The effect of malpractice law on physician supply: Evidence from negligence-standard reforms

We explore whether the composition of the physician workforce is impacted by the clinical standards imposed on physicians under medical liability rules. Specifically, we explore whether the proportion of non-surgeons practicing in a region decreases—and thus whether the proportion of surgeons increases—when liability standards are modified so as to expect that physicians practice more intensively. For these purposes, we draw on a quasi-experiment made possible by states shifting from local to national customs as the basis for setting liability standards. Using data from the Area Health Resource File from 1977 to 2005, we find that the rate of non-surgeons among practicing physicians decreases by 2–2.4 log points (or by 1.4–1.7 percentage points) following the adoption of national-standard laws in initially low surgery-rate regions—i.e., following a change in the law that effectively expects physicians to increase their use of surgical approaches.     

热敏灸治疗顽固性呃逆案

热敏灸作为一种新型的灸疗方法,《医宗金鉴》中述“凡灸诸病,必火足气到,始能求愈”,故热敏灸讲究“敏消量足”,举一临床顽固性呃逆病案加以细说。     

口语化疾病名称向国际规范疾病术语集的映射研究

目的：研究患者口语化疾病名称到术语疾病名称的映射，解决在线口语化疾病名称难以有效利用的问题。方法：抓取“微医网”上患者口语中的疾病名，将PubMed摘要、百度搜索页摘要与百科内容作为语料，训练词向量，用余弦距离计算相似度，由2名具有临床知识和从业经验的编码人员对结果的准确性进行检验。结果：将最相似词条的参数TopN设置为>= 30的时候效果比较好，映射到大类和细类的准确性分别稳定在60%和70%左右。结论：利用词向量将口语化疾病名称映射到国际疾病术语集，具有较强的通用性和可行性，对于在线问诊、智能分诊甚至自动化编码具有明显的参考借鉴价值。     

患者安全目标:加强医学装备安全与警报管理

阐述医疗器械使用安全与警报管理的意义和内涵，分析医疗器械使用安全与警报的风险点，探讨建立医疗器械使用安全与警报风险防范体系的方案，列举了医疗器械使用安全与警报管理的实践案例。     

关于医学硕士研究生科研写作能力的培养思考

随着国家社会经济的高速发展,各领域都需要更多高层次拔尖创新性人才。我国医药卫生事业的快速、稳定发展将会直接关系国民生命的健康,这就需要培养大量硕士研究生及以上的医学高层次人才。目前,医学硕士研究生还存在着科研能力不足的现状,而科研写作是科研水平和科研质量的呈现,是增强沟通、提高创新性的必然媒介。就如何培养提高医学硕士研究生写作能力内外部影响因素进行了阐述,并提出了改善方法。     

Droit à mourir et suicide assisté : état des lieux et analyse critique

ObjectivesIn the context of the present re-examination of the French bioethical laws by the National Advisory Ethics Committee (“Comité consultatif national d’éthique”: CCNE), a recent survey indicated a request of the public opinion to obtain a medical aid in end of life and a so-called “assisted suicide”. This led psychiatrists to re-consider their role and deontological position which usually led them to consider a request for an assistance in suicide as – a priori – a pathological demand, occurring within a suicidal crisis. The present article intends to: 1) describe the laws and practices of countries which allow medically assisted end of life help procedures; 2) clarify the definitions of “assisted suicide”, “assistance to suicide” and “euthanasia”; 3) consider available epidemiological data and the roles given to doctors and, more specifically psychiatrists, in these procedures; 4) analyse the rationale behind these demands. These considerations should enable French psychiatrists to clarify their position when facing requests for a medical aid in dying.MethodsFour European countries (Switzerland, the Netherlands, Belgium, Luxemburg) and Oregon (the first US state to introduce legislation) were considered, since they accumulated and published a large amount of experiences and data about “assisted suicide” and medical help in dying. In total, 127 articles were selected, mainly from PubMed and Cairn databases, published between 1997 and 2020. These articles deal with legal considerations, epidemiological data, ethical and sociological considerations.ResultsLaws and practices differ notably according to the state/country. In Belgium, the Netherlands and Luxemburg, as in Oregon, the medical help in dying has been de-criminalized, as long as certain legal criteria are met. In Switzerland, where no specific law exists in the penal code, non-governmental associations have benefited from the legal vacuum and organized the practice of “assisted suicide” for “altruistic motives”. In the scientific and legal literature, the terms used to describe and define the medical help in dying upon request differ greatly. In France, the National Advisory Ethics Committee defines euthanasia (“euthanasie”), assisted suicide (“suicide assisté”) and suicide assistance (“assistance au suicide”). Available epidemiological data, whatever the country considered, indicate that requests for a medical aid in dying are expressed mainly by patients aged over 60 years and suffering from cancer. Psychiatric diseases account for only 1% to 3%. Most often, systematic assessment by a psychiatrist is neither requested nor made, when the demand does not occur during a primary psychiatric illness. In the case of an existing primary psychiatric pathology, a psychiatrist assesses the case against formal legal predefined criteria. This latter practice was only recently introduced, after some feedback and after legal actions had been brought to Court. When the underlying motivations of the request are considered, it appears that, even in the absence of an evolving psychiatric condition, several psychological or psychopathological reasons prevail such as spirituality, attachment style, social isolation, despair, depression… which should greatly benefit psychiatric exploration, investigation and expertise.ConclusionIn some countries, the request for medically assisted help in dying has become a legal and social reality. In France, where the public debate is still open, it should be emphasized that a psychiatric assessment and interview should be systematically provided to any person requesting medical assistance to die or commit suicide. It is the commitment of psychiatrists to understand the implicit demands and unexpressed motives underlying this request which have strong links with the unique life-events and emotional experiences of the person. The psychiatrist has a unique role in the contextualization of such a request.