Best Interests in the MCA 2005—What can Healthcare Law Learn from Family Law?

The 'best interests' standard is a highly seductive standard in English law. Not only does it appear to be fairly uncontroversial but it also presents as the most sensible, objective and 'fair' method of dealing with decision making on behalf of those who are perceived to be the most vulnerable within society. This article aims to provide a critical appraisal of how the standard has been applied within family law, to outline how the standard is to be applied within healthcare law and, finally, to assess the relevance of the family law experience of the best interests standard to the operation of the standards as envisaged by the MCA.     

浅析医院文化建设——内强职工向心力,外树医院公益形象

上海市第一人民医院通过组织各类义诊、为社区群众提供爱心医疗服务、推出便民惠民措施、举办科普知识讲座、捐献造血干细胞等各种大型公益行动,树立了医院良好的社会形象;通过举办干部培训班和专题讲座,提高干部管理能力和沟通技巧;开展现场救援培训和技术比武,提高临床服务水平;召开老干部座谈会,进行党性教育,增强职工凝聚力。     

Factors associated with difficult electronic health record implementation in office practice

Little is known about physicians' perception of the ease or difficulty of implementing electronic health records (EHR). This study identified factors related to the perceived difficulty of implementing EHR. 163 physicians completed surveys before and after the implementation of EHR in an externally funded pilot program in three Massachusetts communities. Ordinal hierarchical logistic regression was used to identify baseline factors that correlated with physicians' report of difficulty with EHR implementation. Compared with physicians with ownership stake in their practices, physician employees were less likely to describe EHR implementation as difficult (adjusted OR 0.5, 95% CI 0.3 to 1.0). Physicians who perceived their staff to be innovative were also less likely to view EHR implementation as difficult (adjusted OR 0.4, 95% CI 0.2 to 0.8). Physicians who own their practice may need more external support for EHR implementation than those who do not. Innovative clinical support staff may ease the EHR implementation process and contribute to its success.     

医改过程中医院转制现象引发的思考

两次医改过程中,我们分别看到了一种怪现象即少数地方出现公立医院被“卖出”后又被“回购”,引起了人们的高度关注。新医改方案出台伊始,人们不禁担忧个别地方的“回购”风潮将使新医改走向何方？面对新动向,医院管理同仁有必要对此现象进行深入思考,为建立、健全医改配套方案和行为规范积极作为,以保障新医改的正确方向。文章认为,保障宏观卫生政策的稳定和促进医疗卫生事业的发展既是政府的责任,也是医务人员的心声,要加强医改配套方案和制度建设,提高地方政府行政能力,维护人民健康权益、“实现人人享有基本医疗卫生服务”的责任和义务。     

Evaluating a service-learning assignment in a doctor of chiropractic program public health course

ObjectiveDespite the use of service learning in other health care education programs, little is published about its use in doctor of chiropractic programs. Since 2017, the public health course at our institution has included a service-learning assignment in which students volunteer for nonprofit organizations and write an essay about their experience. The objective of this study was to assess the effects of the assignment on students'' self-reported public health knowledge and attitudes.MethodsBetween April 2017 and June 2018, 56 essays were collected from students who volunteered at a nonprofit organization focused on 3 categories: youth, the environment, or poverty. Each essay was deidentified and assigned random 4-digit-number file names. Ten files were randomly selected from each of the 3 categories for qualitative thematic analysis using deductive and inductive coding.ResultsStudent essays demonstrated competency in public health concepts, including organizational systems, levels of prevention, and the social ecological model. In addition, a majority of the students went beyond discussing knowledge gained from this assignment and described the impact of their experience on their personal growth.ConclusionThis study demonstrates that students respond favorably to a service-learning assignment that addresses public health competencies and may foster personal and professional development.     

我国31家省级中医院医生福利待遇满意度及人口学影响因素研究

目的调查我国省级中医院医生福利待遇满意度及人口学影响因素。方法选取全国31个省（自治区、直辖市）31家省级中医院医生进行福利待遇满意度问卷调查。采用SPSS 25.0 软件对数据进行统计学分析。结果被调查中医院医生过去1 a税后实际收入中位数为12万元。薪酬、法定假期、学习深造、餐食、休息室数量满意度分别为27.83%、33.56%、58.67%、44.30%、69.84%。性别、年龄、行政职务是薪酬满意度影响因素,性别、学历、职称、科室和行政职务是法定假期满意度影响因素,性别、年龄、学历和行政职务是学习深造满意度影响因素,性别、学历、职称、科室和行政职务是餐食满意度影响因素,性别、职称、科室和行政职务是休息室数量满意度影响因素。结论被调查中医院医生福利待遇整体情况呈向好趋势,但实际收入不高,薪酬满意度较低。中医院应积极落实国家相关政策要求,根据不同人口学特征医生不同需求,多途径提高医生福利待遇。     

Meta-analysis of determinants for pet ownership in 12 European birth cohorts on asthma and allergies: a GA2LEN initiative

Background: Studies on pet ownership as a risk or protective factor for asthma and allergy show inconsistent results. This may be on account of insufficient adjustment of confounding factors. Aim: The objective of this study was to describe determinants of cat and dog ownership in European families with and without allergies. Methods: Within the EU‐funded network of excellence GA²LEN, we performed meta‐analyses with data from 12 ongoing European birth cohort studies on asthma and allergy. Each of the birth cohort studies enrolled between 485 and 4089 children. Pet ownership, allergic status (asthma, allergic rhinitis, eczema) of parents and siblings, parental education, access to ground floor, and number of people living at home were assessed by questionnaires. Results: Among the 25 056 families from seven European countries cats (14.9%) were more common than dogs (12.0%). Allergic family history significantly reduced the odds to own a cat (adjusted combined random‐effect OR 0.91; 95% CI 0.85–0.99), or dog (0.90; 0.86–0.94). A higher parental educational level had even more pronounced effects on cat (0.84; 0.71–0.98), and dog ownership (0.61; 0.54–0.70). Elder siblings reduced the odds to own cats, but not dogs. Convenient ground access significantly increased the odds, whereas crowding at home was not associated with cat or dog ownership. Conclusions: The chances to own a cat or dog were significantly reduced in allergic families, in parents with a higher educational level, and in homes without convenient ground access. In addition to parental allergies, social and housing factors should be considered as potential confounders in studies on pet exposure and allergic diseases.     

Heart rate variability as a measure of autonomic regulation of cardiac activity for assessing stress and welfare in farm animals -- a review

Measurement of heart rate variability (HRV) is a non-invasive technique that can be used to investigate the functioning of the autonomic nervous system, especially the balance between sympathetic and vagal activity. It has been proven to be very useful in humans for both research and clinical studies concerned with cardiovascular diseases, diabetic autonomic dysfunction, hypertension and psychiatric and psychological disorders. Over the past decade, HRV has been used increasingly in animal research to analyse changes in sympathovagal balance related to diseases, psychological and environmental stressors or individual characteristics such as temperament and coping strategies. This paper discusses current and past HRV research in farm animals. First, it describes how cardiac activity is regulated and the relationships between HRV, sympathovagal balance and stress and animal welfare. Then it proceeds to outline the types of equipment and methodological approaches that have been adapted and developed to measure inter-beats intervals (IBI) and estimate HRV in farm animals. Finally, it discusses experiments and conclusions derived from the measurement of HRV in pigs, cattle, horses, sheep, goats and poultry. Emphasis has been placed on deriving recommendations for future research investigating HRV, including approaches for measuring and analysing IBI data. Data from earlier research demonstrate that HRV is a promising approach for evaluating stress and emotional states in animals. It has the potential to contribute much to our understanding and assessment of the underlying neurophysiological processes of stress responses and different welfare states in farm animals.     

Studies of stress in farm animals

Major changes have taken place in animal production over the last three decades. Housing conditions have changed dramatically over this period, and there has been a striking increase in production. Agricultural animals try to cope with these highly demanding conditions (stressors) using behavioural and physiological stress responses aiming to restore homeostasis. When these responses are not successful or when they are thwarted, typical behavioural and physiological symptoms of chronic stress occur. In this situation, the welfare of the animal is clearly at stake. Moreover, chronic stress may seriously affect the efficiency of animal production and the quality of the product. Ultimately, detailed knowledge of stress responses in agricultural animals will allow the formulation of housing and management requirements, including handling by humans, which will benefit welfare and health of farm animals as well as production efficiency. This paper briefly addresses some important issues regarding the study of stress and welfare in farm animals, and discusses some recently developed experimental methods as well as relevant results obtained in our laboratory. Originally presented at ECCP 97.     

A welfare-theoretic model consistent with the practice of cost-effectiveness analysis and its implications

I look at three debates in the health economics literature in the context of cost-effectiveness analysis (CEA): 1) inclusion of future costs, 2) discounting, and 3) consistency with a welfare-economic perspective. These debates thus far have been studied in isolation leading to confusion and lingering questions. I look at these three debates holistically and present a welfare theoretic model that is consistent with the practice of CEA and can help inform all of these three debates. It shows rationales for the recommendations of the Second Panel and clarifies some nuanced implications for the practice of CEA when taking a societal perspective in the context of distributional CEA and multi-sectorial budgets.