OBJECTIVE To construct a closed-loop management model for externally dispensed intravenous prescriptions， and to provide reference for standardized management of externally dispensed intravenous prescriptions. METHODS Based on the Expert Consensus on Closed-loop Management of Externally Dispensed Intravenous Prescriptions in Guangxi Zhuang Autonomous Region previously formulated by our hospital， risk points during the entire process were systematically identified through multidisciplinary team brainstorming and a fishbone diagram. A series of strategies were subsequently formulated and implemented， including qualifying designated external dispensing pharmacies and the drug catalogs， operating and maintaining the hospital information system and the Pharmacy Intravenous Admixture Service （PIVAS） intelligent management platform， and strengthening differentiated training for staff in the whole workflow. A whole-process closed-loop management system was constructed with PIVAS as the co re hub and the daytime chemotherapy center as the safety terminal. RESULTS A total of 3 cooperating pharmacies and an initial drug list comprising 35 product specifications were selected. A closed‑loop management process encompassing hospital outpatient prescribing， patient drug purchase in designated pharmacies， PIVAS drug dispensing， and medication use in daytime chemotherapy center was successfully established. This system enabled the mandatory grouping and association of externally dispensed intravenous prescriptions with in-hospital diluents， full-process verification based on drug traceability codes， intelligent monitoring of infusion parameters， and whole-process data traceability. CONCLUSIONS The constructed model effectively resolves the coordination and safety oversight during the use of externally dispensed intravenous drugs from out-of-hospital circulation to in-hospital use， and has preliminarily enabled procedural standardization， whole-process information traceability， and proactive control of medication risks.

Objective:To explore the impact of sleep disturbances on the symptoms and functional impairment outcomes in children with attention deficit hyperactivity disorder (ADHD) and their path analysis.Methods:A cross-sectional study was made.Two hundred and seventy-eight ADHD children aged 6-12 years were selected from the Center for Cognition and Sleep, the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2022 to March 2023.The Swanson, Nolan and Pelham Rating Scale Ⅳ was used to evaluate the core symptoms of ADHD (namely, attention deficit and hyperactivity).The sleep disturbance scale for children was used to assess sleep disturbances [including disorders in initiating and maintaining sleep(DIMS), sleep breathing disorders, sleep-wake transition disorders (SWTD), disorders of arousal, disorders of excessive somnolence (DOES) and nocturnal hyperhidrosis].The Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) was used to assess functional impairment (in family, learning and school, life skills, self-concept, social activities, and risky activities).The descriptive statistical analysis, t test, multivariate linear regression and path analysis were used for statistical analysis. Results:Compared with those without sleep disturbances, ADHD children with sleep disturbances had significantly more serious functional impairment in family [(0.87±0.42) scores vs.(0.63±0.45) scores, P<0.001], learning and school [(0.75±0.37) scores vs.(0.62±0.35) scores, P=0.011], life skills [(1.30±0.37) scores vs.(1.08±0.30) scores, P<0.001], self-concept [(1.20±0.57) scores vs.(0.92±0.49) scores, P<0.001], social activities [(0.88±0.44) scores vs.(0.67±0.42) scores, P<0.001] and risky activities [(0.28±0.24) scores vs.(0.21±0.21) scores, P=0.043].The results of multivariate linear regression analysis showed that after adjusting for gender, age, total intelligence quotient, and core symptoms of ADHD, the regression coefficients of DOES in domains of family ( B=0.02, P=0.042) and life skills ( B=0.03, P<0.001) and the regression coefficient of DIMS in self-concept were still statistically significant ( B=0.02, P=0.013).The path analysis results showed that DOES ( β=0.170, P=0.004), attention deficit ( β=0.223, P<0.001) and hyperactivity ( β=0.385, P<0.001) directly affected WFIRS-P.DOES indirectly affected WFIRS-P through attention deficit ( β=0.270, P<0.001), and SWTD indirectly affected WFIRS-P through hyperactivity ( β=0.199, P=0.004). Conclusions:Severer sleep disturbances are associated with severer functional impairment in children with ADHD, and sleep phenotypes can directly or indirectly affect functional impairment outcomes in different domains in children with ADHD through core symptoms of ADHD.

Objective:To explore the application value of Jiedu Jiangtang Futan Decoction combined with acupuncture and moxibustion in the treatment of acute cerebral infarction patients with diabetes(qi deficiency and blood stasis type).Methods:All pa-tients with acute cerebral infarction complicated with diabetes(type of qi deficiency and blood stasis)were treated in Hongdu Tradi-tional Chinese Medicine Hospital from October 2020 to September 2022 and randomly divided into two groups,with 69 cases in each group.The control group was treated with conventional western medicine,and the observation group was treated with Jiedu Jiangtang Futan Decoction and acupuncture and moxibustion,and the efficacy was compared after two weeks of treatment.Results:Compared with before treatment,the serum levels of superoxide dismutase(SOD),vascular endothelial growth factor(VEGF)and brain-derived neurotrophic factor(BDNF)were increased in the two groups after treatment.The levels of serum matrix metalloproteinase-9(MMP-9),IL-6,fasting blood glucose(FBG),2-hour postprandial glucose(2 h PG)and glycated hemoglobin(HbA1c)were decreased.The Barthel index(BI)was increased,and the modified Rankin score(mRS)and National Institutes of Health Stroke Scale(NIHSS)were decreased(P<0.05).Compared with the control group,the levels of SOD,VEGF,BDNF and other indicators in the observation group were higher after treatment.The levels of MMP-9,IL-6,FBG,2 h PG and HbA1c were lower.BI was higher,mRS and NIHSS were lower,the difference were statistically significant(P<0.05).The total effective rate in the observation group was 94.20%(65/69),higher than 84.06%(58/69)in the control group(P<0.05).Conclusion:For patients with acute cerebral infarction complicated with diabetes(type of qi deficiency and blood stasis),the combination of Jiedu Jiangtang Futan Decoction and acupuncture and moxi-bustion treatment is helpful to promote blood supply to the brain,correct the imbalance of oxidative stress,regulate blood sugar level and improve clinical efficacy.

Objective:To analyze the current management status of real-world studies (RWS) in the medical institutions in China and suggest improvement focus for the management optimization.Methods:Surveys were conducted in 81 medical institutions nationwide. Convenience sampling was used to recruit survey subjects, and data were collected through self-administered questionnaires, followed by statistical analysis using descriptive methods.Results:The survey results indicated that 92.6% (75/81) of the medical institutions surveyed had undertaken RWS projects, with electronic medical records being the primary data source (89.3%, 67/75). Retrospective and prospective observational studies were the main types of study designs. Additionally, 96.3% (78/81) of the research subjects indicated that their medical institution expressed willingness to participate in or undertake RWS projects in the future. In terms of management, all types of RWS projects were managed by clinical trial center (24.0, 18/75), but differences existed in the management practices among medical institutions. Moreover, the challenges in data quality and standardization, study design and staff training, data and privacy protection and information technology support appeared in the management of RWS projects.Conclusions:It suggests to optimize the management processes of RWS projects in medical institutions and improve relevant laws and regulations to promote the development of RWS in China.

Objective:To explore the mediating role of anxiety/depression emotions between sleep quality and cognitive function in adolescents with attention deficit hyperactivity disorder(ADHD).Methods:A cross-sectional study design was adopted, involving 204 ADHD adolescents aged 12-18 who were treated between January 2021 and November 2023.All participants were assessed using the Pittsburgh sleep quality index(PSQI)for sleep quality, the self-rating anxiety scale(SAS) and self-rating depression scale(SDS) for emotional states.Four cognitive information processing processes(planning, simultaneous processing, attention, and successive processing) were evaluated by the Das-Naglieri cognitive assessment system(DN: CAS). Data were statistically analyzed using SPSS 23.0 and Zstats software, including descriptive statistics, Spearman correlation analysis, and mediation effect analysis.Results:Among ADHD adolescents, girls exhibited significantly higher rates of sleep disturbance(71.59%(63/88) vs 43.97%(51/116), χ2=15.490, P<0.001)and depressive emotion(47.73%(42/88) vs 33.62%(39/116), χ2=4.159, P=0.041)compared to boys.High school students had a significantly higher rate of sleep disturbance than middle school students(64.84%(59/91) vs 48.67%(55/113), χ2=5.341, P=0.021). Spearman correlation analysis revealed that sleep quality(8.00(6.00, 11.00)) in ADHD adolescents was significantly and positively correlated with anxiety(38.00(32.00, 46.00); r=0.504, P<0.01) and depression(46.00(39.00, 54.00); r=0.427, P<0.01). And sleep quality, anxiety and depression were significantly and negatively correlated with the DN: CAS total score(109.5(91.25, 123.75); r=-0.158--0.237, P<0.05). Mediation analysis indicated that anxiety mediated the relationship between sleep quality and attention function(indirect effect β=-0.159, Bootstrap 95% CI=-0.287--0.046). Conclusion:ADHD adolescents exhibit complex interactions among sleep quality, emotion, and cognitive function, sleep quality indirectly affects attention function through anxiety.

Objective:To explore the impact of sleep disturbances on the symptoms and functional impairment outcomes in children with attention deficit hyperactivity disorder (ADHD) and their path analysis.Methods:A cross-sectional study was made.Two hundred and seventy-eight ADHD children aged 6-12 years were selected from the Center for Cognition and Sleep, the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2022 to March 2023.The Swanson, Nolan and Pelham Rating Scale Ⅳ was used to evaluate the core symptoms of ADHD (namely, attention deficit and hyperactivity).The sleep disturbance scale for children was used to assess sleep disturbances [including disorders in initiating and maintaining sleep(DIMS), sleep breathing disorders, sleep-wake transition disorders (SWTD), disorders of arousal, disorders of excessive somnolence (DOES) and nocturnal hyperhidrosis].The Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) was used to assess functional impairment (in family, learning and school, life skills, self-concept, social activities, and risky activities).The descriptive statistical analysis, t test, multivariate linear regression and path analysis were used for statistical analysis. Results:Compared with those without sleep disturbances, ADHD children with sleep disturbances had significantly more serious functional impairment in family [(0.87±0.42) scores vs.(0.63±0.45) scores, P<0.001], learning and school [(0.75±0.37) scores vs.(0.62±0.35) scores, P=0.011], life skills [(1.30±0.37) scores vs.(1.08±0.30) scores, P<0.001], self-concept [(1.20±0.57) scores vs.(0.92±0.49) scores, P<0.001], social activities [(0.88±0.44) scores vs.(0.67±0.42) scores, P<0.001] and risky activities [(0.28±0.24) scores vs.(0.21±0.21) scores, P=0.043].The results of multivariate linear regression analysis showed that after adjusting for gender, age, total intelligence quotient, and core symptoms of ADHD, the regression coefficients of DOES in domains of family ( B=0.02, P=0.042) and life skills ( B=0.03, P<0.001) and the regression coefficient of DIMS in self-concept were still statistically significant ( B=0.02, P=0.013).The path analysis results showed that DOES ( β=0.170, P=0.004), attention deficit ( β=0.223, P<0.001) and hyperactivity ( β=0.385, P<0.001) directly affected WFIRS-P.DOES indirectly affected WFIRS-P through attention deficit ( β=0.270, P<0.001), and SWTD indirectly affected WFIRS-P through hyperactivity ( β=0.199, P=0.004). Conclusions:Severer sleep disturbances are associated with severer functional impairment in children with ADHD, and sleep phenotypes can directly or indirectly affect functional impairment outcomes in different domains in children with ADHD through core symptoms of ADHD.

Objective:To explore the application value of Jiedu Jiangtang Futan Decoction combined with acupuncture and moxibustion in the treatment of acute cerebral infarction patients with diabetes(qi deficiency and blood stasis type).Methods:All pa-tients with acute cerebral infarction complicated with diabetes(type of qi deficiency and blood stasis)were treated in Hongdu Tradi-tional Chinese Medicine Hospital from October 2020 to September 2022 and randomly divided into two groups,with 69 cases in each group.The control group was treated with conventional western medicine,and the observation group was treated with Jiedu Jiangtang Futan Decoction and acupuncture and moxibustion,and the efficacy was compared after two weeks of treatment.Results:Compared with before treatment,the serum levels of superoxide dismutase(SOD),vascular endothelial growth factor(VEGF)and brain-derived neurotrophic factor(BDNF)were increased in the two groups after treatment.The levels of serum matrix metalloproteinase-9(MMP-9),IL-6,fasting blood glucose(FBG),2-hour postprandial glucose(2 h PG)and glycated hemoglobin(HbA1c)were decreased.The Barthel index(BI)was increased,and the modified Rankin score(mRS)and National Institutes of Health Stroke Scale(NIHSS)were decreased(P<0.05).Compared with the control group,the levels of SOD,VEGF,BDNF and other indicators in the observation group were higher after treatment.The levels of MMP-9,IL-6,FBG,2 h PG and HbA1c were lower.BI was higher,mRS and NIHSS were lower,the difference were statistically significant(P<0.05).The total effective rate in the observation group was 94.20%(65/69),higher than 84.06%(58/69)in the control group(P<0.05).Conclusion:For patients with acute cerebral infarction complicated with diabetes(type of qi deficiency and blood stasis),the combination of Jiedu Jiangtang Futan Decoction and acupuncture and moxi-bustion treatment is helpful to promote blood supply to the brain,correct the imbalance of oxidative stress,regulate blood sugar level and improve clinical efficacy.

Objective:To explore the mediating role of anxiety/depression emotions between sleep quality and cognitive function in adolescents with attention deficit hyperactivity disorder(ADHD).Methods:A cross-sectional study design was adopted, involving 204 ADHD adolescents aged 12-18 who were treated between January 2021 and November 2023.All participants were assessed using the Pittsburgh sleep quality index(PSQI)for sleep quality, the self-rating anxiety scale(SAS) and self-rating depression scale(SDS) for emotional states.Four cognitive information processing processes(planning, simultaneous processing, attention, and successive processing) were evaluated by the Das-Naglieri cognitive assessment system(DN: CAS). Data were statistically analyzed using SPSS 23.0 and Zstats software, including descriptive statistics, Spearman correlation analysis, and mediation effect analysis.Results:Among ADHD adolescents, girls exhibited significantly higher rates of sleep disturbance(71.59%(63/88) vs 43.97%(51/116), χ2=15.490, P<0.001)and depressive emotion(47.73%(42/88) vs 33.62%(39/116), χ2=4.159, P=0.041)compared to boys.High school students had a significantly higher rate of sleep disturbance than middle school students(64.84%(59/91) vs 48.67%(55/113), χ2=5.341, P=0.021). Spearman correlation analysis revealed that sleep quality(8.00(6.00, 11.00)) in ADHD adolescents was significantly and positively correlated with anxiety(38.00(32.00, 46.00); r=0.504, P<0.01) and depression(46.00(39.00, 54.00); r=0.427, P<0.01). And sleep quality, anxiety and depression were significantly and negatively correlated with the DN: CAS total score(109.5(91.25, 123.75); r=-0.158--0.237, P<0.05). Mediation analysis indicated that anxiety mediated the relationship between sleep quality and attention function(indirect effect β=-0.159, Bootstrap 95% CI=-0.287--0.046). Conclusion:ADHD adolescents exhibit complex interactions among sleep quality, emotion, and cognitive function, sleep quality indirectly affects attention function through anxiety.

Objective:To analyze the current management status of real-world studies (RWS) in the medical institutions in China and suggest improvement focus for the management optimization.Methods:Surveys were conducted in 81 medical institutions nationwide. Convenience sampling was used to recruit survey subjects, and data were collected through self-administered questionnaires, followed by statistical analysis using descriptive methods.Results:The survey results indicated that 92.6% (75/81) of the medical institutions surveyed had undertaken RWS projects, with electronic medical records being the primary data source (89.3%, 67/75). Retrospective and prospective observational studies were the main types of study designs. Additionally, 96.3% (78/81) of the research subjects indicated that their medical institution expressed willingness to participate in or undertake RWS projects in the future. In terms of management, all types of RWS projects were managed by clinical trial center (24.0, 18/75), but differences existed in the management practices among medical institutions. Moreover, the challenges in data quality and standardization, study design and staff training, data and privacy protection and information technology support appeared in the management of RWS projects.Conclusions:It suggests to optimize the management processes of RWS projects in medical institutions and improve relevant laws and regulations to promote the development of RWS in China.

Objective:To explore the effects of the core symptoms of attention deficit hyperactivity disorder (ADHD) and behavior problems on the sleep of children with ADHD and their correlation.Methods:In this cross-sectional study, a total of 289 children aged 6-12 years with ADHD who visited the Outpatient Department of the Center for Cognition and Sleep at the People′s Hospital of Guangxi Zhuang Autonomous Region from June 2021 to December 2022 were selected.The Swanson, Nolan and Pelham Rating Scale Ⅳ was used to assess ADHD core symptoms (attention deficit and hyperactivity-impulsivity), the Conners Parent Symptom Questionnaire was used to assess behavior problems (conduct, learning, psychosomatic symptoms, and anxiety), and the Sleep Disturbance Scale for Children (SDSC) was used to assess sleep.Multivariate Logistic regression, multivariate linear regression, and path analysis were performed for statistical analysis of the data.Results:Multivariate Logistic regression analysis showed that after controlling age, gender, verbal intelligence quotient and performance intelligence quotient, attention deficit ( P=0.008, OR=2.60, 95% CI: 1.28-5.28), psychosomatic symptoms ( P=0.027, OR=6.77, 95% CI: 1.24-36.93) and anxiety ( P=0.013, OR=3.96, 95% CI: 1.43-11.67) increased the risk of sleep disturbances in children with ADHD (SDSC score >39 points).Path analysis showed that attention deficit ( β=0.244, P=0.001), psychosomatic symptoms ( β=0.114, P=0.046) and anxiety ( β=0.216, P<0.001) directly affected the SDSC score.Hyperactivity-impulsivity indirectly affected the SDSC score through psychosomatic symptoms ( β=0.142, P=0.039), and attention deficit indirectly affected the SDSC score through anxiety ( β=0.321, P<0.001). Conclusions:The severer the core symptoms of ADHD and behavior problems are, the higher the degree of sleep disturbances in children with ADHD is.Psychosomatic symptoms and anxiety are directly associated with the sleep disturbances of ADHD children.Attention deficit has direct or anxiety-mediated indirect impact on the sleep of ADHD children.Hyperactivity-impulsivity indirectly affects the sleep of children with ADHD through psychosomatic symptoms.