The World Health Organization-recommended patient care indicators in Government Hospitals were assessed in 422 patients attending the Outpatient Department in selected hospitals of the Galle district in Southern Province. The average dispensing time (ADT), percentage of drugs actually dispensed (PDAD), percentage of drugs adequately labeled (PDAL) and patient's knowledge on correct dosage (PKCD) were compared in these selected teaching hospitals (TH), general hospitals (GHs) and district hospitals (DHs) in Galle. ADT in DH (1.16 min) and GH (1.07 min) were high when compared with ADT in TH (0.81 min). PDAD was 100% in DH, 97.79% in GH and lowest in TH (94.64%). PDAL was highest (22.66%) in TH, 17.57% in GH and lowest in DH (1.57%). PKCD was 100% in GH and lowest in DH (0%) and only 50% in TH in Galle district. We noted that there was a significant difference in ADT in all three categories (P < 0.05). We noted that dispensers spend only a short dispensing time and showed a tendency for dispensing errors. We found that PDAL was very low in all hospitals but PDAD was significantly high. Even though the ADT was high in DH, PKCD was 0% due to negligence in dispensing practices. We also noted a 100% PKCD only in GH due to the practice of a well-prepared correct labeling system in GH. We noticed that these patients were provided drugs with inadequate labeling and that patients had only a poor knowledge about the drug administration schedule. We conclude that there was a low dispenser–patient ratio in all three hospitals and that there was a need for an implementation plan for proper dispensing techniques by introducing a well-prepared drug labeling system in a printed format.

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vestment, recognising the NHS budget (providing free universal healthcare) was not unlimited. Local organisation of disinvestment policy was preferred, though some national co-ordination was felt necessary to retain equity across geographical jurisdictions. Technologies of unproven or negligible clinical benefit, or obsolete technologies were cited as disinvestment priorities. Respondents preferred disinvestment decisions be clinician-led. Other decision-making groups (e.g. patients) were expected to be biased or not sufficiently knowledgeable about the relevant issues. When existing technologies conferred clinical benefits to (even small numbers of) patients, responses suggested loss aversion, even under circumstances of increased risks alongside these benefits. Biases are uncontrolled when using a qualitative methodology to explore these issues. CONCLUSIONS: To maximise acceptability to taxpayers, disinvestment policy-making in Scotland should prioritise technologies of comparatively low or unproven benefit. Decisions should be locally-based and clinician-led. Future research on disinvestment should utilise quantitative, preference-elicitation methods to minimise potential biases. OBJECTIVES:With the increasing demands for health care from aging society and rapid technological advancement, the National Health Security Office (NHSO) of Thailand demands for the development of systematic, transparent, and participatory processes for selection of new health interventions to be included into the benefit package of universal health coverage (UC) scheme. This study reviews and describes experiences in the development of guidelines for economic evaluation and participatory process of key stakeholders in submission and topic selection of new health interventions into the UC benefit package. Lessons learnt from this initiative are drawn in order to share experiences of Thailand to other developing countries. METHODS: Research methods comprise comprehensive literature reviews, focus group discussion, and brainstorming meeting among key stakeholders, working groups, and subcommittee members. RESULTS: Research findings indicate that the draft guideline produced by several rounds of stakeholder consultations has been gradually accepted and adjusted by policy makers and key stakeholders. Key features of the guideline comprise a) transparency in topic selection for economic appraisal with full engagement of key stakeholders; b) economic evaluation on selected interventions using incremental cost-effectiveness ratio (ICER); c) budget impact analysis. The ICER threshold of 1 GDP per capita for QALY gained has been applied by the Benefit Package Subcommittee of NHSO. The six criteria for prioritization of topics were adopted in consensus by stakeholder consultations. In Fiscal year 2010 and 2011, this guideline was successfully applied twice a year for topic selection, economic appraisal, and recommendations to the sub-committee and transmitted to NHSO Board for its final decision. CONCLUSIONS: This initiative not only produced a...

Fluggea leucopyrus Willd has been used in the treatment for cancers in the traditional system of medicine in Sri Lanka. This study was aimed on evaluation of anti-cancer activity of F.leucopyrus against Human Ovarian carcinoma and identification of active compounds. Anti-cancer activity of ethyl acetate (EtoAc) extract of leaves and two compounds isolated from EtoAc extract were evaluated using MTS and hTERT assays on Human Ovarian carcinoma (A 2780). MTS assay showed a significant anti-proliferation activity giving IC50 (concentration of extract/compound that inhibits 50% of the activity) values of 36.35±0.17µg/mL, 12.36±1.0 µg/mL and 48.53±1.43 µg/mL for EtoAc extract and two compounds (compound-1 & compound-2) respectively. A rapid depletion of hTERT content in Human Ovarian cancer cells was observed for the compound-2 with the concentration range 50-200 µg/mL. The compounds-1 was identified as bergenin, a known compound, whereas the compound-2 was identified as a diastereoisomer of bergenin (at C-9 and C-14,) with the help of NMR and Mass spectral data, and with the comparison of reported data. Brine Shrimp Lethality assay for EtoAc extract showed LC50 (Lethal concentration) values of 2779.63 µg/mL, implying that no toxicity of plant extract towards brine shrimp. As conclusion, anti-cancer activity of leaves of F. leucopyrus against Human Ovarian cancers is confirmed in this study, and bergenin and its isomer were identified as the responsible compounds for the anticancer activity of this plant.

Background & objectives:Dendritic cells (DCs) are potent antigen presenting cells which proceed from immature to a mature stage during their differentiation. There are several methods of obtaining long lasting mature antigen expressing DCs and different methods show different levels of antigen expressions. We investigated bone marrow derived DCs for the degree of maturation and genetically engineered antigen presentation in the presence of interleukin-4 (IL-4) as a maturity enhancer.Methods:DCs and transfected retrovirus were cultured together in the presence of granulocyte-macrophage colony stimulating factor (GMCSF)-IL4, GMCSF +IL4, lipopolysaccharide (LPS). B 7.1, B7.2 and CD11c were measured by the degree of immune fluorescence using enhanced green fluorescent protein (EGFP) shuttled retrovirus transfected antigen. Degree of MHC class I molecule with antigen presentation of antigen was also evaluated by fluorescence activated cell sorting. The antigen presenting capacity of transfected DCs was investigated. Bone marrow DCs were generated in the presence of GMCSF and IL-4 in vitro. Dividing bone marrow cells were infected with EGFP shuttled retrovirus expressing SSP2 by prolonged centrifugation for three consecutive days from day 5, 6 and 7 and continued to culture in the presence of GMSCF and IL-4 until day 8.Results:IL-4 as a cytokine increased the maturation of retrovirus transfected DCs by high expression of B 7-1 and B 7-2. Also, IL-4 induced DC enhanced by the prolonged centrifugation and it was shown by increased antigen presentation of these dendric cells as antigen presenting cell (APC). Cytolytic effects were significantly higher in cytotoxic T cell response (CTLs) mixed with transfected DCs than CTLs mixed with pulsed DCs.Interpretation & conclusions:There was an enhanced antigen presentation by prolonged expression of antigen loaded MHC class I receptors in DCs in the presence of IL-4 by prolonged centrifugation.