医疗事故技术鉴定结论审查中的问题与对策

医疗事故技术鉴定结论与医疗案件审理结果、医学进步密切相关。目前法院在医疗事故技术鉴定书的审查中存在着实体与形式上的隐患。笔者认为,法院在严格审查医疗事故技术鉴定结论时应充分发挥医学会专业鉴定的作用,善用专家辅助人,规范、监督和保障法官自由裁量权的正当行使。     

136例工伤伤残案例的精神医学鉴定

目的 分析工伤鉴定案例精神伤残评定及其相关因素。方法 对136例工伤鉴定案例的损伤因素、伤残类型、伤残等级、精神医学鉴定诊断等问题进行总结分析,并对工伤精神伤残中的伪装进行了对比分析。结果 有精神伤残94例,占69.0％,其中,智力伤残合并精神障碍伤残17例(12.5％),单一智力伤残者64例(47.1％),单一精神障碍伤残2例(1.5％),性功能伤残10例(7.4％)。未达到伤残程度者42例,占31.0％,包括17例脑挫裂伤后综合征及6例与创伤因素有直接或间接关系的功能性精神障碍。在既有临床评估又有测验评估的71例案例中,临床判断伪装智力低下25例(35.2％),测验判断有伪装智力低下58例(81.7％),临床评估与测验评估之间存在显著差异(P<0.01)。结论 (1)现有的工伤伤残标准有待于完善;(2)工伤伤残鉴定中伪装智力低下的比例较高,值得重视。     

我院医学计量管理模式的探讨

本文结合目前医院计量管理工作中存在的实际问题,介绍了医院计量管理的复杂性和面临的困难,提出了我院计量管理的实施措施,希望与同行共同探讨。     

重庆社区居民糖尿病相关危险因素定量评价标准

目的 探讨重庆市16岁以上社区居民糖尿病相关危险因素,制定危险因素的定量评价模型,为预测个体糖尿病的患病危险奠定基础.方法 采用病例对照研究的方法,从重庆市沙坪坝、小龙坎、天星桥、渝碚路、磁器口5个社区中以1:2的比例抽取糖尿病患者1981例,健康人群3962例进行回顾性调查,利用logistic回归方法分析,得出各危险因素与糖尿病的OR值,运用统计模型将不同暴露水平的危险因素转化成危险分数.结果 得到不同性别、年龄、行为、疾病以及家族史的个体在不同情况下的危险分数,男性为高脂血症史(14.995)、冠心病(6.689)、高血压家族史(4.005)、吸烟(3.111)等13个危险因素进入主效应模型;女性为高脂血症史(12.426)、高血压家族史(3.986)、脑卒中史(2.714)、嗜甜食(1.244)等15个危险因素.根据个体情况得到组合危险分数,从而预测该个体的糖尿病发病危险.结论 改变不良的生活方式以及个人疾病的积极治疗和控制,能有效降低糖尿病的发病率;而根据危险因素建立的危险分数评估模型是健康教育的有力依据,也是当前开展社区卫生服务的重要方法.     

Relevance and practical use of the Consultation and Relational Empathy (CARE) Measure in general practice

BACKGROUND: The Consultation and Relational Empathy (CARE) Measure has been developed as a tool for assessing the patients' perceptions of relational empathy in the consultation. OBJECTIVES: The present paper provides performance data on the CARE measure in a large sample of general practice consultations in areas of high and low deprivation. METHODS: The CARE Measure was included in a self-completed questionnaire study involving 3044 patients attending 26 GPs in 26 different practices (16 in areas of high socio-economic deprivation and 10 in low deprivation areas, in the west of Scotland). RESULTS: GPs and patients, in both high and low deprivation settings, endorsed the relevance of the CARE Measure. Overall, 76% of patients rated the measure as being 'very important' to their current consultation. Higher rating of importance were observed in older patients, patients consulting with psycho-social problems, patients with long-standing illness or disability, and patients with significant emotional distress. Few patients rated individual CARE Measure items as being 'not applicable' to their current consultation; only 3.1% of patients felt that more than 2 of the 10 items in the measure did not apply to their current consultation. Mean values were not influenced by deprivation, gender, reason for consulting, chronic illness, or emotional distress. Correlational analysis indicated that a sample size of 50 patients is sufficient to reliably estimate mean CARE score for an individual GP. CONCLUSIONS: These results indicate that the CARE Measure is considered by GPs and patients alike as being of direct relevance to everyday consultations in general practice, in both high and low deprivation settings. The measures is stable across patient groups and a reliable estimate of perceived GP empathy requires 50 completed questionnaires per doctor.     

深化职称改革建设高素质的卫生人才队伍

卫生技术职务是社会实用职位,职称评审是广大卫生专业技术人员普遍关心的“热点”问题。本文回顾了职称评聘制度的发展过程,分析了现行职称评审制度中存在的问题,提出了改进卫生系列职称评审工作。①降低评审条件中“硬件”所占的比重;②科学设岗;③实行评聘分开;④严格评审推荐工作的公正性;⑤完善考评结合和人才评价制度;⑥建立能上能下的竞争激励机制;⑦完善考核制度及加强人才培养。     

对临床医务人员实施岗位量化考核的思考

文章阐述了在深化卫生人事制度改革期间,对聘任上岗后的医务人员实施岗位量化考核所具有的现实意义,指出在实施过程中需要注意的问题,并针对问题提出了相应的对策。     

软科学学术论文质量评价系统

如何评价和鉴定学术论文水平的高及其学术价值的大小是科学研究或管理部门罗为关注的 题,文章介绍了运用关系数据库建立学术论文质量评价系统的结构功能,量仑 学术论文评价标准和学术价值的鉴定指标,系统具有方便实用、先进有效和安全可靠的特点,所建立的评价体系与方法适用于学术论文评选活动以及专业人员学术能力的考评。     

Some Challenges to Progressive Control of Foot and Mouth Disease in Pakistan – Findings of a Pilot Survey

Pakistan is at an initial stage for progressive control of foot and mouth disease (FMD). Understanding the risk factors for introduction, spread and persistence of the infection is important to design an evidence‐based disease control programme. A rapid appraisal method was adopted, and a convenient sample of twenty commercial dairy farmers was interviewed. The following were considered to contribute in secondary transmission of infection: (i) intermediaries and service providers [animal health workers, animal traders and transporters, raw milk collectors, persons who remove skin of dead animals], (ii) places where animals come in close contact [livestock markets, animal fairs, communal grazing pastures, routes in villages where livestock move, watering points, animal transport vehicles], (iii) use of bulls immediately after recovery from FMD infection, (iv) range land/desert livestock production, (v) small holder sheep and goat production, (vi) purchase of replacement stock and fodder from infected locations. This article reveals contacts within and between villages, some of which may act as routes of transmission of FMD. The study suggests the need for zoosanitary education of the livestock keepers.     

“护理教育学”课程考试改革的实践与探索

目的探索护理专业考试改革方案，建立合理公平的考核机制。方法将2009级和2010级本科护理专业学生分设为对照组（采用传统考核模式）65人和实验组（采用过程考核模式）64人。比较分析两组护生的试卷考试成绩和总成绩。结果两组护生试卷考试成绩差异无显著意义（P〉0．05）；实验组护生总成绩优于对照组，差异有显著意义（P〈0．05）；护生对教师的总体评分有所提高。结论将传统考核模式改为过程评价的考核方式，改变“一张试卷定终分”的考试模式，采用多种考核方式相结合，注重过程考核，达到了从知识、态度、行为及综合素质多方面考核护生的目标。