Current scenario and challenges of clinical pharmacists to implement pharmaceutical care in DRG/DIP payment hospitals in China: a qualitative interview study.

Purpose: The Diagnosis-Related Group (DRG) or Diagnosis-Intervention Packet (DIP) payment system, now introduced in China, intends to streamline healthcare billing practices. However, its implications for clinical pharmacists, pivotal stakeholders in the healthcare system, remain inadequately explored. This study sought to assess the perceptions, challenges, and roles of clinical pharmacists in China following the introduction of the DRG or DIP payment system. Methods: Qualitative interviews were conducted among a sample of clinical pharmacists. Ten semi-structured interviews were conducted, either online or face to face. Thematic analysis was employed to identify key insights and concerns related to their professional landscape under the DRG or DIP system. Results: Clinical pharmacists exhibited variable awareness levels about the DRG or DIP system. Their roles have undergone shifts, creating a balance between traditional responsibilities and new obligations dictated by the DRG or DIP system. Professional development, particularly concerning health economics and DRG-based or DIP-based patient care, was highlighted as a key need. There were calls for policy support at both healthcare and national levels and a revised, holistic performance assessment system. The demand for more resources, be it in training platforms or personnel, was a recurrent theme. Conclusion: The DRG or DIP system's introduction in China poses both opportunities and challenges for clinical pharmacists. Addressing awareness gaps, offering robust policy support, ensuring adequate resource allocation, and recognizing the evolving role of pharmacists are crucial for harmoniously integrating the DRG or DIP system into the Chinese healthcare paradigm.

Integration of UPLC-QE-MS/MS and network pharmacology to investigate the active components and action mechanisms of tea cake extract for treating cough.

The active components and mechanisms of tea cake extract (TCE) were investigated for treating cough. The components of TCE were tentatively identified by ultrahigh-performance liquid chromatography coupled with Q-Exactive MS/MS (UPLC-QE-MS/MS), whose targets were obtained from the Swiss Target Prediction database and the Traditional Chinese Medicine Systems Pharmacology database and analysis platform. Cough-related targets were retrieved from the Gene Cards and Online Mendelian Inheritance in Man database. After the intersection targets had been obtained, enrichment analysis of Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were determined, and the protein-protein interaction network and active compound-intersection target-KEGG pathway network were constructed. Core active compounds and their targets were validated with molecular docking. A total of 78 compounds were identified from TCE, including 24 flavonoids, 17 phenolic acids, 10 alkaloids, seven organic acids, five triterpenes, five amino acids, five coumarins, three carbohydrates, one anthraquinone and one other. A total of 347 intersection targets were obtained. The top five GO terms with the most significant P-values were responses to oxygen-containing compounds and organic substances, chemical and cellular responses to chemical stimulus, and regulation of biological quality. The top five KEGG pathways with the most significant P-values were: the PI3K-Akt signaling pathway, lipids and atherosclerosis, human cytomegalovirus infection, fluid shear stress and atherosclerosis, and proteoglycans in cancer. The top five core active compounds were quercetin, genistein, luteolin, kaempferol and emodin. The top five core targets were protein kinase B (Akt1), prostaglandin-endoperoxide synthase 2 (PTGS2), mitogen-activated protein kinase 1/3 (MAPK1/3) and phosphoinositide-3-kinase regulatory subunit 1 (PIK3R1). The top five core active compounds could stably bind to their targets with LibDockScores higher than 100. Tea cake extract plays the antitussive role via multiple components and targets. Core targets (AKT1, MAPK1, MAPK3 and PIK3R1) and core components (quercetin, genistein, luteolin and kaempferol) involved in the PI3K-Akt signaling pathway are worth more attention in subsequent validation experiments.

[Comprehensive mass spectrum analysis of two flavone-6,8-C-di-glycosides and its application by high resolution electrospray ionization tandem mass spectroscopy in both negative and positive ion modes].

The tandem mass spectrum of apigenin-6,8-C-di-glucoside( 1) and apigenin-6-C-glucose-8-C-rhamnoside( 2) were obtained by high resolution electrospray ionization mass spectrometry( HR-ESI-MS/MS) in both positive and negative ion modes. The elemental composition of each ion was determined according to its accurate mass-to-charge,hence,the fragmentation pathways of each compound were proposed in both negative and positive ion modes. Comprehensive analysis of each ion and its proposed fragmentation pathways of the two compounds was initially conducted in both negative and positive ion mode HR-ESI-MS/MS to explore the diagnostic ions for flavone-6,8-C-di-glycosides and the characteristic ions for each compound and their cleavage rules. The results showed that a family of fragmentation ions with m/z 353,325,311,297 in ESI(-)-MS and m/z 355,325,307,295 in ESI( +)-MS could be the diagnostic ions of flavone-6,8-C-di-glycoside,and characteristic neutral loss could be assigned to glycosyl substitution,for example,neutral losses of C_4H_8O_4( 120),C_3H_6O_3( 90),C_2H_4O_2( 60) for glucoside substitution while neutral losses of C_4H_8O_3(104),C_3H_6O_2( 74),C_2H_4O( 44) for rhamnoside substitution. Furthermore,only one H_2O loss from mother ion( [M-H]-) was observed for 1 & 2 in ESI(-)-MS while five to six H2 O loss from mother ion( [M+H]+) was observed for 1 & 2 in ESI( +)-MS to produce a family of ions by subsequent loss of H_2O,which could be applied for glucosyl difference. The flavone-6,8-C-di-glycosides in both ESI( +)-MS and ESI(-)-MS showed the cleavage similarity at sugar substitutions. However,there were much more differences by the fragmentation pathways and neutral losses between ESI( +)-MS and ESI(-)-MS as following,hyperconjugation ions by subsequent loss of H_2O from precursor ions of flavone-6,8-C-di-glycosides in ESI( +)-MS were not observed in ESI(-)-MS; the subsequent neutral loss of CH_2O in ESI( +)-MS were rarely observed in ESI(-)-MS; the loss of CO only happen at C-ring of flavone ESI( +)-MS other than glycosyl position in ESI(-)-MS; the C4-chain neutral loss of flavone-6,8-C-di-glycosides happened at 8-C-glycosyl position other than at 6-C-glycosyl position. The above cleavage rules and diagnostic ions of ESI( +)-MS were successfully applied for the structure identification of 4 flavone-6 C,8 C-diglycosides from the stem extract of Dendrobium officinale as vicenin Ⅱ,vicenin Ⅰ,isoschaftoside,schaftoside as well as one flavone-O-glysoside named rutin,which were supported by ESI(-)-MS data as well.

Efficacy and safety of traditional Chinese medicine yangxin anshen therapy for insomnia: A protocol of systematic review and meta-analysis.

BACKGROUND: Traditional Chinese medicine (TCM) has gradually drawn the attention of clinicians as an alternative choice for insomniacs and TCM yangxin anshen therapy (TYAT), as a crucial therapy of treating insomniacs, is based on the theory of syndrome differentiation. However, owing to the lack of evidence-based medical evidence, the authors intend to carry out this study to evaluate TYAT's effectiveness and safety. METHODS: Seven electronic databases will be searched from inception to July 2019. Two authors will independently identify randomized controlled trials, fetch data and assess the risk of bias with tools provided by Cochrane. A comprehensive meta-analysis will be conducted with the Cochrane Collaboration software (Review Manager 5.3) for eligible and appropriate studies. Further, the evidence will be assessed with the grading of recommendations assessment, development, and evaluation approach. RESULTS: This article will be dedicated to assessing TYAT's efficacy and safety for insomniacs. CONCLUSION: This systematic review and meta-analysis may provide persuasive evidence for the clinical application of TYAT in treating insomnia. TRIAL REGISTRATION NUMBER: PROSPERO CRD 42019135115.

Hexafluoroisopropanol-based hydrophobic deep eutectic solvents for dispersive liquid-liquid microextraction of pyrethroids in tea beverages and fruit juices.

A series of new hydrophobic deep eutectic solvents (DESs), which are liquid at room temperature and have high density (>1.4 g mL-1), were synthesized using hexafluoroisopropanol (HFIP) as hydrogen-bond donor and l-carnitine/betaine as hydrogen-bond acceptor. Then these hydrophobic DESs were used as extraction solvents to establish dispersive liquid-liquid microextraction (DLLME) method for extraction of pyrethroids. The DES extraction phase was in the bottom after DLLME, being easy to be collected for analysis. After optimization by one-variable-at-a-time and response surface methodology, the enrichment factors of 265-360 were achieved for five pyrethroids. The proposed DLLME method coupled with HPLC has good performance: linear ranges of 0.25/0.5/1-100/200/400 ng/mL (r ≥ 0.9990), limits of detection of 0.06-0.17 ng mL-1, relative recoveries of 85.1-109.4%, intra-day and inter-day RSDs below 7.5%. The novel DLLME method is simple, rapid, highly efficient and eco-friendly for extraction of pyrethroids in real tea beverages and fruit juices.