Objective To analyze the current status of knowledge,attitude,and behavior?(KAP)of doctors and pharmacists regarding iodine contrast agent allergic reactions in medical institutions in China and the influencing factors,to provide reference for the treatment of iodine contrast agent allergic patients.Methods A questionnaire survey on iodine contrast agent allergic reactions was conducted among doctors and pharmacists in China using a self-designed questionnaire.The questionnaire was distributed online via WeChat and the participants were anonymous and voluntary.The scores of knowledge,attitude,and behavior of medical staff of different genders,departments,and titles were statistically analyzed.Wilcoxon rank sum test and multiple linear regression analysis were used to analyze the influencing factors.Results A total of 105 doctors and pharmacists from 19 provinces,autonomous regions and municipalities participated in the survey,completing 105 valid questionnaires.The knowledge score(out of 4 points),attitude score(out of 3 points),and behavior score(out of 3 points)of doctors and pharmacists regarding contrast agent allergy reactions were 2(1,2)points,1(0,2)points,and 1(1,2)points,respectively.Multivariate linear regression analysis showed that job title is a factor affecting the knowledge score.Compared to those with primary and below titles,senior title doctors and pharmacists had higher knowledge scores(P=0.007).Educational level is a influence factor affecting the attitude score.Compared to those with undergraduate and below educational levels,doctors and pharmacists with doctoral degrees had more positive attitudes(P=0.011).Attitude score is a influence factor affecting the behavior score,the more positive the attitude,the more positive the behavior(P=0.015).Conclusion The knowledge,attitude,and practice(KAP)of doctors and pharmacists regarding contrast agent allergy reactions need to be strengthened.Training should be conducted for doctors and pharmacists,taking into account the KAP differences among individuals with different job titles and educational levels,to enhance knowledge levels and actively explore safe and effective desensitization treatment methods for patients with contrast agent allergies.The use of iodinated contrast agents should be rationalized while ensuring patient safety.

Objective To analyze the current status of knowledge,attitude,and behavior?(KAP)of doctors and pharmacists regarding iodine contrast agent allergic reactions in medical institutions in China and the influencing factors,to provide reference for the treatment of iodine contrast agent allergic patients.Methods A questionnaire survey on iodine contrast agent allergic reactions was conducted among doctors and pharmacists in China using a self-designed questionnaire.The questionnaire was distributed online via WeChat and the participants were anonymous and voluntary.The scores of knowledge,attitude,and behavior of medical staff of different genders,departments,and titles were statistically analyzed.Wilcoxon rank sum test and multiple linear regression analysis were used to analyze the influencing factors.Results A total of 105 doctors and pharmacists from 19 provinces,autonomous regions and municipalities participated in the survey,completing 105 valid questionnaires.The knowledge score(out of 4 points),attitude score(out of 3 points),and behavior score(out of 3 points)of doctors and pharmacists regarding contrast agent allergy reactions were 2(1,2)points,1(0,2)points,and 1(1,2)points,respectively.Multivariate linear regression analysis showed that job title is a factor affecting the knowledge score.Compared to those with primary and below titles,senior title doctors and pharmacists had higher knowledge scores(P=0.007).Educational level is a influence factor affecting the attitude score.Compared to those with undergraduate and below educational levels,doctors and pharmacists with doctoral degrees had more positive attitudes(P=0.011).Attitude score is a influence factor affecting the behavior score,the more positive the attitude,the more positive the behavior(P=0.015).Conclusion The knowledge,attitude,and practice(KAP)of doctors and pharmacists regarding contrast agent allergy reactions need to be strengthened.Training should be conducted for doctors and pharmacists,taking into account the KAP differences among individuals with different job titles and educational levels,to enhance knowledge levels and actively explore safe and effective desensitization treatment methods for patients with contrast agent allergies.The use of iodinated contrast agents should be rationalized while ensuring patient safety.

Objective To analyze the current situation and influencing factors of knowledge,attitude and practice among medical personnel in medical institutions in China regarding skin testing of cephalosporins,to provide reference for standardizing medical behavior related to skin test.Methods A self-designed questionnaire on knowledge,attitude and practice of cephalosporins skin test was used to survey medical staff in China.The questionnaire QR code was distributed to medical institutions nationwide through WeChat,and participants participated voluntarily and anonymously.Knowledge,attitude,and practice scores of medical staff with different educational level,job positions,professional titles were calculated,and influencing factors were analyzed using Wilcoxon rank sum test,multiple linear regression analysis,and other statistical methods.Results 873 medical staff from 205 medical institutions in 30 provinces participated in this survey.The scores of knowledge(total score 16),attitude(total score 20)and practice(total score 20)in the cephalosporins skin test were 10(8,12),13(12,15)and 12(9,15),respectively.The results of multiple linear regression showed that educational level,job position and professional title were correlated with knowledge and attitude scores(P＜0.05).Graduate medical personnel had better knowledge and positive attitudes than specialized medical personnel.Pharmacists had better knowledge and a positive attitude than doctors and nurses.Medical personnel with intermediate and senior professional titles had better knowledge mastery and a positive attitude than those with junior and lower professional titles.Knowledge level is positively correlated with attitude(P＜0.05).Gender,job position and professional title were correlated with practice scores(P＜0.05).Female medical staff exhibited less positive practice than the male medical staff.Nurses exhibited more positive practices than pharmacists.Medical personnel with senior professional titles exhibited more positive practice than those with junior and lower professional titles.Knowledge,attitude was positively correlated with practice(P＜0.05).There was no statistically significant difference in the mediating effect of attitude on the influence of knowledge on practice(P=0.085).Conclusion The knowledge,attitude and practice of cephalosporins skin test among medical personnel in China need to be strengthened.Training programs should be tailored to address the differences in knowledge,attitude,and practice among medical staff in different positions and professional titles,to enhance knowledge levels,establish positive attitudes,and standardize skin test-related medical behavior.

Yigongsan， derived from QIAN Yi’s Key to Therapeutics of Children’s Diseases in the Song Dynasty， is a classic pediatric prescription that is included in the Catalogue of Ancient Classic Prescriptions （the Second Batch of Pediatrics） released by the National Administration of Traditional Chinese Medicine in 2022. This paper verifies and analyzes the historical origin， composition， dosage， processing， decoction method and efficacy of Yigongsan by systematically combing ancient books and modern documents. As a result， Yigongsan is composed of five herbs： Panax ginseng， Poria cocos， Atractylodes macrocephala， Citrus reticulata and Glycyrrhiza uralensis， of which P. cocos should be peeled， A. macrocephala is fried with soil， G. uralensis is roasted with honey while P. ginseng and C. reticulata are raw products. According to the dosage of ancient and modern times， each medicinal herb must be ground into fine powder， 1.6 g for each， added with 300 mL of water， 5 pieces of Zingiber officinale， and 2 Ziziphus jujuba， decocted together to 210 mL， and taken before meals. In ancient books， Yigongsan is used to treat vomiting， diarrhea， spleen and stomach deficiency， chest and abdominal distension， and lack of appetite， etc. Modern research showed that Yigongsan could also be used in the diseases of immune system， respiratory system， blood system， etc.， involving infantile anorexia， asthma， anemia， tumors and so on.

OBJECTIVE To compare the general status of training programs for geriatric clinical pharmacists in China and the United States， and provide a reference for further optimizing training programs of geriatric clinical pharmacists in China. METHODS Retrieved from the American Society of Health-System Pharmacists （ASHP） website and the Chinese Hospital Association website， the detailed information and data on training outline， institution type/scale， enrollment number， training contents， project application conditions and graduation assessments for clinical pharmacists in geriatric field were collected and statistical analysis was performed using Excel software. RESULTS & CONCLUSIONS As of January 12， 2024， ASHP provided 24 geriatric clinical pharmacist training programs and 25 positions available for application in the postgraduate year two training， which provided compensation. The training base involved hospitals and pharmaceutical colleges， with varying scales. Applicants needed to obtain a doctor of pharmacy and complete postgraduate year one training. ASHP had designed detailed training objectives for the four essential skills of basic patient care， advanced patient care， leadership and management skills， and knowledge education and teaching dissemination. Each training base could appropriately add optional skills such as academic skills， long-term care skills and other skills according to its characteristics， developed a student rotation plan， and conducted assessments and evaluations at multiple time points during the training process. There were 5 training programs for geriatric clinical pharmacists in China， with 15 positions， which didn’t provide compensation； training bases were all third-grade class A hospitals with relatively large scale. The applicant needed to obtain a bachelor’s degree or above， and different years of work were required based on their major and degree level. The Pharmaceutical Specialized Committee of the China Hospital Association had established a detailed training outline， proposing specific training objectives on theoretical knowledge， practical skills， scientific research thinking， etc. The training base organized assessments and evaluations at the time of enrollment， completion of specified content training， and graduation. According to the experience of the US， it is recommended to provide differentiated knowledge and skills training for students at different levels， flexibly arrange rotating departments， require students to work independently and deeply participate in clinical teaching and research work， conduct multiple and various forms of assessments， and adjust learning plans in a 13264273306@126.com timely manner to comprehensively enhance their abilities.

An 87-year-old female patient with Alzheimer's disease received donepezil 5 mg once daily orally for 8 years and then memantine 10 mg once daily orally was added due to the progression of the condition. Three months later, the patient suddenly fell into a coma and did not respond to call, acompanied by shortness of breath and wheezing. The patient had needle like changes in the pupils of both eyes, with blood pressure 190/100 mmHg and heart rate 56 beats per minute. The Glasgow Coma Scale (GCS) was E1V1M1. It was considered that the patient was poisoned due to drug accumulation caused by combination use of donepezil and memantine (blood concentration of methotrexate 215 mg/L, warning value: 30 mg/L; blood concentration of donepezil 33 mg/L, warning value: 20 mg/L). The 2 drugs were stopped, and symptomatic and supportive treatments such as fluid hydration, blood pressure reduction, and brain awakening were given. On the 3th day after drug discontinuation, the patient′s consciousness temporarily shifted to drowsiness, and her GCS was E1V1M1; on the 7th day after drug discontinuation, the patient′s consciousness became clear and she was able to answer simple questions, with GCS E4V4M4, blood pressure 126/67 mmHg, and normal pupil size.

A 50-year-old male patient was scheduled to undergo epiglottic mass resection under general anesthesia due to an epiglottic cyst. Before anesthesia induction, the patient received dexamethasone, methylprednisolone, midazolam, and ondansetron by intravenous injectionin sequence. After 2 minutes, the patient complained of palpitations, abdominal spasmodic pain, cyanosis of the lips, and patchy changes in the skin on the chest and body. The electrocardiogram monitor showed a heart rate of 175 beats per minute, but his cuff blood pressure cannot be measured. His blood oxygen saturation was 0.76, and he did not respond to the call afterwards. Oxygen through a face mask and pressure ventilation, intravenous injection of 20 mg of esmolol twice were given immediately. The patient′s consciousness recovered, the heart rate gradually decreased to 60 beats per minute (sinus rhythm), and the blood pressure increased to 74/50 mmHg. Continuous IV pumping of norepinephrine 8 μg/min was given. After 25 minutes, the patient′s bedside electrocardiogram showed atrial fibrillation with ventricular differential conduction, myocardial injury or acute myocardial infarction, and QT interval prolongation. Then intravenous injection of furosemide 40 mg was given, his above symptoms were improved,his blood pressure recovered to 110-120/70 mmHg, blood oxygen saturation was 1.00, the skin spots on his chest and body disappeared, and his abdominal pain was alleviated. Anesthesiologists and pharmacists evaluated the patient′s adverse reactions and considered that there was a high possibility of type I Kounis syndrome caused by the combination of glucocorticoids, midazolam, and ondansetron.

An 87-year-old female patient with Alzheimer's disease received donepezil 5 mg once daily orally for 8 years and then memantine 10 mg once daily orally was added due to the progression of the condition. Three months later, the patient suddenly fell into a coma and did not respond to call, acompanied by shortness of breath and wheezing. The patient had needle like changes in the pupils of both eyes, with blood pressure 190/100 mmHg and heart rate 56 beats per minute. The Glasgow Coma Scale (GCS) was E1V1M1. It was considered that the patient was poisoned due to drug accumulation caused by combination use of donepezil and memantine (blood concentration of methotrexate 215 mg/L, warning value: 30 mg/L; blood concentration of donepezil 33 mg/L, warning value: 20 mg/L). The 2 drugs were stopped, and symptomatic and supportive treatments such as fluid hydration, blood pressure reduction, and brain awakening were given. On the 3th day after drug discontinuation, the patient′s consciousness temporarily shifted to drowsiness, and her GCS was E1V1M1; on the 7th day after drug discontinuation, the patient′s consciousness became clear and she was able to answer simple questions, with GCS E4V4M4, blood pressure 126/67 mmHg, and normal pupil size.

A 50-year-old male patient was scheduled to undergo epiglottic mass resection under general anesthesia due to an epiglottic cyst. Before anesthesia induction, the patient received dexamethasone, methylprednisolone, midazolam, and ondansetron by intravenous injectionin sequence. After 2 minutes, the patient complained of palpitations, abdominal spasmodic pain, cyanosis of the lips, and patchy changes in the skin on the chest and body. The electrocardiogram monitor showed a heart rate of 175 beats per minute, but his cuff blood pressure cannot be measured. His blood oxygen saturation was 0.76, and he did not respond to the call afterwards. Oxygen through a face mask and pressure ventilation, intravenous injection of 20 mg of esmolol twice were given immediately. The patient′s consciousness recovered, the heart rate gradually decreased to 60 beats per minute (sinus rhythm), and the blood pressure increased to 74/50 mmHg. Continuous IV pumping of norepinephrine 8 μg/min was given. After 25 minutes, the patient′s bedside electrocardiogram showed atrial fibrillation with ventricular differential conduction, myocardial injury or acute myocardial infarction, and QT interval prolongation. Then intravenous injection of furosemide 40 mg was given, his above symptoms were improved,his blood pressure recovered to 110-120/70 mmHg, blood oxygen saturation was 1.00, the skin spots on his chest and body disappeared, and his abdominal pain was alleviated. Anesthesiologists and pharmacists evaluated the patient′s adverse reactions and considered that there was a high possibility of type I Kounis syndrome caused by the combination of glucocorticoids, midazolam, and ondansetron.

The classic formula Zhulingtang, derived from the medical work Treatise on Cold Damage (《伤寒论》) compiled by ZHANG Zhongjing, a medical sage in the Eastern Han Dynasty, has been included in the Catalogue of Ancient Classic Formulas (First Batch) published by the National Administration of Traditional Chinese Medicine in 2018. Using the method of textual research, this study systematically reviewed ancient and modern literature to conduct a historical and textual analysis of Zhulingtang, including its origin, composition, dosage, processing, decoction methods, efficacy, and applications. A total of 733 pieces of relevant information related to Zhulingtang were collected, involving 206 ancient Chinese medical texts, with 52 of them providing detailed records of the composition, dosage, processing, and efficacy of Zhulingtang. The results of the analysis showed that Zhulingtang was composed of Polyporus, Poria, Alismatis Rhizoma, Asini Corii Colla, and Talcum. Polyporus and Poria should be used without their peels, Asini Corii Colla should be stir-fried with clam powder, and Talcum should be ground into powder or soaked in water. Based on the conversion of ancient and modern dosages, Polyporus, Poria, Alismatis Rhizoma, and Talcum, 15.63 g for each one, were decocted with 800 mL of water to 400 mL. Then the drug residue was removed, and 15.63 g of Asini Corii Colla was added to the drug juice for melting by heating. The decoction should be taken warm, 140 mL each time, three times a day. Zhulingtang has the effects of promoting diuresis, nourishing yin, and clearing heat, and it is mainly used to treat water-heat combination syndrome, characterized by symptoms such as difficult urination, fever, and thirst. Modern research indicates that Zhulingtang is commonly used to treat diseases such as cirrhotic ascites, chronic glomerulonephritis, nephrotic syndrome, diarrhea, and urinary tract infections. This study provides key information about the famous formula Zhulingtang, which can serve as a reference for further development and research on its application.