第二类医疗技术准入管理面临的问题与对策

医疗技术准入制度越来越受到重视,我国这项工作刚刚起步,大多数研究只探讨了高风险、涉及重大伦理问题的第三类医疗技术的临床应用以及伦理问题,而未对第二类医疗技术准入问题进行探讨。第二类医疗技术准入管理刚起步,并存在评价指标的选择问题、申报数据的可靠性和真实性问题及准入后的后期跟踪管理问题等。卫生行政部门必须在认真做好医疗信息公示的前提下,采用科学的评价指标,分步骤实施医疗技术准入管理,并切实做好准入后的跟踪管理。     

医疗技术经济效果的特殊性

一、医疗技术经济效果的定义医院是以医疗工作为中心的部门。医疗服务,既有技术问题又有经济问题。我们在评价医疗效果时,既不能离开经济的合理性而单纯地讲技术效果,也不能离开技术问题而单纯地讲经济效果。我们所     

现代医学技术评估中的几个伦理学问题

医学技术的发展，给人类事来了巨大的利益，但也随之出现了一些新的伦理学问题。生殖技术中人工授精存在技术与卫生标准不规范、精子商品化、非婚妇女人工授精问题；体外受精存在取代自然生殖、一胎多生、性别失调问题。基因技术中基因诊断存在诊断是否保密、有遗传疾病的胎儿如何进行人工流产；基因治疗存在感染病毒和激活原癌基因问题。对一些新新技术如ＣＴ、磁共振等应用增加医源性疾病等问题。     

浅议计划生育技术服务中的告知说明义务与知情同意权利

计划生育技术服务（简称技术服务）是计划生育技术服务人员（简称服务人员）对计划生育技术服务的对象（简称服务对象）进行包括：避孕和节育的医学检查；计划生育手术并发症和计划生育药具不良反应的诊断、治疗；施行避孕、节育手术和输卵（精）管复通手术；开展围绕生育、节育、不育的其他生殖保健项目。因为服务对象主要是健康的育龄群众，技术服务又是解决健康人的生理问题，所以广大群众认为在技术服务中是不会出问题的。随着群众法律意识和维权意识的不断增强，技术服务纠纷的比率也在不断增加，虽然近些年来，经过各级人口计生委和计生服务机构不懈努力，技术服务质量管理有了明显进步，各项管理措施也在不断落实到位，但纵观技术服务全过程，仍存在一些问题和隐患，绝大部分不属技术问题，而是多与服务态度不好、服务质量不高、相互沟通不够和服务不全面、不到位有关。在技术服务中，服务人员对服务对象告知说明义务与知情同意权利了解不全面，履行落实不够，成为诸多问题和隐患中重要且常见的问题，也常为此发生一些不该发生的纠纷。     

等离子体技术净化室内空气的潜能及环境风险研究进展

室内空气污染直接影响人群健康。传统的空气净化方法已不能满足室内空气净化要求,近年来,等离子体技术、光触媒技术及臭氧技术等空气净化技术开始被关注。该文着重阐述了等离子体技术净化室内颗粒物、挥发性有机污染物、微生物等空气污染物的潜能,分析了净化过程中可能引起的二次污染问题,评价了等离子体空气净化器在实际应用中的环境风险,并提出了等离子体技术在室内空气净化方面需要进一步研究的问题和方向。     

从市场营销角度看技术转移中的技术信息发布

技术信息发布是技术转移中非常重要的一个环节。主要论述了技术转移中技术信息发布的必要性、形式及技术信息发布时应注意的问题。     

增强现实技术与医药高等职业教育

增强现实(AR)技术作为新兴的技术在诸多领域有所应用,且逐渐受到关注。作者关注了增强现实技术在医药高等职业教育领域的应用前景,从两者的契合度,AR技术可能的应用方向,存在的瓶颈和问题三个方面展望了AR技术给医药高等职业教育带来的机遇和问题。认为AR技术必将给医药高等职业教育发展与深化改革带来技术红利和技术保障;医药高等职业院校需积极转变思路、整合资源、培养开发人才,真正使得AR技术走进课堂。     

卫生信息化发展趋势渐明

卫生信息化不单单是技术问题，技术只是其中的一部分，要把人、制度、技术三者合一，这样才能真正形成信息化的发展动力。     

病理技术质量控制的常见问题分析

目的：研究病理技术质量控制的常见的几点问题，同时制定相应的改进措施。方法：我院选择2012年7月～2014年7月间住院部的各个科室中出现的200例病理技术工作问题，对其基本资料进行分析。分析病理技术工作存在的主要问题，对质量控制的实施要点展开详细统计。结果：对所选的200例病理技术问题进行分析，28例为病理标本与申请单的接收方面存在问题，占14％；120例为切片处理方面存在问题，占60％；52例为HE染色不当方面存在问题，占26％；相比较而言，切片处理方面存在的病理技术问题明显比其他各项高，数据对比存在显著的差异，有统计学意义（P〈0．05）。结论：为了更好的提升病理技术质量控制工作水平，应根据上述的各种问题，进行规范切片流程、完善制度、控制试剂处理程序、完善HE染色在内的各项质量控制工作，进而为科室的建设和医院的发展做出应用的贡献。     

Nature开放式同行评议实验的问题与对策研究

【目的】 分析2006年Nature开放式同行评议实验存在的问题,为科技期刊开放式同行评议的实践提供参考与对策。【方法】 通过案例分析方法对Nature开放式同行评议实验的过程进行分析,找出其中存在的问题。【结果】 开放式同行评议中参与者心理问题、对学术优先权的担忧、编辑作用过强、技术环境的影响、激励机制的缺失、评议质量的设置问题是Nature 2006年开放式同行评议实验的失败原因。【结论】 改变技术环境、用区块链技术可解决参与者的心理障碍问题;采用预印本技术、出版后同行评议、区块链技术可确认学术优先权;采用出版评议报告的学术激励和区块链代币功能的物理激励方式可建立激励机制;设置开放式同行评议和评论两种方式,以及由人工智能技术辅助编辑职能。     

The relationships between problem characteristics,achievement-related behaviors,and academic achievement in problem-based learning

This study investigated the influence of five problem characteristics on students’ achievement-related classroom behaviors and academic achievement. Data from 5,949 polytechnic students in PBL curricula across 170 courses were analyzed by means of path analysis. The five problem characteristics were: (1) problem clarity, (2) problem familiarity, (3) the extent to which the problem stimulated group discussion, (4) self-study, and (5) identification of learning goals. The results showed that problem clarity led to more group discussion, identification of learning goals, and self-study than problem familiarity. On the other hand, problem familiarity had a stronger and direct impact on academic achievement.     

Parent Aides: An Intervention Program in Cases of Child Abuse and Neglect

Abstract

Research can be successful only if the problem is good; it can be original only if the problem is original. But how can one see a problem, any problem, let alone a good and original problem? For to see a problem is to see something that is hidden. It is to have an intimation of the coherence of hitherto not comprehended particulars. The problem is good if this intimation is true. (Polanyi, 1966, pp. 21–22).     

Problems of research into medical problem solving: some remarks on theory and method

Investigators of medical problem solving, and of problem solving in general, appear to use the term problem solving to denote different concepts.
Medical problem solving sometimes refers to the doctor solving the patient's problem, whereas others use it to refer to the doctor solving his own diagnostic problem. Second, 'problem' is used by some in a subjective sense (something is only called a problem if the subject has difficulties with it), and by others in an objective sense (problem being nearly synonymous with task). Finally, there is the definitional question of whether knowledge and problem solving are regarded as independent or as intimately related.
What one means by problem solving, with one's research objectives (research may be aimed at medical education, medical practice or cognitive theory), constitute the major determinants of the choice of research design.
It is advocated that investigators, before selecting a research design, should clarify their own definitions and research objectives, and before adopting other investigators' definitions and research designs, should consider carefully their research objectives.     

Occupational Factors and Problem Drinking among a Japanese Working Population

Problem drinking is a serious public health problem in the workplace. However, few Japanese epidemiological studies have investigated the occupational characteristics of problem drinking. The purpose of this study is to clarify the occupational risk factors for problem drinking among a Japanese working population. We used data from a random-sampling survey about mental health and suicide, conducted among Hamamatsu City residents aged 15 to 79 yr old during May and June in 2008. The relation between occupational factors and problem drinking was analyzed with multiple logistic regression models stratified by gender. CAGE questionnaire was used to assess problem drinking. With regard to employment types, problem drinkers were more prevalent among self-employed women. With regard to occupational types, clerical and service professions had more problem drinkers of either sex, while administrative/managerial and sales professions had more women with such problem. With regard to company size, male problem drinkers were more prevalent in smaller companies than in larger ones. These results indicate that the prevalence of problem drinkers in the workplace depends on where one works. It is necessary to consider these characteristics to provide effective measures to address problem drinking in the workplace.     

数学探索性问题分类浅析

探索性数学问题具有较高层次的训练价值和启迪科学方法的作用以及创造发现的意义。其具体的类型,大致有探索结论型、探索条件型、探索一般型、探索命题更换型等。     

Multiple Risk Behaviors Among Youth Living with Human Immunodeficiency Virus in Five U.S. Cities

PurposeTo describe multiple risk behaviors (substance use, sexual risk, and medication adherence) in a multi-site sample of youth living with human immunodeficiency virus (HIV) in five U.S. cites.MethodsYouth (N = 352) were recruited from four Adolescent Trials Network (ATN) sites (Philadelphia, Fort Lauderdale, Baltimore, and Los Angeles) and one non-ATN site in Detroit and screened for multiple problem behaviors for an intervention study. A substance abuse problem was determined with the CRAFFT, a six-item adolescent screener. Single items were used to screen for current sexual risk and for an HIV medication adherence problem. Of the youth, 239 (68%) had at least one of the three risk behavior problems based on the screener. A total of 186 (52.8%) completed longer, in-depth questionnaires for each problem behavior.ResultsOf the 352 youth screened, 60% had problem level substance use and 42% had a sexual risk problem. Of the 165 (47%) who were prescribed medications, 91 (55%) reported an adherence problem. A total of 112 (32%) reported no problem behavior, 123 (35%) reported 1 problem behavior, 95 (27%) reported 2 problem behaviors, and 20 (6%) reported 3 problem behaviors. Males were more likely to have a substance use problem. Younger youth living with HIV and those perinatally infected were more likely to have an adherence problem. Among the 186 (52.8%) completing longer measures, those with a substance abuse problem had higher substance use on a timeline follow-back procedure than those without. Participants who screened positive for a sexual risk problem reported more unprotected sex on an in-depth interview than those without. Those who screened positive for an adherence problem had higher viral loads than those without an adherence problem.ConclusionsResults suggest high rates of problem behaviors among youth living with HIV, particularly in older youth. Younger and perinatally infected youth may require specialized adherence interventions. Associations between the screener and more in-depth assessment measures suggest potential clinical utility of screening youth for high-risk behaviors.     

青少年130例心理问题分析

目的探讨青少年不同年龄阶段的心理问题状况，为门诊开展青少年心理咨询提供科学依据。方法对2007年9月30日-2008年12月20日医院门诊心理咨询的130例案例资料进行统计分析，找出他们的普遍问题。结果130例青少年前5位常见心理问题依次为：情绪问题、人际关系问题、学习问题、叛逆心理、性心理问题。结论青少年的心理问题是一个较严重的社会问题，应引起家庭、教育界和全社会的关注，心理门诊同样应加强对青少年心理咨询的力度。     

There's a Problem With the Problem List: Incongruence of Patient Problem Information Across the Home Care Admission

ObjectivesIllustrate patterns of patient problem information received and documented across the home health care (HHC) admission process and offer practice, policy, and health information technology recommendations to improve information transfer.DesignObservational field study.Setting and ParticipantsThree diverse HHC agencies using different commercial point-of-care electronic health records (EHRs). Six nurses per agency each admitted 2 patients (36 total).MethodsResearchers observed the admission process and photographed documents and EHR screens across 3 phases: referral, assessment, and plan of care (POC). To create a standardized data set, we mapped terms within medical diagnoses, signs, symptoms, and Problems to 5 of the 42 Omaha System Problem Classification Scheme problem terms. This created 180 problem pattern cases (5 problem patterns per patient).ResultsEach pattern of problem information being present or absent was observed. In 52 cases (28.9%), a problem did not appear. In 36 cases (20%), the problem appeared in all 3 phases. In 46 cases (25.6%), the problem appeared in referral and/or assessment phases and not on the POC. Conversely, in 37 cases (20.5%), the problem appeared in referral or assessment phases and on the POC. In 9 cases (5%), the problem only appeared on the POC. Within the EHRs, there were no rationale fields to clarify including Problems or not and no problem status fields to identify active, resolved, or potential ones.Conclusions and ImplicationsDiagnosis or problem information transferred from the referral source or gathered during an in-home assessment did not appear in the POC. Because of the EHR structure, clinicians could not identify inactive problem or problem priority. Documentation or mapping of a structured problem list using a standardized interprofessional terminology such as the Omaha System coupled with identification of rationale could support the documentation of problem status and priority and reduce information loss.     

Predicting onset and chronicity of women's problem drinking: a five-year longitudinal analysis.

BACKGROUND. Longitudinal studies of adult drinking have typically excluded or sampled only small numbers of problem drinking women, and have measured a limited range of influences on women's drinking behavior. METHODS. To study the development of women's problem drinking over time, five-year follow-up interviews were conducted with two groups of respondents from a 1981 national survey of women's drinking: 143 problem drinkers and 157 nonproblem drinkers. Regression analyses examined effects of 1981 predictors on six measures of 1986 problem drinking, for problem drinkers and nonproblem drinkers separately. RESULTS. Among 1981 nonproblem drinkers, predictors of onset of problem drinking indicators by 1986 included younger age, cohabiting, and lifetime use of drugs other than alcohol. The most consistent predictor of persistent (chronic) problem drinking was sexual dysfunction; other predictor included being employed part-time or never married, and experiencing recent depression. Divorce or separation predicted lower levels of subsequent alcohol dependance among problem drinkers. CONCLUSIONS. Findings suggest that different personal and social factors predict the onset of problem drinking as compared with its continuation, and point to nontraditional life-style, sexual dysfunction, and role deprivation as potentially important variables.     

坚持科学发展观创建节约型医院

“看病难、看病贵”问题已成为社会反响强烈的热点问题。医院成为矛盾的聚集地,但不是问题的发源地。医院只有坚持科学发展观,从自身出发,通过挖掘潜力、强化管理等措施创建节约型医院,来缓解“看病难、看病贵”的问题。