Thecontinuous practice and exploration of the construction of the public hospital medical union party construction alliance / 现代医院

In the context of comprehensively strengthening party building in public hospitals,multiple medical institu-tions have extended party building to the construction of medical union,explored the establishment of medical union party building alliances,and accumulated rich experience in the integration and development of party building and business.This article takes the Medical Union of the First People's Hospital of Suqian City as an example to deeply summarize and analyze the experience,practices,and existing problems in the process of medical union construction,propose countermeasures and suggestions,and pro-vide beneficial practice and exploration for other medical union party building.

Efficacy of gold microneedle combined with tranexamic acid transdermal administration for treatment of post-inflammatory hyperpigmentation from acne vulgaris / 中华医学美学美容杂志

Objective:To evaluate the efficacy of gold microneedle combined with tranexamic acid transdermal administration for the treatment of post-inflammatory hyperpigmentation caused by acne vulgaris.Methods:From January 2022 to October 2022, 36 patients with post-inflammatory hyperpigmentation of facial acne who went to the Laser Medical Center, Air Force Medical Center were treated, including 10 males and 26 females, with 21-42 (28.3±4.8) years of age. The patients were divided into observation group and control group, with 18 cases in each group. The observation group was treated with gold microneedle combined with transdermal administration of tranexamic acid, the control group with 0.5 mm microneedles combined with transdermal administration of tranexamic acid. Both groups were treated for 2 times with an interval of 2 months. The total effective rate, post acne hyperpigmentation index (PAHPI), UV spots, brown spots, pores, skin texture, and adverse reaction were evaluated at 4 weeks after the last treatment.Results:Clinical observation was completed in all 36 patients. In the observation group, 17 cases were effective, accounting for 94.4%, and in the control group, 11 cases were effective, accounting for 61.1%, The curative effect of the observation group was better than that of the control group, and the difference between the two groups was statistically significant ( P<0.05). The differences in PAHPI score, UV spots, brown spots, pores, and skin texture between the two groups were also statistically significant ( t=3.10, 2.52, 2.71, 2.43 and 3.54; P=0.004, 0.017, 0.001, 0.021 and 0.001). The patiens in both groups had different degrees of burning sensation, erythema, edema. dryness and other symptoms after treatment, which were relieved 3 days after treatment without special treatmet. Conclusions:Gold microneedle plus transdermal administrationof tranexamic acid is a safe and effective method for the treatment of post-inflammatory pigmentation caused by acne vulgaris.

Construction and operation of the multi-level medical security system of the West China Women and Children Alliance / 中华医院管理杂志

Medical mutual aid is an important component of multi-level medical security system. West China Second University Hospital of Sichuan University led the establishment of the pediatric specialty alliance " West China Women and Children Alliance". Based on customized and inclusive mutual insurance product " Family Doctor Mutual Aid Plan", the alliance implemented key links such as mutual aid product forms, patient risk protection, institutional financing and hematopoiesis, and distribution of benefits to all parties, explored innovative mutual aid funding, payment, and incentive mechanisms, forming a closed-loop pediatric tiered diagnosis and treatment service system with the Mutual Aid Plan as the core. This system operated continuously under the " Four-in-One" framework, stimulating the integration of medical insurance and service supply systems while enhancing the synergistic effect between mutual insurance and social security. It has formed a distinctive health-centered multi-level medical security system within the alliance, and could provide reference for the construction and exploration of hierarchical diagnosis and treatment system.

Challenges Faced by "Young" Ethics Committees under the Mode of Collaborative Review / 中国医学伦理学

In the process of exploring standardized and efficient ethical review models for multi-center drug clinical trials, the ethical review alliance emerged as the times require. Compared with mature ethics committees, higher requirements have been put forward for the "young" ethics committees. By analyzing problems existing in review work of "young" ethics committees in the ethics review alliance, this paper discussed the measures to improve the review quality of "young" ethics committees and promote the standardized and efficient operation of the alliance, and put forward countermeasures and suggestions for improving the homogenization of ethics review and accelerating the clinical research process of innovative drugs.

Construction of pediatric pharmaceutical care cloud platform based on Western Pediatric Development Union / 中国药房

OBJECTIVE To explore the construction of a pediatric pharmaceutical care cloud platform based on Western Pediatric Development Union， to provide a reference for narrowing the difference of pediatric pharmaceutical care in western regions and medical institutions. METHODS Based on the Western Pediatric Development Union， the “1+3+3” pediatric pharmaceutical care cloud platform had been built by relying on the alliance telemedicine service network. That was， with Children’s Hospital of Chongqing Medical University as one center， three core pharmaceutical services， including prescription dispensing， pharmaceutical guidance and health education， were carried out in the union through standardized 3 aspects of management of resource information， service process and component interface. RESULTS & CONCLUSIONS Established “1+3+ 3” pediatric pharmaceutical care cloud platform based on the remote service network of the Western Pediatric Development Union registered 1 208 thousands registrations since its operation， with 112 thousands online prescriptions and 44 thousands circulation prescriptions completed； the total number of medication consultation cases was 10 694， and the number of online training people exceeded 15 thousands. However， during the operation， there are also problems such as limited clinical medication data and insufficient coverage of the region. With the accumulation of clinical medication data on the platform， the artificial intelligence technology will be used to extract the data of prescriptions， medication behavior， and physical indicators after medication， the correlation analysis of data will be conducted under the conditions of different geographical environments， different age groups， different heights and weights in the region to obtain clinical medication characteristics for children in the region， providing decision support for further guiding rational and safe medication in pediatric clinical practice.

Measurement and Coping Strategies of Transaction Costs of Health Management System / 中国卫生经济

Based on the reality that the Health Management Alliance(HMA)has been initially established nationwide as an important component of the integrated health care service system,on the basis of summarizing the evolution process of transaction cost theory,discriminating the essential characteristics of HMA,deconstructing HMA transaction cost and putting forward a quantitative measurement model,the coping strategies of HMA transaction cost are summarized into three levels:"knowing","reducing"and"increasing".It aims to solve the high transaction cost effectively and explore the economic system supply path;correct the deviation of the field of vision which only focuses on the"output orientation"of HMA in the early stage,and arouse the attention and thinking of all parties on the transaction cost of HMA;provide a new position and a new idea for HMA policy research and reform practice in China.

The Achievements and Challenges of the Construction of Traditional Chinese Medicine Medical Alliance in China Dur-ing the 13th Five-Year Plan / 中国卫生经济

At present,China's multi-level Traditional Chinese medicine(TCM)Medical Alliance has been gradually formed,the sinking effect of resource sharing is obvious.The level of medical services homogenization has been improved,the operation guarantee mechanism has been continuously improved,and the diagnosis and treatment capacity of each member unit has continued to improve.However,in the construction of various regions,there are still government departments'weak cognition and planning of TCM Medical Alliance,and the characteristics are insufficient.It is recommended to strengthen the functional positioning and connotation construction of TCM Medical Alliance,improve the operation and management mechanism,and give full play to the"baton"role of performance evaluation,so as to effectively promote the sinking and balanced distribution of TCM high-quality resources.

Evaluation of Hierarchical Diagnosis and Treatment Effect and Influencing Factors of Beijing Medical Alliance / 中国医院管理

Objective To understand the status quo of hierarchical diagnosis and treatment effect of medical alliance in Beijing and explore the influencing factors.Methods The convenience sampling method was used to select 26 vertical medical alliances,and the weighted TOPSIS method was used in combination with the index system established in the previous study to evaluate the effect of hierarchical diagnosis and treatment.The factors influencing the effect of hierarchical diagnosis and treatment in medical alliances were summarized through interviews with insiders,and the rank sum test was used to explore the factors influencing the effect of hierarchical diagnosis and treatment in medical alliances.Results The medical alliance B,A2 and A3 ranked high,and the implementation effect was relatively good in the four dimensions of"primary care first consultation,dual-way referral,acute and slow treatment,and vertical linkage";The C2,A8 and F2 medical alliances ranked low,and the implementation effect in the dimensions of"dual-way referral","acute and slow treatment"and"vertical linkage"was significantly lower than that of other medical alliances.The analysis results showed that the differences in the support intensity and core hospital level of different medical alliances were statistically significant(P＜0.05),which affected the hierarchical diagnosis and treatment effect of medical alliances.Conclusion While strengthening the information construction and improving the initiative of grassroots and the signing rate of family doctors,it is necessary to improve the support of core hospitals to promote the sinking of resources.Core hospitals should optimize resource allocation according to local conditions and promote hierarchical diagnosis and treatment.

Research on the Factors Influencing the Acceptability of Internet Medical Association by Medical Staff in Medical Institutions / 中国医院管理

Objective To explore and analyse the factors influencing the acceptability of"Internet medical alliance"among medical staff by UTAUT model,with a view to providing a basis for the sustainable development of"Internet medical alliance".Methods A questionnaire survey was conducted among medical staff participating in the"Internet medical alliance"in municipal hospitals,count-level hospitals,township health centers,village clinics and community health service centers.SPSS 20.0 and Amos 17.0 software were used to statistically describe the acceptance of"Internet medical alliance",and a structural equation model with behavioral intention and satisfaction as dependent variables was constructed.Results In the range of independent variables,the 841 follow-up subjects had the highest individual creativity score at(3.88±0.67),followed by social influence at(3.86±0.66)and the lowest perceived risk score at(3.52±0.78).Of the dependent variables,the behavioural intention score was(3.86±0.68)and the satisfaction score was(7.72±1.88).Conclusion Facilitation,individual creativity,self-efficacy,performance expectations,effort expectations,having heard of"Internet medical alliance"education level and perceived risk were key factors in the behavioral intention and satisfaction of medical staff to participate in"Internet medical alliance".

The Regulatory Status of Functional Foods in the Economic Integration Organizations of Latin America and the Caribbean / El Estatus Regulatorio de los Alimentos Funcionales en las Organizaciones de Integración Económica de Latinoamérica y el Caribe

Introduction. The legal declarations on functional foods of the four main economic integration organizations in Latin America and the Caribbean (LAC) ­ Pacific Alliance (PA), Caribbean Community (CARICOM), Southern Common Market (MERCOSUR) and Central American Integration System (SICA) - are based on the Codex Alimentarius system and do not regulate functional foods. The use of Codex in food marketing is an insufficient condition for its application in functional foods. Regulation based on scientific and technology results are required to be used in the economic integration organizations of LAC. Objective. The objective is to analyze the theoretical framework of the legal foundations that could govern the commercialization processes of functional foods, whose research advances have currently only been manifested in nutritional health. This article also seeks to address this gap through a systematic analysis of international regulations. Materials and methods. For this, a review of the literature emanating from two databases from 2018-2023 is carried by applying the legal-economic research method of documentary content analysis, applied to three general food marketing regulations: food safety declarations, regulations for inspections, food manufacturing and food labeling. Results. The results reveal the absence of specific legislation for functional foods in LAC economic integration organizations. Conclusions. The legal principle of marketing based on peremptory norm (also called jus cogens) can be facilitated through side letters, included in the contents of international contracts. along with the registration requirements of industrial property rights of the member countries associations(AU)

Introducción. Las declaraciones legales sobre alimentos funcionales de las cuatro principales organizaciones de integración económica de América Latina y el Caribe (ALC) ­ Alianza del Pacífico (AP), Comunidad del Caribe (CARICOM), Mercado Común del Sur (MERCOSUR) y Sistema de Integración Centroamericana (SICA) - se basan en el sistema del Codex Alimentarius y no regulan los alimentos funcionales. El uso del Codex en la comercialización de alimentos es condición insuficiente para su aplicación en alimentos funcionales. Se requiere que las regulaciones basadas en resultados científicos y tecnológicos sean utilizadas en los organismos de integración económica de ALC. Objetivo. Analizar el marco teórico de los fundamentos legales que podrían regir los procesos de comercialización de alimentos funcionales, cuyos avances en investigación actualmente solo se han manifestado en salud nutricional. Este artículo también busca abordar esta brecha a través de un análisis sistemático de las regulaciones internacionales. Materiales y métodos. Se realiza una revisión de la literatura emanada de dos bases de datos del período 2018-2023 aplicando el método de investigación jurídico- económica de análisis de contenido documental, aplicado a tres normas generales de comercialización de alimentos: declaraciones de seguridad alimentaria, normas para inspecciones, fabricación de alimentos y etiquetado de alimentos. Resultados. Los resultados revelan la ausencia de legislación específica para alimentos funcionales en las asociaciones comerciales de ALC. Conclusiones. El principio jurídico de comercialización basado en norma imperativa (también llamado jus cogens) puede facilitarse a través de cartas complementarias, incluidas en el contenido de los contratos internacionales. junto con los requisitos de registro de los derechos de propiedad industrial de las asociaciones de los países miembros(AU)

Francisco Javier Muñiz. Cirujano de guerra / Francisco Javier Muñiz. War Surgeon

Francisco Javier Muñiz nació en Monte Grande en 1795 y se graduó de médico en la Facultad de Medicina de la Universidad de Buenos Aires en 1822. Además de la medicina y la paleontología, Muñiz se desempeñó como cirujano de guerra en la guerra con el Brasil y en la guerra de la Triple Alianza. En 1871, encontrándose jubilado, se ofrece como voluntario en la lucha contra la epidemia de fiebre amarilla que asoló a la ciudad de Buenos Aires provocando 14.467 muertos. Muñiz falleció el 8 de abril de 1871 en cumplimiento del deber, contagiado de fiebre amarilla. Médico, periodista, paleontólogo, descubridor de la vacuna nativa contra la viruela y realizador de apuntes de lingüística, Francisco Javier Muñiz, representa uno de los grandes ejemplos para la sociedad argentina. (AU)

Francisco Javier Muñiz was born in Monte Grande in 1795 and graduated as a physician from the Faculty of Medicine of the University of Buenos Aires in 1822. In addition to medicine and paleontology, Muñiz served as a military surgeon in the War with Brazil and in the War of the Triple Alliance. In 1871, when he was retired, he volunteered to fight the yellow fever epidemic that devastated the city of Buenos Aires, causing 14,467 deaths. Muñiz died in the line of duty on April 8, 1871, infected with yellow fever. Doctor, journalist, paleontologist, discoverer of the native vaccine against smallpox and linguistic note-taker, Francisco Javier Muñiz is one of the great examples for Argentinian society. (AU)

Tratamiento psicológico inclusivo como modalidad terapéutica en el estado cognitivo-emocional-conductual en las personas prejubilables / Inclusive psychological treatment as a therapeutic modality for cognitive, emotional and behavioural state in pre-retired people

Introducción: La prejubilación se define como una etapa de la vida donde convergen factores biológicos, psicológicos, sociales, culturales, espirituales y ambientales que preparan al individuo para un cambio global y profundo. Objetivo: Precisar mediante el tratamiento psicológico inclusivo los cambios ocurridos en el proceso cognoscitivo del pensamiento y las modificaciones obtenidas en la esfera emocional en el grupo intervenido. Métodos: Se realizó un estudio cuasi-experimental en el Policlínico Docente «Marta Abreu», de Santa Clara, Villa Clara, en el período de enero de 2017 a febrero de 2019. Se emplearon procedimientos, métodos y técnicas con la aplicación de esta modalidad terapéutica en un grupo estudio de 200 personas prejubilables, de 55 a 65 años de edad. Se utilizaron métodos teóricos, empíricos y estadísticos-matemáticos. Se aplicaron técnicas psicológicas antes del tratamiento psicológico inclusivo, y después de este, en el grupo estudio y en el grupo control. Resultados: Fueron muy reveladores en el grupo estudio, y se registraron cambios muy significativos en los procesos intelectuales, en el pensamiento lógico verbal, práctico constructivo y rumiativo; además estados emocionales ansioso bajo y depresivo leve, autoestima alta, y notable mejoría en la vulnerabilidad al estrés. En el grupo control no se reflejaron cambios favorables. Conclusiones: El tratamiento psicológico inclusivo resultó efectivo por el logro de cambios positivos en el estado cognitivo-emocional-conductual en personas prejubilables del grupo estudio. La aplicación de las estrategias de desactivación fisiológica, cognitivas, reflexivo vivenciales, informativas, así como las habilidades de conductas de afrontamiento, las acciones de mantenimiento y generalización y las ayudas paliativas y moderadoras de estrés en la atención a personas prejubilables, constituyó un novedoso recurso terapéutico.

Introduction: pre-retirement is defined as a stage of life where biological, psychological, social, cultural, spiritual and environmental factors converge to prepare the individual for a global and profound change. Objective: to determine, through the inclusive psychological treatment, the changes occurred in the cognitive process of thinking and the modifications obtained in the emotional sphere in the intervened group. Methods: a quasi-experimental study was carried out at "Marta Abreu" Teaching Polyclinic in Santa Clara, Villa Clara from January 2017 to February 2019. Procedures, methods and techniques were used with the application of this therapeutic modality in a study group of 200 pre-retired people aged 55 to 65 years old. Theoretical, empirical, statistical and mathematical methods were used. Psychological techniques were applied before and after the inclusive psychological treatment in the study and control groups. Results: they very revealing in the study group, and very significant changes were registered in intellectual processes as well as in verbal-logical, practical-constructive and ruminative thinking; also low anxious and mild depressive emotional states, high self-esteem, and notable improvement in vulnerability to stress. No favorable changes were reflected in the control group. Conclusions: the inclusive psychological treatment was effective in achieving positive changes in the cognitive, emotional and behavioural state in pre-retired people from the study group. The application of physiological deactivation, cognitive, experiential, reflective, and informative strategies, as well as coping behavioural skills, maintenance and generalization actions and palliative and moderating stress aids in the care of pre-retired people constituted a novel therapeutic resource.

Application of digital therapeutics in pediatric neurorehabilitation / 国际儿科学杂志

The booming development of modern digital technology, such as IOT(internet of things), big data, artificial intelligence, has given birth to the emerging industry of digital therapeutics(DTx).Compared with the limitations of traditional therapy, the preponderance of DTx makes it a new treatment strategy for neuropsychiatric disorders in children.The digital therapeutics alliance(DTA) defines DTx and sets out the core principles for DTx products.DTx has tremendous potential value for users, providers, payors and enterprises.DTx has extensive indications.At present, DTx is mainly suitable for rehabilitation of attention deficit and hyperactivity disorder(ADHD), autism spectrum disorder(ASD), cognitive impairment, epilepsy and dysopia in the field of children′s neurorehabilitation.Enormous advantages and value are the primary internal factors for the emergence and rapid expansion of DTx, but the maturity of DTx will face many challenges.In coming days, it is believed that under the promotion of many external forces, the DTx industry will grasp the opportunities to win the challenges and provide a new driving force for the development of neurological rehabilitation of children.

Survey on the views of general practitioners on developing special interests in the context of county medical community / 中华全科医师杂志

Objective:To explore the views of general practitioners (GPs) on developing special interests in the context of the county medical community.Methods:A survey was conducted using self-designed questionnaire from November and December 2019, among 49 general practice residents trained in the First Affiliated Hospital of Zhejiang University School of Medicine. Meanwhile, structured interviews were undertaken with 14 general practice residents.Results:Forty-nine valid questionnaires were collected with a response rate of 100.0%. All participants were from the county medical community units. The survey showed that 91.8% (45/49) of respondents were willing to develop special interests and 79.6% (39/45) chose one subject, and the top three subjects were endocrinology, gastroenterology and cardiology. The structured interviews demonstrated that most participants did not understand meaning of general practitioners with special interests (GPwSIs) clearly and were unable to distinguish GPwSIs from specialists; they were confused about the status, training mode, and assessment standards of GPwSIs. The interviews also showed that the demand for developing special interests for them was derived from the needs of patients for diagnosis and treatment, the target population of health care services, peer advice and personal interests.Conclusions:Most general practice residents are willing to develop special interests, and internal medicine is the first choice; however, their understanding of the GPwSIs is insufficient. The survey suggests that the position, training model, assessment and certification of GPwSI need to be further clarified.

Construction on the integrated management information platform of urban medical alliances and county medical communities in Hainan province / 中华医院管理杂志

In order to achieve the goal of integration, homogeneity, a net and a center of medical groups in Hainan province, Hainan province built an integrated management information platform of urban medical alliances and county medical communities based on projects such as the provincial three medical linkage information platform in February 2022. The overall architecture of the medical alliance and medical community platform was divided into system integration layer, data center layer, service layer and application layer. The service layer included four major systems: unified operation management platform, business center, performance evaluation management platform and comprehensive supervision subsystem, which was the core hub connecting the data center layer and application layer, and also was the unified operation and closed-loop management platform of the medical alliance and medical community. As of November 2022, the platform had covered 31 medical alliances or medical communities in 19 cities and counties of Hainan province, achieving information exchange, personnel interaction, resource sharing, business collaboration, and data integration among member units, narrowing the gap between urban and rural medical and health services, which had preliminarily achieved homogeneous management of the medical alliances and medical communities throughout the province, for a reference for the integrated management of medical alliances and medical communities within the regional scope of China.

Work Progress and Outlook of Rare Skin Diseases Team / 罕见病研究

There are many kinds of rare skin diseases, but the research into the diagnosis and treatment of rare skin diseases is relatively scarce. In recent years, the rare skin diseases team has made a series of accomplishments, including establishing the professional committee of Rare Skin Disease Committee of China Alliance for Rare Diseases, establishing China's first Medical Care Alliance for Rare Skin Diseases, launching two national collaborative projects, promoting the project of improving the diagnosis and treatment of rare diseases supported by the Central Special Lottery public welfare Fund, exploring the multidisciplinary diagnosis and treatment model of skin rare diseases, holding academic conferences, and compiling professional books on rare skin diseases. In the future, we will further improve the remote consultation model of rare skin diseases, develop artificial intelligence assisted diagnosis system of rare skin diseases, carry out high-quality clinical research, and improve the overall diagnosis and treatment level of rare skin diseases in China, for the sake of benefiting more patients.

Practice of a three-stage standardized pattern for pediatric diagnosis and treatment ability training for primary doctors / 中华医学教育探索杂志

The shortage of pediatric resources and inadequate diagnosis and treatment capacity in primary hospitals are key problems for implementing hierarchic care system of children's diseases. To solve this difficulty, Zhejiang province has constructed a three-stage standardized pattern for pediatric diagnosis and treatment ability training for primary doctors, which integrates training promotion, continuing education and practice output. Training promotion includes the training courses, theoretical examination, and the certification of Zhejiang Pediatric Alliance. Continuing education includes mobile teaching resource library and online regular Q&A. Practical output includes graded diagnosis and treatment of children's diseases and public lectures. From 2018 to 2021, a total of 1 418 trainees participated in 7 training sessions, 327 of whom passed the examination. Finally, 53 participants completed the certification of Zhejiang Pediatric Alliance and were included in the hierarchical diagnosis and treatment system for children in Zhejiang Province, expanding the coverage of hierarchical diagnosis and treatment from 32 institutions in 24 districts to 73 medical institutions in 38 districts. Members of the alliance completed 40 public lectures, with a total audience of 13 233. The three-stage standardized pattern continuously improves the comprehensive ability of primary doctors by means of multi-forms, standardization and continuity. We hope our experience can provide a reference for the training of primary doctors and the construction of hierarchical diagnosis and treatment system in various regions.

Analysis on the Current Situation,Influencing Factors and Strategies of Data Sharing in Cross-regional Specialty Medical Alliances / 医学信息学杂志

Purpose/Significance To clarify the construction mode and key factors of data sharing in Chinese medical alliances,and to provide references for promoting data sharing in medical alliances.Method/Process Taking children's medical alliance of Yangtze River Delta as an example,Delphi method and qualitative interview method are used to explore the key contents and effect evaluation of specialty alliance construction,and the key factors of specialty alliance data sharing are defined based on the technology-organization-environment framework;SWOT analysis model is used to propose development strategies.Result/Conclusion Member hospitals are less satisfied with the construction effect of information interconnection.Key factors for realizing data sharing in specialty alliances include:support from government administrative departments,uniform and systematic compatibility of information standards,information security emergency response,patient privacy protection and informed consent,willingness of department directors to share,and internal communi-cation and compensation mechanism of alliances.

Development dilemmas and countermeasures of the cross regional loose medical alliances in the Yangtze River Delta / 中华医院管理杂志

The cross regional loose medical alliance is an important carrier in the current integrated development process of medical services in the Yangtze River Delta region. Smith policy implementation process model was used to analyze the development difficulties of cross regional loose medical alliances from idealized policies, policy implementation institutions, policy target groups, and policy implementation environment. Such medical alliances were formed under the background of integrated development in the Yangtze River Delta, with Shanghai′s tertiary public hospitals as leading units and medical institutions in Jiangsu, Zhejiang, and Anhui provinces as member units. Analysis showed that the policies for such medical alliances development had not yet clearly defined the organizational management mode, operational mechanism, and implementation path, and the corporate governance structure of medical alliance was immature; The policy implementation agencies were relatively lagging behind in the support of special funds and the formulation of related supporting policies; Participation of policy target groups was insufficient and their incentive mechanisms was imperfect; There were problems in the policy implementation environment, namely inconsistent medical and health service regulations and systems in different regions, different health financing capabilities of local governments, insufficient coordination of medical institution management concepts, and a lack of unified standards in information systems. Based on the above difficulties, this study proposed to strengthen the development planning and layout of cross regional loose medical alliances, and improve the corporate governance structure; To strengthen the government′s main responsibility and improving policy implementation capabilities; To improve the internal cooperation and operation mechanism of cross regional loose medical alliances, and enhance the sense of identity of the target group; To optimize the policy implementation environment and implement various support measures, so as to provide references for further promoting the coordinated development of high-quality medical resources in the Yangtze River Delta region.

Narrative Review of Feedback -From Definition to Recent Discussion- / 医学教育

Feedback is an educational activity that occurs in a variety of settings in medical education and has been widely discussed since 2008, when Ridder et al. defined it as "Specific information about the comparison between a trainee's observed performance and a standard, given with the intent to improve the trainee's performance." (Ridder et al., 2008, p.3). Since then, discussions on effective feedback have shifted from a behaviorist, instructor-centered approach to a more multifaceted approach that focuses on relationship and the learner as recipient of feedback, or the learner's potential ability to make use of feedback (self-regulated learning, feedback literacy).