Compliance with the legal age limits for alcohol,tobacco and gambling – A comparative study on test purchasing in retail outlets

Aim: To assess whether retail outlets comply with the minimum legal age of 18 for the purchase of alcohol and tobacco and for gambling on slot machines in Finland. Methods: A test-purchase research in 117 retail outlets selling alcohol, tobacco and supplying slot machines in two towns. Five-hundred fifty-seven purchase attempts were made for alcohol (n?=?173), tobacco (n?=?177) and gambling on slot machines (n?=?170) in private outlets and 37 attempts in government alcohol retail monopoly outlets. The differences in denial rates and factors of potential significance for denials were tested using logistic regression. Findings: The denial rate for gambling on slot machines was 4%. The odds that an alcohol or a tobacco purchase was denied were 25- and 20-fold, respectively, compared to gambling. The odds of denial of an alcohol purchase were 12-fold in alcohol monopoly stores compared to private outlets. Conclusion: The low compliance with the age limit for gambling is a challenge in a gambling policy system where slot machines are decentralized in private retail outlets and are widely available. The high denial rate in government alcohol retail monopoly outlets indicates that monopoly outlets are more capable of enforcing legal age limits effectively compared to private outlets.     

医疗纠纷中电子病历应用的相关问题思考

医疗纠纷已经成为社会的一个热点问题,而针对医疗文书在医疗纠纷诉讼中的重要作用,在了解我国电子病历应用和立法现状的基础上,对数据电文构成的病历的合法性进行探讨,并根据电子病历能够替代纸病历,同时在医疗纠纷中具有法律效力。     

Violations of medical confidentiality: opinions of primary care physicians

Background

Physicians should be able to distinguish situations where they need to protect confidentiality from those where they could be obligated to reveal information. Data are scarce concerning physician''s attitudes in daily situations where violations of confidentiality are avoidable. Physicians should be aware of situations where patients are identifiable.

Aim

To solicit participation of primary care physicians in a teaching intervention and to explore participants'' opinions on violations of confidentiality.

Design of study

A questionnaire presented seven vignettes describing avoidable violations of confidentiality (for example, without patient consent a physician mentions a politician''s illness their spouse). Participants answered on a scale of 0–3 (0 = no violation and 3 = serious violation). All contacted physicians were invited to a teaching session during which the study results were discussed.

Method

Three-hundred and seventy-eight members of the Association of Physicians in Geneva (community physicians) working in primary care medicine, and 130 GPs and internists working at the University Hospital of Geneva (hospital physicians) took part. Physicians'' answers were compared to responses from Swiss, UK, and other European law professors, and from 311 medical and law students in Geneva.

Results

Between 4% (case 6) and 57% (case 2), of physicians thought that no violation occurred. Law professors attributed the scores to each case as 3, 3, 2, 3, 2, 3, 3; the means of physicians were: 1.9, 1.4, 0.7, 1.4 (hospital physicians)/1.9 (community physicians), 0.4, 1.6, 2.6. In most cases, physicians'' and students'' answers were similar. A significantly higher percentage of community physicians than hospital physicians and students thought that a physician violates confidentiality if they provide the list of their patients to the police for the investigation of the theft of a purse in the waiting room.

Conclusion

Physicians need to be fully aware of their obligations towards patient confidentiality. Avoidable breaches of confidentiality occur when colleagues and authorities (such as police and those in a judicial context) ask for information.     

图书馆利用博客(Blog)深化人性化服务的探讨

博客(Blog)人性化的特征和“自由、共享、奉献”的文化精神与当代图书馆人性化的发展趋势有着天然的共通性,图书馆利用博客(Blog)深化人性化服务,是现代信息技术与人文科学的相互提升,是双赢之举。     

Ethical,legal, and practical concerns about recontacting patients to inform them of new information: The case in medical genetics

There is a consensus among medical geneticists that it is desirable to recontact patients as new information becomes available. Furthermore, some have suggested that there are legal arguments to support an obligation, creating a duty to recontact. Thus far much of the discussion among medical geneticists has focused on the practical concerns of implementing such a policy. However, we think that any such policy raises a number of important ethical concerns that must first be considered. Furthermore, there has not been a careful evaluation of the legal precedents that may reflect on a hypothetical duty to recontact. In this paper we first present an analysis of the scope of approaches and issues to be addressed in the development of ethical policy on this question. Secondly, we examine whether there is a legal obligation to recontact former patients about advances in genetics, as well as the legal implications if such a policy were to be adopted. Finally, we consider some of the functional and resource implications of adopting a policy of recontact. Our goal is to provide a framework for further discussion of this question and to stimulate further debate and research. © 2001 Wiley‐Liss, Inc.     

《传染病防治法》医疗救治法律制度之完善

现行《传染病防治法》中的医疗救治制度为防控传染病提供了基本法律保障。但此次新冠肺炎疫情的大规模扩散,也充分暴露出传染病医疗救治法律制度在设计及运行中存在的短板和不足:救治网络不健全、应对突发重大疫情能力不足、体系建设主体缺位、人力和物资储备供给机制不完善、医患权利和义务不清、医疗费用保障不明确。为此,需对《传染病防治法》中的医疗救治法律制度进行补充完善。作者从传染病救治网络建设、物资及经费保障、人力调配与保障、医患法律关系及权益保护等方面提出完善建议,以期为及时调整医疗救治制度提供参考。     

肾系藏象病位与病性特征研究

肾系主要包括肾及与之相关联的膀胱、命门、胞宫、精室、二阴、髓、骨、耳、发、齿等。通过收集大量肾系临床病案,在参考中医古籍及专家意见的基础上,系统地归纳并规范了肾系的病位、病性特征症,总结了临床上常见肾系基础证与复合证,为肾系疾病证的诊断提供参考。      

脾系藏象病位与病性特征研究

脾系主要包括脾及与其直接相关联的脏腑、官窍、经络等。通过收集大量脾系临床病案,在参考中医古籍及专家意见的基础上,根据脾系统的生理功能和病理特点,系统地阐述、规范了脾系病位、病性特征症, 总结了临床上常见脾系基础证与复合证,为脾系疾病证的诊断提供参考。      

从《两都医案》探析明代医家倪士奇脉诊特色

[目的]通过对《两都医案》的整理分析,探析明代医家倪士奇的辨证思维及脉诊特色。[方法]运用文献学方法,将《两都医案》中涉及到脉象及脉理阐释的部分进行分类整理,从病因、病机、病位、病性等方面分析倪士奇脉诊特色。[结果]《两都医案》共载医案69则,均有详细的脉象描述及脉理分析,其脉诊特色为:以脉定病因,通过人迎脉辨别内伤外感,并且将人迎脉的变化作为疾病痊愈的标准;以寸、关、尺脉象局部脉判断患者五脏生克关系,从而确定疾病的内在机制;以脉定病性,对于厥症阴阳之气不相顺接者,多舍症从脉;治内痈,皮色不变难以辨证者,以脉诊确定病位,左手沉数则内痈在左,右手沉数则痈在右,中央沉数则痈在中。[结论]《两都医案》内容丰富,阐理详尽,反映了倪士奇的系统辨证思维及诊脉特色,具有独特的临床价值,值得后世进一步研读、总结及传承。     

郭顺治疗面部激素依赖性皮炎临证经验

[目的]总结郭顺主任治疗面部激素依赖性皮炎的辨治思想和遣方用药经验。[方法]通过查阅激素依赖性皮炎的相关文献及指南,结合门诊抄方学习,从病因病机、糖皮质激素(以下简称激素)副作用与激素依赖的鉴别、整体与局部辨治、用药经验等方面阐释郭师治疗激素依赖性皮炎的临床经验,并附一则医案加以验证。[结果]激素依赖性皮炎又称皮质类固醇激素依赖性皮炎,以火、热、毒为主要致病因素,以清热泻火、凉血解毒、养阴润燥等为治疗大法。郭师以五行学说为基,据皮肤“金水之性”立法,临证以“火性”认识激素,明确激素副作用与激素依赖之区别:激素副作用病机为火毒炽盛,甚则耗伤阴液,治以清热泻火养阴;激素依赖由长期使用激素,在表阳气耗损所致,当以温阳为法。所举验案为激素依赖所致脾肾两虚,治疗当以温补脾肾为原则,方选附子理中汤合凉血五花汤加减,治疗后获得显著疗效。[结论]郭师从火论治激素依赖性皮炎,注重整体,明辨激素副作用与激素依赖,分别治以清热养阴和温阳之法,再结合局部辨治,疗效颇佳,其经验值得临床推广学习。