Interpretation for Evidence-based Practice Guideline of Medication Therapy of High-dose Methotrexate in China / 中国药房

Evidence-based Practice Guideline of Medication Therapy of High-dose Methotrexate in China was published in the British Journal of Clinical Pharmacology in February 2022. The guideline followed the latest definition of clinical practice guideline and the methodology specification for the guideline development of WHO. The Grading of Recommendations Assessment ， Development，and Evaluation （GRADE）approach was applied to rate the quality of evidence and determine the strength of recommendations. Finally ，this guideline presents 28 recommendations covering the whole process of clinical medication of high-dose methotrexate ，involving evaluation prior to administration （liver and renal function ，pleural effusion and ascites ， comedication，genetic testing ），pre-treatment and routine dosing regimen （pretreatment of hydration and alkalization ，urine alkalization，routine dosing regimen ），therapeutic drug monitoring （necessity，method，timing，target concentration ），leucovorin rescue（rescue timing ，rescue regimen ，rescue dose optimization ），and management of toxicities （liver and kidney function monitoring，supportive treatment ，blood purification treatment ）. This article aims to summarize and interpret the recommendations of this guideline ，so as to promote the better promotion and implementation of this guideline and provide comprehensive technical support and suggestions for whole-course individualized administration of high-dose methotrexate in China.

Data mining of adverse drug reaction signals for ado-trastuzumab emtansine and brentuximab vedotin based on FAERS database / 中国药房

OBJECTIVE To analyze the adverse drug reaction （ADR）signals of ado-trastuzumab emtansine and brentuximab vedotin，so as to provide reference for clinical medication safety. METHODS Using the FDA adverse drug event reporting system （FAERS）database and OpenVigil 2.1 data platform ，the ADR of the two drugs were collected from being approved by FDA to the Sep. 30th，2021. The ADR signals were detected by frequency method and sorted according to the occurrence frequency and signal strength respectively. RESULTS & CONCLUSIONS A total of 2 319 and 3 178 ADR reports related to ado-trastuzumab emtansine and brentuximab vedotin were collected ，215 and 329 ADR signals were detected respectively. According to the occurrence frequency，the most frequent ADR s of the two drugs were thrombocytopenia （109 cases）and febrile neutropenia （198 cases）， separately，which were consistent with the drug instructions. According to the signal strength ，the spider nevus of ado-trastuzumab emtansine（report odds ratio of 451.46）and the noninfectious endocarditis of brentuximab vedotin （report odds ratio of 304.35） ranked first ，both of which were not reported in the drug instructions. It is suggested that attention should be paid not only to the most common ADR s of blood and lymphatic system caused by both drugs ，but also to the ADRs not reported in the drug instructions such as spider nevus of ado-trastuzumab emtansine and noninfective endocarditis of brentuximab vedotin.

Rapid Health Technology Assessment of Albumin-bound Paclitaxel in the Treatment of Breast Cancer / 中国药房

OBJECTIVE：To evaluate th e effectiveness ，safety and economy of albu min-bound paclitaxel （nab-PTX）in the treatment of breast cancer by using rapid health technology assessment （HTA），and to provide evidence-based reference for drug selection. METHODS ：Retrieved from PubMed ，the Cochrane Library ，CNKI，Wangfang database and other databases ，systematic evaluation/Meta-analysis，HTA and pharmacoeconomic studies about nab-PTX in the treatment of breast cancer were included ；the conclusions were classified and analyzed by using descriptive analysis. RESULTS ：A total of 5 systematic reviews/Meta-analysis ， 8 pharmacoeconomic studies were included in this study. Compared with conventional taxanes ，nab-PTX increased pathological complete response （pCR）rate [OR ＝1.39，95％CI（1.16，1.67），P＜0.001] and event-free survival （EFS）[HR＝0.69，95％CI（0.57， 0.85），P＜0.001] in neoadjuvant chemotherapy （NAC）-treated breast cancer patients. However ，there were no significant differences in overall survival （OS），progression-free survival （PFS），objective response rate （ORR）and disease control rate （DCR）in metastatic breast cancer （MBC）patients between 2 groups. In the terms of safety ，nab-PTX increased the incidence of grade 3-4 sensory neuropathy [OR ＝1.89，95％CI（1.36，2.61），P＜0.001] in MBC patients ，and increased the incidence of neutropenia [OR ＝ 1.52，95％CI（1.23，1.88，P＜0.001]，sensory neuropathy [OR ＝ 2.17，95％CI（1.38，3.40），P＜0.001]，rash [OR ＝1.46，95％CI mei1213@163.com （1.18，1.80），P＜0.001] and fatigue [OR ＝1.28，95％CI（1.04， 1.56）， P＝0.02] in NAC -treated breast cancer patients.Pharmacoeconomic studies showed that nab-PTX could improve the quality adjusted lif e years of MBC patients compared with traditional taxanes ，and it was a economical option. CONCLUSIONS：Nab-PTX enhances pCR in NAC-treated breast cancer patients ，but has no significant advantage in the effectiveness of MBC patients ，and increases the occurrence of ADR. Nab-PTX may have a cost-utility advantage over conventional taxanes for MBC.

Establishment of Hospital Pharmacy Prevention and Control Strategies for Novel Coronavirus Infection Based on 5M1E Analysis Method / 中国药房

OBJECTIVE：To provide re ference f or hospital pharmacy prevention and control management during novel coronavirus（SARS-CoV-2）infection epidemic period. METHODS ：Based on 5M1E analysis method ，according to the needs of epidemic prevention and control ，it is necessary to analyze the risks of 5 aspects as personnel ，equipment and materials ，methods， environment，monitoring of the pharmacy work in hospital ，and establish the prevention and control strategy of hospital pharmacy infection in response to the epidemic situation of novel coronavirus pneumonia （COVID-19）according to the corresponding risks. RESULTS & CONCLUSIONS ：Personnel management strategies include carrying out pharmacist prevention and control training ， focusing on physical and mental health of pharmacists during infection prevention and control ；equipment and materials management strategies include strengthening equipment disinfection management and strengthening the management of materials for infection prevention and control ；method management strategies include developing emergency plans for infection prevention and control，standardizing individual infection prevention and control method ；environment management strategies include environment cleaning and disinfection management ，infection exposure management of related medical material ，medical waste management ； monitoring management strategies include strengthening pharmacists infection monitoring and evaluating pharmacists ’prevention and control effect. By establishing the strategy for COVID- 19 epidemic prevention and control ，it can effectively guiding pharmacists to carry out epidemic prevention and control.

Exposure Protection Countermeasures for Novel Coronavirus Infection in Hospital Pharmaceutical Staff / 中国药房

OBJECTIVE：To pro vide reference for exposure protection countermeasures for Novel coronavirus （SARS-CoV-2） infection in hospital pharmaceutical staff. METHODS ：According to the recommendations of related medical staff protection guideline，combined with the characteristics and prevention and control requirements of novel coronavirus pneumonia （COVID- 19），based on the basic principle of exposure protection ，actual exposure risk of infections for hospital pharmaceutical staff were evaluated，and the countermeasures for exposure protection were constructed under the epidemic condition of COVID- 19. RESULTS：According to the standard prevention principle and the risk evaluation of infection exposure ，most of the pharmaceutical posts in the hospital belonged to low-risk exposure posts ，and only a few posts belonged to medium-and high-risk exposure posts. Personal protective equipment should be provided according to the exposure risk level of different pharmaceutical posts and work demand. At the same time ，infection protection training should be strengthened ；environment and facilities in pharmacy should be cleaned and disinfected. CONCLUSIONS ：Standard prevention principle should be followed by hospital pharmaceutical staff during epidemic period. Based on the characteristics and exposure risks of pharmacy posts ，and according to the regulations of the hospital，personal protection for hospital pharmaceutical staff should be conducted according to the exposure risk level determined by the pharmaceutical department and relevant management regulations to avoid over-protection or inadequate protection ，so as to ensure the smooth and safe development of pharmaceutical care.

Novel Coronavirus Infection Response ：Prevention and Control Strategies Based on Drug ，Material Supply and Emergency Management / 中国药房

OBJECTIVE：To provide drug ，material supp ly and emergency management reference for novel coronavirus （SARS-CoV-2）infection in pharmacy staff in hospital. METHODS ：The method of 5M1E was used to analyze the six main factors，including man ，machine，material，method，environment and measurement of drug ，material supply and emergency management. The relevant prevention and control strategies were put forward. RESULTS & CONCLUSIONS ：In the drug ，material supply and emergency management of epidemic prevention and control ，the man factors were involved ，such as mainly pharmacists from pharmacy departments of medical institutions. At the same time ，the management also involved machine factors such as drug storage，cleaning and disinfection ；material factors such as emergency drugs ，disinfection products ，in vitro diagnostic reagents ， the guarantee of medicine materials for medical team ，investigational products ；methods factors such as relevant management measures；environmental factors such as storage environment and facilities ；measurement factors such as drug use ，drug and substance reserve. In view of the above factors ，it is suggested to strengthen the professional knowledge and communication skills training of pharmacists ，and strengthen humanistic care ，so as to improve their post competency ，communication in emergency response and psychological tolerance. Equipment and materials management shall be strengthened ，and equipment maintenance and disinfection shall be done well to ensure normal use of equipment. According to the evidence-based method ，the emergency drug list should be established. According to the disinfection protection requirements ，the disinfection products should be reasonably selected and their quality and sufficient inventory should be ensured. The qualified in vitro diagnostic reagents should be purchased in time. The investigational products should be managed reasonably according to the relevant requirements of clinical trials ，to ensure the drug and material supply of medical team members. Emergency plans and standard operating procedures shall be formulated，the principle of sympathetic drug use shall be followed ，and the management of off-label drug use and early warning of drug and material shortage shall be done well. Reasonable storage space should be reserved to strengthen environmental monitoring and disinfection. We should strengthen the monitoring and reporting of daily data ，strengthen the quality monitoring ， and accept the independent audit of the third party. Above strategies are helpful to improve the ability of drug supply risk identification and response ability ，and cooperate with the medical team to timely rescue patients.

Interpretation of Novel Coronavirus Infection ：Expert Consensus on Guidance and Prevention Strategies for Hospi tal Pharmacists and the Pharmacy Workforce / 中国药房

OBJECTIVE：To provid e reference for pharmaceutical workers to better understand Novel Coronavirus Infection ： Expert Consensus on Guidance and Prevention Strategies for Hospital Pharmacists and the Pharmacy Workforce （hereinafter referred to as “expert consensus ”），and to apply and practice in specific work ，so as to give full play to the role of pharmacists to help fight the epidemic.METHODS ：The background of the formulation and revision of the expert consensus were introduced ，and its main contents and viewpoints were interpreted. RESULTS & CONCLUSIONS ：The text of expert consensus is divided into 8 parts，mainly including disease diagnosis and treatment [SARS-CoV- 2 infection related background ，clinical manifestations and diagnosis， treatment]，hospital pharmacy （prevention and control strategy ，work guidance ），drug and facility support management（key drug/facility/equipment support ，management and use of the drug in special circumstances ），information sources and related resources ，etc.，which comprehensively and detailedly provide information ，guidance and strategies for coronavirus SARS-CoV-2 infection prevention and control to play the role of pharmacists in hospital pharmacy well ，do well in the protection of staff in different pharmaceutical posts ，drug security work in response to epidemic situation ，and develop pharmaceutical care. So far，the understanding of SARS-CoV- 2 in the pharmaceutical industry is relatively limited. Based on the accumulated experience and progress in epidemic prevention and control ，the expert consensus will be updated and improved continuously ，so as to provide guidance and help for hospital pharmaceutical personnel.

Rapid Health Technology Assessment of Tirofiban in the Treatment of Acute Coronary Syndrome / 中国药房

OBJECTIVE：To evaluate the benefit and risk of tirofiban in the treatment of acute coronary syndrome （ACS），and to provide evidence-based reference for clinical drug selection and decision. METHODS ：Retrieved from domestic and foreign database as PubMed ，the Cochrane Library ，CNKI and Wanfang database ，during the establishment of database to Apr. 2020，two researcher independently screened the literature based on inclusion and exclusion criteria and extracted the data. After the quality evaluation of the included literatures ，based on rapid health technology assessment ，the extracted results were classifiedly evaluated and comprehensively analyzed. RESULTS ：A total of 13 researches of systematic review/Meta-analysis and 1 research of pharmacoeconomics were included. Compared with placebo ，tirofiban could significantly reduce all-cause mortality [OR ＝0.68， 95％CI（0.54，0.86），P＝0.000 1] and the incidence of major adverse cardiac events （MACE）in patients with ACS [RR ＝0.24， 95％CI（0.14，0.40），P＜0.01]，and increased the incidence of TIMI 3 [OR＝5.73，95％CI（2.99.10.97），P＜0.01]. Tirofiban and eptifibatide had similar therapeutic efficacy in the treatment of ACS ，but tirofiban significantly increased the risk of TIMI small bleeding in patients with ACS [RR ＝0.61，95％CI（0.38，0.98），P＝0.04]. For ACS patients with non-ST elevation （NSTE-ACS）， compared with placbo ，tirofiban significantly reduced the incidence of MACE [RR ＝0.76，95％ CI（0.61，0.96），P＝0.018]，but significantly increased the risk of bleeding [OR ＝1.49，95％CI（1.12，1.98），P＝0.006]，while there was no significant difference in its effects on the all-cause mortality of NSTE-ACS patients （P＞0.05）. For STEMI patients ，compared with placebo ，tirofiban significantly reduced the all-cause mortality [RR＝0.61，95％CI（0.35，1.05），P＝0.007] and the incidence of MACE [RR ＝0.63，95％ CI（0.44，0.90），P＝0.007]. When combined with liposuction ，tirofiban also significantly reduced the incidence of MACE [RR ＝ 2.05，95％CI（1.71，2.46），P＜0.01]，and significantly increased the incidence of TIMI 3 [OR＝3.18，95％ CI（2.4，4.22），P＜ 0.01]，but there was no significant difference in its effects on bleeding risk （P＞0.05）. The included pharmacoeconomic study showed that patients treated with bivalutine could get 10.07 QALYs，patients treated with heparin combined with tirofiban could get 9.98 QALYs，and the incremental cost-effectiveness ratio bivalutine compared to the latter one was 28 575.77 yuan/QALYs，which was lower than 3 times of the per capita GDP of some cities. CONCLUSIONS ：Tirofiban has good efficacy in the treatment of ACS，but it can increase the risk of bleeding than eptifibatide and placebo. Domestic bivalirudin treating for ACS has a cost-effectiveness advantage over tirofiban combined with heparin.

Accuracy evaluation of target-controlled infusion of sufentanil at low concentration / 中华麻醉学杂志

Objective To evaluate the accuracy of target-controlled infusion (TCI) of sufentanil at low concentration.Methods Sixty patients with American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-68 yr,scheduled for elective surgery under general anesthesia,were included in this study.Anesthesia was induced and maintained with sufentanil TCI combined with propofol TCI,and muscle relaxation was maintained by intermittent injection of rocuronium as needed.The patients were divided into 3 groups (n=20 each) using the sealed envelope method:0.08 ng/ml group (group Ⅰ),0.10 ng/ml group (group Ⅱ) and 0.12 ng/ml group (group Ⅲ).Arterial blood samples were collected in 10 patients randomly selected from each group for measurement of plasma sufentanil concentrations by liquid chromatography-mass spectrometry/mass spectrometry.The accuracy of sufentanil TCI was evaluated by calculating bias (median performance error),precision (median absolute performance error) and wobble.Results In Ⅰ,Ⅱ and Ⅲ groups,the bias of sufentanil TCI was-6.1％,-10.2％ and-5.0％,respectively,the precision was 19.4％,15.8％ and 14.2％,respectively,and the wobble was 20.9％,11.0％ and 10.8％,respectively.The pooled bias,precision and wobble were-7.1％,16.8％ and 13.5％ in Ⅰ,Ⅱ and Ⅲ groups,respectively.Conclusion The accuracy of sufentanil TCI at low concentration is considered acceptable in clinical anesthesia,and the measured plasma sufentanil concentration is approximately 7％ lower than the target plasma sufentanil concentration in surgical patients.

A Protocol Introduction of Rapid Advice Guideline for Intravenous Azithromycin in Pediatrics / 中国药房

OBJECTIVE: To standardize and guide the formulation process of guideline and guarantee the evidence-based formulation of Rapid Advice Guideline for Intravenous Azithromycin in Pediatrics scientifically. METHODS: The protocol of the guideline was introduced, such as guideline-making institution and registration, establishment of project group, scope of application, declaration of interest and funding support, identification of the clinical issues and outcome indexes, evidence retrieval and processing, invastigation of patients preferences and values, economics analysis, development of recommendation, external review and approval, guideline release, dissemination and update, etc. RESULTS: The construction of guidance committee, expert group and secretarial group, the registration (registration number: IPGRP-2016CN013) of the guideline had been achieved according to this protocol; clinical issues (such as indications, usage and dosage, ADR and treatment, drug use in special population) and effectiveness, safety outcome indexes had been formed. The recommendations have been issued by the end of 2017; the full text and interpretation of the guideline will be published in 2018; the guideline will be updated in 2022. CONCLUSIONS: This protocol provides the methodological and programmatic guide and provides reference for evidence-based formulation of the guideline scientifically so as to promote clinical rational drug use.

Post-marketing surveillance of Tanreqing injection in children: a real world study / 中华流行病学杂志

Objective To evaluate the safety of Tanreqing injection among children in thereal world.Methods A multicenter,large sample,ambispective cohort study,with registration-type clinical safety monitoring.A total of 6 188 inpatients and patients from the emergency units,aged ≤14 years who all had been using Tanreqing injection in 59 secondary and tertiary hospitals in China,were recruited between January,2014 and May,2015.The main outcomes would include incidence and severity of adverse drug reaction (ADR)/adverse drug event (ADE) of Tanreqing injection.Univariate analysis was used to explain the risk factors of ADR.Results The overall incidence of ADE was 4.20％ (26 cases),including 4 serious ones.The incidence of ADR was 3.07％ (19 cases),including 17 cases of general ADR and 2 cases of new ADR.All the ADR cases were mild or moderate,mostly showing damages in skin and appendages.The onset of disease happened in 24 hours after the Tanreqing injection but all the ADR cases got improved or cured.Having histories of allergies to drugs or foods would increase the incidence of ADR.Conclusion Tanreqing injection caused low incidence of ADR in children.Progams as stratifying high-risk patients and improving administrative management could further increase the safety level of Tanreqing injection.

Post-marketing surveillance of Tanreqing injection in children: a real world study / 中华流行病学杂志

Objective To evaluate the safety of Tanreqing injection among children in thereal world.Methods A multicenter,large sample,ambispective cohort study,with registration-type clinical safety monitoring.A total of 6 188 inpatients and patients from the emergency units,aged ≤14 years who all had been using Tanreqing injection in 59 secondary and tertiary hospitals in China,were recruited between January,2014 and May,2015.The main outcomes would include incidence and severity of adverse drug reaction (ADR)/adverse drug event (ADE) of Tanreqing injection.Univariate analysis was used to explain the risk factors of ADR.Results The overall incidence of ADE was 4.20％ (26 cases),including 4 serious ones.The incidence of ADR was 3.07％ (19 cases),including 17 cases of general ADR and 2 cases of new ADR.All the ADR cases were mild or moderate,mostly showing damages in skin and appendages.The onset of disease happened in 24 hours after the Tanreqing injection but all the ADR cases got improved or cured.Having histories of allergies to drugs or foods would increase the incidence of ADR.Conclusion Tanreqing injection caused low incidence of ADR in children.Progams as stratifying high-risk patients and improving administrative management could further increase the safety level of Tanreqing injection.

A bioequivalence evaluation of long-chain triacylglycerol/medium-chain triacylglycerol emulsion in beagle dogs / 中华临床营养杂志

Objective Long-chain triacylglycerol (LCT) by three producers,each mixed with the same medium-chain triacylglycerol (MCT),were compared with the brand MCT/LCT in causing focal necrosis of hepatocytes in beagle dogs (a bioequivalence evaluation).Methods 21 beagle dogs (male,0.7-1.5 years old,10-15 kg) were used in this study.According to the sources of the LCT,the animals were divided into Group A (LCT made in China),Group B (LCT made in Japan),Group C (LCT made in Germany),and the control group (the brand 10％ MCT/LCT).Central venous port was placed via the lumber vein of the animals under general anesthesia.After 2 weeks of rehabilitation,MCT/LCT was administered through this port for 28 days at 9 g/ (kg · d) [while the routine dose used clinically was 1 g/ (kg · d)].The laboratory indexes and the pathomorphism of the liver and kidney were studied single blindly.Results Laboratory tests,including liver and kidney function,blood coagulation function and lipid metabolism,did not identify differences among emulsions with different sources of LCT.Liver biopsy at day 28 showed no focal necrosis in Group C and the control group;there was minor damage in Group B;and Group A had obvious liver necrosis.and the pathological findings of other organs are similar.No significant difference was observed in biopsies of other organs.Conclusions Emulsions with different sources of LCT varied in their damage to the liver.Generics with LCT of higher quality were equivalent to the brand MCT/LCT in terms of safety.

The impact of fish oil (ω-3 fatty acids) intervention on infectious complications and cost-effectiveness for postoperative patients: systematic review (2010-2016) / 中华临床营养杂志

Objective To evaluate the impact of fish oil (ω-3 fatty acids) parenteral nutrition (PN) on outcomes for non-ICU postoperative patients.Methods PubMed,Embase,Cochrane,China National Knowledge Infrastructure (CNKI) and Wanfang Database etc.were searched to retrieve the eligible studies published from January 2010 to June 2016.The studies included were randomized controlled trials (RCTs) that evaluated the effects of supplementation of fish oil (Omegawen) in PN regimens for postoperative patients on clinical outcomes.The methodological quality assessment was based on Jadad scale and Schulz allocation concealment tool.Meta-analysis was conducted by RevMan 5.3 software.Results 19 RCTs,1 170 surgical patients,were included.Meta-analysis indicated that short-term fish oil supplementation significantly reduced the incidence of infectious complications [RR =0.44,95％ CI (0.31,0.64),P ＜0.000 1] and shortened the length of hospital stay [MD =-0.85,95％ CI (-1.67,-0.03),P=0.04],while with no significant effect on mortality [RR =0.42,95％ CI (0.07,2.63),P =0.36] and total expenditure of hospitalization [MD =-216.60,95％ CI (-718.94,285.75),P =0.40].Sensitivity analysis showed similar results.Conclusion According to existing evidence,fish oil in PN for surgical patients could reduce the incidence of postoperative infectious com-plications and shorten the length of hospital stay.

Efficacy and Safety of the Generic and Original Preparation of Atorvastatin:A Systematic Review / 中国药房

OBJECTIVE:To systematically review the efficacy and safety of the generic and original preparation of atorvas-tatin,and provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,EMBase,Cochrane Li-brary,CJFD,Wanfang Database,VIP and CBM,related randomized controlled trials(RCT)about generic preparation of atorvas-tatin(test group)versus original preparation of atorvastatin(control group)were collected. Meta-analysis was performed by using Rev Man 5.3 software after data extract and quality evaluation. RESULTS:Totally 16 RCTs were included,involving 2 077 pa-tients. Results of Meta-analysis showed,compared with control group,there were no significant differences in reducing total choles-terol (TC) [MD=-0.06,95%CI(-0.14,0.01),P=0.11],triglyceride (TG) [MD=-0.00,95%CI(-0.08,0.08),P=0.99], low-density lipoprotein cholesterol (LDL-C) [MD=-0.07,95%CI(-0.16,0.01),P=0.09],increasing high-density lipoprotein cholesterol(HDL-C)[MD=-0.00,95% CI(-0.03,0.03),P=0.96] and the incidence of major adverse cardiac events(MACE) [OR=1.18,95%CI(0.71,1.97),P=0.52] in test group;in terms of safety,compared with control group,there were no significant differences in the resulting in alanine aminotransferase (ALT) increased [OR=1.08,95%CI(0.51,2.30),P=0.83],the incidences of myalgia [OR=2.46,95%CI(0.70,8.65),P=0.16] and gastrointestinal adverse reactions [OR=1.11,95%CI(0.64,1.95),P=0.71]. CONCLUSIONS:Both the generic and original preparation of atorvastatin can effectively reduce blood lipid levels,with sim-ilar safety.

Erythromycin for improving enteral nutrition tolerance in adult critical patients: a systematic review and Meta-analysis / 中华危重病急救医学

Objective To systematically review the efficacy and safety of erythromycin on enteral nutrition (EN) tolerance in adult critical care patients.Methods Databases including PubMed,EMbase,the Cochrane Library,CNKI and Wangfang data were retrieved up to June,2013 to collect the randomized controlled trial (RCT) concerning erythromycin in improving EN tolerance or increasing the successful rate of postpyloric EN tube as compared with other treatments.Two reviewers independently screened the literature,extracted the data,and assessed the quality of methodology.Then Meta-analysis was performed using RevMan 5.2 software.Results A total of 16 RCTs were included.Ten RCTs involving 668 patients were included for evaluating erythromycin in improving EN tolerance.Six RCTs involving 353 patients were included for evaluating erythromycin to increase the successful rate of postpyloric EN tube.The result of Meta-analysis showed that compared with placebo,erythromycin could significantly improve the successful rate of postpyloric EN tube placement [relative risk (RR) =1.82,95％ confidence interval (95％CI) 1.40-2.37,P＜0.000 01],while there was no significant difference between erythromycin and metoclopramide (RR=1.04,95％ CI 0.79-1.36,P=0.799).In patients who needed early EN,compared with placebo or blank control,erythromycin had higher successful gastric feeding rate over 5 days (RR =1.89,95％ CI 1.19-3.00,P=0.007).In patients who failed EN,compared with metoclopramide,erythromycin could significantly increase the successful gastric EN rate for 24 hours (RR=1.30,95％CI 1.02-1.66,P=0.03),72 hours (RR=1.57,95％CI 1.15-2.14,P=0.005) and 144 hours (RR=2.04,95％CI 1.23-3.37,P=0.006).The median time of EN intolerance was postponed in erythromycin group than that in metoclopramide group.Adverse reactions were reported in 5 studies.There was no statistic difference except for the higher diarrhea rate in the combination treatment group compared with erythromycin group.Conclnsions Postpyloric EN tube placement rate can be improved by erythromycin,which could be a choice of substitute for bedside intubation without fluoroscopy or endoscopic assistance.Based on the evidence,we recommended that intravenous erythromycin in a small dose of approximately 3 mg/kg weight as an option for EN intolerance in critical patients.

Determination of Theophylline Concentration in Human Plasma by Micellar Electrokinetic Capillary Chromatography / 中国药房

OBJECTIVE:To develop a simple micellar electrokinetic capillary chromatography for determination of theophylline concentration in human plasma. METHODS: The determination of plasma sample(without any pretreatment) was performed on un-coated fused-silica capillaries (at an effective length of 21 cm) in which the cathodic buffer solution (solution A) was 15 mmol?L-1 borax(pH=10) and the running buffer solution(solution B) was sodium dodecyl sufate (SDS)(200 mmol?L-1) -contained solution A. The sample was injected into capillary by pressure with separation voltage of 12 kV;the UV detection wavelength was set at 280 nm;quantitation was performed by external standard peak area method. RESULTS: The average determination time of each sample was 11 min;the linear range of theophylline was 1.25～40 ?g?mL-1 with its lowest detectable limit at 0.5 ?g?mL-1;the average methodological recovery was 90.33%(RSD=2.51%);the intra-day RSD was 2.34%～3.36% and the inter-day RSD was 2.03%～6.51%,respectively. CONCLUSION: The developed method is simple,rapid and sensitive and it is applicable for the therapeutic drug monitoring of theophylline.

The Application of Bar Code Technology in the Prevention of Medication Errors / 中国药房

OBJECTIVE: To reduce medication errors by using bar code technology.METHODS: By searching the relevant literature about the bar code technology in preventing medication errors,this article systematically introduced the concepts of bar code technology,the FDA's bar code rules and the effect of it in reducing medication errors,as well as the current use of it by providing the relative data,examples and cases.RESULTS & CONCLUSIONS: Bar code technology can effectively reduce the incidence of medication errors.

Pharmaceutical Care for Hypertensive Patients after Renal Transplantation / 中国药房

OBJECTIVE:To provide a pharmaceutical care model for the practice of patient-centered clinical pharmacy so as to ensure safe,effective and economical clinical medication.METHODS:The concept,desired therapeutic outcomes and the treatment method of hypertension after renal transplantation were expounded;the issue of the key points in pharmaceutical care were decided,and immunosuppressive agents and antihypertensive drugs were administered and the pharmaceutical care plan was made based on patients’ conditions.The therapeutic outcomes were evaluated;the patients were educated to elevate their compliances.RESULTS & CONCLUSION:It is feasible to provide clinical pharmacists with an effective pharmaceutical care mode and method so as to provide better services for patients,doctors and nurses.

Effects of neurotropin on neuropathic pain: a pilot systematic review / 中国新药与临床杂志

AIM: To evaluate the efficacy and safety of neurotropin in the treatment of neuropathic pain.METHODS: A systematic literature search was performed in biomedical database including MEDLINE,EMBASE, Cochrane Central Register of Controlled Trials, CBM and CNKI. All studies focused on the clinical controlled trials, especially randomized controlled trials (RCTs) . The outcome measures included efficacy,life quality, cost of the treatment and adverse reactions. Quality assessments of clinical trials were evaluated with Jadad Score. Meta-analysis of included studies was performed with Revman software. RESULTS: Twenty-six clinical trials were included. Jadad Score of 24 trials was less than 3, which indicated the poor quality of the trials. None of the clinical trials evaluated the changes in life quality and cost related to neurotropin treatment.Meta analysis of 11 trials indicated neurotropin was more effective than placebo or blank, and the odds ratio of efficacy was 3.84 [2.68, 5.50] . The combining effect of 6 RCTs showed that neurotropin decreased the pain scores measured by Visual Analog Scale significantly compared with placebo or blank, the weighted mean difference (WMD) was -1.76 [-2.31, -1.21] . The pooled effects of the trials comparing neurotropin with other pain relieving drugs such as earbamazepine or NSAIDs also showed positive effect favored neurotropin.Neurotropin had no more adverse reactions than placebo, carbamazepine or NSAIDs, and the pooled risk difference was -0.01 [-0.04, 0.02] . CONCLUSION: According to present evidence, neurotropin may be effective and safe in the treatment of neuropathic pain. However, the poor quality of the studies decreases the persuasion of the results. Large-scale and well-designed RCTs with enough follow-ups should be carried out to provide further evidence for the use of neurotropin in neuropathie pain.