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ABSTRACT OBJECTIVE：To investigate the present situation of clinical pharmacy in different levels of medical institutions in Chongqing，and to investigate the method for optimizing clinical pharmaceutical care. METHODS：By questionnaire survey，50 sample medical institutions（including 15 third level hospitals，25 second level hospitals and 10 first level hospitals）in Chongqing were selected according to the region，the level of medical institutions，comprehensive and specialized hospitals. The team of clinical pharmacists and the development of clinical pharmacy were investigated，and the results were statistically analyzed to find common problems and put forward relevant suggestions. RESULTS & CONCLUSIONS：Totally 45 questionnaires were collected， with a recovery rate of 90％，of which 39 questionnaires were qualified，with a qualified rate of 86.67％. There were 32 hospitals （82.05％）in 39 medical institutions with clinical pharmacy departments and 4 hospitals（10.26％）with clinical pharmacist training base. There were 239 full-time pharmacists in 39 medical institutions，with an average of 6.13 persons in each medical institution， including 4.5 full-time clinical pharmacists，and 2-5 full-time clinical pharmacists（25 hospitals）in most medical institutions. Top 5 clinical departments that clinical pharmacists mainly participated in were respiratory department，cardiovascular department， endocrinology department，ICU and oncology department. Most of the clinical pharmacists（16 hospitals，42.11％）worked in the clinic for more than 50％ to no more than 80％. The number of medical institutions（28-37，＞70.00％）carrying out ADR monitoring， rational drug use knowledge publicity， prescription and medical order comment， ward round， consultation， editing and publishing drug information was relatively high. 28 medical institutions（78.95％）did not carry out the test of therapeutic drugs；39（100％）medical institutions had carried out the education of patients’drug use，in the form of billboards（30 hospitals，78.95％），science lectures（28 hospitals，73.68％）and drug education forms（28 hospitals，73.68％）The contents of drug use education mainly included precautions（39 hospitals，100％），usage and dosage（37 hospitals，97.37％）， ADR（36 hospitals，94.74％）. 29 hospitals had carried out clinical pharmaceutical research（73.68％），mainly rational drug use research（28 hospitals，73.68％）；5 medical institutions（12.82％）had set up joint pharmacy outpatient service，2（5.12％）had set up independent pharmacy outpatient service，the rest had not set up pharmacy outpatient service（26 hospitals，66.67％）. In this survey，it is found that there are some problems，such as incomplete coverage of beds in the ward in pharmaceutical care，weak foundation of scientific research in pharmaceutical departments. It is suggested that the national and local health committees should strengthen the construction of multi-level clinical pharmacy talent echelon，explore and train resident clinical pharmacists，select and build key clinical pharmacy specialties in Chongqing，and establish incentive mechanism for clinical pharmacists. Medical institutions at all levels can adopt multiple ways to accelerate the training of clinical pharmacists，increase the publicity of pharmacists’outpatient service，change the working mode of the ward，cultivate special clinical pharmacists，improve the ways and paths of continuing education，and enhance the strength of scientific research to improve the level of clinical pharmaceutical care.
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OBJECTIVE： To achieve the homogenization of pharmaceutical care in medical consortium and improve the capacity of pharmaceutical care in the region. METHODS： Medical consortium should be established， and then integrated pharmaceutical care system should be constructed； key points， entry points and effects of the system were introduced. RESULTS： Taking Chongqing Three Gorges Central Hospital as the center， “1+4+30” integrated pharmaceutical care system （which means “1 center， 4 medical communities and 30 medical consortium”） has been established. The system included four key points， such as the integration of supply and management system （the connection of supply catalogue， the integration of drug evaluation）， the standardization of pharmaceutical care （the establishment of pharmaceutical care standards or norms in medical consortium， the establishment and implementation of unified pharmacy service standards， the establishment of outpatient pharmaceutical care standards in drug treatment management）， the integration of personnel training and the sharing of information in the system； one breakthrough point which was “Internet+medical consortium” chronic disease drug treatment whole process management （including offline and online framework， hospital and out of hospital service process， the establishment of chronic disease drug management platform）. The establishment of this system could bring four effects， such as obvious benefits to patients， improvement of the pharmaceutical care ability in basic medical institutions， improvement of pharmaceutical care ability of leading units， accumulation of scientific research data. CONCLUSIONS： “1+4+30” integrated pharmaceutical care system realizes the homogeneity of management and service level within the system， realizes the whole process management of drug treatment for patients with chronic diseases， and constructs a new pharmaceutical care mode that is beneficial to patients， grass-roots units and leading units.
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<p><b>OBJECTIVE</b>To investigate the clinicopathologic characteristics, differential diagnosis and biological behavior of extracardiac rhabdomyoma.</p><p><b>METHODS</b>Nine cases of extracardiac rhabdomyoma diagnosed between January of 1997 and July of 2014 were reviewed. The clinical, pathologic and immunohistochemical profiles were evaluated.</p><p><b>RESULTS</b>There were 5 males and 4 females at diagnosis with age ranging from 2 years and three months to 59 years (mean, 37.6 years). Sites included the head and neck region (7 cases), chest (1 case ) and vagina wall (1 case). Clinically, most cases manifested as a subcutaneous nodule or as a submucosal polypoid lesion with a mean diameter of 3.2 cm. Histologically, 4 were adult-type rhabdomyoma characterized by tightly packed large round or polygonal rhabdomyoblasts with abundant eosinophilic to clear cytoplasm; 3 were myxoid variant of fetal rhabdomyoma composed of immature myofibrils, spindled and primitive mesenchymal cells embedded in a myxoid background, 1 was an intermediate form of fetal rhabdomyoma consisting of densely arranged differentiated myoblasts with little myxoid stroma; 1 was a genital rhabdomyoma composed of elongated or strap-like myoblasts scattered in loose fibrous connective tissue. By immunohistochemistry, they showed diffuse and strong positivity for desmin, MSA and myoglobin with variable expression of myogenin. A case of intermediate type also stained for α-smooth muscle actin. Follow up data (2 months ~ 17 years) showed local recurrence in one patient 6 months after surgery.</p><p><b>CONCLUSIONS</b>Rhabdomyoma is a distinctively rare benign mesenchymal tumor showing skeletal muscle differentiation, which may occassionally recur if incompletely excised. Familiarity with its clinical and morphological variants is essential to avoid misdiagnosing this benign lesion as embryonal rhabdomyosarcoma.</p>