正确认识医疗诉讼的举证责任倒置、规范医务人员的医疗行为

针对就如何正确理解医疗诉讼举证责任倒置的规定,举证责任倒置给我国医疗卫生界带来挑战,以及如何适应举证责任倒置规定等问题进行了论述,提出了提高医务人员法律素质,依法行医,防范医疗纠纷的办法。     

论医患关系的法律属性

医事法（又称卫生法）究竟是属于民法的调整范畴还是属于行政法的范畴,国内学术界争议很大。从医学科学与医疗行为的本质特征看,医患关系并不具备民事法律关系所必须具备的主体平等、双方自愿及等价有偿互惠互利三大特征中的任何一个特征。同时也不存在行政主体与行政相对人的关系。为此,首次提出医事法既不调整横向的民事法律关系,也不调整纵向的行政法律关系,而是调整斜向的医事法律关系的一门独立的法律体系的理论。     

Patients’ intention to speak up for health care providers’ hand hygiene in inpatient diabetic foot wound treatment: a cross-sectional survey in diabetes outpatient centres in Lower Saxony,Germany*

Hand hygiene in wound care by health care providers (HCPs) is a key principle in treating hospitalized patients with diabetic foot infections. This study aimed to estimate the extent to which patients with type-2-diabetes (T2D) intend to speak up for HCPs’ hand hygiene during inpatient foot treatment, test whether this motivation increases given the hospital would invite patients to speak up, and identify associations with socio-demographics, knowledge of hand hygiene requirements, and diabetes-related factors. A questionnaire-survey was conducted in eight diabetes outpatient centres in Lower Saxony/Germany. Intentions to speak up (without and with institutional encouragement) and knowledge about hand hygiene during foot-care were assessed. Analyses of variance were conducted, partly as repeated measures-models with intention-items as within-subject factor. N = 473 patients participated (response = 77.4%). N = 177 (41%) strongly intended to speak up. Institutional encouragement was associated with an increased rate of strong (54% vs. 41%; p < .001) and higher mean intention (M = 3.9 vs. 3.4 with vs. without encouragement [5-point-scales]; F(1, 434)?=?41.5, p < .001). In patients without diabetic foot syndrome, this effect was limited to those with at least medium school education (F(2, 292)?=?4.4, p = .013) and knowledge on HCPs’ hand hygiene (F(2, 294)?=?3.1, p = .047). In conclusion, a majority of T2D-patients in diabetes outpatient centres intend to speak for HCPs’ hand hygiene in inpatient foot treatment, and are receptive to institutional encouragement. However, this presupposes at least medium education and knowledge about hand hygiene, emphasizing that patient empowerment begins with knowledge.     

适宜技术选择中的利益冲突及其化解途径

适宜技术的选择要考虑简、便、廉、验,要从大多数患者的需求出发,要始终定位在医患等利益关系的结合点上,它是一种动态发展的技术或技术体系。然而,正是基于各种利益的结合点,在实际选择适宜技术中常常因为利益冲突的多主体性而变得复杂多样,并衍生出各种各样的利益冲突。分析利益冲突的产生根源对于寻求利益冲突的化解途径具有重要意义,同时也为各种途径提供了理论支持。     

读玄释中——试论《太玄》所本的宇宙说

本文认为《太玄》不仅拟卦气说之易,亦拟《易传》所传之易,由准《文言》之《玄文》,认定《中》首在《太玄》中。地位最为重要。《中》首兼具水、土二行。是扬雄的有意安排,这是由其所本的宇宙思想决定的。本文认为《太玄》浑盖兼采。在对几种盖天说与浑天说分析的基础上．认为只有一种盖天说及一种浑天说为《太玄)所本。以此为基础,对《中》首为何兼准二行做了解释。     

Preference-based escalation: A new interpretation for the responsibility effect in escalating commitment and entrapment

A prominent finding in escalating commitment and entrapment research is the “responsibility effect”: people invest more in a losing course of action or persist with it for longer if they themselves initiated this action (responsibility) as opposed to if it was assigned to them. We argue that this effect is driven by participants’ preferences. Responsible participants usually prefer the chosen alternative since they have chosen it themselves. Non-responsible participants, in contrast, represent a mix of persons who either favor or disfavor the chosen alternative. In two experiments, we demonstrate that responsible participants favor the chosen course of action more strongly than non-responsible participants do, that these preferences facilitate reinvestment in and persistence with the chosen course of action, and that responsibility has no effect over and above this effect of preferences. Non-responsible participants preferring the chosen course of action made similar reinvestments and exhibited similar persistence as responsible participants.     

When forewarning backfires: Paradoxical effects of elaborating social feedback on entrapment in a losing course of action

Entrapment occurs if people persist with losing courses of action. In two experiments, we show how elaborating social feedback (i.e., premature praise or forewarning regarding the chosen course of action) can have paradoxical effects on entrapment. The participants acted as head of a translation department and had to choose one out of four possible translation strategies for their employees. After choosing, they read four arguments (presumably written by former participants) which were either all in favor of the strategy chosen, all against it, or mixed. Half of the participants only read these arguments, whereas the other half elaborated on them by providing written comments (Experiment 1). The results showed that elaborating on other persons' arguments led to stronger entrapment, independently of whether the arguments were positive or negative. This pattern was due to biased argument processing: Whereas confirming thoughts were generated for positive arguments, negative arguments were refuted. Experiment 2 confirmed that this biased argument processing caused subsequent entrapment. These results indicate that elaborating any type of argument can lead to heightened entrapment and, hence, forewarning can backfire. Copyright © 2009 John Wiley & Sons, Ltd.     

Weighing the Evidence: A Systematic Review on Long-Term Neurocognitive Effects of Cannabis Use in Abstinent Adolescents and Adults

Findings on neurocognitive effects of sustained cannabis use are heterogeneous. Previous work has rarely taken time of abstinence into account. In this review, we focus on understanding sustained effects of cannabis, which begin when clinical symptoms of the drug have worn off after at least 14 days. We conducted a search between 2004 and 2015 and found 38 studies with such a prolonged abstinence phase. Study-design quality in terms of evidence-based medicine is similar among studies. Studies found some attention or concentration deficits in cannabis users (CU). There is evidence that chronic CU might experience sustained deficits in memory function. Findings are mixed regarding impairments in inhibition, impulsivity and decision making for CU, but there is a trend towards worse performance. Three out of four studies found evidence that motor function remains impaired even after a time of abstinence, while no impairments in visual spatial functioning can be concluded. Functional imaging demonstrates clear differences in activation patterns between CU and controls especially in hippocampal, prefrontal and cerebellar areas. Structural differences are found in cortical areas, especially the orbitofrontal region and the hippocampus. Twenty studies (57 %) reported data on outcome effects, leading to an overall effect size of r _mean?=?.378 (CI 95 %?=?[.342; .453]). Heavy use is found to be more consistently associated with effects in diverse domains than early age of onset. Questions of causality―in view of scarce longitudinal studies, especially those targeting co-occurring psychiatric disorders―are discussed.