Optimizing postoperative follow-up in pediatric surgery (OFIPS).

BACKGROUND/PURPOSE: The purpose of the study was to determine variables associated with attending postoperative clinic follow-up (POFU) in pediatric surgical patients, predictors of clinical value, and visit cost estimates. METHODS: POFU patterns of children undergoing eight common pediatric surgical procedures over one year at a tertiary pediatric hospital were examined retrospectively. Variables associated with attending POFU and associated with predetermined measures of clinical value and cost were determined. Driving distance to hospital was chosen as a proxy measure of cost to the family. RESULTS: Six-hundred-thirty-three patients were included, and 58% attended POFU. Variables independently associated with attending follow-up included: procedure type (orchidopexy, complicated appendicitis), living close to the hospital, having a defined follow-up order, individual surgeon attending. Clinical value was identified in 16.4% of patient visits and associated with orchidopexies, having required an earlier urgent postoperative visit and longer cases considered "complex". Significant costs to the health care system (~$125,000) and families (~$15,000) could be estimated from follow-up cases that had no clinical issues identified nor required an intervention. CONCLUSION: POFU of common pediatric surgical procedures may have limited clinical value while coming at significant costs to families and the health care system. Further study is needed to define optimal needs and means of follow-up of these common pediatric surgical procedures. LEVEL OF EVIDENCE: Level III.

Drug discovery from viewpoint of medicinal chemists / 药学学报

Taking patient needs as the core and realizing clinical value as the guidance are the purpose and path of drug discovery. Whether the first-in-class drug or follow-on drugs are all to meet the demands of patients for drugs that are not treatable or more safe and effective. In order to realize clinical value, innovative drugs driven by basic biological research include three elements: understanding the molecular mechanism of pathogenesis; Grasping the microscopic features of the disease; clarifying the mechanism of action of drugs. The interrelation among the three is the translational medicine, and the medicinal chemistry plays an important role in the translations. That is, based on the results of basic research in biology/medicine, knowledge of the molecular mechanism of disease depends upon the establishment of various in vitro/in vivo models to find the key node and molecular regulation for the treatment of disease. Combined with the knowledge of gene deletion and variation, proteomics, epigenetics and other technologies, the molecular mechanism of disease provides multi-molecular information on the level of gene, proteins, enzymes, receptors, ion channels and signal transduction for molecular drug design. Insight into the microscopic characteristics of diseases would deepen the understanding of the molecular mechanism of the pathogenesis, as well as provide a feasible scientific path for the creation of new drugs. When the molecular mechanism of disease and the action mechanism of drugs are clarified, we have a deeper and wider understanding of the application of existing drugs (or active compounds), and may offer new ideas for drug design and application. In this translational process the medicinal chemistry plays a key role which requires medicinal chemists to break through the habitual thinking and working mode, backtracking (upstream) to basic research and its achievements and applying to the direction of creating new drugs in time, as well as paying attention to the clinical requirements (downstream) and implementing the specific content of the transformation process for the R&D of innovative drugs.

Curative effect of minimally invasive surgery for patients with medium volume of hypertensive criatocapsular hemorrhage / 中国基层医药

Objective To observe the mini -invasive treatment for patients with medium volume of hyper-tensive criatocapsular hemorrhage.Methods 59 patients with medium volume of hypertensive criatocapsular hemor-rhage(20 -30mL)were selected and randomly divided into mini -invsasive surgery group and conservative treatment group.Two groups were compared the average length of stay,hospital costs and clinical effect.Results The avergae hospital stay (14 ±3.26)days and avergae cost (1.1 ±0.33)ten thousand yuan of the mini -invsasive surgery group was lower than those of the conservative treatment group (25 ±6.58)days and (1.8 ±0.56)ten thousand yuan],the differences were statistically significant (t =7.999,5.768,all P <0.01).After 3 months follow -up,the recovery of self -care ability after operation estimated by ADL scores in the mini -invsasive surgery group was significantly better than that in the conservative treatment group(12 /31 vs.25 /28,χ2 =16.093,P <0.01).Conclusion For patients with medium volume of hypertensive criatocapsular hemorrhage(20 -30mL),minimally invasive surgery can shorten hospital stay,reduce the financial burden of patients,and improve the prognosis significantly.

Game Analysis on Muti-stakeholders in the Listing Decision of Drugs / 中国药房

OBJECTIVE: To provide proposal for government on dealing with the relationship between commercial and social property of drugs.METHODS: Multi-stakeholders subjects and their interrelation in the listing decision of drugs were investigated using game model.RESULTS & CONCLUSIONS: Innovation level of pharmaceutical industry (P),profitability of drugs operator (E),other factors affecting the proceeds of drug operators (K),additional gold cost of drugs (C1),additional cost of gold drugs sale (C2) were confirmed to be the key factors which affected the listing decision of drugs by pharmaceutical manufacturers.Governments are suggested to ensure the rational and fair use of drugs in public by policy supports,encouraging drug innovation and make-up on difference of drugs in medical institutions,optimizing benefit components of medical institutions,creating evaluation criteria for "listing value" and "necessity in clinic" of drugs.