Objective To understand the basis and status of setting up the dispensing fee at home and abroad, and to ascertain the scope of dispensing service, so as to offer references to the setting up and implement of dispensing fee in China. Methods According to the evidence-based principle, the descriptive method was adopted to demonstrate the basis of setting up the dispensing fee. The different definition, payment mode and standard were compared at home and abroad. Results Separation of prescribing and dispensing was the basis of setting up the dispensing fee. In western countries, the charge of dispensing fee was almost at the same level, though its definition and scope were different among countries. It was more reasonable to determine the level of dispensing fee according to the visiting frequency, compared with the price, the number and the type of drugs in the prescription. Conclusion China’s calculation of dispensing fee should be based on the prescription fee, the cost of drug administration and store. Dispensing fee should be implemented in the pilot hospitals firstly. Institutions providing primary health care services (rural health clinics, community health service centers etc) which follow a policy of “separating revenue from expenditures” may not adopt the dispensing fee temporarily. In urban hospitals, it is advisable to promote the separation of prescribing and dispensing gradually and bring pharmacists to provide prescription auditing, dispensing and advisory services. For retail pharmacies, pharmacists should be gradually fully staffed as one of the necessary conditions for operating. Performance evaluation of pharmacist’s services and pharmacy administration also should be developed.
ObjectiveTo summarize the diagnosis and treatment of thoracoomphalopagus conjoined twins according to successful separation of two cases of conjoined twins. MethodsA retrospectives study was performed on two pairs of thoracoomphalopagus twins. One case was omphalopagus with complex congenital heart disease (transposition of the great arteries and single cardiac ventricle), and the other was sternoxiphopagus with single pericardium and complex congenital heart disease (single cardiac ventricle and cardiac atrium). All the two cases of conjoined twins shared the common livers. The separation surgery was performed at one month after birth. Results All the two cases of conjoined twins were successfully separated. These conjoined twins were connected by a liver bridge, and shared a pericardium or had a contact pericardium, respectively. The coloboma of peritoneum, diaphragm， and mediastinum were repaired by Gore-Tex patch. Each patient, to varying degrees, had a wound infection after surgery, and healed by taking out the Gore-Tex, debridement or drainage. The first two infants were discharged on 37 d after operation, but one died of pneumonia after 6 months. The two other infants were discharged on 40 d and 93 d after operation, respectively. ConclusionsDetailed information about the twins’ general and conjoined condition, especially on cardiovascular system and the joined liver, shall be understood by the imagination examinations before the operation. Adequate preoperative preparation, elaborate liver separation and rational reconstruction for thoracic and abdominal wall are the key to successful operation.
Esophageal carcinoma is a kind of common malignant tumor in the digestive tract. Although a lot of basic researches and clinical trials have been carried out all over the world, neither the diagnostic level nor the therapeutic effects have been obviously improved. The 5-year survival rate of esophageal cancer patient is still lower than that of other malignant tumors. Up to now, some frontier researches consider that the reason of the esophageal carcinoma being difficult to cure is related to the stem cells in it. Elimination or suppression of these stem cells may bring new hope for the treatment of esophageal cancer. This article generally introduces the specific markers, separation and indentification methods about the esophageal cancer stem cell. The targeted therapy is also mentioned.