bluuebunny/crossref_metadata_2025 huggingface dataset:
بيان أثر التدقيق الداخلي على مخرجات النظام المحاسبي في قطاع البنوك التجارية الأردنية
Authors: النعيمات د. سعيد مخلد أحمد
Published: July 2023

يهدف البحث إلى التعرف على أثر التدقيق الداخلي على مخرجات النظام المحاسبي في البنوك التجارية الأردنية، وبيان مدى كفاية وحدة التدقيق الداخلي ونظام الرقابة الداخلي في البنوك التجارية الأردنية، وبيان أهمية التدقيق الداخلي في تحقيق التقارير والبيانات المحاسبية ومدى مطابقتها للسياسات والنظم الموضوعية في النوك التجارية الأردنية، والتعرف على المعوقات التي وتواجه عملية التدقيق الداخلي في النبوك التجارية الأردنية،ـ وبيان أثر استقلالية مدقق الحسابات الداخلي وصحة عمله على تسجيل مهمة المدقق الخارجي. ويتكون مجتمع الدراسة من المصارف التجارية الأردنية وفق تصنيف البنك المركزي لها ويشمل هذا التصنيف المصارف الآتية: البنك العربي، البنك الأهلي الأردني، بنك الأردن، بنك القاهرة - عمان، بنك الإسكان، البنك الأردني الكويتي، بنك الأردن والخليج، بنك المؤسسات العربية المصرفية (الأردن)، بنك الصادرات والتمويل، وقد اعتمد الباحث في عملية جمع البيانات اللازمة على نوعين رئيسيين من البيانات هما: البيانات الأولية والبيانات الثانوية، واتبع المنهج الوصفي التحليلي وتوصل إلى: أن هناك علاقة بين المعوقات والصعوبات التي تواجهها عملية التدقيق الداخلي في البنوك التجارية الأردنية وسلامة مخرجات النظام المحاسبي في هذه البنوك. ويوجد علاقة بين التدقيق الداخلي وصحة وسلامة القوائم المالية والتقارير المحاسبية في البنوك الأردنية وأن التدقيق الداخلي يزيد من صحة وسلامة هذه القوائم والتقارير. وقد أكدت الدراسة أن التدقيق الداخلي يساعد على رفع مستوى الكفاءة الانتاجية وعلى الالتزام بالسياسات والقرارات الإدارية.
Non-Native Plants Species and Biodiversity of Socotra Island, Yemen
Authors: S Senan A. . , Somashekar R. K.
Published: July 2023

Socotra Island has significant ecological and economic importance at local, national and global scales. Invasive plant species are often considered as potential competitors of native species due to their usual greater capacity for colonization and expansion. The spread of alien plant species has long been recognized as one of the most significant environmental changes due to its ability to decrease biodiversity and alter ecosystem processes. In areas with homogeneity population of wild invasive species especially Argemone mexicana, 32 random sites were randomly detected. Ninety six Quadrates plots were laid down to study the interaction between the invasive plant and the native species especially with conservation attention of endemic plant species. The main aims is to provide base informatics data to establish comprehensive habitat surveillance programs to enable early detection and rapid response of IAS, prevent both intentional or accidental introductions of harmful invasive alien species to the Socotra Island and reduce the likelihood of alien species invasions by decreasing stresses on vulnerable at-risk ecosystems and species. This study was conducted to identify the different types of invasive species present, the rate and pattern of invasion, its intensity, association of invaders and their habitat preference in the Socotra ecosystem. Vegetation sampled in 96 quadrats, each 10 m _ 10 m; through a combination of random and systematic sampling recorded 42 plant species of 36 genera belonging to 24 families with around 10% was recorded as invasive species. Diversity indices like richness, evenness, Simpson and Shannon-Wiener have been analyzed.
NCCN Guidelines® Insights: Biliary Tract Cancers, Version 2.2023
Authors: Benson Al B. , D’Angelica Michael I. , Abrams Thomas , Abbott Daniel E. , Ahmed Aijaz , Anaya Daniel A. , Anders Robert , Are Chandrakanth , Bachini Melinda , Binder David , Borad Mitesh , Bowlus Christopher , Brown Daniel , Burgoyne Adam , Castellanos Jason , Chahal Prabhleen , Cloyd Jordan , Covey Anne M. , Glazer Evan S. , Hawkins William G. , Iyer Renuka , Jacob Rojymon , Jennings Lawrence , Kelley R. Kate , Kim Robin , Levine Matthew , Palta Manisha , Park James O. , Raman Steven , Reddy Sanjay , Ronnekleiv-Kelly Sean , Sahai Vaibhav , Singh Gagandeep , Stein Stacey , Turk Anita , Vauthey Jean-Nicolas , Venook Alan P. , Yopp Adam , McMillian Nicole , Schonfeld Ryan , Hochstetler Cindy
Published: July 2023

In 2023, the NCCN Guidelines for Hepatobiliary Cancers were divided into 2 separate guidelines: Hepatocellular Carcinoma and Biliary Tract Cancers. The NCCN Guidelines for Biliary Tract Cancers provide recommendations for the evaluation and comprehensive care of patients with gallbladder cancer, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma. The multidisciplinary panel of experts meets at least on an annual basis to review requests from internal and external entities as well as to evaluate new data on current and emerging therapies. These Guidelines Insights focus on some of the recent updates to the NCCN Guidelines for Biliary Tract Cancers as well as the newly published section on principles of molecular testing.
Impact of Asian Race on Prognosis in De Novo Metastatic Prostate Cancer
Authors: Ni Xudong , Michael Luu , Ma Weiwei , Zhang Tingwei , Wei Yu , Freedland Stephen J. , Ye Dingwei , Daskivich Timothy J. , Zhu Yao
Published: July 2023

Background: Little is known about the impact of Asian race on the long-term survival outcomes of males with de novo metastatic prostate cancer (PCa). Understanding racial disparities in survival is critical for accurate prognostic risk stratification and for informing the design of multiregional clinical trials. Methods: This multiple-cohort study included individual patient-level data for males with de novo metastatic PCa from the following 3 cohorts: LATITUDE clinical trial data (n=1,199), the SEER program (n=15,476), and the National Cancer Database (NCDB; n=10,366). Primary outcomes were overall survival (OS) in LATITUDE and NCDB and OS and cancer-specific survival in SEER. Results: Across all 3 cohorts, Asian patients diagnosed with de novo metastatic PCa had better survival than white patients. In LATITUDE, median OS was significantly longer in Asian versus white patients in the androgen deprivation therapy (ADT) + abiraterone + prednisone group (not reached vs 43.8 months; hazard ratio [HR], 0.45; 95% CI, 0.28–0.73; P=.001) as well as in the ADT + placebo group (57.6 vs 32.7 months; HR, 0.51; 95% CI, 0.33–0.78; P=.002). In SEER, among all patients diagnosed with de novo metastatic PCa, median OS was significantly longer in Asian versus white males (49 vs 39 months; HR, 0.76; 95% CI, 0.68–0.84; P<.001). Among those who received chemotherapy, Asian patients again had longer OS (52 vs 42 months; HR, 0.71; 95% CI, 0.52–0.96; P=.025). Using data on cancer-specific survival in SEER resulted in similar conclusions. In NCDB, Asian patients also had longer OS than white patients in aggregate and in subgroups of males treated with ADT or chemotherapy (aggregate: 38 vs 26 months; HR, 0.72; 95% CI, 0.62–0.83; P<.001; ADT subgroup: 41 vs 26 months; HR, 0.71; 95% CI, 0.60–0.84; P<.001; chemotherapy subgroup: 34 vs 25 months; HR, 0.67; 95% CI, 0.57–0.78; P<.001). Conclusions: Asian males have better OS and cancer-specific survival than white males with metastatic PCa across different treatment regimens. This should be considered when assessing prognosis and in designing multinational clinical trials.
Industrial wireless deployments in the navy shipyard
Authors: Candell Richard , Montgomery Karl , Liu Yongkang , Hany Mohamed
Published: July 2023

The National Institute of Standards and Technology (NIST) and the Office of Naval Research (ONR) have partnered to investigate the application of digital manufacturing methods and technologies within the navy shipyard. As a part of the effort, wireless network deployments are considered. This report provides an overview of the wireless networking requirements of navy shipyards specifically for the transmission of machine information outside and inside of the vessel during construction. Recommended approaches are included with each use case. This report is intended to provide the reader with direction to other larger resources and documentation provided by NIST.
La inserció social i l’empoderament a través de l’agricultura social. El cas de Catalunya
Authors: Tulla Pujol Antoni F. , Vera Martin Ana
Published: July 2023

Existeix una segregació social de moltes persones pel fet d’ésser diferents o de no tenir un lloc enl’activitat econòmica d’un territori. En aquest sentit, volem presentar l’agricultura social com una activitatque utilitza els recursos agraris i de la natura, per a poder inserir a la societat les persones en riscd’exclusió social. Es tracta d’una activitat que es desenvolupa a Europa des de fa molts anys i actualmentcompta amb un reconeixement institucional, tant per les seves funcions terapèutiques com per les d’inserciólaboral. Es presenta un resum del marc teòric i conceptual desenvolupat en l’àmbit acadèmic apartir de les diverses experiències. A Catalunya, des de la dècada de 1970, s’hi ha desenvolupat diversosprojectes que han mostrat la seva viabilitat econòmica, social i ambiental. Els mètodes emprats parteixind’una revisió bibliogràfica i d’un seguiment quantitatiu de les característiques dels casos censats, peraprofundir més endavant en la realització d’entrevistes en profunditat, que, entre d’altres objectius,persegueix comprovar el retorn social de les inversions realitzades. Les entitats estudiades es trobenmajoritàriament en l’àmbit periurbà de Barcelona, però també en les àrees rurals on han col·laborat enfavor del desenvolupament local sostenible. Com a part del tercer sector, enforteixen el seu funcionamentpotenciant cooperatives de distribució i xarxes socials de difusió. S’han seleccionat una desenad’entitats entre les 161 censades, per poder analitzar els elements més característics que les conformeni, al mateix temps, avaluar la seva viabilitat a través del mètode del Retorn social de les inversions. Elsresultats obtinguts demostren que hi ha una diversitat de projectes d’acord amb el tipus de persona en risc, del lloc on s’ubica i de l’entitat promotora. D’aquesta desena de casos aprofundits, en conjunt, el retorn es entre 2 i 3 euros per cada euro invertit.
Segregación residencial y recursos locales en el área urbana de Valencia: la necesidad de gobernanza metropolitana
Authors: Nel·lo Oriol , Donat Muñoz Carles
Published: July 2023

El artículo analiza la interrelación entre los procesos de segregación residencial en el área metropolitanade Valencia, por un lado, y la fragmentación administrativa y la disponibilidad de recursoslocales, por otro. Para ello, utiliza los datos de dos fuentes principales, el Atlas de la renta de los hogaresdel Instituto Nacional de Estadística, con información a nivel de sección censal, y la Consulta de presupuestosy liquidaciones de entidades locales, CONPREL, procedentes del Ministerio de Hacienda y FunciónPública, con información del ámbito municipal. Los resultados indican que en aquellos municipios enlos que se produce una mayor concentración de secciones censales situadas en el decil más bajo de ladistribución de la renta (secciones vulnerables), los ayuntamientos tienen menos ingresos per cápita ensus presupuestos. En el lado opuesto, en los municipios con mayor porcentaje de población viviendo ensecciones con niveles de renta situadas en el decil superior (secciones acomodadas), los ayuntamientos disponen de unos ingresos más elevados. Las diferencias de ingresos entre uno y otro tipo de municipio se deben, principalmente, al peso de los impuestos relacionados con los precios del suelo y la vivienda en la cesta impositiva municipal: el impuesto de bienes inmuebles (IBI) y el impuesto sobre el incremento del valor de los terrenos de naturaleza urbana (IIVTNU). Estas diferencias solo son compensadas parcialmente por las transferencias, principalmente provenientes del Estado. Dichos resultados coinciden con los obtenidos en otras áreas urbanas españolas y ponen de relieve la necesidad de articular mecanismos supramunicipales de redistribución de recursos a escala metropolitana.
Validation and reliability of the test of daily Activities-GLITTRE (GLITTRE-ADL TEST) to evaluate functional capacity in older adults
Authors: Gomes Bianca Tiriba , Dal Corso Simone , Kunitake André Issao , Heinz Glauber , Sousa Ingrid Pereira , Nascimento Beatriz Virtuoso , Souza Wesley Alves de , Siqueira Renato Garcia , Araújo Robert Vitor de , Corrêa João Carlos Ferrari , Corrêa Fernanda Ishida
Published: July 2023

Introduction: The decline in functional capacity (FC) interferes with the functional independence of older adults, so it is important to assess the FC and use appropriate instruments for this. Objective: To investigate the Glittre Activities of Daily Living (ADL) test’s validity and reliability for assessing functional capacity in older adults.  Methods: Cross-sectional study with a sample of 100 elderly (68 ± 5.16 years). To assess the convergent validity, the Six-Minute Walk Test (6MWT) and the Timed Up and Go Test (TUG) were performed. The intra-examiner test-retest of the Glittre-ADL test was performed on the same day with a 30-minute interval between repetitions and inter-examiner reliability with an interval of seven days. Results: There was a strong correlation between the Glittre-ADL test and the 6MWT (r= -0.75; p<0.001) and the TUG (r=0.77; p<0.001). The intra-examiner and inter-examiner reliability was excellent (ICC)=0.91 and 95% CI=0.14-0.97; p<0.001 and ICC=0.91; 95% CI: 0.86-0.94; p<0.001, respectively). Conclusion: The Glittre-ADL test demonstrated that it is valid and that its reliability is adequate to assess functional capacity in older adults.
Primeros resultados del programa de seguimiento de micromamíferos comunes de España (SEMICE)
Authors: Torre Ignasi , Arrizabalaga Antoni , Freixas Lídia , Pertierra Desirée , Raspall Alfons
Published: July 2023

We present the results of the first two years of monitoring common small mammals in Spain (SEMICE), developed during 2008 and 2009 in Catalonia and Andorra. The 30 stations (some of them managed by volunteers) are distributed across both the Network of Natural Parks of Barcelona and the Pyrenees, a fact that will provide a reference on small mammal communities in subalpine areas, and allow comparison with those observed in the Mediterranean area. The plots are located across an altitudinal gradient of more than 2,000 m (95-2,255 m.a.s.l.) from typically Mediterranean areas (pine, scrub and oak), through subalpine mountain (scree and meadows), to Eurosiberiane forests (oak and fir). We have used a standardized sampling methodology, consisting of live trapping with Longworth traps in plots of 36 traps spaced 15 meters (0.56 ha). In the Pyrenees we alternated plots with Longworth and Sherman traps to allow the capture of larger species. Throughout the years 2008 and 2009, we captured a total of 1,391 small mammals of 15 species (5 soricidae and 10 rodentia), which represents half of the known species in Catalonia and Andorra. Mammal populations are dominated by Apodemus sp., Crocidura russula, and Mus spretus in the Mediterranean area, and by Myodes glareolus, Apodemus sp. and Eliomys quercinus in the Pyrenees mountains.
Impacto del tráfico rodado en el P. N. del Carrascal de la Font Roja. ¿Cómo influyen las características de la carretera en los atropellos de vertebrados?
Authors: Rico-Guzmán Encarnación , Cantó José Luis , Terrones Beatriz , Bonet Andreu
Published: July 2023

The effect of the road CV-797 on the vertebrate community of Carrascal de la Font Roja Natural Park (north of Alicante) during the period 2000-2008 was studied, analysing environmental variables associated with the road and its surroundings, and their relation with the registered roadkills through a multivariate analysis. The distribution of total roadkills is centred on watercourses and four black spots with different composition, which don’t differ much compared to the three found for mammals. The worst affected group are reptiles, while mammal casualties are scarce. Although relationships with environmental variables are species-specific, reptile casualties are associated with areas that are more exposed to solar radiation. Among the birds, the clearest relation is the one between the common sparrow (Passer domesticus) and urban areas, while the rest of the species are roadkilled at their common habitats. Amphibian roadkill is concentrated on two species, thus the relative impact is greater. The small number of mammal casualties does not allow conclusions to be drawn for these species except for the European rabbit (Oryctolagus cuniculus) where roadkill was associated with open areas and crops. It is proposed to continue with sampling so as to better understand the factors which influence roadkills.
Radioseguimiento post recuperación de erizos europeos (Erinaceus europaeus Linnaeus, 1758) en el Parque Natural de la Sierra de Collserola (Barcelona)
Authors: Cahill Seán , Llimona Francesc , Tenés Anna , Carles Susanna , Cabañeros Lluís
Published: July 2023

The western European hedgehog is in decline in Collserola Natural Park (Barcelona) for various reasons, including the loss of habitats due to urbanisation and infrastructure impact, barrier effect and roadkills on the main road network. Between 2006 and 2008 a radiotracking study was undertaken on 15 hedgehogs (7 ♂♂ and 8 ♀♀) released from the wildlife recovery centre of the Can Balasc Biological Station with the aim of (i) understanding the adaptation and survival capabilities of the recovered individuals after release; (ii) comparing the dispersal response between different release areas; and (iii) characterising the different problems with which they are faced in order to improve their conservation. Hedgehogs released in woodland areas dispersed significantly further during the first days immediately following release when compared to hedgehogs released close to farms, either with or without densely vegetated torrents close by. Eventually however, released individuals tended to show similar dispersal ranges independent of the initial release site surroundings. Dispersal ranges varied widely, generally between 5 and 100 ha (mean 55.3±117.0 ha), but with extreme cases of 0.21 ha and 465 ha. The mean maximum dispersal distance was just over 1 km, and an absolute maximum of 3.9 km in one case. A tendency was observed for dispersal towards more ecotonic peripheral and periurban areas of the park. Dispersal to and use of these areas has consequences for hedgehogs due to the sharp boundary that exists between protected and urban space and the dangers that the latter represents. Of the 15 hedgehogs tracked it was possible to confirm the mortality of at least five of these (33%) during the first two months following their release, the specific causes of death being varied and similar to the main causes of hedgehog admission to the wildlife recovery centre: attacks by carnivores, roadkill, an accident in an industrial zone and other unknown causes. Recommendations are given on the location of release sites in order to reduce dispersal and minimise mortality, and also on reducing the admission of healthy hedgehogs to centres by a well-meaning public.
The economics of vaccination
Authors: Zoellner York , Fröhlich Nadine
Published: July 2023

Since the end of the 18th century, vaccines against several infectious diseases have been developed. Having gone through a long process of technology improvements, traditional vaccination represents one of the most significant and cost-effective public health measures nowadays. Although many infectious diseases are vaccine-preventable, vaccines are generally still under-valued and under-utilized, resulting in a high burden of infectious diseases worldwide. Vaccination coverage rates are often used as a quality indicator of healthcare systems and are an important measure for reducing child mortality as outlined in Millennium Development Goal (MDG) number 4. However, there are challenges to deploying vaccinations as preventive measure to their full extent. For manufacturers, a high level of know-how is required as well as high upfront investments and fixed costs, which leads to there being only relatively few manufacturers for vaccines. At individual and societal level, there are problems of uncertainty and the phenomenon of time preference (for short-term benefits) when it comes to investigating the under-usage of vaccines. Despite these challenges, public health initiatives leading to higher vaccination coverage are likely to play an important role for controlling infectious diseases globally.
Reimbursement of pharmaceuticals in the Czech Republic, Slovakia and Hungary - the update on reference pricing and risk sharing
Authors: Bochenek Tomasz
Published: July 2023

There is a limited amount of published evidence, available to the international audience, on experiences from implementation of various initiatives within the field of pharmaceutical policies of the Czech Republic, Slovakia and Hungary. The reference pricing, both internal and external, has been introduced in the nineties of the 20th century in all countries of the Visegrad Group, however each country has developed its own local version. Hungary has the strongest experience related to the pharmaceutical risk sharing. Due to the economic crisis, the Hungarian health care system is under extremely strong pressure to keep pharmaceutical expenditures on a low level, which could possibly conflict with the appropriate provision of drugs. There is a well justified need for a more intensive exchange of experiences related to pharmaceutical pricing and reimbursement among the Visegrad Group countries - especially today, in the era of the global financial austerities.
Drug Policy – what is it in Poland and UE
Authors: Giermaziak Wojciech
Published: July 2023

Demographic situation – growth population of people advanced in years, greater detestability of illnesses connected with better diagnostic methods and partial covering of the costs of medicines from the public funds what causes the growth of financial expenditure for the protection of health. Considering the payment possibility of the public payer, which is obligated to finance health care services, decisions to be taken in this field must be based on clear specific requirements and defined and verified information. A proper state body which is authorized to create the structured and conscious drug policy should take planned operations aiming at rationalization of budgetary expenditure and furthermore the supply of safe, effective and cheap drugs to patients.
Towards an effective access into Polish national health data - just a step away from a wealth of information
Authors: Tronczynska Dagmara , Zapalska Anna , Podolec Zygmunt
Published: July 2023

Background: Public health institutions (National Health Fund -NFZ, Social Insurance - ZUS, National Institute of Hygiene - PZH) gather population-based, real-time, extensive set of data, characterizing the health status and behaviour of individual patients in relation to health care resources spending pattern. The accessibility of the data for scientific purposes would be a significant step towards optimization of expenditure and assimilation of innovation. Furthermore, improved availability of pharmacoepidemiological and health-related data has been set as one of the strategic goals of The Section of Epidemiology and Cost of Illness of Polish Pharmacoeconomics Society - PTFE. Methods: To show the value of widely-available comprehensive data analysis platform, and to initiate a debate addressing this issue. Non-systematic review of relevant papers dealing with the problem in question has been conducted with special focus on available Polish studies. Results: A few general areas are characterized by a direct link between effective data availability and practical measures taken to optimize expenditure and rationalize innovation assimilation, namely: availability of comprehensive multi-perspective burden of illness studies, accurate identification of complex health care demands through description of co-morbidity patterns, continuous monitoring of treatment patterns enabling the detection of irregularities and implementation of treatment-optimizing mechanisms, as well as the identification of associated phenomena which affect expected treatment effectiveness (compliance) in order to design comprehensive solutions addressed for specific subpopulations of patients. Major obstacles significantly restricting the utilization of data from Polish health care system include: lack of direct link between reported expenditure and covered population in available sources, lack of unique drug record within the system, complex decision-making process leading to merging different public sources into one comprehensive picture. Conclusion: Data collected by public health institutions represent a valuable source of information enabling real-time monitoring of population health status: co-morbidity patterns, burden of illness, compliance, and therapeutic patterns. Analyses based on a comprehensive and actual data will help to define health priorities, allowing the appropriate allocation of financial resources in order to achieve the desired effects with regards to public expenditure and dynamic access to innovations.
System of medicinal maintenance in Russia
Authors: Yagudina Roza
Published: July 2023

The Russian pharmaceutical market has been a continuously developing and growing structure that includes a range of participants in different levels of organization. Annual market research illustrates the increase of volumes of all of the market spheres either in economical or in natural values. Therefore the perspective of prescription drug insurance might become the new force of the market development and it is likely to redefine the whole system of medicinal maintenance in Russia. Some aspects of pharmaceutical market in Russia were presented in this article.
Decision-making processes related to drug pricing and reimbursement. Is Poland far away from global standards?
Authors: Czech Marcin
Published: July 2023

A substantial funding from healthcare budgets in the majority of countries is devoted to drugs. In order to make the best use of these scarce public resources, special agencies were established in order to assess efficacy, effectiveness, safety and cost-effectiveness of drugs. Based on their recommendations decisions regarding pricing and reimbursement are made coupled with guidelines for prescribers. Decisions of four agencies: Common Drug Review (CDR) from Canada, the National Institute for Health and Clinical Excellence (NICE) from the UK, Pharmaceutical Benefits Advisory Committee (PBAC) from Australia, Polish Agency of Health Technology Assessment (AOTM) were analysed and compared, main difficulties and controversies of decision making process were discussed. Two case studies were added for more detailed analysis.
Safety aspects and access to biological treatment in Poland
Authors: Mazurek Joanna
Published: July 2023

The term "biological drugs" (or biological agents, or biologics) is usually applied to denote a class of medicinal products (either already approved to trading or in clinical trial stages), manufactured by means of biological processes, involving recombinant DNA technology. These medications are divided into three types – key signalling proteins (e.g. erythropoietin), monoclonal antibodies and receptor constructors. It has been shown in many clinical studies that biologics offer additional therapeutic options, which are effective for treatment of many diseases in the fields of rheumatology, oncology, dermatology, pneumonology and others. However, the access to these medicines is different in various European countries and depends on many aspects, including adverse episodes, complex regulatory standards and pharmacoeconomic aspects. Selected problems of access to biologics for therapeutic purposes are discussed in this article, both in Polish and European perspective. Seemed to be safe biological agents (named biologicals too) can produce unwanted, adverse side-effects. The side-effects in the course of treatment with biologicals may result from excessively secreted cytokines during treatment, hypersensitivity reactions, cytokine balance disturbances, cross reactions or nonimmunological reactions. Clinically, the first type is usually manifested by influenza-like symptoms. Hypersensitivity reactions depend on the degree of antibody humanisation, the applied adjuvant and, what is important, these are often delayed immunological reactions, mediated by T lymphocytes. Autoimmune reactions are a serious threat for affected patients. The syndrome of disturbed cytokine balance may, however, manifest itself by the occurrence of tuberculosis, listeriosis or granulomatosis, while such complications have also been observed in patients treated with anti-TNF alpha. Non immunologically determined symptoms, such as circulatory failure or hearing loss, may be dangerous as well.
The evaluation of the effectiveness of funding treatment programs in rheumatology
Authors: Śliwczyński Andrzej
Published: July 2023

Background: The public payer in Poland has been financing biological drugs in rheumatology since 2004. Until now, there have been no analyses of the influence of this type of funding on the cost level for the public payer. Financing over an 8 year period allows an objective approach towards the results. Materials and methods: Data extracted with the use of data tools reported to the National Health Fund (NFZ) by health service providers, including drugs used in a patient’s therapy. For data analysis, statistic tools were used: Statistica 9 and 10 and Excel spreadsheet. Results: The number of people treated in Poland with biological drugs is approx. 5% of the potential population with rheumatoid joint inflammation diagnosis and juvenile idiopathic joint inflammation. In the analyses, the results of the Kobelt-Kasteng report have been confirmed, referring to the differences existing in Europe when it comes to therapy cost disparity. The cost of therapy in Poland increases depending on the type of therapy: infliximab (for patients up to 70kg), then rituximab and etanercept, adalimumab and infliximab (for patients over 70kg). The calculated price index and therapy cost indicates that the costs of such therapies are lower in Poland in comparison with other countries. The r-Pearson correlation factor of 0.61 to 0.73 indicates that there is an accurate balance between the number of clinics conducting the therapy and the number of patients. In the analyzed period, the budget for the rheumatology biological drug therapy increased.
Clinical effectiveness analisis of LMWH in the prevention of deep vein thrombosis and pulmonary embolism
Authors: Kawalec Paweł , Wcisło Jacek
Published: July 2023

Background: The aim of the study was to assess the clinical effectiveness of low molecular weight heparins in prevention of deep vein thrombosis and pulmonary embolism in comparison with physical methods, unfractionated heparin and placebo, by a systematic review of reports in medical literature. Methods: The assessment of the clinical effectiveness of undertaken interventions was compliant with the principles of systematic review (EBM), based on the Cochrane Collaboration guidelines. Statistical analysis and meta-analysis were performed by means of the RevMan 4.2 software version. Results: Regarding the risk of postoperative overall deep-vein thrombosis and proximal deep-vein thrombosis, a meta-analysis of obtained results revealed a trend towards low-molecular-weight heparin versus the results of physical methods. However, the difference between the analyzed groups did not reach statistical significance. Compared to placebo, the results of deep vein thrombosis risk assessment by meta-analysis showed statistically significant differences in favor of low-molecular-weight heparins (RR = 0.50, 95% CI: 0.34, 0.74, P = 0.0004, NNT = 23). In comparison to the group, receiving unfractionated heparin, the observed differences did not attain statistical significance, neither in thromboembolism prevention nor in deep vein thrombosis treatment. Regarding the risk of any bleeding episodes, the meta-analysis showed a statistically significant difference in favor of low-molecular-weight heparins administered in the study group vs. placebo results in the control group (RR = 1.55, 95% CI: 1.07, 2.24, P = 0.02) with the NNH equal to 94. Conclusion:Low molecular weight heparins are effective and safe treatment for venous thromboembolism versus placebo, however, no statistically significant advantages were observed vs. physical methods or unfractionated heparins.
Availability of pneumococcal vaccination programmes in Europe. An overview of funding mechanisms
Authors: Niżankowski Rafał , Kargul Agnieszka , Seweryn Michał
Published: July 2023

Increasing antibiotic resistance is a global problem. Vaccinations is one of the best solution to reduce the burden of infectious diseases. Despite universal access to antibiotics, pneumococci still are one of the major causes of morbidity and mortality in both developing and developed countries. Criteria for making the decision on financing immunisation are similar in many countries and include identifying the target groups based on epidemiological risk, the clinical efficacy and safety of a vaccine, and the economic aspects of the implementation of vaccination. To reduce the risk of diseases caused by Diplococcus pneumoniae pneumococcal conjugate vaccine (PCV) is included in national immunisation programmes in most countries. The paper describe international differences of organisations and funding mechanisms for pneumococcal vaccination. The analysis covered 34 countries in Europe. The study analyzed availability and type of vaccines used in vaccination programmes, children in the target age group to vaccination, vaccination financing, level of co-payment to vaccination for children and mechanism of purchasing vaccines. In most European countries, PCV is included in national immunisation programmes. The differences regard the availability of two types of conjugate pneumococcal vaccines (10-valent and 13-valent). The method of recommending vaccines, mechanism of purchasing and funding in different countries is varies.
Development of education on Pharmacoeconomics in Ukraine
Authors: Zaliska Olha , Tolubaiev Viacheslav , Revyatskyy Iwan
Published: July 2023

The education on pharmacoeconomics for postgraduate pharmacists has been introduced in Ukraine since 2000. The objects, the pharmacoeconomic methods and evidence-based pharmacy, specific terms are being systematized and adapted in Ukraine. The discipline of “Pharmacoeconomics” has been entered into curricula, programs for graduate and postgraduate students specializing in pharmacy and clinical pharmacy. We published textbook, tutorials for study on pharmacoeconomics and the Ministry of Health of Ukraine approved of the the pharmacoeconomics curricula, the first author’s textbook for students - "Principles of pharmacoeconomics" (2002), for postgraduate pharmacists “Pharmacoeconomics” (2007) used in 12 medical (pharmaceutical) universities in Ukraine. The active conduct of scientific pharmacoeconomic research in Ukraine, their results are used in the Central Formulary Committee Health of Ukraine while reviewing the State formulary and formulary committees for local formularies. In Ukraine 3 doctoral dissertations and 21 PhD theses were defended during 2004-2012. The results of pharmacoeconomic research in budget purchase and for creation of State Formulary of medicine of Ukraine and local formularies in medical hospitals were used.
The prevalence of combination vaccines for children in Europe. Analysis of the availability and funding
Authors: Koperny Magdalena , Seweryn Michał , Niżankowski Rafał
Published: July 2023

The article presents an analysis of data from 33 European countries on combination vaccines against diphtheria (D), tetanus (T), pertussis (P), polio (IPV), Haemophilus influenzae type b (Hib), hepatitis B (HBV). The purpose of this article is to present the availability and funding mechanisms of vaccinations which represent pharmacological innovations. The performed analysis included 5 approved combination vaccines marketed in Europe (5-in-1 DTaP-IPV-Hib vaccines, and 6-in-1 DTaP-IPV-Hib-HepB vaccines). Although in the vast majority of countries the analysed vaccinations are not mandatory, the vaccination rate remains very high. Significant differences between the European countries can be seen in vaccination schedules or the types of available combination vaccines in the national childhood immunisation programmes. Despite the different rules and regulations regarding the funding of combination vaccinations from public resources, countries systematically seek to provide patients with the latest generation formulations.
Analysis of direct costs of drug-induced skin reactions treatment considering DRG classification in the perspective of medical service provider and public payer
Authors: Wiśniewska Nina , Owczarek Witold , Szkultecka-Dębek Monika , Jahnz-Różyk Karina
Published: July 2023

Background: The aim of this study is an assessment of direct costs of patients’ hospitalization caused by drug-induced skin reactions in Dermatology Department of Military Institute of Medicine during the period 2002-2012 from the public payer’s perspective and service provider, based on the DRG classification. Data and methods: The study was carried out in a retrospective way on a group of 164 adult patients hospitalized in Department of Dermatology between 2002 and 2012. The analysis was based on data from patients’ medical records. Due to the changes in health care system settlement during the long period taken into account for resources used identification, the one-year time horizon was settled to standardize cost calculations. The costs were evaluated in the perspective of public payer and service provider based on the DRG classification. Results: It was evaluated, that patient hospitalization due to drug-induced skin reactions within specific DRGs (J38 and J39), in the perspective of the public payer costs on average 971 euro per patient (J38) and 481 euros (J39) depending on the DRG group. When analyzing the complex diagnostics and pharmacologic therapy of the same group of patients in the perspective of the hospital costs the results is 636 euro in the J38 and 558 euro in J39 group per patient. Conclusions: Within the DRG, in case of J38 group the National Health Fund bear higher treatment costs than health care service provider. Higher costs are usually connected with higher amount of diagnostic examinations in case of severe dermatologic diseases, qualified to the J39 group
Generic substitution in the view of pharmaceutical scientists from Polish medical universities
Authors: Pietrzak Bartosz , Zimmermann Agnieszka
Published: July 2023

Generic substitution is a commonly observed phenomenon in pharmacy. It is promoted as part of the state drug policy and leads to a reduction in expenditure on drugs, facilitates the purchase of medicines by patients and improves compliance. So far researchers have focused on the evaluation of substitution by pharmacists, doctors or patients. The present study investigates the opinion of Pharmaceutical Faculties employees. The respondents acknowledge the importance of generic substitution; nevertheless they do not have a clear opinion on the effectiveness and safety of generic products. The respondents’ experience may have had a significant impact their opinion, especially of those working in the community pharmacies. The studies is part of a broader framework of the national debate on generic substitution. Undoubtedly the approach to generic substitution is one of the contemporary challenges of the pharmaceutical law.
Assessment of the financial barriers in access to cancer pain treatment with opioids in Polish settings
Authors: Faluta Tomasz
Published: July 2023

Effective pain management and pain prevention is one of the fundamental obligations of doctors. The need to improve the management of pain is widely recognized in public debate in Poland. Background: Identification and assessment of financial barriers in access to opioids in pain treatment of cancer patients in Poland. Material and Methods: The main area of investigations was availability of opioids and cost of treatment for patients. The principles, conditions and procedures for reimbursement of opioids were recognized and analyzed from cancer patients point of view. All reimbursement lists announced by MoH were taken into account as well as data concerning reimbursed drug consumption and NHF spending’s. Results: Polish cancer patients have access to subsequent reimbursed opioids: morphine, fentanyl, oxycodone, methadone, buprenorphine, tramadol, dihydrocodeine. In the case of opioids limit groups are narrow and very precisely defined and very compartmentalized. In practical terms, almost all patients may have access to opioids with limit price without additional co-payment. Expenditures on opioids reimbursement between 2012 and 2014 increased from PLN 178M to 231M. Consumption of opioids increased faster than reimbursement expenditures between 2012 and 2014 because growth of consumption between 2012 – 2013 and 2013-2014 accounted for 17,7% and 23,4% respectively. Significant price decrease of opioids leaded to decrease of average patients co-payment for pack of opioids from PLN 9,63 to PLN 6,10. Conclusions: Financial barriers in access to cancer pain treatment with opioids in Poland seems to be very limited.
The use of registries in primary immunodeficiencies: an example of rare diseases
Authors: Kucharczyk Aleksandra , Więsik-Szewczyk Ewa
Published: July 2023

In the field of rare diseases, data on a significant number of patients can only be archived due to national and international collaboration. Data summarized from specialized centers are a powerful tool. Thanks to modern technology and networks, national and international databases can be constructed legally, with respect to ethical and safety principles. Currently registries for primary immunodeficiencies are established on different levels: single center, national collaboration involving specialized tertiary centers on the country level and on international level as for example ESID registry. Not all registries cover the same dataset, but generally allow to estimate prevalence of diseases, description of natural history, morbidity and mortality. Moreover registries can provide information of diagnostic criteria used, quality of care and management modalities. In the field of primary humoral immunodeficiencies is crucial to assess availability of immunoglobulin G substitution and to plan demand for this product. In other ultra-rare primary immunodeficiencies registries are the unique opportunity to compare different treatment interventions and strategies as hematopoietic stem cell transplantation. The review presents current published data from different registries of primary immunodeficiencies to underscore the need for founding polish registry.
Main Medical Library Databases
Authors: Giermaziak Wojciech
Published: July 2023

The current health policy is focused on use of various type of health data systems created for research, clinical trials and studies evaluate health care system. Databases collecting information in the field of medicine, related sciences and public health may be regarded as a specific type of registry. A well-known and highly respected example of this type of database is "Polish Medical Bibliography" (PBL), created in the Medical Information Center in Main Medical Library in Poland. Another data system functioning in the Main Medical Library is Thesaurus-MeSH (Tez-MeSH), which is the Polish version of the American Thesaurus, Medical Subject Headings (MeSH), carried out as a part of the Unified Medical Language System by the National Library of Medicine of the United States (National Library of Medicine-NLM). Creation of Medical Information Center (CIM) in the Main Medical Library enabled continuation and updating highly specialized information databases, which allows CIM to qualify as an opinion-forming instrument tool in the government activities. The Main Medical Library since 2002 functioning also as the World Health Organization (WHO) Documentation Center. WHO’s publications in field of medicine and related sciences are collected, compiled and made available in the premises of the library. The Main Medical Library also allows the use of electronic databases of the fulltext journals.
Adverse skin reactions induced by antibiotics: clinical and economic evaluation - an eleven - year retrospective study
Authors: Wiśniewska (Kiepurska) Nina , Szkultecka-Dębek Monika , Owczarek Witold , Jahnz-Różyk Karina
Published: July 2023

Background: The aim of the study was to clinically evaluate, as well as analyse the direct costs of treating patients hospitalised due to adverse skin reactions related to antibiotics use at the Department of Dermatology of the Military Institute of Medicine, Ministry of Defence in Warsaw, during the years 2002-2012. Method: The study was carried out in a retrospective way on a group of 164 adult patients due to adverse skin drug reactions. The analysis was based on data from patient medical records and medical orders. Results: The most common drugs that caused adverse skin reactions in the examined population between the 2002-2012 were antibiotics with 75 cases, in 39 cases non-steroidal anti-inflammatory drugs (NSAIDs), and in the case of paracetamol 6, in 44 cases other drugs. Amoxicillin was the most common described antibiotic (25.33%). It has been estimated that patient hospitalisation at the Department of Dermatology for adverse skin drug reaction generated costs averaging to an amount of 2784 PLN (662 EUR) per patient. Conclusions: The most frequent form of drug-induced skin reactions, diagnosed in the study group, was the maculopapular rash - (52%). The most common drugs that caused skin lesions were antibiotics. Amoxicillin was the most common described antibiotic (25.33%). The largest average cost have been incurred due to clindamycin - 1059.91 PLN (252 EUR) and to amoxicillin - 1029.56 PLN (245 EUR). Following our analysis, treatment of skin adverse drug effects caused by antibiotics generates significant costs.
Comparator outcomes profile: need for an informed assessment of secondary outcomes for conducting post-launch observational studies in the HE&OR setting
Authors: Gokhale Sameer
Published: July 2023

Secondary clinical and health outcomes provide additional value and help drug molecule distinguish itself from competitor molecules. Comparator outcomes profile (COP) document in health economics and outcomes research (HE&OR) setting is designed to understand comparative clinical and health outcomes relevant to molecule’s value proposition against select comparators. Generic and disease specific clinical as well as patient reported tools to measure secondary outcomes across geographies are identified from literature and studied to assess their reach and acceptability. Collated summary statistics for key outcomes are presented (tables, figures and listings) by healthcare researchers to help program manager make an informed assessment. COP not only can provide guidance on post-launch observational study design, study endpoint discussion, and indirect comparisons but can also give direction to country organizations in developing their local HE&OR strategy. To conclude, COP can be an important construct in HE&OR setting for molecule’s program development activities.