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.

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.

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)

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)

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.

A linha tênue entre a promoção da saúde e a reprodução de discursos gordofóbicos pelos médicos / The fine line between health promotion and the reproduction of fatphobic speech by doctors

Resumo: Introdução: O controle do peso corporal é fundamental para o tratamento e a prevenção das principais comorbidades no mundo, tais como hipertensão, dislipidemia e obesidade. Entretanto, as orientações médicas referentes à perda de peso, muitas vezes, não são baseadas em evidências ou comunicadas de maneira clara, e também não consideram as condições psicológicas e sociais dos pacientes, como ditam os valores da promoção da saúde, mas são abordadas de maneira preconceituosa e rasa. Este estudo busca responder à seguinte questão: "A maneira como os médicos lidam com a obesidade dos seus pacientes é uma forma de promover saúde ou de propagar ainda mais desfechos clínicos desfavoráveis nessa população?". Objetivo: Este estudo teve como objetivo revisar a literatura no que concerne à gordofobia médica e aos seus impactos para o paciente. Método: Trata-se de uma revisão de literatura integrativa, realizada em janeiro de 2022. A busca de dados se deu a partir do ano de 2007 até janeiro de 2022. Usaram-se as seguintes bases de dados: SciELO, Lilacs e PubMed. Utilizaram-se, na busca de artigos, os seguintes descritores: obesity, overweight, social stigma, social discrimination, bullying, fatphobia, weight bias, medication adherence, therapeutic alliance, health professionals, binge-eating disorder. Resultado: Os 16 artigos selecionados foram classificados segundo tipo de estudo, ano, local, público-alvo e resultados, e, em seguida, analisados de maneira crítica. Conclusão: Embora seja crucial os médicos alertarem seus pacientes sobre perda de peso, essas orientações, quando feitas de maneira preconceituosa, grosseira e sem metas bem definidas, fazem com que o paciente se desinteresse em cuidar da própria saúde ou ainda procure perder peso sem apoio profissional. Logo, em vez de combater a obesidade, o atual manejo é responsável por agravá-la e, inclusive, desenvolver outras comorbidades, como a depressão.

Abstract: Introduction: Body weight control is essential for the treatment and prevention of the main comorbidities in the world, such as hypertension, dyslipidemia and obesity. However, medical guidelines regarding weight loss are often not evidence-based or clearly communicated, and they also do not take into account the psychological and social conditions of patients, as dictated by the values of health promotion, but rather, approached in a prejudiced and shallow way. This study seeks to answer the following question: Is the manner physicians deal with their patients' obesity a way of promoting health or of propagating even more unfavorable clinical outcomes in this population? Objective: This study aimed to review the literature regarding medical fatphobia and its impacts on the patient. Method: This is an integrative literature review, carried out in January 2022. The data search took place from the year 2007 to January 2022. The following databases were used: SciELO, Lilacs and PubMed. The following descriptors were used in the search for articles: Obesity, Overweight, Social Stigma, Social Discrimination, Bullying, Fatphobia, Weight Bias, Medication Adherence, Therapeutic Alliance, Health Professionals, Binge-Eating Disorder. Result: The 16 selected articles were classified according to type of study, year, place, target audience and results, and then critically analyzed. Conclusion: Although it is crucial for doctors to warn their patients about weight loss, these guidelines, when made in a prejudiced, rude way and without well-defined goals, make them not interested in taking care of their own health, or even trying to lose weight without professional support. Therefore, instead of fighting obesity, its current management is responsible for aggravating it and even developing other comorbidities, such as depression.

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.

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.

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.

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).

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.

Food Trade for Specific Health Use FOSHU through Patents in LATAM: Relevant Aspects in International Law / Comercio de Alimentos para Uso Específico de Salud FOSHU a través de Patentes en LATAM: Aspectos Relevantes en el Derecho Internacional

Introduction: This article addresses the legal regulations for Foods for Specified Health Uses (FOSHU) in the main trade associations of Latin America (LATAM), based on the Codex Alimentarius system. Objective: The objective is to determine regulatory progress in the trade of FOSHU products. Material and methods: This study includes a review of the literature emanating from the databases from 2018 to 2022, according to the framework of three general food marketing regulations: food safety claims; inspection regulations, and food manufacturing and labeling. Results: The results reveal the absence of a specific legislation for FOSHU foods, as these are only mentioned in the area of nutrition. Conclusions: The legal framework in the trade of these products is based on jus cogens. Registration of industrial patents in the main member countries of LATAM trade associations can be facilitated through the Patent Prosecution Highway (PPH)(AU)

Introducción: El artículo aborda las regulaciones jurídicas en Alimentos para Uso Específico de Salud "FOSHU" en las principales asociaciones comerciales de América Latina (LATAM), basados en el sistema Codex Alimentarius. Objetivo: Determinar el avance regulatorio en la comercialización de productos FOSHU. Materiales y métodos: Se revisa la literatura emanada de las bases de datos desde el año 2018 al 2022, según el marco de tres regulaciones generales de comercialización de alimentos: las declaraciones de seguridad alimentaria; las regulaciones de inspecciones, las de manufacturas de alimentos y etiquetado. Resultados: Los resultados revelaron la ausencia de una legislación específica para alimentos FOSHU, siendo solo mencionados en el área de la nutrición. Conclusiones: El revestimiento jurídico en la comercialización de estos productos; se cimienta en el ius cogens. Las inscripciones de patentes industriales en los principales países miembros de las asociaciones comerciales en LATAM pueden facilitarse por la vía del Patent Prosecution Highway (PPH)(AU)

ICT and the Trading Negotiation for International Sale Contracts in the Pacific Alliance Firms / Las TIC y la Negociación de Contratos de Compraventa Internacional en las Empresas de la Alianza del Pacífico / TIC e a Negociação Comercial para Contratos de Venda Internacional nas Firmas da Aliança do Pacífico

Abstract Introduction. Information and communication technologies (ICT) have changed the way firms conduct their international business transactions, as small, medium and large companies are increasingly adopting these tools in order to improve productivity in operational processes, including the internationalization of goods and services. Objective. This paper aims to identify the ICT most commonly used in the international trade negotiation process for the achievement of import and export contracts in Pacific Alliance firms. Methodology. A survey was conducted among 401 internationalized firms in this regional trade bloc formed by Chile, Colombia, Mexico, and Peru. A descriptive analysis was also applied to present the results of the study, highlighting the ICT most used in international trade negotiations and, likewise, an ordered logistic regression was applied to explain both the level of importance given to ICT in the negotiation process and the frequency of use within this trade agreement. Results The research reveals that ICT are essential for each phase of the international negotiation, especially in the preparation phase. Conclusion. The use of specialized ICT, such as e-procurement, ERP, CRM, NSS and scenario building software, increases as the size of companies also increases.

Resumen Introducción. Las tecnologías de la información y la comunicación (TIC) han cambiado la forma en que las empresas llevan a cabo sus transacciones comerciales internacionales, ya que las pequeñas, medianas y grandes empresas están adoptando cada vez más estas herramientas con el fin de mejorar la productividad en los procesos operativos, incluida la internacionalización comercial e industrial. Objetivo. Este artículo tiene como objetivo identificar las TIC más utilizadas en el proceso de negociación comercial internacional para la consecución de contratos de importación y exportación en las empresas de la Alianza del Pacífico. Metodología. Se realizó una encuesta en 401 empresas internacionalizadas en este bloque comercial regional conformado por Chile, Colombia, México y Perú. Asimismo, se aplica un análisis descriptivo para presentar los resultados del estudio destacando las TIC más utilizadas dentro de la negociación comercial internacional y, del mismo modo, se aplica una regresión logística ordenada para explicar tanto el nivel de importancia que se le da a las TIC en el proceso de negociación como la frecuencia de uso dentro de este acuerdo comercial. Resultados. La investigación también revela que las TIC son esenciales para cada fase de la negociación internacional, especialmente en la fase de preparación. Conclusión. El uso de las TIC especializadas, como la contratación electrónica, el ERP, el CRM, el NSS y el software de creación de escenarios, aumenta a medida que aumenta también el tamaño de las empresas.

Resumo Introdução. As tecnologias de informação e comunicação (TIC) mudaram a maneira como as empresas realizam transações comerciais internacionais, já que as pequenas, médias e grandes empresas estão adotando cada vez mais essas ferramentas a fim de melhorar a produtividade nos processos operacionais, incluindo a internacionalização comercial e industrial. Objetivo. Este artigo visa identificar as TIC mais utilizadas no processo de negociação comercial internacional para a obtenção de contratos de importação e exportação em empresas da Pacific Alliance. Metodologia. Foi realizada uma pesquisa entre 401 empresas internacionalizadas neste bloco comercial regional formado pelo Chile, Colômbia, México e Peru. Uma análise descritiva também foi aplicada para apresentar os resultados do estudo, destacando as TIC mais utilizadas nas negociações comerciais internacionais, e uma regressão logística ordenada foi aplicada para explicar tanto o nível de importância dado às TIC no processo de negociação quanto a frequência de uso dentro deste acordo comercial. Resultados. A pesquisa também revela que as TIC são essenciais para cada fase da negociação internacional, especialmente na fase de preparação. Conclusão. O uso de TIC especializadas, tais como e-procurement, ERP, CRM, NSS e software de construção de cenários, aumenta conforme aumenta o tamanho das empresas.

Practice and exploration of the " 1+ 6+ N" medical alliance cooperation system of a hospital in Xinjiang / 中华医院管理杂志

Medical alliances constitute a vertical integration of regional medical resources, and an effective means to promote the tiered medical services. As one of the largest tertiary hospitals in Xinjiang, a hospital has gradually built a " 1+ 6+ N" medical alliance cooperative system fitting the geographical characteristics of Xinjiang since 2018. The system was based on the hospital, made county-level medical institutions as the hub, primary medical and health units as the focus, and telemedicine as the bridge. It turned a telemedicine service platform as the medium, integrating such service segments, as offline practices of experts like clinical teaching, ward rounds, surgical guidance and discipline construction, and as online practices like remote consultation, remote diagnosis, remote education, and remote new technology training among others. Then these segments were integrated into such cooperative models as the remote cooperative medical alliances, specialist-cooperative medical alliances, inter-department co-construction medical alliances, precision-based assistance medical alliances, urban medical group type of medical alliances, and " alliance-consortium" integrated development medical alliances. These practices enabled the expansion and primary support of high-quality medical resources. By June 2022, the hospital had established cooperation via medical alliances with 285 medical institutions at all levels. The implementation of this cooperation mechanism has effectively improved the medical service capacity, diagnosis and treatment capacity of difficult and critical diseases, diagnosis and treatment homogeneity and remote diagnosis capacity in the region, as well as the smooth and orderly progress of the tiered medical services and two-way referrals within a medical alliance.

Practice of a hemodialysis alliance in the context of closed-loop hospital management / 中华医院管理杂志

Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.

Research on the doctors′ willingness of working at primary institutions and the economic incentive effect from the perspective of mental account / 中华医院管理杂志

Objective:To understand the incentive effect and influencing factors of the current economic incentive policy for medical alliances in Longhua District of Shenzhen(the alliance for short) on doctors′ willingness to work at primary medical institutions(the primary for short) from the perspective of mental account, and to explore the economic incentive effect of different economic incentive distribution methods on doctors′ willingness to work at the primary.Methods:The questionnaire was designed based on mental account theory. Random sampling was made in November 2019 for a questionnaire survey among doctors in two district-level medical institutions of the alliance in Longhua District of Shenzhen. The purpose was to analyze their inclination to work at the primary and their selection preferences for economic incentive distribution methods under the current economic incentive policy. The data were analyzed by descriptive analysis, and the influencing factors of doctors′ willingness to work at the primary were analyzed by χ2 test and binary logistic regression. Results:A total of 254 valid questionnaires were collected with an effective recovery rate of 90.7%. Among the respondents, 189(74.4%) were willing to work at the primary, 168(66.1%) chose to receive the economic incentives specifically for working at the primary, and 148 people(58.3%) hoped to receive such economic incentives immediately. Education background, self-rated economic income level of doctors and different payment methods of economic incentive for working at the primary had significant effects on their willingness to work at the primary( P<0.05). Conclusions:The current economic incentive policy of the alliance can meet the demands for economic incentives in terms of doctors′ material accounts, and doctors′ overall inclination to work at the primary was strong. If the amount of economic incentives is constant, doctors preferred to receive the economic incentives specifically, mainly affected by income accounts and additional income accounts. In addition, education and self-assessment of economic income level were important factors affecting the willingness of doctors to work at the primary, which may be affected by mental accounts other than material accounts.

Research on the willingness of county-level hospital physicians to participate in county-township human resource integration for medical institutions / 中华医院管理杂志

Objective:To study the willingness of county-level hospital physicians within a county medical alliance(alliance)to participate in county-township human resource integration for medical institutions, for furthering the development of such integration.Methods:Based on a discrete selection experiment, a questionnaire was designed for the selection of the work attributes that affect the participation of county-level hospital physicians in such an integration. On-the-job physicians from four county-level hospitals in a prefecture level city were selected by multi-stage stratified random sampling method as the survey objects, and a field questionnaire survey was conducted from November to December 2021. The mixed logit model was used to analyze the preference of physicians in county-level hospitals for five types of work attributes(work unit, monthly income, seniority required for professional title promotion, training opportunities, serving as middle-level and above administrators), the relative importance of each work attribute, and marginal willingness to pay with regard to their participation in the integration.Results:A total of 172 valid questionnaires were collected. When county-level hospital physicians participate in county-township human resource integration for medical institutions, their statistically significant job attributes and level preferences included monthly income, working unit of county-level hospitals, 7 years for professional title promotion, and more training opportunities ( P<0.001). The relative importance of monthly income ranked the highest among the five categories of work attributes, up to 55.55%. Conclusions:When physicians in county-level hospitals participate in the integration of county-township human resources, the most important was their monthly income, and economic incentives could enhance their willingness to participate.

Construction and practice of medical alliance referral system based on blockchain / 中华医院管理杂志

Hierarchical diagnosis and treatment system is an important measure to rationally allocate medical resources and promote the homogenization of basic medical services. The medical alliance is an important service mode and service system of hierarchical diagnosis and treatment, whose role is to perfect the up-down linkage and meet the patient′s medical needs. Informatization construction is an important starting point to promote the services of the medical alliance. In order to solve the problem of connectivity, the medical alliance needs to establish a regional referral platform and realize the integrated service of all medical institutions. Renji Hospital, Shanghai Jiaotong University School of Medicine, has built a blockchain based referral system for hierarchical diagnosis and treatment, incorporating the S2B2C mode concept, and using the traceability, tamper proof and distributed accounting features of blockchain technology, realized independent storage of data in hospitals, realized real-time information sharing and interconnection, and provided a feasible solution for medical alliance management.

Practice and enlightenment of the construction of multi-agent collaborative loose medical alliance under the background of Yangtze River Delta integration / 中华医院管理杂志

Health service is an important part of the integrated development of the Yangtze River Delta. Taking the cooperation practice between Shanghai Tenth People′s Hospital and Suzhou Yinshanhu Hospital as an example, this article introduced the multi-agent cooperation mode of the loose medical alliance including the government, urban hospitals and cross provincial grassroots medical institutions. Among them, the local government provided policy, fund guarantee and guidance, the urban hospital exported management ideas, medicine talents and technologies, and the primary hospital conducted dual training by inviting in and going out to achieve double growth. Through the high gap cooperation between tertiary hospital and primary hospital, Yinshanhu hospital had been comprehensively developed. The loose medical alliance with multi subject coordination and cross region could give full play to the advantages of the loose healthcare alliance mode, achieve multi-win, and have reference significance for promoting the regional integration of medical and health services in the Yangtze River Delta.

Practice of the construction of urban medical alliance in Huzhou city / 中华医院管理杂志

Promoting balanced distribution of medical resources and realizing high-quality sharing of basic medical services between urban and rural areas are an important part of common prosperity. Huzhou urban medical alliance was a new urban and rural of medical alliance mode based on level 4 vertical integration, which played an important role in the whole evolution process of the medical alliance. This medical alliance had not only broken through the " integration of counties" but also explored the " integration of cities" . It was a bridge connecting counties and cities, which was of great significance in narrowing the gap between urban and rural medical health services. The construction of urban medical alliance took digital transformation and systematic integration as two breakthroughs to comprehensively promote the upgrade of energy efficiency and benefit stacking of health governance. In 2021, the grass-roots medical utilization rate and county-level medical utilization rate were 72.7% and 90.6%. In 2020, the average hospitalization cost(8 726.7 yuan)and the average outpatient and emergency expenses(239.6 yuan)of public hospitals were 25.0% and 8.6% lower than the average level of Zhejiang Province, respectively. Although Huzhou city had broken through the restrictions of administrative divisions and actively promoted the construction of the medical alliance, and achieved phased results, there were still structural defects and institutional difficulties. In order to solve these problems, the author proposed to promote the improvement of governance structure and optimization of governance system through " three governance" and " three characteristics" , and then promote the high-quality development of urban medical alliances.