Based on 490 national-level policy documents directly related to hospital construction and development issued since the founding of the People's Republic of China,it divides the evolution of hospital construction and development into four stages:the foundational period,it the exploratory period of the healthcare reform,the acceleration period of the new healthcare reform,and the critical period of deepening medical reform.Applying on policy feedback theory,it analyzes the internal logic underlying the evolution of hospital construction and development in China.The findings reveal that past policies influence future policy-making through four mechanisms:interpretive,resource,evolutionary and learning effects.It suggests that policy optimization should integrate a historical perspective into the policy process to advance the modernization of hospital governance systems and capacities at the public policy level.

Objective To develop measurement instruments of dynamic capabilities for public hospitals,providing a reference for the evaluation and enhancement of their dynamic capabilities.Methods The initial construction of the measurement instruments of dynamic capabilities for public hospitals was based on literature review and focused group discussions.Two rounds of expert consultation were conducted using the Delphi method,and the reliability and validity of the questionnaire was initially examined through pre-survey.Results The effective response rates for both rounds of consultation were above 85％,with high positive coefficient,the authority coefficients greater than 0.8,and variation coefficients less than 0.25,indicating a high level of consensus among experts.Furthermore,the reliability and validity are acceptable.After integrating expert feedback,the measurement instruments of dynamic capabilities for public hospitals were finalized,encompassing four dimensions:sensing,learning,integration capability,and innovation capabilities.Conclusion The measurement instruments of dynamic capabilities for public hospitals,developed based on the Delphi method,can be applied in the practice of evaluating and enhancing the dynamic capabilities of public hospitals.

Objective To develop measurement instruments of dynamic capabilities for public hospitals,providing a reference for the evaluation and enhancement of their dynamic capabilities.Methods The initial construction of the measurement instruments of dynamic capabilities for public hospitals was based on literature review and focused group discussions.Two rounds of expert consultation were conducted using the Delphi method,and the reliability and validity of the questionnaire was initially examined through pre-survey.Results The effective response rates for both rounds of consultation were above 85％,with high positive coefficient,the authority coefficients greater than 0.8,and variation coefficients less than 0.25,indicating a high level of consensus among experts.Furthermore,the reliability and validity are acceptable.After integrating expert feedback,the measurement instruments of dynamic capabilities for public hospitals were finalized,encompassing four dimensions:sensing,learning,integration capability,and innovation capabilities.Conclusion The measurement instruments of dynamic capabilities for public hospitals,developed based on the Delphi method,can be applied in the practice of evaluating and enhancing the dynamic capabilities of public hospitals.

Based on 490 national-level policy documents directly related to hospital construction and development issued since the founding of the People's Republic of China,it divides the evolution of hospital construction and development into four stages:the foundational period,it the exploratory period of the healthcare reform,the acceleration period of the new healthcare reform,and the critical period of deepening medical reform.Applying on policy feedback theory,it analyzes the internal logic underlying the evolution of hospital construction and development in China.The findings reveal that past policies influence future policy-making through four mechanisms:interpretive,resource,evolutionary and learning effects.It suggests that policy optimization should integrate a historical perspective into the policy process to advance the modernization of hospital governance systems and capacities at the public policy level.

Objective:To explore the influencing factors and pathways of social responsibility of public hospitals, and to provide a reference for public hospitals in China to further improve the social responsibility level.Methods:From 2019 to 2020, 22 tertiary public hospitals in a region were selected as study cases. The social responsibility score was used as the outcome variable, social benefit, appropriateness, quality, and efficiency were used as the conditional variables, and the qualitative comparative analysis was applied to investigate the combination of conditions affecting social responsibility evaluation of public hospitals.Results:The consistency of the social benefit, appropriateness, and quality was less than 0.9 and greater than 0.8, indicating that they were sufficient and non-necessary conditions for high social responsibility of public hospitals. The consistency of efficiency was 0.747, indicating that it was neither sufficient nor necessary condition. The configuration analysis showed that there were three paths for public hospitals to achieve high social responsibility: co-driven social benefit and appropriateness with high quality assistance, co-driven social benefit and efficiency with high quality assistance, and co-driven appropriateness and efficiency, with a coverage rate of 92.6%.Conclusions:Social benefit, appropriateness, quality, and efficiency can be combined in different ways to achieve high social responsibility in public hospitals. Public hospitals could develop targeted social responsibility improvement strategies according to the actual situation, and strengthen the synergy between the elements to improve the level of social responsibility in hospitals.

Multiple primary malignancies (MPMs) are two or more primary malignancies diagnosed in the same patient at the same time or at a specific time and do not represent progression, recurrence or metastasis of the first tumor.MPMs are extremely rare. In this paper, we reported a case of male patient who was diagnosed with invasive uroepithelial carcinoma, rectal adenocarcinoma, clear cell renal cell carcinoma and sarcomatoid carcinoma of the bladder, and open partial cystectomy, laparoscopic radical operation for rectal cancer, laparoscopic partial left nephrectomy, transurethral resection of bladder tumor and laparoscopic radical cystectomy with ureterostomy were performed, respectively.The patient was followed up for 16 months after the last surgery, with good general condition and no recurrence or metastasis.

Rheumatic diseases, a typical kind of autoimmune disease, are often treated with glucocorticoids, immunosuppressants, biological agents, and small-molecule targeted drugs, which often leads to immune dysfunction in patients and increases the risk of activation of latent tuberculosis infection. To regulate the screening, diagnosis, and prophylactic treatment of latent tuberculosis infection in patients with rheumatic diseases, reduce the risk of developing active tuberculosis and improve the prognosis, Peking University Shenzhen Hospital, Shenzhen Third People′s Hospital and Peking Union Medical College Hospital jointly organized domestic experts in the field of rheumatology and tuberculosis to establish the expert consensus on the diagnosis and treatment of latent tuberculosis infection in patients with rheumatic diseases. This consensus focuses on epidemiology, the importance of screening, screening methods, and prophylactic anti-tuberculosis treatment strategies for latent tuberculosis infection combined with rheumatic diseases.

Objective : To investigate the influencing factors of the diffusion and utilization of technology for liver cancer screening among clinicians based on the technology acceptance model. Methods : A multi⁃stage sampling method was applied to select the respondents. The des⁃γ⁃carboxy prothrombin ( DCP) detection technology was taken as an example to conduct a structured questionnaire survey , and structural equation modeling was used for data analysis. Results: Perceived ease of use positively affected perceived usefulness (β = 0. 899 , P < 0. 001) and usage attitude (β = 0. 223 , P < 0. 05) ; perceived usefulness positively affected usage attitude (β = 0. 652 , P <0. 001) and behavioral intentions (β = 0. 413 , P < 0. 001) ; usage attitude positively affected behavioral intentions (β = 0. 511 , P < 0. 001) ; behavioral intention positively affected the behavior of using DCP ( β = 0. 237 , P < 0. 01) . There was a partial mediating effect between perceived ease of use and usage attitude , and a partial mediating effect between perceived usefulness and behavioral intention. Conclusion Usage attitudes are important factors influencing the diffusion of DCP detection technologies , and usage attitudes are determined by both perceived usefulness and perceived ease of use. It is recommended that technology manufacture and utilization organizations should focus on technology performance , allocate technical advisers for promoting new technologies , and reduce barriers to their use.

Objective:Based on the technology-organization-environment model and the theory of planned behavior, to construct a theoretical model for exploring the influencing factors of the adoption intention of hepatic contrast-enhanced ultrasound by clinicians in a medical alliance.Methods:By agency of self-administered scales, a questionnaire survey was conducted among the clinicians in liver disease-related departments of four medical alliances from Fujian and Jiangxi provinces between February and August, 2019.Results:Behavioral attitudes, subjective norms, perceived behavioral control, organizational atmosphere, and industry technical environment all had positive impacts on the clinicians′ intention to adopt hepatic contrast-enhanced ultrasound technology in medical alliances. The total influence of the five types of factors on the adoption intention of hepatic contrast-enhanced ultrasound was as follows: perceived behavioral control(0.779), subjective norms(0.635), industry technical environment(0.578), behavioral attitudes(0.359), and organizational atmosphere(0.218).Conclusions:It is recommended to strengthen the intention to adopt corresponding health technologies by providing adequate technical education and training, giving play to the leading role of core members, and building an organizational atmosphere of advocating technological innovation and communication.

Objective:To understand the function of diaphragm and analyze the clinical factors affecting the function of diaphragm by measuring twitch tracheal pressure (TwPtr) in patients with mechanical ventilation and in the weaning phase.Methods:Patients with more than 48 hours of invasive mechanical ventilation admitted to the department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from December 2015 to March 2017 were enrolled. After the patient entered the weaning stage, TwPtr of patients was monitored by two-way non repetitive automatic respiratory trigger device, the effects of duration of mechanical ventilation, severe pulmonary infection, sedative application and chronic obstructive pulmonary disease (COPD) on weaning were analyzed.Results:A total of 62 patients were included, of which 45 were male and 17 were female. The average age was (66.8±11.7) years old. Twenty-three cases had severe pneumonia. The absolute value of TwPtr in severe pneumonia group was lower than that in non-severe pneumonia group [cmH 2O (1 cmH 2O = 0.098 kPa): 10.40±5.81 vs. 14.35±5.22, P = 0.021]. However, there was no significant difference in the duration of mechanical ventilation between the severe pneumonia group and non-severe pneumonia group [days: 26 (17, 43) vs. 15 (11, 36), P = 0.091]. In 62 patients with mechanical ventilation, there was a negative correlation between TwPtr and duration of mechanical ventilation ( r = 0.414, P = 0.002), there was also a negative correlation between the duration of mechanical ventilation and TwPtr after the assessment of diaphragm function ( r = 0.277, P = 0.039). There was a linear relationship between TwPtr and sedatives ( r = 0.220, P = 0.040), but there was no correlation between TwPtr and COPD ( r = -0.178, P = 0.166). Conclusions:For patients in the weaning stage of mechanical ventilation, severe pulmonary infection is one of the factors that affect the diaphragm dysfunction. There is a certain correlation between the diaphragm dysfunction and the use of sedatives.