Objective:To understand the pre-warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre-audit system.Methods:The pre-warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre-audit system in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1, 2021 to December 31, 2021 were collected. The drugs involved were analyzed and determined as drugs in the correct pre-warnings and drugs in the audit rules that needed to be corrected. The drugs involved in the correct pre-warnings and the acceptance of pre-warnings by clinicians were analyzed; drugs that can be used off-label according to the evidence-based information were recorded and the proposed suggestions on the revision of the audit rules were provided.Results:A total of 259 medical advices about pre-warnings related to contraindicated drugs in patients with renal insufficiency were included in the analysis, involving 47 drugs. Among the 259 pre-warnings, 169 were correct, with the correct rate of 65.25%, and 107 (63.31%) of them were accepted by clinicians. The rate of acceptance by surgeons was higher than that by physicians, and the difference was statistically significant [76.39% (55/72) vs. 53.61% (52/97), P<0.01]. The audit rules in the 90 pre-warnings that needed to be modified involved 12 drugs. Of them, one drug (dapagliflozin tablets) had updated instruction, thus the rules can be modified directly according to it. The other 11 drugs were recorded for off-label drug use in the system based on evidence-based information, and of them, pre-warning levels were adjusted for 6 drugs, and audit rules were adjusted for 5. Conclusions:The pre-audit system can effectively pre-warning the contraindicated drug prescriptions of CKD patients, and the correct rate of pre-warning and clinician acceptance rate are more than 60%. The audit rules of some pre-warnings need to be adjusted with the update of the instructions and additional evidence-based information for off-label drug use after recording.

Objective:To understand the pre-warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre-audit system.Methods:The pre-warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre-audit system in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1, 2021 to December 31, 2021 were collected. The drugs involved were analyzed and determined as drugs in the correct pre-warnings and drugs in the audit rules that needed to be corrected. The drugs involved in the correct pre-warnings and the acceptance of pre-warnings by clinicians were analyzed; drugs that can be used off-label according to the evidence-based information were recorded and the proposed suggestions on the revision of the audit rules were provided.Results:A total of 259 medical advices about pre-warnings related to contraindicated drugs in patients with renal insufficiency were included in the analysis, involving 47 drugs. Among the 259 pre-warnings, 169 were correct, with the correct rate of 65.25%, and 107 (63.31%) of them were accepted by clinicians. The rate of acceptance by surgeons was higher than that by physicians, and the difference was statistically significant [76.39% (55/72) vs. 53.61% (52/97), P<0.01]. The audit rules in the 90 pre-warnings that needed to be modified involved 12 drugs. Of them, one drug (dapagliflozin tablets) had updated instruction, thus the rules can be modified directly according to it. The other 11 drugs were recorded for off-label drug use in the system based on evidence-based information, and of them, pre-warning levels were adjusted for 6 drugs, and audit rules were adjusted for 5. Conclusions:The pre-audit system can effectively pre-warning the contraindicated drug prescriptions of CKD patients, and the correct rate of pre-warning and clinician acceptance rate are more than 60%. The audit rules of some pre-warnings need to be adjusted with the update of the instructions and additional evidence-based information for off-label drug use after recording.

OBJECTIVE:To explore the importance and necessity of clinical pharmacists in drug therapy for chronic disease patients,the feasibility of developing medication reconciliation (MR),and to provide reference for establishing the internal medicine working model of clinical pharmacy.METHODS:During May to Jul.2016,inpatients were selected from respiratory department of our hospital as subjects.After detailed pharmaceutical consultation,clinical pharmacist conducted MR for newly inpatients at the first day in the hospital.RESULTS:Through clinical pharmacists classified and organized the problems of drug use in the inpatients during medication,MR records of 98 inpatients were collected,involving 296 medical orders and 96 items of medication errors.Among MR patients,there were only 44 cases of good compliance (44.9％);some problems about drug use existed in other cases,including optional medication,improper usage and dosage,fearing of drug side effects and refusing to use drugs,drug withdrawal due to ADR,follow-up failure of special disease leading to excessive or inadequate dose,poor communication with doctors leading to medication errors,forgetting to take medication or missing,excessive medical treatment and so on.Most common medication error-inducing drugs type was cardiovascular drug,followed by respiratory drug and endocrine system drug.CONCLUSIONS:The development of MR by clinical pharmacists is helpful to identify and correct medication error,avoid potential medication error,and control disease.It can be used as a project of pharmaceutical care in department of internal medicine.

OBJECTIVE:To investigate the mechanism of cross allergy reaction during the application of β-lactam antibiotics, and to provide reference for rational drug use in clinic. METHODS:Based on study experience of author in UIC and its affiliated hospital during advanced study,according to the experience of drug use safety management in patients allergic to β-lactam antibiot-ics from Rush University Medical Center,the mechanism of cross allergy reaction during the application of β-lactam antibiotics was summarized,and the disposal procedure for patients allergic to β-lactam antibiotics in the Affiliated Hospital of UIC was intro-duced. RESULTS:The principal reason for cross allergy reaction induced by β-lactam antibiotics were same or similar side chains between drugs. Cross allergy reaction occurred when IgE recognized these side chains. The disposal procedure for patients allergic to β-lactam antibiotics in the Affiliated Hospital of UIC included that the indication of β-lactam use was evaluated;standard penicil-lin skin testing according to evaluation results,anti-infection treatment by Grade challenge β-lactam antibiotics and course and rap-id drug tolerance induction. CONCLUSIONS:The disposal method for patients allergic to β-lactam antibiotics in the Affiliated Hos-pital of UIC can provide new thought for domestic clinical pharmacists in rational drug use among the patiens with reported aller-gies to special group as pregnant women,children.

OBJECTIVE:To explore the role of clinical evidence-based pharmacy in anticoagulant treatment strategies during continuous renal replacement therapy (CRRT). METHODS:Taking a thrombocytopenia patient of anticoagulant treatment during CRRT for instance,clinical pharmacists analyzed the evidence of taken argatroban anticoagulant therapy during CRRT for high risk blooding and thrombocytopenia patients based on evidence-based pharmacy combined with clinical data,monitored the efficacy and safety and evaluated the treatment process. RESULTS:Totally five literature about anticoagulant treatment strategies during CRRT for high risk blooding and thrombocytopenia patients were obtained,including one systematic review,one RCT and three cohort studies. Based on the above evidences,good results were achieved in the clinical practice of this patient,no thrombotic or hemor-rhagic complications occurred in this patient,platelet count and coagulation indicators of patients also improved. CONCLUSIONS:Evidence-based pharmacy plays an important role in anticoagulant treatment strategies during CRRT.

Objective: To provide reference for clinical pharmacists to write case analysis work .Methods: The reviews of 185 case analysis work of clinical pharmacists from the training bases all over the country were collected .Combined with the practical expe-rience of clinical teaching , the reviews were analyzed and discussed .Results:The problems in title , introduction , drug use analysis , summary and experience of the case analysis work were pointed out , and some improvement suggestions were provided , especially those for the improvement of case analysis evaluation form .Conclusion:Although the case analysis work has been screened by the teachers of training bases , the problems are still outstanding .The rationalization proposals provided in the paper maybe help improve the quality of case analysis work .

OBJECTIVE:To evaluate the economic effectiveness in different pharmacotherapeutic schemes for Hp infection in children.METHODS:To analyze four therapeutic schemes for Hp infection in children with cost - effectiveness analysis.RESULTS: The cost- effectiveness ratios of four therapeutic schemes were 14.92,8.85,8.37 and 8.58 respectively. CONCLUSIONS: scheme C(clarithromycin + bismuth potassium citrate + metronidazole)is the best one.

Objective:To find out the current situation of and objectively evaluate the use of the antidiabetic agents so as to provide reference information to the departments of production, sales and consumption of the agents. 　Methods:A analytic review of 6,639 020 prescriptions during the period of 1995～1999 was made regarding the costs and DDDs.　Results: In recent 5 years, the annual increase rate of the expenses for was(36.03±11.92)%; and that of DDDs was 20.05%. The order of expenses for various antidiabetic agents from high to low was as follows: glicalazide, acarbose, glipizide and metformin, while that of DDDs was glicalazide, glipizide, metformin and acarbose. The percentage of expenditure for oral versus the injection antidiabetic agents was(87.08±3.50)% to(12.92±3.50)%. 　Conclusion: The antidiabetic agents is a kind of common drugs with a bright future of development.

OBJECTIVE:To establish the preparation process of inclusion complex of diclofenac sodium-?-cyclodextrin (DS-?-CD) eyedrops METHODS:The DS-?-CD was prepared by the stir method and identified with instrumental method The content of diclofenac sodium was detected by UV,HPLC RESULTS:The inclusion ratio of DS-?-CD was(67 48?2 96)% There was no difference between diclofenac sodium and DS-?-CD in UV absorption spectrum The crystal diffraction peak of DS inclosed in DS-?-CD disappeared in X-ray CONCLUSION:The DS-?-CD can be used as eyedrops in clinical practice

OBJECTIVE:To evaluate the economic effectiveness in different pharmacotherapeutic schemes for Hp infection in children.METHODS: To analyze four therapeutic schemes for Hp infection in children with cost - effectiveness analy-sis. RESULTS: The cost - effectiveness ratios of four therapeutic schemes were 14.92, 8.85, 8.37 and 8.58 respective-ly. CONCLUSIONS: scheme C(clarithromycin + bismuth potassium citrate + metronidazole)is the best one.