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OBJECTIVE To investigate the current situation of pharmaceutical clinic service in medical institutions in China and provide experience and suggestions for promoting the development of pharmaceutical clinics. METHODS Questionnaire survey was used to investigate the development of pharmaceutical clinics in medical institutions of 31 provinces （autonomous regions and municipalities directly under the central government） in March to April 2023， and the descriptive analysis was conducted. The regression analysis was carried out for the influential factors of pharmaceutical clinic service. RESULTS A total of 1 368 questionnaires were distributed in this survey and 1 304 valid questionnaires were collected with the effective response rate of 95.32%. A total of 463 medical institutions carried out pharmaceutical clinic service， the rate of which was 35.51% （463/1 304）； the rates of pharmaceutical clinics in tertiary， secondary， primary and other medical institutions were 52.80%， 17.18% and 5.88%， respectively. The frequency of opening pharmaceutical clinics was 3.17 days per week on average， with an average of 5.99 visiting pharmacists in each medical institution. Among the visiting pharmacists， clinical pharmacists accounted for the vast majority （88.68%， 2 459/2 773）. There were various categories of pharmaceutical clinics， including joint clinics and pharmacist-independent clinics； among pharmacist-independent clinics， pharmaceutical specialty/specialty disease clinics were the main ones， accounting for 89.72% of the total number of pharmaceutical clinics. The value of pharmacists in pharmaceutical clinics was manifested in various forms， among which the proportion of medical institutions charging pharmaceutical clinics was 10.80%. The main experiences in developing pharmaceutical clinics were to attach importance to discipline construction and personnel training. The main difficulties in developing pharmaceutical clinics were low compensation levels and a shortage of talent.The number of clinical pharmacists， the number of visiting pharmacists in pharmaceutical clinics and additional compensation were positively correlated with the amount of pharmaceutical clinic services（P＜0.05）. CONCLUSIONS In recent years， pharmaceutical clinics have made significant progress； in the future， it is still necessary to further strengthen discipline construction and talent cultivation， pay attention to the value embodiment of pharmacists， to promote the healthy development of pharmaceutical clinics.
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OBJECTIVE To interpret Teacher Training Syllabus for Clinical Pharmacist Training Program （2023 edition） （hereinafter referred as to the “new syllabus”）， and to provide reference and guidance for promoting the implementation of the new syllabus and realizing the quality-improving goal of the reform of the clinical pharmacist teacher training program initiated by China Hospital Association. METHODS From the perspective of the management and based on the position of the designer， the new syllabus was interpreted from four aspects： the background of its compilation and release， the process of its compilation and its characteristics， the key improvements of the program and the points for attention about its subsequent implementation. RESULTS & CONCLUSIONS The development and release of the new syllabus provide a “construction blueprint” for the reform of the clinical pharmacist teacher training program of the China Hospital Association. The whole process of compiling the new syllabus is characterized by four basic features： theory-led， goal-oriented， research-based， and synergistic. Compared with the previous syllabus， in addition to the adjustment of the text structure，the new syllabus presents more complete and clearer competence requirements for clinical teaching competence in terms of training objectives； in terms of training content， it further structures the group of task items， pays attention to the 育。E-mail：zhenjiancun@163.com sequential planning and time arrangement of items， and puts forward both quantitative and qualitative refinement requirements for each specific training task；in terms of training methods， it emphasizes the interaction of lecturing， demonstrating and guiding， and the progression of observation， operation and reflection， with the intention of guiding teacher trainees to “learn how to teach by teaching”. In the subsequent implementation of the new syllabus， it is necessary for the teacher training bases to attach great importance to the guarantee of training conditions and process quality management， and to organize the teacher training team to do a good job in the two training programs of “clinical pharmacist training” and “clinical pharmacist teacher training”. Based on further improving the connection between the two training programs， the teacher training team should continue to explore the scientific model of clinical pharmacist teacher training oriented by clinical teaching competence.
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OBJECTIVE：To interpret the new version of the Implementation Plan for Enrollment and Assessment of Clinical Pharmacist Teacher Training Project of Chinese Hospital Association （Trial）（hereinafter referred to as the “New Plan ”）officially announced by the Chinese Hospital Association in Sept. 2021，in order to provide guidance and reference for smoothly promoting the implementation of the New Plan and realizing the original intention of the reform. METHODS ：The New Plan was interpreted from four aspects ，including the background of the formulation of the New Plan ，the main features presented ，the innovations and the issues that need to be paid attention to in the next implementation. RESULTS & CONCLUSIONS ：The formulation and release of the New Plan marks the beginning of a new round of reform of the clinical pharmacist teacher training program of the Chinese Hospital Association. It is mainly based on the actual problems encountered in the operation of the current clinical pharmacist teacher training system ，the importance of clinical pharmacistteacher training itself ，and the opportunities and challenges that the development of the times has brought to our country ’s 163.com clinical pharmacy business. Research foundation ， problem orientation and professional demonstration present important characteristics. Compared with the old plan ，the New Plan adds a substantive selection mechanism for majors ，which intends to achieve the necessary “strictness”in the enrollment process ；it reconstructs the overall training goal of the benchmarking project and the three-in-one assessment system ，which intends to achieve a reasonable “lax”of assessment link ；it removes restrictions on off-site training ，advocates wide-ranging professional docking，and improves the flexibility of the training system and process management. The implementation of the New Plan is a complex work involving multiple parties and is affected by many factors. It requires multiple teams to perform their duties and promote together. The teacher training base and expert team must understand the spirit of reform and achieve the stable implementation of the New Plan ；at the same time ，the communication between the project working group and the teaching base and experts should be strengthened ，and finally realize the original intention of the reform of cultivating more high-quality clinical pharmacy teachers.
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OBJECTIVE：To provide reference for improving the pharmaceutical care in China. METHODs ：By comparing the development history ，training contents and status quo of the standardized training system of resident pharmacists in Beijing and clinical pharmacists in China ，combining with policy guidance of the current development trend of clinical pharmacy ，the regins were discussed to optimize the mode of standardization training for inpatient pharmacists in Beijing. RESULTS & CONCLUSIONS：Standardized training for resident pharmacists in Beijing was a compulsory post-graduate education for pharmacists in Beijing hospitals. Post training of clinical pharmacists mainly focused on post-graduate education ，and the main training content was the practical ability of pharmacists in clinical pharmacy ，could be divided to general clinical pharmacists and specialized clinical pharmacists. The standardized training for resident pharmacists in Beijing consisted of two stages ，the first stage was general skills training ，the second stage was specialized skills training. The training content and rotation department of clinical pharmacy in the first stage were similar to post training of general clinical pharmacists in China ，and the training assessment required was more workload for trainees ，but it was not the key point of completion assessment for standardized training of resident pharmacists. During 2015-2017，154 trainees completed the training in Beijing and participated in the second stage completion examination of the standardized training of the resident pharmacists. At the same time ，43 trainees（27.92％）participated in the training of clinical pharmacists. 228 trainees participated in the training of clinical pharmacists in Beijing during the same period ， and showed an increasing trend ；most of them had passed the Beijing standardized training for resident pharmacists. It is suggested that the standardized training of resident pharmacists in Beijing can absorb the advantages of post training of clinical pharmacists. In the first stage of training ，the post training of general clinical pharmacists should be carried out at the same time. The post training of specialized clinical pharmacists can be included in the two-stage training of inpatient pharmacists.
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Medication safety is a top concern for medical institutions. Outpatient prescription standard is designed to standardize prescription, dispensing, and supervision for outpatient and emergency prescriptions at medical institutions. The standard covered prescription authorization management, prescription issuance, prescription dispensing, prescription saving and supervision. These four parts focus on risk exposure of patients′medication safety, and aim at safeguarding patient medication safety, which were formulated according to China′s laws and regulations, domestic and international industrial standards and technical specifications, as well as prescription conditions at medical institutions and experts opinions. The standard covers technical requirements and guidance, management measures and system development, serving as an important basis to guide medical institutions on standardize management of outpatient prescription and emergency prescription.
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Medication safety is one of patient safety goals, and medication error prevention is its main content. Risk managements such as hazard analysis and critical control points ( HACCP) and failure mode and effect analysis ( FMEA) with a lot of applications in health care field have a proper condition to be used for medication error prevention. A risk management was carried out for medication error prevention through the design and practice in our hospital, which contained the following 7 steps:the medication error prevention project was determined, the management team was made up, the links of medication and types of medication errors were confirmed, the critical control points were determined by using HACCP, the critical control points were analyzed by using FMEA, the links with high scores were performed improvement in prevention plan, and the improvement plan was applied and evaluated. The results showed the risk management used in medication error prevention is flexible and practical, which is especially suitable for the risk management for high-alter drugs.
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OBJECTIVE:To provide reference for improving pharmaceutical consultations and the quality of pharmaceutical care. METHODS:The records of pharmaceutical consultations were collected from medication consultation center of Huilong-guan district in our hospital during Jan. 2014-Dec. 2016,and then summarized in terms of consultants composition,consultation form,consulting contents and drugs consulted,while Pareto Diagram was used to analyze the main and minor factors of consult-ing contents. RESULTS:The medication consultation center provided pharmaceutical consultations 20353 cases during 2014-2016. Main consultants were patients (20039 cases,98.5%). A total of 6307 persons were involved,mostly female (3646 persons,57.8%). Face to face was the most common consulting method (19440 cases,95.5%). There were 13 types of consulting contents,among which usage and dosage and guidance for special formulation use were the main factors,including 10392 cases (51.1%) and 3844 cases (18.9%). Among 20353 cases of pharmaceutical consultations,18874 cases of in-volved drugs,and involved 11 categories,mostly respiratory drugs (11756 cases,62.3%). CONCLUSIONS:Usage and dos-age and guidance for special formulation use are the main contents of pharmaceutical consultations in the hospital district. The services of pharmaceutical consultations for patients,physicians and nurses provided by pharmacists can solve the questions on medications,and can promote rational drug use in clinic.
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OBJECTIVE:To provide reference for rational use of antiemetics in cancer patients. METHODS:The utilization of antiemetics in cancer outpatients and inpatients from 87 hospitals involved inHospital Prescription Analysisproject during 2012-2014 was analyzed statistically by time or by hospital category. RESULTS:14 antiemetics were used in 87 hospitals during 2012-2014. The consumption sum and person number of antiemetics in cancer outpatients were 5763000 yuan and 34000 persons [22000 yuan/(year·hospital),133.1 person/(year·hospital) in average];those of cancer inpatients were 61711000 yuan and 515000 persons [256000 yuan/(year·hospital),2137.9 person/(year·hospital) in average];those of outpatient were lower than those of inpatient. The ratio of consumption sum of antiemetics in cancer outpatients and inpatients were 5.2‰-34.0‰;the ratio of person number ranged 2.9%-10.9%. Those of inpatient were higher than those of outpatient;those of special hospital were higher than those of comprehensive hospital. Main drugs included ondansetron,tropisetron,metoclopramide and palonosetron. CONCLU-SIONS:Antiemetics are frequently used in cancer patients,especially for 5-HT3 receptor antagonists and metoclopramide.
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Objective:To understand the medication safety events about cephalosporin in our hospital in order to provide evidence for the better medication safety of cephalosporin. Methods:Adverse drug reaction ( ADR) reports, medication error ( ME) reports and drug quality problem records about cephalosporin in our hospital were collected and the critical indicators in the reports were analyzed. Re-sults:The ADR reports selected in our hospital were mainly reported by pharmacists. More males were involved in the related patients, and young adults were in the majority. Second and third-generation cephalosporin were the major drugs used in the reports. The damages in skin and its appendages were the major damages in organs. The ME reports selected in our hospital were totally reported by pharma-cists. Errors in frequency and dose of drug administration were the most common, and the main causes were lack of knowledge and train-ing. No serious quality problem in cephalosporin was found in our hospital, and the inner and outer packaging in damaged conditions was the most common problems in our records. Conclusion:Cephalosporin as one widely used antibacterial agent is considered safe and effec-tive. Because of its large amount of application, cephalosporin should be paid more attention by health care professionals. MEs should be avoided as far as possible. ADRs should be treated timely and properly in order to decrease medical disputes. More attention should be paid to ensure security of drug use for patients.
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Objective To evaluate the rationality of antibiotic use in the outpatient and emergency departments in some class 3A hospitals in China through International Network for Rational Use of Drugs (INRUD).Methods The antibiotic prescriptions were collected from the outpatient and emergency departments in 78 class 3A hospitals of 25 provinces through INRUD during 2014-2015.The basic information of the antibiotic prescriptions and the prescriptions rationality were evaluated.Results A total of 447 894 prescriptions of antibiotics were analyzed.From 2014 to 2015,the qualified rate the prescriptions increased from 91.52％ to 93.08％,and the antibiotic use rate was similar (11.72％ and 12.04％).The major irrational prescription type was inappropriate prescription,including inappropriate indication (32.42％,34.02％) and inappropriate usage and dosage (24.22％,18.56％).Conclusions Totally,the antibiotic use in the outpatient and emergency department reached the standard in China.However,the use of antibiotics didn' t meet the national requirements in some area.It is necessary to promote the rational use of antibiotics.
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Objective To evaluate the rationality of antibiotic use in the outpatient and emergency departments in some class 3A hospitals in China through International Network for Rational Use of Drugs (INRUD).Methods The antibiotic prescriptions were collected from the outpatient and emergency departments in 78 class 3A hospitals of 25 provinces through INRUD during 2014-2015.The basic information of the antibiotic prescriptions and the prescriptions rationality were evaluated.Results A total of 447 894 prescriptions of antibiotics were analyzed.From 2014 to 2015,the qualified rate the prescriptions increased from 91.52％ to 93.08％,and the antibiotic use rate was similar (11.72％ and 12.04％).The major irrational prescription type was inappropriate prescription,including inappropriate indication (32.42％,34.02％) and inappropriate usage and dosage (24.22％,18.56％).Conclusions Totally,the antibiotic use in the outpatient and emergency department reached the standard in China.However,the use of antibiotics didn' t meet the national requirements in some area.It is necessary to promote the rational use of antibiotics.
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OBJECTIVE:To analyze the situation of the minimum sales package unit,and to provide reference for standardiz-ing package. METHODS:According to related regulations of New Edited Materia Medica(17th edition)and package inserts,373 kinds of oral drugs,57 kinds of oral drugs for lowering blood glucose,blood lipid and blood pressure,6 kinds of second kind psy-chotropic oral drugs were analyzed statistically in respect of minimum sales package unit and medication duration. RESULTS:There were 30 kinds of minimum sale package unit for 373 oral drugs,among which common capacity were 20,10,100 grain/tab-let/pill,accounting for 14.21%,14.21%,12.33% respectively,and 57.11% were used within 7 d. There were 13 kinds of mini-mum sale package unit for 57 oral drugs for lowering blood glucose,blood lipid and blood pressure,among which the common ca-pacity were 7,30,14,10 grain/tablet/pill,accounting for 33.34%,14.04%,14.04%,14.04% respectively,and 85.97% were used within 14 d,indicating sales package unit often based on weekly dosage. Among 6 kinds of type Ⅱ psychotropic oral drugs, minimum sales package unit capacity of 3 kinds were all 20 grain/tablet/pill,and those of other 3 kinds were 10,7,6 grain/tablet/pill;one of them were used more than 7 d. CONCLUSIONS:Minimum sales package unit is confirmed discretionarily. It is sug-gested that minimum sale package unit of oral drugs for lowering blood glucose,blood lipid and blood pressure should be packaged according to the dosage of 2 weeks to one nonth;the capacity of type Ⅱ psychotropic oral drugs is lower than the dosage of 7 days,and daily dose package is the best.
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Objective To investigate risk factors for Pseudomonas aeruginosa infected AECOPD patients and the signifi-cance of immune regulation .Methods The clinical pharmacist is involved in the administration and guardianship of immuno-compromised patients with recurrent AECOPD .The clinical pharmacist provides recommendations and theoretical support in antimicrobial drug selection and regulating immunity .Results Clinical pharmacist gave rationalized medication recommenda-tions .It made anti-infective programs more reasonable and effective .Conclusion By assisting physicians in formulating regi-mens ,clinical pharmacists can provide more optimal individualized treatment for patients .
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Objective To evaluate the effect of prescription review on rational clinical use by means of regional data.Methods Analysis of two prescriptions review data of Beijing municipal hospitals,to compare the rational rate of prescriptions,makeup of irrational prescriptions,and effect variations following feedback.Results Of the 21 hospitals involved,the total rational rate of prescriptions rose from 89.4% to 97.1% following prescription review and feedback of results.In the second review,those found of the highest irrational and the most significant improvements were both irrational indications, with the irrational rate dropping from 90.7% to 44.2%. As reported in feedback for the first prescription review,9 out of 10 druguses found as irrational,have disappeared from the second review. Conclusion The regional administrative prescription reviews can improve the rational clinical drug use, encouraging rational drug use.
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<p><b>BACKGROUND</b>High-dose methotrexate (HD-MTX) with folinic acid (leucovorin) rescue is the gold standard therapy in the treatment of osteosarcoma. The plasma concentration of MTX is closely related to efficacy and toxicity. There are large individual differences. Many authors have described the pharmacokinetic (PK) profile of MTX regarding osteosarcoma under a variety of circumstances. However, no data concerning Chinese osteosarcoma patient PKs using the nonlinear mixed effects models (NONMEM) have been previously reported. The goals of this study were to establish the population pharmacokinetics (PPK) of HD-MTX treatment in Chinese osteosarcoma patients, and to explore the influence of patient covariates and between-occasion variability on drug disposition.</p><p><b>METHODS</b>An intravenous HD-MTX solution (10 g/m 2 ) was given 274 times to 148 osteosarcoma patients. MTX plasma concentrations were measured at 0, 6, 12, 24, 48 and 72 h after commencement of the infusion, and the fluorescence polarization immunoassay was used to determine MTX plasma concentrations. The PPK model and parameters were estimated using NONMEM software. The effects of fixed-effect factors were evaluated, and the final regression model was obtained.</p><p><b>RESULTS</b>The following population parameters were obtained using a two-compartment model: CL1 (clearance of central compartment): (CL1 ) = CL1TV × [1 - θ CL1- MTXNUM × MTXNUM] × [1 - θ CL1- CrCl1 × (CrCl1 - 1.89)] × e ηCL1i (L/h). V1 (central volume): (V1)i = V1TV × e ηV1i (L). CL2 (clearance of peripheral compartment): (CL2)i = CL2TV × [1 - θCL2 - BODY AREA × (body area - 1.62)] × e ηCL2i (L/h). V2 (peripheral compartment): (V2 )i = V2TV × [1 - θ V2-bodyarea × (bodyarea-1.62)] × e ηV2i (L). The PPK parameters (RSD%) were CL1, V1, CL2 and V2 with values of 6.20 L/h (8.48%), 19.6 L (extremely small), 0.0172 L/h (50.9%) and 0.515 L (39.1%), respectively. Creatinine clearance and the number of methotrexate chemotherapy cycles before MTX infusion had a significant effect on the CL1, and body surface area had a significant effect on the CL2 and the V2 (P < 0. 01).</p><p><b>CONCLUSIONS</b>A good fit was derived for the PPK. The model could be used to provide guidance for MTX treatment and reduce adverse effects.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Young Adult , Infusions, Intravenous , Leucovorin , Therapeutic Uses , Methotrexate , Therapeutic Uses , Models, Molecular , Osteosarcoma , Drug TherapyABSTRACT
Amid the progress of public hospitals reform,the paper probed into the influences and opportunities of the health reform on the development the hospital pharmacy.They discussed the roles of pharmacists in medical service,and recommended on building the pharmaceutical service system in view of the current caliber of the pharmacists.
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OBJECTIVE: To investigate the regularity and characteristics of moxifloxacin-induced torsade de pointes (TDP), and to provide reference for rational use of drugs. METHODS: A total of 5 reported cases of moxiflixacin-induced TDP in recent 10 years were analyzed retrospectively. RESULTS: Of 5 cases, 2 cases were male and 3 female with mean age of (81?7) years. 5 patients suffered from organic heart disease. The onset time of TDP by oral administration was later than that by intravenous administration. Mean QTc intervals was (567?35) ms at attach period and the time recovered to base level (18?15) h. Potassium, magnesium, and sodium were kept at normal level at attach period. CONCLUSION: Clinical physicians and pharmacists should pay attention to moxifloxacin-induced TDP.
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OBJECTIVE:To analyze the rationality of the preventive use of antibiotics in Chinese ophthalmologic patients with type Ⅰ incision.METHODS:By means of retrospective study,a total of 1 273 ophthalmologic cases from 113 hospitals of 2006～2007 from National Monitoring Network of Ministry of Health for Clinical Application of Antibiotic with type Ⅰ incision involving preventive administration of antibiotics via different routes were analyzed.RESULTS:The local administration (eye drops and local injection) was rational on the whole,but the systemic administration (intravenous or oral administration) was irrational to some degree in which the drug grade was on the high side,the antibacterial spectrum was inappropriate,and the medication time was delayed.CONCLUSION:Preoperative local administration and rational use of dosage forms should be emphasized in the preventive use of antibiotics for patients undergoing ophthalmologic surgery.
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OBJECTIVE:To improve rational drug use level by monitoring prescription evaluation.METHODS:The management,technique,design of indexes and the computation of the indexes,etc.in the prescription evaluation were analyzed and standardized in accordance with Prescription Management Method.RESULTS & CONCLUSIONS:An effective method and standard of prescription evaluation has been put forward;it is advisable for medical institutions to conduct prescription evaluation based on the actual situation of their own so as to improve rational drug use level.
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OBJECTIVE:To discuss the development prospect of the hospital pharmacists in clinical trials and to accumulate experience for the development of hospital pharmacy. METHODS: The current strengths,weakness,opportunities and threats of the hospital pharmacists were systematically analyzed and evaluated with the Porter's five strengths and PSET models;the development strategies were formulated by SWOT matrix. RESULTS: There were not only the apparent strengths and weakness but also the opportunities and threats for hospital pharmacists in clinical trials. CONCLUSION: At present,hospital pharmacists should take advantage of the opportunities of clinical trials market,stick to the aim of the professional development,spare no effort in discipline construction and training of professional talents and establish the space for their development and their indispensable position by giving priority to scientific research with service as target.