OBJECTIVE To provide references for medical institutions’ outpatient pharmacies to increase the scanning rate， scanning efficiency and scanning accuracy of drug traceability codes.METHODS A total of 4 157 unscanned traceability code records from the first two‑week period of June 2025 were selected from the outpatient pharmacy of our hospital. Pareto chart was adopted to analyze the reasons for unscanned codes， and the Objective-Rules-Training-Check-Culture （ORTCC） model was utilized to carry out fine management. The traceability code scanning rate， pharmacists’ work efficiency （number of prescriptions dispensed per pharmacist per hour， number of drug boxes dispensed per pharmacist per hour）， patients’ medication-waiting time and dispensing errors were compared among four periods： before scanning implementation （June 2024）， before management intervention （June 2025）， the first phase after management （September 2025）， and the second phase after management （December 2025）， so as to evaluate the management effects.RESULTS The traceability code scanning rates in the first phase and second phase after management were remarkably higher than those before management （ P ＜0.05）， and the scanning rate in the second phase after management was obviously higher than that in the first phase after management （ P ＜0.05）. Compared with the period before scanning implementation， the number of prescriptions dispensed per pharmacist per hour， the number of drug boxes dispensed per pharmacist per hour， decreased significantly and patients’ medication-waiting time prolonged markedly before management （ P ＜0.05）. In the second phase after management， both the number of prescriptions dispensed per pharmacist per hour and the number of drug boxes dispensed per pharmacist per hour increased significantly， and patients’ medication-waiting time shortened greatly in contrast with the status before management （ P ＜0.05）. Besides， no statistically significant differences were found in the number of drug boxes dispensed per pharmacist per hour and patients’ medication-waiting time between the second phase after management and the period before scanning implementation （ P ＞0.05）.After the implementation of traceability-code scanning management， dispensing errors presented a gradually declining trend in each stage.CONCLUSIONS The fine management system for outpatient drug traceability codes constructed based on Pareto chart and ORTCC model can improve the traceability code scanning rate and pharmacists’ work efficiency of outpatient pharmacies， and reduce drug dispensing errors.

OBJECTIVE To analyze the non-genetic risk factors for severe cutaneous adverse reactions （SCARs） related to antiepileptic drugs （AEDs） in HLA-B*15：02 negative patients， and provide a basis for clinical precision medication. METHODS A retrospective case-control design was used to include patients who underwent HLA-B*15：02 testing at our hospital from January 2022 to December 2024. Patients were divided into SCARs group （15 cases who were HLA-B*15：02 negative and diagnosed with SCARs） and control group （38 cases who were HLA-B*15：02 negative and used AEDs）. Risk factors were evaluated using univariate analysis and a multivariable Firth penalty likelihood logistic regression model （Firth regression）， and Benjamin-Hochberg false discovery rate （FDR） and Firth regression were used for correction， and sensitivity analysis was used to quantify the impact of potential biases in carbamazepine exposure rates in the control group on the results. RESULTS Univariate analysis showed that age≥50 years， use of carbamazepine， and combination use of antibiotics/antiviral drugs were risk factors for developing AEDs- related SCARs （OR＝18.15， 7.54， 13.46， 95%CI of 4.13-79.84， 1.89-30.08， 1.36-133.18， all P＜0.05）， while taking lamotrigine was a protective factor [OR＝0.10， 95%CI of 0.02-0.39， P＜0.05]. After FDR correction， the above factors still maintained statistical significance （P＜0.05）. The results of multivariate analysis showed that age≥50 years [adjusted OR＝16.27， 95%CI of 3.98-66.55， P＜0.001] and taking carbamazepine [adjusted OR＝7.11， 95%CI of 1.82-27.85， P＝0.005] were independent risk factors for the occurrence of SCARs-related AEDs. The results of sensitivity analysis showed that the adjusted risk OR range for taking carbamazepine was between 14.2 and 28.4. CONCLUSIONS Age≥50 years and use of carbamazepine are independent non- genetic risk factors for the development of SCARs-related AEDs in HLA-B*15：02 negative patients. It is recommended that elderly patients should prioritize the use of AEDs other than carbamazepine.

OBJECTIVE： To investigate the role of clinical pharmacists in the individual anticoagulation of warfarin for the patients with lower extremity venous thrombosis （LEVT） and pulmonary arterial thromboembolism （PATE）. METHODS： Clinical pharmacists participated in individual anticoagulation of warfarin for the patients with LEVT and PATE. It was suggested to detect the gene type of the patient. According to the results of gene test [cytochrome P450 （CYP）2C9*1*1 and vitamin K epoxide reductase complex subunit Ⅰ] and the dose recommended by FDA based on the patient’s gene， the initial dose of warfarin （3.125 mg，once a day） was determined according to the patient’s living habits， height and body mass. Then the maintenance dose of warfarin （the maintenance dose of warfarin was 2.5 mg and 3.125 mg， once a day， alternately taken every other day） was calculated according to the warfarin maintenance dose prediction formula established by Warfarin Pharmaeogenetics Consortium. Pharmaceutical monitoring was conducted， such as INR， prothrombin time and bleeding event monitering. RESULTS： Physicians adopted the suggestion of clinical pharmacists. The maintenance dose of warfarin was 2.5 mg and 3.125 mg， once a day， alternately taken every other day. It was suggested to give Flucloxacillin sodium injection which had less influence on warfarin. The patient recovered well and was discharged. CONCLUSIONS： Based on pharmacogenomics， clinical pharmacists participate in the formulation of individualized anticoagulant regimens for patients， which promote TNR ralue of patients， reduce the risk of early postoperative thromboembolism， and further ensure the safety of drug use in patients.

Objective To investigate the change of plasma vitamin D, A and E levels in infant with infantile hepatitis syndrome (IHS) and to provide reliable basis for clinical treatment. Methods Seventy-three infant with IHS (IHS group) from January 2015 to May 2016 and 82 cases of physical examination infant (control group) were enrolled in this study.The levels of plasma vitamin D, A and E were tested and compared between two groups. Results The levels of vitamin D, A and E in IHS group were significantly lower than those in control group:(37.871 ± 20.111) nmol/L vs. (97.708 ± 28.827) nmol/L, (1.082 ± 0.657)μmol/L vs. (1.810 ± 0.517)μmol/L, (21.252 ± 7.596)μmol/L vs. (26.647 ± 6.495)μmol/L, P<0.01 or <0.05. The nutritional status of vitamin D, A and E in two groups had significant differences (P<0.01). Conclusions There have obvious deficiency in fat-soluble vitamin D, A and E in infant with HIS , and vitamin D deficiency is the most obvious. The levels of vitamin D, A and E are the dynamic monitoring indicators of treatment, nutritional status evaluation and long-term complications development.

Objective To investigate status of the intravenous use of antibiotics in outpatients and emergency patients of a tertiary first-class hospital, and provide a reference for developing management measures in next step. Methods By a retrospective method,all the prescriptions using antibiotics by intravenous administration in outpatients and emergency department patients from a tertiary first-class hospital in 2013 were extracted from the hospital information system. The categories of antimicrobial agents,proportion of intravenous use of antimicrobial drugs,ranking of the antibiotic consumption sum and defined daily dose,and the top 10 clinical departments or wards intravenously using antimicrobial drugs were chosen to analyze. The data in 2014 were extracted as a comparison. Results Outpatients and emergency department patients respectively used 8 categories 31 kinds and 8 categories 30 kinds of intravenous antimicrobial drugs, with high consumption of cephalosporins and restricted antimicrobials such as sodium cefoxitin.Intravenous use of antimicrobial drug prescription proportion in emergency department is higher than that in outpatient department. Conclusion After intervention in 2014, antibiotic consumption is effectively controlled as compared that in 2013. But management should be strengthened and appropriate interventions should be taken to ensure the use of intravenous antibiotics in a safe,effective and economical manner.

Objective To investigate the value of spectral CT for the discrimination of benign and malignant lung lesions through multi-parameter quantitative measurement.Methods Eighty-one patients who had lung nodule or mass on X-ray or plain CT were scanned using spectral CT,generating iodine concentration,water concentration and 101 sets of monochromatic images.Iodine concentration,water concentration,spectrum energy curve and CT value at 40 keV were measured with spectral post-processing software.70 eligible patients were divided into pneumonia group and tumor group.ANOVA analysis was used for the statistic analysis in two groups.Results The iodine concentration in pneumonia group and tumor group were (1.47 ± 0.17) and (0.77 ± 0.19) g/L (F =203.97,P ＜ 0.05).The slope rates of spectrum energy curve in pneumonia group and tumor group were 1.65 ± 0.27 and 0.88 ± 0.22 (F =161.59,P ＜0.05).The CT values at 40 keV in pneumonia group and tumor group were (139.00 ± 16.25) and (83.29 ± 17.44) HU (F =160.45,P ＜ 0.05),there were significant differences in iodine concentration,slope rates and CT values at 40 keV between two groups.The water concentration in pneumonia group and tumor group were (1021.56 ± 11.68) and (1022.62 ±8.56) g/L (F=0.19,P＞0.05),there was no significant difference.Conclusion Spectral CT technique has very important value for the discrimination of benign and malignant lung lesions.