Metabolic diseases are common complications after solid organ transplantation (SOT) and significantly affect recipients’ quality of life and long-term survival. To our knowledge, no validated questionnaire specifically evaluates medical staff’s knowledge, attitude and practice (KAP) regarding post-transplant management of metabolic complications. This study aimed to develop and examine the validity and reliability of a questionnaire on KAP regarding management of metabolic complications after SOT among medical staff. This study was conducted in two phases from November 2024 to April 2025. In phase I, the initial item pool was developed within the KAP framework, based on a literature review and research team discussions. A two-round Delphi method with 15 experts was employed to revise the initial questionnaire. In phase II, the questionnaire was distributed to medical staff in the field of SOT from China. Following data collection, item analysis was conducted using the critical ratio method, correlation analysis, and Cronbach’s α. The validity and reliability of the questionnaire were then evaluated by assessing its content validity, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and internal consistency reliability. After two rounds of Delphi consultation, the questionnaire contained 26 knowledge, 12 attitude, and 12 practice items. A total of 277 questionnaires were included in the analysis. Item analysis led to the removal of six items that failed to meet the t value (P > 0.05) or correlation coefficient thresholds (r < 0.3). The overall content validity index for the remaining items was 0.939. Subsequent EFA resulted in the removal of one knowledge item with factor loading below 0.4, resulting in a stable three-factor structure with a cumulative variance contribution of 61.459%. The final CFA model exhibited an acceptable fit to the data (χ2/df = 2.106, RMSEA = 0.063, CFI = 0.916, TLI = 0.909, SRMR = 0.044). Excellent reliability was confirmed by a high Cronbach's α for the overall questionnaire and three dimensions (> 0.900), and further supported by split-half reliability (Spearman–Brown coefficient = 0.976; α = 0.917 and 0.909 for the halves). This study indicates that the developed 43-item questionnaire can serve as a valid and reliable instrument for assessing the KAP status of medical staff in the management of metabolic complications after SOT, thereby guiding the development of targeted training and clinical management strategies.

BackgroundMetabolic complications are a major challenge after solid organ transplantation (SOT), impacting graft and patient survival. Understanding staff’s knowledge, attitude, and practice (KAP) is crucial to optimize management.MethodsUtilizing data from a nationwide convenience sample (February–April 2025) of SOT clinicians and clinical pharmacists on the post-transplant metabolic complications management, this study analyzed 43-item KAP responses from 277 participants. Analyses included descriptive statistics, Spearman’s correlation, and multinomial logistic regression to assess KAP levels and identify influencing factors.ResultsAmong 277 participants, the high-level rate for overall KAP was 67.5%, with high-level rates of 62.8, 88.1, and 56.3% for the knowledge, attitude, and practice dimensions, respectively. All three KAP dimensions were significantly positively correlated (r = 0.372–0.462, all p < 0.05). Multinomial logistic regression identified variables associated with high level of KAP. Significant positive factors included: female gender, a master’s degree, and 10–19 years of work time for high-level knowledge; both 10–19 and ≥20 years of work time for high-level attitude; being a clinical physician for high-level practice; and age 36–44 years, a master’s degree and vice senior or chief senior titles for a high-level overall KAP score. Age 45–60 years was negatively associated with high-level attitude.ConclusionChinese SOT care providers demonstrate positive attitudes but suboptimal knowledge and practice in post-transplant metabolic complications management. Our study identifies self-reported educational needs and perceived practice gaps that may inform future training or quality-improvement initiatives.

ObjectivesThe charging policy of pharmacy intravenous admixture service (PIVAS) is not merely a minor “billing issue” confined to individual hospitals, but rather a critical component that impacts the safety, efficiency, equity, and long-term sustainability of the national healthcare system. Its implications extend across patients, medical institutions, the pharmaceutical industry, and even the broader public health landscape. To establish a foundation for the national charging standard of intravenous admixture service, this study comprehensively investigated and analyzed the operational costs and current charging policies of PIVAS across 30 provinces in China.MethodsQuestionnaires were distributed through the “Wenjuan Xing” platform from May 6th to 1 July 2022. After data generation and export by the platform, statistical and descriptive analyses of the questionnaire results were conducted using statistical software, including EXCEL, SPSS.ResultsA total of 761 PIVAS surveyed, 91.59% were affiliated with the pharmacy department, while 6.70% belonged to the hospital independent department. Most PIVAS strongly agreed with imposing fees, while most tertiary hospitals agreed that dispensing fees should be categorized based on hospital levels; however, most secondary hospitals disagreed. Approximately 60.58% of PIVAS have implemented a charging system which allows charges after inspection and evaluation. Regarding changes for different drugs nationwide, common drugs had an average charge standard of 4.39 yuan per bag while antibacterial drugs averaged 5.01 yuan per bag. Hazardous drugs had an average charge of 23.17 yuan per bag, whereas parenteral nutrition solutions averaged 38.75 yuan per bag. The annual operating cost of PIVAS in China was approximately RMB 2,098,100, with the integrated operating cost comprising 89.36% of the total, while dispensing cost accounted for only 10.64%. Human costs emerged as the highest annual consumption (74.20%), followed by facility maintenance (4.77%) and equipment acquisition costs (3.44%).ConclusionThe lack of a unified inspection and evaluation standard as well as charging standard in China is currently an urgent issue that needs to be addressed. The existing charging standard falls below the recommended level, thus it is necessary to develop a more reasonable and equitable charging standard that takes into account operational costs. This study can serve as an empirical reference for national medical insurance and health administration authorities in establishing unified regulatory standards and dynamic pricing adjustment mechanisms for PIVAS. It contributes to the transition of PIVAS from “regionally fragmented management” to “nationally standardized operations,” thereby supporting the dual objectives of enhancing healthcare service quality and optimizing the utilization efficiency of medical insurance funds.

Introduction This study explored the state of rational drug use among older adults in central China, aiming to unveil factors influencing their medication literacy and proposing targeted improvement measures. Methods A cross-sectional study involving 454 participants aged 60 and above was conducted in Hubei province between February 1 and May 30, 2023, with data collected through face-to-face interviews by pharmacists. Multiple logistic regression analysis was conducted to determine factors that affected medication literacy. Results Of the 412 valid questionnaires, findings revealed inadequate knowledge of rational drug use among older adults in central China. Those who fully understood (105, 25.49%, OR = 9.349, p < 0.001, 95%CI = 3.884–22.502) or partially understood (228, 55.34%, OR = 3.295, p = 0.002, 95%CI = 1.548–7.013) drug instructions exhibited significantly higher medication literacy than those who did not understand (79, 19.17%). Subsequent research revealed a lack of awareness in reading drug instructions or difficulty in understanding them. Most older adults seldom heard of but exhibited high acceptance of medication guidance services. Discussion In conclusion, the ability to comprehend drug instructions significantly influenced the medication literacy of older adults. Initiatives such as revising age-appropriate drug instructions could effectively enhance rational drug use among this demographic.

Objective. To explore the practice of comprehensive pharmacy management mode under the strategy of healthy China. Methods. Combining with hospital practice, the advantages and disadvantages of comprehensive pharmacy management mode were discussed and considered. Results. The comprehensive pharmacy has advantages in improving work efficiency, optimizing resource allocation, refining pharmacy management, checking the compatibility of Chinese and Western medicines, and improving service quality, and it also increases the labor intensity of staff and is prone to prescription dispensing errors. Conclusion. Hospitals with mature conditions and permission can use the management mode of comprehensive pharmacy.

INTRODUCTION:Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swept rapidly throughout the world. So far, no therapeutics have yet proven to be effective. Ribavirin was recommended for the treatment of COVID-19 in China because of its in vitro activity. However, evidence supporting its clinical use with good efficacy is still lacking. METHODS:A total of 208 confirmed severe COVID-19 patients who were hospitalized in Wuhan Union West Campus between 1 February 2020 and 10 March 2020 were enrolled in the retrospective study. Patients were divided into two groups based on the use of ribavirin. The primary endpoint was the time to clinical improvement. The secondary endpoints included mortality, survival time, time to throat swab SARS-CoV-2 nucleic acid negative conversion, and the length of hospital stay. RESULTS:68 patients were treated with ribavirin while 140 not. There were no significant between-group differences in demographic characteristics, baseline laboratory test results, treatment, and distribution of ordinal scale scores at enrollment, except for coexisting diseases especially cancer (ribavirin group vs no ribavirin group, P = 0.01). Treatment with ribavirin was not associated with a difference in the time to clinical improvement (P = 0.48, HR = 0.88, 95% CI = 0.63-1.25). There were also no significant differences between-group in SARS-CoV-2 nucleic acid negative conversion, mortality, survival time, and the length of hospital stay. CONCLUSIONS:In hospitalized adult patients with severe COVID-19, no significant benefit was observed with ribavirin treatment.

Background Secondary bloodstream infection (SBI) is considered one of the most perilous complications of coronavirus disease 2019 (COVID-19). Although the etiology of SBI has been reported, the clinical course and outcomes of this illness have not been well described. Methods In this retrospective study, all patients with confirmed SBI were included from a cohort of 1,651 patients hospitalized with COVID-19 in the Wuhan Union Hospital between January 25 and April 23, 2020. Demographics, clinical features, laboratory findings, treatments and outcomes were extracted from electronic medical records. The data were compared between survivors and non-survivors based on whether patients died within 30 days following SBI onset. Results A total of 31 patients corresponding to 1.9% (31/1,651) who exhibited SBI were included in the present study. The median time from admission to the onset of SBI was 22.0 days (2.0–64.0). The most common symptoms were shortness of breath (74%), fever (65%) and decreased blood pressure (52%) at the onset of SBI. The levels of white blood cell count, C-reactive protein, and procalcitonin were mostly elevated. Carbapenem-resistant Klebsiella pneumoniae (15 [48%]) and Acinetobacter baumannii (7 [23%]) were the main pathogens. In empirical treatment, carbapenems were still the first choice. The 30-day mortality following SBI onset and the hospital mortality of the 31 patients were 67.7% (21/31) and 77.4% (24/31), respectively. Almost every patient with SBI had complication due to sepsis (28 [90%]). The median time periods to sepsis and septic shock were 1 days (1.0 ~ 5.0) and 3.0 days (1.0 ~ 12.0), respectively. The proportion of carbapenem-resistant gram-negative bacteria (CRGNB) detected in blood cultures of non-survivors was higher (18 [86%] vs. 4 [40%]) compared to that of the survivors. These patients were more likely to develop sepsis (21 [100%] vs. 7 [70%]), and acute cardiac injury (19 [90%] vs. 5 [50%]). Conclusions The mortality of SBI patients with COVID-19 is considerable. Increased risk of mortality was noted for the following three subgroups: Patients infected with CRGNB, patients with complications of sepsis and patients with acute cardiac injury.

目的探讨黏液溶解性祛痰药治疗新型冠状病毒肺炎（COVID-19）重症患者的临床疗效。方法对2020年2月1日—3月10日收治于华中科技大学同济医学院附属协和医院西院治疗的COVID-19重症患者进行回顾性分析。按实际治疗方案分为黏液溶解性祛痰药治疗组和对照组,主要研究终点为依据7分等级量表评估的临床好转时间,次要研究终点为死亡率和核酸转阴时间。结果共纳入COVID-19重症患者208例,其中黏液溶解性祛痰药治疗组127例,对照组81例。两组在人口学特征、临床症状及实验室检查均无显著差异,入院第1天的临床情况亦无统计学差异,具有良好的可比性。黏液溶解性祛痰药不能明显缩短患者临床好转时间（P=0.129）或提高累计临床改善率（P=0.756,HR=0.949,95%CI0.683-1.318）,对核酸转阴时间和死亡率亦无改善作用。结论黏液溶解性祛痰药治疗对COVID-19重症患者作用不明显。

目的:基于帕累托图分析静脉用药调配中心(PIVAS)不合理医嘱,为医嘱审核以及临床合理化用药提供参考.方法:审方药师对本院住院部2019年1月～12月静脉用药长期医嘱进行前置审核,对审核不合理医嘱的科室和类型进行帕累托图分析,发掘不合理用药的主次要因素,阐明医嘱不合理原因.结果:共审核长期医嘱371799组,发现不合理医嘱1145组(0.31％),干预成功的不合理医嘱有905组,干预成功率为79.0％.在不合理医嘱科室中,泌尿外科、胃肠外科、骨科等为主要因素(占79.4％).在不合理医嘱类型中,溶剂不合理(35.0％)和用法用量不合理(25.7％)为主要因素;频次不合理(21.4％)为次要因素;配伍禁忌(11.8％)和联用不合理(3.4％)等为一般因素.结论:利用帕累托图可精准掌握不合理用药医嘱中的主次要因素,便于审方药师针对性干预,保障临床合理用药.

PURPOSE:Researches revealed that probiotics maybe a potential strategy for COVID-19, whereas there is a lack of related evidence. This study aims to analyze the role of probiotics on severe COVID-19 patients. METHODS:In the current retrospective single-center study, we collected data of 311 consecutive severe patients with confirmed COVID-19 in Wuhan Union Hospital from Feb 3rd to Feb 20th, 2020. Epidemiological, clinical and medication characteristics were compared and analyzed between patients with or without probiotics. RESULTS:In total, 93 of the 123 patients (75.61%) who were treated with probiotics survived to hospital discharge with the median inpatient day of 32 days and mean virus clearance time of 23 days, which were significantly longer than those of patients without probiotics. There were no bias in laboratory parameters, except for IL-6 and ESR, which were significantly higher in patients treated probiotics. We tracked the dynamic changes of 8 selected laboratory parameters (IL-6, CRP, total T lymphocytes, NK cells, B lymphocyte, CD4 + T cells, CD8 + T cells and CD4/CD8 ratio) and found that probiotics could not reduce the increased IL-6 levels but possessed the ability to moderate the immunity and decreased the incidence of secondary infection in COVID-19 patients. CONCLUSIONS:Probiotics could be an effective strategy for the treatment of COVID-19 patients to reduce the secondary infection and moderated the immunity.

Background The effect of corticosteroids on COVID-19 remains controversial. This study aims to clarify the potential roles of corticosteroids in severe COVID-19 patients. Methods In the current retrospective single-center study, we collected data of 214 severe patients with confirmed COVID-19 in Wuhan Union Hospital from Feb 20th to Mar 1st, 2020. Epidemiological, clinical and treatment were analyzed between patients treated with corticosteroids or not. Results Corticosteroids used patients have higher levels of lactate dehydrogenase (LDH), interleukin-6 (IL-6), CD4+/CD8+ cells, C-reactive protein (CRP) and procalcitonin (PCT). Virus clearance time and hospital length of stay in corticosteroids group were also significantly higher. The antiviral treatment and antibiotics treatment in patients given corticosteroids were both significantly higher. Antibiotics treatment duration was significantly longer in corticosteroids group. And the usage of multiple antibiotics in corticosteroid group was also significantly higher. And patients who treated by corticosteroids beyond 5 days showed a significantly longer antibiotics duration. Whereas there were no differences on virus clearance time and multiple antibiotics between the patients treated with corticosteroids beyond 5 days and less than 5 days. Multivariate analysis showed that patients with sputum production and higher IL-6 at admission, or treated with corticosteroid therapy were associated with prolonged virus clearance time and lianhua qingwen capsule may contributed to shorten virus clearance time. Conclusions The use of corticosteroids could prolong the virus clearance. The benefits and harms should be carefully weighed in the COVID-19 patients who intend to use corticosteroids. The dosage should be low-to-moderate (≤ 0.5-1 mg/kg per day methylprednisolone or equivalent) and the duration should be short (≤ 5 days) to avoid secondary infections.

1例70岁男性患者,因腰腹部疼痛不适1月余入院,给予曲马多注射液、丹红注射液、塞来昔布片等药物治疗.为明确诊断行上下腹部、肺、纵膈/胸部平扫+增强,胸腹主动脉造影.检查前给予碘美普尔注射液80mL.造影前患者肾功能在正常范围,造影后约24h患者出现少尿症状,48h尿素氮升高至13.11mmol·L-1,肌酐高达511μmol·L-1,考虑为碘美普尔诱导的急性肾损伤.经利尿、纠正电解质紊乱等治疗后,患者尿量增加,但肌酐值仍进行性下降,可能与对比剂肾病发生后未及时停用塞来昔布有关.

Background: A considerable proportion of patients hospitalized with coronavirus disease 2019 (COVID-19) acquired secondary bacterial infections (SBIs). The etiology and antimicrobial resistance of bacteria were reported and used to provide a theoretical basis for appropriate infection therapy.Methods: This retrospective study reviewed electronic medical records of all the patients hospitalized with COVID-19 in the Wuhan Union Hospital between January 27 and March 17, 2020. According to the inclusion and exclusion criteria, patients who acquired SBIs were enrolled. Demographic, clinical course, etiology, and antimicrobial resistance data of the SBIs were collected. Outcomes were also compared between patients who were classified as severe and critical on admission.Results: Among 1495 patients hospitalized with COVID-19, 102 (6.8%) patients had acquired SBIs, and almost half of them (49.0%, 50/102) died during hospitalization. Compared with severe patients, critical patients had a higher chance of SBIs. Among the 159 strains of bacteria isolated from the SBIs, 136 strains (85.5%) were Gram-negative bacteria. The top three bacteria of SBIs were A. baumannii (35.8%, 57/159), K. pneumoniae (30.8%, 49/159), and S. maltophilia (6.3%, 10/159). The isolation rates of carbapenem-resistant A. baumannii and K. pneumoniae were 91.2% and 75.5%, respectively. Meticillin resistance was present in 100% of Staphylococcus aureus and Coagulase negative staphylococci, and vancomycin resistance was not found.Conclusions: SBIs may occur in patients hospitalized with COVID-19 and lead to high mortality. The incidence of SBIs was associated with the severity of illness on admission. Gram-negative bacteria, especially A. baumannii and K. pneumoniae, were the main bacteria, and the resistance rates of the major isolated bacteria were generally high. This was a single-center study; thus, our results should be externally examined when applied in other institutions.

Background: Coronavirus disease-2019 (COVID-19) spreads rapidly throughout the world. So far, no therapeutics have yet been proven to be effective. Ribavirin was recommended for the treatment of COVID-19 because of its in vitro activity. However, evidence supporting its clinical use with good efficacy is still lacking. Methods: A total of 208 confirmed severe or critical COVID-19 patients who were hospitalized in Wuhan Union West Campus between 1 February 2020 and 10 March 2020 were enrolled in the retrospective study. Patients were divided into two groups based on the use of ribavirin. The primary endpoint was the time to clinical improvement. The secondary endpoints included mortality, survival time, time to throat swab SARS-CoV-2 nucleic acid negative conversion, and hospital duration. Results: 68 patients were treated with ribavirin while 140 not. There were no significant between-group differences in demographic characteristics, baseline laboratory test results, treatment, and distribution of ordinal scale scores at enrollment, except coexisting diseases especially cancer (ribavirin group vs no ribavirin group, P = 0.014). Treatment with ribavirin was not associated with a difference in the time to clinical improvement ( P = 0.483, HR = 0.884, 95% CI = 0.627-1.247). There were also no significant differences between-group in the number of patients with SARS-CoV-2 nucleic acid negative conversion, mortality, survival time, and hospital duration. Conclusion: In hospitalized adult patients with severe or critical COVID-19, no significant benefit was observed with ribavirin treatment.

目的:建立2型糖尿病患者药学监护路径(PCP),为开展规范化糖尿病药学服务提供思路.方法:100例2型糖尿病患者随机分为对照组(n=50)和监护组(n=50).应用临床路径的方法和原理,按糖尿病治疗特点,建立2型糖尿病患者PCP并用于监护组患者,对照组患者则给予常规管理.随访6个月后比较两组患者不合理用药发生率、糖尿病主要控制指标情况、自我管理水平、疾病认知情况和相关药物知识了解情况.结果:与对照组比较,监护组患者的不合理用药发生率,糖尿病主要监测指标空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbAlc)、收缩压(SBP)和舒张压(DBP)情况,自我管理水平(用药依从性、每天监测血糖、饮食、睡眠)、对疾病的认知情况(相关指标控制水平、并发症、饮食、运动、吸烟、饮酒)和对糖尿病药物相关知识的了解情况(降糖药的种类、降糖药的作用机制、降糖药的使用时间、降糖药的不良反应、胰岛素名称)等各项指标均优于对照组(P<0.05).结论:采用本研究制定的2型糖尿病PCP对患者进行药学监护,有利于保障患者的合理用药,改善患者的糖尿病相关控制指标,提高患者的自我管理水平、对疾病的认知及相关药物知识的了解水平.

以赤灵芝为原料提取碱溶性多糖，考察了提取时间、提取温度、液料比、NaOH浓度及提取次数对碱溶性多糖提取率的影响，并采用正交设计试验，确定了赤灵芝中碱溶性多糖最佳提取工艺参数，即提取时间2 h，提取温度60℃，液料比15 mL/g，NaOH质量浓度5%以及提取次数3次。验证性试验中实际测得碱溶性多糖平均提取率为10.98%，证明该优化工艺稳定可靠，切实可行。

近年来,生物制剂快速发展,在医疗领域发挥着不可或缺的作用.生物制剂分子量大、结构复杂,分子结构不同功能也不同.生物制剂的生产和纯化是一个复杂的过程,储存、运输应满足一定的条件,临床使用应具有一定的规范性,其中任何环节出问题都可对生物制剂的安全性、有效性及稳定性产生特殊的风险.本文就生物制剂在生产、储存、运输和临床使用的风险及其风险管理进行了全面综述.

目的:排查和防控武汉市大中型医疗机构药品质量安全管理体系中存在的风险,规范医疗机构药品全流程的管理.方法:依据《医疗机构药事管理规定》、《湖北省药品使用质量管理规定》等要求,药学专家和药品监管人员以全市56家大中型医疗机构为评估对象,对组织机构与人员管理、文件管理、药库管理、药房管理、医院制剂配制管理、特药抗菌药及ADR监测管理进行药品质量安全风险评估,排查药品安全管理中存在的风险点,提出合理化建议.结果:本次评估56家医疗机构的平均得分率为88.2％,评级优秀的占76.8％;药库管理是6个大项中风险最高的项目,82.1％医疗机构此项目存在风险;按子项目风险级别排序,排名前5的分别是冷链管理、临床药师配备、药库药品存放、药品养护和特药管理.三级医院药品质量安全风险管理情况优于二级医院、综合医院风险管理情况优于专科医院.结论:该市大中型医疗机构药品质量安全管理还存在一定的风险,各级医疗机构应加强药品管理,降低药品质量安全风险,保障患者用药安全.