滨州市滨城区2005～2008年一级以下医疗机构卫生行政处罚案件分析

目的通过分析2005～2008年近3年来滨州市滨城区一级以下医疗机构卫生行政处罚案件,明确当前一级以下医疗机构的主要违法行为以及卫生监督员在执法方面存在的主要问题,为探索长效医疗机构监管模式提供依据。方法对2005～2008年已经结案的一级以下医疗机构卫生行政处罚案件进行统计分析。结果（1）一级以下公立医疗机构主要违法行为是医师超范围执业,尤其是非影像学专业医师从事影像学专业诊断治疗工作;一级以下民营医疗机构主要违法行为是非法发布医疗广告和超出登记诊疗科目执业;个体门诊主要违法行为是未取得《医疗机构执业许可证》擅自执业和聘用非卫生技术人员,尤其是聘用无《护士执业证书》人员;（2）卫生监督人员监管单一、取证单一是执法中存在的主要问题。监管过程中侧重对相关资质的认定忽视其他违法行为的调查,取证过程重视现场检查笔录,忽视其他证据的收集。     

放射诊疗许可制度概述

医疗机构开展放射诊疗工作,应当具备与其开展的放射诊疗工作相适应的条件,经所在地县级以上地方卫生行政部门的放射诊疗技术和医用辐射机构许可。本文系统介绍了我国放射诊疗许可的法律和技术要求。     

实施《处方管理办法》对某三级医院处方质量影响

目的 了解<处方管理办法>(以下简称<办法>)的颁布对某三级甲等医院处方质量的影响.方法 采用系统随机抽样的方法,抽取该院2007年400例门急诊处方和60名患者,按照<办法>要求,进行处方点评.结果 该院处方平均合格率为37.2%.不合格处方主要表现为处方不完整、不规范和不合理等.<办法>实施后,部分指标有显著改善,处方平均合格率提高了12.2%(P=0.004),抗菌药物使用百分率显著降低(P=0.001),药品使用通用名的百分率显著提高(P=0.000).结论 <办法>的实施对医院处方质量起到了积极的促进作用     

Trends in use of opioids for non-cancer pain conditions 2000-2005 in commercial and Medicaid insurance plans: the TROUP study

Opioids are widely prescribed for non-cancer pain conditions (NCPC), but there have been no large observational studies in actual clinical practice assessing patterns of opioid use over extended periods of time. The TROUP (Trends and Risks of Opioid Use for Pain) study reports on trends in opioid therapy for NCPC in two disparate populations, one national and commercially insured population (HealthCore plan data) and one state-based and publicly-insured (Arkansas Medicaid) population over a six year period (2000–2005). We track enrollees with the four most common NCPC conditions: arthritis/joint pain, back pain, neck pain, headaches, as well as HIV/AIDS. Rates of NCPC diagnosis and opioid use increased linearly during this period in both groups, with the Medicaid group starting at higher rates and the HealthCore group increasing more rapidly. The proportion of enrollees receiving NCPC diagnoses increased (HealthCore 33%, Medicaid 9%), as did the proportion of enrollees with NCPC diagnoses who received opioids (HealthCore 58%, Medicaid 29%). Cumulative yearly opioid dose (in mg. morphine equivalents) received by NCPC patients treated with opioids increased (HealthCore 38%, Medicaid 37%) due to increases in number of days supplied rather than dose per day supplied. Use of short-acting Drug Enforcement Administration Schedule II opioids increased most rapidly, both in proportion of NCPC patients treated (HealthCore 54%, Medicaid 38%) and in cumulative yearly dose (HealthCore 95%, Medicaid 191%). These trends have occurred without any significant change in the underlying population prevalence of NCPC or new evidence of the efficacy of long-term opioid therapy and thus likely represent a broad-based shift in opioid treatment philosophy.     

The importance of children's ADHD for parents' relationship stability and labor supply

Children with attention-deficit/hyperactivity disorder (ADHD) have much worse long-term outcomes than other children. This paper uses Danish register-based data on children born from 1990 to 1997 to investigate the significance of children's ADHD for parents' outcomes. We observe 172,299 pairs of parents from 1990 to 2007 of which 2457 have a firstborn child diagnosed with ADHD and 169,842 have a firstborn child without ADHD. Ten years after the birth of the child, parents of children diagnosed with ADHD have a 75% higher probability of having dissolved their relationship and a 7–13% lower labor supply. Parents of children with ADHD are, however, particularly disadvantaged in terms of socioeconomic background and mental health. We explain about half of the gaps in partnership stability and labor supply when these factors are taken into consideration, but a statistically and economically significant gap remains to be explained. Additionally, we find that the receipt of a diagnosis to some extent moderates the influence of underlying ADHD on partnership stability. Still, our study concludes that poor child health in terms of ADHD reduces parental socioeconomic status (SES) by lowering their labor supply (and earnings) and reducing relationship stability.     

香港特别行政区医院体制改革

香港特别行政区的卫生筹资及服务主要由政府提供。但通过改革，政府管理的职能已从直接提供医院服务，逐渐转到对医疗质量的监管，具体的立公医院管理工作则由医院管理局负责。医院管理局管理香港所有公立医院、诊所的财务预算分配、医疗服务质量，并将公立医院分成8个网络，网络内医院互相合作，以提高资源的利用率。香港医院通过加强继续教育、临床工作审核、整体护理、落实临床诊疗常规，同行评议等措施，来提高医院服务质量。     

Antagonism of Corticotrophin‐Releasing Factor Type 1 Receptors Attenuates Caloric Intake of Free Feeding Subordinate Female Rhesus Monkeys in a Rich Dietary Environment

Social subordination in macaque females is a known chronic stressor and previous studies have shown that socially subordinate female rhesus monkeys consume fewer kilocalories than dominant animals when a typical laboratory chow diet is available. However, in a rich dietary environment that provides access to chow in combination with a more palatable diet (i.e. high in fat and refined sugar), subordinate animals consume significantly more daily kilocalories than dominant conspecifics. Substantial literature is available supporting the role of stress hormone signals in shaping dietary preferences and promoting the consumption of palatable, energy‐dense foods. The present study was conducted using stable groups of adult female rhesus monkeys to test the hypothesis that pharmacological treatment with a brain penetrable corticotrophin‐releasing factor type 1 receptor (CRF₁) antagonist would attenuate the stress‐induced consumption of a palatable diet among subordinate animals in a rich dietary environment but would be without effect in dominant females. The results show that administration of the CRF₁ receptor antagonist significantly reduced daily caloric intake of both available diets among subordinate females compared to dominant females. Importantly, multiple regression analyses showed that the attenuation in caloric intake in response to Antalarmin (Sigma‐Aldrich, St Louis, MO, USA) was significantly predicted by the frequency of submissive and aggressive behaviour emitted by females, independent of social status. Taken together, the findings support the involvement of activation of CRF₁ receptors in the stress‐induced consumption of excess calories in a rich dietary environment and also support the growing literature concerning the importance of CRF for sustaining emotional feeding.