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  • 01 March 2024 Volume 43 Issue 3
      

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    Objective To provide a comprehensive evaluation framework for assessing the value of clinical pharmacy services, and to offer guidance for improving and optimizing the provision of clinical pharmacy services. Methods The World Health Organization (WHO) handbook for guideline development were used for the research design of the evaluation system guidelines. The Delphi method was used to identify clinical questions. The secretariat conducted systematic searches and collected existing evidence for the identified questions. Systematic reviews and evidence grading were performed,and evidence summaries were created. Based on the analysis report from the secretariat,the writing group developed specific guidelines. The Australian Joanna Briggs Evidence Level System, and the Grading of Recommendations Assessment,Development,and Evaluation (GRADE) system recommended by the World Health Organization in 2004 were used to grade the quality of evidence for this guideline. Consensus on recommendations and evidence grading was reached through a Delphi process. Finally,the practice Guidelines for the Value Evaluation of Clinical Pharmacy Services (First Edition) were established. Results More than 100 experts participated in the voting process by the Delphi method,and 23 value indicators for assessing the value of clinical pharmacy were included in the guidelines. The included indicators were searched and relevant systematic reviews,meta-analyses,network meta-analyses,and original studies were identified following the PICO principle. The Guideline Development Committee reviewed each search strategy. Consensus was reached on the definition and content of the included indicators,and 20 recommendations for the value assessment of clinical pharmacy were determined. Conclusion This guideline provides a set of indicators for measuring the quality and effectiveness of clinical pharmacy services,which is of great significance for improving the quality of clinical pharmacy services.
  • CHEN Xiaojing, ZHOU Li, LIU Kaiqi, DUAN Jufeng, LIU Ming, LI Hongliang, WANG Xuanbin
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    Objective To investigate the inhibitory effects and mechanisms of α-hederin,an active ingredient in Fructus Akebiae,on hepatocellular carcinoma (HCC) cells. Methods HCC cells were divided into four groups and treated with α-hederin (0,10,20,and 30 μmol·L-1) for 24 h and 48 h,respectively.MTT assays were used to detect the cell proliferation rate,flow cytometry (FCM) was used to detect the apoptotic rate,transcriptomics was used to screen signaling pathways in α-hederin-treated HCC cells,RNA interference was exploited to verify the underlying signaling pathway,and real-time quantitative PCR (qRT-PCR) and Western blotting (WB) were used to detect expression changes of the mRNA and protein of TP53 (p53),PMAIP1 (Noxa),and apoptosis-associated proteins,Caspase9 and Caspase3. Results α-Hederin induced apoptosis by activating apoptosis-associated proteins,PARP,Caspase9 and Caspase3.Transcriptomics,qRT-PCR,and WB results also showed that α-hederin increased the mRNA and protein expression of p53 and Noxa.Furthermore,α-hederin inhibited the protein degradation of p53 and Noxa,reversing the apoptosis decrease in p53/Noxa siRNA-knocked-down HCC cells. In vivo results showed that α-hederin inhibited the growth of HCC tumors. Conclusion α-hederin may induce the apoptosis of HCC cells by activating and stabilizing the p53/Noxa signaling pathway.
  • HU Nan, JIANG Zhenwei, QIAN Minyan, ZHANG Wenting, CHEN Lujun, ZHENG Xiao, YING Hanjie, JIANG Jingting
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    Objective To establish a method of LC-MS/MS for determining cordycepin (Cor)and 3'-deoxyinosine (3'-Deo)concentration in rat plasma,and to study their pharmacokinetics in rats. Methods Protein was precipitated with methanol using 2-chloadenosine (2-Chl)as an internal standard.The chromatography was performed on Kinetex C18 (3 mm×100 mm,2.6 μm,Phenomenex,USA)with gradient elution in aqueous (5 mmol·L-1 ammonium acetate)-methanol solution as mobile phase.ESI ion source was used for mass spectrometry,and positive ion multiple reaction monitoring (MRM)was used for scanning detection.The pharmacokinetics of Cor and 3'-Deo after oral administration of Cor (10 mg·kg-1)were studied in rats. Results Cor at 0.5-100 ng·mL-1 and 3'-Deo at 1-200 ng·mL-1 had good linearity,and the lower limits of quantification were 0.5 and 1 ng·mL-1,respectively. After oral administration of Cor in rats,the plasma concentration of Cor was low,which was mainly converted into the metabolite 3'-Deo.The Cmax of Cor and 3'-Deo were (5.4±3.4)and (142.0±50.0) ng·mL-1,and AUC0-360 min min were (658.4±459.3)and (18 034.9±4 981.1) ng·min·mL-1,respectively. Conclusion The method is simple,sensitive, and accurate,which is suitable for determining Cor and 3'-Deo concentration in plasma and the pharmacokinetic study.
  • YIN Jiaxin, SONG Yuxiao, ZHANG Bicheng
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    Immunotherapy,represented by immune checkpoint inhibitors (ICIs),has significantly changed the treatment strategy of non-small cell lung cancer (NSCLC) and has become an important therapy for all stages of NSCLC.However,there is an urgent need for further clarification regarding ICIs for elderly patients with advanced NSCLC.Treatment strategies for ICIs were guided by assessing survival data of elderly NSCLC patients included in clinical trials.We concluded that treatment regimens such as ICI monotherapy,dual immunotherapy,and ICIs combined with chemotherapy could be carried out in elderly NSCLC patients with a performance status (PS) score <2.Elderly NSCLC patients treated with ICIs could achieve similar benefits as younger patients and are generally well tolerated.However,as age increases (especially above 80 years),the efficacy decreased and the incidence of immune-related adverse events (irAEs) gradually increased.Therefore,ICIs should be carefully selected for advanced NSCLC patients at an advanced age.Compared to age,PS was a key factor causing patients to be excluded from ICIs and poorer survival outcomes.In conclusion,immunotherapy in elderly patients with advanced NSCLC is extremely challenging,and many issues still need further exploration in this field.

  • WANG Xinli, XUE Yan
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    Elderly breast cancer patients have different characteristics from young breast cancer patients,and their treatment faces many challenges.The treatment for elderly patients with breast cancer is often based on retrospective studies or evidence of general population lacks Class I clinical evidence. This article summarized the relevant clinical studies of advanced breast cancer with different molecular subtypes,explored the optional treatments and development directions for advanced elderly breast cancer,and provided reference for clinicians.

  • WANG Liqiang, DENG Haiyi, LIU Ming, LIN Xinqing, XIE Xiaohong, XIE Zhanhong, QIN Yinyin, OUYANG Ming, ZHOU Chengzhi
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    Patients with severe tumors do not refer to the patients with end-stage tumors,but rather to the patients with a performance status(PS) score between 2 and 4 in certain stages due to various reasons,such as acute or chronic comorbidities,tumor itself,or treatment-related adverse events.To these patients,there is a high probability of achieving survival benefit and/or improvement in PS scores after synergistic management of available life-support technologies and anti-tumor therapies based on dynamic and precise testing.Elderly patients with tumors frequently present with one or more chronic illnesses and have poor tolerance and compliance to treatment.Moreover,their treatment regimens often lack high-quality clinical evidence,making them more susceptible to developing severe tumors.The management of severe tumors in the elderly is based on three basic diagnosis and treatment technologies:dynamic and precise detection,powerful life support technologies,and skillful application of current anti-tumor treatments.In specific clinical practice,the following 7 flexible and individualized treatment strategies should be adopted for different tumor types:1.concurrent management of cancer and comorbidities,2.upgrading and downgrading of anti-tumor drugs based on PS score,3.dynamic accurate detection,4.skillful combinations for increasing efficacy and reducing toxicity,5.complete overview,paying equal attention to systemic therapy and local therapy,6.safety first in medication for the elderly,7.multi-disciplinary participation,individualized and comprehensive treatment.This article introduced the concept of severe tumors in the elderly and the associated management strategies,to increase awareness and provide feasible guidance for clinical practice.

  • SUN Yiting, TENG Zan, LIU Yunpeng, QU Xiujuan
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    Senescence is the major risk factor that promotes development of different stages of chronic liver diseases and is closely related to occurrence of hepatocellular carcinoma.Significant differences consist in clinicopathological features and tumor microenvironment between elderly and young patients with hepatocellular carcinoma.With rapid development of systemic therapy,immune checkpoint inhibitors combined with targeted therapy have greatly improved the prognosis of patients with advanced hepatocellular carcinoma.The selection of treatment decisions for elderly patients with hepatocellular carcinoma requires to consider unique age-related issues.Adequate communication and necessary evaluation should be carried out before making decisions.Elderly patients with hepatocellular carcinoma are speculated to benefit from combination immunotherapy based on age subgroup analysis of large clinical studies.However,data of effects and security obtained from clinical trials has certain limitations when being applied in elderly populations of real world.The optimal therapeutic strategies for elderly patients with hepatocellular carcinoma still remain to be further explored in large-scale prospective clinical studies.

  • LI Hui, LIU Xiufeng
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    Elderly patients are often complicated with a variety of underlying diseases. Because aging can impact the pharmacokinetics and pharmacodynamics of drugs,and affect the immune effect,conventional anti-tumor treatment modes such as radiotherapy,chemotherapy,targeted therapy,or immunization,can not achieve optimal efficacy.Comprehensive geriatric assessment (CGA) is a multi-dimensional and multidisciplinary diagnostic process,which is currently regarded as the core of the assessment of elderly patients with cancer.By utilizing a variety of tools and scales,comprehensive assessment of elderly patients with cancer can facilitate early intervention,guide reasonable treatment,increase the chances of benefit, and improve the quality of life for some elderly patients.Moreover,CGA can help reasonably allocate medical resources and reduce the economic burden on the community.

  • HUA Chengkun, LIU Jinwei, LIAO Xiaohong, CHEN Qiuling, ZHU Guifen, TANG Hongmei
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    Objective To establish the theories and methods for the compatibility of Chinese patent medicines in prescription review. Methods Based on the prescription combination theory and the classics literatures of traditional Chinese medicine,the methods of prescription suitability review for the compatibility of Chinese patent medicines were discussed. Results Based on the examples of the compatibility of Chinese patent medicines,five basic principles of combined Chinese patent medicines and the key points for reviewing the combined Chinese patent medicines dosage form were discussed in detail. Conclusion The methods for the compatibility of Chinese patent medicines prescription review have been established,which can provide a theoretical reference for the review of combined Chinese patent medicines prescriptions.
  • WEI Wenhao, MO Chou, HE Ying
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    Prescription indication reviews are the problematic points in reviewing prescriptions of Chinese patent medicines.However,there is no commonly recognized review standard.This article conducted a statistical analysis of the prescriptions reviewed by pharmacists from July to December 2022 in the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine. Combined with work experience,we analyzed the results and reasons for unqualified indication reviews,combed out the difficulties of the indications review in Chinese patent medicines,and proposed feasible strategies to provide support for the standardization and standardized development in reviewing prescriptions of Chinese patent medicines.

  • AN Qi, LI Shuang, YANG Dezhi, LYU Yang, DU Guanhua
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    In recent years,due to the development of disciplines such as molecular biology,cell biology,and materials science,the research of targeted therapy drugs has become a hot spot.Compared with conventional drugs,targeted therapy drugs can selectively increase the concentration and effectively reduce the toxic side effects of drugs in target tissues,which is an ideal way of drug delivery.Nanomaterial is receiving more attention for its superior performance in animals.The application and development of nanocrystals in targeted drug delivery systems has effectively broken the limitation of insoluble drugs and plays an indispensable role in drug delivery systems.In this paper,we briefly reviewed the characteristics and classification of targeted therapy drugs and the application of nanocrystals in pharmaceutical research to provide a reference for the related research.

  • LI Xian, YU Fei
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    L-carnitine is a carrier that assist in transport of long-chain fatty acids into mitochondria and an effective drug for treating primary carnitine deficiency (PCD).Starting supplementation as early as possible before irreversible organ damage occured can alleviate organ damage,reduce the risk of sudden death,and improve the quality of life.However,in recent years,some studies have suggested that long-term oral L-carnitine has potential risks,the metabolism of L-carnitine through intestinal flora results in the production of trimethylamine oxide (TMAO),which can increase the risk of cardiovascular disease (CVD).Therefore,this paper summarizes the clinical research progress of L-carnitine in treating PCD to provide a theoretical basis for the clinical application of L-carnitine in PCD.

  • JIAO Quanhui, ZHONG Lingyun, CHENG Ziwen, LYU Xiaobin, ZHANG Changhua
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    Ferroptosis is a unique iron-dependent cell death pattern,a novel death phenotype distinct from apoptosis,various forms of necrosis,and autophagy.Numerous active ingredients extracted from traditional Chinese medicine have been found to exert anti-cancer effects by inducing ferroptosis in various cancers.An increasing number of studies have found that the regulation of ferroptosis can influence the sensitivity of tumor cells to drugs and even reverse drug resistance.When combined with chemotherapy drugs such as cisplatin,5-FU and gemcitabine, some natural products enhance cancer cells’ sensitivity to chemotherapeutic drugs by inducing ferroptosis.This paper mainly summarizes traditional Chinese medicine and its natural products that can exert anti-cancer effects by inducing ferroptosis,providing new insights for cancer treatment and drug resistance reversal.Additionally, it contributes to exploring the potential advantages of traditional Chinese medicine, thereby expanding its scope of application.

  • WANG Liman, CHEN Yan, XU Lili, ZHOU Yujie, GE Weihong, XU Hang
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    Intestinal microorganisms and their metabolites are involved in the pathogenesis and progression of various cardiovascular diseases, especially in the progression of heart failure. This paper mainly discussed the gut microbial metabolites trimethylamine oxide (TMAO)participated in the pathological process of heart failure, and application value of TMAO in heart failure patients.This paper introduced the change characteristics of intestinal flora and its metabolites in heart failure patients,illuminated the TMAO-mediated inflammatory response,and the related signal pathways and mechanism of myocardial hypertrophy and heart failure.High levels of TMAO are associated with poor outcomes in patients with heart failure indicating a good predictive value for the prognosis of heart failure.Regulating TMAO levels through diet,probiotics and prebiotics,antibiotics,fecal transplantation,and other pathways is expected to be a potential treatment for heart failure.

  • LI Lian, ZHENG Xingyue, WU Liuyun, YIN Qinan, HAN Lizhu, LEI Yang, BIAN Yuan
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    Patients with primary membranous nephropathy (PMN)tend to develop thrombosis,especially in the early phase of the disease.The pathogenesis of thrombosis is multifactorial,with hypoalbuminemia being widely regarded as an independent risk factor.Other factors include proteinuria,M-type phospholipase A2 receptor antibody,and D-dimer.Although prophylactic anticoagulation therapy is frequently used in clinical practice to prevent thrombosis in PMN patients,there are still many unresolved issues regarding the optimal prevention of thrombosis in this condition.The timing of prophylactic anticoagulation,the threshold of serum albumin level,and the choice of treatment regimen are still lacking consensus.This article reviewed the relevant literature on these topics,aiming to establish a standard for thrombosis prevention and treatment for this population in the future and provide guidance for clinical practice.

  • YE Weiwen, GAO Lin, CAI Guowei, LAI Yecai, QIN Fei
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    Objective To develop a method for rapid determination of the dissolution of cefixime capsules,to explore the consistency of the dissolution curves of the generic and reference preparations in different media,and to assess the reliability of the in vitro dissolution evaluation method according to the results of bioequivalence studies. Methods The dissolution test was performed by the paddle method at 50 r·min-1,using pH1.2 hydrochloric acid solution,pH6.8 phosphate buffer solution,pH7.5 phosphate buffer solution, and water as the dissolution media.And a high-performance liquid chromatography (HPLC)method with a core-shell column was established to determine the dissolution curves of the generic and reference preparations respectively.The bioequivalence of the generic and reference preparations was evaluated through the bioequivalence (BE)test. Results The similarity factors (f2)of the three batches of the generic and reference preparations in the four media were greater than 60.The fasting and postprandial pharmacokinetic parameters (Cmax,AUC0-t,AUC0-∞)of the generic and reference preparations in humans were all in line with the bioequivalence standard. Conclusion The in vitro dissolution behavior of the generic and reference preparations was consistent, and the two preparations were bioequivalent.The method is simple and quick, and it can be employed to measure the dissolution of cefixime capsules,which can provide references for the consistency evaluation of cefixime capsules.
  • DAI Xiangrong, LIANG Jie, JIANG Tao, LI Gang, XU Leiming
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    Objective To screen and establish a method for determining the biological activity of anfibatide. Methods Three methods of light transmittance aggregometry (LTA),whole blood electrical impedance aggregometry,and continuous platelet count method were compared and studied.And the constant platelet counting method was chosen and verified to detect the biological activity of anfibatide. Results The RSD values of anfibatide biological activity detected by LTA,whole blood electrical impedance aggregometry,and continuous platelet count method were 10.3%,14.0%,and 3.6%,respectively.RSD of repeatability of 6 parallel test articles was 11.0%.The RSD of intermediate precision of 12 test articles for different personnel was 9.8%,and the inhibition rate of anfibatide was linear in the range of 0.3-0.5 U.The correlation coefficient was more than 0.990. The activity of three batches of anfibatide was determined,and the inhibition rate was 49.9%~53.6%. Conclusion The continuous platelet count method for determining anfibatide activity was established and verified,which can be used for quality control for anfibatide activity since the precision and detection limit of the method met the requirement for activity assay of biological products.
  • WANG Xiaolei, SUN Huizhu, LEI Rong, AN Qi, LIU Yongli
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    Objective To analyze the residual status,transfer behavior,and risk of paclobutrazole in the national market of Shenmai granules. Methods GC-MS/MS determined the residual amount of paclobutrazol in Shenmai granules,and ANOVA analyzed the distribution characteristics of sample residuals.The transfer rule of paclobutrazol from Ophiopogonis Radix to Shenmai granules was investigated by simulating the production process,and chronic exposure assessment was performed using the point evaluation model. Results The established method can accurately determine the residual amount of paclobutrazol in Shenmai granules.The residual amount of paclobutrazol in 85 batches of Shenmai granules ranged from 0.001 3 to 0.015 8 mg·kg-1,and there was a statistical difference in the residual amount among different enterprise samples.The transfer rate of paclobutrazol from decoction pieces to preparations was 29.8%.The chronic risk quotient (HQc) of paclobutrazol residues in Shenmai granules was 0.000 7%,far lower than 1. Conclusion There is a general presence of paclobutrazol residues in Shenmai granules.The risk assessment results show that the normal dosage of Shenmai granules does not pose an unacceptable risk to the general population.The residual distribution characteristics and process transfer rules can provide a reference for safety risk control in production enterprises.
  • GUI Xinjing, LI Han, WANG Yanli, FAN Xuehua, LI Haiyang, HOU Fuguo, YAO Jing, ZHANG Lu, SHI Junhan, LIU Ruixin, LI Xuelin
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    Objective To establish a rapid identification method for Bletilla Rhizoma and its similar decoction pieces using artificial intelligence nose technology and chemometric methods. Methods A total of 134 batches of Bletilla Rhizoma and its approximate decoction pieces (Gastrodiae Rhizoma,Polygonati odorati Rhizoma,and Bletilla ochracea)were collected.The α-FOX4000 electronic nose olfactory sensory data were set as the independent variable X.The decoction pieces were identified according to the Chinese Pharmacopoeia Commission 2020,local standards, and traditional identification experience.And the identification results were set as the benchmark identification information Y.Five chemometrics methods,principal component analysis-discriminant analysis (PCA-DA),partial least squares-discriminant analysis (PLS-DA),support vector machine (SVM),least squares- support vector machine (LS-SVM)and back propagation neural networks (BP-NN)were used to establish the two-class identification models of Bletilla striata and non-Bletilla striata and the four-class identification models of four kinds of decoction pieces Y=F(X).Taking the identification accuracy rate as the index,the optimal classification identification model is optimized. Results The positive discrimination rates of PCA-DA、PLS-DA、SVM and BP-NN in the two classification identification model were 95.52%,97.01%,91.79% and 84.33%,respectively.The PLS-DA identification model showed best accuracy.In the four classification identification model,the positive discrimination rates of PCA-DA、PLS-DA、LS-SVM and BP-NN models were 91.04%,88.06%,89.55% and 82.28% respectively.And PCA-DA identification model was the best. Conclusion The electronic nose technology can be used to characterize the odor characteristics of Bletilla Rhizoma and its approximate decoction pieces,and combined with multivariate statistical analysis methods,it can accurately and quickly identify Bletilla Rhizoma,providing a new idea and method for the objective expression of the odor of Chinese herbal decoction pieces and the identification of authenticity.
  • ZHOU Liujun, LI Xiaoling, WANG Yuqin, ZHANG Qingxia
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    Objective To investigate the incidence and causes of medication errors (MEs)related to aspirin in the elderly (≥ 60 years old)of China, to provide data for targeted precautions, and to promote medication safety in the elderly. Methods Reports about aspirin-related MEs in the elderly were extracted from the National Monitoring Network for Clinical Safe Drug Medication from September 22,2012 to September 22,2022.The severity of errors,content of errors,where errors were made,the personnel who made these errors,and causes of errors were analyzed retrospectively and statistically. Results A total of 386 MEs reports were extracted,235 males and 151 females,with a median age of 70 (60-98)years old.Regarding the severity of MEs,errors of class B were dominating (314 cases,81.35%).As for the severe MEs (9 cases,2.33%),5 cases of ME were associated with bleeding.There are four patients suffering from gastrointestinal bleeding:one patient took aspirin three times a day,one patient broke off enteric-coated tablets,one patient took aspirin as acarbose mistakenly,one patient took aspirin with Xuesaitong for long time.One patient had urinary urgency, but did not seek medical attention in time, then developed into visible hematuria.Two patients missed taking aspirin led to stent thrombosis.One patient suffered from diarrhea after overdosing on 29 pills of aspirin by mistake.One patient with hyperuricemia had gout after taking aspirin.Among these 386 MEs,224(58.03%)cases were triggered by physicians,the first three error factors were frequency (multiple times a day),dosage (the dosage of enteric-coated tablets is not the whole tablet), and variety.Most of these MEs were due to a lack of knowledge or training, and fatigue.Regarding the MEs caused by pharmacists (87 cases,22.54%).Pharmacists identified 274 cases (70.98%)of errors. Conclusion When it comes to aspirin-related MEs,it ought to be noticed that the drug usage and dosage,drug interaction,and selection of drug varieties when combining with other diseases (such as atrial fibrillation and hyperuricemia).It is recommended that information construction be fortified to decrease the ME of the prescription link,and the clinicians be better informed of rational drug use.At the same time,patient medication education should be improved.
  • CAO Xinrui, ZHANG Ruobin, LIU Ziqiu, YAN Simin, GE Weihong
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    Objective To retrospective analyze the use of inpatients taking sacubitril/valsartan in Nanjing Drum Tower Hospital, and to provide references for rational clinical application. Methods The relevant data of inpatients taking sacubitril/valsartan in our hospital were systematically collected from July 2019 to September 2021, and the rationality of drug use was evaluated. Results A total of 2 682 cases were collected, and 868 cases (32.36%) of them involved 918 times of irrational drug use. The specific situations of irrational drug use included off-label use (182 times), irrational usage and dosage(389 times), irrational conversation of drugs (251 times), and irrational drug use for special populations (96 times). Conclusion The use of sacubitril/valsartan exists in unreasonable situations in our hospital. Clinical pharmacists should participate in medication management to a certain extent, strengthen the pharmaceutical care of patients, and improve the rational rate of drug use.
  • YU Fei, LU Jing, GAO Chenxu, LI Jingwei
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    Payment by diagnosis related groups (DRG) is an important research direction in China's current medical insurance payment reform.However, it limits the clinical development and utilization of innovative medicines to a certain extent.Additional payments for innovative medicines have been thoroughly studied in many countries.This paper conducted an analysis and summary of the global experience regarding additional payment for innovative medicines under the DRG payment system.Using the United States,France, and Germany as case studies, this paper also examined the current state of medical insurance payment for innovative medicines in China and the influence of DRG payment on the development of such medicine.In addition, it has put forward explicit policy recommendations, including the establishment of inclusion criteria, the selection of appropriate payment modes, the implementation of dynamic adjustment mechanisms, the enhancement of payment methods,etc.This paper aims to provide references to comprehensively promote DRG payment reform while further establishing and enhancing medical insurance payment mechanisms related to innovative medicines in the context of China's national conditions.

  • SHEN Haijuan, QIN Qiong, WEI Wei
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    Objective To investigate the effectiveness of 4M1E refined management method in reducing dispensing time of outpatient prescription in outpatient pharmacies under the implementation of a long-term prescription policy. Methods The hospital started to implement 4M1E refinement management in July 2022.Ten thousand prescriptions were randomly selected for each of the pre-implementation (from January to June 2022) and post-implementation (from July to December 2022) human-machine hybrid dispensing windows.The dispensing time of a single prescription,the volume of prescriptions dispensed and the number of drugs prescribed during peak periods,the use of intelligent equipment,and patient satisfaction before and after implementation were compared. Results After implementation,the single prescription drug dispensing time at the mixed human-machine dispensing window was reduced from (96.88±1 401.17) s to (55.84±526.24) s(P<0.01);The number of prescriptions dispensed in the window increased from (135.20±21.06) to (147.19±21.24)prescriptions per 2 h,and the number of drugs prescribed increased from (871.74±215.61) to (1 008.53±267.87) prescriptions per 2 h during peak hours. The rate of straight prescription and the rate of equipment automation have been greatly improved. Outpatient satisfaction was higher than before management.The data showed statistical differences (P<0.05). Conclusion Under long-term prescription pressure,hospital outpatient pharmacies can greatly reduce prescription dispensing time and improve patient satisfaction after applying the 4M1E fine management method.