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OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions for each diagnosis was basically the same as before； the defined daily dose system （DDDs） and proportion of a few antimicrobial drugs changed compared with before according to the anatomical therapeutic chemical classification of drugs， among which DDDs of lincomycin， gentamicin and other drugs declined significantly； DDDs of antimicrobial drugs for each classification was basically the same as before according to AWaRe classification. CONCLUSIONS The management mode of the use of antimicrobial drugs led by anti-infective clinical pharmacists is constructed in the prescription pre-reviewing center of county-level medical communities， which can effectively improve the rational use of antimicrobial drugs in the primary township medical institutions.
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OBJECTIVE To make up the research gap of the concept of collaboration between clinical pharmacists and physicians in China， and to provide a theoretical basis for further improving the collaboration. METHODS Literature analysis was used to sort out the existing concepts of collaboration. Combined with the current practice and development trend of the collaboration between clinical pharmacists and physicians in China， the basic elements of the concept were deconstructed and the connotation of each component of the concept was explained in detail. RESULTS & CONCLUSIONS Based on the above theoretical research and practical analysis， the concept of collaboration between clinical pharmacists and physicians in the context of China was defined， that is， clinical pharmacists and physicians adhere to the patient-centered and rational drug use as the core in clinical drug therapy， and make joint decisions on drug management and drug therapy on the basis of communication， respect， trust and sharing， so as to ensure the effectiveness， safety and economy of clinical pharmaceutical care， and improve the coordination and cooperation process of comprehensive disease treatment system.
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OBJECTIVE To explore the effects of intensive pharmaceutical intervention led by clinical pharmacists on hypertension patients with medium and high risk of ischemic stroke. METHODS The hypertension outpatients with medium and high risk of ischemic stroke， who were assessed by the modified Framingham stroke scale in Zhengzhou People’s Hospital from Oct. 2019 to Apr. 2020， were randomly divided into control group and intervention group， with 200 cases in each group. Patients in the control group received conventional treatment without pharmaceutical intervention； on the basis of conventional treatment， patients in the intervention group received 12-month intensive pharmaceutical intervention （grading management of compliance+ regular follow-up， involving medication education and guidance， blood glucose， blood pressure， blood lipid management and healthy life guidance） provided by clinical pharmacists. The blood glucose indexes， blood lipid indexes， blood pressure compliance rate， medication compliance， 10-year stroke risk and stroke incidence were compared between two groups at baseline and 12 months after enrollment. RESULTS After 12 months of enrollment， the level of low-density lipoprotein cholesterol （LDL-C） in intervention group was significantly lower than that in the same group at baseline， and the levels of fasting blood glucose， glycosylated hemoglobin， total cholesterol and LDL-C in intervention group were significantly lower than those in control group at the same time points （P＜0.05 or P＜0.01）. The compliance rate of blood pressure and medication compliance in intervention group were significantly higher or better than those in control group （P＜0.01）. There were 12 and 15 patients in control group and intervention group turned into low-risk ones respectively， and the proportion of high-risk patients in intervention group was significantly lower than that in control group（P＜0.01）， while the proportion of medium-risk patients was significantly higher than that in control group（P＜0.05）； the incidence of stroke in intervention group was significantly lower than that in control group （1.0% vs. 4.5%， P＜0.05）. CONCLUSIONS The pharmaceutical intensive intervention led by clinical pharmacists can reduce blood glucose and blood lipid levels of hypertensive outpatients， improve their blood pressure compliance rate and medication compliance， and help reduce the risk of stroke.
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OBJECTIVE To explore the construction of mind map by clinical pharmacists for the consultation of pulmonary nocardiosis and its application in clinical practice， and to provide reference for promoting the correct selection of nocardiosis treatment drugs in clinical practice and ensuring drug safety and efficacy. METHODS A total of 7 patients with Nocardia pulmonary infection from January 2017 to April 2022 in our hospital were collected. Based on evidence-based medicine， a consultation mind map （mainly including understanding the medical history， identifying infectious bacteria， identifying risk factors， developing treatment plans， and conducting evaluations） was constructed to address the difficulties of large differences in drug sensitivity among different strains of Nocardia and numerous adverse reactions of Compound sulfamethoxazole as a first-line drug. The treatment plan was developed for 7 patients with pulmonary nocardiosis， and whole-process pharmaceutical care was provided. RESULTS Combined with the mind map， different antibiotic combination regimens were given according to the drug sensitivity results of Nocardia， the different species of Nocardia， and the patient’s allergy history. Among them， 4 cases were treated with imipenem cilastatin， the patients receiving Compound sulfamethoxazole and linezolid for a long time were given full pharmaceutical care， and the adverse drug reactions were timely treated.CONCLUSIONS Clinical pharmacists apply the consultation mind map of pulmonary nocardiosis to the treatment of inpatients， take advantage of pharmacy， participate in clinical drug therapy， and really play a role in the clinical treatment team so as to promote rational drug use.
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Objective To explore the starting point of pharmaceutical care by clinical pharmacists for patients after heart valve replacement. Methods Combined with typical cases, the content, focus and effects of pharmaceutical care for patients after heart valve replacement were summarized. Results Clinical pharmacists provided pharmaceutical services such as anticoagulant care and warfarin dosage adjustment, infection monitoring and rational use and care of antibacterial, perioperative airway management, stress ulcer (SU) prevention and pharmaceutical care, and warfarin medication education for patients, which had promoted the rational use of drugs and improved the treatment results of patients. Conclusion Pharmaceutical care by clinical pharmacists could be helpful to improve the safety and efficacy of drug treatment for patients after heart valve replacement.
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OBJECTIVE To explore the pharmaceutical service model in multidisciplinary diagnosis and treatment （MDT） of rare diseases in children. METHODS Clinical pharmacists of West China Second University Hospital （hereinafter referred to as “our hospital”） participated in the process of MDT of children’s rare diseases. Clinical pharmacists took part in the entire diagnosis and treatment process of children and established the MDT pharmaceutical service model of children’s rare diseases by formulating drug treatment plans based on evidence-based practice， improving the accessibility of drugs， pharmaceutical monitoring and drug treatment management. RESULTS From January 2021 to April 2022， clinical pharmacists of our hospital had participated in a total of 39 cases of rare diseases MDT in children， including 21 hospitalized children with rare diseases and 18 outpatient com children with rare diseases， involving a total of 23 rare diseases. Clinical pharmacists completed 45 pharmaceutical zhanglingli@scu.edu.cn rounds and 26 pharmaceutical consultations for rare diseases inpatients， 25 outpatients’ MDT and 5 pharmaceutical outpatient service for outpatients with rare diseases， 38 medication educations for inpatients and outpatients with rare diseases and 25 follow-up services for out-of-hospital patients. There were 24 cases （61.54%） of off-label drug use， involving 13 rare diseases and 16 therapeutic drugs， among which off-label drug use registration of 11 drugs had been completed or was in progress. The temporary purchase evaluations of 3 drugs had been completed； 268 cases of medical insurance drug and high-value drug prescription had been reviewed. CONCLUSIONS Our hospital have primarily established a loop pharmaceutical service model of MDT for children with rare diseases， which covers inpatients and outpatients. The model improves the availability and standardization of clinical application of therapeutic drugs， and diagnosis and treatment level for children with rare diseases in our hospital.
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OBJECTIVE To provide reference for safe use of bevacizumab in tumor patient. METHODS Retrospective analysis was performed for a case of tracheomediastinal fistula caused by bevacizumab after radiotherapy in which clinical pharmacist participated. Retrieved from PubMed ，Elsevier Science Direct ，Springer Link ，Wiley Oline Library ，CNKI and Wanfang database ，the cases of respiratory fistula caused by bevacizumab were collected ，and the causes of respiratory fistula were analyzed. RESULTS & CONCLUSIONS Referring to relevant literatures ，combined with the formation position of fistula and considering its correlation with the use time of bevacizumab ，considering that it may be bevacizumab related tracheomediastinal fistula，clinical pharmacists recommended that patients stopped bevacizumab and underwent stent implantation. The patient refused to implant stent for personal reasons ，but the tracheomediastinal fistula improved 3 months after drug withdrawal. Combined with the data of 16 patients with respiratory fistula caused by bevacizumab ，it could be inferred that the use of bevacizumab on the basis of radiotherapy may be the cause of tracheomediastinal fistula ；the mechanism may be related to bevacizumab inhibiting angiogenesis and affecting wound healing. This suggests that for patients who have received radiotherapy ，clinical pharmacists should strengthen medication monitoring and medication education when using bevacizumab ；clinical pharmacists should not only pay attention to the common adverse reactions such as hypertension and bleeding caused by the drug ，but also pay attention to rare but life-threatening adverse reactions such as respiratory fistula ，so as to ensure the safety of drug use.
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Objective:To investigate the safety and efficacy of moxifloxacin in children with severe Mycoplasma pneumoniae pneumonia (SMPP).Methods:The patients with SMPP in the Pediatric Intensive Care Unit of Beijing Children's Hospital between January 2017 and April 2020 were retrospectively analyzed. Clinical data were collected to assess therapeutic efficacy, analyze drug safety and summarize positive rate of macrolide-resistant Mycoplasma pneumoniae genes mutation.Results:Thirty-nine children diagnosed SMPP treated with moxifloxacin were included. The positive rate of macrolide-resistant Mycoplasma pneumoniaegenes mutation was 95.2%. In the 39 patients, 6 (15.4 %) were cured, 29 (74.4 %) were effective, 2 (5.1 %) were no response, 2 (5.1 %) were discharged automatically during treatment with moxifloxacin, and the overall response rate was 89.8 %. The situations of consciousness, skin, joint, heart rhythm and gastrointestinal function were carefully observed; Blood routine test, liver and kidney function were closely monitored. There were no adverse drug reactions in the period of medication. No children were discontinued due to adverse reactions.Conclusions:Moxifloxacin can improve efficacy and prognosis for pediatric patients with SMPP. There are no drug adverse reactions during treatment with moxifloxacin, indicating that short-term medication is safe. The application of quinolones in pediatric patients is off-label drug use, and clinical pharmacists should assist clinicians in reducing medical risks.
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OBJECTIVE：To summarize and analyze t he clinical characteristics of acarbose-induced skin ADR ，and to provide reference for its therapy. METHODS ：Clinical pharmacists participated in the treatment of a patient with acarbose-induced skin ADR. The patient developed erythema multiforme several days after oral administration of Acarbose tablets （100 mg/d）. After consultation by dermatology and clinical pharmacy ，considering that the adverse reaction was related to acarbose ，clinical pharmacists suggested to stop the drug. Based on the above cases ，clinical pharmacists searched Wanfang database ，CNKI， PubMed，Embase and other databases to collect case reports of skin ADR caused by acarbose ，summarize its general situation （gender，age，usage and dosage ，etc.），latency，ADR（diagnosis and manifestation ），intervention and outcome ，etc. RESULTS ： The doctor adopted the pharmacist s’advice，stopped the use of acarbose ，and gave symptomatic treatment as Methylprednisolone sodium succinate for injection 40 mg（intravenous injection ，qd）+Medloratadine tablets 8.8 mg（oral administration ，qd）+Calamine lotion（for external use ）. The patient improved and was discharged after 10 days. A total of 12 literatures involving 12 patients were retrieved. Among the 13 patients included in the analysis （including the above clinical case and 12 literature cases ），there were 8 males and 5 females，and 8 patients of them aged 50 and over；the dosage of acarb ose in most patients was within the requirements of the drug instructions. The primary diseases of 12 patients were diabetes mellitus. The latency of skin ADR in 11 patients was within 6 days of administration. Among the 13 patients，the ADR were diagnosed as rash in 4 cases，pustulosis in 3 cases， erythema multiforme in 2 cases， urticaria in 2 cases， maculopapular rash in 1 case and lip swelling in 1 case. The ADR of 1 patient improved after drug withdrawal ，and 12 patients also improved after drug withdrawal and symptomatic treatment such as glucocorticoid or antihistamine. Acarbose was re-used in 2 patients after the improvement of first skin ADR ，and skin ADR occurred again ，and the ADR were improved after drug withdrawal and symptomatic treatment. CONCLUSIONS ：Skin ADR are acarbose-induced rare ADR ，mostly within 6 days of medication ，and are more likely to occur in middle-aged and older men. When the patients suffer from ADR ，the drug should be stopped in time and given glucocorticoids or antihistamines for symptomatic treatment. Clinical pharmacists should do a good job in drug publicity and education ，remind patients to closely monitor relevant indicators and ensure drug safety.
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OBJECTIVE：To summarize the current output research status of collaboration between clinical pharmacists and physicians in China ，and to provide reference for comprehensively understanding the development trend of relevant research and the collaborative value of clinical pharmacists and physicians. METHODS ：Literature analysis was used to sort out the general characteristics，the indexes and results of output related researches ，and investigate the focuses and results of collaboration output indexes from 3 dimensions，such as time ，hospital level and disease type /situation. RESULTS & CONCLUSIONS ：In the aspect of focuses，the number of output related researches in China had decreased in recent years ，among which tertiary hospitals conducted more related researches ；secondary hospitals had few related researches and a limited perspective on evaluating outputs. On the whole，the current researches paid more attention to t he use of antibiotics in bacterial in fection. Most of the research sites were inpatient departments ，and most of the research designs were historical controlled parallel trials and single arm trials. In addition，the three output measurement indexes of safety ， cpulucyxia@163.com effectiveness and economy develop diversely ， scientifically and comprehensively. Ho wever，at the present ，little attention was paid to complex and dif ficult measurement indexes ，such as“cognitive level of patients ”“recurrence rate ”improvement in “quality of life ”“cost-effectiveness/benefit analysis of clinical pharmaceutical care ”. In aspect of research result ，most of the existing researches could prove that the collaboration can significantly improve medication safety ，effectiveness and economy ；the proportion of “significantly improved ”results of most indicators had been stable or had increased stage by stage. However ，there were still a small number of researches that had not carried out statistical test on the results before and after collaboration. In the future ，relevant researchers still need to strengthen the research on outpatient pharmaceutical care ，randomized controlled trials and multi disease and multi situation ，and should scientifically and reasonably select output measurement indicators and pay attention to the application of statistical methods ，so as to further expand the focus of research and comprehensively explore the value of collaboration between clinical pharmacists and physicians.
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OBJECTIVE：To est ablish the working mode of the first pharmaceutical ward rounds of clinical pharmacists in our hospital，in order to provide a useful reference for establishing a national standardized pharmaceutical ward rounds model. METHODS：By sharing the clinical cases of the first pharmaceutical ward rounds ，the work content and process of the first pharmaceutical ward rounds in our hospital were introduced. RESULTS & CONCLUSIONS ：The clinical pharmacist ’s first pharmaceutical ward round in our hospital mainly includes self introduction of clinical pharmacists ，diagnosis of patients ’condition under the guidance of doctors ，collection and evaluation of patients ’previous medication information （including previous medication varieties ，usage methods ，efficacy and safety evaluation ），assistance for doctors in formulating initial treatment plan ， carrying out initial medication and diet education ，and intensive communication and cooperation with nurses. The development of first pharmaceutical ward rounds promotes the rational use of drugs in clinic ，elevates the hospitalization satisfaction of patients and improves the professional quality of clinical pharmacists.
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Objective To explore the role of clinical pharmacists in the treatment of drug poisoning by analyzing the clinical pharmacist's participation in the treatment of a patient with sodium valproate poisoning. Methods Clinical pharmacists measured the plasma concentration of sodium valproate to inform the doctor to diagnose illnesses. At the initial stage when the concentration is high, to eliminate the free drug by continuous venous-venous hemodialysis-filtration (CVVHDF). Then, the combined drug was cleared by hemoperfusion (HP). Results The blood concentration dropped by half at the first CVVHDF and decreased obviously after two HPs. After stable observation in five days’ course of disease, the blood concentration was maintained at a low level and the patient was cured and discharged. Conclusion The implementation of the blood purification program under the monitoring of the blood drug concentration with the participation of pharmacists is helpful for the rescue of drug overdose and is worthy of promotion.
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OBJECTIVE：To investigate the role of clinical pharmacists in the diagnosis and treatment of liposome-induced hand-food syndrome （HFS），and to provide reference for rational use of liposome preparation in clinic. METHODS ：One case of elderly female patient with breast cancer ，admitted to our hospital suffered from HFS （grade 2）after treated with Doxorubicin hydrochloride liposome ；after successful therapy ，the patient had skin symptoms （grade 3）again due to Paclitaxel liposome ，and clinical pharmacist judged the recurrence of HFS. For symptomatic treatment ，stopping the treatment and external use of hormone was suggested ，and whole-process pharmaceutical care was provided. The pathogenesis ，differential diagnosis ，risk factors and therapeutic drugs of HFS were summarized based on literature review and 2 case reports in the database. RESULTS ：The physicians adopted the suggestion of clinical pharmacists ；the patient ’s symptoms improved significantly on the third day and disappeared after 1 week. Combined with literature analysis and 2 case reports ，doxorubicin liposome metabolized more slowly than non liposomes in palms and soles of feet ，resulting in accumulation of doxorubicin in sweat duct and stratum corneum ，aggravating skin damage and leading to HFS. Sequential paclitaxel in liposome form may also lead to the accumulation in eccrine duct ，further caused skin damage and induced HFS. CONCLUSIONS ：Clinical pharmacists actively participate in the diagnosis and treatment of ADR ， which is conducive to the rehabilitation of patients. At same time ，combination or sequential of Paclitaxel liposome with PLD should be avoided ，as it can lead to ADR as HFS.
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Chronic Kidney Disease (CKD) patients usually require the use of anticoagulants for treatment or prevention of thromboembolic diseases. One such commonly used anticoagulant is enoxaparin. However, special attention is advised when using this drug for CKD patients because dosage adjustments may be needed. This prospective observational study was conducted in adult patients (> 18 years) with CKD stages 3 to 5 who were followed-up daily via prescriptions, medical records and laboratory tests. Enoxaparin doses, renal function and adverse drug events (ADEs) were thus monitored. Of the 87 ADEs identified in this study, 56 (64.3%) occurred in patients requiring enoxaparin prescription adjustment. Out of the 9 patients who had severe ADEs, 8 (88.9%) needed enoxaparin prescription adjustment. The results of this study suggest an overall increased risk of major bleeding and ADEs in patients requiring enoxaparin prescription adjustment. Further investigation of alternative dosing regimens in patients with CKD to maintain efficacy while reducing risks is imperative, as are studies on the utility of monitoring anti-factor Xa activity to guide dosing of enoxaparin. In addition, the role of clinical pharmacists in the management of CKD patients is crucial, as dose adjustments are often necessary.
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OBJECTIVE：To provide th e ideas a nd for individualized anti-infective treatment of infection after surgery for infants and young children with intussusception and enterobrosis ，and to provide reference for clinical pharmacists participating in the clinical treatment. METHODS ：Clinical pharmacists optimized the anti-infection program for an 11-month-old infant patient infected after surgery with intussusception and enterobrosis in Ordos Central Hospital ；they put forward medication suggestions in respects of the selection of initial anti-infection treatment program ，drug replacement ，the selection of anti-infection treatment program after blood culture showed Enterococcus coli and Enterococcus faecium ，and dosage adjustment. RESULTS ：According to the judgment of the common pathogens and the hospital or community infections in the infant patient with intussusception and enterobrosis，cefoperazone sulbactam 1.0 g，q12 h was adjusted to cefoperazone sulbactam 0.5 g，q8 h combined with Metronidazole chloride sodium injection 20 mL，q8 h；when the blood culture showed E. coli （ESBL-）and E. faecium ，it was recommended to add vancomycin 0.15 g，q12 h. After poor treatment ，it was recommended to adjust the vancomycin dose to 0.2 g，q8 h. All the above suggestions were adopted by doctors. And the child ’s body temperature dropped after treatment ，the blood culture turned negative and laboratory indicators returned to normal. The child was discharged smoothly. CONCLUSIONS ：Infants and young children are special groups. Therefore ，before using antibiotics ，clinical pharmacists should evaluate the age ，body weight ，liver and kidney functions of infants and young children. They should also help doctors select and adjust drugs ，frequency and dosage on the basis of pharmacokinetic characteristics and safety ，so as to avoid adverse drug reactions while ensure curative effect.
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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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OBJECTIVE：To provide reference for performance evaluation of pharmaceutical care for clinical pharmacists. METHODS：Based on literature review ，weighted TOPSIS method was used to formulate a performance evaluation system of pharmaceutical care. The performance of 120 pharmaceutical care work of 5 clinical pharmacists in our hospital from Jan. 2017 to Dec. 2018 was evaluated. RESULTS ：The performance evaluation detailed rules of clinical pharmacists ’pharmaceutical care work were successfully constructed ，including pharmaceutical ward round ，medication education ，medication consultation and pharmacy consultation，with a total of 17 evaluation indicators. Among 120 cases，there were 21 cases with relative approach degree ＞0.6 （17.5％）；73 cases had relative approach degree between 0.5 and ＜0.6（60.8％）；26 cases had relative approach degree between 0.4 and ＜0.5（21.7％）. The major problem was that the participation of clinical pharmacists in muti-disciplinary treatment ，the approval of scientific research fund projects were insufficient and not much paper was written. CONCLUSIONS ：The performance evaluation system of clinical pharmacists ’pharmaceutical care work based on weighted TOPSIS method is normative and reasonable，and it can be used in the evaluation of clinical pharmacists ’pharmaceutical care work . The results suggest that there are some defects in the performance of clinical pharmacists ’pharmaceutical care work in our hospital ，which need to be improved.
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OBJECTIVE： To provide reference for standardization and improvement of teaching model for endocrinology speciality in community clinical pharmacists training base. METHODS： Based on the requirments of community clinical pharmacists training in Shanghai， the characteristics and contents of community clinical pharmacists training were summarized， and teaching characteriatiostics， effect evaluation and problems werer analyzed on the basis of the acutual situation in our hospital. RESULTS & CONCLUSIONS： Community clinical pharmacists training has the characteristics of training for chronic diseases， short training cycle， and support from the medical consortium platform. Its contents are theoretical learning and professional knowledge training， pharmaceutical care and medication education， case discussion， homework guidance and comment. Compared with other specility， endocrinology speciality has the characteristics of strengthening comprehensive pharmaceutical care （for example， pharmaceutical care of diabetic patients should pay attention not only to hypoglycemia， but also to hypobaric， hypolipidemic and complications）， emphasizing medication treatment management （MTM） teaching （provide a series of professional services such as medication education， counseling and guidance， and medical reorganization for patients， so as to improve the safety， effectiveness and compliance of medication， and then control blood glucose， delay or avoid complications）， emphasizing the cultivation of health education ability and communication ability. The evaluation of training effect included the evaluation of trainees and teachers. The former includes objective evaluation （theoretical knowledge test， bedside medication education assessment and homework assessment） and subjective evaluation （attendance， attitude， clinical practice performance）. The latter is mainly scored by trainees on teachers （including professional level， teaching attitude， teaching ability and content）. Through the training， it is found that the trainees’ literature retrieval ability is poor， the trainees have not clear idea to diabetic patients， the homework writing and typesetting are not standardized； the teaching teachers have less experience and teachers could not teach the students in accordance with their aptitude and provide individualized training. The training and teaching mode needed to be further improved.
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OBJECTIVE： To explore the role of clinical pharmacists in medication therapy management （MTM）. METHODS： Referring to the practice model of MTM in the United States， taking a noninfectious chronic disease （obesity diabetes mellitus） patient as an example， clinical pharmacists of endocrinology specialty carried out MTM according to five processes， such as patient information collection， medication therapy review， the formulation of medication-related action plan （MRP）， interventions related to direct communication with physicians or advising patients to consult relevant medical service personnel， record and follow-up. RESULTS： The information of patients collected by clinical pharmacists included past medical history， family history， allergy history and medication history， etc. It was the top priority MRP for this patient to identify inappropriate hypoglycemic drug therapy， obesity-induced obstructive sleep apnea-hypopnea syndrome and hyperlipidemia. For obesity patients with type 2 diabetes mellitus， clinical pharmacists recommend that patients changed insulin drugs to non-insulin drugs， and liraglutide was recommended. In view of the poor control of blood lipid level， fenofibrate was recommended for patients on the basis of oral administration of simvastatin. The patient’s attending physician agreed with the above suggestion and adjusted the prescription. Clinical pharmacists provided medication education for the patients about the importance of each drug， control of total energy intake， balanced diet and physical exercise. The follow-up results after 6 months showed that blood glucose （fasting blood glucose 5-7 mmol/L， postprandial blood glucose 8-10 mmol/L） and blood lipid （total cholesterol 4.80 mmol/L， triglyceride 1.60 mmol/L， low density lipoprotein 3.05 mmol/L） of the patient were effectively controlled and body weight was reduced by 3 kg， but the improvement of lifestyle was poor， mainly due to the nature of his work. Clinical pharmacists once again communicated with him and emphasized the importance of proper physical exercise. The patients agreed to continue the follow-up. CONCLUSIONS： Clinical pharmacists can provide professional consultation and service for patients with chronic diseases by means of MTM service mode， which has certain value for improving medical quality.
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OBJECTIVE： To construct a collaborative relationship model between clinical pharmacists and physicians which is suitable for medical situations in China， and to provide guidance and reference for the relevant research. METHODS： Guided by theories relating to collaborative relationship， combined with the existing collaborative theories and practices of collaboration between pharmacists and physicians， the model was constructed through model synthesis， and was revised and improved on the basis of expert interview. Finally， the theory of the model was constructed. RESULTS： The collaborative relationship model of clinical pharmacists and physicians in China （CPPCR） was built， which was composed of five collaborative levels and three types of collaborative factors. Five collaborative levels included collaborative demand germination period， collaborative value identification period， collaborative relationship bonding period， collaborative mode strengthening period and collaborative relationship establishment period， while three types of collaborative factors included individual characteristics， work environment characteristics and interactive characteristics of clinical pharmacists and physicians. CONCLUSIONS： CPPCR is helpful to provide reference and basis for promoting their collaborative relationship and the development of related research.