Use of Non-Formulary Medicines at a Kenyan Private Hospital

Background: Hospital formularies are used to encourage the use of safe, ef-fective and most affordable medications. Institutions need to make provi-sions for non-formulary medicines (NFM) due to the dynamic nature of dis-eases and their management. The aim of this study was to describe the pat-terns of non-formulary medicine prescriptions at the Nairobi Hospital, the reasons for their purchase as well as the duration taken to avail them. Methods: A descriptive review of all the non-formulary medicine prescrip-tions from January 2021 to June 2022. The medicines were listed and catego-rized according to the WHO Anatomical Therapeutic Chemical (ATC) classi-fication system. Correspondence between pharmacy and procurement was reviewed to understand the reason for the requests and the duration it took to avail the medicines. Results: A total of 183 NFM were purchased, with a general increase in the number from January 2021 to June 2022. Vitamins, Mineral supplements and General nutrients accounted for 41 (22.4%) of the NFM. Dermatologicals 27 (14.6%), Genito-urinary system drugs and sex hormones 20 (10.9%), Ophthalmologicals 14 (7.6%) and Antineoplastic and Immuno-modulating agents 12 (6.6%) were also frequently purchased out of formulary. The main reasons for NFM purchases were: having no therapeutic equivalents in the hospital formulary 72 (39.3%) and prescriber or patient preference 69 (37.7%). It took a median (IQR) of 4 (2 - 7) days for the phar-macy to avail these drugs;with 18.6% being availed in 1 day and 55.2% tak-ing more than 3 days. For the NFM where no alternative was available in the hospital formulary, sales amounted to USD 63,362 which was 79.1% of the value of all the NFM sales. Conclusion: There’s a need to regularly update the hospital formulary and to emphasize to the prescribers the importance of adhering to it, as much as possible.

Self-adaptive fuzzy controller with formulary rule for servo control of discharge gap in Micro EDM

In micro electrical discharge machining （micro EDM）, it is difficult for servo controlling the narrow discharge gap with the characters of non-linear and quick change. In this paper, aiming at solving the problems above, a self-adaptive fuzzy controller with formulary rule （SAFCFR） is presented based on the dual feedbacks composed by gap electric signal and discharge-ratio statistics. To ensure the properties of self-optimizing and fast stabilization, the formulary rule was designed with a tuning factor. In addition, the fast-convergence algorithms were introduced to adjust control target center and output scale factor. In this way, the normal discharge ratio can tend to the highest value during micro-EDM process. Experimental results show that the proposed algorithms are effective in improving the servo-control performance. According to the drilling-micro-EDM experiments, the machining efficiency is improved by 20% through applying SAFCFR. Moreover, SAFCFR is a prompt way to optimize parameters of discharge-gap servo control.

Looking up Prescriptions to Treat Infectious Disease:Anti-epidemic Books of Medical Formularies and Epidemic Prevention and Control in the Qing Dynasty

Copying,compiling,publishing,disseminating,and referencing anti-epidemic books of medical formularies were common activities during the outbreak of epidemics in the Qing dynasty.Its emergence,motivated by epidemic disease again and again,was important component parts of epidemic prevention and control.They played a unique role as media on affairs such as treating patients suffering from infectious diseases,mobilizing peoples to make contributions to anti-epidemic activities,integrating and popularizing knowledge of epidemic prevention.Anti-epidemic books of medical formularies were important to link peoples,things,and substances related with epidemic prevention and control,and were a kind of motivation to actively deal with the infectious disease,control the epidemic,and maintain health.Compared to other common measures,anti-epidemic books of medical formularies participated in many prevention and control practices deeply,which actually built a low cost,spontaneous,dispersed and non-institutional system to respond to epidemic,and the system had characteristics of stronger conductibility,bigger coverage area,and better external benefits.

The Silk Road and Sources of Chinese Medicine Expansion:Part 2-Formularies

Medicines have been traded along the Silk Road from antiquity until modern times.These products and their associated knowledge have been transferred over the land and sea between Asia,Europe,and Africa.Numerous texts that contain formulas and treatments passed along the Silk Road.Collections of these formulas and treatment methods called formularies contain unique information that informs this transfer of medicine.The texts and information flowed in both directions along these routes and while Chinese medicine influenced foreign medical practices both in history,and today,the incorporation of non-Chinese medicine and information also continues to influence Chinese medicine.

The US Payor Landscape： Results from a Survey of Medical Directors and Pharmacy Directors on Comparative-Effectiveness Research

The paper is to determine the types of approaches preferred by medical and pharmacy directors of US payer organizations to enhance the Pharmacy ＆ Therapeutic decision-making process and how medications accepted onto the formulary should be covered. An online interactive survey of US medical and pharmacy directors was conducted in 2012. In addition to a 10-point Likert scale （10 = agree completely, 1 = disagree completely）, qualitative responses and interpretive analysis were used to explore beliefs about certain statements. The results showed that the 30 respondents （20 medical directors and 10 pharmacy directors） rated current progress in obtaining usable CER （comparative-effectiveness research） at only an average of 4.17 on the 10-point scale. They hoped to regularly utilize CER information in formulary decision making by 2015 （average rating, 6.03）. The rating of evidence-based medicine use in coverage decision making today was somewhat higher, at an average of 7.08 （medical directors, 7.38; pharmacy directors, 6.40）. The survey participants believe that emerging CER results will greatly affect the following areas： optimization/improvement of clinical guidelines, medical/pharmacy benefit management, assessments of the value and appropriateness of interventions, and pharmaceutical research and development. Therefore, payers expect CER to play an increasing role in helping them determine the value of new therapies.

Anti-inflammatory Effects of Components in Shuxiong Tablet and Its Possible Formulary Rationality

Objective To determine whether the anti-inflammatory properties of Shuxiong Tablet (SXT) and the effective components group of SXT (ECGS) are equivalent and to assess the formulary rationality. Methods ECGS consisted of Panax notoginsen saponion (PNS), hydroxysafflor yellow A, and ferulic acid plus volatile oil of Ligusticum chuanxiong, which was based on the active ingredients and their ratios in SXT. We compared the anti-inflammatory actions of ECGS and SXT using the xylene-induced edema model and the carrageenan-induced edema model, as well as the analgesic activity of them using the acetic acid-induced writhing model. Moreover, cultured macrophages were incubated with media containing serum isolated from SXT-, ECGS-, or every component of ECGS-treated rats, to compare the depress effects on lipopolysaccharide (LPS)-stimulated NO production and inducible nitric oxide synthase (iNOS) expression. Results ECGS and SXT had equivalent anti-inflammatory actions and analgesic effects at an equipotent dosage in a dose-dependent manner. The drug-containing media could inhibit the LPS-stimulated NO production and iNOS expression in cultured macrophages. A 2 × 2 × 2 ANOVA revealed that three effective components could produce synergistic effect on the inhibition of NO production, and PNS was the capital component. Conclusion ECGS and SXT display an equivalent anti-inflammatory effect, and the formula follows traditional Chinese medicine compatibility principle, which shows obvious formulary rationality.

A homeopathic nosode, Hepatitis C 30 demonstrates anticancer effect against liver cancer cells in vitro by modulating telomerase and topoisomerase Ⅱ activities as also by promoting apoptosis via intrinsic mitochondrial pathway

OBJECTIVE： Homeopathic nosodes have seldom been scientifically validated for their anticancer effects. This study was conducted to examine if a recently developed hepatitis C nosode has demonstrable anticancer potential in cancer cells in vitro.METHODS： Anticancer effects of Hepatitis C 30C（Hep C 30）, if any, were initially tested on three cancer cell lines, HepG2（liver cancer）, MCF-7（breast cancer） and A549（lung cancer） and one normal liver cell line WRL-68 cells and subsequently a more thorough study using further scientific protocols was undertaken on HepG2 cells（against WRL-68 cells as the normal control） as HepG2 cells showed better anticancer response than the other two. Three doses, one at 50% lethal dose（LD50） and the other two below LD50, were used on HepG2 cells subsequently. Protocols like apoptosis induction and its possible signaling mechanism were deployed using immunoblots of relevant signal proteins and confocal microscopy, with particular reference to telomerase and topoisomerase Ⅱ（Top Ⅱ） activities, two strong cancer biomarkers for their direct relationship with divisional activities of cells and DNAs. RESULTS： Hep C 30 induced apoptosis, caused distorted cell morphology typical of apoptotic cells, increased reactive oxygen species generation and produced increased DNA nicks. Further it enhanced pro-apototic signal proteins like Bax, cytochrome c and inhibited anti-apoptotic signal proteins, Bcl-2, cytochrome c and caspase-3, changed mitochondrial membrane potential and caused externalization of phosphatidylserine. The drug also decreased expression of two cancer biomarkers, Top Ⅱ and telomerase, consistent with its anticancer effect. CONCLUSION： Hep C 30 has demonstrable anticancer effects against liver cancer cells in vitro.

International Corporate Taxation at a Crossroads

Transnational corporations(TNCs)act as unitary firms in an increasingly globalised economy,but taxes on their profits are levied by national states.Hence,international tax rules have from the start been riven by contradictory approaches:ei-ther to determine the taxable profits attributable to each separate constituent entity of the TNC in their jurisdiction by comparing them with independent firms conducting a similar business,or to tax an appropriate share of the TNC’s global profits appor-tioned by factors reflecting its activities within the jurisdiction.The separate entity principle became dominant,especially with the adoption of the OECD Transfer Pricing Guidelines in 1995,but it gave a perverse incentive to TNCs to devise tax avoidance strategies,based on attributing high levels of profit to entities in countries where they would be taxed at low rates.The project on base erosion and profit shifting(BEPS)was mandated by the G20 to reform these rules so that TNCs could be taxed where their activities occur,signaling a return to the unitary principle.The latest proposals now adopt the principle of unitary taxation of TNCs,together with technical standards for formulary apportionment,but only as an overlay on top of existing rules based on the incompatible independent entity principle.A stable foundation for international tax depends on resolving this dilemma and agreeing a fair and balanced allocation of rights to tax TNCs’profits based on their real activities in each jurisdiction.