Application of FMEA model and 6S management method in reducing dispensing errors in PIVAS of children’s hospitals / 中国药房

OBJECTIVE To reduce dispensing errors in pharmacy intravenous admixture service （PIVAS） of children’s hospitals. METHODS The risk of dispensing procedures in our PIVAS was identified by applying failure mode and effect analysis （FMEA） model. Potential failure modes that might lead to dispensing errors in each link were determined， and failure causes were analyzed. The severity， incidence and detection degree of potential failure modes were quantitatively scored， and their risk priority number （RPN） was calculated to screen failure modes that needed to be improved in priority； the corresponding improvement measures were developed by 6S management method from six aspects， namely， finishing （seiri）， rectifying （seiton）， sweeping （seiso）， sanitation （seiketsu）， literacy （shitsuke） and safety. The effect of intervention before and after rectification was evaluated. RESULTS Based on the RPN， 32 potential failure modes were selected， of which a total of 18 critical failure modes that needed to be improved in priority. After implementing corresponding measures according to 6S management method， the RPN of 18 critical failure modes decreased. The total RPN decreased from 497 to 142 with a decrease rate of 71.43%. The error rates of 15 critical failure modes were significantly lower than before implementation （P＜0.05）. CONCLUSIONS Applying FMEA model and 6S management method to the risk control of all aspects of PIVAS workflow can effectively reduce the risk of PIVAS dispensing errors and ensure the safety of children’s intravenous medication.

Cohort Study on the Effectiveness and Safety of Tiapride Combined with Clonidine versus Tiapride and Clonidine Alone for Children with Tic Disorders / 中国药房

OBJECTIVE：To compa re the effectiveness and safety of three regimens of tiapride ，clonidine and tiapride combined with clonidine in the treatment of tic disorder （TD）in children. METHODS ：A sequential collection of 312 children with TD from the outpatient department of West China Second Hospital of Sichuan University were conducted during Jan.-Dec. 2019. They were divided into clonidine group ，tiapride group ，tiapride combined with clo nidine group ，with 104 cases in each group. Tiapride group was given Tiapride hydrochloride tablets with initial dose of 50-100 mg per day ，and the dose was gradually increased to 150-500 mg per day according to tolerance and clinical experience. Clonidine group was given Clonidine transdermal patches ，once a week ，with initial dose of 1 mg each week ，maintenance dose of 1-2 mg each week ，once a week. Tiapride combined with clonidine group was given Tiapride hydrochloride tablets （same usage and dosage as tiapride group ）+ Clonidine transdermal patches （same usage and dosage as clonidine group ）. The treatment course of 3 groups was 3 months. After the treatment ，they were followed up every 3 months（the following were expressed as 24，36 and 48 weeks after treatment ）. Yale global tie severity scale （YGTSS）scores of 3 groups were observed before treatment ，after 4，8，12，24，36，48 weeks of treatment，and the occurrence of ADR was recorded at different follow up time points. RESULTS ：Before treatment ，there was no statistical significance in YGTSS scores among 3 groups（P＞0.05）. After 4，8，12，24，36 and 48 weeks of treatment ，YGTSS scores of 3 groups were significantly lower than those before treatment （P＜0.05）. After 4，8 and 12 weeks of treatment ，YGTSS scores of tiapride combined with clonidine group were significantly lower than tiapride group and clonidine group （P＜0.05），while there was no statistical significance between tiapride group and clonidine group （P＞0.05）. At 24 weeks of treatment ，YGTSS score of children in tiopride combined with clonidine group was significantly lower than tiopride group （P＜0.05），but there were no significant differences between tiopride combined with clonidine group and tiopride group ，and between tiopride group and clonidine group （P＞0.05）. After 36 and 48 weeks of treatment ，there was no significant difference in YGTSS scores among 3 groups（P＞0.05）. After 12 weeks of treatment ，the results of P value corrected by Bonferroni method showed that YGTSS score of tiopride combined with clonidine group was significantly lower than those of tiopride group and clonidine group （P＜0.016 7）， while there was no statistical significance in the difference between tiopride group and clonidine group （P＞0.016 7）. There was no statistically significant difference in the total incidence of ADR among 3 groups（P＞0.05）. CONCLUSIONS ：Clonidine，tiapride and tiapride combined with clonidine can significantly improve the tic symptoms of TD children with good safety .

Study on the Medication Compliance of Children with Tic Disorder Based on the Theory of Protective Motivation / 中国药房

OBJECTIVE：To study the current status and influencing factors of medication compliance in children with tic disorder（TD），and to provide reference for improving medication compliance in TD children. METHODS：The questionnaire was designed according to the protection motivation theory. The cross-sectional study was adopted to conduct questionnaire survey among TD children in West China Second Hospital of Sichuan University from Jan. 2018 to Dec. 2019. The structural equation model was established according to the theoretical assumptions，and the maximum likelihood method was used to estimate the model；multiple linear regression analysis was carried out for the factors with significant influence in the single factor analysis，and path analysis and intermediary effect test were carried out. RESULTS：A total of 317 patients with TD were included，the mean age was（8.38±2.54）years，and the mean course of disease was（3.19±2.46）years. Average medication compliance scores was （5.70±1.69），among which 15.1％ was low compliance，37.5％ moderate compliance，and 47.3％ high compliance. Multivariate linear regression analysis showed that comorbidities（β＝0.124，SE＝0.167，P＝0.011），education level of the main guardian（β＝ 0.236，SE＝0.110，P＜0.001），quality of life（β＝0.399，SE＝0.112，P＜0.001）and the types of drugs taken（β＝0.166，SE＝ 0.047，P＝0.001）were the factors affecting medication compliance of children with TD. Structural equation model analysis showed that severity（β＝0.295，95％CI：0.103-0.493），external return（β＝0.830，95％CI：0.662-1.002），self-efficacy（β＝0.200，95％CI： 0.057-0.353），susceptibility（β＝0.220，95％CI：0.084-0.352）and quality of life（β＝0.353，95％CI：0.211-0.500）had a direct positive impact on medication compliance. Quality of life mediated between external returns and compliance variables（intermediary effect accounted for 13.9％ of the total effect value）. CONCLUSIONS：Children with TD have low medication compliance. It is recommended that pediatricians in medical institutions at all levels to manage the medication compliance of patients with TD from the severity，susceptibility，external returns and self-efficacy，so as to improve patients and guardians’awareness of the severity and susceptibility of disease and medication non-adherence，weaken external returns and increase self-efficacy，and ultimately improve medication compliance of patients

Genetic analyzing for a Chinese intellectual disability pedigree with ARX gene mutation / 中华检验医学杂志

Objective:To investigate the molecular mechanism of the disease based on the clinical characterization and genetic mutation analysis in a family with intellectual disability.Methods:The proband with intellectual disability was diagnosed at Luohe Central Hospital in December 2019. Peripheral blood samples were collected from four family members. Whole exome sequencing (WES) was used to screen the pathological mutations. Then the PCR and Sanger sequencing were used to verify the selected mutations and combine the relevant database to analyze variation loci.Results:We infer that the ARX c.1162 A>G was co-segregated with the phenotype of the family based on the results of WES. The results of sanger sequencing and WES are consistent. The mother of the proband is the carrier of the mutation. There is no mutation frequency reported in the healthy population. The mutation of the ARX c.1162A>G is harmful inferred by a variety of bioinformatics software. Combined with the phenotypic analysis of OMIM database, we infer the phenotype caused by the mutation is consistent with the patients in the family.Conclusion:The mutation of the ARX c.1162 A>G may be the cause of the intellectual disability in the family affected. And the variant has not been reported in China.

Evaluation of the Application Status Quo of Blockchain Technology in China ’s Pharmaceutical Field / 中国药房

OBJECTIVE：To evaluate t he c urrent status of the application of blockchain technology in China ’s pharmaceutical field，and to provide direction and decision support for its wide application and development in the domestic pharmaceutical field. METHODS：Retrieved from Embase ，PubMed，Cochrane library ，CBM，CNKI，VIP and Wanfang databases during the inception of databases to Sept. 30th，2019，the studies on application status of blockchain technology in China ’s pharmaceutical field were collected；descriptive analysis was conducted for research type ，publication time ，main research fields and existing problems. RESULTS & CONCLUSIONS ：A total of 60 literatures were included ，and all of them were Chinese literatures. Among them ，38 literatures were reviews ，19 were original researches ，2 were dissertation ，1 was conference paper. The publication time range was from 2016 to 2019. The application of blockchain technology in the main pharmaceutical fields is to promote the sharing of electronic medical record data ，personal health data ，clinical research data and genomic data ；the traceable path is mainly provided in medical insurance audits ，drug quality traceability and anti-counterfeiting ，medical devices and medical supplies traceability. These applications are still in the preliminary theoretical verification or trial stage. At present ，there are still some limitations or problems in the relevant policies and application standards ，data storage space and processing ，data privacy and security ，and professionals in China ’s pharmaceutical field. However ，it has high application value and potential in medical data sharing ， reducing treatment costs ， improving medical claim system ， strengthening medical management and optimizing medical decision-making.

Investigation and Analysis of the Status Quo and Influence Factors for Scientific Research Training of Pharma- cists（Nurses）in PIVAS of China / 中国药房

OBJECTIVE：To investigate the status quo and influential factors for scientific research training of pharmacists （nurses）in PIVAS of China ，to provide direction and reference for the development of PIVAS. METHODS ：The survey method was used to conduct a questionnaire survey of PIVAS pharmacist （nurses）from 29 tertiary and secondary hospitals in 24 provinces， autonomous regions ， municipalities from eastern ， western and central China through the i nternet by using self-designed questionnaire. The survey period was from Mar. to Apr. 2019. The survey content included the basic information （gender，region， hospital level ，professional and technical title ，education background ，employment nature ）of the survey participants and the status quo of scientific research training （frequency and content of scientific research training ，degree of need for scientific research ， degree of interest in scientific research ，etc.）and status quo of scientific research output （publication and application of the project）. Main influential factors for scientific research training were analyzed. RESULTS ：A total of 504 questionnaires were sent out，and 501 valid questionnaires were collected ，with effective response rate of 99.40％ . Totally 63.1％（316/501）of the respondents had scientific training ，and the frequency of scientific training was mainly less than one time/month （26.1％，131/501） and 1-2 times/month（25.0％，125/501）；72.1％（361/501）of the respondents have medium or above scientific research needs ， 82.4％（413/501）of the respondents have medium or above interest in scientific research ，only 6.0％（30/501）of the respondents had mastered the major scientific research methods ， only 5.4％（27/501）of the respondents thought that their scientific research ability were strong. The pharmaceutical re search - direction was mainly related to clinical rational use of drugs ， song_123@126.com less to precision medicine ，new drug and new dosage form： development， therapeutic drug monitoring research ， 028-85503220。E-mail：linyunzhu99@163.com translational medicine ， etc. Only 16.6％ （83/501） of the respondents had published articles after working in PIVAS ，and 9.0％（45/501）had applied for projects. There were statistical significances in the scientific research training among the respondents with different regions ，professional and technical titles ， educational backgrounds and employment natures （P＜0.05）. CONCLUSIONS ：The scientific research training of PIVAS pharmacist（nurses）in China is inadequate and the research output is low. Main influential factors for scientific research training include region ，professional and technical title ，educational background and employment nature .

Antimicrobial resistance profile of the gram-negative bacilli isolated from urinary tract infections / 中国感染与化疗杂志

Objective? To?investigate?the?antimicrobial?resistance?and?beta-lactamase?production?profile?in?the?gram-negative?bacilli?isolated from urinary tract infections in the Second People's Hospital of Gansu Province during the period from 2014 to 2015. The results will provided to clinicians for better antimicrobial treatment. Methods? The?bacterial?isolates?were?identified?via?conventional?laboratory?tests?or?automatic?identification?systems?and?subjected?to?antimicrobial?susceptibility?testing?by?using?Kirby-Bauer?method.?Three-dimensional test was used to detect the enzymes conferring antimicrobial resistance. The susceptibility testing results were interpreted according to the CLSI breakpoints issued in 2012. Results A total of 987 gram-negative strains were isolated from urinary tract infections, including E. coli (51.6%, 509/987), Enterobacter (11.0%, 109/987), P. aeruginosa (10.5%, 104/987), K. pneumoniae (9.9%, 98/987), P. mirabilis (9.3%, 92/987), C. freundii (4.7%, 46/987), and other gram-negative bacilli (2.9%, 29/987). ESBLs were produced?in?494?(50.1?%)?of?the?987?strains?of?gram?negative?bacilli.?Preliminary?screening?test?identified?243?AmpC?beta-lactamases?producing?strains,?and?135?(13.7?%)?strains?were?confirmed?by?three-dimensional?test.?Both?ESBLs?and?Amps?beta-lactamases?were?produced in 16 (1.6%) strains. The prevalence of ESBLs-producing strains was 79.6% in E. coli, 34.6% in P. aeruginosa and 37.8% in K. pneumoniae?isolates.?Metallo-β-lactamase?or?KPC?beta-lactamase?was?not?identified.?The?antimicrobial?resistance?was?serious?in?gram-negative bacilli, which showed relatively low resistance rate to imipenem (0.02%), amikacin (10.6%), cefoperazone-sulbactam (23.8 %), and nitrofurantoin (25.2 %). E. coli prevalence of levofloxacin,?ciprofloxacin?resistance?respectively?were?89.8%,?91.8%. The gram-negative bacilli from urinary tract also showed various levels of resistance to cephalosporins. Conclusions The gram-negative bacilli isolated from urinary tract infections are mainly E. coli. The gram-negative isolates show high level antimicrobial resistance and high prevalence of beta-lactamases. Imipenem, amikacin, cefoperazone-sulbactam, and nitrofurantoin still have very high antibacterial activity against these isolates in vitro.

Efficacy and safety of Radix Astragali in the treatment of hypoxic ischemic encephalopathy in newborns:Meta-analysis / 国际药学研究杂志

Objective To evaluate the efficacy and safety of Radix Astragali(Huang Qi)for newborns with hypoxic ischemic encephalopathy(HIE). Methods We searched the Cochrane library,PubMed,Cochrane,EMBASE,CBM,CNKI,VIP and Wan?fang database,randomized controlled trial(RCT)evaluating the efficacy and safety of Huang Qi for newborns with HIE would be in?cluded and the methodological quality of RCT was evaluated according to the Cochrane Handbook for Systematic Reviews of Interven?tions version 5.1.0. Results Thirteen studies were included(1031 patients),11 RCT used open control as control,2 RCT used posi? tive control. There was no trial reported the death or disability at the end of 12 months follow-up period. Meta-analysis of one study showed Huang Qi group could not significantly reduced mortality rate of HIE compared with open control group〔RR=0.33,95%CI (0.04,3.07)〕. Meta analysis of 7 studies(n=597)showed that the efficacy rate of huang Qi group was significantly higher than that of open control group in treatment of HIE〔RR=1.22,95%CI(1.07,1.39),I2=48%〕. Meta-analysis of 3 trials(n=163)showed that there was significant difference in the improvement of NANA scale on the seventh day〔MD=5.37,95%CI(1.46,9.27),I2=89%〕be?tween Huang Qi group and open control group. Meta-analysis of 2 trials(n=111)showed that there was significant difference in the im?provement of NANA scale on the tenth day〔MD=2.03,95%CI(1.37,2.69),I2=0〕between Huang Qi group and open control group. No fatal side effects were reported. Conclusion Based on the current evidence,due to the limitation of quality of included studies and sample size,the routine use of Huang Qi for treatment of HIE in newborns is not recommended. The long-term efficacy and safety studies are required to confirm it.