The aim of this study was to explore the perceptions of community pharmacists towards the concept of pharmaceutical care, implementing frequencies of pharmaceutical care, and barriers to implementation of pharmaceutical care in China. A 38-item self-completion pre-tested questionnaire was administered to a quota sample of 130 pharmacists in community pharmacies in Xi'an, Shaanxi Province, northwest China in April 2008. Main outcome measures included understanding of pharmaceutical care; perceived frequency of pharmaceutical care activities; attitude towards pharmaceutical care; barriers to implementation of pharmaceutical care. A response rate of 77.7% (101/130) was achieved. The data were analysed descriptively. Factor analysis was used to explore potential barriers to the provision of pharmaceutical care. Respondents' understanding of the definition of pharmaceutical care was not entirely satisfactory: it was widely but incorrectly seen as a medication counselling service and many pharmacists appeared to misunderstand their role in the process. Respondents spent most of their work time performing prescription checks and providing patients with directions for drug administration, dosage, and precautions, but they tended to ignore health promotion within and outside of pharmacy settings. Factor analysis suggested four factors influencing the implementation of pharmaceutical care in the surveyed community pharmacies: lack of external conditions for developing or providing pharmaceutical care, lack of time and skills, absence of information and economic incentive, and lack of full support from other health professionals, with a cumulative variance of 64.7%. Cronbach's alpha for the four factors was 0.71, 0.72, 0.69 and 0.74, respectively. Although the respondent pharmacists had a certain degree of understanding of the definition, aim, function and use of pharmaceutical care, and carried out some activities currently, a range of barriers need to be overcome before comprehensive pharmaceutical care becomes a reality in China. These barriers could be overcome through participation in effective continuing educational programmes, availability of more resources, effective collaboration with other health professionals.

Summary What is known and objective To compare the penetration of vancomycin into cerebrospinal fluid (CSF) in patients with postoperative intracranial infection and community‐acquired meningitis, and to identify related factors influencing the penetration in these two diseases. Methods The concentrations of vancomycin in serum and CSF were determined by enzyme amplified immunoassay, and the CSF‐to‐serum ratios were calculated. The correlation between CSF‐to‐serum ratios of vancomycin and CSF elements was analyzed. Results and discussion In postoperative intracranial infection patients and community‐acquired meningitis patients, the vancomycin concentration in CSF was 1.90 ± 1.29 mg/L and 2.47 ± 1.15 mg/L, while the CSF‐to‐serum ratio was 0.19 ± 0.12 and 0.26 ± 0.12, respectively. There was a significant correlation between vancomycin serum concentration and bodyweight (P < 0.05). The CSF‐to‐serum ratio in postoperative intracranial infection patients was correlated to white blood cell count in CSF. However, in community‐acquired meningitis patients, no relationship was seen with regards to CSF white blood cell count, protein or glucose. What is new and conclusion Cerebrospinal fluid vancomycin penetration was similar in postoperative intracranial infection and community‐acquired meningitis patients. The CSF‐to‐serum ratio was only correlated to CSF white blood cell count in postoperative intracranial infection patients.

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Purpose To determine whether combinations of antifungal drugs are effective and safe for patients in intensive-care units. Methods This study compared the efficacy and safety of caspofungin (CAS), voriconazole (VOR), amphotericin B liposome (L-AmB), CAS+VOR, and CAS+L-AmB as empirical, preemptive, and targeted therapies for invasive fungal infection (IFI). Results Comparing the CAS, VOR, and CAS+VOR groups revealed that there were no differences in response rates between all therapy types, IFI-associated death within 90 days was less common in the CAS+VOR group (1.8%) than the VOR group (14.3%), and there were more adverse events in the VOR group than in the CAS group ( P < 0.05). For empirical or preemptive therapy, the CAS group had a better response rate (80.0%) than the CAS+VOR group (47.1%), and there were more adverse events in the VOR group than in the CAS group ( P < 0.05). For targeted therapy, no differences were found for efficacy and safety. There were no differences among the CAS, L-AmB, and CAS+L-AmB groups in efficacy and safety. Conclusion Patients who received CAS monotherapy as an empirical or preemptive therapy could achieve good outcomes. Patients who received CAS+VOR or CAS+L-AmB achieved almost the same outcomes when compared with those who received CAS, VOR, and L-AmB monotherapy as targeted therapies, but those who received CAS+VOR had a lower IFI mortality rate than did those who received VOR monotherapy.

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