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In the Philippines, medicines are procured at higher rates in government hospitals. The prices of essential medicines have high variability, and a significant portion of out-of-pocket expenditures by Filipinos is for medicines. This study's objective is to determine the factors associated with the variation in drug pricing among public hospitals.
This was a mixed-methods, case-control study of 57 hospitals. Two tools were developed based on: (i) Management Sciences for Health (MSH)’s Rapid Pharmaceutical Management Assessment and (ii) World Health Organization (WHO)’s Good Pharmaceutical Practices. The dependent variable is a drug price reference ratio of a preselected drug basket. Examples of factors studied are: (i) preference for generics, (ii) procurement type, and (iii) time out of stock.
Hospitals with proper procurement planning and performance monitoring are expected to decrease the price ratio (R = -0.030). However, interview data showed that forecasting is still not robust enough. Past consumption (91 percent) remained the most frequently used input to procurement planning. Few hospitals took into consideration other factors such as morbidity, mortality, and patient demographics. The expertise of hospital procurement staff increases the hospital's price mark-up. Interview results suggest this is because members and hospital units do not meet eye-to-eye to ensure accountability and coordination across units in planning and implementing the procurement procedures.
By having a forward-looking procurement plan, forecasting can be more efficient. Potential improvement lies in finding mechanisms where nearby hospitals could participate in pooled procurement. Pooled procurement could have an impact on reducing prices by capturing economies of scale, provided this is operated efficiently and transparently.
A new route to synthesize hybrid silica-based network with bridging organic units via molecular recognition is described. The hydrolysis of two monosilylated complementary base pairs, one bearing an adenine fragment and the other a thymine fragment leads to the formation of a powdered sample that has been characterized by Scanning Electron Microscopy (SEM), Powder X-ray Diffraction (PXRD) FTIR and solid state NMR (1H, 13C and 29Si). This last technique proved to be extremely powerful to directly demonstrate the occurrence of heteroassembly of the nucleobase-based silylated fragments, through the use of two-dimensional 1H double-quanta MAS-NMR that could probe spatial proximities between the thymine NH groups and the adenine NH2 groups.
A new method has been developed for the synthesis of shaped-controlled bridged silsesquioxanes by the acid hydrolysis of urea-derived silylated precursors. This method is based on the ability of the hydrogen bonds of the urea groups to organize the molecules in a supramolecular architecture and provides after hydrolysis a new access to hybrid materials with controlled morphologies. A chirality transcription from a molecular precursor to a hybrid solid has been achieved. A right- and a left-handed helices have been obtained respectively from the chiral (R,R)- and the (S,S)-enantiomers of the diureido derivatives of trans-diaminocyclohexane. In a related way, a long range ordered hybrid solid has been obtained. Long carbon chain as spacer between the urea groups of the precursor affords lamellar hybrid silicas.
Two patients are described with sudden death as the first presenting symptom of Kawasaki disease. The first patient died of cardiac tamponade as a result of rupture of a coronary arterial aneurysm at the age of three months and nineteen days. The second patient, one and half years old, developed acute myocardial infarction secondary to coronary arterial aneurysm and thrombosis. The true nature of their underlying disease was realized only after postmortem examination. Their clinical signs and symptoms of Kawasaki disease might be so mild as to escape recognition. A high index of suspicion should be exercised by the clinician in order not to miss this condition, especially in places where Kawasaki disease is uncommon.
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