新医疗鉴定:"科学公正"第一位

从2002年9月1日起,我国《医疗事故处理条例》开始实施,其中主要一点就是:是医疗事故,赔;不是医疗事故,不赔。因此,医疗事故鉴定成为关键的证据。而医疗事故鉴定也有了全新的改革,突出了其“科学和公正”。目前,各地专家库已经建立,并着手开始了新的医疗事故鉴定工作。为帮助医学专家们从旧鉴定的惯性中走出来,用新的思维和方法确保医疗事故鉴定的科学公正,一些法律工作者总结了鉴定中出现过的突出问题,给专家们提个醒。程序合法是前提山东威海一位农民日前要状告一家医院,当事双方委托威海市医学会组织医疗事故鉴定,在抽取鉴定专家时,办事人…     

构建医疗事故技术鉴定监督机制之探讨

医疗事故鉴定是解决医患纠纷的一个必经环节.现阶段,医疗事故鉴定存在诸多缺陷,原因之一在于缺乏一套完善的监督机制来规范鉴定行为.文章从外部监督和内部质量监控两个维度着手构建一套医疗事故鉴定监督制度,为处理医患纠纷提供科学、公正的证据支持.     

基于委托-代理视角分析医学会的鉴定行为

医疗技术鉴定是医疗事故纠纷处理的关键,只有设计出科学合理的鉴定制度才能做出公正、公平的鉴定结论.从民事委托-代理制度的视角,对医学会的鉴定行为进行法律分析,对医学会做为代理人的鉴定行为提出质疑,并提出了完善鉴定制度的建议.     

对《医疗事故处理条例》在实施过程中的两点建议

国务院 2 0 0 2年颁布的《医疗事故处理条例》相对1987年颁布的《医疗事故处理办法》,在鉴定机构、鉴定程序和事故等级等方面进行了重大改变 ,对事故的赔偿和责任程度的划分亦做了明确规定 ,使医疗事故的鉴定更加公平、公开、公正、科学、权威 ,实实在在地保护了患者和医疗机构及其医务人员的合法权益 ,为依法处理医疗事故和纠纷提供了有力保障 ,但笔者在实际工作中认为有两个方面有待进一步修改和完善 ,现提出供同行共同商讨。1　要进一步明确卫生行政主管部门在医疗事故鉴定中的职责和作用《医疗事故处理条例》第二十条和第四十八条均明确…     

处理医疗事故的难点及对策

由于医疗卫生事业的向个重大法律特性来被广泛重视,医疗事故鉴定程序、立法和机构组成不适应当当前的不到加之医疗事故补偿额度不公正等情况明显滞后,因此给医疗事故处理带来了非常大的难度。为此,就当前处理的难点问题阐述,并提出对策。     

对现行医疗事故技术鉴定若干问题的探讨

医疗事故技术鉴定对于公平、公正处理医疗纠纷具有重要意义,通过分析医疗事故处理中技术鉴定结论在纠纷处理中的重要性,及医学会组织鉴定过程中存在的缺陷,并结合医院管理和医疗纠纷处理经验提出了公平、公正、科学鉴定的几点建议,以期进一步促进医疗规章制度完善。     

医疗事故技术鉴定结论差异的分析及启示

医疗事故技术鉴定实行多次鉴定制 ,各次鉴定结论是卫生行政部门、司法机关处理医疗纠纷的重要依据和证据 ,具有法律证明效力。通过对结论差异案例的原因分析 ,提出正确理解和准确把握医疗事故定义是正确判定医疗事故的关键和核心 ;恰当地运用举证责任分配原则是医疗事故技术鉴定的重要环节 ;完善《医疗事故处理条例》、《医疗事故分级标准》、《医疗事故技术鉴定暂行办法》是鉴定结论准确、公正的基础 ;准确地把握法律法规的主旨 ,依法鉴定是保障医疗事故技术鉴定性准确的保证     

加强医疗事故鉴定工作的思考

医疗事故技术鉴定结论是解决医疗纠纷的重要前提，医疗事故鉴定是否客观、公正直接关系到医疗机构（医务人员）和患者双方的合法叔益能否得到有效的保护。自2002年《医疗事故处理条例》实施以来，医疗事故技术鉴定对解决医患纠纷发挥了积极的作用，如何建立一个科学、完善、认同性高的医疗事故技术鉴定制度是社会各界十分关注的焦点。本文分析了医疗鉴定的现状及存在问题，并提出进一步完善的对策。     

试论医患纠纷案件处理中的司法鉴定

在目前医患纠纷诉讼案件的司法处理中，存在两种鉴定形式，即医疗事故技术鉴定和医患纠纷的司法鉴定．而司法鉴定由于其较医疗事故技术鉴定更为公正、客观，正逐渐被越来越多的当事人（主要是惠方）所接受，文章分析了医患纠纷中司法鉴定的特点，也对其提出了完善的建议。     

再议医疗事故技术鉴定

在医疗事故技术鉴定方面,<医疗事故处理条例>(以下简称<条例>)相对于<医疗事故处理办法>有了较大的进步,使医疗事故技术鉴定的决定权、组织权、实施权三权分离,使医疗事故技术鉴定有了体制上的保证、程序上的公开,以保证鉴定结果的公平公正.     

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.     

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.