再论医疗诉讼新证据规则--兼谈医疗机构应诉技巧

就最高人民法院发布并实施《关于民事诉讼证据的若干规定》1周年,小结医疗诉讼中贯彻执行新规则的实践体会,再次讨论新证据规定对医疗诉讼的影响,重点探讨了举证责任倒置及举证期限的适用问题,并结合作者的代理经验介绍了医疗机构相关应诉技巧,最后介绍了关于新证据规则的最新发展动态。     

医疗机构在医疗诉讼中举证及抗辩应注意的几个问题

根据最高人民法院《关于民事诉讼证据的若干规定》及《医疗事故处理条例》 ,结合参与医疗诉讼的经验 ,阐述医疗机构在医疗诉讼中举证及抗辩方法 ,从而增强医疗机构应诉能力 ,保护医护人员的合法权益     

医改对医疗机构的影响及其对策

医改离不开医疗机构。医疗机构充当着控制医疗费用和提供基本医疗服务的载体,在医改中起着不可代替的重要作用,但医改又从方方面面影响医疗机构的生存与发展。新的形势下,医疗机构如何去适应医改,这是当今和今后相当长一段时间的重点工作。     

DRG收付费改革下医疗机构流程优化探讨

DRG收付费改革的实施对医疗机构的运营模式提出了新的挑战。医疗机构收付费方式由原来的以医疗服务价格项目信息为核心进行收付费,变为以对患者的疾病诊断和诊疗行为及其对应资源消耗为核心进行收付费。文章重点阐述DRG收付费改革对医疗机构的影响,并从患者入院流程、医生诊疗流程以及医疗质量监管流程三个方面,分析DRG改革背景下医疗机构流程改造的要点,探讨医疗机构在以诊断和操作为核心的流程优化设计的思路与实践,供广大医疗机构实践中参考。     

基于博弈理论的DRG支付制度对医疗机构诊疗行为影响分 析

目的:用博弈理论分析DRG支付制度对我国现行按项目付费制度下医疗机构诊疗行为的影响。方法:通过理论分析医疗机构的收入结构,构建并求解医疗机构诊疗行为的博弈模型,得到博弈模型的均衡解。结果:在按项目付费制度设计下,医疗机构会选择过度医疗的行为策略以获得更大的利润。在DRG支付下,医疗机构会从过度医疗的行为向缩减医疗的行为转化,最终选择缩减医疗的行为策略以获得更大的利润。结论:与按项目付费比较,DRG支付制度可以从根本上纠正医疗机构的过度诊疗行为,遏制医疗资源的浪费。但是缩减医疗会导致医疗服务不足,医保的监督重点必须放在防范医院减少必要的诊疗项目、降低医疗质量的行为。     

对第二周期医疗机构评审工作的探讨

1 医疗机构评审工作重点 1.1 提高认识,实施评审 依法建立和完善具有中国特色的医疗机构评审制度是为了综合评价医疗机构的执业活动、医疗质量和管理水平,检查医疗机构能否为群众提供符合标准的医疗服务,也是评定医疗机构能否继续执业的一项法律制度。对不参加评审和评审不合格的医疗机构,由卫生行政部门吊销执业许可证,停止医疗活动,限期改进方可继续进行医疗活动。     

5.12汶川大地震对都江堰市医疗机构医院感染预防控制的影响与对策

目的 了解5.12汶川大地震对都江堰市医疗机构医院感染预防控制的影响,为地震后的医院感染预防控制提供依据和对策.方法 采用表格和现场调查形式,对汶川大地震后恢复阶段初期都江堰市医疗机构医院感染管理与消毒灭菌现况进行调查.结果 全市医疗机构的医疗工作条件、医疗功能开展、医院感染管理组织、消毒灭菌方法与效果监测、职业防护、医疗废物处理等方面均因地震受到严重影响,对医院感染预防与控制提出了严峻挑战.结论 改善医疗条件、规范布局流程、加强医院感染监控管理和培训、强化消毒灭菌效果监测、抓好重点环节和重点部门的感染控制等方面工作,是预防医院感染发生的关键环节.     

过度医疗行为的表现、成因及监管路径选择

文章对医疗机构过度医疗行为的主要表现形式和成因进行了分析,重点针对医疗机构主观故意造成的过度医疗行为,选择确定具体监管路径,制定监管措施,促进合理诊治、合理用药与合理检查,并就卫生行政部门如何加强对过度医疗行为的监管提出了六条建议.     

医疗欠费的现状分析及对策研究

医疗欠费是目前各医疗机构普遍存在的问题,对于医疗欠费较多的机构影响了资金周转,制约医疗机构的发展。本文采用文献综述和比较的方法,对我国医疗机构中的医疗欠费现状进行概述,从经济、法律、医院管理等方面对医疗欠费产生的原因进行分析,并提出可行性对策。     

贵州省基层医疗机构数字化远程医疗设备使用情况调查

目的 对基层医疗机构9种数字化远程医疗设备使用情况及影响因素进行调查,为推动贵州远程医疗服务工作更好地开展提供政策建议。方法 随机抽取全省207家基层医疗机构（乡镇卫生院和社区卫生服务中心）,对其9种数字化远程医疗设备使用情况进行问卷调查;对10家乡镇卫生院负责人进行访谈调查。结果 使用9种设备的基层医疗机构数、检测总人次数均呈逐年增加趋势。至2019年6月,79.7%～88.9%机构使用DR、静态心电、彩超;37.7%～56.5%机构使用全自动生化分析仪、尿液分析仪、电解质分析仪、血球检验仪;动态心电、全科诊疗仪基本未使用;贵州各市州远程医疗设备使用情况有差异,其中六盘水市、黔西南州日常仅使用DR、静态心电、彩超。访谈结果显示,缺乏专业技术人才、就诊人数少、医患双方对远程医疗认知度不高等问题是影响设备使用的因素。结论 数字化远程医疗设备在基层医疗机构的使用情况逐年向好,但仍应重点加强对远程医疗服务的宣传和相应专业人才的培养。在设备配置上不搞“一刀切”,重点加强六盘水市、黔西南州以及就诊人数多、距离较偏远的基层医疗机构的远程医疗服务建设。     

Evidence against functional differences between "central" and "peripheral" fat

As shown in 1639 men and 1851 women in the 20-49 y age range, four commonly used skinfold measurements (triceps, subscapular, iliac, and abdominal) are all highly covariant and do not show clear evidence of upper-body and lower-body or central and peripheral groupings. Moreover, the four skinfold measurements are similarly related to systolic and diastolic blood pressures and to total serum cholesterol at each decile of skinfold thickness and to a degree that strikingly parallels summed skinfold thickness (sigma sf). The changing relative contributions of the different skinfold measurements to the summed skinfold thicknesses with increasing levels of fatness also reveal no evidence of consistent anatomical or topographical groupings by body segment or distance from the body core.     

从证据法学角度看《病历书写基本规范》对入院记录要求的瑕疵及对策

从证据法学角度看,《病历书写基本规范》对入院记录的要求存在病历作为证据形式上不完整的瑕疵。实行患方确认病史签名,可以有效弥补这一瑕疵,维护医院、患者及其他第三方的正当权益。但由此引起的法律相关问题,需要进一步研究。     

The "Child Health Evidence Week" and GRADE grid may aid transparency in the deliberative process of guideline development

ObjectiveTo explore the evidence translation process during a 1-week national guideline development workshop (“Child Health Evidence Week”) in Kenya.Study Design and SettingNonparticipant observational study of the discussions of a multidisciplinary guideline development panel in Kenya. Discussions were aided by GRADE (Grading of Recommendations Assessment, Development, and Evaluation) grid.ResultsThree key thematic categories emerged: 1) “referral to other evidence to support or refute the proposed recommendations;” 2) “assessment of the presented research evidence;” and 3) “assessment of the local applicability of evidence.” The types of evidence cited included research evidence and anecdotal evidence based on clinician experiences. Assessment of the research evidence revealed important challenges in the translation of evidence into recommendations, including absence of evidence, low quality or inconclusive evidence, inadequate reporting of key features of the management under consideration, and differences in panelists’ interpretation of the research literature. A broad range of factors with potential to affect local applicability of evidence were discussed.ConclusionThe process of the “Child Health Evidence Week” combined with the GRADE grid may aid transparency in the deliberative process of guideline development, and provide a mechanism for comprehensive assessment, documentation, and reporting of multiple factors that influence the quality and applicability of guideline recommendations.     

"总量控制、结构调整"政策的循证分析

上海市是在医疗费用迅猛增长的背景下出台“总量控制、结构调整”政策的。总控的实施确实控制了医疗费用的快速增长，并给整个卫生体系带来了一定的益处，但在政策实施过程中也存在着总控指标的制定、费用转移、支付机制、管理等方面的问题。在全国推广上海经验时，值得首先对上海市的总控政策作进一步深入的分析。     

Evidence of a dose-response relationship between "truth" antismoking ads and youth smoking prevalence

OBJECTIVES: In early 2000, the American Legacy Foundation launched the national "truth" campaign, the first national antismoking campaign to discourage tobacco use among youths. We studied the impact of the campaign on national smoking rates among US youths (students in grades 8, 10, and 12). METHODS: We used data from the Monitoring the Future survey in a pre/post quasi-experimental design to relate trends in youth smoking prevalence to varied doses of the "truth" campaign in a national sample of approximately 50000 students in grades 8, 10, and 12, surveyed each spring from 1997 through 2002. RESULTS: Findings indicate that the campaign accounted for a significant portion of the recent decline in youth smoking prevalence. We found that smoking prevalence among all students declined from 25.3% to 18.0% between 1999 and 2002 and that the campaign accounted for approximately 22% of this decline. CONCLUSIONS: This study showed that the campaign was associated with substantial declines in youth smoking and has accelerated recent declines in youth smoking prevalence.     

Evidence that hormesis represents an "overcompensation" response to a disruption in homeostasis

The hypothesis that growth hormesis represents an overcompensation to a disruption in homeostasis was supported in experiments assessing the effects of the synthetic plant growth inhibitor phosfon (2,4-dichlorobenzyl tributyl phosphonium chloride) on peppermint. While dose-dependent decreases in growth occurred initially in all treatment groups substantial compensation growth subsequently occurred across treatment groups. The low-dose treatment groups more than fully compensated for the initial growth decrement (20-25%), displaying a net stimulatory response by 5 weeks, whereas the high-dose treatment groups never fully compensated for the initial growth decrement (50-75%). These findings, within the context of other similar reported observations, are believed to be widely generalizable and may have important implications for biomedical fields including the design and interpretation of the bioassay especially within the context of the hazard/risk assessment process.     

"欣弗"事件暴露的问题及其对策

2006年7月发生的“欣弗”事件,暴露出我国医药行业、国家监督管理部门,甚至是国家医药卫生体制的一些问题。为了确保国民的身体健康,必须不断完善医药卫生体制和监管体制。本文在这些方面提出了一些对策建议。