OBJECTIVE To analyze the deep-seated impeding factors in the implementation process of the policy integrating retail pharmacies into the outpatient pooling system， and explore practical paths to improve policy implementation efficiency. METHODS Based on Smith’s policy implementation process model， an analytical framework was constructed. Selecting Hunan province as a typical sample， this study combined policy text analysis and semi-structured interviews to conduct an in-depth interpretation of relevant policy documents and interviewed a total of 42 key stakeholders from multiple parties， including medical insurance administrative departments， designated medical institutions， retail pharmacies， and insured persons， and the interview texts were analyzed. RESULTS & CONCLUSIONS The study indicated that the effective implementation of this policy faces four dimensions of impediments： first， the policy itself suffered from systemic design problems and insufficient coordination， leading to source-based constraints； second， there was a lack of effective synergy mechanisms among implementing agencies， resulting in fragmented service and supervision capabilities， and their behaviors were distorted by interest-driven motives； third， there were cognitive biases regarding the policy among the target group， and their behaviors were distorted by interest-driven motives； fourth， environmental factors such as pressure on medical insurance funds and traditional medical-seeking concepts overlapped to restrict the space for policy implementation. Therefore， the following optimization strategies are proposed： strengthening top-level design to eliminate rule ambiguity and implementation deviation； improving multi-party synergy mechanisms to enhance policy operational efficiency； deepening policy interpretation and interest coordination to guide rational behavior among the target group； and breaking environmental barriers to build an external ecosystem adaptable to policy development， thereby promoting the high quality development of incorporating retail pharmacies into the outpatient pooling system.

Objective To compare the clinical application of FACS analysis indicators and traditional infection indicators in early diagnosis of infection in premature infants .Methods 60 premature infants were divided into the infected group (n=29) and non-in-fected group(n=31) according to their clinical symptoms and laboratory results .BD FACSCanto Flow Cytometry was employed to detect CD11b ,CD64 and CD45RO ,BACTEC 9120 Automated Blood Culture System was used to conduct body fluids and secretions culture .Sysmex XE-5000 Automated Hematology Analyzers and i-CHROMA Reader Immunofluorescence Analyzer were adopted to conduct the complete blood count test and hypersensitive C-reactive protein (hs-CRP) detection ,respectively .Receiver operator characteristic(ROC) curve was used to analyze the diagnostic value of indexes above in preterm infants with infection ,and their sen-sitivity ,specificity ,positive predictive value and negative predictive value were calculated .Results On the first day after birth ,neu-trophil CD11b ,CD64 ,monocyte CD64 and hs-CRP levels of preterm infants in infection group were obviously higher than those in non-infection group(P<0 .05) .Differences of CD45RO ,WBC ,neutrophil absolute and percentage between the two groups showed no statistical significance(P>0 .05) .ROC area under the curve(AUC)>0 .7 was found in Neutrophil CD64 ,monocyte CD64 and hs-CRP ,which had higher value in early diagnosis of infection in premature infants .The highest sensitivity ,specificity ,positive pre-dictive value and negative predictive value were 79 .31% ,96 .78% ,83 .34% and 75 .00% ,respectively .Conclusion FACS analysis indicators has better clinical value in the early diagnosis of infection in premature infants .

Objective To explore the value of the 64-slice spiral CT angiography(SCTA)in diagnosis of aortic disease.Methods 32 cases with aortic diseases confirmed by operation underwent 64-slice spiral CT enhanced scan,raw data were dealed with multiplanar reformation(MPR),curved plannar reformation(CPR),maximum intensity projection(MIP),volume rendering(VR)and advantage vessel analysis(AVA).Results The aortic disease in 32 cases included aortic dissection in 16 cases,pseudoaneurysm in 7 cases,true aneurysm in 4 cases,narrowing of the aortic arch in 3 cases and amputation of aortic arch in 2 cases.The endometrial break and mural thrombus better showed with MPR and the detecting rat of intimal flake and the initial break was 81%(13/16),while for the periphery thrombosis in 7 cases with pseudoaneurysm,the detecting rate was 100%(7/7).The showing rate for displaying the whole with CR was 100%(32/32).In showing calcification and accurate of vessels with MIP,the detecting rate was 84%(27/32).The showing rate of the extent of the disease and the relationship between peripheral vascular was 100%(32/32).AVA was of significance in the measurement of vascular diameter and vascular cross-sectional area,the showing rate was 44%(14/32).Conclusion 64-slice spiral CT angiography is of significance in diagnosing aortic diseases.