OBJECTIVE To evaluate the effect of manipulation of Imipenem and cisplatin sodium (ICS) for injection on the consistency of its main drug imipenem (IPN) content,and the stability of different concentrations of ICS solution,to provide a reference for the safe and effective use of ICS in children.METHODS Three operators prepared ICS solutions according to the two commonly used dosage methods for children (10 mL or 20 mL 0.9％ Sodium chloride injection to prepare the initial ICS solution and draw the required dose from the initial suspension).The content of IPN was determined by ultra-high performance liquid chromatography-tandem mass spectrometry after parallel processing.The content consistency of solutions in each group was determined according to the coefficient of variation (CV)<15％ of the IPN content.ICS test solution X1 was prepared according to the instructions,and then test solutions X2 and X3 were prepared by diluting X1 with 0.9％ Sodium chloride injection in the volume ratios of 1:1 and 1:2,which were stored at room temperature[(23.0±0.5) ℃],in a thermostatic water bath at 30 ℃,and in a refrigerator at 2-8 ℃.The stability of the drug solution was determined by the ratio of the IPN mass concentration measured at the specified temperature and time to the initial (0 h) mass concentration (if the ratio was≥90％,it was considered that the drug solution was stable).RESULTS CV of IPN content was<15％ in each group of solutions prepared with two manipulation methods by each operator,indicating a small deviation in IPN content.The solutions at the three concentration levels were stable at room temperature for 6 h or refrigerated for 18 h.The test solutions X1 and X2 were also stable when placed at 30 ℃ for 6 h,but the IPN concentration in test solution X3 decreased by about 20％ compared with that of 0 h.CONCLUSIONS The consistency of the content of IPN is good in the two commonly used methods for ICS manipulation in children.The stability of ICS solution is affected by concentration,temperature and time.Lower concentrations at higher temperatures resulted in decreased stability of IPN.Clinical attention should be paid to controlling the amount of solvent as well as temperature and time during preparation and use.
OBJECTIVE To know about the perception and current status of drug risk management among pharmacists in Chinese medical institutions,providing insights and recommendations for enhancing the drug risk management system in medical institutions.METHODS A questionnaire survey was conducted across 28 provinces,cities,and autonomous regions;stratified radom sampling was employed to study the population of medical workers and pharmaceutical professionals in medical institutions nationwide.The survey included information on the survey population,the current status of drug risk management implementation in medical institutions,the cognition,definition and process of drug risk management related concepts,and the content and mode of drug risk management work in medical institutions.Finally,suggestions were collected from various medical institutions on the system construction of drug risk management.Descriptive statistical analysis was adopted to summarize the obtained data.RESULTS A total of 446 questionnaires were collected in this survey,including 420 valid questionnaires and 26 invalidquestionnaires.The questionnaire collection rate was 100％,and the effective rate was 94.17％.51.19％ of the respondents based their understanding of drug risk management on Management Measures for Adverse Drug Reaction Reports and Monitoring,while 87.38％ recognized the need for drug risk management throughout the drug use process.63.33％ of the participants stated that their medical institutions had dedicatedpositions related to drug risk management,with the highest proportion (72.17％) was in third-grade class A medical institutions.66.43％ reported implementing risk management across all drug use stages.Suggestions for the development of drug risk management systems in medical institutions by the research participants focused on enhancing guiding documents,clarifying concepts,establishing information-sharing mechanisms.CONCLUSIONS The overall awareness of drug risk management in China's medical institutions is high,with practices in place across various stages in multiple forms.However,there remains a need to strengthen institutional documents,management regulations,system development,and information-sharing mechanisms to improve collaborative governance,improve drug management levels,and ensure patient safety.
OBJECTIVE To explore the practice and application effect of lean Six Sigma (LSS) management in the cost-benefit management of PIVAS operation in a tertiary comprehensive hospital (hereinafter referred to as "S Hospital"),providing reference for the operation and management of PIVAS in hospitals.METHODS The five steps (define,measure,analyze,improve and control,i.e.DMAIC) of LSS management were implemented for PIVAS operation cost-benefit of S Hospital,and lean management was implemented for its cost-benefit management elements (human resource cost,medical and health material cost,and all-in-one parenteral nutrition preparation income).Several intervention measures including personnel training and performance assessment,refined management system of consumables,and doctor's advice package of full parenteral nutrition were developed.Finally,the overall improvement effect was evaluated by the total benefit,total cost and net benefit of PIVAS.The effects of human resource allocation optimization and improvement were evaluated by the work efficiency,work quality,job satisfaction,turnover rate and accumulated rest days.The effects of consumables cost management were evaluated by the amount of medical and health materials cost.The improvement effects of all-in-one parenteral nutrition preparation income were evaluated by the profit amount,quantity and the proportion of single bottle of parenteral nutrition.RESULTS After implementing DMAIC in S Hospital,the total benefit of PIVAS was increased from (471366.50±9201.5) yuan/month to (479679.50±14320.14) yuan/month (P>0.05),the total cost was decreased from (305878.88±3201.75) yuan/month to (294610.59±5007.33) yuan/month (P<0.05),and the net benefit of PIVAS was increased by 11.83％ compared with that before the improvement.The work efficiency,work quality and job satisfaction of employees were significantly improved,the accumulated rest days were significantly reduced,and the turnover rate of third-party employees was reduced from 15.0％ before the improvement to 7.5％ after the improvement.The cost of medical and health materials significantly decreased from (67826.42±2812.76) yuan/month before improvement to (56384.33±4607.67) yuan/month after improvement (P<0.05).The quantity of all-in-one parenteral nutrition was significantly increased from (1263.75±135.83)group/month before improvement to (2061.25±89.04) group/month after improvement (P<0.05),and the proportion of users of single bottle of parenteral nutrition in total users decreased from 93.25％ before improvement to 58.75％ after improvement.The profit of all-in-one parenteral nutrition was 63.18％ higher than that before implementing DMAIC.CONCLUSIONS The implementation of PIVAS operation cost-benefit management based on DMAIC is conducive to strengthening the cost control of PIVAS and promoting the healthy development of PIVAS.
OBJECTIVE To systematically evaluate the relationship of semaglutide with malignant neoplasms in type 2 diabetes mellitus (T2DM) patients.METHODS Retrieved from the Cochrane Library,PubMed,Embase,ClinicalTrials.gov,CNKI,Wanfang data and CBM,randomized controlled trials (RCTs) about semaglutide in the treatment of T2DM patients with outcome measures including malignant tumor events were collected from the establishment of the database to June 2024.Meta-analysis was performed by using RevMan 5.3 software to assess the risk of malignant neoplasms.RESULTS A total of 24 RCTs (26 trials) involving 24145 patients were included.Results of meta-analysis showed that compared to placebo,there was no statistical significance in the risk of semaglutide in pancreatic cancer[RR=0.39,95％CI(0.10,1.50),P=0.17],thyroid cancer[RR=1.29,95％CI(0.38,4.36),P=0.68],prostate cancer[RR=1.05,95％CI(0.36,3.12),P=0.92],skin cancer[RR=1.27,95％CI(0.80,2.02),P=0.31],gastrointestinal cancer[RR=1.00,95％CI(0.47,2.14),P=1.00],colorectal cancer[RR=0.96,95％CI(0.40,2.26),P=0.92],lung cancer[RR=1.62,95％CI(0.74,3.55),P=0.23],breast cancer[RR=1.25,95％CI(0.45,3.51),P=0.67]or all malignant neoplasms[RR=0.96,95％CI(0.76,1.21),P=0.73].Compared to other antidiabetic drugs,there was no statistical significance in the risk of semaglutide in pancreatic cancer[RR=0.62,95％CI(0.18,2.09),P=0.44],thyroid cancer[RR=1.09,95％CI(0.25,4.78),P=0.90],prostate cancer[RR=2.09,95％CI(0.46,9.47),P=0.34],skin cancer[RR=1.76,95％CI(0.65,4.72),P=0.26],gastrointestinal cancer[RR=0.68,95％CI(0.19,2.35),P=0.54],colorectal cancer[RR=0.60,95％CI(0.20,1.78),P=0.36],lung cancer[RR=1.00,95％CI(0.24,4.11),P=1.00],breast cancer[RR=0.82,95％CI(0.25,2.66),P=0.74]or all malignant neoplasms[RR=1.36,95％CI(0.96,1.94),P=0.09].CONCLUSIONS Semaglutide does not increase the risk of any type of malignant neoplasms in T2DM patients.
OBJECTIVE To explore the clinical features,diagnosis,treatment and management measures of multiple immune-related adverse event (irAE) after toripalimab treatment,in order to provide reference for the clinical management of similar cases.METHODS A retrospective analysis was conducted on a post-operative bladder cancer patient who developed various irAEs after toripalimab treatment.The patient's medical history,laboratory tests,imaging studies,treatment course and outcomes were detailed.The Naranjo scale was used to assess the relationship between the irAEs and toripalimab.RESULTS The patient developed irAEs after receiving toripalimab,such as immune-related myocarditis,liver dysfunction,and myasthenia.According to the Naranjo scale evaluation,it was assessed that these adverse events were related to the administration of toripalimab.After high-dose corticosteroid pulse therapy and immunoglobulin immunomodulation,the patient's symptoms were effectively relieved,with a improved trend in various physiological indicators and significant improvement in the degree of system/organ damage.CONCLUSIONS Toripalimab may lead to multiple irAEs,including immune-related myocarditis,liver injury,and myasthenia.Early recognition,timely diagnosis,and appropriate treatment of irAE are crucial for improving patient's prognosis.
