación. Fueron entidades como la Diputación Provincial y el Ayuntamiento de la cuidad los que sufragaron los gastos que el mismo originó (AU)

The settlement of several infantry and cavalry regiments in the area of Trujillo led the general captain to install a Hospital in the town. Such hospital was placed in San Miguel’s convent, since it was unoccupied. The three physicians, a pharmacist and the nursery assistant of Trujillo rendered service at the hospital, together three nurses hired to attend military patients. The Province Council of Caceres was encharged of supply the hospital material necessities, and the City Council beared the cost of expenses and staff salary. As the recordings shown, 93 military patients and one prisioner were attended at the hospital in a three-months period, rendering 1714 days of internment. San Miguel Hospital was operative for two years, being closed at the end October 1839. Objectives: to determine the staffing of the institution, focusing on the figure of the nursing staff; exposing the materials that had the care team to give such care and attention given to describe the military patients who were admitted to the hospital resources. It has made a historical documentary study for the years 2013-2014, of the files that are deposited in the Municipal Archives of Trujillo. Following this research we can conclude that the figure of the nurses was crucial in the functioning of the Military Hospital of San Miguel, because this group is responsible for providing the necessary care for military patients towards recovery. Were entities like the County and the City of the city which covered the cost that it originated (AU)

Em 1838 o Capitão-general decide instalar um hospital militar na cidade de Trujillo devido às varias companhias assentadas na zona. Estabeleceu-se o hospital no antigo mosteiro de São Miguel, na altura desabitado. Davam assistência a este hospital os três médicos, o boticário e o practicante (pessoa encarregada pela administração de medicamentos e injecções sob a direção do médico) da cidade assim como três enfermeiros que foram contratados para o atendimento dos militares doentes. A Deputação Provincial de Cáceres, foi a encarregada de fornecer parte dos recursos materiais, lingerie e roupa para os militares. A Câmara Municipal suportava o resto das despesas, entre as quais as de pessoal, vitualhas e medicamentos. Segundo os registros do arquivo, no hospital foram atendidos -num periodo de três meses- 93 militares e um recluso, com um total de 1.714 dias de internamento. O Hospital de São Miguel esteve a funcionar por volta de dois anos até, em Outubro de 1839. Os objetivos do presente trabalho são: conhezer a dotação do pessoal da dita instituição, nomeadamente do pessoal de enfermagem; expor os recursos materiais com os que contava o pessoal técnico para facilitar os ditos cuidados assim como pormenorizar a atenção dada aos militares doentes hospitalizados nesta instituição. Para isto foi realizado um estúdio histórico-documental ao longo de 2013-2014 dos documentos depositados no Arquivo Municipal de Trujillo. Após a pesquisa podemos concluir que o pessoal de enfermagem era essencial para o funcionamento do Hospital Militar de São Miguel, pois era esta coletividade a encarregada nos cuidados dados aos militares doentes para a sua recuperação. Foram instituições tais como a Deputão Provicial e a Câmara Municipal da cidade quem custearam as despesas geradas pelo Hospital (AU)