An Environmental Scan of the National and Provincial Diagnostic Reference Levels in Canada for Common Adult Computed Tomography Scans

Several regulatory bodies have agreed that low-dose radiation used in medical imaging is a weak carcinogen that follows a linear, non-threshold model of cancer risk. While avoiding radiation is the best course of action to mitigate risk, computed tomography (CT) scans are often critical for diagnosis. In addition to the as low as reasonably achievable principle, a more concrete method of dose reduction for common CT imaging exams is the use of a diagnostic reference level (DRL). This paper examines Canada's national DRL values from the recent CT survey and compares it to published provincial DRLs as well as the DRLs in the United Kingdom and the United States of America for the 3 most common CT exams: head, chest, and abdomen/pelvis. Canada compares well on the international scale, but it should consider using more electronic dose monitoring solutions to create a culture of dose optimization.     

Evaluating the transparency of pharmaceutical company disclosure of payments to patient organisations in the UK

Patient organisations contribute to many areas of pharmaceutical policy. In developing their organisational capacity, many turn to financial support from pharmaceutical companies, which may create conflicts of interests. However, the transparency of the industry’s self-regulatory approach to the disclosure of payments to patient organisations has evaded scrutiny. Using company reports disclosing payments to UK patient organisations in 2012–2016, we evaluate the transparency of reporting using indicators derived from industry’s European patient organisation Code. We found a large proportion of companies did not have any disclosure reports available despite many having made payments, confirmed by comparing with annual financial accounts of patient organisations registered as charities. Where disclosure reports were available, many payments were not adequately described, resulting in large portions of money being disclosed without clarity as to the payment type and purpose. We found companies were clearer regarding whether payments were financial or benefits-in-kind, but transparency was particularly inadequate as to whether it could be determined if payments were indirect or direct and restricted or unrestricted, and almost no companies mentioned the VAT status of payments. Our findings suggest that the industry’s self-regulatory approach to transparency has not been working efficiently. We suggest ways for standardising and increasing the precision of information by pharmaceutical companies and advocate for the introduction of a centralised, and easily accessible national-level payment database.     

从产业组织学角度看中国医疗广告

随着医疗卫生体制改革的全面推行,医疗行业竞争日趋激烈,众多医院采取不同的策略组合以提高其核心竞争力,而广告正是其主要的营销策略之一.本文在对医疗广告特性、类别、作用进行分析的基础上,从产业组织学角度阐述了医疗广告与医疗市场结构、市场效益的关系,提出了中国医疗广告的发展趋势.     

化工行业职业性机械伤害危险因素的病例-交叉方法研究

目的 研究化工行业机械伤害的有关诱发因素，估计其作用强度。方法 采用病例-交叉设计的方法。以操作和检修时受伤的化工工人为研究对象，每个对象在受伤后2d内完成调查，收集他们受伤前10min、上一工作日同一段时间和受伤前1周内有关诱发因素暴露的信息，用配对时间段方法和一般频数法进行分析，评估各种诱发因素的危险度。结果 一般频数法分析的结构表明，操作方法异常、设备工具缺陷、工作紧迫、注意力不集中、不使用防护用品、精神状况较差、与同事配合不协调、工作环境发生变化等瞬时危害因素的RR值及95%可信限的下限均大于1。配对时间段方法分析的结果与其相拟，但95%可信限较宽。结论 化工行业职业性机械伤害的发生存在着诸多诱发因素。病例-交叉研究中的一般频数法与配对时间段方法相比，前者所得结果较为可靠，研究的相对效率较高。建议进一步使用多个时间段方法进行研究，以减小混杂因素的影响。     

医疗侵权责任中的过失——论医师的注意义务

过失作为构成侵权行为的一个重要条件，在医疗侵权行为中主要表现为医师的过失，其本质是对“注意义务”的违反。因此正确认识医师的注意义务，对医疗侵权行为中的过失判断有着重要意义。     

化工废水中N-亚硝基二正丙胺的吹扫捕集-GC-MS测定法

目的建立简单快速提取并测定N-亚硝基二正丙胺(NDPA)的方法。方法采用Trap3捕集管,利用标准吹扫捕集程序(吹扫气体流速40ml/min,吹扫时间11min,解吸温度225℃,解吸时间4min,烘烤温度230℃,烘烤时间10min),有效富集了化工废水中μg/L级的NDPA,建立了吹扫捕集(P&T)气相色谱质谱联用(GC-MS)化学源(CI)选择离子模式(uSIS)快速、准确分析废水中NDPA的分析方法。结果方法的相对标准偏差为7.5%;废水的加标回收率在62.60%～96.31%;在5～30μg/L范围内线性良好,线性回归系数为0.978;方法的最低检出限为3μg/L。结论采用P&T-GC-MS/CI/uSIS法可用于化工废水中半挥发性有机物NDPA的测定。     

浅谈医疗商业贿赂的成因及预防对策

医疗商业贿赂已引起全社会的高度关注，成为2006年六大重点领域里治理的商业贿赂之一。作者通过分析医疗商业贿赂的危害和原因，提出：①加强思想教育；②坚持依法行政；③完善相关制度；④深化体制改革；⑤完善监督制度等预防对策。