医学研究登记备案信息系统设计与应用

基于《干细胞临床研究管理办法(试行)》的要求,全国获准从事干细胞研究的机构均在医学研究登记备案信息系统上进行机构登记注册,全国各级医院所进行的临床研究,均应进行注册并公告。详细介绍医学研究登记备案信息系统的架构及功能,并与国际上相似功能的注册登记系统进行比较。     

Everyone is entitled to a good doctor

All patients want good doctors they can trust. Good doctors are competent, respectful, honest, and able to form good relationships with their patients and colleagues. Medical practice is inherently risky. The public, recognising this, believes that in a modern health service the competence and professionalism of all doctors should be a given, not an additional avoidable hazard. Some doctors find this expectation reasonable, others threatening. Good medical practice may be best achieved by professional regulation based on explicit, patient-centred professional standards embedded in medical education, registration and licensure, specialist certification and doctors' contracts. Effective professional regulation and professionalism should be an integral part of wider quality improvement and quality assurance. The advantages for patients are self-evident, but the trustworthiness, influence and good name of individual doctors and the medical profession collectively would be enhanced if together they were able to show that the house of medicine is being maintained in good order.     

The ethics of doctors and big business

Ethically conducted medical treatment puts the healthcare needs of patients first, ahead of profit, but corporations may pressure GPs to act as their agents instead of the patient's agent. The medical profession requires an industrial code outlining the specific conditions needed to maintain high standards of medical practice. Health professional organisations also need a code of conduct. Recent legislation should limit the influence of corporations on doctors: non-medical directors of medical corporations can now be fined or disqualified if they are party to professional misconduct by medical practitioners, and GPs can be prosecuted for offering or accepting pecuniary benefits for referrals. Doctors need to act now to implement systems which protect the public interest and professional standards before the influence of corporatisation becomes pervasive, and leads to increased legislation and regulation of medical practice.     

“三位一体”安宁疗护教育模式探讨

通过对医学生、医务工作者和社会公众安宁疗护教育调查的文献分析,发现中国目前安宁疗护教育存在学科体系尚未健立、实践基地缺乏、医务工作者的专业知识基础薄弱、公众认知度低等问题,远远不能满足人民群众全生命周期健康的需要及追求“优逝”获得善终的需求。必须加强安宁疗护课程体系建设,组建学科队伍,创建实践基地;加强医务工作者岗位培训,提高临床技能水平;普及安宁疗护知识,提高公众认知度,构建院校教育、继续教育和公众教育“三位一体”的安宁疗护教育模式,推动中国安宁疗护事业发展。     

完善预约挂号管理探索门诊服务创新

自今年6月起,北京市开始实施“取消点名挂号”,即按职称或者专科挂号。而我院一直跟进此项政策,至今已有数月。本文就我院对预约挂号模式的现状及困难进行探索研究,结合实践,切实提高门诊医疗服务水平,力求为广大患者提供一个更好、更快捷的就医环境。     

国际上对医师多点执业的利弊研究简

目前医师多点执业问题引人关注,而医师主动受聘的多点执业更是国内管理重点。通过对国际上医师多点执业的研究,发现医师多点执业能引起克扣公立医院本职工作时间、降低公立医院服务质量、制度性过度医疗、滥用公立医疗资源、搜刮公立医院患者等弊端。但医师多点执业同时也能节省招募和挽留熟练医师的预算负担、减少非法收入、提高患者医疗可及性、让贫穷患者更多利用公办医疗资源等有利面。总结来看,医师多点执业的研究结果显示有一些不利因素,但由此并不能形成结论性意见,需要更深入分析医师多点执业的积极效应与负面效应相抵后的净效应结果。     

Practical virtue ethics: healthcare whistleblowing and portable digital technology

Medical school curricula and postgraduate education programmes expend considerable resources teaching medical ethics. Simultaneously, whistleblowers' agitation continues, at great personal cost, to prompt major intrainstitutional and public inquiries that reveal problems with the application of medical ethics at particular clinical "coalfaces".Virtue ethics, emphasising techniques promoting an agent's character and instructing their conscience, has become a significant mode of discourse in modern medical ethics. Healthcare whistleblowers, whose complaints are reasonable, made in good faith, in the public interest, and not vexatious, we argue, are practising those obligations of professional conscience foundational to virtue based medical ethics. Yet, little extant virtue ethics scholarship seriously considers the theoretical foundations of healthcare whistleblowing.The authors examine whether healthcare whistleblowing should be considered central to any medical ethics emphasising professional virtues and conscience. They consider possible causes for the paucity of professional or academic interest in this area and examine the counterinfluence of a continuing historical tradition of guild mentality professionalism that routinely places relationships with colleagues ahead of patient safety.Finally, it is proposed that a virtue based ethos of medical professionalism, exhibiting transparency and sincerity with regard to achieving uniform quality and safety of health care, may be facilitated by introducing a technological imperative using portable computing devices. Their use by trainees, focused on ethical competence, provides the practical face of virtue ethics in medical education and practice. Indeed, it assists in transforming the professional conscience of whistleblowing into a practical, virtue based culture of self reporting and personal development.     

继续医学教育学分管理系统在医院中的应用探讨

继续医学教育学分是卫生专业技术人员年度考核、执业再注册、职称晋升的重要依据。在深化医药卫生体制改革,加强医药卫生信息化建设的同时,如何推进继教学分的信息化管理应引起医院和卫生管理部门的思考和重视。     

国际临床试验注册概述

临床试验是进行医学研究的重要手段,目前为止,只有部分临床试验在不同性质的注册机构进行了注册。临床试验注册能够避免临床研究中的各种偏倚以及由于重复研究而造成的浪费,有利于开展循证医学研究,进而促进人类健康事业的进步。因此,临床试验进行注册的重要性和必要性已日益显现。本文就临床试验注册的定义、原因、要求、内容、历史与现状进行了概述,并详细介绍了重要的国际临床试验注册机构。通过分析临床试验注册的历史与现状,提出未来的临床试验注册将趋向于透明化、强制性和综合性的方向发展。     

口腔治疗师培养规划的初步研究

目的进行口腔治疗师医学技术岗位和教育现状分析,提出我国口腔治疗师培养的初步规划。方法通过现有资料收集和现场调查,了解口腔技术职业教育的现状和发展趋势。采用专家咨询法讨论口腔治疗技术专业的培养目标与方向。结果在基本口腔治疗技术专业方面,以高职教育为主要培养途径,培养高级应用型口腔治疗师,以培养通科口腔治疗师为主。教学内容应以实践技能为主,通过专业课程评价的学生可以获得口腔治疗师资历,同时对课程设置、教学模式和专业师资配备提出初步规划。结论与高等职业教育的目标相适应,口腔医学高职教育应致力于培养应用能力强的口腔治疗师。口腔治疗师标准从人文素质、理论知识、专业技能和其他相关能力四个方面对学生提出要求,通过准入标准的具有口腔治疗师资历的人可以在国内登记注册,作为口腔治疗师开业。     

从澳大利亚等西方国家全科医学发展史引发的思考

本文回顾了澳大利亚、北美等西方国家全科医学发展的历史,重点考察了这些国家的医学教育中全科医生培训的演变过程,与医院的专科培训的关系,全科医学专业组织的建立过程和发展经历,政府在全科医学发展中的作用。通过比较,讨论和分析历史沿袭下来的因素对我国医学发展方向及全科医学发展的影响,以医院为基础的医学教育和医院提供大量“一般服务”的矛盾,医学权威结构的状况及其对全科医学发展的影响,并提出几点政府支持全科医学发展的建议。     

Educating physicians for population-based clinical practice.

Debates about changing the current paradigm of medical education and medical practice have become fairly common in recent years. Based on my experience as a research director of a prepaid group practice program and as chair of a medical school department of public health and preventive medicine, I contend that the traditional one-to-one physician-patient role obligations should be expanded to include a set of "one-to-n" physician-population obligations. The latter include at least three components: (1) a resource allocation component, (2) a component focusing on the epidemiologic nature of clinical practice, and (3) a component focusing on members of the population who are not regularly attended to within the normal context of physician care. Discussing these in turn, I argue for a population-based clinical practice model of medical education that preserves the Hippocratic tradition while better preparing physicians for the complex practice and insurance realities of the 21st century.     

我国三城市社区卫生服务中心临床医师队伍现状调查

目的了解我国部分城市社区卫生服务中心临床医师队伍现状及存在的问题,为制定相关政策提供客观依据。方法在天津市、南京市、武汉市各选取2个城区,对6区全部共62个社区卫生服务中心进行问卷调查,并进行小组访谈。结果①62个社区卫生服务中心中医保定点单位60个,占96．8％;59个为国家及公立医疗机构举办;中心全部开展了社区公共卫生与基本医疗服务;运行较好;②在册医师1664人,平均年龄（45±11）岁,45岁及以上医师942人,占总数的56．6％,35岁以下仅占24．4％;医学大专及以下学历占70．1％。③874名中高级技术资格医师中,具备全科专业技术资格38人,占4．4％。④1024名临床类别的执业、执业助理医师中,注册范围为内科专业者538人,占52．5％;注册全科专业65人,占6．3％。全科诊室应诊医师257名,注册全科专业45人,占17．5％。⑤近三年临床医师晋升105人,其中晋升全科专业17人,占16．2％。⑥临聘医师354人,占在岗医师的20．0％。结论①社区卫生服务中心全科诊室医师超范围行医问题严重;②临床医师晋升全科专业意愿不强、报考比例太低;③全科医师数量明显不足,队伍整体素质偏低,年龄老化;④建议加大投入、完善政策,提高岗位吸引力;加强全科医师管理与执法监督,杜绝超范围行医。     

北京市基层卫生人力资源制度建设现况及影响因素研究

卫生人力资源作为各级医疗机构的宝贵资源,不仅从根本上决定了医疗机构的总体业务水平,而且也是未来各医疗机构,尤其是基层医疗机构长远发展的宝贵财富。我国存在基层卫生人力资源长期短缺问题,相关制度成因决定了解决此问题的系统性和复杂性。本文根据2017年4月原国家卫生计生委施行的《医师执业注册管理办法》内容和国务院办公厅2018年1月下发的《关于改革完善全科医生培养与使用激励机制的意见》精神,结合北京市基层卫生人力资源制度建设现况,应用问卷调查和深入访谈的方法,对北京市全科医师职业状况和职业预期进行了调查分析。归纳出5条严重影响基层卫生人力资源合理分配的因素：（1）医师执业注册中的执业范围限制;（2）职称晋升体系的限制;（3）事业单位原有人事制度中“人治因素”限制;（4）基层卫生人才长期短缺所导致管理者本位的主观限制;（5）北京特有的户籍制度制约。给出了5条对策建议：（1）规范培养、提升薪酬,建立良好职业预期;（2）变革人事管理制度,建立双向转岗机制;（3）完善相关法律制度,明确人事权力边界;（4）依法增加执业范围,打通人才进出通道;（5）借鉴三级医院经验,构建人才流动机制。     

Active euthanasia in The Netherlands

Active euthanasia in the Netherlands remains a topic for both professional and public debate. However, many aspects of the medical practice of active euthanasia remain unclear, and no figures on the actual incidence of this practice exist. Legally, active euthanasia is a criminal offense, but a pattern of jurisprudence has developed since the first court case in 1973 that has allowed physicians to practice euthanasia under certain strict conditions. Two proposals, one from the Royal Dutch Medical Association and one from a government-appointed state commission, have advised that the current law be changed. While the debate continues, a number of Dutch institutions have developed procedures and policies to enable physicians and health care providers to participate in active euthanasia in an acceptable and controllable manner. However, many Dutch physicians remain uncomfortable with the professional and public tolerance of this practice.     

基于IC卡技术的区域卫生人力资源管理系统研究与实现

利用区域卫生信息网络平台,建立区域卫生人力资源管理系统,开发分级管理功能,推广至各级各类医疗卫生机构使用。通过下发统一标识的医务人员IC卡工作证,卫生监督人员利用手持机读卡器实现现场监督执法,利用公众网站『旬社会公示注册医生的信息,实现对医务人员的执业注册管理及监督,规范执业行为。利用系统建立区域卫生人力资源电子档案,记录工资、简历、职称、职务等变更信息,通过灵活的报表分析功能,为管理决策提供及时、科学、可靠的依据,建立了创新、高效的卫生人力资源管理新模式。     

两种门诊挂号方式的探讨

文章从社会上广受关注的医院看病难、挂号难问题入手,对一般医院采取集中挂号方式所遇到的排队等候时间长、挂号环境拥堵问题,以及分层挂号具有人员疏散、与就诊科室相近、减少排队时间等特点进行了分析,并将分层挂号方式与集中挂号方式的效果进行了对比,从而得出了相应的结论,认为分层挂号的方式是值得推广的。     

校园文化中渗透医德教育的研究

通过分析学校医德教育的困扰,提出学校医德教育应多渠道、多途径,多方式,并介绍了笔者学校融医德教育于文体娱乐活动中、社会实践活动中、宣传舆论导向中和争先评优活动中的经验,总结了在校园文化活动中渗透医德教育应遵循娱乐性与思想性,趣味性与知识性,理论性与实践性、典型性与教育性、专业性与创新性的原则.     

医学伦理学实践教学有效途径的研究与实践

右江民族医学院建立了多种形式的医德教育实践基地,并有计划地组织学生到教育实践基地开展活动:依托附属医院为医德教育实践基地,搞好医学伦理学"床边教学";在敬老院建立学生职业道德教育实践基地,促进医学生践行奉献精神,弘扬中华民族传统美德;组织学生到特殊教育学校开展献爱心活动,提高医学生职业道德素质;组织学生到社区和农村开展社会公益活动,增强学生的社会责任感;利用校园文化建设的载体,发挥医学伦理学第二课堂的教育作用等。