OBJECTIVE:To fathom American pharmaceutical benefit managers(PBMs).METHODS:The development of PBMs in America was reviewed and the role they played in American pharmaceutical management was analyzed.RESULTS:PBMs,whose strength was increasing,did play a role in curbing the increase of drug expenses though their place was still somewhat controversial.CONCLUSION:PBMs in American sets a good example for other countries including China to follow.

Objective To compare the effect of procedure prolapse hemorrhoids (PPH)and traditional milligan morgan hemorrhoidectomy in treatment of circumferential mixed hemorrhoids. Methods All 60 cases annular mixed hemorrhoid patients were randomly divided into observation group and control group,each group 30 cases, observation group un-derwent the procedure for prolapse and hemorrhoids,the control group underwent milligan morgan hemorrhoidectomy,op-erative time, bleeding, hospitalization time, VAS, complications were compared between two groups. Results The mean operative time, hospitalization time of observation group was significantly shorter than the control group,intra-operative bleeding volume was less than the control group (P<0.05), after operation 24 h, VAS of observation group decreased more significantly than the control group(P<0.05),the complication rate in the observation group was 13.3%,was lower than the control group 40.0%(P<0.05). Conclusion The procedure for prolapse and hemorrhoids than tradi-tional milligan morgan hemorrhoidectomy has advantages of less bleeding, shorter operative time, less postoperative complications,less pain,worthy of promotion and application.

Objective To evaluate the efficacy and safety of prompt phacoemulsification, intraocular lens implantation, visco-goniosynechialysis, combined with pseudo-pupilloplasty for refractory acute primary angle closure (APAC) with atonic dilated pupil and to describe a feasible method of pupilloplasty. Methods A consecutive series of refractory APAC patients who had atonic dilated pupil and undergone prompt phacoemulsification combined with pseudo-pupilloplasty at our center were retrospectively analyzed. Pseudo-pupilloplasty referred to a method of pupilloplasty which included 4.5-mm capsulorhexis, postoperative opacification of anterior capsule residue, and ultimate pseudo-pupil formation. Preoperative and postoperative measurements included intraocular pressure (IOP), best corrected visual acuity (BCVA), and anterior chamber depth (ACD). Intraoperative and postoperative complications were documented. The process of pseudo-pupil formation was also observed. Results A total of 20 eyes of 19 APAC patients were followed up for 19.7 ± 9.8 months. IOP was lowered from preoperative 44.0 ± 9.8 mmHg to 15.5 ± 2.6 mmHg at final visit (t=11.945, P < 0.001). ACD was deepened from preoperative 1.77 ± 0.21 mm to 3.40 ± 0.20 mm at final visit (t=-27.711, P < 0.001). Twelve of 20 eyes had residual angle synechiae, whereas only 3 eyes needed anti-glaucoma medications. No severe complication was observed. All eyes had pseudo-pupil gradually formed within 3 months, accompanied with the gradual improvement of BCVA from preoperative 1.18 ± 0.55 to 0.58 ± 0.22, 0.26 ± 0.09, 0.11 ± 0.09, and 0.11 ± 0.09 at postoperative day 1, month 1, month 3, and last visit. Conclusions Prompt phacoemulsification-goniosynechialysis is effective and safe for refractory APAC with atonic dilated pupil. Pseudo-pupilloplasty is a feasible procedure for pupil reconstruction.

Objective To establish a set of scientific and standardized quality control indicator system for occupational pneumoconiosis (hereinafter referred to as "pneumoconiosis") medical care. Methods A research group was set up to establish an indicator pool of quality control indicator system for pneumoconiosis, including three first-level indicators and 48 second-level indicators, based on literature review, analysis and sorting, and the current national quality control indicators of respiratory diseases in disease-specific quality monitoring. Two rounds of consultation were conducted with 15 experts through Delphi method to establish the quality control indicator system for pneumoconiosis medical care. Results The questionnaire recovery rates of the two rounds of expert consultations were 100%, and the effective questionnaire recovery rates of both consultations were 100%. The expert authority coefficient was 0.91, and the expert coordination coefficients were 0.208 and 0.209, respectively (both P<0.001). The coefficient of variation ranged from 0.10 to 0.37, with nine indicators having a coefficient of variation >0.25. The constructed quality control indicator system for pneumoconiosis medical care includes three primary indicators, 15 secondary indicators, and 32 tertiary indicators. Conclusion The constructed quality management indicator system for pneumoconiosis medical care has high scientificity and reliability. It provides a basis for the quality evaluation of pneumoconiosis medical care. However, continuous improvement is needed in practical applications.

Objective The aim of this study was to investigate the prognostic value of body composition indicators in evaluating the development risk of gestational diabetes mellitus(GDM).Methods A total of 1431 pregnant women who were registered and underwent prenatal examinations in the Clinical Nutrition Department of Guizhou Hospital of Beijing Jishuitan Hospital were selected in this study from January 2018 to September 2021.Among them,263 participants were diagnosed with GDM(GDM group),and 1168 healthy individuals underwent physical examinations were enrolled as Con group.Results The GDM detection rate was 18.38%(263/1431).Logistic regression analysis showed that age and percent body fat were risk factors for the development of GDM.The area under the ROC curve of percent body fat for GDM prediction was 0.732,with sensitivity,specificity of 67.7%,68.3%.Conclusions High percentage of body fat during pregnancy is a risk factor for the development of GDM in late pregnancy,and the risk of developing diabetes during pregnancy can be predicted by the percentage of body fat index.

Objective To observe the clinical efficacy of Xiaozhi Yanggan tea on mixed hyperlipidemia with Phlegm-damp obstruction type. Methods According to the inclusion criteria,a total of 80 cases of mixed hy-perlipidemia were randomly divided into treatment group and control group,with 40 cases in each group. All pa-tients were treated with Atorvastatin Calcium capsule and those in the treatment group were additionally treated with Xiaozhi Yanggan tea,for a total of 12 weeks. Two groups of patients were observed for the integral of Tradition-al Chinese Medicine(TCM)syndrome,the change of blood lipids and safety. Results After treatment,the total effective rate for TCM syndrome was 95.00% in treatment group,which was better than 75.00% in control group (P < 0. 05). TC,LDL-C and non-HDL-C levels in the treatment group were lower than those in the control group (P < 0. 05). HDL-C was higher than that in the control group(P < 0.05). TG in the treatment group were lower than that before(P < 0. 05),while it was not obvious in the control group(P > 0.05). No obvious abnormality in hepatorenal function and creatine kinase in the two groups after treatment. Conclusion Xiaozhi Yanggan tea was an effective and safe therapy for mixed hyperlipidemia with Phlegm-damp obstruction type.