Objective To provide a home care pharmacy for a patient with severe heart failure and diuretic resistance,and to provide a reference for healthcare pharmacists to carry out home care pharmacy practice.Methods As part of the family physician team,clinical pharmacists performed home care pharmacy practice on a patient with severe heart failure and diuretic re-sistance.This involved providing an assessment of medication regimen,medication reorganization,medication education,medication counseling,popularization of medical knowledge,management of the home medicine box,and guidance on a healthy lifestyle.Mean-while,online and offline methods were adopted to conduct regular follow-up visits to the patient.Results The patient's medica-tion adherence was dramatically improved,the symptoms of heart failure were improved,and no adverse reactions occurred.Con-clusion Clinical pharmacists' home care pharmacy practice contributes to improving patients' diseases,reducing the risk of ad-verse drug reactions and potential medication errors,and promoting safe and rational drug use for patients.

Drug quality problems seriously threaten the life and health of patients,drug quality problems handling is an important part of pharmaceutical management in medical institutions,and strengthening the management of drug quality problems in medical institutions can provide a strong guarantee for drug safety of patients.This standard was compiled by the Pharmaceutical Affairs Commission of the Chinese Hospital Association,and the process included problems identification,framework development,manuscript writing,opinions gathering,expert argumentation and deliberation,and standards development.The standard regulates the basic requirements,coping strategies,quality control and continuous improvement of drug quality problems handling in medical institutions.This article elaborates on the methods and contents of formulating standards for drug quality problems handling,to pro-vide reference and inspiration for medical institutions to carry out drug quality problems handling.

Objective To provide a home care pharmacy for a patient with severe heart failure and diuretic resistance,and to provide a reference for healthcare pharmacists to carry out home care pharmacy practice.Methods As part of the family physician team,clinical pharmacists performed home care pharmacy practice on a patient with severe heart failure and diuretic re-sistance.This involved providing an assessment of medication regimen,medication reorganization,medication education,medication counseling,popularization of medical knowledge,management of the home medicine box,and guidance on a healthy lifestyle.Mean-while,online and offline methods were adopted to conduct regular follow-up visits to the patient.Results The patient's medica-tion adherence was dramatically improved,the symptoms of heart failure were improved,and no adverse reactions occurred.Con-clusion Clinical pharmacists' home care pharmacy practice contributes to improving patients' diseases,reducing the risk of ad-verse drug reactions and potential medication errors,and promoting safe and rational drug use for patients.

Drug quality problems seriously threaten the life and health of patients,drug quality problems handling is an important part of pharmaceutical management in medical institutions,and strengthening the management of drug quality problems in medical institutions can provide a strong guarantee for drug safety of patients.This standard was compiled by the Pharmaceutical Affairs Commission of the Chinese Hospital Association,and the process included problems identification,framework development,manuscript writing,opinions gathering,expert argumentation and deliberation,and standards development.The standard regulates the basic requirements,coping strategies,quality control and continuous improvement of drug quality problems handling in medical institutions.This article elaborates on the methods and contents of formulating standards for drug quality problems handling,to pro-vide reference and inspiration for medical institutions to carry out drug quality problems handling.

Objective To investigate the diagnostic efficacy and clinical value of GNB4 and Riplet gene methylation alone and in combination in the diagnosis of primary liver cancer.Methods A total of 313 patients were selected,including 78 patients with primary liver cancer,41 patients with other digestive system tumors,17 patients with non-digestive system tumors,20 patients with postoperative liver cancer,and 157 patients with benign liver disea-ses.The levels of GNB4 and Riplet gene methylation in plasma were detected using quantitative methylation-specific PCR(qMSP).Serum alpha-fetoprotein(AFP)levels were measured by direct chemiluminescence.Results The sensitivity and specificity of AFP in diagnosis were 51.3％and 94.3％,respectively;the sensitivity and specificity of GNB4 gene methylation in diagnosis were 83.3％and 99.4％,respectively;the sensitivity and specificity of Riplet gene methylation in diagnosis were 73.1％and 99.4％,respectively.The sensitivity and specificity of GNB4 and Riplet gene methylation combined diagnosis were 92.3％and 98.7％,respectively;the sensitivity and specificity of AFP,GNB4 and Riplet gene methylation combined diagnosis were 92.3％and 98.7％,respectively;the sensitivity and specificity of combined diagnosis including age and gender were 93.6％and 97.5％,respective-ly.Conclusion The sensitivity and specificity of AFP in the diagnosis of primary liver cancer are limited,while the methylation levels of GNB4 and Riplet genes are higher,and the sensitivity and specificity of their combined de-tection are higher than those of AFP.The sensitivity and specificity of AFP,GNB4 and Riplet gene methylation combined diagnosis are significantly higher than those of AFP,GNB4 and Riplet gene methylation alone.

Objective: To investigate the value of combined stool syndecan-2 (SDC2) and tissue factor pathway inhibitor 2 ( TFPI2) gene methylation testing in the early screening of colorectal cancer． Methods : 106 patients with colorectal cancer (colorectal cancer group) ，75 patients with advanced adenoma ( advanced adenoma group) and 35 patients with non-advanced adenoma (non-advanced adenoma group) were selected as study subjects，and 153 patients with other gastrointestinal disorders and 182 patients with negative colonoscopy results during the same period were selected as the control group．The quantitative methylation-specific PCR(qMSP) method was used to detect SDC2 and TFPI2 gene methylation in the stool specimens of all subjects．The sensitivity and specificity of the combined SDC2 and TFPI2 gene methylation assay for the detection of colorectal cancer and adenoma were evaluated using colonoscopy and pathology results as the gold standard. Results : Among 106 patients with colorectal cancer， the sensitivity of combined methylation test was 93. 4% ; among 75 patients with advanced adenoma，the sensitivity of combined methylation test was 62. 7% ; among 35 patients with non-advanced adenoma，the sensitivity of combined methylation test was 34. 3% ; the specificity of the combined SDC2 and TFPI2 gene methylation test for colorectal cancer and adenoma screening was 94. 6%． Conclusion The combined SDC2 and TFPI2 gene methylation test has high sensitivity for colorectal cancer and its early lesions，and it also maintains high specificity.

OBJECTIVE To evalu ate relat ed researches about the cost- benefit of pharmaceutical care in medical institutions with cost- benefit analysis，in order to provide evidence-based basis for related policy decisions and provide methodological reference for the cost- benefit evaluation of pharmaceutical care in the future. METHODS Retrieved from PubMed ，Embase，the Cochrane Library ，CBM，Wanfang database ，VIP and CNKI ，cost-benefit analysis was used to evaluate the researches about the cost-benefit of pharmaceutical care in medical institutions. Two researchers independently screened the research and extracted data according to the “Consolidated Health Economic Evaluation Reporting Standards Checklist ”. The quality of included studies was scored and evaluated systematically. RESULTS A total of 46 studies from 17 countries were included. Most of them came from the United States （21.74％），China（19.57％）and France （8.70％）. Average score of 46 literature was 14.30，of which 1 literature was excellent ，5 literature were good ，25 literature were qualified and 14 literature were unqualified. There were 25 research protocols of prospective study type ；the type of pharmaceutical care involved mostly was pharmaceutical monitoring （60.87％）， followed by prescription review （23.91％），medication reconciliation （8.70％）and outpatient pharmacy （6.52％）were less. The median cost-benefit ratio of pharmaceutical care was 5.05 （3.08，11.28）. CONCLUSIONS Pharmaceutical care shows good economic value ，and pharmacists have played an important role in saving medical resources ，but the design level and report quality of the existing studies need to be improved.

OBJECTIVE： To investigate the protective effect and its mechanism of thymoquinone （TQ） on myocardial fibrosis （MF） induced by lipopolysaccharide in rats. METHODS： Totally 40 male Wistar rats were randomly divided into control group， model group， TQ low-dose and high-dose groups [5， 10 mg/（kg?d）]， with 10 rats in each group. Except that control group was given constant volume of normal saline intraperitoneally， other groups were given LPS intraperitoneally to induce MF model， once a day， for consecutive 3 weeks. Since the first day of modeling， administration group was given relevant medicine intraperitoneally， once a day， for consecutive 3 weeks. After last medication， ELISA method was used to detect the contents of serum inflammation factors （IL-1β， IL-6， TNF-α） in rats. Cardiac mass parameters （HW/BM， LVW/BW） were weighed and calculated. HE staining was used to observe the histopathological changes of myocardial tissue. The contents or activities of oxidative stress indicators （MDA， SOD） and myocardial collagen indexes （HYP， Col-Ⅰ， Col-Ⅲ） were detected by chemical analysis， xanthine oxidase method or ELISA. mRNA expression of regulation genes （Col-Ⅰ， Col-Ⅲ， MMP-3， MMP-9， TGF-β1 and Smad3） related to myocardial fibrosis were determined by real-time fluorescence quantitative PCR. RESULTS： Compared with control group， there were swollen myocardial cells， disordered nuclei of different sizes and visible fiber hyperplasia in model group； the levels of serum inflammatory factors and LVW/BW， cardiac contents of MDA， HYP， Col-Ⅰand Col-Ⅲ， mRNA expression of Col-Ⅲ， TGF-β1 and Smad3 in model group were increased significantly （P＜0.05）， while SOD activity was decreased significantly （P＜0.05）. Compared with model group， the degree of myocardial fibrosis was improved in TQ groups to different extents； serum content of IL-1β and the contents of MDA， HYP and Col-Ⅰ in cardiac tissue in TQ low-dose group， serum contents of IL-1β， IL-6 and TNF-α， LVW/BW and the contents of MDA， HYP， Col-Ⅰ and Col-Ⅲ in cardiac tissue of TQ high-dose group as well as mRNA expression of Col-Ⅰ， Col -Ⅲ， TGF-β1 in TQ groups were decreased significantly （P＜0.05）. The activities of SOD in cardiac tissue were increased significantly in TQ groups （P＜0.05）. There was no statistical significance in other indexes among groups （P＞0.05）. CONCLUSIONS： TQ can protect against MF model rats to certain extent， the mechanism of which may be associated with the inhibition of inflammation reaction and oxidant stress reaction， and down-regulation of mRNA expression of Col-Ⅰ， Col-Ⅲ and TGF-β1.

OBJECTIVE:To provide reference for the clinical pharmacists to determine their work orientation,and improve their work mode and pharmaceutical care level. METHODS:The questionnaire survey was conducted among doctors,nurses, patients and pharmacists from 65 third grade class A hospitals of 18 provinces(regions,cities)in China. The collected data were analyzed statistically and suggestions were presented. RESULTS:Totally 3 840 questionnaires were sent out,3 045 were effectively received with a recovery of 79.30%[involving 56 third grade class A hospitals of 17 provinces(regions,cities)]. Of 3 045 valid questionnaires,1 001 questionnaires were filled out by the doctors and nurses,1 013 questionnaires were filled by the pharmacists and 1 031 questionnaires were filled out by the patients. 88.45% of the survey doctors and nurses thought that clinical pharmacists were needed in their wards. The major clinical pharmaceutical care they needed were the participation of clinical pharmacists in the clinical ward round,patients management,difficult case discussions,consultation(77.32%),etc. 64.54% of the survey doctors and nurses thought that clinical pharmacists could participate the clinical work and solve some simple medicine-related problems, and 27.17% of the survey doctors and nurses thought that clinical pharmacists could resolve clinical medicine-related problems. 14.59% of the survey doctors and nurses believed that clinical pharmacists lacked clinical thinking and could not communicate with medical staff. The most common problems the survey medical staff met were as follows:ADR (78.02%),usage and dosage(72.83%),contraindications(72.63%),drug indication(63.14%)and solvent selection (61.74%),etc. As regards the ratio of working time which clinical pharmacists spent on their clinical work,over 50%(35.55%)and 30%(23.46%)were most chosen by the survey pharmacists,while 13.19% of the survey pharmacists thought clinical pharmacists almost did not participate in clinical work. The survey pharmacists thought that there were some deficiencies in the knowledge structure of clinical pharmacists, such as clinical medical science and therapeutics(92.50%), communication skills(47.19%),professional knowledge of pharmacy(46.10%),etc. 87.90% of the survey patients were willing to accept the medication guidance provided by clinical pharmacists. The services they required were as follows:medication guidance(79.92%),observation and discovery of medication problem(71.00%),etc. CONCLUSIONS:Medical staff and patients have demands in many ways associated with clinical work and rational drug use provided by clinical pharmacists,while the clinical pharmacists have yet not reached the demands of medical staff and patients in regard to their evaluation. It is suggested that the clinical pharmacists should ascertain their work orientation,improve their work mode,participate the clinical work in full-time, complete their knowledge structure and ascent their pharmaceutical service level.

OBJECTIVE:To provide reference for promoting smoothly implementation of deprescribing. METHODS:A total of 335 elderly patients with chronic disease were randomly selected from 4 communities and 9 village clinic of a Chongqing community health service center. Questionnaire survey was conducted about general information of respondents,disease and drug use condition and attitude to deprescribing by using Australian Patients'Attitudes Towards Deprescribing questionnaire as reference. The results of questionnaire survey were analyzed statistically. The cognitive function was assessed by Hastgawa Dementia Scale. The degree of weakness was evaluated by Chinese edition of Edmonton Frail Scale. The quality of life was evaluated by Chinese edition of European Five Dimensional Health (EQ-5D) Scale. RESULTS:Totally 311 valid questionnaires were obtained,with effective recovery rate of 92.8％. Overall,311 participants were recruited,with a median age of 70 years,5 types of median disease (hypertension was most common) and 5 types of median medication (mainly calcium channel blocker and non-insulin hypoglycemic agent);54.7％(170 cases)participants took multiple drugs. The attitudes towards deprescribing were that 39.5％ of respondents believed that they took too many drugs;73.9％ had a desire to reduce their drugs;83.6％ reported that they would be willing to reduce drugs if their doctor said it was possible. The patients taking multiple drugs preferred to use less drugs (P=0.001) and reduce current drugs (P=0.001),and were more willing to reduce drug cost by reducing drug use;they were also more worried about drug side effects than those without taking multiple drugs (P=0.005). CONCLUSIONS:The phenomenon of elderly chronic diseases patients with multiple diseases and multiple drug use are popular in community. It is necessary to simpilfy prescription. Most elderly patients would like to reduce their medications if doctors say it is possible;the patients with multiple drug use are more willing to simplify prescription than those without multiple drug use.