中英“注册前住院医师”临床执业现状对比及思考

通过对比中英两国"注册前住院医师"临床执业现状,从培养模式、医师资格获取的时间点、临床执业资质以及执业法律环境等多个角度,分析两国"注册前住院医师"临床执业的不同之处,在借鉴英国经验的基础上提出相关建议,旨在解决我国"注册前住院医师"临床执业中的现存问题,保障"注册前住院医师"临床执业的合法性。     

关于医师执业注册的法律问题研究

就医师执业注册的法律时限、执业地点变更等法律问题进行分析和研讨,认为在医师执业注册法律规范中存在时限较长、手续烦琐等若干法律缺陷,因而完善卫生法律法规规定,规范医师执业注册极为重要,并从法律和可行性对策的角度提出了建议。     

从一起医疗美容门诊部聘请外国“医师”开展医疗美容案探讨非法行医罪认定中的有关问题

作者通过对一起医疗美容门诊部聘用无资质"外国医师"在酒店客房非法开展医疗美容(注射肉毒毒素)案例的分析,针对"提供场所者"、"外国医师"和"门诊部"三个违法主体,涉及"假药"和"非法行医罪"问题,与食品药品监督管理部门、公安部门进行有效衔接,对境外人员在境内医师执业注册、非法行医罪主体认定和"假药"认定等问题进行了深入探讨,提出了意见建议,为今后类似案件办理提供参考。     

医师资格考试暂行办法

1999年7月16日,卫生部部长张文康签署中华人民共和国卫生部令第4、5号,发布实施《医师资格考试暂行办法》和《医师执业注册暂行办法》。7月23日,张文康部长签署卫生部令第6号,发布实施《传统医学师承和确有专长人员医师资格考核考试暂行办法》。 卫生部、人事部近期曾就具有医学专业技术职务任职资格人员认定医师资格及执业注册问题下发通知,明确在《执业医师法》颁布之日(1998年6月26日)前已取得医学专业技术职务任职资格的“老人”不必参加医师资格考试,可直接申请执业医师及执业助理医师资格认定并申请执业注册。     

专家解读体检新规

近日,卫生部日前印发<健康体检管理暂行规定>,规定将健康体检界定为一种医疗行为,任何未取得<医疗机构执业许可证>的单位不得从事体检活动.该规定还明确,开展健康体检的医疗机构应具有相对独立的健康体检及候检场所,体检场所建筑面积不少于400平方米,包括内科、外科、妇产科等诊疗科目.健康体检机构至少有2名内科或外科副高以上任职资格的执业医师,每个临床检查科室至少有1名中级以上任职资格的执业医师,至少有10名注册护士等.     

对一起聘用未经注册的外国医师开展诊疗活动案例分析

近年来随着社会经济的发展,各种类别的医疗美容机构如雨后春笋般出现,外国医师特别是韩国医师来中国开展医疗美容执业活动现象越来越普遍。作者通过分析研究一起医疗美容机构聘用未经注册的外国医师开展诊疗活动的典型案例,寻求更能合理、合法解决医疗美容机构违法使用外国医师开展美容外科手术行为的途径和方法,目的是依法打击医疗美容机构存在的非法行医的行为,规范医疗美容机构执业人员资格,确保执业活动安全,保障人民群众的身体健康和生命安全。     

我国医师多点执业试点进展、问题及对策

选取我国最早开展医师多点执业试点的10个城市和近年来试点情况良好的典型省市,采用文献分析、问卷调查和定性访谈相结合的研究方法,梳理了医师多点执业国家层面的政策制定情况以及典型地区医师多点执业政策要点,总结了我国医师多点执业试点在注册程序由"审批制"转向"备案制"、注册条件由"高级职称"降为"中级及以上职称"、执业地点由"定点制"扩大为"区域制"3方面的亮点进展。同时,也分析了我国医师多点执业试点还存在国家立法滞后、医疗责任风险分担制度不健全、传统人事管理制度的障碍、基层医疗机构人才流失、医生面临的双重阻力等方面的问题,并提出完善医师多点执业的法律规范、通过医师责任保险来化解多点执业医疗风险、改革医师人事制度、构建竞争性的薪酬体系以防止人才流失、打造医患利益共同体等建议。     

卫生部关于取得医师资格但未经执业注册的人员开展医师执业活动的批复

一、根据《执业医师法》规定 ,取得医师资格的人员 ,“未经医师注册取得执业证书 ,不得从事医师执业活动。”二、对于医疗机构聘用取得医师资格但未经医师注册取得执业证书的人员从事医师执业活动的 ,按照《医疗机构管理条例》相关规定处理。三、对于取得医师资格但未经医师注册取得执业证书而从事医师执业活动的人员 ,如在教学医院中实习的本科生、研究生、博士生以及毕业第一年的医学生可以在执业医师的指导下进行临床工作 ,但不能单独从事医师执业活动。四、取得医师资格但未经医师注册取得执业证书而从事医师执业活动的人员在行医过程中…     

医生执业形态及相关法律规定浅析

1 执业医师 1.1 按照注册的执业地点、执业类别、执业范围执业 《中华人民共和国执业医师法》(执业医师法)第14条规定:医师经注册后,可以在医疗、预防、保健机构中按照注册的执业地点、执业类别、执业范围执业,从事相应的医疗、预防、保健业务.未经医师注册取得执业证书,不得从事医师执业活动.第21条规定医师在执业活动权利,第40条规定了侵犯医师权利应受到治安管理处罚甚至依法追究刑事责任.执业医师按照注册的执业地点、执业类别、执业范围执业,这是法律所规定的状态,受到法律的保护.     

具有医学专业技术职务任职资格人员认定医师资格及执业注册办法

第一条 根据《中华人民共和国执业医师法》(以下简称《执业医师法》)第四十三条的规定,制定本办法。 第二条 《执业医师法》颁布之日前,按照国家有关规定已取得医学专业技术职务任职资格的人员,申请执业医师资格或执业助理医师资格认定和申请医师执业注册的,适用本办法。 第三条 已取得医师以上专业技术职务任职资格的,可以申请执业医师资格。 已取得医士专业技术职务任职资格,以及1995年、1996年大学专科毕业生已经转正但未取得医师专业技术职务任职资格的,可以申请执业助理医师资格。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.