Objective To investigate the effectiveness of 4M1E refined management method in reducing dispensing time of outpatient prescription in outpatient pharmacies under the implementation of a long-term prescription policy.Methods The hospital started to implement 4M1E refinement management in July 2022.Ten thousand prescriptions were randomly selected for each of the pre-implementation(from January to June 2022)and post-implementation(from July to December 2022)human-machine hybrid dispensing windows.The dispensing time of a single prescription,the volume of prescriptions dispensed and the number of drugs prescribed during peak periods,the use of intelligent equipment,and patient satisfaction before and after imple-mentation were compared.Results After implementation,the single prescription drug dispensing time at the mixed human-ma-chine dispensing window was reduced from(96.88±1 401.17)s to(55.84±526.24)s(P<0.01);The number of prescriptions dispensed in the window increased from(135.20±21.06)to(147.19±21.24)prescriptions per 2 h,and the number of drugs pre-scribed increased from(871.74±215.61)to(1 008.53±267.87)prescriptions per 2 h during peak hours.The rate of straight prescription and the rate of equipment automation have been greatly improved.Outpatient satisfaction was higher than before man-agement.The data showed statistical differences(P<0.05).Conclusion Under long-term prescription pressure,hospital outpa-tient pharmacies can greatly reduce prescription dispensing time and improve patient satisfaction after applying the 4M1E fine management method.

By silica gel column chromatography, solvent extraction and preparative high performance liquid chromatography (HPLC), four new related substance were isolated and purified from the mass production and preparation process of alogliptin benzoate. Then it was analyzed and confirmed by various spectrum identification methods such as nuclear magnetic resonance (NMR) spectroscopy, high-resolution mass spectrometry (HR-MS) and Fourier-transform infrared spectroscopy (FTIR) according to its physical and chemical properties. The chemical structures of the four related substances produced in each step of the synthesis process of alogliptin benzoate were determined, and they were named as impurities L, M, T, and V. These four related substances were new impurities which were found for the first time. The isolation and identification of these impurities are of great importance to the quality control of alogliptin benzoate, and the optimization of manufacturing process.

Objective? To explore the family function of stroke patients and their rehabilitation exercise compliance level, as well as the correlation between them. Methods? By convenience sampling, totally 400 stroke patients undergoing re-examination in Department of Neurology, a ClassⅢ Grade A hospital in Zhejiang Province from June 15th, 2018 to December 15th 2018 were selected as the research objects. General Information Questionnaire, Questionnaire of Exercise Adherence(EAQ),Family Assessment Device(FAD) were adopted in the study. A total of 400 questionnaires were distributed and 389 valid ones were collected. Results? The 389 stroke patients had a total score of (37.07±11.55) in EAQ and (115.78±32.75)in FAD. The dimensional scores in family function(except emotional intervention) were negatively correlated with the total score of rehabilitation exercise compliance (P＜ 0.05). The total score of FAD was negatively correlated with each dimensional scores of EAQ (P＜ 0.05). Multivariate linear regression analysis indicated that, problem-solving, communication, role, emotional reaction, behavior control and the overall family function were the influencing factors of the patient's exercise compliance (P＜ 0.05). Conclusions? The stroke patients' family function and rehabilitation exercise compliance have great space to improve. For those with good family function, their rehabilitation exercise compliance is also good. Improving family function, especially coming up with effective problem-solving plan, is the effective way to improve the stroke patients' rehabilitation exercise compliance.

Objective To investigate the complications of different enteral nutrition in patients after surgery for massive cerebellar infarction,so as to guide rational application of enteral nutrition in patients.Methods Forty-nine patients with massive cerebellar infarction were divided into three groups randomly:conventional nasogastric tube feeding group (group A,n =12),nasogastric tube feeding plus gastric motor drug group (group B,n =18),and nasojejunal tube feeding group (group C,n =19).The incidences of diarrhea,reflux,aspiration,upper gastrointestinal bleeding and aspiration pneumonia within 3 weeks after initiation of enteral nutrition were observed and compared among the groups.Results The incidence of diarrhea showed no statistically significant difference among the 3 groups (x2 =0.092,P =0.955).Compared with group A,the incidences of reflux,aspiration and aspirafion pneumonia were significantly lower in group B and group C (P ＜ 0.05),and lower in group C compared with group B (P ＜ 0.05).Compared with group C,the incidence of upper gastrointestinal bleeding was significantly lower in group C than in group A and group B (x22 =4.748,P2 =0.029;x23 =4.284,P3 =0.038),but the difference between group A and group B was not significant (x21 =0.000,P1 =1.000).Conclusions Because of the unique pathophysiological features in patients after surgery for massive cerebellar infarction,early enteral nutrition by conventional nasogastric tube feeding may be inappropriate.Nasogastric tube feeding plus gastric motor drug may be applied in mild case with short course of disease.Nasojejunal tube feeding may be the approach of choice for enteral nutrition in critical patients with massive cerebellar infarction for its association with lower incidence of complications.

A 70-year-old female patient presented with several cutaneous masses on the left neck and trunk for 40 years. Some masses were removed by surgical operation more than 10 years prior to the presentation, but recurred subsequently along with an increase in lesion number. Persistent dull pain emerged at the lesion sites 2 months prior to the presentation and the masses on the left neck ulcerated 10 days prior to the presentation. Histopathology showed tumor cell clumps in the dermis with benign eccrine spiradenoma components in the centre region and carcinomatous components in the periphery. The carcinomatous components included slightly atypical cells and hyaline degeneration. Immunohistochemically, carcinoembryonic antigen and epithelial membrane antigen were observed in the tumor tissues. The case was diagnosed as eccrine spiradenocarcinoma. The masses were surgically removed, but recurred 1 month later, increased in size and number and ulcerated 3 months later, and the patient died 6 months after the surgery.

The result of a nutritional survey on potassium intakes of population and serum potassium contents of healthy adults in Shanghai (high occurrence of hypokalemia), Sichun (moderate occurrence of hypokalemia) and Shandong (null occurrence of hypokalemia) revealed that the average daily potassium intakes for the three areas were 60.1?16.6, 54.6? 13.4 and 58.7? 11.1 mmol per capita per day respectively; The serum potassium contents of the three areas were 4.2?0.3,4.0 ?0.3 and 4.2?0.4 mmol/L respectively. These results indicated that the daily potassium intakes and serum potassium contents between Shanghai and Shandong were not significantly different and might suggest that the occurrence of gossypol related hypokalemia in Shanghai and Sichun could not be attributed to the low potassium intakes and low serum potassium contents of the population.

Dietary fiber contents in 34 common foods perchased in Beijing markets have been determined with detergent method, including neutral detergent fiber, acid detergent fiber, cellulose, hemicellulose and lignin. On dry basis, the dietary fiber contents of vegetables varied with kinds of food: the dietary fiber contents were higher in tender stems, leaves, stalks and flowers; lower in starchy tubers and roots; medium in non-starchy tubers and roots. The propotions of dietary fiber components were different in various categories of foods. Cellulose was the major component in vegetables and legumes, but in most cereals, hemicellulose content was higher than cellulose. All foods had the lowest lignin content with the exception of garlic bolt.