OBJECTIVE To provide reference for improving the pre-prescription review system and reducing the occurrence of medication error by analyzing the drug-related problems （DRPs） in the pre-prescription review orders of pediatric outpatient clinics using the Pharmaceutical Care Network Europe （PCNE） classification system. METHODS The data of pre-prescription review orders were retrospectively collected from outpatient department of Shanghai Children’s Medical Center， Shanghai Jiao Tong University School of Medicine from July 2022 to June 2023； DRPs in the pre-prescription review orders were classified and summarized by using the PCNE classification system （version 9.1）， and then analyzed in terms of types and causes of issues， and the acceptance of interventions. RESULTS A total of 66 017 DRPs orders were included， involving 41 165 patients. The proportion of DRPs orders in children aged ≤5 years old was the highest （58.25%）， followed by children aged 6-12 years old （33.52%）； the department with the highest proportion of DRPs was internal medicine of pediatrics department （71.41%）； the department with the highest incidence of DRPs was thoracic surgery department （9.73%）； top three drug categories of DRPs orders were systemic anti- infective drugs （25.26%）， Chinese patent medicines （24.74%） and respiratory drugs （22.38%）. Referring to PCNE classification system， the types of DRPs mainly focused on treatment safety （64.86%）； the reasons of DRPs orders mainly focused on dose selection （82.09%）， of which 41.26% were due to excessive drug dosage； 92.13% of interventions could be accepted and fully executed by doctors. CONCLUSIONS DRPs orders identified by the pre-prescription review system can be effectively analyzed by using PCNE classification system. Pharmacists should focus on medication use in children aged ≤5 years old， update and develop personalized prescription review rules timely， and meet the rational needs of clinical medication for children.

Objective To evaluate the safety and efficacy of transcatheter arterial chemoembolization(TACE)combined with lenvatinib and camrelizumab in the treatment of advanced hepatocellular carcinoma(HCC).Methods The clinical data of a total of 63 patients with advanced HCC,who received TACE combined with lenvatinib and camrelizumab(triple therapy)or TACE combined with lenvatinib(dual therapy)at the Jingmen Municipal People's Hospital of China between April 2020 and December 2021,were retrospectively analyzed.Triple therapy group had 30 patients,and dual therapy group had 33 patients.The post-treatment tumor response,disease progression-free survival(PFS),overall survival(OS),and the incidence of adverse drug reactions were recorded.Results The median follow-up period of the two groups was 14 months(range of 4-26 months).Compared with the dual therapy group,in the triple therapy group the objective response rate(ORR)was remarkably higher(83.3%vs.57.6%,P=0.026),the disease control rate(DCR)was obviously higher(93.3%vs.69.7%,P=0.039),the median PFS was significantly longer(8.0 months vs.5.0 months,P＜0.01),and the median OS was strikingly longer(24.0 months vs.12.0 months,P=0.004).No statistically significant difference in the incidence of adverse drug reactions existed between the two groups(P＞0.05).Conclusion For the treatment of advanced HCC,TACE combined with lenvatinib and camrelizumab is clinically safe and effective.(J Intervent Radiol,2024,32:57-62)

Objective:To investigate the effects of Neibu Huangqi Decoction combined with Kangfuxin Liquid on wound healing after hemorrhoid fistula.Methods:Randomized controlled trial. A total of 90 patients with hemorrhoid fistula surgery in Tangshan Hospital of Traditional Chinese Medicine from January 2020 to June 2021 were selected as the observation objects and divided into 2 groups by random number table method, with 45 cases in each group. The control group was treated with Kangfuxin Liquid after surgery, and the observation group was treated with Neibu Huangqi Decoction. Both groups were treated continuously for 14 days. Wound symptom score was performed before and after treatment. The levels of TNF-α, IL-6 and IL-8 were determined by ELISA. The wound healing time was observed and the wound healing rate was calculated. Adverse reactions were recorded and clinical efficacy was evaluated.Results:The total effective rate was 93.33% (42/45) in the observation group and 66.67% (30/45) in the control group, with statistical significance ( χ2=9.89, P=0.002). After treatment, the scores of pain [(0.63±0.14) vs. (0.97±0.27), t=7.50], exudation [(0.67±0.12) vs. (1.09±0.31), t=8.48], edema [(0.78±0.17) vs.(1.25±0.36), t=7.92], pruritus [(0.78±0.20) vs. (1.32±0.33), t=9.39] were lower than those in the control group ( P<0.01); serum TNF-α [(33.46±2.86) μg/L vs. (45.78±3.92) μg/L, t=25.39], IL-6 [(41.86±5.84) μg/L vs. (56.12±6.75) μg/L, t=15.98], IL-8 [(27.40±3.58) ng/L vs. (36.16±3.84) ng/L, t=16.69] were lower than those in the control group ( P<0.01). The wound healing time of the observation group was shorter than that of the control group ( t=8.60, P<0.01), and the wound healing rate was higher than that of the control group ( t=24.65, P<0.01). During treatment, the incidence of adverse reactions was 11.11% (5/45) in the observation group and 6.67% (3/45) in the control group, without statistical significance ( χ2=0.14, P=0.711). Conclusion:Neibu Huangqi Decoction combined with Kangfuxin Liquid can promote wound healing, reduce inflammatory cytokines, relieve pain and exudation, improve clinical efficacy, and have few adverse reactions.

Objective:To establish a calculation model of drug preparation difficulty coefficient for outpatient pharmacy intrave -nous admixture center ( OUIVA) in a children's hospital, and construct the performance model .Methods: All the prescriptions in a week in OUIVA of Shanghai children's medical center were randomly selected .According to the actual difficulty level in the process of outpatient and emergency drug preparation , a basic drug difficulty coefficient and difficulty coefficient addition method was constructed . The difficulty index of every prescription was calculated .All the prescriptions in a week were randomly selected , and according to the difficulty coefficient analysis method , the daily difficulty coefficient of the prescriptions was calculated in order to build a performance model for OUIVA in the hospital .Results:The difficulty coefficient of medicine mainly included four basic difficulty coefficients and nine difficulty addition coefficients .According to the statistics , the average difficulty coefficient of daily prescriptions was (3.83 ± 2.86 )with the highest difficulty coefficient of 35, and the prescription data showed that there was significant difference between outpa -tient and emergency prescriptions and daytime blood tumor prescriptions .Conclusion:A performance model based on the difficulty co-efficient for OUIVA in children ' s hospital is a more scientific reflection to the daily work .

Objective:To analyze the dosage distribution and the frequency of each dosage of high-risk tablets in the hospitalized patients in a children's hospital,and study whether the existing specifications of high-risk tablets meet the pediatrics clinical needs. Methods:All the prescriptions including high risk tablets were analyzed from 2014 to 2016 in Shanghai children's medical center. The frequency of every dosage of every drug was analyzed,and the current specifications were judged according to the frequency. New specifications were proposed when the existing specifications did not match the clinical needs. The new frequency of the proposed speci-fications was re-accounted for all the three-year prescriptions in order to evaluate whether the proposed new specifications met the clini-cal needs. Results:Among the five kinds of high-risk oral tablets,methotrexate tablets and vitamin A acid tablets were in accordance with the actual clinical requirements. Mercaptopurine tablets should add two specifications including 12.5 mg and 17 mg,and warfarin sodium tablets should add one specification(1.25 mg). Hydroxyurea tablets(250 mg) and warfarin sodium tablets(1 mg) were rec-ommended used in the children's hospital. Conclusion:The existing specifications of high-risk oral tablets can't fully meet the clini-cal needs,therefore,specifications still needs to be adjusted.

Objective:To analyze the safety of generics and lactation of commonly used drugs in outpatient and emergency department of a children's hospital in Shanghai to formulate the related high-risk medicines list. Methods:According to the drug directory for outpatient and emergency department in the sample hospital,the medication assistant software was used to check the safety level of the related drugs used during pregnancy and lactation. Drugs with pregnancy safety grade D or X,and the lactation safety grade L4 or L5 involved in the high-risk pregnancy or breast-feeding drug list. Results:Of the 151 kinds of infusion medicines commonly used in outpatient and emergency department in the sample hospital, a total of 118 kinds were with a specified level of pregnancy safety,which accounted for 78.15%,and a total of 86 kinds were with a clear indication of the safety level of lactation,which accounted for 56.95% of the total number of medicines. A total of 25 kinds of drugs labeled pregnancy safety grade D or X, which accounted for 16.56%, and 21 species were with lactation safety L4 or L5, which accounted for 13.90% of the total number of drugs. The drugs with high pregnancy or lactation risk in the outpatient and emergency department of the sample children's hospital were anti-tumor drugs,anti-infective drugs,some cardiovascular drugs and central nervous system drugs. Conclusion:There are still many deficiencies in the information about the safety of pregnancy or breast-feeding in the existing medicines used in the sample hospital,which need to be improved.

Objective: To study the correlation between the empty bottle volume, negative pressure and gas production of the freeze-dried powder in the out-patient pharmacy intravenous admixture center of a children' s hospital in order to provide reference for the drug production. Methods:20 ml Syringes were used to measure the volume of empty bottles, negative pressure and produced gas. The relationship between the theoretical drug dissolution volume and the actual dissolution volume was compared, and the precautions for the drug production were put forward. Results:Among the tested 30 drugs, 6 ones were with the actual dissolution volume half of the theoretical dissolution volume, 8 ones were with negative pressure in the bottles, and 3 ones were with produced gas after dissol-ving. It was appropriate that the empty bottle volume be 4 ml larger than the theoretical dissolution volume, and it was appropriate that the negative pressure volume of drugs was slightly larger than the theoretical dissolution volume. Negative pressure should be still kept in the bottles after the gas production. Conclusion:The design of part of freeze-dried powder injection needle shows defects resulting in drug mixing difficulties to a certain extent.

Objective To discussed application effect of modified flowchart of preoperational articles in the operating room. Methods A group for the reconstructed flowchart was set up to look into the problems of traditional flowchart for articles preparation and then have the flowchart modified upon the found problems. The duration for article preparation and the flaw rate were compared between pre-and post-modification. Result The duration for preparation after modification was significantly shorter than that before modification and the flaw rate was significantly lower as well (P<0.001). Conclusion The modified flowchart for article preparation in the operation room can reduce the flaw rate and shorten the duration for article preparation, thus ensuring smooth operation.

Objective To discuss the causes and nursing strategies for unplanned extubations of hemodialysis patients with central vascular catheter .Methods Using the retrospective method , we analyzed and reviewed 11 unplanned extubations hemodialysis patients with central vascular catheter in our hospital between January 2010 and December 2012, in order to proposed the effective preventive nursing strategies . Results Eleven unplanned extubations were related to personal ( patients and nurses ) factors and central vascular catheters ’ maintenance and management .According to above causes , nursing strategies were made and none unplanned extubations happened after January 2013 .Conclusions During the process of using central vascular catheters , many reasons may cause unplanned extubation .Through designing workflow and guidelines , improving nurse training , strictly following operation specification , early detection of potential factors and the communication with patients and their relations , the rate of unplanned extubations can be effectively reduced .

ObjectiveTo study whether the abductor pollicis brevis been effected by the reinnervation of the Riche-Cannieu anastomosis in the median nerve injury cases.MethodsCollect 43 cases (29male,14 female,mean age 32.6)corresponds with the study needs: (1)The traumatic median nerve injury (proved by the results of electrophysiological examine and the clinic diagnose)on or below the forearm.(2)The existence of RCA was verified by the electrophysiological examine results,and the amplitude of electric potential was under 1mv.(3) Rule out the cases with the other injure of nerve or nervous system disease and cervical vertebra disease,diabetes patient.The analysis base on the results of 43 case's periodical examine,the periodical criteria as following: within 2-4th week,within the 2-4thmonth and 1 year after the injury.Results Forty-three cases had not obvious recovery indication of the median nerve under the clinical and electrophysiological aspect,eight cases of abductor pollicis brevis function improved quickly in 3 months,the relevant CMAP amplitude of Riche-Cannieu anastomosis increased apparently,the EMG (Electromyography)results of abductor pollicis brevis ameliorated accordingly.ConclusionIn the case of RCA combined with the median nerve injury,the abductor pollicis brevis fibra might be dominated by RCA reinnervation when losing domination of median nerve,the reinnervation process will much faster than the regeneration process of the broken nerve.