互联网医疗法律规制论要

互联网医疗具有独特的功能定位,应用前景广阔。但是,依据现行规则,我国互联网医疗实践面临着合法性困境。我国应当遵循“三角法则”,在立法层面对特殊时期和特殊地域的互联网医疗规则的灵活调整进行明确授权,允许对以下规则进行针对性调整：第一,调整复诊规则,允许通过互联网进行初诊,但要求医患双方使用实时同步通信技术进行沟通,并要求医生及时进行随访;第二,调整常见病、慢性病规则,采用“负面清单”模式,明确列举并尽量压缩不得线上诊疗的疾病范围;第三,以互联网情境下的平均诊疗水平设定注意义务基准,为医生在线诊疗创造合理空间。

     

医联体背景下分级诊疗的难点与对策

自主选择的就医模式使得大多数患者选择三级医院首诊,三甲医院承担了不应该的轻症、常见病诊治。我国医联体服务模式探索较早,也是分级诊疗制度的重要载体。分析医联体与分级诊疗的关系,结合本单位在医联体建设中的遇到的实际问题,分析认为目前分级诊疗中存在办医主体利益难协调、下转动力不足、基层能力不足、转诊系统信息化建设不完善的问题,提出紧密合作、完善流程、加强引导、发挥基层特色,提高分级诊疗制度的实施力度。

     

A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.     

妊娠合并结核临床诊治的决策

妊娠合并结核是一种对母婴健康危害极大的妊娠期疾病。在妊娠期结核病中,多数患者无明显症状,早期症状与妊娠期某些生理反应相似,加之妊娠与结核病的相互影响,x线、CT等重要的影像学检查受限,致使本病易被误诊或误治。某些抗结核药物对母婴的不良影响,使其治疗难以实施,由于结核病本身及治疗后可能对胎儿的影响,在临床上是否终止妊娠往往难以决策。本文就妊娠合并结核诊治过程中的相关问题进行综述,以期为临床诊治决策提供帮助。     

The structure of “communities” and communications in the new millennium

The three lineages of information,—the genetic, the cultural and artifactual—will increasingly merge their constituent information contents through advances in biotechnology and information technology. This will redefine what constitutes “social” and what constitutes “community.” A community's members communicate with their “significant others” and change their internal information states (and their internal and external behaviors). Under conditions of merging, information exchanges occur across all the three lineages. In this sense, the concept of significant other,—that is, a communicating entity—, is now spread from human communities to encompass also the biological and the artifactual. A seamless merging between the three realms now occurs affecting their respective internal information stores. The resulting image of interactions that now arises is of multiple oceans of communities, operating at different levels, the genetic, the cultural and the artifactual. There are exchanges across the different levels, up and down and sideways, as information is translated from one realm to the other. These dynamics result in changes in the evolutionary characteristics of each lineage and sub‐lineage, including the internal perceptions from within a lineage, namely in the language of evolutionary epistemology, its “meanings” and “hypotheses” on the world. A future sociology must necessarily take into account these factors and incorporate the dynamics of all three realms.     

I Am A Woman

No abstract available for this article.     

Thirty Years Later: An Oncologist Reflects on Kubler-Ross's Work

As compared with conventional vaccine production systems, plant-made vaccines (PMVs) are said to enjoy a range of advantages including cost of production and ease of storage for distribution in developing countries. In this article, we introduce the science of PMV production, and address ethical issues associated with development and clinical testing of PMVs within three interrelated domains: PMVs as transgenic plants; PMVs as clinical research materials; and PMVs as agents of global health. We present three conclusions: first, while many of the ethical issues raised by PMVs are familiar, PMVs add a new dimension to old issues, and raise some novel issues for ethicists and policy-makers; secondly, it is premature to promise broad applicability of PMVs across the developing world without having demonstrated their feasibility; thirdly, in particular, proponents of PMVs as a solution to global health problems must, as a condition of the ethical conduct of their research, define the commercial feasibility of PMVs for distribution in the developing world.     

基因工程药物发展的历史及启示

基因工程诞生20余年,运用于医药行业,研制和开发工程药物,已取得长足进展,迄今为止,已有近100个基因工程新药上市,并有数百种正在研制和开发中,可以预计,基因工程药物的发展具有无比强大的生命力。就基因工程药物发展史进行概述,会从中得到许多启示。     

走出慢性乙型、丙型病毒性肝炎诊断的误区

我国病毒性肝炎是一个非常重要的肝病,病毒性肝炎的诊断不仅依靠临床表现,肝功能指标的改变,也依赖于病毒标志物的检测。病毒血清学检查是确定诊断的唯一标准。乙、丙、丁型病毒性肝炎的血清标志物项目繁多,临床意义相差较大,正确理解能为诊断提供很大帮助。     

儿童发展中的社会过程和遗传的影响：双生子和养子女设计的新颖方法

双生子与养子女的研究尤其能对环境影响的机制提供证据。本文扼要地概述了“非共享环境与青少年发展”（NEAD）计划的部分研究成果,特别是子代对父代影响的成果,同时本文也讨论了今后计量行为遗传学的可能走向