Abstract Background China has implemented policies to strengthen its pharmacist workforce since the 2009 healthcare reform, yet a comprehensive evaluation of their long-term systemic effects is lacking. Objective To systematically analyze the evolution of China’s pharmacist workforce in healthcare institutions from 2007 to 2023 across four dimensions: quantity, quality, structure, and distribution, providing an empirical foundation for policy optimization. Methods A retrospective analysis was conducted using longitudinal data from the China Health Statistics Yearbooks. Trends were delineated via descriptive statistics. Equity and spatial evolution were assessed using the Gini coefficient, Theil index decomposition, and spatial autocorrelation analyses (Global Moran’s I and hotspot analysis). Results From 2007 to 2023, the total number of pharmacists increased from 357,700 to 569,500 (average annual growth: 2.2%). This growth lagged behind physicians (4.6%) and nurses (7.4%),causing the pharmacist-to-physician ratio to decline from 1:5.15 to 1:8.39. The workforce showed trends of feminization (female proportion rose from 59.7% to 70.8%) and aging. While quality improved, 51.1% still held an associate degree or below, and only 6.6% held senior titles. Equity analysis revealed the provincial Gini coefficient improved from 0.145 to 0.093. Theil index decomposition confirmed intra-provincial disparities as the primary inequality driver. Spatial analysis showed a non-significant global Moran’s I by 2023 (0.154, P *>0.05), down from 0.254 ( P <0.01) in 2007. Hotspot analysis confirmed this transition, revealing a contraction of high-confidence clusters and a trend toward balanced distribution. Conclusions China has made measurable progress in expanding pharmacist workforce size and improving inter-provincial equity since 2007. However, persistent structural challenges remain: relative workforce contraction compared to other health professions, an aging demographic, a shortage of senior talent, and significant intra-provincial inequity. Future policies must prioritize optimizing workforce structure and enhancing clinical service capabilities to catalyze a shift toward patient-centered pharmaceutical care. Highlights First longitudinal study (2002–2023) tracking China’s institutional pharmacist workforce post-healthcare reform, revealing a critical structural shortage. Pharmacist growth rate (2.2% annually) severely lagged physicians (4.6%) and nurses (7.4%), causing the pharmacist-to-physician ratio to plummet from 1:5.15 to 1:8.39. 69.2% of China’s drug market (prescription drugs) is managed by only 569,500 institutional pharmacists—175,000 fewer than retail pharmacists, exposing a critical workload imbalance. Spatial disparity paradox: Gini coefficient improved to 0.093 (high equity), yet Theil decomposition revealed intra-provincial (urban/rural) gaps as the primary driver of inequality. High-level talent deficit: Despite quality gains, only 6.6% hold senior titles and 6.1% have master’s degrees—a bottleneck for advancing clinical pharmaceutical care.

BACKGROUD:With the reform of medical system in China, Beijing municipal hospitals explored a new pharmaceutical care model and set up medication therapy management services (MTMs) in ambulatory care since 2019. We were one of the first hospitals to set up this service in China. At the present, there were relatively few reports about the effect of MTMs in China. In this study, we summarized the implementation of MTMs in our hospital, explore the feasibility of pharmacist-led MTMs in ambulatory care and the impact of MTMs on patients' medical costs. METHODS:A retrospective study was conducted in a university-affiliated, tertiary comprehensive hospital in Beijing, China. The patients who received at least one MTMs and with complete medical records and pharmaceutical documents from May 2019 to February 2020 were included. Pharmacists provided pharmaceutical care for patients according to the MTMs standards issued by the American Pharmacists Association, identified the numbers and classification of the patients' perceived medication-related demands, identified medication-related problems (MRPs), and developed the medication-related action plans (MAPs). All MRPs found by pharmacists, pharmaceutical interventions, and resolving recommendations were documented, and calculate the cost of treatment drugs that patients can reduce. RESULTS:A total of 112 patients received MTMs in ambulatory care, among them 81 cases with the completed record were included in this study. 67.9% of patients had five or more diseases, 83% of them co-took over 5 drugs. While performing MTMs, 128 patients' perceived medication-related demands were recorded in all, monitoring and judgment of adverse drug reaction (ADR) (17.19%) was the most common demand. 181 MRPs were found, with an average of 2.55 MPRs per patient. Nonadherence (38%), excessive drug treatment (20%), and adverse drug events (17.12%) were the top three MRPs. Pharmaceutical care (29.77%), adjustment of drug treatment plan (29.10%) and referral to the clinical department (23.41%) were the top three MAPs. Whereby the MTMs provided by pharmacists, the cost-saving of each patient was about $ 43.2 monthly. CONCLUSION:By participating in the MTMs of outpatients, the pharmacists could identify more MRPs and develop personalized MAPs timely for patients, thereby promoting rational drug use and reducing medical expenses.

Background The variabilities of the pharmacotherapeutics’ efficacy and safety in the ICU geriatric patients further highlighted the importance of optimization of antimicrobial therapy. The aim of our study was to assess the impacts of clinical pharmacist intervention on antibiotic use, cost outcomes, and clinical benefits of the geriatric patients with infectious diseases in the critical care unit (ICU). Methods A propensity score matching (PSM) retrospective cohort study was undertaken in ICU patients with infectious diseases from 2017 to 2019. Baseline demographic, pharmacists’ activities and clinical outcomes including the patients’ mortality, antibiotic utilization, length of ICU stay (LOS), and costs of the drugs were compared between these two groups. Univariate analysis and bivariate logistic regression were adopted to illustrate the influencing factors on the mortality outcome. Results Of 1523 patients evaluated during the observed period, a total of 102 geriatric ICU patients with infectious diseases were enrolled in each group after PSM matching. Top 5 recommendations occurred by the pharmacist were medication regimen adjustments by diseases on progression, medication regimen adjustments by microbial results, drug withdrawal by full treatment courses, suggestions for TDM and medication regimen adjustments by de-escalation. The antibiotic use density (AUD) of all antibiotics consumed decreased significantly (p=0.018) from 241.91 DDD/100 bed days in the control group to 176.64 DDD/100 bed days in the pharmacist exposed group. AUD proportion was dropped in carbapenems from 23.07% to 14.43% and tetracyclines from 11.56% to 6.26% after pharmacist interventions. Although the mortality or LOS had no statistical difference between these two groups, the total cost of antibiotics was reduced significantly from $836.3 (IQR 426.88, 1682.09) in the control group to $362.15 (IQR 148.23, 1034.4) (p＜0.001) in the pharmacist intervention group, and cost for all the medications were reduced from $2868.18 ($1268.44, $5059.00) to $1941.5 ($1092.89, $3538.97) (p=0.016). Univariate analyses showed that there was no statistically difference in pharmacist intervention between the groups of survival and death (p=0.288) Conclusions The services provided by the critical care pharmacist could promote the rational use of drugs, which benefit both ICU geriatric patient and hospital care.

家庭不合理储备药品造成了极大的药品浪费,其原因主要为:患者在缺乏专业指导下自行购药、医师开具不合理处方量、患者依从性低、改变治疗计划、药品规格与包装不适宜和过期药品回收机制不健全等.建议多部门联动,加大对公众合理用药的宣传力度,规范零售药店管理,加强医疗机构药事管理,改进药品规格与包装,建立过期药品回收与销毁体系,打击非法回收渠道,加强药品可及性保障体系建设,提高药品可及性.

目的:从药物不良反应(adverse drug reaction,ADR)风险信号的角度评价常见的5类降压药对驾驶能力的影响,为驾驶者合理用药提供参考.方法:提取美国不良反应数据库中2004年第1季度至2019年第4季度的数据,分析常见降压药引起眩晕或晕厥、头疼、幻觉、疲乏、视力受损5种ADR的报告,利用比例报告比值法(proportional reporting ratio,PRR)和贝叶斯可信传播神经网络法(Bayesian confidence propagation neural network,BCPNN),对降压药可能影响驾驶能力的ADR数据进行挖掘.结果:在纳入的药物中,吲达帕胺、非洛地平、咪达普利、培哚普利、替米沙坦、奥美沙坦、奈必洛尔影响驾驶能力风险较小,氢氯噻嗪、硝苯地平、乐卡地平、福辛普利、赖诺普利、氯沙坦、缬沙坦、普萘洛尔、美托洛尔风险则较高.结论:相同作用机制的各降压药干扰驾驶能力的风险存在一定差异,驾驶者的临床用药应考虑该因素.

There have been few clinically useful targetable biomarkers in uterine cervical carcinomas. Estrogen receptor (ER), HER2, and fibroblast activation protein (FAP) are potential therapeutic or theranostic targets in other gynecologic and genitourinary carcinoma types. We determined the immunohistochemical expression patterns of these markers in treatment-naive cervical carcinoma, and whether expression correlated with clinical outcomes after definitive chemoradiation therapy. Tissue microarrays were created from 71 patient samples taken before therapy (57 squamous cell carcinomas and 14 nonsquamous cell carcinomas) and stained for ER, HER2, and FAP. ER was positive in 25/70 cases (36%). Of 66 tumors with evaluable HER2 staining, only 1 had positive (3+) staining (3%, positive for HER2 amplification by fluorescence in situ hybridization), and 1 had equivocal (2+) staining (negative for amplification by fluorescence in situ hybridization). The remainder were negative for HER2 overexpression. FAP expression was widely variably in the tumor stroma. ER positivity and FAP expression did not correlate with cervical recurrence, pelvic recurrence, distant recurrence, or cancer death. In conclusion, HER2 amplification is very rare in nonmetastatic treatment-naive cervical carcinomas, but if present, could represent a target for antibody therapy. ER and FAP were expressed in a subset of tumors, but expression did not correlate with clinical outcomes. These immunohistochemical markers do not demonstrate prognostic significance in treatment-naive cervical cancer, but they may have utility in targeted therapy or imaging.

目的 建立老年综合科管饲给药标准操作流程,评估其对用药错误和管饲并发症发生率的影响.方法 以2019年1月至6月老年科的管饲患者为对照组,2019年7月至12月的管饲患者为试验组.通过建立管饲药物的给药标准、管饲标准给药流程、管饲冲管流程、降低管饲腹泻措施、出现腹泻后的处理流程,并对医护人员进行同质化培训,对试验组患者进行干预,比较干预前后的不合理医嘱百分比、堵管率和腹泻率.结果 老年综合科管饲给药不合理医嘱百分比由干预前的19.35％显著降至7.89％(P<0.05);临床堵管率由干预前的14.55％显著降至5.77％(P<0.05);腹泻率由之前的11.82％显著降至3.85％(P<0.05).结论 建立管饲给药、堵管、腹泻的标准化处理流程有利于减少用药错误的发生,同时显著降低管饲喂养并发症的发生率.

What is known and objective Reduced folate carrier 1 (RFC1), which is encoded by the human solute carrier family 19 member 1 (SLC19A1) gene, plays an essential role in the cellular uptake of methotrexate (MTX). RFC1 expression is regulated by genetic variations and epigenetic modifications. The aim of the present study was to investigate the methylation status of the SLC19A1 promoter in peripheral blood and its association with MTX levels and toxicities in children with acute lymphoblastic leukaemia (ALL). Methods Serum MTX concentrations were measured using a fluorescence polarization immunoassay. Methylation quantification for SLC19A1 promoter region #17 was performed by Sequenom MassARRAY in 52 paediatric ALL patients. Results and discussion Overall, the investigated region of the SLC19A1 promoter was in a hypermethylated state. No significant associations were detected between the methylation levels of six CpG units in the SLC19A1 promoter region #17 and clinical parameters of patients with ALL, including sex, age, immunotype and risk stratification. The methylation level of CpG_10 showed a significant positive correlation with MTX 24 hours after the initiation of infusion. No significant differences in the methylation levels of six CpG units were observed between patients with and without MTX toxicities. Due to the small sample size of this study, there was a high chance of false-positive results. A large-scale study would be required to confirm these preliminary results. What is new and conclusion Our preliminary results suggested the hypermethylated status of the SLC19A1 promoter in children with ALL. The methylation levels of the SLC19A1 promoter might affect MTX exposure. These findings have implications for the mechanisms underlying the variability of MTX responses in childhood ALL.

目的 探讨祛白片对小鼠B16脱黑色素细胞模型促黑色素生成的影响.方法 采用H2O2建立小鼠B16黑色素瘤脱黑色素模型,设置模型对照组、溶媒组、8-MOP组(25、50、100μmol/L)、祛白片组(25、50、100 μg/mL).CCK-8检测小鼠B16黑色素瘤细胞存活,检测黑色素合成及酪氨酸激酶,Western blot、RT-PCR分别检测CD4、CD8蛋白及mRNA表达.结果 祛白片可促进脱黑色素细胞生长,高剂量祛白片可促进黑色素形成,抑制酪氨酸激酶活性,低剂量祛白片促进酪氨酸激酶活性.高剂量祛白片作用于脱黑色素细胞48 h后,可促进CD4蛋白及mRNA表达,而抑制CD8蛋白及mRNA表达.结论 祛白片可促进脱黑色素细胞黑色素生成,其分子作用机制可能是通过干预T淋巴细胞免疫路径实现.

Abstract Background We aims to investigate the roles of clinical pharmacist on optimizing the antibiotic pharmacotherapy regimens and achieved better clinical and economic outcomes in the critical care unit (ICU). Methods A retrospective cohort study in real world was undertaken from the year of 2016 to 2017 as the pharmacist pre-intervention period and 2018 to 2019 as the pharmacist intervention period in ICU. All interventions and consensus with clinicians were recorded. The outcomes of the patients’ mortality, microorganism detections, antibiotic utilities, length of ICU stay (LOS), costs of the antibiotics and the total drugs used were reviewed. Results Of 1436 patients were evaluated and 1252 recommendations were identified. The main points of the pharmacist interventions were medication regimen adjustments (52.32%) and drug withdrawal (22.60%). Before and after the pharmaceutical interventions, the AUD of all antimicrobials consumed decreased from 211.83 to174.02 (p = 0.000), the rate of antimicrobial utility decreased from 89.88–86.82% (p = 0.001), mortality reduced from 18.73–15.21% (p = 0.002), antibiotic charges were from ࿥8,644 ± 12,556 to ࿥5,587 ± 7,606 (p = 0.000) with 39% reduction. Conclusions The services provided by the clinical pharmacist with highly professional training could optimize the antibiotic therapy regimes, saved the drug costs and did not increase mortalities.

A recent study is raising concerns that dipeptidyl peptidase 4 inhibitors are associated with increased risk of venous thromboembolism. We aimed to assess the association between dipeptidyl peptidase-4 inhibitors and venous thromboembolism using the US Food and Drug Administration Adverse Event Reporting System database. We searched the venous thromboembolism cases related to dipeptidyl peptidase-4 inhibitors from 2004 first quarter to 2018 first quarter. We compared dipeptidyl peptidase-4 inhibitors versus three groups: (1) all other glucose-lowering drugs excluding insulins; (2) sulfonylureas and sodium–glucose-cotransporter-2 inhibitors; (3) sodium–glucose-cotransporter-2 inhibitors. In each comparison, we calculated proportional rate ratios and 95% confidence ratios by SAS 9.4. We obtained 873 dipeptidyl peptidase-4 inhibitors-associated venous thromboembolism events. Compared to all other glucose lowering-drugs excluding insulins, the proportional reporting ratio for overall venous thromboembolism, deep vein thrombosis, pulmonary embolism were 0.92 (0.86, 0.99), 0.91 (0.82,1.01), and 0.82 (0.74,0.90), respectively; the proportional reporting ratio for portal vein thrombosis, splenic vein thrombosis, mesenteric vein thrombosis were 3.94 (2.96, 5.25), 10.80 (6.14, 18.99), and 4.98 (2.76,8.96), respectively. Our analysis found no association between dipeptidyl peptidase-4 inhibitors and venous thromboembolism risk, while moderate to strong signals of portal vein thrombosis, splenic vein thrombosis, mesenteric vein thrombosis risks were observed.

It is known that γ‐glutamyl hydrolase (GGH) is involved in the disposition of methotrexate (MTX), and GGH activity is regulated by DNA methylation in acute lymphoblastic leukemia (ALL) cells. The present study explores the methylation status of the GGH promoter in peripheral blood and its association with MTX levels and toxicities in Chinese children with ALL.

临床试验用药物的管理和质量控制非常重要.本文阐述临床药师利用药学专长及临床工作特点,参与专业科室试验用药物质量控制,明确职责及质控重点环节.

目的 提示临床医师和药师在临床工作中要警惕和重视替加环素可能引起的Stevens-Johnson综合征(SJS)/中毒性表皮坏死松解症(TEN).方法 报道1例高龄患者应用替加环素、联合奥硝唑和氟康唑后出现中毒性表皮松解综合征的案例,并结合国内外文献资料进行分析与讨论.结果和结论 在美国食品药品监督管理局药物不良反应数据库中搜索到替加环素相关TEN 19例,SJS 26例. 国内为首例报道替加环素疑致TEN的案例. 根据药物不良反应关联性评价标准,该患者出现的TEN与替加环素可能相关,停药以后症状逐渐好转.

Gamma-Glutamyl hydrolase (GGH) plays an important role in the disposition of anti-folate analogs. Several studies noted the pharmacological relevance of rs3758149 C/T polymorphism located in the human GGH promoter. The present study aimed to investigate the role of rs3758149 C/T polymorphism and transcription factors in the regulation of GGH expression in human acute lymphoblastic leukemia (ALL) CEM/C1 cells. Compared with the rs3758149 T allele, the C allele showed significantly higher transcriptional activity in luciferase reporter assays, as well as a stronger binding affinity for the nuclear protein extracts in an electrophoretic mobility shift assay. Sp1 was identified as the target transcription factor that exhibited allele-specific binding to the location of rs3758149 C/T polymorphism in the chromatin immunoprecipitation assay. Overexpression of Sp1 led to enhanced GGH promoter activity and GGH mRNA expression in allele-specific manners. These findings suggested that Sp1 acted as a positive regulator of human GGH transcription through the rs3758149 polymorphism in CEM/C1 cells. This study contributed to the present understanding of the mechanisms underlying variable responses of ALL to anti-folates.

目的:建立客观、规范和统一的住院药师出组考核体系,为其他医院提供参考.方法:以《北京市医院药师规范化培训细则(2013版)》和北京地区住院医师规范化培训考核手册(北京市卫生局监制)为依据,制定住院药师出组考核方法和流程,细化考核标准及考核评分表,并在日常培训考核中加以实施和完善.结果:住院药师出组考核体系的建立与实施,提升了师资的带教水平及学员的培训质量.结论:出组考核是加强住院药师培训过程管理的重要环节,有利于进一步提高培训质量,是培养适应改革发展需求的医院药学人才的重要手段.

目的 调查北京市丰台区某小区老年患者潜在的不适当用药情况,为老年患者临床合理用药提供参考.方法 以美国2015版Beers标准为依据,利用问卷调查的方式,评价老年患者潜在不适当用药的情况.结果 在调查的332例患者中,存在与药物相关的潜在不适当用药55例(16.6％),其中短效和中效苯二氮基类、质子泵抑制剂和长效苯二氮革类药物例数最多,分别为21例(6.3％)、15例(4.5％)和7例(2.1％).共3例(0.9％)患者存在与疾病或状态相关的潜在不适当用药,10例(3.0％)老年患者应慎用潜在不适当药物,发生药物相关不良事件有23例(6.9％).结论 有必要采取措施预防社区老年患者的潜在不适当用药,进一步提高老年患者用药安全.

Organic anion-transporting polypeptide 1A2 (OATP1A2) is involved in the cellular uptake of methotrexate (MTX). Genetic variation in solute carrier organic anion transporter family member 1A2 (SLCO1A2, the coding gene of OATP1A2) has important implications for the elimination of MTX. We investigated the association between a microRNA (miRNA) binding site polymorphism (rs4149009 G > A) in the 3'-untranslated region (3'-UTR) of SLCO1A2 with the serum MTX concentrations in Chinese children with acute lymphoblastic leukemia (ALL). Genotyping for SLCO1A2 rs4149009 G > A in 141 children with ALL was performed using the Sequenom MassARRAY system. Serum MTX concentrations were determined by fluorescence polarization immunoassay. The percentages of MTX level ≥1 μmol/L at 42 h were compared among the AA, GA, and GG genotypes. The minor allele frequency observed in this study (33.0%) was significantly lower than that in the African samples reported in the 1000 Genomes Project (57.4%, P = 0.00). The incidence rate of delayed MTX elimination was significantly higher in patients with the GG genotype (23.1%) compared with the AA genotype (0.0%, P = 0.03). Bioinformatics tools predicted that the rs4149009 A allele would disrupt the putative binding sites of hsa-miR-324-3p and hsa-miR-1913. These results indicate that the rs4149009 G > A polymorphism might affect MTX pharmacokinetics by interfering with the function of miRNAs.