放弃治疗与医学伦理

放弃治疗是指对不可治愈的患者，根据本人及其家属的要求终止治疗行为，这是医学伦理学当前迫切需要解决的重要总是，关系到医患双方的道德观念，人身权益。放弃治疗可减少公共卫生资源的浪费，是社会公众对生死意义的再认识，是人类道德意识进步的体现。但在其它实施过程中，可能导致医患双方的伦理冲突乃至医疗纠纷，想信随着国家卫生体制改革的深化，医疗保险体系的建立健全，卫生法律体系的完善，社会文明程度的提高，矛盾将逐步得到解决。     

Formal verification of software-based medical devices considering medical guidelines

Objective

    Software-based devices have increasingly become an important part of several clinical scenarios. Due to their critical impact on human life, medical devices have very strict safety requirements. It is therefore necessary to apply verification methods to ensure that the safety requirements are met. Verification of software-based devices is commonly limited to the verification of their internal elements without considering the interaction that these elements have with other devices as well as the application environment in which they are used. Medical guidelines define clinical procedures, which contain the necessary information to completely verify medical devices. The objective of this work was to incorporate medical guidelines into the verification process in order to increase the reliability of the software-based medical devices.

Materials and  methods

   Medical devices are developed using the model-driven method deterministic models for signal processing of embedded systems (DMOSES). This method uses unified modeling language (UML) models as a basis for the development of medical devices. The UML activity diagram is used to describe medical guidelines as workflows. The functionality of the medical devices is abstracted as a set of actions that is modeled within these workflows. In this paper, the UML models are verified using the UPPAAL model-checker. For this purpose, a formalization approach for the UML models using timed automaton (TA) is presented.

Results

    A set of requirements is verified by the proposed approach for the navigation-guided biopsy. This shows the capability for identifying errors or optimization points both in the workflow and in the system design of the navigation device. In addition to the above, an open source eclipse plug-in was developed for the automated transformation of UML models into TA models that are automatically verified using UPPAAL.

Conclusions

    The proposed method enables developers to model medical devices and their clinical environment using clinical workflows as one UML diagram. Additionally, the system design can be formally verified automatically.     

Proposal for a medical master class system of medical education for common complex medical entities

It is imperative that the management of complex outpatient medical problems be taught using an apprentice system of education. The implementation of highly experienced and outcome successful "master physicians" to train outpatient practicing clinicians will provide a powerful frame of reference and a highly imitatable model on which clinicians can base their presentations of information and medications to patients with complex medical problems such as type 2 diabetes, cardiovascular disease, chronic pain, obesity, or tobacco addiction. Because doctors have always learned by observation, we must ensure that those who they observe will be "worth watching" and that those watched can provide skills of patient management currently not taught in the Flexnor-styled medical educational system, which effectively ended the apprentice system of training. The reintroduction of a carefully crafted apprentice system will foreseeably improve patient care and reduce morbidity, mortality, medical errors, and medical expenses.     

The emergency department medical director as supervisor of medical professionals

The overall success of the ED in the eyes of its customers demands the successful performance of a complex operation involving a team of skilled professionals from various disciplines interacting with support staff and the public. The strong personalities, intelligence, and training of emergency physicians provides the medical director significant challenges as their supervisor. The ED medical staff provides a great impact on the culture and overall perceived performance of the department. It is essential that their leader provide clear direction regarding the performance expectations of the organization for the medical staff. A systematic approach to developing and expressing those expectations, providing timely feedback regarding performance to those expectations, and addressing variation from expectations can provide a valuable tool in supporting the ED medical director's success.This article has been a brief overview of the basic components ofa performance management system for physicians. It has described a process for arriving at explicit performance expectations across dimensions commonly associated with a medical practice, an approach to measuring critical performance factors and delivering ongoing routine feedback to individuals and the group regarding performance to expectations. Finally, it addressed important steps to include in the management of marginal and exceptional performers to preserve the functional integrity and long-term success of the ED. In adopting this approach to the supervisory responsibilities of the medical director, a strong foundation is established for successful performance management.     

医护一体化专项管理在降低临时药疗医嘱率中的应用

目的:探讨降低临时药疗医嘱率的方法,使临时药疗医嘱率降低。方法:成立医护一体化专项管理小组,调研科室临时药疗医嘱的现状,分析原因,提出对策。医护人员共同制定降低临时药疗医嘱率的细节,明确制度,加强合作,多形式学习,由医师和护士共同把关、共同监督、反馈、改进,对实施前后临时药疗医嘱率进行统计。结果:实施医护一体化管理使临时药疗医嘱率明显降低。结论:将医护一体化运用于临时药疗医嘱管理有助于规范医师开具临时药疗医嘱行为,减轻护士工作量,有利于提升医疗护理质量。     

上海地区医疗机构实验室质量管理现状分析

目的根据2019年上海地区不同类别医疗机构实验室现场督查结果分析上海地区实验室质量管理现状。方法依据《上海市医疗机构临床实验室质量管理规范》(简称管理规范),采用现场督查方式对289家实验室的质量管理情况进行评价,并分析督查不符合结果。结果289家医疗机构实验室得分中位数为89分,其中通过ISO 15189认可的37家实验室得分中位数为98分。三级医院、二级医院、一级医院、医学检验实验室和社会办医院实验室的优秀率分别为70.0%(35/50)、23.4%(18/77)、0(0/80)、47.8%(22/46)和16.7%(6/36),不合格率分别为0(0/50)、7.8%(6/77)、17.5%(14/80)、2.2%(1/46)和19.4%(7/36)。不同类别医疗机构实验室不符合发生率居前3位的条款均包括"5.6检验结果质量保证";其余条款不完全相同,包括"4.2质量管理体系""4.5受委托实验室的检验""4.14评估和审核""5.1人员""5.3实验室设备、试剂和耗材"。结论通过ISO 15189认可实验室质量管理优于非认可实验室,三级医院实验室质量管理总体情况优于其他医疗机构实验室。不同类别医疗机构实验室不符合条款发生频率不尽相同。     

Videotelephony-assisted medical direction to improve emergency medical service

IntroductionIn South Korea, on-line medical direction using voice calls has been implemented to improve the quality of the emergency medical system. However, in the same, short time span, video will be able to convey more information than by voice. The purpose of this study is to find out if videotelephony-assisted medical direction (VAMD) can change the intervention of the emergency medical technician compared to using conventional voice calls.MethodsWe conducted a prospective study of 312 patients with online medical direction from November 2017 to November 2018. We assisted patients with direct medical direction using conventional voice calls from October to November 2017, and then VAMD was implemented from October to November 2018.ResultsFrom the total number of conventional voice calls, 131 were used for this study, and of the total number of VAMD interventions, 181 were included. There were differences between conventional voice call and VAMD interventions in such types of medical direction as hospital selection (7.6% vs. 36.6%), ECG interpretation (0% vs. 3.4%), and advice on medical techniques (0% vs. 25.1%). The effectiveness of VAMD by survey is greater compared to conventional direct medical direction using voice calls (median value, 3.0 vs. 1.5).ConclusionsThe number of instances of medical direction for some interventions, such as interpretation of ECG and advice on medical techniques that did not perform well in conventional voice calls, increased in VAMD. VAMD may play an important role in the prehospital emergency care.     

规范医疗行为 预防医疗纠纷

随着科学的发展、社会的进步和人民生活水平的不断提高，人们对健康水平的认识上升到一个新的层次，对医疗服务提出了更高的要求。同时卫牛法制建设不断健全和完善，医疗法律环境及其法律规则的变化以及医疗行业的特殊性使医疗行为的法律风险愈加显现出来，再加上一部分医务人员思想观念转变滞后，法律意识淡薄．医疗纠纷的发生日益增多已成为不争的事实.     

Seminar教学法在医学继续教育课医疗纠纷案例教学中的应用

目前的医学继续教育课程传统的“传授——接受”单向教学模式的教学方法存在一定不足。它过于注重细节，没有充分利用现代化的先进手段。教学内容枯燥乏味，教学模式相对落后，理论知识过于理想化，学员们对实际中遇到的问题常常无从下手，与创新能力培养的要求相脱节。这一教学模式，已经不能适应当前人才培养的需要。     

规范医疗行为预防医疗纠纷

随着科学的发展、社会的进步和人民生活水平的不断提高,人们对健康水平的认识上升到一个新的层次,对医疗服务提出了更高的要求。同时卫生法制建设不断健全和完善,医疗法律环境及其法律规则的变化以及医疗行业的特殊性使医疗行为的法律风险愈加显现出来,再加上一部分医务人员思想观念转变滞后,法律意识淡薄,医疗纠纷的发生日益增多已成为不争的事实。2005年卫生部组织开展了“医院管理年”活动,其中把“努力提高基础医疗质量,保证医疗安全”作为活动的重要内容。所以,提高医务人员的法律意识、规范医疗行为,加强医疗管理,已不仅仅是医学科学…     

Why medical research needs a new specialty of 'pure medical science'

Sciences tend to go through boom and bust phases. Following decades of rapid expansion, medical science is now due for a collapse in overall funding. Furthermore, there has been a decline in the rate of therapeutic innovation, with fewer significant breakthroughs and little progress in several major areas of medicine such as oncology, psychiatry and autoimmune disorders. Mainstream medical research has gradually evolved into a form similar to industrial research and development (R&D), aiming at steady, reliable, predictable progress by ringing minor variations on existing approaches. Where this risk-averse approach is failing, a more speculative strategy is indicated. A new research specialty of 'pure medical science' would aim to seek radical new theories, technologies and therapies, and subject these to professional evaluation to the point where they can be applied in practice by more mainstream 'applied' medical scientists. A specialty of 'pure medical science' might be launched by financial support from patrons who wish to be associated with an elite new medical research discipline.