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This review article summarizes recent developments and innovations in China's pharmaceutical process chemistry over the last several decades. Case studies of dozens of blockbuster drug processes are presented, including bulk drugs, such as the over-the-counter medicine biotin, demonstrating China's substantial effort to green its pharmaceutical processes. Owing to the increasing stringent environmental regulations, Chinese chemists have invented several cutting-edge and eco-friendly synthetic methods that are beneficial to environmental protection. Applied to large-scale industrial production, these processes have a greatly reduced environmental footprint, promoting the sustainable development of global economy and health. Year Archive Download PDF. CC BY 4. Also available at. Keywords pharmaceutical industry - green process - asymmetric catalysis - chiral drugs - stereoselectivity. Google Scholar. Crossref PubMed Google Scholar. Crossref Google Scholar.

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Official websites use. Share sensitive information only on official, secure websites. These authors have contributed equally to this work and share first authorship. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Unsafe medication practices and medication errors are a major cause of harm in healthcare systems around the world. This study aimed to explore the factors that influence the risk of medication and provide medication risk evaluation model for adults in Shanxi province, China. The data was obtained from the provincial questionnaire from May to December , relying on the random distribution of questionnaires and online questionnaires by four hospitals in Shanxi Province. Multiple linear regression analysis was used to explore the factors affecting the KAP score of residents. Univariate and multivariate logistic regression was used to determine the independent risk factors, and the nomogram was verified by receiver operating characteristic curve, calibration and decision curve analysis. A total of 3, questionnaires were collected, including 3, valid questionnaires. The average scores of drugs KAP were Sex, monthly income, place of residence, insurance status, education level, and employment were regarded as independent risk factors for medication and a nomogram was established by them. Males, low-income, and low-educated people are important factors affecting the risk of medication. The application of the model can help residents understand the risk of their own medication behavior and reduce the harm of medication. Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in healthcare systems from all over the world Glavin, ; Rishoej et al. Adverse drug events lead to 2. It is essential to raise public awareness of the safety risks associated with medication use and the need for safer medication practices. Self-medication is the practice of using drugs to treat common diseases and health problems without consulting a doctor or a pharmacist Ruiz, It is very common in China, where people can easily access drug information through various media channels. Self-medication can help protect health and save medical costs, but it can also pose significant health risks Hughes et al. Many surveys and studies have shown that Chinese residents often use drugs improperly because of factors such as socioeconomic level, cognitive level, traditional culture, personal experiences, limited medication knowledge, and false advertising. Some examples of improper drug use are blind medication, not following drug instructions, wrong administration methods, arbitrary changes in dosage and duration, and using health supplements as drugs. Irrational drug use can lead to serious health problems and even life-threatening consequences for Chinese residents Hu et al. Shanxi is a significant resource province in China that supplies coal power resources for 24 provinces across the China in As the economy grows, the people here are becoming more aware of health issues and the healthcare costs are rising every year He et al. To ensure the health of residents, we as medical workers need to examine and understand their medication situation and the potential risks involved in the medication process, especially regarding self-medication. The KAP model comprises three components: knowledge, attitude, and practice. By imparting knowledge, fostering confidence, and ultimately modifying their behavior, the KAP model has been widely applied in healthcare activities such as preventive healthcare, intervention evaluation, and medication behavior risk assessment Chaudhary et al. The KAP model can help us explore the relationships among knowledge, attitude, and practice behavior of health or the associations between basic resident information and KAP Dopelt et al. The main challenge at present is that the residents are unaware of their own medication cognitive level, and the doctor or pharmacist cannot devote much time to each patient in real life. It is impractical for the residents to spend a lot of time evaluating their medication every time they see a doctor. Therefore, it is essential to develop a simple and practical predictive model to assess the risks of self-medication for the residents. Multivariate logistic regression analysis is a multivariate analysis method that examines the dependent variable as binary observations and influencing factors. It is widely used in data mining, economic forecasting, disease risk factor analysis, and other fields Sheikh et al. The nomogram is a graphical representation of a logistic regression model that visualizes a prediction Olofsson Bagge et al. However, there is no report on using a nomogram-based model to evaluate the risks of self-medication. Thus, the objective of this study is aimed to build a nomogram based on multiple logistic regression after the KAP survey and to predict the risk profiles for medication practice Figure 1. This regional survey was conducted in Shanxi Province, where four major cities—Taiyuan, Yuncheng, Jincheng, and Yangquan—were selected for investigation and research. Each institution participated in the trial, secured approval from their respective ethics committees. The survey time of the questionnaire was from May to December , and the survey was carried out by means of offline and online questionnaires for residents aged 19 years and older who voluntarily participated in the survey. The questionnaire is developed by the Science and Technology Development Center of the Chinese Pharmaceutical Association, and the content includes the following items:. Basic information of residents, including sex, age, monthly income, place of residence, health insurance status, education level, employment status, and occupation eight questions ;. Refer to the Likert 5-level rating scale, and quantify the actual frequency of behavior and the degree of approval: one point for strong disapproval, two points for disapproval, three points for neutral, four points for approval, five points for strong approval, and six points for unclear. The higher score on medication knowledge questions, the higher risk level; the lower your score on medication attitude questions, the higher your risk level; for medication practice questions, a lower score on good practices and a higher score on bad practices indicate a higher risk level. The resident rating scale is shown in Table 1. Before conducting the survey, the investigators received unified training, including introduce the content and purpose of the survey to the potential respondents and ensure that the participation was voluntary. In order to ensure the validity and reliability of the survey, it was stipulated that one valid questionnaire can be submitted only once per IP address. Any questionnaires that were less than 1 min, incomplete, or multiple-choice were excluded. Multivariate linear regression models were used to analyze the correlation between basic resident information and the scores of KAP, and to find the influencing factors of the resident KAP. Significant influencing factors were counted in the multivariable analysis and used to build a new nomogram for predicting the risk of resident medication practice. The accuracy and reliability of the nomogram were verified by the validation cohort. The receiver operating characteristic ROC curve was constructed and the predictive accuracy of the nomogram was evaluated by the area under the curve AUC. The calibration plots were used to verify the accuracy of the predictions of the nomogram. Decision curve analysis DCA was used to evaluate the clinical significance of the nomogram Vickers et al. When the same dataset is analyzed multiple times, the p -values should be adjusted using the Benjamini-Hochberg method Author Anonymous, A total of 3, resident questionnaires were collected and 3, of them were included in the analysis, accounting for Each institution that participated in the trial collected 1,; ; ; and valid questionnaires, respectively. Of these, 2, were obtained through online methods, and 1, were collected offline. The survey participants included 1, males and 2, females, mostly young 19—34 or middle-aged 35—49 residents Most residents Most had basic social medical insurance Most residents were employed Based on the scoring criteria, we grouped the error-prone questions in the KAP survey of medicines Table 3 and assessed the risks of residents in relation to antibiotic use, drug storage, disposal of expired drugs, and adjustment of the drug dose. Meanwhile, the traditional medical science popularization and education work, such as organizing lectures and consultations, should also adapt to the changing times, shifting from offline to online platforms, such as the Internet, WeChat public accounts and other channels, which will be more effective. The KAP scores were used as dependent variables, and basic information of residents were the independent variables. A multiple linear regression model was used to analyze the relationship Table 4. The results revealed that sex, place of residence, education level and employment status were the factors affecting medication knowledge; Sex was the only factor influencing attitudes toward medication; Sex, age, place of residence, health insurance coverage, and education level were the factors influencing good practices toward medication; Bad practices of medication was influenced by sex, health insurance coverage, education level, and employment status. Univariate analysis showed that sex, age, monthly income, place of residence, health insurance coverage, education level, employment status, and occupation were significant risk factors for KAP of medication. The multivariate analysis revealed that only sex, monthly income, health insurance coverage, education level and employment status remained as independent risk factors for KAP of medication Table 5. Univariable and multivariable logistic analysis of medication-related risks in the training cohort. The p -values in the tables were the adjusted values, which were adjusted using the Benjamini-Hochberg method. According to the results of multiple linear regression analysis, the place of residence was also an important factor for KAP of medication, so the factor was involved in the construction of a nomogram with the multivariate analysis results. Based on the above, the nomogram for KAP risk was established Figure 2. The score of each independent factor and the total score were identified according to the point scale at the top of the nomogram. Then, the risk of medication KAP was predicted by the total score and the point scale at the bottom of the nomogram. The calibration curve showed good agreement between the actual survey values and the model predictions for both training and validation cohorts used to predict risk of mediation KAP Figures 4A,B. The DCA was used to evaluate the clinical utility and benefit of the risk of mediation nomogram to further assess its potential application worth. Both training and validation cohorts could receive more clinical net benefits from these results Figure 5, B. The calibration curve for the predictive medication risks in training cohort A and validation cohort B. Decision curves of the nomogram predicting medication risks in training cohort A and validation cohort B. We conducted a large survey on medication KAP among residents across the province in this paper, aiming to understand their drug use, cognition, and safety awareness. We selected 3, residents aged 19 or above from various regions of the province as survey subjects by random sampling. The results showed that the drug KAP level of residents in our province was generally moderate, with some misconceptions and bad habits, such as the use of antibiotics, drug storage, and disposal of expired drugs. Therefore, it is still necessary to strengthen drug education and guidance for residents and improve their ability to use drugs rationally and their self-protection awareness. For drug knowledge score, it was negatively correlated with sex, but positively correlated with residence, education level, and employment status. This is consistent with previous studies Islam et al. This might be because there are more ways to obtain drug knowledge in urban areas Xiang et al. Education level was closely related to knowledge scores. Lower education levels were associated with higher risks of medication errors. This was in accordance with the results of a study on medication KAP among Haikou residents Wu et al. The knowledge score of employment status showed that retired or unemployed residents had higher score than currently employed ones, indicating that working residents had the best drug awareness. This might be because working residents had more communication and a wider range of ways to obtain drug knowledge Lombardo and Cosentino, For medication attitude scores, sex had a positive correlation with medication attitudes. For medication practices, sex, Health insurance coverage, and educational background were all important influencing factors. Women were still better than men in medication practices. Basic social medical insurance was superior to other insurance. Theoretically, the higher the education level, the better the drug behavior. However, we found the opposite result in good behavior. We developed and validated a nomogram to predict the risk of medication in residents, which can be used to guide clinical decision-making. Our results indicate that the nomogram has good discrimination, calibration, and some net clinical benefit. The nomogram contains six predictors: sex, monthly income, place of residence, insurance status, education level, and employment status. Finally, we found that male, low-income groups, commercial insurance and self-paid medical care groups, groups with lower education levels, factory workers, company employees, government officials, and businessmen were people with a high incidence of drug risk. In the follow-up work, targeted medication education activities should be carried out for such high-risk groups. The questionnaire method is a popular tool for gathering data due to its direct approach in obtaining information. However, the questionnaire still has certain limitations. Due to the large number of questions and the extensive range of dimensions involved, some respondents lacked the patience to complete the questionnaire, resulting in only 5. In a major agricultural and mining province, rural residents made up just Certain sections of the questionnaire are highly specialized and may be beyond the comprehension of respondents, potentially compromising the accuracy of patient reports on adherence to treatment regimens, which is often linked to literacy levels Lee et al. Questionnaires are known to be less sensitive Basu, , and patients may be prone to social desirability bias, which can affect the accuracy of survey data. The fixed format of the questionnaire might restrict the opportunity for respondents to provide deeper insights. In this study, for some patients with low education levels, face-to-face interview surveys are conducted to gather samples. For those who find it inconvenient to complete the questionnaire themselves, responses are dictated to the investigator and collected on the spot, enhancing the diversity and representativeness of the sample, but this is not sufficient. Therefore, in subsequent studies, we will complement the questionnaire data with qualitative research methods or design a more flexible questionnaire format to allow for more free-form feedback. Additionally, pre-testing the questionnaire to assess the validity of the questions and including appropriate open-ended questions in the design are also effective strategies to improve data quality. A more strategic distribution approach will ensure the questionnaire reaches a diverse group of respondents, making the data more comprehensive, reliable, and enhancing the validity and universality of the research. Logistic regression is characterized by its strong interpretive ability and its effectiveness in handling binary classification problems. For the first time, a drug risk assessment model for residents is established using a nomogram, providing a simple and effective prediction tool for the majority of residents. In this study, the AUC area, sensitivity and specificity of the model at the optimal threshold still did not reach the ideal results. In subsequent research, we aim to enhance both the quantity and quality of the questionnaire by optimizing its design, selecting suitable delivery channels, and strengthening its logical structure. In the follow-up work, we will develop corresponding drug education materials for common medication misconceptions in the questionnaire, such as disposal of expired drugs Alnahas et al. We will also cater to the needs of special groups such as men, low-income and rural residents, and conduct personalized drug science popularization activities. For example, for the older adult, we will offer medication training lectures, current medication consultation activities, etc. Finally, we will organize pharmacist community activities, and relevant pharmacists will sign contracts with community hospitals and families to assist community doctors and patients to familiarize themselves with medication-related knowledge and enhance public awareness and education, strengthening drug regulation and supervision, promoting rational medication use and consultation, and reducing antibiotic misuse or abuse. In summary, a new monogram was established to predict the medication risks for residents based on a large, province-wide KAP survey. The tool can help residents assess their medication risk and report their medication knowledge and practices to doctors, who can then implement appropriate interventions to reduce medication adverse effects. The authors are grateful to Dr. Le Ma for her assistance with the statistical analysis in this paper. The authors would like to express their deep gratitude to the Science and Technology Development Center of the Chinese Pharmaceutical Association, which provided the questionnaire upon request. Thanks also to everyone involved in the study and the researchers who helped us collect the data. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. L-hY: Investigation, Writing—review and editing. XZ: Investigation, Validation, Writing—review and editing. Y-tX: Investigation, Writing—review and editing, Supervision. Y-jN: Investigation, Validation, Writing—review and editing. X-jC: Investigation, Supervision, Writing—review and editing. S-jD: Investigation, Project administration, Writing—review and editing. S-wW: Investigation, Project administration, Writing—review and editing. L-hH: Investigation, Project administration, Writing—review and editing. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Front Pharmacol. Find articles by Da-shuai Xie. Find articles by Xue-hu Xie. Find articles by Li-hua Yang. Find articles by Na Li. Find articles by Xiao Zhang. Find articles by Yi-tong Xie. Find articles by Wei Yang. Find articles by Yao-jun Ning. Find articles by Jun Xie. Find articles by Xiao-jun Cheng. Find articles by Shao-jun Duan. Find articles by Shi-wei Wang. Find articles by Li-hong Hao. Find articles by Ping Shi. Received Oct 26; Accepted Mar 28; Collection date Open in a new tab. Characteristics NO. As long as you do not abuse antimicrobials, you will not develop resistance Medicines that run out of use should be stored in the refrigerator as much as possible When buying drugs, the price does not matter, the key is good efficacy In my community, I listened to a lecture on the knowledge of rational drug use in the community 6. Listen to lectures on rational drug use in hospitals or community health service centers Participate in pharmacist community or street counseling 9. Regular inspections of medicines stored at home Check the drug approval number on the drug packaging before taking the medicine Discard expired medicines at home in the trash When taking medication, you will consider your physical condition every time After the condition improves, reduce the dose or stop the drug on your own Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. As long as you do not abuse antimicrobials, you will not develop resistance. Medicines that run out of use should be stored in the refrigerator as much as possible. When buying drugs, the price does not matter, the key is good efficacy. In my community, I listened to a lecture on the knowledge of rational drug use in the community. Listen to lectures on rational drug use in hospitals or community health service centers. Check the drug approval number on the drug packaging before taking the medicine. When taking medication, you will consider your physical condition every time. After the condition improves, reduce the dose or stop the drug on your own.

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