论当前医疗纠纷的表现特点,处理及防范对策

报道本教研室４３年３１６例医疗纠纷尸检资料的分析结果,结合实际工作经验与体会,论述当前医疗纠绿的表现特点,处理对策和防范措施。认为近年来医疗纠纷逐渐增多;发生科室以妇产科和外科多见;医疗纠纷中非医疗事故多于医疗事故。处理对策建议是：遵循法律,注意程序,讲究方法,公平合理。指出完善医疗管理是防范医疗纠纷的关键,提高医疗水平是防范医疗纠纷的根本。     

Relative Value Units: Using the New “Currency” for Measuring Clinical Productivity in a Productivity/Incentive Plan

This paper presents an overview of a productivity/incentive plan for faculty in an academic medicine center's department of behavioral medicine and psychiatry. The model utilizes the Resource-Based Relative Value Scale (RBRVS) for its measurement of clinical productivity. The paper provides an introduction to RBRVS terminology and how the RBRVS system was developed. The productivity/incentive plan developed for the Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, is described. The advantages and limitations of utilizing Relative Value Units (RVUs) in a productivity model are discussed. The paper may provide helpful insights to those charged with developing productivity/incentive plans at other academic health science centers.     

Assessing unit-price related remifentanil choice in rhesus monkeys

Given a commodity available at different prices, a unit-price account of choice predicts preference for the cheaper alternative. This experiment determined if rhesus monkeys preferred remifentanil (an ultra-short-acting micro-opioid agonist) delivered at a lower unit price over a higher-priced remifentanil alternative (Phases 1 and 3). Choice between equal-priced alternatives also was assessed (Phase 2). A discrete-trials procedure was arranged in which three monkeys chose between two remifentanil alternatives by responding on one of two levers. Different prices were arranged by manipulating drug dose (0.3 and 0.1 microg/kg/injection) and/or the ratio requirement. Monkeys usually chose the larger-dose alternative even when it was more expensive. Only when unit prices were relatively high (e.g., large response requirements) did monkeys choose the cheaper (or equally priced) smaller-dose alternative. Employing larger doses (0.9 and 0.3 microg/kg/injection) attenuated the larger-dose preference. The results demonstrate that choice was not determined simply by unit price. An alternative model that employs demand-function analysis to generate choice predictions is proposed.     

医院医疗欠费情况调查研究

运用描述性统计方法,对某三级甲等综合性医院五年来医疗欠费情况进行统计,探讨了医疗欠费患者的社会人口学特征和卫生经济学特征,提出解决医院医疗欠费问题的根本途径是建立覆盖全民的医疗保险体系。     

替罗非班不同给药途径对DM合并急性STEMI患者PCI术后血小板α-颗粒膜蛋白及心肌灌注水平的影响

为探讨替罗非班不同给药途径对糖尿病（DM）合并急性ST段抬高型心肌梗死（STEMI）患者PCI术后血小板α-颗粒膜蛋白及心肌灌注水平的影响,对149例DM合并急性STEMI患者进行研究,测定并比较经静脉（A组）、冠脉给药途径（B组）和无替罗非班（C组）的患者术前及术中应用替罗非班后血小板α-颗粒膜蛋白GMP140浓度、造影结果、心肌酶及肌钙蛋白I水平峰值及峰值时间、心电图变化。结果显示A、B两组术中血小板α-颗粒膜蛋白浓度较术前明显降低（P〈0．05）,且B组较A组降低更明显（P〈0．05）,而C组未见明显变化（P〉0．05）,A、B两组术后即刻TIMI血流、2h sumSTR、心肌酶及肌钙蛋白Ⅰ峰值及峰值时间的变化均优于C组（P〈0．05）,且B组优于A组（P〈0．05）。因此,替罗非班可以降低血小板α-颗粒膜蛋白浓度和改善心肌灌注水平,与静脉途径给药相比,经冠脉给药更具有优势。     

Conservatism positively predicted fading affect bias in the 2016 US presidential election at low,but not high,levels of negative affect

Unpleasant affect fades faster than pleasant affect and this Fading Affect Bias (FAB) phenomenon is positively related to healthy outcomes and negatively related to unhealthy outcomes, which makes the FAB a healthy coping process/reaction. Rehearsal seems to be the cognitive mechanism responsible for the FAB. Although the FAB and its relation to healthy outcomes and rehearsal have been examined in many contexts, they have not been evaluated in the realm of politics. Therefore, we evaluated the FAB across event type and we examined the relation of FAB to political leaning (conservatism), unhealthy variables, healthy variables, and rehearsal for the 2016 US Presidential Election. We expected and found that FAB was larger for non‐political events than for election/political events, and conservatism positively predicted FAB. We also expected and found that unhealthy/healthy outcome variables related to FAB in predictable ways. Importantly, we found that negative affect moderated the relation of FAB and conservatism, and rehearsal ratings mediated this 3‐way interaction. The results supported emotion regulation models, such as the mobilization‐minimization hypothesis and self‐enhancement theory.     

An Experimental Investigation of Election Promises

We analyze the effect of election promises on electoral behavior in a laboratory experiment. In the experiment, politicians can make nonbinding election promises about how to split an endowment between themselves and the group. We find that promises affect both voting and voter beliefs about how much the politician will contribute to the public fund. The relationship is inverted U‐shaped with decreasing credibility of higher promises. Contributions of politicians are correlated with their promises in a similar pattern. The election promises are generally credible unless particularly high. Politicians keep promises more often if a reelection is possible and if the politician came into power by vote rather than by random draw. Voters reward high contributions in the previous period and punish promise breaking even after controlling for the contribution in the previous period or voters' beliefs about future contributions. By controlling for voters' beliefs, we distinguish retrospective from prospective voting. Our results suggest that voters both use promises for prospective voting and retrospectively punish broken promises.     

努力避免肿瘤的过度化疗

化疗是肿瘤治疗的主要手段之一,在临床实践中发挥着十分重要的作用,但是其有明显的毒副作用,避免过度化疗是医疗的基本要求。临床过度化疗的原因与现行医疗管理与流程、医生的诊疗水平有关。近年来,人们对肿瘤生物学行为规律认识不断深入,更加注重个体化治疗,肿瘤治疗领域快速更新,因此对医疗决策水平也提出更高的要求。需要通过规范肿瘤诊疗流程、更新知识、积累经验、临床试验并结合我国国情,权衡利弊,使患者接受恰当治疗。     

AMPing Racial Attitudes: Comparing the Power of Explicit and Implicit Racism Measures in 2008

In 2008, ANES included for the first time—along with standard explicit measures of old‐fashioned and symbolic racism—the Affect Misattribution Procedure (AMP), a relatively new implicit measure of racial attitudes. This article examines the extent to which four different measures of racial prejudice (three explicit and one implicit) predict public opinion during and after the 2008 election, including Americans' views towards several racial policy issues, their evaluations of, and feelings toward, Barack Obama, and their attitudes toward a Black president in general. Oversamples of African American and Latino respondents in the 2008 ANES enable us to broaden our tests of these measures beyond traditional White samples. We find that racial prejudice played an important role for all racial/ethnic groups but that the traditional explicit measures of racism are by far the stronger predictors for all of our dependent variables (compared to the new implicit measure) for both White and Black respondents. Surprisingly, the AMP adds clear explanatory power only to models in the Latino sample.     

The Effect of Group Polarization on Opposition to Donald Trump

Using focus groups, we examined support and opposition for Donald Trump prior to the 2016 presidential election. When ingroup members participate in discussion, this conversation alone typically strengthens and intensifies members’ initial attitudes. We used a pre‐ to post‐focus‐group questionnaire to assess attitudes toward Trump, his campaign, and policies. We argue that group polarization influenced people’s opinions about Trump such that attitudes became more extreme after discussion with like‐minded individuals. We report changes for Trump nonsupporters for which group polarization occurred on attitudes toward illegal immigration, political correctness, the military, women, and veterans after the group discussion. For each, level of support for Trump’s views decreased. To further explore potential psychological mechanisms associated with group polarization, we employed network science methods to examine the structure of the language associated with these issues and identify potential drivers of attitude change. Results provide some support for a common mechanism for group polarization, which may be driven by language dynamics specific to individual attitudes.