保定医学堂的初创

保定医学堂是在我国医学教育中较早的一所中西医结合院校,该校的建立为中西医结合的发展起到了积极的作用。本文介绍了该学堂建立时的历史背景,教学计划及学生管理等方面的规章制度,这对当前的教育、教学改革无疑有所裨益。     

深化医院改革的几点思考

医疗机构管理是卫生管理领域的一个重要方面,医院综合改革是卫生改革的一项重点。改革开放20年来,上海卫生事业取得了蓬勃发展,医院的队伍建设、设备条件和服务水准都有很大进步。在总结已取得的成绩同时．也给我们以下几点启示：在医院改革中必须切实抓好精神文明建设,必须坚持“两手抓、两手都要硬”的方针,必须把社会效益放在第一位;改革中必须抓重点,解决工作中突出问题;改革必须着眼于机制、体制、法制的完善,解决深层次问题。对人的管理,首先是要营造一个人才能脱颖而出的环境氛围,关键是要促进人才流动;对物的管理要严格按经济规律办事,实现低耗高效;对医院必须强化经济管理,要考虑成本、价格等问题。1999年任务是：推进区域卫生规划的制订与实施;继续完善“总量控制、结构调整”政策;进一步推进人事制度。分配制度、财会制度的改革;加强对医疗机构的法制化管理与监督。     

Policy incongruence and public health professionals' dissonance: the case of immigrants and welfare policy

The steady increase in immigrants to the United States has fueled a critical analysis of the process of allocation of health and social benefits to these newcomers. The myriad of interests and values surrounding this issue precipitated the formulation and adoption of the Personal Responsibility and Work Opportunity (Welfare Reform) Act of 1996. This dramatic welfare reform impacts federal, state, and local agencies that are required to determine the eligibility of benefits and manage the attendant consequences to the public as well as members of this vulnerable group. Especially challenging are the decisions confronting public health professionals who struggle to reconcile the resulting policy, programmatic mandates, and compliance imperatives with prevailing public health principles and practice norms. This paper proposes a framework for understanding the incongruence between the provisions of the law as it pertains to legal and illegal immigrants and public health values. The impact of policy incongruence and professionals' dissonance on public health practice norms is explored with an explicit focus on public health outcomes and legal implications. The examination of tuberculosis as a health example reveals the policy conflicts and public health dilemmas. Finally, the paper elicits a range of options available to public professionals for responding to these legal mandates.     

World Wide Web and Internet: applications for radiologists

Global exchange of information is one of the major sources of scientific progress in medicine. For management of the rapidly growing body of medical information, computers and their applications have become an indispensable scientific tool. Approximately 36 million computer users are part of a worldwide network called the Internet or “information highway” and have created a new infrastructure to promote rapid and efficient access to medical, and thus also to radiological, information. With the establishment of the World Wide Web (WWW) by a consortium of computer users who used a standardized, nonproprietary syntax termed HyperText Markup Language (HTML) for composing documents, it has become possible to provide interactive multimedia presentations to a wide audience. The extensive use of images in radiology makes education, worldwide consultation (review) and scientific presentation via the Internet a major beneficiary of this technical development. This is possible, since both information (text) as well as medical images can be transported via the Internet. Presently, the Internet offers an extensive database for radiologists. Since many radiologists and physicians have to be considered “Internet novices” and, hence, cannot yet avail themselves of the broad spectrum of the Internet, the aim of this article is to present a general introduction to the WWW/Internet and its applications for radiologists. All Internet sites mentioned in this article can be found at the following Internet address: http://www.univie.ac.at/radio/radio.html (Department of Radiology, University of Vienna) Received: 2 February 1998; Revision received: 11 June 1998; Accepted: 27 July 1998     

The impact of student-generated learning issues on individual study time and academic achievement

OBJECTIVES: The aim of this study was twofold. The first question concerns the way students make use of the learning issues they generate (as strict guidelines or as global guidelines) and whether this changes across years of training. The second question concerned the relationship between the way students make use of learning issues and the time spent on individual study and achievement on two tests of knowledge. DESIGN: A questionnaire was developed, containing seven items that measured to what extent students study strictly according to the student-generated learning issues and six items that measured to what extent students study beyond the student-generated learning issues. The questionnaire also contained one question in which students had to estimate the mean time spent on individual study. Achievement was measured by two forms of tests of knowledge, a block test assessing course content and a progress test assessing long-term functional knowledge. SETTING: Medical School of Maastricht University, the Netherlands. SUBJECTS: Medical students (response=69%) from the problem-based curriculum at the Maastricht University. RESULTS: During their first year students study strictly according to the content of the learning issues, whereas in later years students studied more according to their own learning needs and interests. In addition, students who tended to study beyond the generated learning issues spent more time on individual study and achieved better on both tests. CONCLUSIONS: Students in a problem-based curriculum seem to become better self-directed learners during the years of training.     

Students conducting consultations in general practice and the acceptability to patients

OBJECTIVES: The General Medical Council has recommended that medical students should gain more experience in general practice. The study set out to determine patients' reactions to consultations conducted by a medical student alone prior to seeing their GP. DESIGN: A random sample of patients attending general practice surgeries in the Oxford area completed a questionnaire following consultation with a medical student. SETTING: Six general practice teaching surgeries. SUBJECTS: Fifth-year medical students. RESULTS: Of 130 responders 98% experienced no disadvantage in seeing the student; 35% considered that there were advantages in seeing the student; 98% said that they would be prepared to consult with a student again; 85% expressed no concerns about the gender of the student. CONCLUSIONS: The results of this study are very reassuring concerning the acceptability to patients of consulting with medical students and are more favourable than those reported for studies of students being present in consultations by GPs.     

Rape attitudes amongst British medical students

OBJECTIVES: To examine the rape attitudes of a sample of 252 British medical students. DESIGN: A 20-item questionnaire was used. SETTING: A London medical school. SUBJECTS: Fourth-year medical students. RESULTS: In general, students were well informed on legal and factual issues regarding rape and sexual assault. However, significant differences were found in the attitudes to rape between males and females. Female students were significantly more positive in their responses to victims. CONCLUSIONS: These results support findings from previous studies of rape attitudes in other professional groups. Better knowledge and enlightened attitudes amongst health care staff can have a significant impact on the management of sexual assault and influence the likelihood of victims presenting for treatment. In conclusion, this study emphasizes the importance of teaching about sexual violence in British medical schools.     

Occupational therapy in mental health: challenges and opportunities

The National Mental Health Policy and National Mental Health Plan published in 1992 provided directions for the reform of mental health services in Australia. They stated that mental health services should be part of the mainstream health system and that integrated mental health programmes should be developed to cover the full range of specialist mental health services, focusing on improved quality of service, the consumers, equity of access, continuity of care and redistribution of resources. The Queensland Mental Health Plan published in 1994 set out specific objectives and strategies for implementing mental health service reform in Queensland. In Queensland there has been a concentration on developing core mental health services involving the reorientation of service delivery from institutions to the community, based on the principles of integration, mainstreaming and regional self-sufficiency. Major restructuring of mental health services is taking place, which has meant changes in service development, organizational structures and work practices. There has been a significant impact on the roles and skills required by the mental health workforce in the context of today's mental health services climate. There is a focus on staff providing individualized assessment and continuing treatment using a case management approach, within a continuum of care. Implications for occupational therapists include developing a generic skill base in preparation for broad-spectrum mental health professional roles while maintaining their professional identity. It is recommended that research be conducted to examine the capacity of occupational therapists to adapt to the changing mental health environment. Copyright © 1999 Whurr Publishers Ltd.     

医院后勤服务社会化的思考

医院后勤服务社会化是医院后勤改革的关键,面对改革的趋势,我们必须认真研究、悉心思考、统一认识、采取措施,改变目前医院后勤管理中不适应市场机制和现代医院管理的落后状态,主动寻找对策,充分利用和发掘现有后勤资源,在保证医院中心工作、“一切以病人为中心”为目标的前提下,把医院后勤管理和服务职能分离,认真操作、大胆探索,加快医院后勤服务社会化进程