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Post-trial access to treatment: How managed access programs could be a solution 试验后治疗的可及性:管理可及性项目如何成为一种解决方案
Pub Date : 2018-08-28 DOI: 10.1177/2399202618795431
K. Lewis
The rising cost of clinical development, coupled with the ethical obligation to ensure that patients exiting a clinical trial are able to remain on active treatment if necessary, has led some pharmaceutical and bio-pharmaceutical companies to review their trial protocols and consider alternative options. The traditional open-label extension or phase IV trial is appropriate in some instances, as is a post-trial supply program using the legislation available for unlicensed medicines in the many countries around the world. This article looks at some of the key considerations and how many companies are adopting different supply models.
临床开发成本的上升,再加上确保退出临床试验的患者在必要时能够继续积极治疗的道德义务,导致一些制药和生物制药公司审查其试验方案并考虑替代方案。在某些情况下,传统的开放标签扩展或第四期试验是合适的,使用世界上许多国家对无证药物可用的立法的试验后供应计划也是合适的。本文着眼于一些关键的考虑因素,以及有多少公司正在采用不同的供应模式。
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引用次数: 3
Improving access to post-treatment support for patients with cancer – thinking outside the box: A patient perspective 改善癌症患者获得治疗后支持的机会——跳出框框思考:患者视角
Pub Date : 2018-07-13 DOI: 10.1177/2399202618786932
C. Lewis
Introduction: Aggressive cancers such as mantle cell lymphoma are life-changing diseases, affecting all aspects in the life of a patient. Not only affecting a patient physically due to the disease itself and potential treatments but also mentally, socially and economically as well. The aim of this article is to describe the journey of a patient from a clinical and personal perspective, highlighting the importance of a collaborative approach to patients’ post-treatment care from clinicians, allied health professionals and patient advocacy groups/charities. Case presentation: The case presented the journey of a 51-year-old male with stage IV mantle cell lymphoma presented from his own perspective. The clinical case highlights a number of key issues on post-treatment support and the need for improvement to ensure cancer survivors have the best quality of life once treatment has ended. Conclusions: It is essential that cancer survivors receive the support and information they require to adjust to lifestyle changes arising from their disease and treatment. Improving communication and access to care and providing additional emotional support may assist survivors in adapting to these changes. Increased collaboration among physicians, researchers, allied health professionals, patient groups and charities and patients will continue to improve quality of life for cancer patients after treatment has ceased.
侵袭性癌症如套细胞淋巴瘤是改变生活的疾病,影响患者生活的方方面面。由于疾病本身和潜在的治疗方法,不仅会影响患者的身体,还会影响精神、社会和经济。本文的目的是从临床和个人的角度描述患者的旅程,强调临床医生、联合卫生专业人员和患者倡导团体/慈善机构合作方法对患者治疗后护理的重要性。病例介绍:病例介绍了一位51岁男性IV期套细胞淋巴瘤患者的经历,从他自己的角度进行了介绍。该临床病例突出了治疗后支持的一些关键问题,以及改善的必要性,以确保癌症幸存者在治疗结束后拥有最佳的生活质量。结论:癌症幸存者获得所需的支持和信息以适应因疾病和治疗引起的生活方式改变是至关重要的。改善沟通和获得护理以及提供额外的情感支持可能有助于幸存者适应这些变化。医生、研究人员、联合保健专业人员、患者团体和慈善机构与患者之间加强合作,将在治疗停止后继续改善癌症患者的生活质量。
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引用次数: 1
The top 5 issues in EU medicines policy for 2018 2018年欧盟药品政策的五大问题
Pub Date : 2018-05-29 DOI: 10.1177/2399202618774510
Yannis Natsis
The present analysis looks at the key issues which dominate the EU medicines policy agenda during 2018 namely the proposed regulation on European collaboration on Health Technology Assessment (HTA), the ongoing discussion around the role of intellectual property related incentives in biomedical R&D, the future of initiatives such as BeNeLuxA, the role of the European Medicines Agency and the reaction of the pharmaceutical companies to the unprecedented debate around access to medicines in Europe.
本分析着眼于2018年主导欧盟药品政策议程的关键问题,即关于欧洲卫生技术评估合作(HTA)的拟议法规,围绕知识产权相关激励措施在生物医学研发中的作用正在进行的讨论,BeNeLuxA等举措的未来,欧洲药品管理局的作用以及制药公司对欧洲前所未有的药品获取辩论的反应。
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引用次数: 1
Medicine Thefts And Their Prevention: Current Approach In Italy And Future Perspectives 药品盗窃及其预防:目前在意大利的做法和未来的观点
Pub Date : 2018-04-17 DOI: 10.1177/2399202618768676
Lidio Brasola, Domenico Di Giorgio, Fulvio La Bella, M. Pani, G. Turchetti
In recent years, medicine thefts have become a European challenge. In Italy, the number of thefts, from hospitals, has increased exponentially since 2011. The major drivers were the introduction of life-saving expensive medicines, the price differentials between countries and the different reimbursement regimes adopted in the European Union. This situation resulted in the AIFA (Italian Medicines Agency) Counterfeiting Prevention Unit setting up a number of preventive strategies that have minimized and in some cases eradicated the problem. In this review, we briefly describe trends and impacts of medicine thefts in Italy, the ‘Herceptin Case’, a major criminal effort that has been dismantled, and some of the preliminary results of PADLOck (Progetto di Adeguamento Dei Livelli di sicurezza delle farmacie Ospedaliere contro il rischio di furti e definizione di standard tecnici), a study aimed at evaluating the safety of hospital pharmacists and made sure that preventive and corrective measures against medicine thefts are put in place. The implementation of some of the tools developed by AIFA is under evaluation and/or implementation by other European Authorities, leading to a more effective approach in tackling one of the most relevant challenges in access to medicines in the European Union.
近年来,药品盗窃已成为欧洲面临的一大挑战。在意大利,自2011年以来,医院的盗窃数量呈指数级增长。主要的驱动因素是采用挽救生命的昂贵药物、各国之间的价格差异以及欧洲联盟采用的不同报销制度。这种情况导致AIFA(意大利药品管理局)防伪股制定了一些预防战略,尽量减少并在某些情况下根除了这个问题。在这篇综述中,我们简要地描述了意大利药品盗窃的趋势和影响,“赫赛汀案”,一个已经被破获的主要犯罪活动,以及PADLOck的一些初步结果(Progetto di Adeguamento Dei livellidi sicurezza delle pharmacy Ospedaliere控制il rischio di进一步定义标准技术)。一项研究旨在评估医院药剂师的安全,并确保对药品盗窃的预防和纠正措施到位。AIFA开发的一些工具的实施情况正在由其他欧洲主管部门进行评估和/或实施,从而采用更有效的方法来应对欧盟药品可及性方面最相关的挑战之一。
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引用次数: 3
Initiatives driving accelerated access to medicines in Europe: Review of recent concepts and developments 推动欧洲加速获得药物的举措:对最近概念和发展的审查
Pub Date : 2018-03-14 DOI: 10.1177/2399202618761854
Mia Gannedahl, A. Udechuku, M. Bending
Improving timely patient access to new medicines, particularly in areas with high unmet need, has been a healthcare priority during the past 5–10 years, with several new regulatory initiatives from the European Medicines Agency, as well as on national level within the European Union. Nevertheless, evidence suggests that medicines going through these regulatory initiatives experience variable reimbursement outcomes due to uncertainties in the clinical or economic evidence base. New initiatives, including the adaptive pathways concept, have therefore been introduced that embrace a holistic view of a medicine’s route to patient access. These involve expanded clusters of stakeholders working together to prospectively influence and design evidence generation strategies, including use of real-world evidence, to ensure that development plans meet the needs of multiple stakeholders including regulatory agencies and health technology assessment bodies. Multi-stakeholder dialogues, provided through scientific advice, are already available for medicines in Europe in various forms and are important tools for regulators, health technology assessment bodies and pharmaceutical companies to develop evidence generation plans optimised to support decision-making on marketing authorisation and reimbursement of new medicines. Multiple stakeholder groups have been actively engaged in advancing developments of initiatives driving timely access and it is likely to continue due to the need to balance this with affordability. The aim of this article is to provide a review of the latest, as well as a future perspective on, developments with respect to accelerated access of medicines in the European Union with a particular focus on procedures for formal scientific advice.
在过去5至10年期间,改善患者及时获得新药的机会,特别是在未满足大量需求的地区,一直是卫生保健的优先事项,欧洲药品管理局以及欧洲联盟国家一级采取了若干新的监管举措。然而,有证据表明,由于临床或经济证据基础的不确定性,通过这些监管举措的药物经历了可变的报销结果。因此,引入了包括适应性途径概念在内的新举措,这些举措包含了对患者获得药物途径的整体看法。这涉及扩大利益攸关方集群,共同努力,前瞻性地影响和设计证据生成战略,包括使用真实世界的证据,以确保发展计划满足包括监管机构和卫生技术评估机构在内的多个利益攸关方的需求。通过科学咨询提供的多方利益攸关方对话已经以各种形式适用于欧洲的药品,并且是监管机构、卫生技术评估机构和制药公司制定优化证据生成计划的重要工具,以支持新药上市许可和报销方面的决策。多个利益相关方团体一直在积极推动推动及时获取的举措的发展,由于需要在这方面与可负担性之间取得平衡,这种情况可能会继续下去。本文的目的是回顾欧盟加快药品可及性方面的最新发展以及未来发展,特别侧重于正式科学咨询的程序。
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引用次数: 7
Health diagnosis improvement in remote community health centers through telemedicine 通过远程医疗改善偏远社区卫生中心的健康诊断
Pub Date : 2018-02-14 DOI: 10.1177/2399202617753101
P. Galván, Miguel Velázquez, Ronald Rivas, G. Benítez, Antonio Barrios, E. Hilario
Introduction: Information and communication technologies (ICTs) applied to the healthcare offer multiple advantages for diagnostic services and remote consultations. However, evidence on the diagnosis improvement in rural communities is limited. The usability of telemedicine to improve the coverage of diagnostic services in Paraguay was investigated. Methods: The goal of this descriptive study was to evaluate whether a telemedicine system implemented in remote public regional and district hospitals in Paraguay over a period of 3 years from 2014 to 2016 could facilitate the universal coverage of diagnostic services in rural communities. Results: In the study period, 182,406 remote diagnoses from 54 hospitals through a telemedicine system were performed. Of the total, 37.31% (68,085) corresponded to tomography, 62.00% (113,059) to electrocardiogram (ECG), 0.68% (1243) to electroencephalogram (EEG), and 0.01% (19) to ultrasound (US). Tomography was performed in 12 hospitals: 54.4% corresponded to head injuries, 13.8% to chest, and the rest to other anatomical regions. ECG was carried out in 52 hospitals; and in 62.1% of the cases, the results were normal; 12.5% unspecified arrhythmias; and 10.4% sinus bradycardia among the most frequent pathologies. EEG diagnosis showed history of seizure (54.3%), evolutionary control (14.0%), and headache (11.5%) among the most frequent diagnoses. All 19 US studies corresponded to prenatal control. Conclusion: These results showed that telemedicine may enhance the diagnostic services in rural communities, thus reducing the number of referrals and optimizing human and financial resources.
引言:应用于医疗保健的信息和通信技术为诊断服务和远程会诊提供了多种优势。然而,关于农村社区诊断改善的证据有限。调查了远程医疗在巴拉圭提高诊断服务覆盖率方面的可用性。方法:本描述性研究的目的是评估巴拉圭偏远公立地区和地区医院在3年内是否实施了远程医疗系统 从2014年到2016年的几年可以促进诊断服务在农村社区的普及。结果:在研究期间,通过远程医疗系统从54家医院进行了182406次远程诊断。在总数中,37.31%(68085)对应于断层扫描,62.00%(113059)对应于心电图,0.68%(1243)对应于脑电图,0.01%(19)对应于超声。在12家医院进行了断层扫描:54.4%对应于头部损伤,13.8%对应于胸部,其余对应于其他解剖区域。在52家医院进行心电图检查;62.1%的病例结果正常;12.5%未明确心律失常;窦性心动过缓占10.4%。脑电图诊断显示,癫痫发作史(54.3%)、进化控制史(14.0%)和头痛史(11.5%)是最常见的诊断。所有19项美国研究均与产前对照相一致。结论:这些结果表明,远程医疗可以提高农村社区的诊断服务,从而减少转诊次数,优化人力和财力资源。
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引用次数: 4
The advantages of electronic patient-reported measures and an example digital platform to collect ePROs after total knee arthroplasty 全膝关节置换术后电子患者报告测量的优势及数字化平台采集示例
Pub Date : 2018-01-01 DOI: 10.1177/2399202618813463
Diarmuid De Faoite
The patient’s perspective is increasingly being sought out in measuring the success of a medical procedure. Patientreported outcome measures (PROMs) are the tools used to elicit patient options. Despite increased popularity, issues still remain around their use. Electronic PROMs have been suggested as an improvement on paper-based collection of data. Begun in 2004, the US-initiated Patient-Reported Outcome Measurement Information System (PROMIS®) aims to improve the standards for the assessment of self-reported health status. The PROMIS initiative has generated a reliable and sensitive system, customised to the patient, which poses as few questions as possible. This is achieved through the use of computer-adaptive tests (CATs), which are individually tailored electronic questionnaires. Smith & Nephew collaborated with Wellframe Inc., a US-based patented health management solution, to adapt their platform for total knee arthroplasty patients and PROMIS CAT data collection. The platform’s app can be used outside of scheduled clinic visits to collect data from patients. This enables orthopaedic surgeons, for the first time, to remotely track their patients’ real-time healing progress and satisfaction levels. Smith & Nephew is currently investigating the use of this application for clinical research purposes. If electronic PROMs deliver on their promise, there is great potential to introduce them to the many clinical studies that the company runs and/or funds.
在衡量医疗程序的成功与否时,越来越多地寻求患者的观点。患者报告的结果测量(PROMs)是用来引出患者选择的工具。尽管越来越受欢迎,但它们的使用仍然存在问题。电子prom被认为是对基于纸张的数据收集的改进。从2004年开始,美国发起的患者报告结果测量信息系统(PROMIS®)旨在提高自我报告健康状况的评估标准。PROMIS计划产生了一个可靠而敏感的系统,为患者量身定制,尽可能少地提出问题。这是通过使用计算机适应性测试(cat)实现的,这是一种单独定制的电子问卷。Smith & Nephew与美国专利健康管理解决方案公司Wellframe Inc.合作,调整其平台,用于全膝关节置换术患者和PROMIS CAT数据收集。该平台的应用程序可以在预定的诊所访问之外使用,以收集患者的数据。这使得骨科医生第一次能够远程跟踪患者的实时愈合进度和满意度。Smith & Nephew目前正在研究将该应用程序用于临床研究目的。如果电子prom实现了它们的承诺,那么将有很大的潜力将它们引入到公司运营和/或资助的许多临床研究中。
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引用次数: 3
The EU Falsified Medicines Directive: Key Implications for Dispensers 欧盟伪造药品指令:对配药员的关键影响
Pub Date : 2017-12-23 DOI: 10.5301/maapoc.0000024
B. Naughton
The EU Falsified Medicines Directive (FMD) mandates the serialisation of prescription-only medicines using a two-dimensional (2D) barcode by pharmaceutical companies and the systematic verification of this 2D barcode in pharmacies. This European directive has ramifications for many stakeholders, including market authorization holders, wholesalers, parallel importers, and dispensers. Focusing primarily on the impact on UK dispensers, the following questions are addressed in this article: Where should the affected medicines be scanned? and who will pay for the incoming changes to practice? The role of the EU FMD in terms of drug recalls, the preparation required for EU FMD compliance, and the potential for added healthcare value are also discussed. Dispensers must prepare for the February 2019 EU FMD deadline date by choosing a point within their dispensing processes to scan medicines. Dispensers must also budget appropriately for the incoming costs associated with new hardware and processes.
欧盟伪造药品指令(FMD)要求制药公司使用二维条形码对处方药进行序列化,并在药店对二维条形码进行系统验证。这项欧洲指令对许多利益相关者产生了影响,包括市场授权持有人、批发商、平行进口商和经销商。本文主要关注对英国配药员的影响,解决了以下问题:受影响的药物应该在哪里扫描?谁将为即将到来的实践变革买单?还讨论了欧盟FMD在药品召回方面的作用、遵守欧盟FMD所需的准备工作以及增加医疗保健价值的潜力。配药员必须在配药流程中选择一个点来扫描药物,为2019年2月欧盟FMD截止日期做好准备。分配器还必须为与新硬件和工艺相关的传入成本进行适当的预算。
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引用次数: 4
Unveiling the Peril of Substandard and Falsified Medicines to Public Health and Safety in Africa: Need for All-Out War to End the Menace 揭开不合格和假冒药品对非洲公共卫生和安全的威胁:需要全面战争来结束威胁
Pub Date : 2017-12-23 DOI: 10.5301/maapoc.0000023
N. Aminu, A. Sha’aban, A. Abubakar, M. Gwarzo
The peril of substandard and falsified medicines (SFM) risk complete failure of the United Nations Sustainable Development Goals on access to safe, effective, quality, and affordable essential medicines in African countries. The global market volume of SFM could be up to US$200 billion, and up to 70% of the total medicines in circulation could be SFM in some parts of Africa. This dominance in the region is a clear sign of SFM proliferation, which continues to cause avoidable health hazards leading to severe adverse effects and devastating loss of human lives, by compromising treatment of chronic, infectious, and life-threatening diseases, such as malaria, cancer, pneumonia, tuberculosis, and diabetes. Besides these consequences to public health and safety, the economic and societal detriments are also grave. Although the recent advancement in detection technology coupled with increased collaborative efforts among some African drug regulatory agencies has led to a considerable success in countering the SFM pandemic, there is need to amplify and intensify such efforts in order to curb or totally eradicate the menace. Here, we provide an overview of the detrimental impact of SFM on the healthcare system in African countries and highlight various strategies for curbing the menace in order to arrest its hazardous consequence to the public.
劣质和假药的危险可能使联合国关于在非洲国家获得安全、有效、优质和负担得起的基本药物的可持续发展目标完全失败。SFM的全球市场规模可达2000亿美元,在非洲某些地区,SFM可占流通药品总量的70%。该区域的这种主导地位是SFM扩散的明显迹象,它继续造成可避免的健康危害,导致严重的不利影响和毁灭性的生命损失,损害对疟疾、癌症、肺炎、结核病和糖尿病等慢性、传染性和危及生命的疾病的治疗。除了对公众健康和安全造成这些后果外,对经济和社会造成的损害也很严重。虽然最近检测技术的进步,加上一些非洲药物管制机构之间加强合作的努力,在防治SFM流行病方面取得了相当大的成功,但仍有必要扩大和加强这种努力,以遏制或彻底根除这一威胁。在这里,我们概述了SFM对非洲国家医疗保健系统的有害影响,并强调了遏制威胁的各种策略,以阻止其对公众的危险后果。
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引用次数: 11
Timely Access to Priority Medicines in Europe 及时获得欧洲优先药品
Pub Date : 2017-12-22 DOI: 10.5301/MAAPOC.0000021
E. Bosone, G. Giuliani, Nicoletta Martone, A. Ponzianelli, Valeria Viola
Many tools have been developed in Europe to accelerate the access to and the availability of medicines. However, this is currently governed by the national Member State procedures for pricing and reimbursement. In many cases, this leads to procedures that often take many months or even years to be completed. This paper explores ways that would allow a more accelerated approach and thus enable a more efficient administrative procedure to be adopted. Therefore, this would favor the timely availability of medicines for severe diseases when an unmet medical need is present.
欧洲开发了许多工具来加快药品的获取和供应。然而,这目前由会员国的定价和报销程序管理。在许多情况下,这导致程序通常需要数月甚至数年才能完成。本文件探讨了如何加快处理速度,从而能够采用更有效的行政程序。因此,当存在未满足的医疗需求时,这将有利于及时获得治疗严重疾病的药物。
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引用次数: 0
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Medicine access @ point of care
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