Objective To investigate the impact of pregnancy complications and gestational exposure to toxic chemical on birth defect,to provide scientific basis for effective intervention measures.Methods 11 studies were included,the quality evaluation and information extraction were carried out on the studies according to include and exclude standard.3 248 examples in case group and 5 722 examples in control group.Fixed or random effects model was used according to heterogeneity test results,and the combined result was analyzed by Chi -square test.The publi-cation bias of the studies was also evaluated.Results The combined results of single factor analysis of pregnancy complications was 1.074(0.926 -1.222),showed that pregnancy complications were risk factors of birth defects.The combined results of single factor and multiple factors analysis of gestational exposure to toxic chemical were 1.426 (1.147 -1.704),1.421(1.174 -1.668),also showed that gestational exposure to toxic chemical was a risk factor of birth defects.Conclusion Pregnancy complications and gestational exposure to toxic chemical are risk factors of birth defects,this targeted provides reference to birth defects prevention.

Objective To explore the main risk factors related to birth defects to provide the scientific basis for making the best prevention policy and implementing the effective interventions .Methods Totally 21 domestic research articles on the risk fac‐tors of birth defects were comprehensively analyzed by the meta analysis method ,including accumulated 6 112 patients and 15 741 control cases .The articles were screened preliminarily according to inclusion and exclusion standard ,and then the fixed and random effects model were selected according to the homogeneity test .The merged results were performed the chi‐square test .Results The main merged results OR values of single‐factor‐analysis were as follows:the family history of birth defects 36 .22 ,early pregnant in‐fectious disease 5 .62 ,early pregnancy exposure to chemicals 4 .19 ,paternal smoking 3 .89 ,contact sedatives during pregnancy 3 .19 , pregnancy complication 2 .94 ,high protein food during pregnancy 0 .37 ;the main merged results OR values of multiple‐factor‐analy‐sis were as follows :early pregnancy infectious disease 7 .65 ,poor prenatal mental state 5 .44 ,early pregnancy fever 4 .70 ,early preg‐nancy exposure to toxic chemical 3 .90 ,history of abortion 3 .59 ,supplement of multivitamin during pregnancy 0 .45 .Conclusion The main risk factors of birth defects in our country are family history of birth defects ,early pregnancy infectious disease ,early pregnancy exposure to chemicals ,paternal smoking and pregnancy complication;the protective factors are eating more high protein food during pregnancy ,supplement of multivitamin during pregnancy and taking folic acid during pregnancy .

Objective To analyze the risk factors of congenital heart disease(CHD) in China by using the meta‐analysis method to provide reference for etiology study and prevention of CHD .Methods The Chinese literature database such as CBM , VIP ,CNKI ,Wan Fang were retrieved from 2005 to 2015 for collecting the related literatures ,then the collected literatures were screened ,performed the information extraction ,quality evaluation and merged analysis by using the Stata12 .0 software .Results In this study ,37 articles were included ,including 20 provinces (municipalities and autonomous regions) ,8 588 cases in the case group and 12 479 cases in the control group;a total of 21 risk factors(5 pre‐pregnant factors and 16 gestational factors) were included . Conclusion All 21 risk factors include 4 pre‐pregnancy factors ,15 gestational factors and 2 factors which not be verified .The top 3 risk factors and their OR values with 95% CI were gestational diabetes 5 .80(2 .72-12 .37) ,contacting the occupational risk factors 5 .14(3 .30-8 .00) ,advanced age before pregnancy 4 .96(1 .45-16 .97) .Not considering to be as the risk factors and their OR value with 95% CI are high body mass index before pregnancy 1 .32(0 .99 -1 .75) ,living near street during pregnancy 1 .36(0 .50-3 .71 ) .

Objective To evaluate the efficacy and safety of donepezil combined with memantine in the treatment of Alzheimer′s disease and provide a guidance for the proper clinical use of those medications.Methods The literatures published from 2014 to 2016 in CNKI/VIP/WanFang Med-online/CBM and other databases were collected.Screening and quality evalua-tion were carried out with include and exclude standard.The software RevMan 5.3 was used for data analysis.Results Eight-een studies included are randomized controlled trials with 900 cases in study group and 896 cases in control group.The com-bined results showed that MMSE,NPI and BEHAVE-AD of the combination therapy were superior to those of monotherapy group.There is no significant difference in ADL and ADAS-Cog.Conclusion The combination therapy was better than mono-therapy both in mental state and pathological behavior.The clinical application of those medications should be based on the spe-cific conditions of individual patient.

Objective Assessing the publication and quality of systematic reviews/Meta-analyses correlated to levofloxa-cin for MDR-TB in China to promote the rational use of levofloxacin .Methods A literature retrieving was made in CNKI/VIP/WanFang Med-online/CBM and other databases ,to collect literatures published in the nearly 10 years correlated to sys-tematic reviews/Meta-analyses of levofloxacin for MDR-TB .Two researchers screened the literatures ,extracted data and as-sessed the quality of literatures independently ,and then cross-checked .OQAQ and AMSTAR scale were used to qualify the methodological quality of included studies ,PRISMA scale was used to evaluate the report quality .Results Fourteen literatures were included ,of which 4 were Meta analysis and 10 were systematic reviews .OQAQ methodological quality rating up to 7 points and the lowest was 3 .5 points ,the average was 6 .21 points .The highest rate of in line with AMSTAR were entry 1 and 9 ,and the compliance rate of entries 2 ,4 ,8 ,10 were good as well .PRISMA report quality scored up to 21 points and the low-est was 13 .5 points ,the average was 19 .29 points .The main problems were:incomprehensive search strategy and scrope , none specific inclusion and exclusion criteria ,unreported selection bias and no evaluation of the quality of part of the included studies .Conclusion The publication and quality of systematic reviews/Meta-analyses correlated to levofloxacin for MDR-TB in China were good ,but still need further improvement .

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.

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.