Exploration of Teaching Reform of TCM Dispensing Technology in Higher Vocational Colleges Based on Traditional Chinese Medicine Skills Competition

This paper aims to thoroughly explore the teaching reform of Traditional Chinese Medicine(TCM)dispensing technology in higher vocational colleges,with a focus on the Traditional Chinese Medicine Skills Competition.By analyzing the current teaching status and main challenges of TCM dispensing technology,and aligning with the requirements of the skills competition,a series of detailed and practical teaching reform measures are proposed.These measures are designed to comprehensively improve the teaching quality of TCM dispensing technology in higher vocational colleges,enhance students’practical skills and professional qualities,and ultimately meet the demand for high-quality,skilled talents in the field of TCM.

Jetting-based bioprinting:process,dispense physics,and applications

Jetting-based bioprinting facilitates contactless drop-on-demand deposition of subnanoliter droplets at well-defined positions to control the spatial arrangement of cells,growth factors,drugs,and biomaterials in a highly automated layer-by-layer fabrication approach.Due to its immense versatility,jetting-based bioprinting has been used for various applications,including tissue engineering and regenerative medicine,wound healing,and drug development.A lack of in-depth understanding exists in the processes that occur during jetting-based bioprinting.This review paper will comprehensively discuss the physical considerations for bioinks and printing conditions used in jetting-based bioprinting.We first present an overview of different jetting-based bioprinting techniques such as inkjet bioprinting,laser-induced forward transfer bioprinting,electrohydrodynamic jet bioprinting,acoustic bioprinting and microvalve bioprinting.Next,we provide an in-depth discussion of various considerations for bioink formulation relating to cell deposition,print chamber design,droplet formation and droplet impact.Finally,we highlight recent accomplishments in jetting-based bioprinting.We present the advantages and challenges of each method,discuss considerations relating to cell viability and protein stability,and conclude by providing insights into future directions of jetting-based bioprinting.

Microcapillary cell extrusion deposition with picolitre dispensing resolution

Extrusion-based cell deposition has become a prominent technique for expanding bioprinting applications.However,the associated print resolution in the order of nanolitre or above has been a limiting factor.The demand for improving print resolution towards the scale of a single cell has driven the development of precision nozzle extrusion,although the benefits gained remain ambiguous.Here,aided by in situ imaging,we investigated the dynamics of cell organisation through an extrusion-based microcapillary tip with picolitre precision through in-air or immersion deposition.The microcapillary extrusion setup,termed‘Picodis’,was demonstrated by generating droplets of colouring inks immersed in an immiscible medium.Next,using 3T3 fibroblast cells as an experimental model,we demonstrated the deposition of cell suspension,and pre-aggregated cell pellets.Then,the dynamic organisation of cells within the microcapillary tip was described,along with cell ejection and deposition upon exiting the tip opening.The vision-assisted approach revealed that when dispersed in a culture medium,the movements of cells were distinctive based on the flow profiles and were purely driven by laminar fluid flow within a narrow tip.The primary process limitations were cell sedimentation,aggregation and compaction,along with trapped air bubbles.The use of picolitre-level resolution microcapillary extrusion,although it provides some level of control for a small number of cells,does not necessarily offer a reliable method when a specified number of cells are required.Our study provides insights into the process limitations of high-resolution cell ink extrusion,which may be useful for optimising biofabrication processes of cell-laden constructs for biomedical research.

RUN TO RUN CONTROL OF TIME-PRESSURE DISPENSING SYSTEM

In electronics packaging the time-pressure dispensing system is widely usedto squeeze the adhesive fluid in a syringe onto boards or substrates with the pressurized air.However, complexity of the process, which includes the air-fluid coupling and the nonlinearuncertainties, makes it difficult to have a consistent process performance. An integrated dispensingprocess model is first introduced and then its input-output regression relationship is used todesign a run to run control methodology for this process. The controller takes EWMA scheme and itsstability region is given. Experimental results verify the effectiveness of the proposed run to runcontrol method for dispensing process.

Modeling and Control of Time-pressure Dispensing for Semiconductor Manufacturing

To improve the consistency of the adhesive amount dispensed by the time-pressure dispenser for semiconductor manufacturing, a non-Newtonian fluid flow rate model is developed to represent and estimate the adhesive amount dispensed in each cycle. Taking account of gas compressibility, an intelligent model-based control strategy is proposed to compensate the deviation of adhesive amount dispensed from the desired one. Both simulations and experiments show that the dispensing consistency is greatly improved by using the model-based control strategy developed in this paper.

Analysis of the application and practice of PDCA cycle in management of the naked medicine dispensing——the quality and safety of the drug

Objective:To explore the application of plan–do–check–action(PDCA)cycle in the management of the naked medicine dispensing about the automatic package and to analyze the practice improved in the quality of naked medicine dispensing medicine management.Methods:The PDCA theory was used to analyze the data,to find out the causes of the problem,and to formulate the corresponding countermeasures to intervene.The data of the naked medicine/adverse drug events satisfaction degree of the inpatients in 18 inpatient departments given for the adoption of PDCA cycle in January 2017 were set as the observation group.The number of the naked medicine/adverse drug events satisfaction degree of patients in 18 inpatient departments before adoption of PDCA cycle in December 2016 was set as the control group.The number of the naked medicine/adverse drug events satisfaction degree of patients in 18 inpatient departments before and after adoption of PDCA cycle was observed and analyzed.Results:The number of the naked medicine/adverse drug events after implementing the method of PDCA cycle management rate was significantly lower than before the implementation method of PDCA cycle management,and the difference had statistical significance(P<0.05).The satisfaction degree of the inpatients after implementing the method of PDCA cycle management rate was significantly higher than that before the implementation method of PDCA cycle management,and the difference had statistical significance(P<0.05).Conclusion:Application of PDCA cycle in the management of the naked medicine dispensing about the automatic package can help to reduce the adverse drug events,to improve the safety of drug treatment,and to increase the patients’satisfaction degree.

Run by Run Control of Time-pressure Dispensing for Electronics Encapsulation

To alleviate the influence of gas compressibility on the process performance of time-pressure dispensing for electronics encapsulation,a predictive model is developed based on power-law fluid to estimate the encapsulant amount dispensed.Based on the simple and effective model,a run by run (RbR) supervisory control scheme is delivered to compensate the variation resulting from gas volume change in the syringe.Both simulation and experiment have shown that the dispensing consistency has been greatly improved with the model-based RbR control strategy developed in this paper.

An automated dispensing system for improving medication timing in the emergency department

BACKGROUND:Numerous medical conditions require timely medication administration in the emergency department(ED).Automated dispensing systems(ADSs)store premixed common doses at the point-of-care to minimize time to administration,but the use of such automation to improved time to medication administration has not been studied.Since vancomycin is a commonly used empiric antimicrobial,we sought to quantify the effect of using an ADS on time to drug delivery in patients presenting to the ED.The study aimed to determine the efficacy of utilizing an ADS to improve time to administration of vancomycin and determine any negative effects on dosing appropriateness.METHODS:The institional review board approved the retrospective quality improvement study took place in a single,urban academic tertiary care ED with an annual census of 80 000.Study subjects were all patients receiving vancomycin for the management of sepsis between March 1 to September 30,2008 and the same time period in 2009.The primary outcome was the proportion of patients who received vancomycin within one hour of bed placement and the secondary outcome was dosing appropriateness.RESULTS:Sixty-three patients had weight and dosing information available(29 before and 34after intervention)and were included in the study.Before intervention,no patient received vancomycin in less than 60 minutes,while after intervention 14.7%of the patients received it in less than 60minutes(difference in proportions 14.7%,95%CI 0.39%-30.0%,P=0.04).A similar proportion of the patients received correct dosing before and after intervention(44.8%vs.41.2%,difference in proportions 3.7%,95%CI-20.0%-26.7%,P=0.770).CONCLUSION:The use of an ADS may improve the timing of medication administration in patients presenting to the ED without affecting dosing appropriateness.

SENSITIVITY OF THE CONCENTRATION CHANGE OF DYE DISPENSING USING COMPUTER SYSTEMS

This paper employs computer colour generation,and match prediction systems and aims tofind the most critical change of dye concentration corresponding to changes of Hue,or Chroma,orLightness of 1 unit just visible colour difference,thus investigating the required accuracy level fordyeing dispensing.This leads to the selection of one critical colour-difference dimension of threefrom CMC (1:c) measurement.The results reveal that the concentration change in dye dispensing ismost critical for change of Hue in a computer controlled system.The formula describing the rela-tionship Of △E and △H in CMC (2:1) measurement is selected for further investigation.

Directional Dispensing of KE-Rod

With the numerical simulation and high-speed camera, a series of images of dispensing of rod from different devices were obtained. The process of dispensing of rods driven by aiming explosive charge and the influence of different structures on dispensing velocity and angle of KE-rod were studied through analyzing the images. All these can be helpful for the design of new concept anti tactical ballistic missile(ATBM) KE-rod warheads.

Importance of labelling and patient knowledge to ensure proper care during drug dispensing: A case study from a tertiary hospital in Ethiopia

Correct drug labelling is central for ensuring proper drug dispensing and thus for patient safety. Labelling errors may result in adverse health outcomes. The objective of this study was, therefore, to assess the effect of labelling on the quality of drug dispensing and patient knowledge about dispensed drugs in Jimma University model and specialized hospital outpatient Pharmacies. Individual packages with prescribed drugs were examined using pretested questionnaire and observational check lists during the dispensing process. Patients’ knowledge about drugs dispensed to them was assessed at the exit interview using a pretested questionnaire. Out of 743 prescribed drugs, 682 (91.8%) were dispensed to 426 patients. The average labelling score (range from 0 to 6) of dispensed drugs in Model and Outpatient pharmacy was 2.00 (95% CI 1.97 to 2.04) and 1.73 (95% CI 1.6 to 1.8) respectively, with overall average labelling score of 1.90 (95% CI 1.84 to 1.91). The average patient knowledge score (range from 0 t0 5) was 3.45 (95% CI 3.31 to 3.59) and 3.5 (95% CI 3.35 to 3.64) for model and outpatient pharmacy, respectively, while the overall average knowledge score was 3.46 (95% CI 3.37 to 3.57). Major labelling problems were absence of patient’s name and dose followed by frequency of administration, duration of treatment, and the reason for prescription. Literacy status of patients had a significant effect on their knowledge (p 0.05). We recommend that corrective measures targeting both, labelling and patients’ knowledge should be implemented to improve the patients’ safety and drug therapy adherence.

Study of Factors Affecting Medical Incident: 1. Dispensing

In recent years, medical institutions have taken a variety of measures to prevent medical incident. In addition, progress has been made toward the development of a fully automated system for the purpose of medicine dispensing. However, automating the dispensing, or having it replaced by artificial intelligence (AI) will not, eradicate human error. Thus, measures against human error will continue to serve as an important topic. Therefore, hospitals are required to improve the efficiency of the pharmacy department. For these purposes, attention has now shifted to Supply Processing and Distribution (SPD). In this study, we measured for the gaze of the pharmacist and SPD, and examined the factors affecting dispensing error;moreover, we examined prevention of the human error. In the results of the eye tracking, SPD members tended to spend a greater number of gaze time and gaze counts, for each medicine, on “medicines” and “picking lists,” than pharmacists. On the other hand, when pharmacists picking medicines, they performed various work operations in parallel, such as checking the prescription and looking the next shelf location. It was conjectured that SPD members had more clearly defined items to check when picking, compared to pharmacists. This may have possibly led to a lower chance of dispensing errors being introduced by SPD members. These results suggest that the process of selection is not a mandatory requirement of pharmacists during the action of dispensing. Instead, SPD members, pharmacy assistants, or automatic dispensing devices could serve as substitutes for picking. It is suggested that pharmacists should spend more time and effort on prescription inspection, medicines checking and dosing operations.

Study of Factors Affecting Medical Incident: 2 Powdered Medication Dispensing

Medical incidents have been collected, analyzed and built up preventive measures by each medical institution for a long time. For powdered medication, there is the problem that it is difficult to tell at a glance the quantity of the active ingredient in the medication that has been dispensed and the quantities that have been mixed together. Therefore, special prevention measures are considered essential. In this study, we examined the work content of pharmacists’ powdered medication dispensing, using an eye-tracking technology of measuring a human eye movement, and studied on factors that affect medical incident. Participants were five pharmacists with 8 to 26 years of working experience (expert), and five pharmacists with less than one year of working experience (newcomer). Gaze measurement experiments were implemented for powdered medication dispensing during regular work activity. The gaze measurement equipment used was Tobii Pro Glasses 2. Based on the results of the eye tracking, newcomer had a longer dispensing time than expert for all powdered medication dispensing. In particular, it was suggested that there is a close relationship to “years of experience” and “weighing and mixing skills.” Experts did unwasted and efficient movements, when preparing the dispensing apparatus, taking medications from the shelves, and scanning the barcode in the powders dispensing checking system. These movements led to shorter working time in experts. In contrast, newcomer had individual differences at the dispensing. Even with the same pharmacist, the work progression differed depending upon the prescription. Therefore, it is thought that the factor of common error was inadequate check and overlooked. The state that it’s messy on the workplace is also considered highly likely to cause dispensing mistakes. At the weighing, expert started weighing after the inspection of the prescription and checking weighed amount. However, certain newcomer dispensed to depend on the powders dispensing checking system only for the weighing process, without the inspection of the prescription or checking weighed amount. Irregular doses for infants and older patients require fine adjustments;therefore, the powders dispensing checking system may not find all dispensing errors. It is important for a pharmacist to, first, be written calculated weight on the prescription and checked by themselves, and next to begin dispensation work. In the future, as well as the powdered medication dispensing, it is necessary to make use of measures for preventing errors in the various dispensing process, such as the medication inspection, sterile products preparation, clinical practice et al.

Novel consistency control strategy for jet dispensing

A new consistency control method for jet dispensing is proposed. First, the working parameters, namely, viscosity, supply pressure and supply time, are experimentally investigated. Then, the glue viscosity is approximated by a polynomial model using the least square method. Based on this model and temperatme control implemented using the Dahlin principle, the viscosity of the glue can be maintained at a constant value. Then, the viscosity model of the glue is applied to deriving the droplet mass as the nominal model of the temperature controller. The robustness of the temperature controller is analyzed by applying the small gain theory. The glue supply pressure controller is designed using the consistency control strategy, and the robustness is analyzed. Finall）, simulations and experiments are conducted using a jet dispensing control system. The results show that the proposed control strategy can significantly improve the droplet consistency.

Economic Impact of a Dispensing Analog Insulin Strategy to Diabetic Patients

Objective： Assess the economic impact of the dispensing control strategy implementation on analogue insulin dosage indiabetic patients of the subsidized system of Antioquia. Methodology： A retrospective cohort study compares the units of analogueinsulin consumed with the expense per patient during the periods of December/l 4-May/15 versus December/15-May/16. Statisticaltreatment is applied to data obtained and the results are analyzed. Results： The expense per patient during the period ofDecember/15-May/16 was statistically less than the one during the same period on the year before （December/14-May/15）, having astate dispensing saving per patient of US$ 1.34 per month. And a saving per patient in the pharmaceutical care is approximatelyUS$ 2.82 per month. Conclusions： Cost savings in care of insulin-dependent diabetic population enrolled in the subsidized plan waspossible due to the development of cost/effective dispensing strategies that allowed access and safety of insulin therapy.

Effect of Healthcare Failure Mode and Effect Analysis on Reducing Error Risk of Neonatal Parenteral Nutrition Solution Dispensing

[Objectives]To investigate the effect of healthcare failure mode and effect analysis(HFMEA)on reducing error risk of neonatal parenteral nutrition solution dispensing.[Methods]A research team was established to identify the failure mode(FM)in each link of the formulation process of neonatal parenteral nutrition solution by HFMEA,quantify the severity(S),occurrence(O)and detection(D)of FM,and evaluate FM by risk priority number(RPN).For FM with the values of RPN>16,failure cause analysis was conducted,and corresponding improvement measures were formulated.The weight coefficient and random consistency ratio(CR)of deployment process were calculated in Matlab R2018a by compiling the Analytic Hierarchy Process(AHP)program.Six months after the implementation of improvement measures,the implementation effect was evaluated by comparing the changes of the values of RPN which was evaluated comprehensively and the rate of dispensing errors before and after the implementation of HFMEA.[Results]In the preparation process of neonatal parenteral nutrition solution,a total of 13 FMs with medium and above risk were found,the weight coefficient of medical order review,dosing and mixing was 0.2703,the weight coefficient of drug dispensing check and review was 0.1432,the weight coefficient of print label was 0.1015,the weight coefficient of distribution was 0.0716,and CR=0.0491<0.1.After six months of intervention,the total RPN value decreased by 64.81%from 127.8 to 45.0.The deployment error rates were significantly lower after the implementation,and the difference was statistically significant(P<0.05).[Conclusions]HFMEA can effectively reduce the error risk in preparation of neonatal parenteral nutrition solution,improve the quality of dispensing and promote the safety of neonatal medication.

基于FMEA法的住院药房智能药柜用药安全研究

目的提高住院药房智能药柜(ADC)的用药安全管理。方法采用失效模型和效应分析(FMEA)法,经医院护士、药师等讨论后,从信息系统、人员操作、药品信息、硬件设备、管理方法5个方面建立20个失效模型(包括32个风险点),汇总为调查问卷,并通过专家咨询和药师讨论后建立问卷评分标准。于干预前发放问卷进行调查,根据发现的风险对其中30个可操作的风险点设定干预措施,持续干预5个月后(干预后)再次进行问卷调查,比较干预前后的风险优先级数(RPN)。结果干预后,30个风险点的RPN值均不同程度降低,其中22个显著降低(P<0.05)。管理方法方面的全部风险点RPN值均显著降低(P<0.05);硬件设备方面的全部风险点RPN值均无显著改变(P>0.05)。结论FMEA法用于住院药房ADC的用药安全研究,可减少其用药风险,促进药护共同管理安全使用ADC规则的形成,尤其适用于麻醉药品等特殊药品的用药管理。

多因素线性回归模型分析门诊药房自动发药机对药师工作效率的影响

目的分析使用自动发药机对药师工作效率的影响。方法选择北京积水潭医院新街口院区和回龙观院区门诊药房(两种工作场景:配备自动发药机、完全传统手工调配模式)。以患者取药等候时间为因变量,分别以日门诊药房窗口药师数、当日该院区门诊药房处方量、患者当日就诊科室数、实际取药数量4项指标作为自变量,建立多因素线性回归模型,比较不同模型下患者取药等候时间的影响因素。以患者取药等候时间为因变量,以日门诊药房窗口药师数、是否配备自动发药机、当日该院区门诊药房处方量、患者当日就诊科室数、实际取药数量5项指标作为自变量,建立多因素线性回归模型,分析门诊药房工作药师数、是否采用自动发药机等对患者取药等候时间的影响。结果使用自动发药机院区每增加1名药师,患者取药等候时间缩短9.63 s,未使用自动发药机院区每增加1名药师,患者取药等候时间缩短5.41 s。将自动发药机作为影响因素纳入模型后,5项自变量均对患者取药等候时间有影响(P<0.05)。其中采用自动发药机的院区相比另一院区的取药等候时间节省20.08 s;院区日处方量每增1张,患者取药等候时间增加0.07 s;每增加1名门诊上班药师,患者取药等候时间减少5.69 s;患者当日每多就诊1个科室,取药等候时间增加72.72 s;患者取药数方面,取2~10盒/支相比取1盒/支、取超过10盒/支相比取1盒/支,患者取药等候时间分别减少15.72、9.25 s。结论自动发药机有助于提升门诊药房的工作效率,改善就医体验。

创新软件和设备在口服外摆拆零药品智能化管理中的应用

目的通过开发智能创新软件结合独立调配桌对住院药房口服外摆拆零药品进行高效、安全的管理和调配,确保药品的安全供应。方法设置独立外摆药品调配操作台,利用创新软件集成掌上电脑(PDA)智能系统,结合条码扫描导入技术与全自动药品分包机,优化和改进口服外摆药品调剂、加药、有效期维护等易错环节。对比创新软件使用前后口服医嘱平均调剂时长(min),外摆拆零药品月均盘存时长(min)和外摆拆零药品有效期维护平均时长(min)。结果使用创新软件和设备后,口服医嘱平均调剂时长从(218.07±6.72)min缩短至(173.81±6.08)min(P<0.01),均值减少44.26 min;外摆拆零药品月均盘存时长从(156.00±5.29)min缩短至(108.00±2.64)min(P<0.01),均值缩短48.00 min;外摆拆零药品有效期维护平均时长从(147.00±2.64)min缩短至(23.00±3.00)min(P<0.01),均值缩短124 min。结论该项创新应用可解决传统外摆拆零药品容易出现的药品混装、定位混乱、库存数量不明、效期管理困难等问题,实现了药品管理的精细化、科学化,有效提高了药师的工作效率和服务质量,同时也为患者提供了更加安全、便捷的用药服务。

饵剂投放站对田间红火蚁的饵剂搬运量及防控效果研究

饵剂诱杀是防控红火蚁Solenopsis invicta Buren最广泛和最有效的措施。本研究利用一种新型饵剂投放站(简称饵剂站)对比分析红火蚁工蚁对0.08%茚虫威杀蚁饵剂及其载体的搬运量,并使用5 g/巢、10 g/巢、20 g/巢3种剂量的饵剂对田间红火蚁蚁巢进行单蚁巢处理,评价饵剂站对田间红火蚁的饵剂搬运量及防控效果的影响。结果表明,红火蚁工蚁对饵剂站内0.08%茚虫威饵剂及其载体的搬运量少于直接撒施处理方式的搬运量。施药24 h后,红火蚁工蚁对饵剂站内和直接撒施的0.08%茚虫威饵剂搬运量分别为14.84±3.18 g和17.71±5.88 g,差异不显著。使用饵剂站施用10 g、20 g饵剂处理28 d后,工蚁减退率、蚁巢减退率、蚁群级别降低率和综合防治效果均可达到90%以上,与直接撒施处理方式均无显著差异。虽然饵剂站会一定程度上降低红火蚁工蚁对饵剂的搬运量,但却不影响对红火蚁的防控效果,基于其防雨、防潮的优点,饵剂站可显著延长红火蚁防控的窗口期。