In 2024, a total of 27 309 cases of medication error (ME) from 484 hospitals in 27 provincial administrative regions were collected in the National Monitoring Network for Clinical Safe Medication. Among them, 279 (1.02%) were classified as grade A, 22 081 (80.86%) as grade B, 4 268 (15.63%) as grade C, 472 (1.73%) as grade D, 96 (0.35%) as grade E, 105 (0.38%) as grade F, 6 (0.02%) as grade H, and 2 (<0.01%) as grade I; no MEs of grade G occurred. Among the 27 030 patients involved in MEs of grade B to I, 15 124 (55.95%) were male and 11 906 (44.05%) were female; their ages were from 1 day to 104 years; 3 369 (12.46%) were children (<18 years old), 12 113 (44.81%) were young and middle-aged adults (≥18 to <60 years old), and 11 548 (42.72%) were elderly (≥60 years old). The top 3 contents of ME were wrong drug class (5 347 cases, 19.13%), wrong dosage (4 913 cases, 17.58%), and wrong administration frequency (3 429 cases, 12.27%). Among the 27 030 grade B-I MEs, the main person who triggered the event were physicians (18 703 cases, 69.19%) and pharmacists (6 343 cases, 23.47%). These MEs mainly occurred in clinics (11 009 cases, 40.73%), in hospital wards (7 393 cases, 27.35%), and in pharmacies (6 219 cases, 23.27%). The main persons who discovered the MEs were pharmacists (21 021 cases, 74.14%). The top 3 factors causing ME were lack of related pharmacologic knowledge (8 716 cases, 26.49%), tiredness (5 755 cases, 17.49%), and inexperienced skills (4 505 cases, 13.69%). A total of 209 patients were involved in severe MEs (grade E-I), including 133 (63.64%) males and 76 (36.36%) females, aged from 21 months to 94 years, of which 42 (20.10%) were children, 75 (35.88%) were young and middle-aged adults, and 92 (44.02%) were elderly. The top 3 diseases diagnosed in severe MEs were drug poisoning (41 cases, 19.62%), diabetes (34 cases, 16.27%), and hypertension (14 cases, 6.70%); the main person who triggered the MEs were patients and their families (135 cases, 64.59%); the MEs occurred mainly in patients′ houses (116 cases, 55.50%). Drug poisoning was mainly related to accidental ingestion by children, and MEs in patients with diabetes and hypertension were often related to issues on patient compliance. Based on the data of MEs in 2024, it was proposed to establish a better medication safety culture and improve the ME reporting situation in China, pay attention to the risks of misusing external drugs for internal use, children′s accidental ingestion and insulin-related MEs, strengthen the prevention of MEs related to look-alike sound-alike drugs, pay attention to the post administration management and the compliance education of home care for patients with chronic diseases, so as to improve the medication safety of patients in China.

In 2024, a total of 27 309 cases of medication error (ME) from 484 hospitals in 27 provincial administrative regions were collected in the National Monitoring Network for Clinical Safe Medication. Among them, 279 (1.02%) were classified as grade A, 22 081 (80.86%) as grade B, 4 268 (15.63%) as grade C, 472 (1.73%) as grade D, 96 (0.35%) as grade E, 105 (0.38%) as grade F, 6 (0.02%) as grade H, and 2 (<0.01%) as grade I; no MEs of grade G occurred. Among the 27 030 patients involved in MEs of grade B to I, 15 124 (55.95%) were male and 11 906 (44.05%) were female; their ages were from 1 day to 104 years; 3 369 (12.46%) were children (<18 years old), 12 113 (44.81%) were young and middle-aged adults (≥18 to <60 years old), and 11 548 (42.72%) were elderly (≥60 years old). The top 3 contents of ME were wrong drug class (5 347 cases, 19.13%), wrong dosage (4 913 cases, 17.58%), and wrong administration frequency (3 429 cases, 12.27%). Among the 27 030 grade B-I MEs, the main person who triggered the event were physicians (18 703 cases, 69.19%) and pharmacists (6 343 cases, 23.47%). These MEs mainly occurred in clinics (11 009 cases, 40.73%), in hospital wards (7 393 cases, 27.35%), and in pharmacies (6 219 cases, 23.27%). The main persons who discovered the MEs were pharmacists (21 021 cases, 74.14%). The top 3 factors causing ME were lack of related pharmacologic knowledge (8 716 cases, 26.49%), tiredness (5 755 cases, 17.49%), and inexperienced skills (4 505 cases, 13.69%). A total of 209 patients were involved in severe MEs (grade E-I), including 133 (63.64%) males and 76 (36.36%) females, aged from 21 months to 94 years, of which 42 (20.10%) were children, 75 (35.88%) were young and middle-aged adults, and 92 (44.02%) were elderly. The top 3 diseases diagnosed in severe MEs were drug poisoning (41 cases, 19.62%), diabetes (34 cases, 16.27%), and hypertension (14 cases, 6.70%); the main person who triggered the MEs were patients and their families (135 cases, 64.59%); the MEs occurred mainly in patients′ houses (116 cases, 55.50%). Drug poisoning was mainly related to accidental ingestion by children, and MEs in patients with diabetes and hypertension were often related to issues on patient compliance. Based on the data of MEs in 2024, it was proposed to establish a better medication safety culture and improve the ME reporting situation in China, pay attention to the risks of misusing external drugs for internal use, children′s accidental ingestion and insulin-related MEs, strengthen the prevention of MEs related to look-alike sound-alike drugs, pay attention to the post administration management and the compliance education of home care for patients with chronic diseases, so as to improve the medication safety of patients in China.

Cirrhotic portal hypertension (CPH) is a manifestation of decompensated liver cirrhosis, with ascites, portal collateral circulation formation, hypersplenism and splenomegaly as the typical clinical symptoms. In recent years, the incidence of CPH has been increasing year by year, and the treatment of CPH has gradually become a hot issue in medical research. In order to further explore the diagnosis and treatment scheme of CPH. We briefly describe the pathophysiological mechanism and diagnosis of CPH, and the current situation of CPH treatment and the new progress of internal and external treatment were reviewed.

Primary prostate synovial sarcoma (PPSS) is rare in clinic. One patient was admitted to our hospital in May 2021. The patient was admitted to the hospital because of the physical examination. Preoperative pelvic enhanced MR, PETCT and preoperative puncture pathology suggested that pelvic soft tissue sarcoma was likely. Robot-assisted radical resection of pelvic tumor was performed, and the unilateral PPSS was diagnosed by postoperative pathology, immunohistochemistry and gene detection. Patients were treated with ifosfamide + adriamycin adjuvant chemotherapy one month after operation, and Proton therapy radiotherapy five months after operation. Follow-up for more than 2 years showed that the patients were generally in good condition, and no recurrence or metastasis was found in imaging.

Objective:To understand the current status of perioperative analgesics use and management in China.Methods:A questionnaire was self-designed with the content consisting of 4 dimensions (the basic information of the respondents, perioperative analgesics management, medical behaviors in perioperative analgesia, and understanding of analgesics-related knowledge) and 55 questions (8, 10, 22, and 15 questions under 4 dimensions, respectively). The questionnaire was sent through Wechat by the members of Chinese Pharmacological Society Professional Committee of Drug-induced Diseases and Anesthesiology Branch of the Chinese Medical Association. Anesthesiologists, surgeons/nurses and clinical pharmacists volunteered to participate in the survey and submitted in anonymous form directly. The investigation period was from August 1 to 31, 2020.Results:A total of 204 effective questionnaires were received from 45 hospitals in 19 provinces and cities, including 43 tertiary hospitals (95.6%) and 2 secondary hospitals (4.4%). Among the 204 respondents, 46 were surgeons (22.5%), 80 were anesthesiologists (39.2%), 32 were clinical pharmacists (15.7%), and 46 were surgical nurses (22.5%). Of the 45 hospitals where the respondents work, 35 (77.8%) had established regular communication mechanisms for perioperative pain management, and 22 (48.9%) arranged clinical pharmacist to assist the work of the physician in the clinical division. Among the 204 respondents, 76.5% (156 respondents) received knowledge training on analgesics once or twice a year; 60.3% (123 respondents) had found irrational use of perioperative analgesics in their daily work, and the top 3 problems were about drug selection [74.0% (91/123)], usage and dosage [69.1% (85/123)], and drug interactions [46.3% (57/123)]; 37.3% (76 respondents) had found the problem of irrational use of the analgesia pump, and the top 3 problems were about the usage and dosage [69.7% (53/76)], drug selection [67.1% (51/76)], and contraindications [36.8% (28/76)]. Only 13.7% (28/204) of the respondents had a score of ≥120 points (full score of 150 points) in the survey for understanding of knowledge about analgesics. There was 53.9% (110/204) of the respondents with a score of <90 points, including 50.0% (23/46) of the surgeons, 43.8% (35/80) of the anesthesiologists, 46.9% (15/32) of the clinical pharmacists, and 80.4% (37/46) of the surgical nurses. Only 4 of the 15 questions had a correct answer fill rate of >50%.Conclusion:Most of the hospitals surveyed have established relevant mechanisms for perioperative pain management, but there are still problems of irrational use of perioperative analgesics and analgesia pumps. About half of the surgeons, anesthesiologists, clinical pharmacists, and most of the surgical nurses have little understanding of knowledge about analgesics.

Objective:To understand the current status of perioperative analgesics use and management in China.Methods:A questionnaire was self-designed with the content consisting of 4 dimensions (the basic information of the respondents, perioperative analgesics management, medical behaviors in perioperative analgesia, and understanding of analgesics-related knowledge) and 55 questions (8, 10, 22, and 15 questions under 4 dimensions, respectively). The questionnaire was sent through Wechat by the members of Chinese Pharmacological Society Professional Committee of Drug-induced Diseases and Anesthesiology Branch of the Chinese Medical Association. Anesthesiologists, surgeons/nurses and clinical pharmacists volunteered to participate in the survey and submitted in anonymous form directly. The investigation period was from August 1 to 31, 2020.Results:A total of 204 effective questionnaires were received from 45 hospitals in 19 provinces and cities, including 43 tertiary hospitals (95.6%) and 2 secondary hospitals (4.4%). Among the 204 respondents, 46 were surgeons (22.5%), 80 were anesthesiologists (39.2%), 32 were clinical pharmacists (15.7%), and 46 were surgical nurses (22.5%). Of the 45 hospitals where the respondents work, 35 (77.8%) had established regular communication mechanisms for perioperative pain management, and 22 (48.9%) arranged clinical pharmacist to assist the work of the physician in the clinical division. Among the 204 respondents, 76.5% (156 respondents) received knowledge training on analgesics once or twice a year; 60.3% (123 respondents) had found irrational use of perioperative analgesics in their daily work, and the top 3 problems were about drug selection [74.0% (91/123)], usage and dosage [69.1% (85/123)], and drug interactions [46.3% (57/123)]; 37.3% (76 respondents) had found the problem of irrational use of the analgesia pump, and the top 3 problems were about the usage and dosage [69.7% (53/76)], drug selection [67.1% (51/76)], and contraindications [36.8% (28/76)]. Only 13.7% (28/204) of the respondents had a score of ≥120 points (full score of 150 points) in the survey for understanding of knowledge about analgesics. There was 53.9% (110/204) of the respondents with a score of <90 points, including 50.0% (23/46) of the surgeons, 43.8% (35/80) of the anesthesiologists, 46.9% (15/32) of the clinical pharmacists, and 80.4% (37/46) of the surgical nurses. Only 4 of the 15 questions had a correct answer fill rate of >50%.Conclusion:Most of the hospitals surveyed have established relevant mechanisms for perioperative pain management, but there are still problems of irrational use of perioperative analgesics and analgesia pumps. About half of the surgeons, anesthesiologists, clinical pharmacists, and most of the surgical nurses have little understanding of knowledge about analgesics.

Objective:To investigate the clinical characteristics, differential diagnosis and treatment of IgG4-related kidney disease (IgG4-RKD) presenting as a cystic renal mass.Methods:A 42-year-old male patient was found having a tumor in the left kidney in an annual physical examination. Subsequent CTU scan revealed a round shadow in the lower pole of the left kidney, with slightly lower, uneven density and obscure boundaries, which was slightly enhanced on contrast-enhanced CT imaging, suggesting a cystic mass (Bosniak category Ⅲ). Contrast-enhanced MRI showed a long T1, long T2 signal lesion in the lower pole of the left kidney, which was not obviously enhanced in the cortical phase but exhibited continuous and separated enhancement in parenchymal and delayed phases, suggesting a cystic renal cell carcinoma. A preoperative diagnosis of a left renal mass was made, for which the patient underwent a laparoscopic partial nephrectomy.Results:The resected cystic mass was grey white with obscured boundaries. Microscopically, the mass showed lymphoplasmacytic hyperplasia with lymphoid follicles, cystic formation, fibrosis hyperplasia and vascular obstruction. Immunohistochemistry revealed that the number of IgG4 (+ ) plasma cells was more than 50/HPF, and over 40% IgG (+ ) plasma cells were IgG4 (+ ). By virtue of the radiologic and pathologic findings, the patient was diagnosed with IgG4-RKD. At 2 weeks after operation, serum IgG level was 0.71g/L (reference: 0.03-2.01 g/L). Chest and abdominal CT scans performed 3 months after operation showed no evidence of other organ involvement and serum IgG4 level was within the normal range. Therefore no adjuvant therapy was prescribed.Conclusions:It is usually difficult to differentiate IgG4-RKD presenting as a cystic renal mass by radiography alone. The presence of other organ involvement, serum IgG4 test and renal biopsy can help the diagnosis and so as to avoid unnecessary surgery.

Objective:To establish a drug-related problems (DRPs) classification system for outpatients and home patients and provide healthcare staff with tools for standardized recording of DRPs.Methods:DRPs classification systems-related literature were collected by searching foreign databases. The selected DRPs classification systems were compared and analyzed, and the initial DRPs classification system was formed by integrating the characteristics of pharmaceutical care for outpatients and home patients in China. The expert consultation form of DRPs classification system was made, expert consultation was performed for 2 rounds using Delphi method, and the final DRPs classification system was formed through modification and adjustment according to expert opinions.Results:A total of 25 DRPs classification systems were obtained, of which 16 were selected and then integrated to form the initial version of the DRPs classification system. The primary structure of the initial DRPs classification system consisted of 5 parts: problem state, problem type, problem cause, problem intervention, and intervention result. Each part had different number of items, among which there were different number of secondary structure items in problem cause, problem intervention, and intervention result. In the first round of consultation, 32 experts were invited and 30 consultation forms were collected, with a recovery rate of 94%. In the second round of consultation, 30 experts were invited and 30 consultation forms were collected, with a recovery rate of 100%. After 2 rounds of consultation, the acceptance rates of experts for the question state, problem type, problem cause, question intervention, and intervention result in the primary structure were 100%, 90%, 83%, 83%, and 97%, respectively. For the evaluation of 5 categories of drug treatment (indications, effectiveness, safety, economy, and compliance) in DRPs classification system, except for that the expert authority coefficient of economics was 0.79, the expert authority coefficient of the other 4 categories of issues was all >0.8. In the first and second round of consultation, the coordination coefficient of expert opinions was 0.386 ( χ2=995.258, P<0.001) and 0.364 ( χ2=971.232, P<0.001), respectively. After modifying with expert opinions, a final version of DRPs classification system was formed, which included 38 primary structure items in 5 categories and 90 secondary structure items in 3 categories. Conclusion:A DRPs classification system for outpatients and home patients suitable for China′s national conditions has been initially established, which can be used as a standardized recording tool for DRP.

Objective:To establish a drug-related problems (DRPs) classification system for outpatients and home patients and provide healthcare staff with tools for standardized recording of DRPs.Methods:DRPs classification systems-related literature were collected by searching foreign databases. The selected DRPs classification systems were compared and analyzed, and the initial DRPs classification system was formed by integrating the characteristics of pharmaceutical care for outpatients and home patients in China. The expert consultation form of DRPs classification system was made, expert consultation was performed for 2 rounds using Delphi method, and the final DRPs classification system was formed through modification and adjustment according to expert opinions.Results:A total of 25 DRPs classification systems were obtained, of which 16 were selected and then integrated to form the initial version of the DRPs classification system. The primary structure of the initial DRPs classification system consisted of 5 parts: problem state, problem type, problem cause, problem intervention, and intervention result. Each part had different number of items, among which there were different number of secondary structure items in problem cause, problem intervention, and intervention result. In the first round of consultation, 32 experts were invited and 30 consultation forms were collected, with a recovery rate of 94%. In the second round of consultation, 30 experts were invited and 30 consultation forms were collected, with a recovery rate of 100%. After 2 rounds of consultation, the acceptance rates of experts for the question state, problem type, problem cause, question intervention, and intervention result in the primary structure were 100%, 90%, 83%, 83%, and 97%, respectively. For the evaluation of 5 categories of drug treatment (indications, effectiveness, safety, economy, and compliance) in DRPs classification system, except for that the expert authority coefficient of economics was 0.79, the expert authority coefficient of the other 4 categories of issues was all >0.8. In the first and second round of consultation, the coordination coefficient of expert opinions was 0.386 ( χ2=995.258, P<0.001) and 0.364 ( χ2=971.232, P<0.001), respectively. After modifying with expert opinions, a final version of DRPs classification system was formed, which included 38 primary structure items in 5 categories and 90 secondary structure items in 3 categories. Conclusion:A DRPs classification system for outpatients and home patients suitable for China′s national conditions has been initially established, which can be used as a standardized recording tool for DRP.

Objective To preliminarily understand the current status of medication safety management of medical institutions in China. Methods Medication Safety Panel in China Core Group of International Network for the Rational Use of Drugs (INRUD) and Chinese Pharmacological Society Professional Committee of Drug-induced Diseases jointly established a research group. Basing on the voluntary principle,members (medical institutions)of the group did medication safety self-assessment using the questionnaires of "2011 ISMP Medication Safety Self Assessment? for Hospitals (Chinese version)", which included 10 key elements,20 core indicators,and 270 assessment projects. The questionnaires were handed out on August 17,2018 and needed to be completed and submitted within 2 months. Results As of October 19,2018,67 hospitals of 16 provincial administrative regions in total had submitted their questionnaires,including 61 (91. 0％)3A hospitals and 6 (9％)2A hospitals. The average value of total scores of medication safety self-assessment in the 67 hospitals was 58. 9％ (7. 6％ -90. 0％). None of the 67 hospitals evaluated the key element Ⅵ(medication device acquisition,use,and monitoring). The scores of the other 9 key elements from high to low were 67. 6％,66. 2％,65. 1％,64. 8％,64. 1％,58. 2％, 54. 5％,54. 4％,and 52. 5％ respectively for element Ⅶ (environmental factors,workflow and staffing patterns),element Ⅳ(drug labeling,packaging and nomenclature),element Ⅸ (patient education), element Ⅲ(communication of drug orders and other drug information),element Ⅷ (staff competency and education),element Ⅴ(drug standardization,storage and distribution),element Ⅹ (quality processes and risk management),element Ⅰ (patient information),and element Ⅱ (drug information). Conclusion The data of medication safety from 67 hospitals of 16 provincial administrative regions were obtained through the first national self-assessment questionnaire survey in medical institutions,which initially reflected the current status of medication safety in medical institutions in China.