Clinical pharmacist teacher training is an important mean to improve the quality of clinical pharmacy talent cultivation and ensure the service ability and level of the clinical pharmacist team.The Pharmacy Administration and Pharmacy Practice in Healthcare Institutions-Part 4-8-2:Pharmacy Administration-Pharmacy Training Management-Clinical Pharmacist Teacher Training was based on the newly revised management document for clinical pharmacist teacher training of the Chinese Hospital Association.After sorting out relevant materials,such as standards,policies and regulations,technical specifications,liter-ature,documents of the Chinese Hospital Association,expert opinions,and the current situation of clinical pharmacist teacher training in China,the standard was formulated.In the standard,12 key elements,which can be divided into 3 parts of base manage-ment,training process and assessment,quality management and evaluation improvement,were standardized.This article aimed to introduce the construction method and content of the standard,to facilitate the understanding of the standard content for medical institutions which joined or willing to join the clinical pharmacist teacher training base,and to provide a reference for other medi-cal institutions to carry out related work.

Objective: To investigate the urban and rural differences in adverse outcomes of pulmonary tuberculosis (PTB) in patients with pulmonary tuberculosis-diabetes mellitus comorbidity (PTB-DM), so as to provide insights into improving the prevention and treatment measures for PTB-DM. Methods: Patients with PTB-DM who were admitted and discharged from 14 designated tuberculosis hospitals in Hangzhou City from 2018 to 2022 were selected. Basic information, and history of diagnosis and treatment were collected through hospital information systems. The adverse outcomes of PTB were defined as endpoints, and the proportions of adverse outcomes of PTB in urban and rural patients with PTB-DM were analyzed. Factors affecting the adverse outcomes of PTB were identified using a multivariable Cox proportional hazards regression model. Results: A total of 823 patients with PTB-DM were enrolled, including 354 (43.01%) urban and 469 (56.99%) rural patients. There were 112 (13.61%) patients with adverse outcomes of PTB. The proportions of adverse outcomes of PTB in urban and rural patients were 14.41% and 13.01%, respectively, with no statistically significant difference (P>0.05). Multivariable Cox proportional hazards regression analysis identified first diagnosed in county-level hospitals or above (HR=2.107, 95%CI: 1.181-3.758) and drug resistance (HR=3.303, 95%CI: 1.653-6.600) as the risk factors for adverse outcomes of PTB in urban patients with PTB-DM, while the treatment/observed management throughout the process (HR=0.470, 95%CI: 0.274-0.803) and fixed-dose combinations throughout the process (HR=0.331, 95%CI: 0.151-0.729) as the protective factors for adverse outcomes in rural patients with PTB-DM. Conclusions There are differences in influencing factors for adverse outcomes of PTB in urban and rural patients with PTB-DM. The adverse outcomes of PTB are associated with first diagnosed hospitals and drug resistance in urban patients, and are associated with the treatment/observed management and fixed-dose combinations throughout the process in rural patients.

Objective:To evaluate the predictive value of whole blood cell derived inflammatory marker (including systemic immunoinflammatory index (SII), systemic inflammatory response index (SIRI), neutrophil count/lymphocyte count (NLR), platelet count/lymphocyte count (PLR), and monocyte count/lymphocyte count (MLR)) and in combination with N-terminal pro-B-type natriuretic peptide (NT-proBNP) on the prognosis of patients with chronic heart failure.Methods:This study was a retrospective cohort study. Patients with chronic heart failure hospitalized in the Department of Cardiovascular Medicine, Nanfang Hospital, Southern Medical University from January 2019 to August 2022 were enrolled. Patients were followed up and were divided into survival group and death group according to the follow-up results. Clinical characteristics of the two groups were compared. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of each whole blood cell derived inflammatory marker for predicting all-cause death in patients with chronic heart failure. Kaplan-Meier survival curve was drawn, and log-rank test was used to compare the difference in survival of chronic heart failure patients with different levels of whole blood cell derived inflammatory markers. Univariate and multivariate Cox proportional hazards models were used to analyze the effects of whole blood cell derived inflammatory markers and NT-proBNP on the all-cause death of patients with chronic heart failure. ROC curve was used to analyze the predictive value of whole blood cell derived inflammatory markers combined with NT-proBNP on the prognosis of patients with chronic heart failure.Results:A total of 324 patients with heart failure aged (64.76±13.78) years were enrolled, with 212 males (65.43%). 297 patients (91.67%) completed follow-up, 27 patients (8.33%) were lost to follow-up. The follow-up time was 24.0 (18.0, 41.8) months. There were 258 patients in the survival group and 66 patients in the death group. The optimal cut-off values of SII, SIRI, NLR, PLR and MLR determined by ROC curve were 739.83, 1.65, 3.14, 151.95 and 0.37, respectively. Kaplan-Meier survival curve analysis showed that patients with chronic heart failure with high levels of SII (≥739.83), SIRI (≥1.65), NLR (≥3.14), PLR (≥151.95) and MLR (≥0.37) had higher incidence of all-cause death than patients with low levels of inflammatory markers (all P<0.001). Multivariate Cox proportional hazard regression analysis showed that age ( HR=1.04, 95% CI 1.01-1.06, P=0.002), NT-proBNP ( HR=2.93, 95% CI 1.64-5.23, P<0.001), SII≥739.83 ( HR=3.27, 95% CI 1.18-9.02, P=0.022) and PLR≥151.95 ( HR=2.67, 95% CI 1.02-6.96, P=0.045) were independent predictors of all-cause death in patients with chronic heart failure. ROC curve analysis showed that the predictive value of SII and PLR combined with NT-proBNP ( AUC=0.850) for the prognosis of patients with chronic heart failure was better than that of SII ( AUC=0.779)、PLR ( AUC=0.782)、NT-proBNP ( AUC=0.727) and CRP ( AUC=0.668) alone (all P<0.001). Conclusions:Whole blood cell derived inflammatory markers——SII, PLR, and NT-pro BNP were independently associated with all-cause death in patients with chronic heart failure. SII and PLR can independently predict the prognosis of patients with chronic heart failure, combination of SII and PLR with NT-pro BNP has better predictive value for the prognosis of patients with chronic heart failure.

Mycophenolic acid (MPA), the active moiety of both mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS), serves as a primary immunosuppressant for maintaining solid organ transplants. Therapeutic drug monitoring (TDM) enhances treatment outcomes through tailored approaches. This study aimed to develop an evidence-based guideline for MPA TDM, facilitating its rational application in clinical settings. The guideline plan was drawn from the Institute of Medicine and World Health Organization (WHO) guidelines. Using the Delphi method, clinical questions and outcome indicators were generated. Systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence quality evaluations, expert opinions, and patient values guided evidence-based suggestions for the guideline. External reviews further refined the recommendations. The guideline for the TDM of MPA (IPGRP-2020CN099) consists of four sections and 16 recommendations encompassing target populations, monitoring strategies, dosage regimens, and influencing factors. High-risk populations, timing of TDM, area under the curve (AUC) versus trough concentration (C₀), target concentration ranges, monitoring frequency, and analytical methods are addressed. Formulation-specific recommendations, initial dosage regimens, populations with unique considerations, pharmacokinetic-informed dosing, body weight factors, pharmacogenetics, and drug‍-‍drug interactions are covered. The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy, promoting standardization of MPA TDM, and enhancing treatment efficacy and safety.
Mycophenolic Acid/administration & dosage* ; Drug Monitoring/methods* ; Humans ; Organ Transplantation ; Immunosuppressive Agents/administration & dosage* ; Delphi Technique

Clinical pharmacist teacher training is an important mean to improve the quality of clinical pharmacy talent cultivation and ensure the service ability and level of the clinical pharmacist team.The Pharmacy Administration and Pharmacy Practice in Healthcare Institutions-Part 4-8-2:Pharmacy Administration-Pharmacy Training Management-Clinical Pharmacist Teacher Training was based on the newly revised management document for clinical pharmacist teacher training of the Chinese Hospital Association.After sorting out relevant materials,such as standards,policies and regulations,technical specifications,liter-ature,documents of the Chinese Hospital Association,expert opinions,and the current situation of clinical pharmacist teacher training in China,the standard was formulated.In the standard,12 key elements,which can be divided into 3 parts of base manage-ment,training process and assessment,quality management and evaluation improvement,were standardized.This article aimed to introduce the construction method and content of the standard,to facilitate the understanding of the standard content for medical institutions which joined or willing to join the clinical pharmacist teacher training base,and to provide a reference for other medi-cal institutions to carry out related work.

Objective:To evaluate the predictive value of whole blood cell derived inflammatory marker (including systemic immunoinflammatory index (SII), systemic inflammatory response index (SIRI), neutrophil count/lymphocyte count (NLR), platelet count/lymphocyte count (PLR), and monocyte count/lymphocyte count (MLR)) and in combination with N-terminal pro-B-type natriuretic peptide (NT-proBNP) on the prognosis of patients with chronic heart failure.Methods:This study was a retrospective cohort study. Patients with chronic heart failure hospitalized in the Department of Cardiovascular Medicine, Nanfang Hospital, Southern Medical University from January 2019 to August 2022 were enrolled. Patients were followed up and were divided into survival group and death group according to the follow-up results. Clinical characteristics of the two groups were compared. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of each whole blood cell derived inflammatory marker for predicting all-cause death in patients with chronic heart failure. Kaplan-Meier survival curve was drawn, and log-rank test was used to compare the difference in survival of chronic heart failure patients with different levels of whole blood cell derived inflammatory markers. Univariate and multivariate Cox proportional hazards models were used to analyze the effects of whole blood cell derived inflammatory markers and NT-proBNP on the all-cause death of patients with chronic heart failure. ROC curve was used to analyze the predictive value of whole blood cell derived inflammatory markers combined with NT-proBNP on the prognosis of patients with chronic heart failure.Results:A total of 324 patients with heart failure aged (64.76±13.78) years were enrolled, with 212 males (65.43%). 297 patients (91.67%) completed follow-up, 27 patients (8.33%) were lost to follow-up. The follow-up time was 24.0 (18.0, 41.8) months. There were 258 patients in the survival group and 66 patients in the death group. The optimal cut-off values of SII, SIRI, NLR, PLR and MLR determined by ROC curve were 739.83, 1.65, 3.14, 151.95 and 0.37, respectively. Kaplan-Meier survival curve analysis showed that patients with chronic heart failure with high levels of SII (≥739.83), SIRI (≥1.65), NLR (≥3.14), PLR (≥151.95) and MLR (≥0.37) had higher incidence of all-cause death than patients with low levels of inflammatory markers (all P<0.001). Multivariate Cox proportional hazard regression analysis showed that age ( HR=1.04, 95% CI 1.01-1.06, P=0.002), NT-proBNP ( HR=2.93, 95% CI 1.64-5.23, P<0.001), SII≥739.83 ( HR=3.27, 95% CI 1.18-9.02, P=0.022) and PLR≥151.95 ( HR=2.67, 95% CI 1.02-6.96, P=0.045) were independent predictors of all-cause death in patients with chronic heart failure. ROC curve analysis showed that the predictive value of SII and PLR combined with NT-proBNP ( AUC=0.850) for the prognosis of patients with chronic heart failure was better than that of SII ( AUC=0.779)、PLR ( AUC=0.782)、NT-proBNP ( AUC=0.727) and CRP ( AUC=0.668) alone (all P<0.001). Conclusions:Whole blood cell derived inflammatory markers——SII, PLR, and NT-pro BNP were independently associated with all-cause death in patients with chronic heart failure. SII and PLR can independently predict the prognosis of patients with chronic heart failure, combination of SII and PLR with NT-pro BNP has better predictive value for the prognosis of patients with chronic heart failure.

Objective To explore the diagnostic value of deep medullary vein (DMV) score for cognitive impairment in patients with cerebral small vessel disease (CSVD).Methods Collect clinical and imaging data of 108 patients who visited Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from May 2022 to December 2023.According to the mini-mental state examination,patients were divided into a cognitive impairment group (36 cases) and a cognitive function normal group (72 cases).On magnetic sensitive images,the DMV scores of the six regions on both sides of the frontal lobe,parietal lobe,occipital lobe are rated from 0 to 3 points based on their visual conditions,and the total scores of the six regions is the DMV score (0 to 18 points).Applying international CSVD guidelines to assess CSVD burden in patients.Analyze the correlation between DMV score and cognitive impairment,and compare the diagnostic value of DMV scores and CSVD score for cognitive impairment.Results The median CSVD burden score of 108 patients was 1 (0,2) points,and the median DMV score was 4 (1,9) points.The DMV score was positively correlated with the presence of cognitive impairment (r=0.525,P<0.001).There were statistically significant differences in age,cerebral microbleeds,perivascular space enlargement,white matter hyperintensities,CSVD burden,and DMV score between the cognitive impairment group and the cognitive function normal group (P<0.05).The area under the receiver operating characteristic curve of diagnosed with cognitive impairment using DMV score was 0.820 (95％CI:0.741-0.898,P<0.001).Conclusion DMV score is positively correlated with CSVD cognitive impairment,and it has certain predictive value for cognitive impairment.

Objective To compare the clinical efficacy of emergency and elective laparoscopic common bile duct exploration(LCBDE)in the treatment of choledocholithiasis with acute cholangitis based on propensity score matching(PSM).Methods Retro-spective cohort study was used.The clinical data of 162 patients with choledocholithiasis complicated with acute cholangitis who underwent LCBDE in Wuhu Hospital,East China Normal University from January 2021 to October 2023 were retrospectively analyzed.Among them,59 patients underwent emergency LCBDE(emergency group),and 103 patients underwent elective LCBDE after conservative treatment(elective group).The PSM method was used to match the two groups of patients by 1∶1,and the relevant clinical data of the two groups were compared.Results The two groups successfully matched 44 pairs of patients.The intraoperative blood loss in the emergency group was more than that in the elective group(65.00±19.88ml vs 54.89±17.90ml,P=0.014).The use time of antibiotics was lower than that in the elective group(3.68±1.46days vs 5.95±1.46days,P＜0.001).The total hospitalization time was lower than that in the e-lective group[7.0(6.0,8.0)days vs 8.0(7.0,9.0)days,P＜0.001].The hospitalization cost was lower than that in the elective group[1.19(1.10,1.45)ten thousand yuan vs 1.43(1.22,1.67)ten thousand yuan,P=0.001].There was no significant difference in operation time,conversion rate,operation method,peritoneal drainage tube removal time,postoperative hospital stay,and postoperative complication rate between the two groups(P＞0.05).Conclusion Both emergency and elective LCBDE are safe and effective in the treatment of choledocholithiasis with mild to moderate acute cholangitis,but emergency LCBDE has significant advantages in the use of an-tibiotics,total hospitalization time and hospitalization costs.

Objective To compare the clinical efficacy of emergency and elective laparoscopic common bile duct exploration(LCBDE)in the treatment of choledocholithiasis with acute cholangitis based on propensity score matching(PSM).Methods Retro-spective cohort study was used.The clinical data of 162 patients with choledocholithiasis complicated with acute cholangitis who underwent LCBDE in Wuhu Hospital,East China Normal University from January 2021 to October 2023 were retrospectively analyzed.Among them,59 patients underwent emergency LCBDE(emergency group),and 103 patients underwent elective LCBDE after conservative treatment(elective group).The PSM method was used to match the two groups of patients by 1∶1,and the relevant clinical data of the two groups were compared.Results The two groups successfully matched 44 pairs of patients.The intraoperative blood loss in the emergency group was more than that in the elective group(65.00±19.88ml vs 54.89±17.90ml,P=0.014).The use time of antibiotics was lower than that in the elective group(3.68±1.46days vs 5.95±1.46days,P＜0.001).The total hospitalization time was lower than that in the e-lective group[7.0(6.0,8.0)days vs 8.0(7.0,9.0)days,P＜0.001].The hospitalization cost was lower than that in the elective group[1.19(1.10,1.45)ten thousand yuan vs 1.43(1.22,1.67)ten thousand yuan,P=0.001].There was no significant difference in operation time,conversion rate,operation method,peritoneal drainage tube removal time,postoperative hospital stay,and postoperative complication rate between the two groups(P＞0.05).Conclusion Both emergency and elective LCBDE are safe and effective in the treatment of choledocholithiasis with mild to moderate acute cholangitis,but emergency LCBDE has significant advantages in the use of an-tibiotics,total hospitalization time and hospitalization costs.