关于高等医学教育管理体制与学制改革的思考

高等医学教育管理体制与学制改革是二十一世纪社会发展的需要。文章阐述了医学教育小规模、长学制、高投入的基本特征,强调了遵循医学教育规律的重要性,分析了医学院在综合性大学的重要地位,医学院与附属医院以及相关院系的关系。文章还依据社会发展的需要和医学教育国际化的趋势,分析了医学教育学制调整的必要性以及学制调整思路。     

上海市农村合作医疗筹资与补偿调查分析

目的：为改革和完善上海市农村合作医疗的政策，制度，规划，计划，措施提供科学依据。方法：使用调查研究，比较研究，描述性统计及SAS统计分析等方法。结果：调查分析了上海市1997－1999年8区（县）合作医疗资金来源，数量，比例，补偿等。结论：1997年以来，上海市农村合作医疗得到了快速发展，仍存在保障水平，补偿比例，投保率低下及发展不平衡，资金使用不合理等问题。     

Teaching psychiatric ethics

In the last decade, we have witnessed a burgeoning of interest in ethical issues amongst psychiatrists. Teaching of the subject, however, remains at a rudimentary stage. Various approaches to such instruction are available, particularly modelling (students observe their experienced counterpart), the case method (examining specific clinical situations which involve a need for ethical decision-making), and the seminar approach (trainees are exposed to a core body of knowledge, mainly theoretical in nature). Faced with these different teaching models, the University of Oxford Department of Psychiatry has opted for a blend of all three approaches, which incorporates two goals: an increase in the trainees' sensitivity to the many intricate moral dilemmas facing the psychiatric profession; and their familiarity with salient concepts in moral philosophy which constitute a basis for ethical reasoning and which have a bearing on clinical practice. The teaching programme comprises the following: a pair of trainees prepares a presentation on an aspect of psychiatric ethics under the supervision of a senior psychiatrist. A moral philosopher assumes the role of discussant of the ethical problems raised by the trainees; this is followed by a general discussion. Topics have included involuntary hospitalization, dual loyalty, suicide, psychiatric diagnosis, and ethical issues in various spheres of psychiatric practice such as sex therapy, psychotherapy and child psychiatry. The approach has worked effectively and proved rewarding to all participants involved.     

Gestion des risques et choix de maintenance à l'hôpitalRisks management and maintenance choices at the hospital

Regulations evolve and risks management becomes one of the biomedical engineers' preoccupations. Thus, risks are various, and consequently it is difficult to identify, to manage and to bring them under control. Furthermore, regulations exist for sectors like healthcare technology monitoring, but it is not the same thing for instance for the risks linked to the maintenance. Thus regulation in the sector of maintenance evolves and the decree of the 1^st July law of health safety is going to modify the biomedical environment. The goal of this work is to study the tools and the methods of risks management that have been used for several years in the industrial field and to use them for some biomedical equipment like monitors or IV pumps. These methods adapted to these equipment will allow us to determine some appropriate rules of maintenance.     

A follow‐up study of electromagnetic interference of cellular phones on electronic medical equipment in the emergency department

Objective: Considering the growing use of cellular phones and the fast appearance of new phone models, the electromagnetic interference of currently popular cellular phones on electronic medical equipment was tested. Methods: Three Personal Communication System cellular phones were put at different distances from multiple electronic medical devices, the interference effect was observed and the electromagnetic field strength measured with a spectrum analyser. Results: Only two small pieces of equipment, the CO₂ airway adapter and the haemoglucostix meter were affected and then only when the phone was in very close proximity. Conclusion: Compared to the results of our study in 1997 testing Global System for Mobile Communication phones, the Personal Communication System phones generated less electromagnetic interference. However a much larger scaled study and an accurate international electromagnetic interference standard are recommended before any change in the current restrictive hospital policy on mobile phone usage could be recommended.     

以军事斗争卫勤准备为牵引 努力提高海上医疗救护能力

作者总结了医院开展海上卫勤战备训练的做法，在针对海上医疗救护的使命任务不断增强做好卫勤准备的责任感，紧扣海上医疗救护平台的特殊要求努力提高医院船医疗队救治能力，突破海上医疗救护技术的瓶颈制约积极开展海战伤救治技术及应用研究等方面，取得了明显效果。     

Developing a model for clinical and basic science teaching skills

This report describes a model for identifying sets of teaching abilities considered to be effective for medical school teaching staff, based on roles teachers assume and functions they are expected to perform as instructors. The specification of these teaching abilities was the first step in the development of a comprehensive course on Medical Instruction at the Basic Institute of Medical and Agricultural Biology of the State University of Sao Paulo, Botucatu, Brazil, where the senior author is employed. The work was based on the assumption that medical school teachers are expected to assume a variety of teaching roles and that identification and specification of the abilities that define their roles can result in more effective and efficient teaching.     

重视医学信用伦理的研究与开发

医疗行业市场化是必然趋势。在医疗行业市场化进程中，医学伦理道德除了道德价值之外，还含有积极的经济内涵。医学伦理道德也是重要的医疗资源，通过参与医疗市场资源的配制和运作，也可以产生经济效益，转化为医疗资本。医疗行业要重视医学伦理道德资源的开发。信用伦理是在市场经济条件下形成的，这是医学伦理学所面临的新课题。笔者认为，不说谎、不期诈，兑现承诺，保证医疗质量，发扬医学人道主义，是医学信用伦理的四项基本标准。     

肺心病患者血清碱性成纤维细胞生长因子水平的变化及其与肺动脉压的关系

目的　探讨碱性成纤维细胞生长因子 (b FGF)在低氧性肺动脉高压发病中的作用。方法　采用酶联免疫吸附法对具有低氧性肺动脉高压的肺心病患者 2 1例、无低氧性肺动脉高压的慢性阻塞性肺疾病 (COPD)患者 2 3例和 2 4例正常人血清 b FGF水平进行检测 ,以多普勒超声心动仪测定肺心病和 COPD患者的平均肺动脉压 (m PAP)。结果　肺心病组 m PAP水平 (33.33± 7.0 3m m Hg)明显高于 COPD组 (13.13± 2 .34mm Hg) ,P<0 .0 0 1;肺心病组血清 b FGF水平 (6 9.84± 16 .2 9pg/m l)明显高于 COPD组 (43.94± 7.5 7pg/ml)和正常对照组(44 .6 4± 6 .31pg/m l) ,P<0 .0 0 1;肺心病血清 b FGF水平与 m PAP之间呈明显正相关 ,r=0 .730 ,P<0 .0 0 1。结论慢性肺心病患者血清 b FGF水平明显升高 ,可能与其慢性低氧性肺动脉高压的形成有一定的关系。     

基于医疗伦理观的医疗质量成本计量与决策分析

医疗质量成本是建立在医疗伦理基础上的决策过程中或医疗服务决策时所必须考虑的一个重要因素。基于医疗伦理观的医疗信誉成本的正确计量及决策分析是医疗卫生机构提升医疗服务价值的关键所在。