创伤骨科的不当医疗

不当医疗问题已经引起社会各界的广泛关注,它包括过度医疗行为、错误医疗行为和缺陷性医疗行为.创伤骨科疾病不当医疗既与医学发展水平和医学本身规律特点有关,又与现行医疗体制、医院经营机制有关,是患者及家属、医务人员和社会等多因素参与,受现行医学科学发展制约的治疗行为.应避免不当医疗,追求适度医疗,尽量达到最优化医疗.     

医学的新定位:走出医院,迈向社会

医学的服务范围、作用领域和责任载体等逐渐从医院向社会延伸、扩展."医学的目的"决定医学发展和医院定位的方向,社会、经济等诸多因素促使医学不断地从医院走向社会.医院唯有在清醒认识医学目的的前提下,抓住医疗卫生体制变革完善的契机,在医学模式上转变,在医疗服务上拓展,在医疗管理上改进,才能步入良性的发展轨道.     

论德沃金的医疗资源分配思想

德沃金医疗资源分配思想试图超越平等主义与自由至上主义的对立,解决个人责任与社会责任的矛盾,德沃金主张在医疗资源分配领域,平等优先于自由,强调政府的责任也强调个人责任,他提倡谨慎的保险原则.谨慎的保险原则根据利益和风险对治疗的预期价值进行权衡,谨慎的保险原则可以确定个人和国家医疗支出的限度和方式.     

创伤骨科的不当医疗

不当医疗问题已经引起社会各界的广泛关注,它包括过度医疗行为、错误医疗行为和缺陷性医疗行为。创伤骨科疾病不当医疗既与医学发展水平和医学本身规律特点有关,又与现行医疗体制、医院经营机制有关,是患者及家属、医务人员和社会等多因素参与,受现行医学科学发展制约的治疗行为。应避免不当医疗,追求适度医疗,尽量达到最优化医疗。     

企业环境责任的伦理考量

责任伦理是面向未来的一种伦理概念.企业责任伦理的缺失是我国环境污染日趋严重不可忽视的因素之一.企业作为环境污染中的主体,必须为其行为后果承担责任.当我们强调作为集体的企业的责任伦理,强调企业对其行为所导致的后果负责时,其实质即指企业在责任伦理下的社会责任承担问题.     

医学的新定位：走出医院，迈向社会

医学的服务范围、作用领域和责任载体等逐渐从医院向社会延伸、扩展。"医学的目的"决定医学发展和医院定位的方向,社会、经济等诸多因素促使医学不断地从医院走向社会。医院唯有在清醒认识医学目的的前提下,抓住医疗卫生体制变革完善的契机,在医学模式上转变,在医疗服务上拓展,在医疗管理上改进,才能步入良性的发展轨道。     

心灵的挑战：医生责任伦理问题与诉求

道德赤字、人性亏损是当代医学最大的危机,单纯法律、伦理、制度已难以管控医生的真实医疗行为,现代医学正面临前所未有的道德冲击和人性挑战。作为一种新道德思维,医学责任伦理具有新的精神气质和新的伦理追求,它超越传统的道德思维局限性,以他者的思维方式重新审视医学责任,开辟了一条解决现代医学面临的道德难题的新路径。责任伦理要求医生不仅要具备精湛的医术,更要具有善良的人格,要践行一种自愿的、主动的、不求回报的伦理责任,让医学技术为社会可持续、为人类健康和子孙后代造福。     

构建高质量的外科医学教育体系

医学教育是贯穿医疗职业生涯全过程的行为,是伴随医学进步和发展的重要工程.医学教育的质量直接影响医疗的质量和医学人才的素质,尤其是外科学领域,是以有创性的手段、方法治疗疾病.医生的职业素养、医疗水平均取决于医学教育的结果.医疗质量不能简单地用医生的学历衡量,学历教育是载体,其中应充实培养能力的教育项目、内容,以适应未来就职、就业的社会需求.医疗质量、医疗水平对医院而言是生命线,是生产力.同时,医生的教育及教育的质量是医疗质量的基础与保障.随着医学的飞速发展,医疗技术的日新月异,医学模式的改变,构建新的医疗环境下的医学教育体系,显得更为重要.     

"灯塔经济"与医改的"穷人经济学"

我国卫生改革一开始就缺乏伦理基准,医疗服务过度市场化倾向、政府责任不到位和伦理缺席已将卫生改革引向功利主义的死胡同,使得卫生改革背离了公正目标.在今后的深化改革中,必须强调医学目的,贯彻以人为本的指导思想,加大政府的投入,围绕公正目标,建立覆盖全民的医疗保障体制.     

河南省医疗改革的公平性分析

河南省医疗改革突出的难题在于如何实现保健资源的公平公正.影响河南医疗改革公平的因素是产权改制的方向偏差,道德异乡人的利益博弈,资本和技术对医学的剥蚀,医学、医疗自身发展的失衡.实现医疗改革公平的对策建议是显化政府责任伦理,重建医患利益共同体,整合优化卫生资源的配置,推行医学整体化的发展模式.     

Infant illness severity and family adjustment in the aftermath of NICU hospitalization

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants’ medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider−patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.     

举证责任倒置对医疗纠纷诉讼的影响

举证责任倒置是一般举证责任原则的例外,在医疗纠纷诉讼中施行举证责任倒置的法理依据。主要是医患双方的诉讼地位不平等和医患双方的信息不对称,导致患方举证困难,实施新的举证规则后,必将会对医疗纠纷诉讼产生一系列的影响,医方对此要有深刻的认识并积极研究其对策。     

当代医生心理压力现状探讨

随着社会的进步,医学模式的转变,医疗服务行业面临着更多的压力,医生同样面临着各种各样的压力,他们来自于患方、医院、社会。一些医务人员在工作中,思想负担重,心理压力大,因此工作愉悦度低,有消极的工作情绪,甚至采取了选择离开医生工作岗位的行为。通过对某院的208名医生进行的简单问卷调查,寻找出问题的症结和医生心理压力的主要原因,从伦理学角度加以分析,为缓解医务人员压力,更好地服务患者寻求解决办法。     

The burden of disease among adolescents with personality pathology: quality of life and costs

In adults, personality disorders are associated with a low quality of life and high societal costs. To explore whether these findings also apply to adolescents, 131 adolescent patients were recruited from a mental health care institute in The Netherlands. Axis I and Axis II disorders were diagnosed using semi-structured interviews. The EuroQol EQ-5D was used to measure quality of life and costs were measured by the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness. The mean EQ-5D index value was 0.55. The mean direct medical cost in the year prior to treatment was €14,032 per patient. The co-occurrence of Axis I and Axis II disorders was a significant predictor of a low quality of life. Direct medical costs were higher for the depressive personality disorder. This study shows that the burden of disease among adolescents with personality pathology is high. This high burden provides evidence to suggest that further research and development of (cost-)effective treatment strategies for this population may be worthwhile.     

辽宁省农村不同经济水平地区居民医疗保健需要、需求与利用

对2001年对辽宁省农村医疗保健需要、需求和利用进行调查.样本选择主要根据不同地区经济水平,抽取9个县、27个乡、54个村,共调查了1084户、3 812人.分析了不同经济水平地区农村居民的患病率、医疗服务利用频率、就医流向、医疗费用支出水平及其在家庭支出中的比例、患病未利用原因及比例的差异和特征.并分析了医疗需要和利用的变化状况,调查对象对农村医疗保障形式的意愿.研究结果揭示低经济水平地区居民高需要、低需求、未就医率高、医疗费用负担重的状况.     

Quality of Life Among Patients with Mucopolysaccharidoses

To investigate preference-based quality of life (i.e., utility) in patients with mucopolysaccharidoses, a cross-sectional survey was carried out among proxy respondents. Preference-based quality of life of the six main subtypes of mucopolysaccharidoses was evaluated by utility measurement tools: visual analogue scale, standard gamble and time trade-off. Subjects were 93 medical students in a medical school and 6 medical experts on mucopolysaccharidoses in Japan. Group and individual interviews were carried out respectively. In standard gamble measurement among medical students, the mean utility value of mucopolysaccharidosis IH was the lowest (0.24), followed by mucopolysaccharidosis IIs (0.30) and mucopolysaccharidosis III (0.35). That of mucopolysaccharidosis IIm was the highest (0.76). The utility values of visual analogue sacle were significantly lower than those of standard gamble in all subtypes. All the correlation coefficients of utility values in each subtype of mucopolysaccharidoses between the three methods, using standard gamble as a reference standard, were statistically significant. The results among medical experts were similar to those among medical students. The utility values of patients with mucopolysaccharidoses were at low or medium levels. These results indicate that mucopolysaccharidoses pose a significant burden on overall health in these patients.     

Medical burden, cerebrovascular disease, and cognitive impairment in geriatric depression: modeling the relationships with the CART analysis

Herein, the background information reflecting roles of medical burden, cerebrovascular disease and risk factors, and cognitive impairment in geriatric depression are reviewed. The authors then propose a nonparametric statistical approach to the data analysis of multiple putative causal variables for late-life depression, the Classification and Regression Tree Analysis. This analysis presents a useful approach to modeling nonlinear relationships and interactions among variables measuring physical and mental health, as well as magnetic resonance imaging and cognitive measures in depressed elderly. This method uncovers the existing interactions among multiple predictor variables, and provide thresholds for each variable, at which its predictive power becomes statistically significant. It presents a "hierarchy" of the predictors in a form of a decision tree by finding the best combination of predictors of an outcome. The authors present two models based on demographic variables, measures of vascular and nonvascular medical burden, neuroimaging indices, the Mini-Mental State Examination score, and neuropsychological test scores of 81 elderly depressed subjects. Cognitive tests of verbal fluency and executive function are identified as the best predictors of depression, followed by the frontal lobe volume and Mini-Mental State Examination. The authors observed that an interaction between frontal lobe volume, total lesion volume, and medical burden was predictive of depression.     

口腔科医疗收费要坚持以病人为本

2004年重庆市新的医疗收费制度实行后,口腔科针对新的收费标准和口腔科治疗项目费用上涨的收费现实,坚持以病人为中心,一方面严格执行新的收费精神,同时采取各种灵活和变通的收费措施,为病人着想,尽可能减轻病人负担。两年多来的实践取得了良好的社会效益,获得病人和家属的好评。     

论医疗侵权诉讼中的举证责任倒置规则

医患关系的紧张再次引起了人们对医疗侵权诉讼中举证责任倒置这一规则的关注。在对有关基本知识和人们争议焦点的分析之后,提出了应该在准确理解医疗侵权诉讼中举证责任倒置的适用条件和内容的基础上,结合这一规则设置的目的在当事人之间合理地进行举证责任的分配。     

不可轻视医药贿赂现象

近年来,随着市场经济的发展,医药贿赂问题相继发生,对社会造成了不良影响。一方面,这种现象严重破坏了正常的医药购销秩序,导致假药、伪劣器械层出不穷;另一方面,加重了患者的经济负担,损害群众的身心健康。从医药分家、健全法制以及行业自身建设方面提出治理医药贿赂的对策。