民事诉讼中举证如何分配

由于我国民事案件程序法体系规定了在医疗纠纷案件中实行举证责任倒置,对于因医疗行为引起的侵权诉讼,由医疗机构就医疗行为与损害结果之间不存在因果关系及不存在医疗过错承担举证责任。但在实践中,医疗机构到底承担什么样举证责任,该怎么样举证,而患者又应当承担什么样的举证责任,是医疗纠纷案件中举证责任倒置适用的一大难点。以下两篇文章首先从我国民事诉讼举证责任的一般分配原则入手,探讨什么是举证责任,举证责任分配的一般原则与举证责任倒置的关系等相关理论;其次在对民事诉讼举证责任进行深入探讨的基础上,对我国医疗纠纷举证责任的分配问题进行了分析,就医疗纠纷中举证责任倒置如何适用的问题作了说明。     

浅谈我国医务界对医疗举证责任倒置的几个认识误区

2001年12月6日，最高人民法院审判委员会第1201次会议通过了《最高人民法院关于民事诉讼证据的若干规定》(以下简称《规定》)，就医疗纠纷诉讼的举证责任问题作出了明确规定。根据该(《规定》第4条第8项：因医疗行为引起的侵权诉讼，由医疗机构就医疗行为与损害结果之间不存在因果关系及不存在医疗过错承担举证责任。相对于我国过去司法实践中所遵循的“谁主张，谁举证”的医疗举证责任而言，《规定》将医疗举证责任纳入了举证责任倒置的范围之内，     

防范医疗赔偿风险的财务对策

从２００２年４月１日开始实施的司法解释《关于民事诉讼证据的若干规定》第四条第 (八)项明确规定 :因医疗行为引起的侵权诉讼 ,由医疗机构就医疗行为与损害结果之间不存在因果关系及不存在医疗过错承担举证责任。从此确立了医疗侵权纠纷的举证责任倒置制度 ,一改过去医疗纠纷     

举证责任倒置与信任和谐的医患关系

《最高人民法院关于民事诉讼证据的若干规定》第四条第 8点解释 (简称《解释》)医疗诉讼 :因医疗行为引起侵权诉讼 ,由医疗机构就医疗行为与损害结果之间不存在因果关系及不存在医疗过错承担举证责任[1] 。即医疗诉讼举证责任倒置。《解释》成为近期社会各界关注的热点问题。笔者就举证责任倒置的利弊做一粗浅分析。一、举证责任倒置对医疗行为的积极影响随着我国经济和社会发展 ,科学公正地处理医疗纠纷 ,维护医患双方合法权益 ,保持社会稳定是处理医疗纠纷的准则。以往“谁主张 ,谁举证”的原则 ,由于医疗资料都存放在医院 ,患者不便查阅…     

举证责任倒置后医疗行为的难点与对策

实施举证责任倒置后，一些传统的医疗行为面临很多困惑。本就此展开讨论，并提出了一些有效措施，为规范医院的医疗行为，减少医疗纠纷提供参考。     

医生维权,明确举证责任

所谓医疗纠纷案件,是指因医疗机构在从事诊断、治疗和护理等过程中因过失而导致病员死亡、残 废、组织器官功能障碍或其他不良后果的一种特殊的侵权责任。面对这种情况,医生明确举证责任对于 维护自己的权利有很大的助益。尽管《最高人民法院关于民事诉讼证据的若干规定》第四条第八款规定: "因医疗行为引起的侵权纠纷,由医疗机构就医疗行为与损害后果之间不存在因果关系及不存在医疗过错 承担举证责任。"但是,医疗纠纷案件千差万别,绝少雷同,其中的举证责任,绝非一律机械的适用上述 举证责任。此外,同一案件中双方主张的过错和因果关系也往往并非惟一,举证责任的分配并非十分明 确,而是呈多样化,具有灵活性。     

医疗纠纷中的举证责任的分配

随着医疗事业的发展和人民权利意识的增强医疗纠纷已经成为全社会的热点话题之一,医疗纠纷诉讼案也呈逐步上升之势。关于医疗纠纷的法律、法规的不断完善。2002年4月1日实行的《最高人民法院关于民事诉讼证据的若干规定》和2002年9月1日起实施的《医疗事故处理条例》,更将使这一问题在社会生活中受到广泛关注。因为其专业技术性强,故在鉴定与医疗过错责任举证中均存在很大争议。现今医疗纠纷的举证责任有了新的改进,本文就医疗纠纷的举证责任分配谈一谈自己的看法。目前我国医疗纠纷的举证责任为医疗机构举证,也就是所说的举证倒置。这种举证方法在医疗纠纷中越来越表现出它的优势比如举证方式公正、方便举证、医方会更重视举证等。当然从《最高人民法院关于民事诉讼证据的若干规定》的一些条款中也看出,目前就医疗纠纷的举证责任分配还是存在着一些问题。比如举证责任分配不详,举证责任的具体分配方法不明确和证据的鉴定可行性。     

医疗机构举证责任倒置的思考与对策

文章就医疗机构举证责任倒置所面l临的问题做了论述。医疗机构举证责任倒置存在着不能举证之处;医学科学发展有其限制性；医疗行为具有不可避免的侵袭性；医疗机构举证责任倒置的局限性；医学本身的风险性和不可预见性。阐述了医疗机构防范与对策：以病人为中心，规范医疗行为不端；加强业务学习，提高医院诊疗水平；建立完善的各项规章制度；建立和谐和信任的医患关系；加强法律意识教育，提高法制观念；加强病历质量控制与簧理，规范病历书写；门诊的医疗行为的举证责任。     

浅谈医疗设备器材与医疗纠纷

随着医学工程学的快速发展,医疗机构大量购置各种医疗设备,由医疗设备器材直接或间接引发的医疗纠纷时有发生,医院管理层和设备器材科管理人员应予以高度关注。医疗设备器材引发的纠纷文献报道甚少,探讨医疗设备器材与医疗纠纷的关系,有利于从医疗设备器材科学管理的角度防范医疗纠纷。1设备器材可能引发医疗纠纷1.1医疗纠纷间接涉及医疗设备器材随着2002年4月1日《最高人民法院关于民事诉讼证据的若干规定》的实施,其中在医疗事故与纠纷中实施“举证责任倒置”,将使医疗机构分担更大的医疗风险。2002年9月1日实施国务院发布的《医疗事故处…     

护士应对护理侵权诉讼中举证责任倒置的策略

最高人民法院《关于民事诉讼证据的若干规定》在第四条第一款第八项确立了医院在医疗纠纷中的举证责任,即在医疗侵权诉讼中实行举证责任倒置。护理工作是医疗工作的重要组成部分,同样因护理侵权导致的诉讼亦应实行举证责任倒置。本文结合临床实践,就举证责任倒置的内容及护理工     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.