BACKGROUND

The pharmaceutical subsystem is a complex interrelationship among different stakeholders that ensure access to safe, effective, and quality pharmaceutical products in the market. Understanding the availability and affordability as key areas for access to medicines is essential to appreciate the strategies needed to strengthen the pharmaceutical subsystem.

OBJECTIVES

This study aimed to determine the availability and affordability of essential antihypertensive medicines in public primary care facilities and private retail drugstores in a 4th class municipality. Further, the study determined the price comparisons of these essential antihypertensive medicines with international reference prices.

METHODS

This is a quantitative, cross-sectional study design which employed a modified WHO/HAI methodology to quantify antihypertensive medicines’ availability and affordability in public and private primary care drug facilities. Selection of medicines was based on a criteria applicable for the primary care setting. Availability was measured through visual inspection of the selected medicines in the facility, affordability was estimated through the selling price of medicines in the public and private facilities, respectively, and was divided by the local minimum wage of the municipality. Median price ratio was computed using the local median prices over the MSH 2015 international reference prices adjusted for inflation.

RESULTS

Availability of essential antihypertensive medicines was found to be 12.96% in public facilities and 60.32% in private facilities (p=0.0002). Only amlodipine is observed to be available in both public (83.33%) and private (85.71%) facilities, while only metoprolol 50 mg tab (33.33%) and amlodipine 5 mg tab (83.33%) were available in public facilities. All medicines are below 1 MPR, but carvedilol 6.25 mg (1 tab BID: 1.32; 2 tabs BID: 2.65), 25 mg (BID: 2.65), and enalapril 5 mg (BID: 1.14; TID: 1.70) treatment regimens are unaffordable compared to a worker’s day wage.

CONCLUSION

Availability of essential antihypertensive medicines is diverse comparing public and private facilities. There is a need to increase the availability of antihypertensive medicines in public facilities as this is an important quality measure of primary care services. Public facilities can leverage on the availability of medicines in private pharmacies by forming Primary Care Provider Networks. While most medicines were deemed affordable in the private setting, there are still drugs such as carvedilol and enalapril, that need to be regulated. There is a need to strengthen the local pharmaceutical subsystem because it is essential to ensure safe, effective, and quality medicines in the local health system through adequate mobilization of resources.

Human ; Access To Medicines ; Health Services Accessibility ; Affordability ; Costs And Cost Analysis

Background: The pharmaceutical subsystem is a complex interrelationship among different stakeholders that ensure access to safe, effective, and quality pharmaceutical products in the market. Understanding the availability and affordability as key areas for access to medicines is essential to appreciate the strategies needed to strengthen the pharmaceutical subsystem. Objectives: This study aimed to determine the availability and affordability of essential antihypertensive medicines in public primary care facilities and private retail drugstores in a 4th class municipality. Further, the study determined the price comparisons of these essential antihypertensive medicines with international reference prices. Methods: This is a quantitative, cross-sectional study design which employed a modified WHO/HAI methodology to quantify antihypertensive medicines’ availability and affordability in public and private primary care drug facilities. Selection of medicines was based on a criteria applicable for the primary care setting. Availability was measured through visual inspection of the selected medicines in the facility, affordability was estimated through the selling price of medicines in the public and private facilities, respectively, and was divided by the local minimum wage of the municipality. Median price ratio was computed using the local median prices over the MSH 2015 international reference prices adjusted for inflation. Results: Availability of essential antihypertensive medicines was found to be 12.96% in public facilities and 60.32% in private facilities (p = 0.0002). Only amlodipine is observed to be available in both public (83.33%) and private (85.71%) facilities, while only metoprolol 50 mg tab (33.33%) and amlodipine 5 mg tab (83.33%) were available in public facilities. All medicines are below 1 MPR, but carvedilol 6.25 mg (1 tab BID: 1.32; 2 tabs BID: 2.65), 25 mg (BID: 2.65), and enalapril 5 mg (BID: 1.14; TID: 1.70) treatment regimens are unaffordable compared to a worker’s day wage. Conclusion Availability of essential antihypertensive medicines is diverse comparing public and private facilities. There is a need to increase the availability of antihypertensive medicines in public facilities as this is an important quality measure of primary care services. Public facilities can leverage on the availability of medicines in private pharmacies by forming Primary Care Provider Networks. While most medicines were deemed affordable in the private setting, there are still drugs such as carvedilol and enalapril, that need to be regulated. There is a need to strengthen the local pharmaceutical subsystem because it is essential to ensure safe, effective, and quality medicines in the local health system through adequate mobilization of resources.
Human ; access to medicines ; health services accessibility ; affordability ; costs and cost analysis

Blood Pressure Monitoring, Ambulatory ; COVID-19/therapy* ; Cardiac Rehabilitation ; Cardiovascular Diseases/therapy* ; Communicable Disease Control ; Contact Tracing ; Health Literacy ; Health Services Accessibility ; Healthcare Disparities ; Humans ; Internet Access ; Poverty ; SARS-CoV-2 ; Singapore ; Social Class ; Social Conditions ; Socioeconomic Factors ; Telemedicine ; Telerehabilitation ; Transients and Migrants

No abstract available.
Fires ; Open Access Publishing

"Those with access to these resources -- students, librarians, scientists --

you have been given a privilege. You get to feed at this banquet of knowledge

while the rest of the world is locked out. But you need not -- indeed, morally,

you cannot -- keep this privilege for yourselves. You have a duty to share it

with the world."

Aaron Swartz1 (who killed himself at the age of 26,

facing a felony conviction and prison sentence

for downloading millions of academic journal articles)

 

The Philippine Journal of Otolaryngology Head and Neck Surgery was accepted into the Directory of Open Access Journals (DOAJ) on October 9, 2019. The DOAJ is "a community-curated online directory that indexes and provides access to high quality, open access, peer-reviewed journals"2 and is often cited as a source of quality open access journals in research and scholarly publishing circles that has been considered a sort of "whitelist" as opposed to the now-defunct Beall's (black) Lists.3

As of this writing, the DOAJ includes 13,912 journals with 10,983 searchable at article level, from 130 countries with a total of 4,410,788 articles.2 Our article metadata is automatically supplied to, and all our articles are searchable on DOAJ. Because it is OpenURL compliant, once an article is on DOAJ, it is automatically harvestable. This is important for increasing the visibility of our journal, as there are more than 900,000 page views and 300,000 unique visitors a month to DOAJ from all over the world.2 Moreover, many aggregators, databases, libraries, publishers and search portals (e.g. Scopus, Serial Solutions and EBSCO) collect DOAJ free metadata and include it in their products. The DOAJ is also Open Archives Initiative (OAI) compliant, and once an article is in DOAJ, it is automatically linkable.4

Being indexed in DOAJ affirms that we are a legitimate open access journal, and enhances our compliance with Plan S.5 The Plan S initiative for Open Access publishing launched in September 2018 requires that from 2021, "all scholarly publications on the results from research funded by public or private grants provided by national, regional, and international research councils and funding bodies, must be published in Open Access Journals, on Open Access Platforms, or made immediately available through Open Access Repositories without embargo."5 Such open access journals must be listed in DOAJ and identified as Plan S compliant.

There are mixed reactions to Plan S. A recent editorial observes that subscription and hybrid journals (including such major highly-reputable journals as the New England Journal of Medicine, JAMA, Science and Nature) will be excluded,6 quoting the COAlition S argument that "there is no valid reason to maintain any kind of subscription-based business model for scientific publishing in the digital world."5 As Gee and Talley put it, "will the rise of open access journals spell the end of the subscription model?"6

If full open access will be unsustainable for such a leading hybrid medical journal as the Medical Journal of Australia,6 what will happen to the many smaller, low- and middle-income country (southern) journals that cannot sustain a fully open-access model? For instance, challenges facing Philippine journals have been previously described.7

According to Tecson-Mendoza, "these challenges relate to (1) the proliferation of journals and related problems, such as competition for papers and sub-par journals; (2) journal funding and operation; (3) getting listed or accredited in major citation databases; (4) competition for papers; (5) reaching a wider and bigger readership and paper contribution from outside the country; and (6) meeting international standards for academic journal publications."7  Her 2015 study listed 777 Philippine scholarly journals, of which eight were listed in both the (then) Thomson Reuters (TR) and Scopus master lists, while an additional eight were listed in TR alone and a further twelve were listed in Scopus alone.7 To date, there are 11,207 confirmed Philippine periodicals listed on the International Standard Serial Number (ISSN) Portal,8 but these include non-scientific and non-scholarly publications like magazines, newsletters, song hits, and annual reports. What does the future have in store for small scientific publications from the global south?

I previously shared my insights from the Asia Pacific Association of Medical Journal Editors (APAME) 2019 Convention (http://apame2019.whocc.org.cn) on the World Association of Medical Editors (WAME) Newsletter, a private Listserve for WAME members only.9 These reflections on transformation pressures journals are experiencing were the subject of long and meaningful conversations with the editor of the Philippine Journal of Pathology, Dr. Amado Tandoc III during the APAME 2019 Convention in Xi'an China from September 3-5, 2019. Here are three main points:

the real need for and possibility of joining forces- for instance, the Journal of the ASEAN Federation of Endocrinology Societies (JAFES) currently based in the Philippines has fully absorbed previous national endocrinology journals of Malaysia and the Philippines, which have ceased to exist.  While this merger has resulted in a much stronger regional journal, it would be worthwhile to consider featuring the logos and linking the archives of the discontinued journals on the JAFES website. Should the Philippine Journal of Otolaryngology Head and Neck Surgery consider exploring a similar model for the ASEAN Otorhinolaryngological - Head and Neck Federation? Or should individual specialty journals in the Philippines merge under a unified Philippine Medical Association Journal or the National Health Science Journal Acta Medica Philippina? Such mergers would dramatically increase the pool of authors, reviewers and editors and provide a sufficient number of higher-quality articles to publish monthly (or even fortnightly) and ensure indexing in MEDLINE (PubMed).the migration from cover-to-cover traditional journals (contents, editorial, sections, etc.) to publishing platforms (e.g. should learned Philippine societies and institutions consider establishing a single platform instead of trying to sustain their individual journals)? Although many scholarly Philippine journals have a long and respectable history, a majority were established after 2000,7 possibly reflecting compliance with requirements of the Commission on Higher Education (CHED) for increased research publications. Many universities, constituent colleges, hospitals, and even academic and clinical departments strove to start their own journals. The resulting journal population explosion could hardly be sustained by the same pool of contributors and reviewers.

In our field for example, faculty members of departments of otorhinolaryngology who submitted papers to their departmental journals were unaware that simultaneously submitting these manuscripts to their hospital and/or university journals was a form of misconduct. Moreover, they were not happy when our specialty journal refused to publish their papers as this would constitute duplicate publication. The problem stemmed from their being required to submit papers for publication in department, hospital and/or university journals instead of crediting their submissions to our pre-existing specialty journal. This escalated the tension on all sides, to the detriment of the new journals (some department journals ceased publication after one or two issues) and authors (whose articles in these defunct journals are effectively lost).

The older specialty journals are also suffering from the increased number of players with many failing to publish their usual number of issues or to publish them on time. But how many (if any at all) of these journals (especially specialty journals) would agree to yield to a merger with others (necessitating the end of their individual journal)? Would a common platform (rather than a common journal) provide a solution?

more radically, the individual journal as we know it today (including the big northern journals) will cease to exist- as individual OA articles (including preprints) and open (including post-publication) review become freely available and accessible to all. However proud editors may be of the journals they design and develop from cover to cover, with all the special sections and touches that make their "babies" unique, readers access and download individual articles rather than entire journals. A similar fate befell the music industry a decade ago. From the heyday of vinyl (33 and 78 rpm long-playing albums and 45 rpm singles) and 8-tracks, to cassettes, then compact disks (CD's) and videos, the US recorded music industry was down 63% in 2009 from its peak in the late 70's, and down 45% from where it was in 1973.10 In 2011, DeGusta observed that "somewhat unsurprisingly, the recording industry makes almost all their money from full-length albums" but "equally unsurprising, no one is buying full albums anymore," concluding that "digital really does appear to have brought about the era of the single.10 As McDowell opines, "In the end, the digital transforms not only the ability to disrupt standard publishing practices but instead it has already disrupted and continues to break these practices open for consideration and transformation."11

Where to then, scientific journals? Without endorsing either, will Sci-Hub (https://sci-hub.se) be to scholarly publishing what Spotify (https://www.spotify.com) is to the music industry? A sobering thought that behooves action.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Adult (a Perso ; Open Access Publishing ; Open Access Publishing ; Journalism

BACKGROUND: Controlled hypotension (CH) provides a better surgical environment and reduces operative time. However, there are some risks related to organ hypoperfusion. The EV1000/FloTrac system can provide continuous cardiac output monitoring without the insertion of pulmonary arterial catheter. The present study investigated the efficacy of this device in double jaw surgery under CH.METHODS: We retrospectively reviewed the medical records of patients who underwent double jaw surgery between 2010 and 2015. Patients were administered conventional general anesthesia with desflurane; CH was performed with remifentanil infusion and monitored with an invasive radial arterial pressure monitor or the EV1000/FloTrac system. We allocated the patients into two groups, namely an A-line group and an EV1000 group, according to the monitoring methods used, and the study variables were compared.RESULTS: Eighty-five patients were reviewed. The A-line group reported a higher number of failed CH (P = 0.005). A significant correlation was found between preoperative hemoglobin and intraoperative packed red blood cell transfusion (r = 0.525; P < 0.001). In the EV1000 group, the mean arterial pressure (MAP) was significantly lower 2 h after CH (P = 0.014), and the cardiac index significantly decreased 1 h after CH (P = 0.001) and 2 h after CH (P = 0.007). Moreover, venous oxygen saturation (ScVO2) decreased significantly at both 1 h (P = 0.002) and 2 h after CH (P = 0.029); however, these values were within normal limits.CONCLUSION: The EV1000 group reported a lower failure rate of CH than the A-line group. However, EV1000/FloTrac monitoring did not present with any specific advantage over the conventional arterial line monitoring when CH was performed with the same protocol and same mean blood pressure. Preoperative anemia treatment will be helpful to decrease intraoperative transfusion. Furthermore, ScVO2 monitoring did not present with sufficient benefits over the risk and cost.
Anemia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiac Output ; Catheters ; Erythrocyte Transfusion ; Humans ; Hypotension, Controlled ; Medical Records ; Operative Time ; Orthognathic Surgery ; Osteotomy, Le Fort ; Oxygen ; Retrospective Studies ; Vascular Access Devices

Access to Information ; Biomedical Research ; Editorial Policies ; Ethics, Research ; Humans ; Internet ; Journal Impact Factor ; Open Access Publishing ; Peer Review ; Periodicals as Topic ; Singapore

Dorsalis pedis artery (DPA) aneurysms are very rare and fewer than 60 cases have been reported in the literature. Most affected patients present with false aneurysms after orthopedic surgery or trauma. Here we report an unusual case of a giant DPA pseudoaneurysm after cannulation for arterial line placement in a patient newly diagnosed with systemic lupus erythematosus (SLE). A diagnostic delay resulted in necrosis of the overlying skin. Excision of the pseudoaneurysm, ligation of the DPA, and debridement of the foot dorsum were performed, followed by a second flap coverage surgery. Although a DPA false aneurysm is rare after arterial line removal, it can cause the serious complications of skin necrosis, rupture and toe necrosis. Arterial puncture sites should be carefully monitored, especially in patients with SLE or other vasculitis.
Aneurysm ; Aneurysm, False ; Arteries ; Catheterization ; Debridement ; Delayed Diagnosis ; Foot ; Humans ; Ligation ; Lupus Erythematosus, Systemic ; Necrosis ; Orthopedics ; Punctures ; Rupture ; Skin ; Toes ; Vascular Access Devices ; Vasculitis

PURPOSE: Long-term venous access is cumbersome in children because of their thin caliber veins, less cooperative nature, and easy compromise of venous integrity. Hence, a study was conducted to evaluate the indication, efficacy, and safety of chemoport in children who require chronic venous access. MATERIALS AND METHODS: Children who underwent chemoport insertion between January 2008 and December 2017 were retrospectively evaluated. RESULTS: A total of 159 children (169 chemoports) were included in the study. The most common indication for chemoport insertion was acute lymphoblastic leukemia (51.5%). The mean chemoport days were 832±666 days. Among the 169 chemoports, 55.0% were removed after treatment completion. The chemoport was not removed in 35.5% of the patients, as 28.4% of the patients were still under treatment and 7.1% died during the treatment. Sixteen patients (0.1 per 1,000 chemoport days) had a premature chemoport removal. The indications were port-related bloodstream infection (12 patients), port pocket infection (1 patient), exposed chemoport (1 patient), and blocked chemoport catheter (2 patients). Twenty-two patients (0.15 per 1,000 chemoport days) had complications of port-related bloodstream infection (0.09 per 1,000 chemoport days), making it the most common. Other complications include block, fracture, arrhythmias, avulsion, bleeding, decubitus-over-port, and port pocket infection. CONCLUSION: Owing to the safe, reliable, and low complication rate of chemoports, more children can be saved from deadly illnesses. Chemoport is the best option for children who require chronic venous access.
Arrhythmias, Cardiac ; Catheters ; Child ; Hemorrhage ; Humans ; Leukemia ; Observational Study ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies ; Vascular Access Devices ; Veins

No abstract available.
Open Access Publishing