推行院务政务公开 促进医院和谐发展

本文介绍了自2002年2月新一届领导班子成立以来,东莞市桥头医院紧紧围绕医院发展大局,创新管理机制,大力推行院务政务公开的具体做法、成效及其体会,有力地促进了医院的和谐发展。     

药品行政处罚中自由裁量权的运用及其内部控制

通过阐述自由裁量权的形成及在药品行政处罚中的表现,进一步探讨药品行政管理机关如何加强对自由裁量权的内部控制,减少因"恣意裁量"而导致的行政复议和行政诉讼的发生.     

药品行政保护品种介绍:神经系统与精神药物(五)(续完)

神经妥乐平片剂通用名:牛痘免疫病毒疫苗接种家兔炎症皮肤组织提取物片剂.商品名:神经妥乐平(Neurotropin)片剂.     

卫生行政处罚裁量标准制定过程中存在的问题及思考

卫生行政机关通过制定裁量标准等形式对行政处罚自由裁量权进行限制是必要的,但应正确把握对裁量权的限制程度,防止走向僵化.裁量标准制定主体的多元化带来了法制统一问题和低层级行政机关制定裁量标准是否合法的疑问.在具体裁量标准的制定中,还存在对法律越权变更、过于僵化、忽视部分裁量因素、不同地域差距过大等问题,需要进一步研究和思考.     

Le politiquement incorrect en psychiatrie : l’expérience d’une vie professionnelle

The author criticizes theorists show, phenomenon of “administrative ecstasy”, and dominance of political correctness against truth and scientifically established facts. He tells three professional experiences where he refuses the official position, preferring the politically incorrect: mental report, AIDS in prisons, care reform in his own prison psychiatric department.     

Hepatitis C Testing,Status and Treatment among Marginalized People Who Use Drugs in an Inner City Setting: An Observational Cohort Study

Background: Chronic hepatitis C virus (HCV) infection is common among people who inject drugs (PWID) and is associated with morbidity and premature death. Although HCV can be cured, treatment may be inaccessible. We studied HCV testing, status and treatment among marginalized people who use drugs in Ottawa, Canada, a setting with universal insurance coverage for physician services.

Methods: We analyzed data from the Participatory Research in Ottawa: Understanding Drugs study, a cross-sectional, peer-administered survey of people who use drugs from 2012 to 2013. We linked responses to population-based health administrative databases and used multivariable Poisson regression to identify factors independently associated with self-reported HCV testing, self-reported positive HCV status, and database-determined engagement in HCV treatment. Results: Among 663 participants, 562 (84.8%) reported testing for HCV and 258 (45.9%) reported HCV-positive status. In multivariable analysis, HCV-positive status was associated with female gender (RR 1.27; 95%CI 1.04 to 1.55), advancing age (RR 1.03/year; 95%CI 1.02 to 1.04), receiving disability payments (RR 1.42; 95%CI 1.06 to 1.91), injecting drugs (RR 5.11; 95%CI 2.64 to 9.91), ever injecting with a used needle (RR 1.30; 95%CI 1.12 to 1.52), and ever having taken methadone (RR 1.26; 95%CI 1.05 to 1.52). Of HCV positive participants, 196 (76%) were engaged in primary care but only 23 (8.9%) had received HCV therapy. Conclusions/Importance: Although HCV testing and positive status rates are high among PWID in our study, few have received HCV treatment. Innovative initiatives to increase access to HCV treatment for PWID are urgently needed.     

Disease-Modifying Therapy Adherence and Associated Factors in a National Sample of Medicare Patients With Multiple Sclerosis

ObjectivesDisease-modifying therapies (DMTs) reduce relapse rates and disability progression for relapsing multiple sclerosis (MS). Although 25% to 30% of all US patients with MS are Medicare beneficiaries, limited information exists on this population. This is the first study using national Medicare data to (1) describe characteristics of patients with MS using DMTs, (2) estimate adherence to DMTs over a 1-year and 3-year follow-up, and (3) examine factors associated with DMT adherence.MethodsThis retrospective claims analysis used 2011-2014 100% Medicare files. Monthly adherence to MS DMTs was defined as the proportion of days covered ≥0.80 with any DMT in each month for 1-year (n = 36 593) and 3-year (n = 17 599) follow-up samples of MS DMT users. Generalized estimating equation logistic regressions were used to estimate factors associated with adherence to DMTs.ResultsOver 90% of patients were eligible for Medicare owing to disability, and about three-quarters qualified for low-income subsidies. A downward trend in DMT adherence was observed over time in both samples. Monthly adherence dropped significantly between December of the prior year to January of the following year (from 76% to 65% in the 1-year follow-up sample and similar drops seen across all years in the 3-year follow-up sample). Multivariable regressions indicated characteristics such as being low-income, having a disability, and having high patient out-of-pocket DMT costs associated with poor adherence to DMTs.ConclusionOur study provides important insights into the characteristics and DMT adherence of Medicare patients with MS and highlights the need for interventions and policies mitigating barriers to adherence in this population.     

Choice of ICD‐10 codes for the identification of acute coronary syndrome in the French hospitalization database

The objective of this study was to evaluate the performance of the ICD‐10 (International Classification of Diseases and Related Health Problems, 10^th Edition) coding in the French hospitalization database (PMSI) to identify acute coronary syndrome (ACS) occurrence. Eligible hospitalizations were those that occurred at the Bordeaux teaching hospitals between 1 January 2011 and 31 December 2011 and had one of the ICD‐10 codes related to ischaemic heart diseases (I20 to I25, excluding I23 and I25.2). Among these, 100 hospitalizations were randomly selected; for each case, the ACS diagnosis was confirmed/excluded after medical file examination by an independent events validation committee and the performance of codes, and combinations of codes, to identify ACS was evaluated by calculating the positive predictive value (PPV). Of the individual codes, I20.0, I21 and I24 had the highest PPV; 100.0% for I24 (95%CI [15.8–100.0]); 90.0% for I21 (95%CI [76.3–97.2]); and 66.7% for I20.0 (95%CI [38.4–88.2]). The combination of I20.0 or I24 codes was able to identify 12 of the 56 validated ACS cases with a PPV of 70.6% (95%CI [44.0–89.7]), the combination of I21 or I24 identified 38 cases with a PPV of 90.5% (95%CI [77.4–97.3]), the combination of I20.0 or I21 identified 46 cases with a PPV of 83.6% (95%CI [71.2–92.2]), and the combination of I20.0, I21 or I24 identified 48 cases with a PPV of 84.2% (95%CI [72.1–92.5]). The combination of I20.0, I21 or I24 codes had the best performance to identify occurrence of ACS in the French hospitalization database.