Nebulization therapy is a direct drug administration process that turns liquid medications into mist that can be inhaled into the lungs and respiratory tract and is an important strategy for various respiratory problems and diseases. In recent years,there has been a high prevalence of respiratory diseases in China,so the popularity of nebulization at home and at basic-level hospitals has increased significantly. Therefore, the standardized application and rational administration of nebulization therapy should be concerned seriously. Led by the Chinese Medical Association Clinical Pharmacy Branch,the updating work of the Expert Consensus on the Rational Use for Inhaled Medicines Administrated by Nebulizers (2024 Edition) was carried out jointly by Chinese Medical Education Association Pharmacy Administration Professional Committee and Clinical Rational Drug Use Professional Committee.This consensus comprehensively introduces the drug delivery characteristics,safety and effectiveness,medication indications,application process and pharmaceutical care of nebulization therapy,the selection of small-volume nebulizers,new drugs for nebulized inhalation,recommended dosing regimens for respiratory diseases,etc.It aims to offer professional guidance for all healthcare providers of standardized nebulization therapy and rational administration.

Objective To summarize the exploration and current situation of pharmaceutical service fees in China,to analyze it in conjunction with practices in foreign countries,and to provide references for further improvement of pharmaceutical service fees in China. Methods The official websites of the National Health Commissi, National Healthcare Security Administration, and their provincial braches were retrieved to summarize the changes in policies in China and the latest pharmaceutical service fees policies in each province.At the same time,databases such as CNKI,VIP,and Pubmed were searched to summarize research on pharmaceutical service fees. Results There were some studies in China on the calculation of pharmaceutical service costs and fee standards,but they mostly focused on pharmacy dispensing services,with less discussion on the technical and labor value of specific pharmaceutical services,while international research in this area was relatively abundant.Currently,eight provinces and one municipality directly under the central government have issued medical service price items related to pharmaceutical service,with differences in fee items,fee standards,medical insurance payment ratios,and monitoring and evaluation indicators. Conclusions The inclusion of pharmaceutical services in the national medical pricing system recognizes the transformation of pharmaceutical services and the value of pharmacists.However,it is still in the early stages,and there is room for improvement and enhancement.

Objective To construct and validate a risk prediction model for poor inhalation in chronic obstructive pulmonary disease (COPD) patients receiving inhaler therapy,providing a decision support tool for personalized prevention of poor inhalation. Methods A cross-sectional study was conducted to collect data related to COPD patients receiving inhaler therapy,forming a dataset.The dataset was randomly divided into a training set and a test set in a ratio of 4:1.Four different methods for missing value imputation,3 methods for variable feature selection,and 18 machine learning algorithms were employed to successfully construct 216 models on the training set.The monte carlo simulation method was used for resampling in the test set to validate the models,with the area under curve (AUC),accuracy,precision,recall,and F1 score used to evaluate model performance.The optimal model was selected to build the poor inhalation prediction platform. Results A study involving 308 patients with COPD found that 135 (43.8%) were at risk of adverse inhalation.Using 33 predictor variables,216 risk prediction models were developed.Of these models,the ensemble learning algorithm yielded the highest average AUC of 0.844,with a standard deviation of 0.058 [ 95%CI=(0.843,0.845)].The differences in predictive performance among the 216 models were statistically significant (P<0.01).Under the ensemble learning algorithm,adherence to inhaler use(38.087 4%),inhaler satisfaction(25.680 1%),literacy(24.031 3%),number of inhalers(5.482 3%),age(4.204 5%)and number of acute exacerbations in the past year(2.184 7%)contributed most to the predictive model.The model exhibited superior performance,with an AUC of 0.869 3,an accuracy of 83.87%,a precision of 86.96%,a recall of 74.07%,and an F1 score of 0.8. Conclusion This study has developed a predictive model for poor inhalation risk in COPD inhaler therapy patients using machine learning algorithms,which exhibits strong predictive capabilities and holds potential clinical application value.

This article introduced the background,drafting process,and main content of the Interim Measures for the Management of Surplus Drugs in Medical Institutions of Hubei Province(referred as the Measures).It focused on explaining the definition of surplus drugs and analyzing the requirements for drug dismantling,surplus drug billing,recovery and use procedures,special fund management,and duties and responsibilities of management departments. This paper aimed to guide readers to learn the Measures, understand the Measures and implement the Measures. It would help to improve the efficiency of medical resources,ensure medication safety,reduce patients' medication burden,and promote the rational use of medical insurance funds.

Objective The purpose of this study is to investigate patients' willingness to pay for pharmacy services and its influencing factors by reviewing and analyzing the literature related to pharmacy services. Methods Relevant studies were identified by searching the CNKI database,Wanfang database,Sinomed,PubMed,and Web of Science from January 2010 to December 2023.Literature in both English and Chinese that elicited patient willingness to pay for pharmacy services was included.An analysis was carried out according to the year of publication,country,methodology,patient willingness to pay,and its influencing factors. Results 24 studies were retrieved,and the average willingness to pay ranged from $1 to $20.Patient willingness to pay for pharmacy services is influenced by various factors.Higher willingness to pay for pharmacy services is associated with higher income and education levels and lower out-of-pocket spending. Conclusions It is generally found that patients' willingness to pay is generally influenced by their income level,educational background,and medical insurance.We suggest that pharmacy services should be promoted and integrated into medical insurance coverage,and pharmacists' competency should be enhanced to accelerate the high-quality development of pharmacy services.

To define the concept of digital-intelligent pharmacy from three aspects:digital technology,digital intelligence,and data intelligence.By sorting out the development process of hospital pharmacy from informatization to digitalization and then to intelligence in recent years,and combining with the practical experience of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in the field of digital pharmacy,this paper discussed the meaning of digital pharmacy and provided new ideas and new assistance for the transformation of hospital pharmacy.Digital pharmacy refers to pharmacists with digital intelligence,who apply digital technology to hospital pharmacy scenarios,combining their own pharmaceutical knowledge,to obtain and produce data intelligence,and realize the digital transformation of hospital pharmacy.Digital pharmacy has become an emerging interdisciplinary subject in hospital pharmacy,which can promote the high-quality development of hospital pharmacy in the future and is a new productive force in hospital pharmacy.

Objective To investigate the current status and awareness of pharmaceutical services in hospitals in Guizhou province and to provide a reference for exploring and carrying out pharmaceutical service fees. Methods The questionnaire was designed by the “wjx.cn” website.Three kinds of questionnaires were designed for pharmacists,doctors,nurses,and patients as the research objects,with corresponding differences in some questions,and promoted on WeChat,Dingxiangyuan,and other network platforms. Results A total of 655 questionnaires were collected,and 639 valid questionnaires were recovered,with an effective recovery rate of 97.56%.324 pharmacists(50.70%),82 doctors and nurses(12.83%),233 patients(36.46%) were surveyed.The average approval score of these three groups of respondents on pharmaceutical service fees was 4.67,4.23,and 4.22,respectively(full score:5). Conclusions Overall,pharmacists' professional services have received support from medical staff and patients.However,patients' pharmaceutical service projects currently focus on dispensing services.The recognition of pharmacists' work and the public's awareness of pharmaceutical services can be improved by enhancing the professional ability of pharmacists,strengthening publicity and guidance,and exploring "Internet + pharmaceutical services",etc.,to promote the sustainable development of pharmaceutical services.

Objective To investigate the current awareness of pharmaceutical service fees among pharmacists in hospitals of Shaanxi province to provide a theoretical basis and decision-making framework for establishing such fees in hospitals of various provinces and cities in the future. Methods A questionnaire survey was conducted among 47 representative hospitals and 53 pharmacists within these hospitals in Shaanxi province.The results were analyzed using differential analysis. Results In most hospitals of Shaanxi province,pharmaceutical services are not provided or not charged for,indicating a lack of practical experience in the establishment of pharmaceutical service fees.Among hospitals that provide and charge for pharmaceutical services,there remains a need for uniformity in specific service content and fee standards,clear regulatory policy support,and a unified evaluation system.Significant differences exist among hospitals of different levels and types in terms of their capacity to provide pharmaceutical services and the forms in which they are offered.There is inconsistency among pharmacists within hospitals regarding crucial aspects of establishing pharmaceutical service fees,and further enhancement is needed in their awareness of relevant policies and the latest guidelines. Conclusions There is considerable room for improvement in establishing pharmaceutical service fees in hospitals of Shaanxi province.Stakeholders should promptly establish and standardize the fee establishment model,differentiate the fee standards for various services,enhance the publicity and dissemination of relevant document requirements to support the smooth implementation of pharmaceutical service fee policies.

In recent years,the National Health Commission has set improving the standardized utilization rate of intravenous infusion for inpatients as one of the goals for improving medical quality and safety.The rational allocation of intravenous drugs in medical institutions is a prerequisite for the standardized use of intravenous infusion.Therefore,it is imperative to establish a suitable evaluation and selection system for intravenous drugs.Based on the previous work,the Professional Committee of Intravenous Drug Formulation Management of the Chinese Pharmaceutical Association organized experts to discuss the dimension setting,score distribution,and scoring rules of the Quantitative Record Sheet for Evaluation and Selection of Intravenous Drug and compiled the Expert consensus on Evaluation and Selection of Intravenous Drug in Medical Institution.The aim is to provide references for selecting intravenous drugs and clinical medication decisions in medical institutions,ensuring that patients receive safe,effective,economical,and appropriate drug treatment.

Home enteral nutrition(HEN) has demonstrated advantages in improving patients' quality of life and reducing medical costs.It is widely embraced in the United States,Europe,and other regions.Due to individual differences in the characteristics of HEN preparations,drug interactions,and variations in patient nutritional status,patients need pharmaceutical supervision from a nutritional support pharmacist(NSP) when using HEN.HEN in China is still in its infancy.There are no corresponding norms and guidelines for NSP participation in HEN and a need for specific operating standards.This article delves into the current situation of NSP participation in HEN management,the content of pharmaceutical care,and the value of pharmaceutical services.It aims to offer valuable reference evidence for future practice and research.

Objective To systematically evaluate the efficacy and safety of the ceftazidime-avibactam (CAZ-AVI) regimen versus other regimens for treatment of carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infections, and to provide an evidence-based foundation for drug selection in clinical CRE bloodstream infections. Methods A computerized search was conducted in Pubmed, Embase, Cochrane Library, Web of Science, Wanfang Medical Network, CNKI and China Science and Technology Journal Database for literature on CAZ-AVI for CRE bloodstream infections from the inception of each database up to November 2023. The literature quality evaluation and data extraction were independently performed by two researchers. A meta-analysis was performed using Review Manager 5.3 software. Results A total of 15 English articles and 1 580 patients were included. The results showed that the clinical cure rate [OR=3.32, 95%CI=(2.25, 4.90), P<0.000 01] and microbial clearance rate [OR=3.00, 95%CI=(1.15, 7.81), P=0.02] were significantly higher in the CAZ-AVI group than in the control group, and the 28 d/30 d all-cause mortality rate of patients in the CAZ-AVI group was lower than that of the control group [OR=0.38, 95%CI=(0.29,0.51), P<0.000 01]. The recurrence rates of infection in the two groups were equivalent and statistically non-significant [OR=0.75, 95%CI=(0.39,1.42), P=0.37]. Subgroup analysis indicated that the CAZ-AVI group had a lower all-cause mortality rate than the tigecycline group [OR=0.20, 95%CI=(0.11,0.39), P<0.000 01]. In terms of safety, the incidence of adverse events between the two groups was comparable and statistically non-significant [RR=0.47, 95%CI=(0.20,1.07), P=0.07]. However, the nephrotoxicity was significantly lower in the CAZ-AVI group than in the control group [OR=0.36, 95%CI=(0.21,0.64), P=0.000 5]. Conclusion Based on the findings of the current study, CAZ-AVI offers potential clinical advantages in the treatment of CRE bloodstream infections by improving clinical cure rates and reducing mortality rates.

With the widespread use of carbapenem antibiotics, the clinical detection rate of carbapenem-resistant Gram-negative bacilli has shown a significant increase. Carbapenem-resistant Gram-negative bacilli isolates are often extensively or fully resistant, resulting in limited antimicrobial treatment options and high morbidity and mortality rates, posing a serious public health threat. The clinical treatment of carbapenem-resistant Gram-negative bacilli includes the use of single or combination antimicrobials such as polymyxin, tigecycline, and fosfomycin. A number of new antimicrobials and therapeutic approaches are under development. The clinical management of carbapenem-resistant Gram-negative infections is severely challenged by the limited choice of antimicrobial agents. Therefore, this article reviews the current status and progress of antimicrobial treatment for carbapenem-resistant Gram-negative bacilli to providing clinical reference.

The eighteen incompatible medicaments and nineteen counteraction theory belongs to the category of compatibility contraindications in Traditional Chinese Medicine (TCM), and has been used as a basis for rational evaluation in the review and evaluation of TCM prescriptions for a long time. However, there is constant controversy on the theory from perspectives of the historical origins, content categories, modern research, clinical applications, and ancient and modern academic. Thus the author gathered opinions medical and pharmaceutical experts from various types of medical institutions across the country based on literature review, expert interviews, and questionnaire surveys. The improved Delphi method and evidence review evaluation system were used to classify and understand, the eighteen incompatible medicaments and nineteen counteraction theory in a hierarchical manner. The core principles of this theory were analyzed using a classification model of "toxic-toxic" combination, "toxic-non toxic" combination and "non toxic-non toxic" combination. The recommendations for clinical safety risk assessment were formed on various types of evidence. The final consensus consists of three parts and a total of 19 statements, aiming to provide reference for the scientific and rational use of herbal medicines and the high-quality development of the industry.

Objective To explore the clinical characteristics and treatment strategies of patients with Carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection. Methods A retrospective analysis was conducted on demographic information, microbiological data, and clinical characteristics of patients with CRE bloodstream infections in Sichuan Provincial People's Hospital from September 2018 to December 2021. Results A total of 53 cases of CRE bloodstream infections were identified, with a treatment failure rate of 47.2%. Patients with bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) had a worse prognosis (P<0.05). Patients with treatment failure showed higher levels of procalcitonin, C-reactive protein, lactate dehydrogenase, and prolonged prothrombin time, along with lower levels of globulin (P<0.05). Among the 53 patients included in the outcome analysis following drugs, there was no statistically significant difference between monotherapy (n=15) and combination therapy (n=38) (P>0.05). Treatment regimens containing tigecycline were not superior to other strategies without tigecycline (P>0.05). Univariate analysis results indicated that the prognosis of CRE bloodstream infection was associated with endotracheal intubation, central venous catheterization, bacterial species which lead infection, comorbidities of the hepatobiliary system, and infection occurring after ICU admission (P<0.05). Health issues involving the hepatobiliary system and ICU-onset admission were independent risk factors for the prognosis of CRE bloodstream infection (P<0.05). Conclusion Patients with CRE bloodstream infections have a high mortality rate, and those with elevated procalcitonin and C-reactive protein levels indicate a poor prognosis. The use of tigecycline in combination or alone may not be the optimal treatment choice for CRE-related BSI.

Objective For more focused prevention and management, this investigation examines the risk factors for multidrug resistant organisms (MDRO) infections in intensive care unit (ICU) patients. Methods Case-control studies and cohort studies of risk factors for MDRO infection in ICU patients were searched in the Embase, Website of Science, Cochrane Library, PubMed, CNKI, WanFang, and VIP databases from their start to October 26, 2022. The Meta-analysis was carried out with RevMan 5.3. Results A total of 32 papers were included, with 10 985 cases studied, with the quality of the literature rated as moderate to high. The results of Meta-analysis of this study showed that gender [OR=1.21, 95%CI=(1.08,1.36), P=0.002], ICU length of stay [WMD=5.36, 95%CI=(3.99,6.73), P<0.000 01], total length of stay [WMD=8.96, 95%CI=(6.51,11.41), P<0.000 01], hypertension [OR=1.33, 95%CI=(1.10,1.60), P=0.003], abnormal renal function [OR=1.69,95%CI=(1.33,2.16), P<0.000 01], hypoproteinemia [OR=1.87,95%CI=(1.51,2.32), P<0.000 01], mechanical ventilation [OR=2.26,95%CI=(1.18,4.33), P=0.01], duration of mechanical ventilation [WMD=8.83,95%CI=(2.52,15.14), P=0.006], arteriovenous placement [OR=1.46,95%CI=(1.23,1.72), P<0.000 1], placement of urinary catheter [OR=1.71,95%CI=(1.25,2.36), P<0.000 01], gastrointestinal tube placement [OR=0.10,95%CI=(0.03,0.18), P=0.008], antimicrobial drug type ≥3[OR=4.27,95%CI=(2.06,8.85), P<0.000 01], use of carbapenem antibiotics [OR=4.09, 95%CI=(300,5.58), P<0.000 01], the use of the third-generation cephalosporin[OR=1.63, 95%CI=(1.15,2.33), P=0.007], the use of quinolone antibacterials [OR=1.86,95%CI=(1.42,2.44), P<0.000 01], the use of aminoglycoside antibiotics[OR=1.99, 95%CI=(1.49,2.67),P<0.000 01], use of piperacillin-tazobactam [OR=2.94, 95%CI=(1.56,5.54), P=0.000 9], use of glycopeptide antibiotics [OR=3.78, 95%CI=(2.48,5.78), P<0.000 01], use of sedatives [OR=3.25,95%CI=(2.06,5.14), P<0.000 01], and use of acid suppressants [OR=1.51,95%CI=(1.06,2.16), P=0.02] are risk factors for MDRO infection in ICU patients. Conclusion MDRO infections in ICU patients are associated with gender, duration of ICU stay, chronic lung disease, total length of stay, hypertension, abnormal renal function, hypoproteinemia, mechanical ventilation, duration of mechanical ventilation, arteriovenous placement, placement of urinary catheters, gastrointestinal placement, type of antimicrobial drugs≥3, use of carbapenem antibiotics, use of third-generation cephalosporin, use of quinolone antibacterials, use of aminoglycoside antibiotics, use of piperacillin-tazobactam, use of glycopeptide antibiotics, use of sedatives, use of acid suppressants, and other factors. Targeted controls of different factors such as underlying diseases, comorbidities, invasive procedures performed, and the use of antimicrobial medications and other therapeutic pharmaceuticals could limit the risk of infection in MDRO in ICU patients.

Objective In order to improve the rationalization of medication use for thrombosis prevention and treatment in children,the guideline aims to develop a comprehensive and practical guideline for pharmacy practice in the prevention and treatment of thromboembolic diseases in children.Through a systematic review of the available evidence-based medical evidence,specific recommendations for drug prevention and treatment are presented. Methods The World Health Organization (WHO) guideline development manual was used for the study design of the guideline.A systematic search and extensive collection of common medication problems for the prevention and treatment of thrombosis in children existed nationwide,and the Delphi method was used to research experts and determine the final clinical problems to be included.Then,a systematic literature search was conducted to comprehensively assess the existing original studies,systematic evaluations,and guidelines or consensus of professional organizations.Quality evaluation was conducted according to the grades of recommendations assessment,development and evaluation(GRADE) method,and consensus on the recommendations and level of evidence was reached again through the Delphi method,which ultimately led to the formation of the pharmacy practice guidelines for the prevention and treatment of thromboembolic diseases in children. Results A total of 29 clinical problems assessed by 74 experts in clinical pharmacy and clinical medicine were collected during the development of the guideline;15 clinical problems were screened through two rounds of questionnaires;and 15 clinical medication recommendations were developed under the supervision of two methodologists. Conclusion By comprehensively evaluating the feasibility and safety of clinical practice,the guideline will provide specific antithrombotic medication recommendations for pediatric healthcare professionals,which will help improve the prevention and treatment of thrombosis in children and promote more standardized and effective medical practice.

目的 探讨耐碳青霉烯类鲍曼不动杆菌颅内感染的治疗方案,以及多黏菌素类药物鞘内/脑室内给药方案的可行性。方法 根据患者的病情和医嘱,临床药师通过查阅文献,协助临床医师调整多途径给药物治疗方案:头孢哌酮钠舒巴坦钠(2 g,静脉滴注,qid)+注射用多黏菌素E甲磺酸钠(70 mg,静脉滴注, bid)+注射用多黏菌素E甲磺酸钠(10 mg,鞘内注射,qd),并对国内外近10年多黏菌素类药物治疗耐碳青霉烯类鲍曼不动杆菌颅内感染相关文献回顾分析。结果 给药14 d后,该患者感染得到治愈,未发现不良反应。共检索到15篇文献,涉及15例患者。纳入分析16例患者中(包含该文1例),男11例,女4例,1例性别不明,年龄1~74岁,基础疾病均与颅脑相关。15例成功治愈,仅1例因不能耐受不良反应(类变态反应)而停药。7例无多黏菌素类药物药敏结果,均成功治愈。11例经静脉联合鞘内/脑室多途径给药,均成功治愈。结论 多黏菌素类药物鞘内/脑室内给药可有效的治疗耐碳青霉烯类鲍曼不动杆菌颅内感染,大多数不良反应较轻且可逆。但文献多为个案报道,其在颅内感染的应用仍需进一步证实。

Immunotherapy, represented by immune checkpoint inhibitors (ICIs), has significantly changed the treatment status of most patients with malignant tumors. In order to regulate and guide the immunotherapy of cancer patients in China, the Chinese Society of Clinical Oncology (CSCO) has updated the Immune Checkpoint Inhibitor Clinical Practice Guidelines every year since 2020, which has been widely praised. The Version 2024 released this year has been significantly updated in terms of content, which can be summarized in five keywords as: "addition", "deletion", "upgrade", "downgrade" and "definiteness", with the characteristic of a large overall update range, the continuous advancement of immunotherapy, continuous enrichment of combination strategies, more first-line treatment options, and excellent performance of several drugs. This article provides a point-to-point interpretation of major updates in the new guideline.

The lack of preoperative guidelines for the management of drugs for psychiatric disorders will affect the quality of surgical management of psychiatric patients and increase the probability of perioperative complications.To standardize the preoperative management of medications for the treatment of mental disorders,the Perioperative Assessment and Quality Improvement Society issued 《Preoperative Management of Medications for Psychiatric Diseases: Society for Perioperative Assessment and Quality Improvement Consensus Statement》 in February 2022 to provide clinicians with recommendations for the preoperative management of psychotropic medications.This article interpreted the consensus,summarized the perioperative interactions,special precautions,and auxiliary examination precautions,and provided corresponding preoperative suggestions on antidepressants,mood stabilizers,anxiety,antipsychotics,and attention deficit hyperactivity disorder drugs,to provide a reference for the standardized management of perioperative drugs.

To promote the development of the prescription-based processing of Chinese herbal pieces,the China Association of Chinese Medicine published the social organization standard of the Standard for Prescription-based Processing of Chinese Herbal Pieces (T/CACM 1367-2021)in June 2021.The standard was led by the First Affiliated Hospital of Henan University of Chinese Medicine and Jiangsu Province Hospital of Chinese Medicine.It was jointly drafted by 28 Traditional Chinese medical institutions across the country.This paper introduced the standards in detail to promote the implementation and propel the inheritance and innovation of the processing of Chinese herbal pieces.