OBJECTIVE To formulate Guidelines for the standardized implementation of pharmacist-managed clinics （ 2026 edition ） in response to the challenges faced by such clinics in China， including uneven development， large discrepancies in service specifications， insufficient patient awareness， and limited medical insurance coverage. METHODS Led by the Pharmaceutical Affairs Professional Committee of the Chinese Hospital Association， the Evidence-based Pharmacy Professional Committee of the Chinese Pharmaceutical Association， and the Hospital Pharmacy Professional Committee of the Cross-strait Medical and Health Exchange Association， a total of 19 domestic hospital pharmacy experts were organized. Through a systematic review of national policies and literature research， current practical experience was summarized. Consensus on the contents of the guidelines was reached after in-depth discussions. RESULTS &CONCLUSIONS The guidelines covered five sections： definition and connotation of pharmacist-managed clinics， establishment requirements， implementation and management， post competency， and practical research. Firstly， the definition and connotation included three operational forms of pharmacist-managed clinics （independent mode， physician-pharmacist joint mode， and online pharmacist-managed clinic mode） and classified service modes （specialty-specific， drug-specific， and disease-specific pharmacist-managed clinics）. The establishment requirements were further refined， covering system construction （pharmaceutical service management system， quality control and assessment mechanism）， personnel qualifications （professional credentials， continuing education and professional training， etc）， service recipients， as well as service venues and facilities. Subsequently， the implementation and management of pharmacist-managed clinics were proposed， involving service procedures， intervention measures， documentation and records， patient education and follow-up， humanistic care， as well as risk management and quality control. Finally， post competency encompassed the competency requirements for pharmacists providing services in pharmacist-managed clinics， as well as the suggestions on teaching methods； practical research encouraged the conduct of high-quality pharmaceutical practice in the setting of pharmacist-managed clinics. The guidelines provide valuable guidance for the standardized implementation of pharmacist-managed clinics in China in terms of establishment， management， teaching， and research， fill the guideline gap in this field， and can promote the high-quality development of pharmacist-managed clinics.

Objective To explore the effects of postoperative self-controlled analgesic pump containing esketamine(ESK)on psychological status and early cognitive function of elderly patients after radical surgery for colorectal cancer(CRC).Methods The data of elderly patients after radical CRC surgery in Jianyang People's Hospital were retrospectively collected from January 2021 to January 2024,and were divided into the control group[only using sufentanil(FEN)]and the combined group(FEN combined with ESK)according to the different medications in the self-controlled analgesic pump.The pain levels[visual analog scale(VAS)and the number of presses of the self-controlled analgesic pump],psychological state[90-item symptom self-assessment scale(SCL-90)],and early cognitive function[Montreal Cognitive Assessment Scale(MoCA)]before and after treatment were compared between the two groups.Adverse reactions during the use of self-controlled analgesic pumps were observed and recorded in both groups to assess the safety.Results A total of 86 patients were included in the study,with 45 in the control group and 41 in the combined group.At 1 h before the surgery,there was no statistically significant difference in the VAS scores,dimensional mental status scores and MoCA scores between the two groups(P＞0.05).At 1 h(T2),12 h(T3),24 h(T4)and 72 h(T5)after the surgery,the VAS scores of the combined group were significantly lower than those of the control group(all P＜0.05)and the times of using the analgesic pump in the combined group were significantly lower than those in the control group(P＜0.05).After 72 h of using analgesic pumps,the psychological state scores of patients in both groups in terms of somatization scores,obsessive-compulsive symptom scores,and interpersonal relationship scores decreased significantly compared with the pre-treatment period,and the score of combined group was lower than that of the control group(P＜0.05).During the use of analgesic pumps,the MoCA scores of patients in both groups showed a decreasing and then a increasing trend(P＜0.05),and the MoCA scores of the combined group were significantly higher than those of the control group at T4 and T5(P＜0.05).In terms of the safety,the difference in the incidence of gastrointestinal symptoms,arrhythmia,vertigo and drowsiness between the two groups was not statistically significant(P＞0.05).Conclusion ESK postoperative self-control analgesic pump can effectively relieve the pain level,psychological state and early cognitive function of elderly patients after radical CRC surgery,and the safety is good.

OBJECTIVE To compare the similarities and differences of the two methods in analyzing the use of opioids in third grade class A medical institutions and provide a reference for the management of opioids in medical institutions. METHODS Two methods， Defined Daily Dose （DDD） and Oral Morphine Equivalent （OME）， were used to count the opioid prescription data of five comprehensive medical institutions of third grade class A （named H1-H5） in Shanxi province in 2020， calculate consumption sum of opioid， annual per capita consumption sum， patient cost burden and drug consumption sum ratio， compare the index results presented by the two analysis methods， and explore the application scenarios of the advantages of each of the two evaluation methods. RESULTS The ranking of consumption sum of opioid and patient cost burden calculated by the two methods was the same in the five sample medical institutions， but the ranking of per capita consumption sum was different. Taking the 5 medical institutions as a whole， the top 4 rankings of consumption sum ratio for each species of opioid compared by both methods were the same， i. e. remifentanil＞sufentanil＞oxycodone＞morphine. The ratio of remifentanil was close to 50%. When comparing the ranking of consumption sum ratio in each medical institution， the ranking calculated by the two methods was different for those medical institutions except for H1 medical institutions. The consumption sum ratio of fentanyl calculated by DDD method was significantly higher than that of OME method； whereas consumption sum ratio of remifentanil calculated by OME method was significantly higher than that of DDD method. Perioperative patients had the highest consumption sum ratio， about 50%. The consumption sum ratio of critically ill patients in H3 jwsydey@163.com medical institutions and inpatient patients with cancer pain and other patients in H5 medical institutions calculated by DDD method was significantly higher than that by OME method. There were differences in the order of cost burden of different types of patients calculated by two methods. CONCLUSIONS DDD method can accurately reflect the dosage of opioid drugs and facilitate the monitoring and management of the dosage； OME method can more reflect the analgesic effect and compare the cost burden of patients.

When applying deep learning to the automatic segmentation of organs at risk in medical images, we combine two network models of Dense Net and V-Net to develop a Dense V-network for automatic segmentation of three-dimensional computed tomography (CT) images, in order to solve the problems of degradation and gradient disappearance of three-dimensional convolutional neural networks optimization as training samples are insufficient. This algorithm is applied to the delineation of pelvic endangered organs and we take three representative evaluation parameters to quantitatively evaluate the segmentation effect. The clinical result showed that the Dice similarity coefficient values of the bladder, small intestine, rectum, femoral head and spinal cord were all above 0.87 (average was 0.9); Jaccard distance of these were within 2.3 (average was 0.18). Except for the small intestine, the Hausdorff distance of other organs were less than 0.9 cm (average was 0.62 cm). The Dense V-Network has been proven to achieve the accurate segmentation of pelvic endangered organs.
Algorithms ; Humans ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; Neural Networks, Computer ; Organs at Risk ; Pelvis ; Tomography, X-Ray Computed

Objective To investigate the effect of special CT monochromatic images on improving imaging quality in Budd-Chiari Syndrome.Methods 40 patients with Budd-Chiari Syndrome underwent CT venography (CTV)with gemstone spectral imaging (GSI).Using the optimal contrast to noise ratio (CNR)curve of GSI software,the optimal CNR monochromatic images of the infe-rior vena cava and hepatic vein were chosen.The CT value of the intrahepatic segment of inferior vena cava,hepatic vein and the same level liver tissue were measured,and the CT value of the same region were measured on 140 kVp mixed energy images and 70 keV images.CNR on the optimal monochromatic images,the 140 kVp mixed energy images and 70 keV images were calculated respectively,and the image quality of the optimal monochromatic image,the 140 kVp mixed energy images and 70 keV images were subjective scoring.One-way ANOVA was used for statistical analysis using SPSS1 7.0 software.Results The optimal keVs from monochromatic images were distributed at 40 keV (50%)and (5 1 ± 1 )keV (50%)for IVC and 40keV (25%)and (53 ± 3)keV (75%)for HV.The CNR and CT value and subjective score of IVC/HV got from the optimal monochromatic images were signifi-cantly higher than those from 140 kVp mixed energy images and 70 keV images respectively(P <0.01 ).Conclusion The optimal monochromatic images provide higher image quality of IVC and HV in patientswithBudd-Chiari syndrome.

The in vivo measurements of rabbit brain tissue impedance were taken under both normal and ischemic conditions by using two-electrode measurement method in the frequency range from 0.1 Hz to 1 MHz. The dynamic images about the resistivity of cerebral ischemia were reconstructed based on a 16-electrode system. The results of in vivo measurement showed that the ratio of impedance increased can be as high as 75% at frequencies lower than 10 Hz. In the range from 1 KHz to 1 MHz, the ratio showed a constant value of 15%. The electrical impedance tomography (EIT) images obtained suggested that the regions of impedance changes highly correspond to the position of ischemia. It is confirmed that the brain function changes caused by local deficiency of blood can be detected and imaged by EIT method.
Animals ; Brain ; physiology ; Brain Ischemia ; physiopathology ; Electric Impedance ; Female ; Male ; Rabbits ; Tomography ; methods

The complex impedance measurements of human brain tissue in vitro are made by using four-electrode measurement methods in the frequency range from 0.1 Hz to 1 MHz. The Solartron 1255 B frequency response analyzer is used. The frequency response curves of the imaginary part of human brain's complex impedance do not appear as a single peak curve which other bio-tissues show, and the Cole-Cole diagram of human brain is different from the others as well. The construction of the equivalent circuit model obtained is more complex. However, these characteristics of human brain are all the same as rabbit brain's. The equivalent circuit model obtained will be helpful to constructing the equivalent circuit model of human head in the EIT researches.
Adult ; Brain ; physiology ; Electric Impedance ; Electrodes ; Humans ; In Vitro Techniques ; Male ; Models, Biological

The human skull impedance was quantitatively measured by means of Frequency Response Analyzer and its software. The impedance-frequency response curves of human skull were obtained. By analyzing the curves, we found that the characteristic frequency of human skull should be around 10 KHz.
Adult ; Electric Impedance ; Humans ; Middle Aged ; Skull ; physiology ; Time Factors