随着公立医院免陪照护试点推进，家属由床旁陪伴转为院外等待，信息不对称、分离焦虑及信任弱化等问题日益凸显。本文围绕国际免陪照护实践，梳理家属数字化参与从虚拟探视、信息共享到共同决策的演进路径，并总结住院门户、电子日记、代理访问等工具在维系家庭支持、提升照护透明度中的作用。在此基础上，提出我国应依托智慧病房构建医护患属闭环沟通机制，完善授权分级、隐私保护、数字公平与人文支持制度，推动免陪照护兼具效率与温度。

With the advancement of pilot programs for accompaniment-free care in public hospitals, family members have shifted from bedside companionship to waiting outside the ward, giving rise to increasingly prominent problems such as information asymmetry, separation anxiety and weakened trust. Focusing on international practices of accompaniment-free care, this paper reviews the evolutionary path of digital family participation from virtual visits and information sharing to shared decision-making, and summarizes the role of tools such as inpatient portals, electronic diaries and proxy access in maintaining family support and improving care transparency. On this basis, it proposes that hospitals in China should rely on smart ward construction to establish a closed-loop communication mechanism integrating healthcare professionals, patients and family members, and improve institutional arrangements for hierarchical authorization, privacy protection, digital equity and humanistic support, so as to promote accompaniment-free care that combines efficiency with warmth.

【摘要】 目的 评价基于智慧教室的PBL教学法在肾内科临床教学中的应用效果，并探讨该模式对提升临床科室带教同质化水平的潜在价值。方法 选取2023年9月—2024年10月在江苏大学附属医院肾内科轮转的临床医学专业学生及住院医师规范化培训学员共80名为研究对象，采用区组随机化方法分为实验组和对照组，每组40名。实验组在智慧教室环境中实施PBL教学，对照组采用传统讲授法。两组课堂学时完全一致（每周2次，每次2学时，共16学时），但实验组课前预习与课后拓展为自愿完成，未对课外学习时间进行量化记录。通过理论考核、临床技能评估、模拟临床演练评估及问卷调查评价教学效果。结果 Mini-CEX评估显示，实验组在临床判断（7.65±0.78 vs 6.82±0.85，P<0.001）和沟通技能（7.80±0.72 vs 6.95±0.88，P<0.001）维度改善最为明显，均从达标水平（4~6分）跨越至优秀水平（7~9分）；临床技能考核中腹膜透析置管术成绩实验组（45.82±1.45分）高于对照组（42.15±2.03分）（t=9.24，P<0.001，Cohen's d=2.08）。实验组理论考核成绩（89.45±3.12）分高于对照组（84.23±4.56）分（t=5.89，P<0.001, Cohen's d=1.32），临床技能考核成绩（45.82±1.45）分高于对照组（42.15±2.03）分（t=9.24, P<0.001, Cohen's d=2.08）。实验组在学习动机、课堂互动性和学习效率方面自评优于对照组（P<0.05），但团队合作能力培养两组差异无统计学意义（62.5% vs 52.5%, P=0.340）。结论 该联合模式能有效促进规培生临床核心胜任力的转化，可为临床科室高仿真技能带教提供实操路径。

医联体是分级诊疗制度建设的重要抓手,对“健康中国”战略目标的实现具有重要作用。在当前医疗改革背景下,探究医联体建设模式具有重要意义。文章介绍了广州市属A医院和区属B医院探索的非托管紧密型医联体实践举措、成效、创新与不足,总结了该模式对我国医联体建设的启示：一是政府层面要做好顶层设计,给与政策支持;二是网顶医院要下沉优质资源,因地制宜帮扶;三是成员单位要主动参与建设,抓住发展机遇。

The establishment of medical unions is a crucial step in the development of a hierarchical diagnosis and treatment system and plays a significant role in achieving the strategic goal of “Healthy China．”Given the current context of healthcare reform,it is highly important to explore effective models for constructing medical unions．This paper introduces the practical measures taken by Guangzhou Hospital A and Hospital B to establish a non-trustee-close medical commonwealth．It discusses the effects achieved as well as innovations made through this approach while also highlighting its limitations．Furthermore,this study summarizes key insights that can be drawn from this model for building medical commonwealths in China：firstly,governments should focus on top-level design and provide policy support;secondly,leading hospitals should allocate high-quality resources based on local conditions;thirdly,member units should actively participate in construction efforts and seize development opportunities．

前人总结的用药禁忌十八反未必是绝对禁忌,笔者从广东省名中医陈国成主任独创星夏止痛膏外治中得到反药“乌头-半夏”的配伍启示。本文简要叙述反药配伍的源流及应用,重点对陈国成使用乌头配半夏外用的经验及思路进行论述,认为乌头与半夏配伍可通过多种方式减毒增效,为临床安全使用该配伍药物提供新的思路。

The eighteen antagonisms summarized by predecessors may not be absolute contraindications．The author obtained the inspiration of the antagonism medicinals “aconite-pinellia” from the external treatment of Xingxia painkiller ointment created by Chen Guocheng．The present paper provides a concise overview of the origin and application of anti-drug compatibility,with a specific focus on Chen Guocheng's expertise and insights regarding the external use of aconite combined with pinellia．It is postulated that diverse approaches can be employed to modulate the compatibility between aconite and pinellia,thereby offering novel perspectives for ensuring the safe utilization of this drug combination in clinical practice．