沟通、信任、和谐——第二届医师协会医师节活动在人民大会堂举行

<正>本刊讯2012年6月26日第二届医师协会"医师节"活动在人民大会堂拉开了大幕。中国医师协会和各地医师协会领导、各专科医师分会、专业委员会、协会主办报刊代表等近600人参加此次医师节活动。医师协会"医师节"是应各地医师协会和医师们的倡议于2011年设立的,选定6月26日是根据1998年6月26日九届全国人大常委会第三次会议通过了《中华人民共和国执业医师法》,医师协会也是依照《医师法》而成立。"医师节"的设立为了激励广大医师自尊、自爱,热爱本职、忠于岗位,崇尚医德、钻研医术,引导全社会理解和     

陈志潜先生公共卫生实践对完善公卫医师执业制度的启示

目的 探讨陈志潜先生公共卫生实践对新时期完善公共卫生医师执业制度的启示。方法 通过文献研究对中国公共卫生之父陈志潜先生的公共卫生实践进行总结,并通过比较公共卫生医师和临床医师的执业模式,提出公共卫生医师的核心职能和完善公共卫生医师执业制度的建议。结果 完善新时期公卫医师执业制度需明确公卫医师的核心职能,包括公共卫生调查、诊断、干预制定、实施和效果评价,需保障公卫医师处方权,建立完善上下级公卫医师的工作机制、公共卫生医师与其他类别医师的会诊制度、与其他医疗卫生专业人员之间、以及其他非医疗卫生专业人员之间的工作机制。结论 可通过明确公卫医师的核心职能、执业领域、落实公卫医师处方权、明确公卫医师与其他工作者之间的工作机制等完善公卫医师执业制度。     

医师执业权利的保障

医疗行为是一项具有高风险性的行为,医师执业兼具科学性和社会性,医师执业权利是获得医师资格和注册许可的医师在执业活动中享有的权利,医师执业过程中的权利应该得到充分的保障,医师执业权利的保障需要医师自身和社会的共同努力。     

执业医师的细分与规范化管理

目前，在中国医疗机构中工作的医生可按照执业证书、执业地点、执业类别、执业范围、执业资格进行分类。具体又可细分为：医疗机构正式聘用的拥有卫生部颁发医师执业证书的本机构执业医师（包括执业医师和执业助理医师）；在医疗机构进修的医师；短期行医的境外医师；军队专业医师；实习医师。细分后的各种医师情况各异，有的情况尚不在《执业医师法》调整的范围之内。文章回顾了我国执业医师队伍建设的历史和现状，提倡引进医师培养国际标准的同时体现本国特色，提出了完善医师管理工作的建议。     

医师工作能力的现况分析

[目的]了解医师的工作能力现况及其影响因素。[方法]应用工作能力指数(Work Ability Index,WAI)法对342名医师(医师组)和362名非卫生部门脑力劳动者(对照组)进行测试和分析。[结果]医师工作能力以中等占绝大多数(77.5%)。男医师工作能力指数的平均水平高于女医师(t=2.03,P<0.05);男女医师工作能力均呈现出随年龄的增高而下降的趋势(P<0.05),中青年医师工作能力高于高龄医师。[结论]在医师人群中应积极开展职业卫生服务,以提高医师的身心健康和工作能力。     

新世纪医师职业精神——医师宣言高层论坛

新世纪的医师耻业精神——医师宣言（以下简称《医师宣言》）．是由美国内科学基金、美国医师学院基金和欧洲内科医学联盟共同发起和倡议的。中国医师协会于2005年5月22日正式加入推行《医师宣言》活动。2006年11月，“新世纪医师职业精神——医师宣言高层论坛”在北京中民大厦召开。     

上海某三甲医院推行医师执业责任保险实证研究

目的 通过实证研究,了解上海某三甲医院临床医师参加医师执业责任保险的情况和影响参保的因素,为我国推广医师执业责任保险提供政策建议。方法 以上海某三甲医院医师为调查对象(2019年度400名,2020年度455名),在全院范围内推行医师执业责任保险,通过评价2019年度和2020年度医师执业责任保险各条目的参保率和满意率,分析医师执业责任保险的参保效果和影响因素。结果 医师执业责任保险参保率由2019年度的49.50%增加到2020年度的69.70%,增长幅度达20.5%;不同临床医师工作年限、职称和科室间比较,医师执业责任保险参保率差异有统计学意义(P<0.05);近3年经历过医疗纠纷的临床医师其参保率高于未经历过的临床医师,差异有统计学意义(P<0.05)。结论 试点的三甲医院医师执业责任保险参保率较高,科室、工作年限、职称、是否经历过医疗纠纷是医师购买执业责任保险的影响因素;医师执业责任保险体系需完善,相关部门应在现有制度范畴下,简化保险公司理赔程序、提高承保范围;要加强宣传力度,从根本上强化临床医师的医疗执业保险意识,提高医师执业责任保险参保率。     

公共卫生医师定位的思考

公共卫生医师是我国法定的四类医师之一,但其内涵定位尚未形成共识。存在的主要问题是把公共卫生医师与执行公共卫生任务的工作人员混为一谈,未明确公共卫生医师与临床医师的关系以及处方权内涵,公共卫生教育、相关法规存在局限性。公共卫生医师定位为针对群体健康相关问题开展监测、调查、评估和干预的专业技术人员。建议保留公共卫生医师执业资格,突出公共卫生医师针对群体健康开具大处方的属性,鼓励公共卫生医师获取临床医师执业资格,针对个体开具处方,鼓励临床医师获取公共卫生医师执业资格,改进公共卫生院校教育,试点公共卫生医师规范化培训,培养"防治结合"的医师。     

我国医务人员配置质量的结构性差异分析

目的分析我国医疗机构卫生人力质量在医改10年间的变化,比较医院和基层医疗机构的医务人员配置的数量与质量。方法比较2008年和2018年医院和基层医疗机构执业(助理)医师、注册护士的数量和结构差异,通过基尼系数评价医务人员的配置公平性。结果2018年,医院医师中,执业医师占93.07%,只有不足7%是执业助理医师;而基层医疗机构中执业医师只占67.60%,有1/3是执业助理医师。医院的执业医师和执业助理医师的配置基尼系数分别为0.12和0.24,东部省份医院执业医师比例明显高于中西部。基层机构执业医师和执业助理医师的基尼系数分别为0.14和0.15,东部省份基层机构执业医师比例仍然高于中西部,但差距小于医院。医院和基层机构的医护比分别为1:1.47和1:0.65,差距明显。结论目前我国卫生人力资源在各类医疗机构间的分配呈现较明显的不均衡现象,基层医疗机构的医师质量明显低于医院,中西部低于东部,有针对性地提升人员质量仍是下一步改革的重要课题。     

医疗机构在《执业医师法》实施中的权利义务和法律责任

《中华人民共和国执业医师法》的实施,给医院管理的理论研究和实际工作提出了新的问题。医疗机构作为医师执业的地点,具有在集体办理医师资格认定和医师执业注册方面、注销医师执业注册的报告方面、保障医师实现权利义务和履行执业规则方面、对医师的考核和培训等方面的权利和义务。如不履行法定的权利义务,医疗机构可能将承担法律责任。文中分析了《中华人民共和国执业医师法》实施后医师与医疗机构之间的权利义务关系,医疗机构与卫生行政部门之间的权利义务关系,以及医疗机构、医师与患者之间的医患法律关系的变化,并指出《中华人民共和国执业医师法》的实施可能在医师的管理体制、医师的人才流动和医师队伍的优胜劣汰等方面促进医院管理体制的改革。     

Component-Resolved Diagnosis of Hazelnut Allergy in Children

Hazelnuts commonly elicit allergic reactions starting from childhood and adolescence, with a rare resolution over time. The definite diagnosis of a hazelnut allergy relies on an oral food challenge. The role of component resolved diagnostics in reducing the need for oral food challenges in the diagnosis of hazelnut allergies is still debated. Therefore, three electronic databases were systematically searched for studies on the diagnostic accuracy of specific-IgE (sIgE) on hazelnut proteins for identifying children with a hazelnut allergy. Studies regarding IgE testing on at least one hazelnut allergen component in children whose final diagnosis was determined by oral food challenges or a suggestive history of serious symptoms due to a hazelnut allergy were included. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Eight studies enrolling 757 children, were identified. Overall, sensitivity, specificity, area under the curve and diagnostic odd ratio of Cor a 1 sIgE were lower than those of Cor a 9 and Cor a 14 sIge. When the test results were positive, the post-test probability of a hazelnut allergy was 34% for Cor a 1 sIgE, 60% for Cor a9 sIgE and 73% for Cor a 14 sIgE. When the test results were negative, the post-test probability of a hazelnut allergy was 55% for Cor a 1 sIgE, 16% for Cor a9 sIgE and 14% for Cor a 14 sIgE. Measurement of IgE levels to Cor a 9 and Cor a 14 might have the potential to improve specificity in detecting clinically tolerant children among hazelnut-sensitized ones, reducing the need to perform oral food challenges.     

Bayesian meta-analysis across genome-wide association studies of diverse phenotypes

Genome-wide association studies (GWAS) are a powerful tool for understanding the genetic basis of diseases and traits, but most studies have been conducted in isolation, with a focus on either a single or a set of closely related phenotypes. We describe MetABF, a simple Bayesian framework for performing integrative meta-analysis across multiple GWAS using summary statistics. The approach is applicable across a wide range of study designs and can increase the power by 50% compared with standard frequentist tests when only a subset of studies have a true effect. We demonstrate its utility in a meta-analysis of 20 diverse GWAS which were part of the Wellcome Trust Case Control Consortium 2. The novelty of the approach is its ability to explore, and assess the evidence for a range of possible true patterns of association across studies in a computationally efficient framework.     

What Is a Valid Mapping Algorithm in Cost-Utility Analyses? A Response From a Missing Data Perspective

ObjectivesAlthough numerous mapping algorithms from a non–preference-based measure to a target health utility measure have been developed and applied in cost-utility analyses (CUAs), conditions for a mapping algorithm to work well in a CUA are still unclear. In this research, we formulate the mapping problem as a missing data problem and clarify these conditions.MethodsWe defined a valid mapping algorithm based on the purpose of mapping (ie, not for prediction but for CUA), and derived a sufficient set of conditions for a valid mapping algorithm. We also conducted a simulation study to investigate properties of a mapping algorithm under situations where the conditions are satisfied and violated.ResultsThe derived sufficient conditions indicate that the complete overlap of the source measure with the target health utility measure is important and that a covariate that is omitted from a mapping algorithm but has an effect on the target health utility measure not captured by the source measure may invalidate a mapping algorithm. The conditions cannot be verified from data in a CUA but can be supported using external data. A simulation study showed that when at least 1 of the 3 conditions was violated, a mapping algorithm provided biased health utility estimates in a CUA, and that prediction accuracy did not necessarily reflect performance of a mapping algorithm in a CUA.ConclusionThe derived conditions provide a fundamental basis for better practices in developing and selecting a mapping algorithm.     

The effects of a ‘pets as therapy’ dog on persons with dementia in a psychiatric ward

A pets as therapy (PAT) programme was initiated in a closed ward of a major psychiatric hospital. The effect of regular contact with a dog on a selected group of chronic ward-bound patients suffering from dementia was assessed over a 12 week period using a number of measures. These included global measures of daily functioning, physiological measures (blood pressure and heart rate) and a measure of general ward noise levels. A matched group from a similar closed ward was used as a control. Results indicated significant experimental group changes in heart rate and a substantial drop in noise levels in the experimental ward during the presence of the dog.     

Neighbourhood characteristics and 10-year risk of depression in Canadian adults with and without a chronic illness

The neighbourhood environment could play a role in the risk of depression in adults and those with a chronic illness. We investigated the effects of a range of neighbourhood characteristics on the 10-year risk of depression in a representative sample of 9026 Canadian adults and subsamples with a chronic condition. Characteristics of neighbourhoods were not significantly related to the risk of depression in the general sample and subsamples with a chronic condition. However, residing near a park was significantly associated with a lower risk of depression for people living in crowded households, and having a local health service nearby was protective for those living in materially deprived neighbourhoods. Living in a neighbourhood that was both socially advantaged and offered cultural services was also associated with lower risk of depression. Additional research is needed for smaller effect size detection. Future intervention research is warranted for health policy recommendations.     

Blastomycosis in man after kinkajou bite

We report transmission of Blastomyces dermatitidis fungal infection from a pet kinkajou to a man. When treating a patient with a recalcitrant infection and a history of an animal bite, early and complete animal necropsy and consideration of nonbacterial etiologies are needed.     

Psychological Meaning of a Woman with a Hysterectomy Among Mexican Physicians and Women

The psychological meaning of women who have had a hysterectomy, and attitudes toward them, were explored in 121 Mexican gynecologists, 155 women who had undergone a hysterectomy, and 115 women who had not had a hysterectomy. The surveys were completed between January and May 2011. Both groups of women defined a woman who had had a hysterectomy using words with positive meanings (healthy, happy, reassured, and complete), as well as words with negative meanings (sad, incomplete, and irritable). However, the participants who had not had a hysterectomy defined a woman who had had a hysterectomy using more negative words and showed more negative attitudes toward such a woman with a hysterectomy than those women who had undergone a hysterectomy. Among participants who had undergone a hysterectomy, those who were premenopausal prior to the surgery and those who had undergone bilateral salpingo-oophorectomy defined a woman who had had a hysterectomy in a more negative manner and showed the most negative attitudes. The gynecologists did not use words with emotional content regarding women who had had a hysterectomy and showed more neutral attitudes toward such a woman than did both groups of women. These findings could be helpful in designing support programs for women facing a hysterectomy.     

Usual source of care in preventive service use: a regular doctor versus a regular site

OBJECTIVE: To compare the effects of having a regular doctor and having a regular site on five preventive services, controlling for the endogeneity of having a usual source of care. DATA SOURCE: The Medical Expenditure Panel Survey 1996 conducted by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. STUDY DESIGN: Mammograms, pap smears, blood pressure checkups, cholesterol level checkups, and flu shots were examined. A modified behavioral model framework was presented, which controlled for the endogeneity of having a usual source of care. Based on this framework, a two-equation empirical model was established to predict the probabilities of having a regular doctor and having a regular site, and use of each type of preventive service. PRINCIPAL FINDINGS: Having a regular doctor was found to have a greater impact than having a regular site on discretional preventive services, such as blood pressure and cholesterol level checkups. No statistically significant differences were found between the effects a having a regular doctor and having a regular site on the use of flu shots, pap smears, and mammograms. Among the five preventive services, having a usual source of care had the greatest impact on cholesterol level checkups and pap smears. CONCLUSIONS: Promoting a stable physician-patient relationship can improve patients' timely receipt of clinical prevention. For certain preventive services, having a regular doctor is more effective than having a regular site.     

Robust Bayesian sample size determination in clinical trials

This article deals with determination of a sample size that guarantees the success of a trial. We follow a Bayesian approach and we say an experiment is successful if it yields a large posterior probability that an unknown parameter of interest (an unknown treatment effect or an effects-difference) is greater than a chosen threshold. In this context, a straightforward sample size criterion is to select the minimal number of observations so that the predictive probability of a successful trial is sufficiently large. In the paper we address the most typical criticism to Bayesian methods-their sensitivity to prior assumptions-by proposing a robust version of this sample size criterion. Specifically, instead of a single distribution, we consider a class of plausible priors for the parameter of interest. Robust sample sizes are then selected by looking at the predictive distribution of the lower bound of the posterior probability that the unknown parameter is greater than a chosen threshold. For their flexibility and mathematical tractability, we consider classes of epsilon-contamination priors. As specific applications we consider sample size determination for a Phase III trial.