《侵权责任法》系列讲座之六:医事侵权赔偿散论

《医疗事故处理办法》时代,医疗事故除补偿之外,还建立了配套的保障制度,从补偿标准规定来看,当时医疗机构直接的补偿数额确实不大,但是,当时患方最终得到的补偿却并不少。《医疗事故处理条例》关于医疗事故民事赔偿的7条规定,具有可操作性,在《侵权责任法》生效后继续合法有效。死亡赔偿金现行规定存在的问题是体系混乱、内部互相矛盾、赔偿项目名称和计算标准不一致、赔偿范围不一致等。被侵权人由于其人身权益受到侵害造成死亡的能否请求精神损害赔偿,国内外立法及司法在实践和理论上都存在争议。     

医疗费用结构优化对策研究

目的就优化医疗费用结构提出几点建议,为医疗费用结构优化提供参考。方法从医疗费用结构角度,分析目前我国医疗费用结构特征,医疗市场存在的问题。结果药品费用比重居高不下,检查费比率上升过快,护理费等医疗服务所占份额相对偏低。结论完善医疗机构补偿机制、转移医疗补偿途径重心、创建医疗费用结构优化的度量标准、逐步实现对医疗费用结构定量的科学管理是优化医疗费用结构的有效对策。     

Orem自护模式及其在精神分裂症护理中评估工具的应用进展

通过综述Orem自护模式的主要内容、补偿系统在精神分裂症患者护理中的具体措施、干预效果的测评工具及干预效果,以期为今后Orem自护模式在精神分裂症护理干预及评估效果的测评工具的发展提供参考。     

Effect of mild cognitive impairment on the patterns of neural activity in early Parkinson's disease

We have previously observed decreased activation of corticostriatal loops involved in planning (cognitive loop) and execution (motor loop) of a set shift in patients with early Parkinson's disease (PD) compared with control subjects. Here, we aimed to assess whether cognitive impairment in PD could drive these differences. Nondemented patients underwent a comprehensive neuropsychological evaluation and participated in our Wisconsin Card Sorting task functional magnetic resonance imaging protocol. Patients were separated into 2 groups according to the presence of mild cognitive impairment (MCI). Patients with MCI displayed reduced activity in the cognitive corticostriatal loop, which includes the caudate nucleus and prefrontal cortex while planning a set shift, whereas non-MCI patients exhibited activation patterns similar to those of healthy participants from our previous studies. Furthermore, reduced activation was observed in the premotor cortex of the MCI patients. Finally, hippocampal activity, correlated with individual memory scores, suggesting a compensatory mechanism in patients with preserved memory. These results suggest that the presence of MCI in PD affects activity in the prefrontal cortex and caudate nucleus as well as motor-related regions.     

Structural brain plasticity in Parkinson's disease induced by balance training

We investigated morphometric brain changes in patients with Parkinson's disease (PD) that are associated with balance training. A total of 20 patients and 16 healthy matched controls learned a balance task over a period of 6 weeks. Balance testing and structural magnetic resonance imaging were performed before and after 2, 4, and 6 training weeks. Balance performance was re-evaluated after ∼20 months. Balance training resulted in performance improvements in both groups. Voxel-based morphometry revealed learning-dependent gray matter changes in the left hippocampus in healthy controls. In PD patients, performance improvements were correlated with gray matter changes in the right anterior precuneus, left inferior parietal cortex, left ventral premotor cortex, bilateral anterior cingulate cortex, and left middle temporal gyrus. Furthermore, a TIME × GROUP interaction analysis revealed time-dependent gray matter changes in the right cerebellum. Our results highlight training-induced balance improvements in PD patients that may be associated with specific patterns of structural brain plasticity. In summary, we provide novel evidence for the capacity of the human brain to undergo learning-related structural plasticity even in a pathophysiological disease state such as in PD.     

下肢残肢功能综合训练系统的研发

目的　为最大限度保留下肢截肢患者残肢残存功能,充分发挥假肢代偿功能,研制开发了具有数字化控制和反馈的下肢残肢功能综合训练系统。方法　由髋关节训练系统和膝关节训练系统两部分组成,可增大关节活动角度、增加残肢肌容积、促进残肢愈合。结果　根据多病科结合,成功研发出综合康复训练系统。结论　该系统从根本上提高截肢者的残肢功能,促进残肢定型,改善残肢装配假肢所需条件。     

Neurologic evaluation of dysphagia

Unexplained dysphagia is often caused by unrecognized neurologic disease. A previous article (Buchholz 1987) discussed the many neurologic diseases that may cause dysphagia. This article reviews a neurologist's approach to dysphagia of possible neurologic origin. As with most medical problems, a careful history provides more information about dysphagia than any other data-gathering technique. Therefore, history-taking is discussed first, followed by review of pertinent aspects of the general and neurologic examinations and ancillary testing.     

基于云式薪酬的公立医院薪酬体系优化研究

介绍了云式薪酬理论及其优化层次。通过对公立医院的薪酬体系进行优化,使薪酬体系能够覆盖到医院内每一名员工,并将医疗服务和对医院的战略性贡献进行量化,使其与薪酬有机结合,实现薪酬的柔性化,对于医疗行业的薪酬激励制度创新具有一定的借鉴意义。