สถานะทางการเงินและคุณภาพการบริการของโรงพยาบาลภายใต้กลไกการจ่ายเงินแบบกลุ่มวินิจฉัยโรคร่วม Hospital Financial Status and Quality of Care under Diagnosis Related Groups Payment Mechanism

Objective: To assess impact of diagnosis related groups (Diagnosis relatedgroups, DRGs) on hospital financial performance, to identify diseases whichcause negative financial status, to evaluate appropriateness of inpatientresource consumption and to assess quality outcomes. Methods: Thisstudy was retrospective study. We used data of all in-patients eligible forthe universal coverage (UC) scheme in fiscal year 2010 of NopparatRajathani hospital. Financial performance was defined as differencebetween hospital cost and the reimbursement received from the NationalHealth Security Office (NHSO). Appropriateness of resource consumptionwas determined as proportions of resource used among top ten mostnegative financial performance medical conditions. Internal medicinedepartment (IMD) head was asked to review appropriateness of resourceutilization. Quality of care was measured by two concepts; readmission ratewithin 30 days and pre-mature discharge. Results: There were 11,404admissions during 2010 fiscal year. Cost of care for these patients was202.62 million baht; however, the hospital was reimbursed at 103.70 millionbaht, resulting in 98.92 million baht lost per year. Pneumonia (J189),Urinary tract infection (N390), COPD with exacerbation (J441) were top 3medical conditions that caused highest lost. Medical materials andequipments (such as electrocardiogram and respirator), with their costs tobe the highest proportion, were however confirmed necessary by the IMDhead. Use of expensive originator drugs were found among top ten DRGswhich caused financial lost. If half of that were replaced by generic drug, itwould have saved the hospital 1.16 million baht. Hospital readmission ratewas found to be 5.3%. This rate was lower than other studies, whichreadmission rate ranged from 5 - 17%. Premature discharge was reportedby 27.8%; however, 85.8% of these discharges were labeled “improved.”Conclusion: DRGs payment method caused negative financial status forthe studied hospital. Resource utilization was appropriate. Re-admissionrate and pre-mature discharge was low. Further studies should focus onhigh financial lost DRGs and the hospital own unit cost data.Keywords: diagnosis related groups, financial status, quality of care,universal coverage schem

ผลของการมีเภสัชกรร่วมในโปรแกรมการเปลี่ยนแปลงและชี้นำการใช้ยาต้านจุลชีพต่อความเหมาะสมในการสั่งใช้ยาต้าน จุลชีพ Effects of Pharmacist Participation in an Antimicrobial Stewardship Program on Appropriate Antibiotic Use

Objective: To evaluate outcomes of pharmacist participation in anantimicrobial stewardship program (ASP) on improving appropriateantibiotic use and consumption. Method: The data were collected bymedical chart review in a retrospective cohort design. This study included380 prescriptions from 283 patients admitted to a medicine ward(Sawaslom-3 ward) of the King Chulalongkorn Memorial hospital fromJanuary to May 2013 of which the ASP using education approaches anddrug use evaluation forms with no pharmacist participation had beenimplemented. Data when pharmacist participation were collected fromJanuary to May 2014, of which pharmacists evaluated the prescriptions andfeedback the prescribers. Effects of pharmacist participation onappropriateness of antimicrobial prescribing and antibiotic consumptionwere determined in forms of defined daily dose/1,000 inhabitants(DDD/1000 inhabitants) of 3rd generation cephalosporins,betalactam/betalactamase inhibitors (BLBIs) and carbapenems. Results:ASP with pharmacist participation was associated with increasingprescribing appropriateness from 89.2% to 78.2% (P = 0.008).Inappropriate dosage was the most declining cause, from 6.7% to 2.5% (P= 0.047). The overall antibiotic consumption was slightly increased with nostatistical significance. Conclusion: Pharmacist participation in the ASPcould increase the appropriateness of antimicrobial prescribing especiallyinappropriate dosage, but not overall antibiotic consumption.Keywords: antimicrobial stewardship program, appropriate antibiotics use,pharmacis

Antimitotic and anti-HIV reverse transcriptase mechanisms mediated by natural and synthetic compounds.

Antimitotic and anti-HIV reverse transcriptase mechanisms mediated by natural and synthetic compounds

Influence of ABCC2 and ABCC4 Polymorphisms on Tenofovir Plasma Concentrations in Thai HIV-Infected Patients

Contains fulltext : 153170.pdf (publisher's version ) (Open Access)Tenofovir (TFV) is eliminated by renal excretion, which is mediated through multidrug-resistant protein 2 (MRP2) and MRP4, encoded by ABCC2 and ABCC4, respectively. Genetic polymorphisms of these transporters may affect the plasma concentrations of tenofovir. Therefore, the aim of this study was to investigate the influence of genetic and nongenetic factors on tenofovir plasma concentrations. A cross-sectional study was performed in Thai HIV-infected patients aged >/=18 years who had been receiving tenofovir disoproxil fumarate at 300 mg once daily for at least 6 months. A middose tenofovir plasma concentration was obtained. Multivariate analysis was performed to investigate whether there was an association between tenofovir plasma concentrations and demographic data, including age, sex, body weight, estimated glomerular filtration rate (eGFR), hepatitis B virus coinfection, hepatitis C virus coinfection, duration of tenofovir treatment, concomitant use of ritonavir-boosted protease inhibitors, and polymorphisms of ABCC2 and ABCC4. A total of 150 Thai HIV-infected patients were included. The mean age of the patients was 43.9 +/- 7.2 years. The mean tenofovir plasma concentration was 100.3 +/- 52.7 ng/ml. In multivariate analysis, a low body weight, a low eGFR, the concomitant use of ritonavir-boosted protease inhibitors, and the ABCC4 4131T --> G variation (genotype TG or GG) were independently associated with higher tenofovir plasma concentrations. After adjusting for weight, eGFR, and the concomitant use of ritonavir-boosted protease inhibitors, a 30% increase in the mean tenofovir plasma concentration was observed in patients having the ABCC4 4131 TG or GG genotype. Both genetic and nongenetic factors affect tenofovir plasma concentrations. These factors should be considered when adjusting tenofovir dosage regimens to ensure the efficacy and safety of a drug. (This study has been registered at ClinicalTrials.gov under registration no. NCT01138241.)

4 DITERPENE ESTERS FROM EUPHORBIA-MYRSINITES .3. BIOLOGICALLY-ACTIVE COMPOUNDS FROM THE EUPHORBIACEAE

The Turkish species Euphorbia myrsinites has yielded four new tetracyclic diterpene tetraesters from a cytotoxic acetone extract, in addition to the known cycloartane-type triterpenoids and betulin. The new compounds and their hydrolysis product have been extensively characterized by high field spectroscopic techniques, and were shown to be four new tetraesters of the parent alcohol, myrsinol

Saniculoside N from Sanicula europaea L.

Extracts from the aerial parts of Sanicula europaea L. were investigated for their anti-HN activity, and the 50% ethanolic extract was shown to exhibit the highest activity. A new triterpene saponin glycoside, 21 beta-(angeloyloxy)-3-O-[beta-D-arabinopyranosyl(1-->4)-beta-D-glucopyranosyl(1-->3)-beta-D-glucuronopyranosyl propyl ester]-3 beta,15,16,22 alpha,28 beta-pentahydroxy-Delta(12)-oleanene, saniculoside N (1), in addition to the known phenolic acids, rosmarinic acid (2), and caffeic acid(3) were isolated as major components. Rosmarinic acid was established as the principal active substance