医院引进股份制机制改革的伦理思考

在卫生改革中医院可不可以进行股份制的试点是一个极富挑战性的问题,我国医院公有制已经实行了数十年,在保障国民健康上作出巨大贡献,但随着改革的进程,医院的发展遇到现有体制、机制方面的许多难题。浙江、上海等地已经实行医院股份制改革试点的经验证明,股份制不等于私有制;在国力不可能更多增加卫生投入的情况下,医院股份制改革促进了医院的管理、社会效益和经济效益,可能是发挥社会力量办好医院、解决我国卫生改革深层次矛盾的途径之一。     

公立医院体制改革的思考

公立医院体制改革给一些难以为继的中小医院带来一线生机,但是医院体制改革过程中存在的一些问题一直未得到妥善解决。通过对公立医院体制改革的益处及弊端的剖析,提出公立医院体制改革的建议,以保证改革的步伐健康有序地发展。     

论医院伦理委员会的建设

医院伦理委员会作为维护医患关系之间权益公平的中介力量,把医学技术与人文关怀结合起来,在医患之间构筑起一种新型的关系,让患者得到细致入微的人本关怀。目前,我国在依法推进、规范医学伦理审查方面仍是空白,所以应尽快对医院伦理委员会的工作性质及作用做出明确的规定,以保障医疗工作更加安全。     

医疗机构单病种限价面面观

单病种限价收费是医院经营的一种管理模式,是指在临床诊疗收费中,对单一病种病人限定最高费用的做法,是医院的一种自发行为。这在一定程度上解决了群众看病难、看病贵的问题,缓解了社会医疗费用过度增长的压力,有助于医疗机构收费更趋于合理化。拟从社会的各个层面对医疗机构单病种限价问题进行深入地探讨。     

Inpatient perspectives on physical activity in a secure mental health setting

This study offers the first insight into the perspectives of secure inpatients regarding exercise. Individuals living with severe mental illness (SMI) engage in less exercise and more sedentary behaviour than their counterparts in the general population. Secure psychiatric hospitals are often considered obesogenic environments that inadvertently promote inactivity. Access to exercise is often restricted due to issues of risk and patient safety. Existing literature exploring exercise perspectives is dominated by SMI populations living in the community. This study involved semi-structured interviews with 15 medium secure inpatients (aged 19–40, mean age 27.8). Primary diagnoses included; schizophrenia and affective disorders, mood disorders and personality disorders. Data were analysed using reflexive thematic analysis. Findings denoted three overarching themes; (i) Barriers to exercise; mental or environmental? (ii) Is exercise always holistically beneficial? (iii) Staff; a barrier and facilitator to exercise. Acute mental health symptoms and unwanted medication side effects, such as lethargy and weight gain limited exercise motivation. The restrictions of a secure environment limited opportunities to regularly exercise. Exercise provided a relief from both psychiatric symptoms and associated low mood, however in some cases engaging in exercise exaggerated manic symptoms and led to acts of aggression. Inpatients considered staff crucial to facilitate exercise, however access, education and inconsistent attitudes limit provision. Strategies to change the sedentary ‘culture’ within secure wards should involve both staff and patients.     

Vertical integration in medical settings: A brief introduction to its potential effects on professional psychology

Vertical integration in medical settings typically involves the merging of independent physicians, physician groups, and hospitals to render an organized health care network. Such systems are considered to be vertical, as they may allow for a seamless continuation of services throughout the range of needs a patient may require. Mergers often result in the redefining of professional services offered in the acquired facility or across the network. As such, mergers have the potential of adversely impacting psychological practices. Professional psychology needs to take a proactive stance in this changing health care landscape. Research regarding empirically validated treatments and effects of psychological interventions on overall health-care costs needs to be properly disseminated to health care administrators to assure their knowledge of the utility of psychological services in the medical setting. Training psychologists to assume leadership positions in health-care institutions, gaining representation on hospital staff boards, and linking psychologists and physicians through collaborative training, to provide improved care, may allow for psychology to influence health care delivery.     

区级中医院中医专科的调查研究

中医专科是祖国传统医学的重要组成部分，是中医的精华和灵魂，对中医的延传和发展意义重大。为了解区级中医院中医专科的发展现状，笔者对广州各区级中医院进行实地问卷调查。结果显示区级中医院中医专科设置较单一，各专科在医疗方面的优势地位不突出，学科队伍建设欠完善，部分专科的科研水平亟待提升。     

中国传统伦理对医院道德管理之贡献

随着经济的腾飞,儒家管理思想在文化、伦理道德层面上给予医院经营管理以深刻影响。在医院道德管理的建设中,中国传统儒家伦理起着重要的作用,“仁”是医院经营发展的中心,“义”是医院经营立足的根本,“礼”是医院经营成功的保证,“智”是医院经营腾飞的关键,“信”是医院经营兴旺的标志。     

异化现象与临床医生的处境

通过对异化理论的阐述,揭示了异化现象的普遍存在性,从医院管理、医疗体制、医疗技术等各个方面分析了异化现象对于临床医生的思维和判断的制约。提出向＂以人为本＂的思想回归才是弱化异化的消极影响的途径。     

L’expertise en responsabilité hospitalière dans le secteur public : l’exemple de l’AP–HP

Public hospitals in France are submitted to special rules different from those in private hospitals. Missions of judicial experts are quite similar but some differences may be found during expertal meetings.