MXene-Coated Ion-Selective Electrode Sensors for Highly Stable and Selective Lithium Dynamics Monitoring.

Lithium holds immense significance in propelling sustainable energy and environmental systems forward. However, existing sensors used for lithium monitoring encounter issues concerning their selectivity and long-term durability. Addressing these challenges is crucial to ensure accurate and reliable lithium measurements during the lithium recovery processes. In response to these concerns, this study proposes a novel approach involving the use of an MXene composite membrane with incorporated poly(sodium 4-styrenesulfonate) (PSS) as an antibiofouling layer on the Li+ ion selective electrode (ISE) sensors. The resulting MXene-PSS Li+ ISE sensor demonstrates exceptional electrochemical performance, showcasing a superior slope (59.42 mV/dec), lower detection limit (10-7.2 M), quicker response time (∼10 s), higher selectivity to Na+ (-2.37) and K+ (-2.54), and reduced impedance (106.9 kΩ) when compared to conventional Li+ ISE sensors. These improvements are attributed to the unique electronic conductivity and layered structure of the MXene-PSS nanosheet coating layer. In addition, the study exhibits the long-term accuracy and durability of the MXene-PSS Li+ ISE sensor by subjecting it to real wastewater testing for 14 days, resulting in sensor reading errors of less than 10% when compared to laboratory validation results. This research highlights the great potential of MXene nanosheet coatings in advancing sensor technology, particularly in challenging applications, such as detecting emerging contaminants and developing implantable biosensors. The findings offer promising prospects for future advancements in sensor technology, particularly in the context of sustainable energy and environmental monitoring.

The anchor design of anchor-based method to determine the minimal clinically important difference: a systematic review.

BACKGROUND: Positive results for clinical outcomes should be not only statistically significant, but also clinically significant. The minimum clinically important difference (MCID) is used to define the minimum threshold of clinical significance. The anchor-based method is a classical method for ascertaining MCID. This study aimed to summarise the design of the anchors of the anchor-based method by reviewing the existing research and providing references and suggestions. METHOD: This study was mainly based on literature research. We performed a systematic search using Web of Science, PubMed, CNKI, Wanfang, and VIP databases. Two reviewers independently screened titles and abstracts to identify relevant articles. Data were extracted from eligible articles using a predefined data collection form. Discrepancies were resolved by discussion and the involvement of a third reviewer. RESULT: Three hundred and forty articles were retained for final analysis. For the design of anchors, Subjective anchors (99.12%) were the most common type of anchor used, mainly the Patient's rating of change or patient satisfaction (66.47%) and related scale health status evaluation items or scores (39.41%). Almost half of the studies (48.53%) did not assess the correlation test between the anchor and the research indicator or scale. The cut-off values and grouping were usually based on the choice of the anchor types. In addition, due to the large number of included studies, this study selected the most calculated SF-36 (28 articles) for an in-depth analysis. The results showed that the overall design of the anchor and the cut-off value were the same as above. The statistical methods used were mostly traditional (mean change, ROC). The MCID thresholds of these studies had a wide range (SF-36 PCS: 2-17.4, SF-36 MCS: 1.46-10.28), and different anchors or statistical methods lead to different results. CONCLUSION: It is of great importance to select several types of anchors and to use more reliable statistical methods to calculate the MCID. It is suggested that the order of selection of anchors should be: objective anchors > anchors with established MCID in subjective anchors (specific scale > generic scale) > ranked anchors in subjective anchors. The selection of internal anchors should be avoided, and anchors should be evaluated by a correlation test.

Association of the availability of pharmaceutical facilities provided in secondary and tertiary hospitals with clinical pharmacists' work performance.

BACKGROUND: Clinical pharmacists always work as the pivotal role in the process of facilitating the proper use of drug. Based on the person-environment fit theory, the availability of facilities required in pharmaceutical service may influence pharmacists' performance, but which of them may have positive or negative impact remains unclear. OBJECTIVES: This study aims to analysed the quantitative association of the availability of pharmaceutical facilities provided in Chinese hospitals and clinical pharmacists' work performance to assist hospitals formulating plans of the improving pharmaceutical working conditions to enhance clinical pharmacists' performance. METHOD: Demonstrated by the panel of expert and literature review, the questionnaire for administrators and clinical pharmacists of secondary and tertiary hospitals in China was formed. Then a mixed sampling was adopted to gather data on information of the participants, as well as evaluation indexes of the availability of facilities and clinical pharmacists' work performance. RESULTS: Overall, 625 questionnaires distributed to administrators of hospitals and 1219 ones distributed to clinical pharmacists were retrieved. As for the Pharmaceutical facilities, while the increased availability of Traditional Chinese medicine pharmacy (p = 0.02) has a significantly positive impact on clinical pharmacists' performance, the great availability of the preparation room (p = 0.07) negatively influences their work performance. CONCLUSION: Improving the availability of facilities that significantly influence clinical pharmacists' work performance possibly reduce their workload, enhance their efficiency and further promote progress in pharmaceutical service.

Influencing factors of nonclinical pharmacists' willingness to transform: a cross-sectional survey in Xinjiang, China.

BACKGROUND: There is a serious shortage of clinical pharmacists in Xinjiang, China. A six-month to one-year on-the-job training programme can rapidly transition nonclinical pharmacists into clinical pharmacists to resolve this issue. However, not all nonclinical pharmacists are willing to become clinical pharmacists, and many factors may influence their willingness. This study aims to assess the transformation intention of nonclinical hospital pharmacists and the contributing elements to make recommendations to accelerate the transformation of hospital pharmacists to clinical pharmacists. METHODS: Cross-sectional survey was conducted in secondary and tertiary hospitals in Xinjiang. Taking 14 prefectures in Xinjiang as a cluster, 34 hospitals were randomly selected. By snowball sampling, the heads of pharmaceutical departments introduced non-clinical pharmacists to participate in an anonymous questionnaire survey, which included 41 questions about basic demographic information, cognition and attitudes towards pharmaceutical care, potential factors and willingness to transform, and it took an average of 10 min to complete. Using multifactor logistic regression, the contributing elements of transformation intention were analysed. RESULTS: The survey was conducted from May to October 2022. 338 valid responses were obtained, with a response rate of 91.85% and a willingness to transform rate of 81.67%. There were significant differences in the willingness to transform among nonclinical pharmacists of different ages (P < 0.05), marital statuses (P < 0.05), years of employment (P < 0.05), and technical titles (P < 0.05). There were significant differences between the two groups in the following four aspects: whether the setting of human resources in the pharmaceutical department was reasonable (P < 0.05), the educational level of clinical pharmacists (P < 0.05), the higher salary level of clinical pharmacists (P < 0.05), and whether they had experience in pharmaceutical care (P < 0.05). There was a significant difference in the total score of the pharmaceutical care attitude scale (P < 0.05) between the willing and unwilling groups. The results of multivariate logistic regression analysis revealed that the experience of providing pharmaceutical care (OR = 4.601, 95% CI: 1.13-18.69, P < 0.05) and attitude towards pharmaceutical care (OR = 3.302, 95% CI: 1.19-9.19, P < 0.05) had a statistically significant influence on the transformation intention of nonclinical pharmacists. CONCLUSIONS: One-fifth of nonclinical pharmacists were unwilling to transition to clinical pharmacists. The attitude towards and experience of pharmaceutical care affected pharmacists' transformation intention, so the suggestion is proposed to promote the transformation of nonclinical pharmacists into clinical pharmacists.

Exploring the training of pharmacists oriented to the demands for clinical pharmacy services: from the perspective of physicians.

BACKGROUND: To evaluate physicians' perceptions, experiences and expectations of clinical pharmacists in China from the perspective of physicians' demands, to improve the training of pharmacists. METHODS: A cross-sectional survey involving physicians (except for primary physicians) was conducted from July to August 2019 in China. Using a field questionnaire, this study gathered data on descriptive information about the respondents and their perceptions, experiences and expectations of clinical pharmacists. Data were analysed descriptively using frequencies, percentages and mean. Several subgroup analyses using Chi-square tests were conducted to identify physicians' demands for clinical pharmacists in China. RESULTS: A total of 1376 physicians from secondary and tertiary hospitals in China (response rate = 92%) participated. The majority of the respondents were comfortable with clinical pharmacists providing education to patients (59.09%) and detecting and preventing prescription errors (60.17%), but they appeared uncomfortable when asked about clinical pharmacists suggesting the use of prescription medications to patients (15.71%). Most respondents agreed that clinical pharmacists are a reliable source of general drug information (81.84%) instead of clinical drug information (79.58%). The majority of the respondents expected clinical pharmacists to be knowledgeable drug therapy experts (95.56%) and to educate their patients about the safe and appropriate use of medications (95.56%). CONCLUSION: Physicians' perceptions and experiences were positively associated with the frequency of their interaction with clinical pharmacists. They had high expectations of clinical pharmacists as knowledgeable drug therapy experts. Corresponding policies and measures are needed to improve the education and training system of clinical pharmacists in China.

Exploring the training of chinese medical staff oriented to the need for clinical drug information services: from the perspective of drug information patients obtained and need.

BACKGROUND: There are some gaps between the training of drug information service competencies for medical staff and drug information patients need in China. OBJECTIVE: To investigate drug information patients obtained and need for further providing directions for the training of drug information service competencies among medical staff in China from patients' perspectives. METHODS: A face-to-face nationwide survey was conducted using a stratified sampling method. Data were analyzed descriptively using frequencies, percentages and mean. Several subgroup analyses using Chi-square tests were conducted to identify patients' need for drug information in China. RESULTS: A total of 1994 questionnaires from medical institutions in China were returned. Most of the drug information obtained by patients came from physicians, and different types of drug information were important to patients. Additionally, patients had different needs for drug information due to age, gender, diagnosis and treatment status, and education level. CONCLUSIONS: The training of medical staff needs to increase the presence of nurses and pharmacists in drug information services, enhance the awareness of "patient-centered" services, and improve the ability to provide information services specific to the characteristics of patients.

Forward-Looking Roadmaps for Long-Term Continuous Water Quality Monitoring: Bottlenecks, Innovations, and Prospects in a Critical Review.

Long-term continuous monitoring (LTCM) of water quality can bring far-reaching influences on water ecosystems by providing spatiotemporal data sets of diverse parameters and enabling operation of water and wastewater treatment processes in an energy-saving and cost-effective manner. However, current water monitoring technologies are deficient for long-term accuracy in data collection and processing capability. Inadequate LTCM data impedes water quality assessment and hinders the stakeholders and decision makers from foreseeing emerging problems and executing efficient control methodologies. To tackle this challenge, this review provides a forward-looking roadmap highlighting vital innovations toward LTCM, and elaborates on the impacts of LTCM through a three-hierarchy perspective: data, parameters, and systems. First, we demonstrate the critical needs and challenges of LTCM in natural resource water, drinking water, and wastewater systems, and differentiate LTCM from existing short-term and discrete monitoring techniques. We then elucidate three steps to achieve LTCM in water systems, consisting of data acquisition (water sensors), data processing (machine learning algorithms), and data application (with modeling and process control as two examples). Finally, we explore future opportunities of LTCM in four key domains, water, energy, sensing, and data, and underscore strategies to transfer scientific discoveries to general end-users.

Electrospraying Zwitterionic Copolymers as an Effective Biofouling Control for Accurate and Continuous Monitoring of Wastewater Dynamics in a Real-Time and Long-Term Manner.

Long-term continuous monitoring (LTCM) of water quality can provide high-fidelity datasets essential for executing swift control and enhancing system efficiency. One roadblock for LTCM using solid-state ion-selective electrode (S-ISE) sensors is biofouling on the sensor surface, which perturbs analyte mass transfer and deteriorates the sensor reading accuracy. This study advanced the anti-biofouling property of S-ISE sensors through precisely coating a self-assembled channel-type zwitterionic copolymer poly(trifluoroethyl methacrylate-random-sulfobetaine methacrylate) (PTFEMA-r-SBMA) on the sensor surface using electrospray. The PTFEMA-r-SBMA membrane exhibits exceptional permeability and selectivity to primary ions in water solutions. NH4+ S-ISE sensors with this anti-fouling zwitterionic layer were examined in real wastewater for 55 days consecutively, exhibiting sensitivity close to the theoretical value (59.18 mV/dec) and long-term stability (error <4 mg/L). Furthermore, a denoising data processing algorithm (DDPA) was developed to further improve the sensor accuracy, reducing the S-ISE sensor error to only 1.2 mg/L after 50 days of real wastewater analysis. Based on the dynamic energy cost function and carbon footprint models, LTCM is expected to save 44.9% NH4+ discharge, 12.8% energy consumption, and 26.7% greenhouse emission under normal operational conditions. This study unveils an innovative LTCM methodology by integrating advanced materials (anti-fouling layer coating) with sensor data processing (DDPA).

The influence of non-clinical pharmacists' understanding of and attitudes towards pharmaceutical care on their willingness to serve as clinical pharmacists in China.

BACKGROUND: The shortage of clinical pharmacists is severe in China, and transferring non-clinical pharmacists into clinical pharmacists serves as a feasible solution to this problem. In China, a one-year training programme is available for non-clinical pharmacists, and those who have finished the programme are certificated as clinical pharmacists. However, not all non-clinical pharmacists are willing to serve as clinical pharmacists, and their willingness to serve as clinical pharmacists may be related to their attitudes towards pharmaceutical care. This study aims to test whether non-clinical pharmacists' attitudes towards pharmaceutical care is positively correlated with their willingness to serve as clinical pharmacists. METHODS: A cross-sectional survey was conducted in secondary and tertiary hospitals in China to collect non-clinical pharmacists' basic demographic information, attitudes towards pharmaceutical care and willingness to serve as clinical pharmacists. An ordered logistic regression analysis was performed to test the relationship between non-clinical pharmacists' attitudes towards pharmaceutical care and their willingness to serve as clinical pharmacists. RESULTS: One thousand five hundred eighty non-clinical pharmacists from 755 hospitals were invited to participate in the study. Finally, 1308 valid responses were obtained and the response rate reached 82.78%. The regression results (R2 = 0.052, chi-square = 174.024, p < 0.0001) suggested that attitudes towards pharmaceutical care had a positive impact on non-clinical pharmacists' willingness to serve as clinical pharmacists (p < 0.01). Control variables, such as age (p < 0.05), marital status (p < 0.05), professional title (p < 0.1), educational level (p < 0.1), salary expectations (p < 0.01) and experience providing pharmaceutical care (p < 0.01), also influenced non-clinical pharmacists' willingness to serve as clinical pharmacists. CONCLUSIONS: Based on the results, suggestions are made to increase non-clinical pharmacists' willingness to serve as clinical pharmacists.

Association of education background with clinical pharmacists' clinical pharmacy workload in tertiary hospitals of China.

BACKGROUND: Workload of healthcare providers may affect the quality of healthcare. Practical evidences have indicated that healthcare providers are differentially associated with workload due to their different education and training background. Clinical pharmacists are an indispensable part of medical teams. Under the precondition that clinical pharmacists in China generally undertake uneven clinical pharmacy workload, the relationship of workload and clinical pharmacists' different education backgrounds remains unclear. This study aimed to assess the association between the education background of clinical pharmacists and their clinical pharmacy workload in China. METHODS: A field questionnaire survey using a stratified sampling was conducted to gather data on education background and clinical pharmacy workload through a self-developed instrument. Ordinary least squares regression was used to evaluate the association of the participants' education background with their clinical pharmacy workload. RESULTS: A total of 625 clinical pharmacists from 311 tertiary hospitals in China participated. Two levels of education: less than bachelor's degree in general pharmacy, or doctoral degree in clinical pharmacy was associated significantly with clinical pharmacy workload of the participants. Participants who had credentials of national level and provincial-level specialized training for clinical pharmacists had undertaken more work than those without. Moreover, the participants' specialized field, such as respiratory medicine and nephrology, was associated with their clinical pharmacy workload. CONCLUSION: Enhancing several aspects of education or training among clinical pharmacists in tertiary hospitals in China may help improve their capability to provide clinical pharmacy services. Efforts are needed to improve the education and training system of clinical pharmacists in China.

Association of hospital pharmacy-related knowledge and skills with occupational stress of clinical pharmacists in tertiary hospitals of China.

OBJECTIVE: Occupational stress of health care providers may lower the quality of care. Person-environment fit theory and practical evidence have indicated that various types of knowledge and skills of health care providers are differentially associated with occupational stress. Clinical pharmacists are an indispensable part of medical teams. Clinical pharmacists in China are generally under high occupational stress, but what kind of knowledge and skills can relieve their occupational stress remains unclear. This study aimed to assess the association between the specific knowledge and skills of clinical pharmacists and their occupational stress in China. This study aimed to assess the association between the specific knowledge and skills of clinical pharmacists and their occupational stress in China. METHODS: A field questionnaire survey using a stratified sampling was conducted to gather data on occupational stress, knowledge and skills related to hospital pharmacy, and other factors of occupational stress using the Brief Job Stress Questionnaire and a self-developed instrument. Ordinary least squares regression was used to evaluate the association of the participants' knowledge, skills, and other factors with their occupational stress. RESULTS: A total of 625 clinical pharmacists from 311 tertiary hospitals in China (response rate = 84%) participated. Knowledge of or skills related to pharmaceutical care service provision (P = 0.02), the use of computers and the Internet in pharmacy practice (P = 0.02), interpersonal communication (P = 0.10), or pharmacoepidemiology (P = 0.08) was associated with reduced occupational stress of the participants. Participants who had credentials of nation-level specialized (P = 0.09) and general training (P = 0.04) for clinical pharmacist had lower degrees of occupational stress than those without these credentials. The participants' clinical professions, routine tasks, technical titles, and type of hospital they work in were also associated with their occupational stress. CONCLUSION: Enhancing several aspects of knowledge or skills among clinical pharmacists in tertiary hospitals in China may help reduce their occupational stress. Efforts are needed to improve the education and training system of clinical pharmacists in China.

Real-time in situ auto-correction of K+ interference for continuous and long-term NH4+ monitoring in wastewater using solid-state ion selective membrane (S-ISM) sensor assembly.

Potassium ions (K+) present in wastewater has caused severe interference for NH4+ monitoring, over-estimation of NH4+ concentration and ultimately leads to extra energy consumption. Past effort for enhancing the selectivity of NH4+ over K+ were oftentimes complex, costly, or compromised the selectivity and accuracy of the NH4+ ion selective membrane (ISM) sensors. This study targeted this imminent challenge by developing an integrated NH4+/K+ auto-correction solid-state ISM (S-ISM) sensor assembly combined with a data-driven model to monitor [NH4+] under different [NH4+] and [K+] concentrations. The results showed that the interference of K+ was substantially alleviated for NH4+ measurement. The accuracy was enhanced by over 70% when examined using real wastewater and energy consumption was expected to reduce by 26% for a wastewater treatment plant, especially for wastewater with high [K+]. Furthermore, the uniquely structured S-ISMs were made by embedding the ionophores in a robust polyvinyl chloride (PVC) matrix containing plasticizers and a layer of carbon nanotubes (CNT) as ion-to-electron transducer, which maintained the selectivity and accuracy of the S-ISM sensor for 4 weeks in wastewater. NH4+/K+ sensor assembly integrated with data-driven correction models poses great potential in high-efficiency and energy-saving wastewater treatment and water reuse processes.

The current status of pharmaceutical care provision in tertiary hospitals: results of a cross-sectional survey in China.

BACKGROUND: Pharmaceutical care is attached with increasing importance around the world due to its clinical and economical effects. Tertiary hospitals are equipped with the richest healthcare resources and pioneer in the implementation of pharmaceutical care. Understanding current status of pharmaceutical care provision in tertiary hospitals not only helps to improve the practice in tertiary hospitals but also guide the development of pharmaceutical care in secondary and primary health institutions. METHOD: Data of a cross-sectional survey were used. The cross-sectional survey was conducted from July 2015 to June 2016, involving 520 hospital directors, 740 clinical pharmacists, 1298 physicians, 778 dispensing pharmacists and 3096 patients from 292 hospitals of 23 provinces, 4 municipalities in mainland China. The survey aimed to comprehensively investigate the current status of pharmaceutical care and health care professional's understanding of clinical pharmacist system in tertiary hospitals. This study reports results pertaining to current status of pharmaceutical care, including pharmacy department practice rules, guidelines and records, application of rational drug use software, staffing and working arrangement of clinical pharmacists and physicians, patients' satisfaction toward pharmaceutical care. RESULTS: A majority of the tertiary hospitals established clinical pharmacist system (84.2%), clinical pharmacist management rules (89%), clinical pharmacists' working ethics (89%) and applied clinical rational drug use software (93.8%). However, a number of hospitals did not establish a performance evaluation system (37%) and payment rules for pharmaceutical care (81.9%). Most of the clinical pharmacists met the educational background set by the government. Averagely there were 8.3 clinical pharmacists per hospital and 90.7% of the tertiary hospitals had at least five full-time clinical pharmacists. Pharmaceutical care services provided include checking prescriptions, making treatment plans and joining clinical rounds and etc. Both physicians and patients were generally satisfied with pharmaceutical care services provided. CONCLUSION: China has made progress in pharmaceutical care provision, but problems such as lack of rules for pharmaceutical care payment and a performance evaluation system, a monotonous variety of pharmaceutical care activities remain unsolved. Policy makers and hospitals directors are suggested to pay more attention to these problems.

Real-Time in Situ Monitoring of Nitrogen Dynamics in Wastewater Treatment Processes using Wireless, Solid-State, and Ion-Selective Membrane Sensors.

Real-time, in situ accurate monitoring of nitrogen contaminants in wastewater over a long-term period is critical for swift feedback control, enhanced nitrogen removal efficiency, and reduced energy consumption of wastewater treatment processes. Existing nitrogen sensors suffer from high cost, low stability, and short life times, posing hurdles for their mass deployment to capture a complete picture within heterogeneous systems. Tackling this challenge, this study presents solid-state ion-selective membrane (S-ISM) nitrogen sensors for ammonium (NH4+) and nitrate (NO3-) in wastewater that were coupled to a wireless data transmission gateway for real-time remote data access. Lab-scale test and continuous-flow field tests using real municipal wastewater indicated that the S-ISM nitrogen sensors possessed excellent accuracy and precision, high selectivity, and multiday stability. Importantly, autocorrections of the sensor readings on the cloud minimized temperature influences and assured accurate nitrogen concentration readings in remote-sensing applications. It was estimated that real-time, in situ monitoring using wireless S-ISM nitrogen sensors could save 25% of electric energy under normal operational conditions and reduce 22% of nitrogen discharge under shock conditions.

Do clerkship schemes effectively improve pharmacy students' understanding of and attitudes regarding pharmaceutical care?--a pre-post study in China Pharmaceutical University.

BACKGROUND: Clerkship is potentially an effective measure of improving the pharmacy students' understanding of and attitudes toward pharmaceutical care. This research aimed to validate whether clerkship schemes in China effectively improve pharmacy students' understanding of and attitudes toward PC, and discuss on how to improve the clerkship schemes for better quality. METHODS: A pre-post and self-administrated questionnaire survey among three continuous years of students was conducted to measure Chinese fifth-year clinical pharmacy students' differences in understanding of pharmaceutical care and attitudes toward pharmaceutical care before and after their clerkship schemes. Statistical analysis was conducted on the retrieved data. RESULTS: 602 respondents completed the post-part survey (drop rate = 1.8%). Correct rates of all statements regarding students' understanding of pharmaceutical care were generally increased, but the rates of respondents holding correct understanding of the primary goal of pharmaceutical care (71.9 to 85.0%), the necessity of drug information support in pharmaceutical care (77.1 to 87.5%) and the patients' role and duty when receiving pharmaceutical care (66.1 to 70.6%) were unsatisfactory before the clerkship and the improvement was not significant. Most statements regarding students' attitudes toward pharmaceutical care were improved in general. However, rates of respondents holding negative attitudes toward students performing pharmaceutical care during their clerkship (3.7 to 7.5%) and choosing pharmaceutical care provider as their career after clerkship schemes (10.8 to 14.8%) had increased after the clerkship schemes. CONCLUSION: Clerkship generally improves clinical pharmacy students' understanding of and attitudes toward pharmaceutical care, yet adjustments are also required in some contents of the clerkship for further improvements in its outcomes.

Association of the barriers of pharmaceutical care perceived by clinical pharmacists and occupational stress in tertiary hospitals of China.

Objective: As an important member of the healthcare team, clinical pharmacists' occupational stress will lead to a decline in the quality of pharmaceutical care. According to person-environment fit theory, barriers of pharmaceutical care perceived by clinical pharmacists may be a potential factor influencing occupational stress. This study aimed to assess the association between the specific barriers of pharmaceutical care perceived by clinical pharmacists and their occupational stress in China. Method: A field-based questionnaire survey of tertiary hospitals was conducted in 31 provincial administrative regions in mainland China using a multi-stage stratified sampling method. Data on occupational stress, barriers of pharmaceutical care perceived by clinical pharmacists and other factors of job stress were collected using the Brief Job Stress Questionnaire and a self-administered instrument. The instruments have undergone multiple rounds of pilot investigations, and their reliability is acceptable. Ordinary least squares regression was used to evaluate the association of the perceived barriers and other factors with their occupational stress. Result: A total of 625 clinical pharmacists from 311 tertiary hospitals in China (response rate = 84%) participated. Perceived resource dimension barriers (p = 0.00) and self-improvement dimension barriers (p = 0.01) were associated with increased occupational stress of the participants. In addition, clinical pharmacists with senior professional titles and engaged in neurology and ICU have higher occupational stress. Conclusion: By removing barriers to pharmacists' resources and self-improvement, it is possible to better meet the work needs of clinical pharmacists and may effectively reduce occupational stress, thereby improving the quality of pharmaceutical services.

Health utility of patients with established rheumatoid arthritis and its influencing factors: a multi-center study in China.

To assess the health utility value (HUV) of Rheumatoid Arthritis (RA) patients and its influencing factors in China. A cross-sectional survey was conducted in 8 tertiary hospitals across four capital-cities. The demographic characteristics, patient-reported outcomes including the HUV got by EQ-5D-5L, clinical characteristics, and clinician-reported outcomes of 171 RA patients were collected both from themselves and their physicians. Both the univariate and multivariate analyses were used to assess the potential factors of EQ-5D-5L HUV of the patients. The mean age of the patients was 50.7 years, with female being 64.9% (n = 111). The mean HUV and EQ visual analogue scale score of all patients were 0.586 and 47.3, respectively. The univariate analysis showed that the patients who were female, older, living in rural areas, with lower education level, advanced disease stage, higher the patient's assessment of arthritis pain visual analogue scale (PtAAP-VAS), the patient's global assessment of disease activity visual analogue scale (PtGADA-VAS), and the Physician's global assessment of disease activity visual analogue scale (PhGADA-VAS) scores had significantly lower EQ-5D-5L HUVs. The multivariate analysis further suggested that older age, female, higher body mass index and higher PtGADA-VAS score were statistically significantly related to lower HUVs. The study provided the HUVs for RA patients with different characteristics and outcomes, which could be used in the economic evaluation of interventions for the RA patients. The identified factors could also assist the health care managing and improving the health-related quality of life on RA patients.

A Study on Influencing Factors of Physicians' Suboptimal Health Status in Primary Healthcare Institutions.

Purpose: This study aims to investigate the current health status of Chinese physicians in primary healthcare institutions (PHI) and the effects of personal characteristics, lifestyle, work-related environment and life-related environment on the subhealth status (SHS) of them. Methods: A conceptual framework of various influencing factors was constructed with reference to the concept of health-related quality of life before the convenience sampling. Self-administered questionnaires are distributed to acquire the cross-sectional information of nationwide PHI physicians. A logit regression model was constructed to investigate the influence of various factors on the SHS of PHI physicians. Results: Among 682 valid cases included in the logit regression, 457 physicians were in SHS, with an SHS rate of 67%. The regression results (R2=0.3934, chi-square=337.07, p<0.0001) showed that long working hours (p<0.05), personal income (p<0.05) and life stress (p<0.05) were protective factors for subhealth. The frequency of alcohol consumption (p<0.01), smoking (p<0.05), fear of making mistakes at work (p< 0.001), tension with colleagues (p < 0.0001), and job satisfaction (p < 0.05) were all risk factors. Other factors such as education (p < 0.1) also had an effect on the SHS of primary care physicians. Conclusion: A large proportion of PHI physicians in China are in SHS and many of them are not aware that they are in a poor health state. The logit regression model showed that factors including worries about the occurrence of accidents, strained relationships with colleagues, job satisfaction, and frequency of smoking and drinking negatively influence the SHS of PHI physicians, which should be paid more attention. Meanwhile, annual personal income, long working hours and life stress are protective factors, which means that these factors need to be encouraged.

Association between lifestyle behaviors and health-related quality of life among primary health care physicians in China: A cross-sectional study.

Background: Primary health care (PHC) serves as the gatekeeper of health system and PHC physicians take on significant obligations to provide health care services in the pursuit of Universal Health Coverage (UHC). PHC physicians' health-related quality of life (HRQoL) can have a strong impact on patients, physicians and the health care system. Lifestyle interventions are found to be effective to improve HRQoL. The purpose of this study was to evaluate the association between lifestyle behaviors and HRQoL among PHC physicians, so that lifestyle intervention can be tailored by policy makers for health promotion. Methods: A survey covering 31 provinces and administrative regions in China was conducted in 2020 using a stratified sampling strategy. Data on sociodemographic characteristics lifestyle behaviors and HRQoL were collected by a self-administered questionnaire. HRQoL was measured through EuroQol-five dimension-five level (EQ-5D-5L) instrument. A Tobit regression model was performed to evaluate the association between sociodemographic characteristics, lifestyle behaviors and HRQoL. Results: Among 894 PHC physicians who completed the survey, Anxiety/Depression (AD) was the dimension with the most problems reported (18.1%). Regular daily routine (ß = 0.025, 95%CI 0.004 to 0.045) and good sleep quality (ß = 0.049, 95% CI = 0.029 to 0.069) were protective factors for HRQoL, while smoking (ß = -0.027, 95% CI = -0.079 to -0.003) and frequency of eating breakfast (ß = -0.041, 95%CI = -0.079 to -0.003) were negatively associated with HRQoL. Physical activity and alcohol drinking were not significantly associated with HRQoL. Conclusion: These findings suggest that tailored interventions on daily routine, improving sleep quality, and tobacco control among PHC physicians may be effective strategies to improve their HRQoL.

Factors influencing clinical pharmacists' integration into the clinical multidisciplinary care team.

Objectives: To investigate the factors influencing clinical pharmacists' integration into the clinical multidisciplinary care team, using interprofessional collaboration between clinical pharmacists and physicians as the focus. Methods: Through stratified random sampling, a cross-sectional questionnaire survey was conducted among clinical pharmacists and physicians in secondary and tertiary hospitals in China from July to August 2022. The questionnaire, comprising the Physician-Pharmacist Collaborative Index (PPCI) scale to reflect the collaboration level and a combined scale to measure influencing factors, was made available in two versions for clinical pharmacists and physicians. Multiple linear regression was adopted to analyze the association between the collaboration level and influencing factors, as well as the heterogeneity of the significant factors in hospitals of different grades. Results: Valid self-reported data from 474 clinical pharmacists and 496 paired physicians were included, who were serving in 281 hospitals from 31 provinces. In terms of participant-related factors, standardized training and academic degree, respectively, exerted significant positive effects on the perceived collaboration level by clinical pharmacists and physicians. In terms of context characteristics, manager support and system construction were the main factors for improving collaboration. In terms of exchange characteristics, clinical pharmacists having good communication skills, physicians trusting others' professional competence and values, and both parties having consistent expectations had significant positive effects on collaboration. Conclusion: The study provides a baseline data set on the current level and associated factors of clinical pharmacists' collaboration with other professionals in China and other countries with a related health system, providing references for individuals, universities, hospitals, and national policymakers to facilitate the development of clinical pharmacy and multidisciplinary models and further improve the patient-centered integrated disease treatment system.