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 cost-effectiveness of budesonide/formoterol powder inhalation(BF)versus salmeterol/fluticasone powder inhalation(SF)for the treatment of persistent asthma in adolescents,and to provide economic evidence and reference for clinical medication and decision-making.Methods From perspective of Chinese healthcare,a Markov model was established based on a prospective cohort study conducted by Shanghai Fudan University Affiliated Minhang Hospital.The cycle length was 7 days,and the time horizon was 6 years.A discount rate of 5％per year was applied.Clinical parameters including asthma acute exacerbation,treatment costs,and health utility values were obtained from relevant literature.The primary outcomes were direct medical costs,quality-adjusted life-years(QALYs),and incremental cost-utility ratio(ICUR).Cost-utility analysis was performed using TreeAge Pro 2022.The one-way sensitivity analysis and probabilistic sensitivity analysis were conducted to validate the robustness of the basic analysis results.Results Compared with SF group,BF group contributed to an incremental QALYs of 0.002 5 and reduced the cost by 7 043.93 yuan,which implied that BF group was a dominating treatment.Results of one-way sensitivity analysis showed that SF price,BF price and Hazard ratio of asthma acute exacerbation(BF vs.SF)were the main sensitivity factors of model.Probabilistic sensitivity analysis demonstrated the probability of BF being cost-effective was about 80％within the willingness to pay threshold of 257 100 yuan/QALY.Conclusions It was found out in this study that BF was a more cost-effective option for the adolescents with persistent asthma compared with SF.

Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.

Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.

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 analyze the common dosage of oral liquid preparations used in a children's hospital in order to provide reference for the best drug specifications for children's medicines. Methods: The prescription data of patients containing oral liquid preparations were collected from January 2014 to December 2016 and used for the analysis in the sample hospital. The most commonly used doses were compared with the existing specifications to provide suggestions on the best specifications for children. Results: There were 11 kinds of oral liquid preparations commonly used in the children's hospital. Only 4 kinds of drugs met with the best drug speci-fications for children, and the others were not able to meet the clinical needs in the children's hospital. Conclusion: The best specifi-cations of children's medicines need to be readjusted.

OBJECTIVE: To investigate the effect of G protein-coupled receptor 17 (GPR17) on hypoxia injury in retinal ganglion cells . METHODS: CoCl (400 μmol/L) was used to induce hypoxic injury in RGC-5 cells. The expression of GPR17 and the effect of GPR17 ligands were investigated, and the role of GPR17 in hypoxia injury was further studied by transfection of RGC-5 cells with GPR17 small interfering RNA (siRNA). The cell viability was determined by MTT and the cell apoptosis rate was detected by flow cytometry analysis. The expression of GPR17 mRNA was determined with RT-PCR. RESULTS: mRNA expressions of GPR17 in RGC-5 cells with and without CoCl treatment were 0.36±0.05 and 0.26±0.08(<0.01). Compared with hypoxia without any treatment, pretreatment with GPR17 agonists (LTD, UDP, UDP-G) significantly reduced cell viability (the survival rates of cells decreased by 29.6%, 31.8% and 33.9%, all <0.01), while the effect of GPR17 antagonist (cangrelor) was the opposite (the survival rates of cells increased by 33.2%, <0.01). Transfection with GPR17 SiRNA inhibited hypoxia-induced up-expression of GPR17 mRNA (<0.01)and reduced cell apoptosis[rates of cell apoptosis were(39.73±2.06)%,(42.50±3.64)% and (24.98±2.16)% for blank control, NC siRNA and GPR17 siRNA groups, <0.01]. CONCLUSIONS GPR17 may mediate hypoxia injury in RGC-5 cells, while the knockdown of GPR17 can reduce the hypoxia injury.
Apoptosis ; Cell Hypoxia ; genetics ; Cell Line ; Cell Survival ; Cobalt ; Gene Expression Regulation ; drug effects ; Gene Knockdown Techniques ; Humans ; Hypoxia ; chemically induced ; genetics ; Receptors, G-Protein-Coupled ; genetics ; metabolism ; Retinal Ganglion Cells ; drug effects

Objective: To establish the standardized management mode for emergent medicines of inpatient area based on JCI. Methods:The expiry verification data of emergent medicines in hospital wards were collected from 2013 to 2015. The number and the amount of emergent medicines expired in the last three months in each calendar month during the three years were analyzed, the exist-ing problems in the management mode were found out and gradually optimized using PDCA cycle. Results:From 2013 to 2015, the re-placement amount of emergent medicines expired in the next month was 3497. 37 yuan. The number of emergent medicines expired in current month was 62. A total of 420 times of emergent medicines didn' t meet the requires of expiry verification from 2013 to 2015. After the check-in form redesign for emergent medicines and the standardization of replacement process, the number of expired medi-cines in the rescue carts was reduced, and the validity and quantity of drugs in all the rescue vehicles could be clearly shown in the new form. Conclusion:The standardization of emergent medicine management model can guarantee the safety of emergent medicines used in patients.