和谐医患关系的伦理维度与法律支撑

我国医患关系尚未实现真正的和谐,其原因是多重的。就伦理层面而言,多数医疗纠纷源于医患双方缺乏信任,以自我为中心,过分强调经济利益,缺少人文关怀。就法律层面而言,医患关系重大涉法问题研究薄弱,调整、规制医患关系的法律滞后甚至缺失,医疗纠纷处理机制不健全、不完备以及医患双方法律意识失衡与法律知识不健全。构建和谐医患关系,应当加快立法进程,保障医患双方利益;加强德育,明确医患关系的伦理诉求。     

对药品广告法律制度的立法思考

目的：为完善我国药品广告法律规制提出解决措施,以供相关部门参考。方法分析现行药品广告监管法律制度存在的问题,从法律规制的角度探寻违法药品广告存在的原因。结果与结论：借鉴国外药品广告法律规制的经验,从原因出发,在强制审查、监管主体、广告内容和形式及惩罚措施等方面提出建议和意见。     

违反国有资产管理办法的法律责任

国有资产管理范围主要包括资产的配置、资产使用、资产处置等。为维护国有资产的安全和完整,医院必须全面执行国有资产管理办法,否则会造成资产的不合理配置和利用效率的低下。本文除研究国有资产的具体管理办法外,侧重提出违反国有资产管理办法应承担的法律责任。目的是提高医院领导的法律意识,全面保护国有资产的安全和完整。     

重视急诊医疗中的伦理问题

目的探讨急诊医疗中伦理问题的重要性。方法参考相关文献,并融合本院急诊的特点,探讨目前急诊医疗中所存在的伦理问题,以及重视伦理问题的必要性,并根据本院急诊医生小范围调查结果所反映的问题探讨相应对策。结果因目前急诊医疗的特殊性,产生了与其他科室所不同的伦理问题。结论要重视急诊医疗中伦理问题产生的原因,要完善急诊医疗中相应的政策法规和急诊流程问题;要重视病人权益,加强医患沟通,保障病人返家后的安全;同时也要减轻急诊医生工作压力,加强急诊医生可持续性培训和团队合作精神。     

医疗机构麻醉药品和一类精神药品管理体会

目的加强医疗机构麻醉药品和一类精神药品管理。方法从麻醉精神药品使用管理部门、执业医师、患者、药学人员等多个层面来分析实施相关法规所面临的问题和对策。结果麻醉精神药品管理法规体系日趋完善,重视人文关怀,更显人性化;但在实施法规的过程中,同时存在处方专册登记,处方限量,出诊用药,以及剩余药品和空安瓿不能正常回收等问题。结论加强医务人员对法规和规范化疼痛处理新技术的学习和培训,从而加速观念的改变是贯彻实施相关法规的关键。     

医患关系紧张的法律成因与对策

通过2007年对北京市的政府工作人员、社会民众、医务人员和患者进行的关于医患关系的问卷调查结果分析表明,医患关系总体是和谐的,但仍存在一定程度的紧张.分析影响医患关系紧张的法律成因主要表现为医疗立法不完备、医疗主体依法行医或就医的意识与能力不强以及医疗纠纷处理法律制度不健全.对此提出了加强卫生立法工作以建立健全医药卫生法律制度;提升医患双方依法行医和依法就医的能力;建立多元化的医疗纠纷解决机制和患者权利保障制度的法律对策.     

中国医疗卫生法治的历史、现状与走向——中国医疗卫生法治30年之评析

1978年以来,我国的医疗卫生立法、医疗卫生执法、医疗卫生司法、医疗卫生守法、医疗卫生参与和医疗卫生法律监督工作取得了巨大的成就。1997年国家正式提出依法治国方略后,我国的医疗卫生工作正式走向法治化的轨道。目前,无论是从环节上,还是从整体的判断指标上分析,或者从实效上评估,都说明我国的医疗卫生法制架构已经基本形成。符合科学发展观和和谐社会的医疗卫生法治工作正在完善之中。完善的措施既包括立法完善工作,还包括执法、司法、守法、参与和监督环节的体制、制度和机制的创新工作。     

Intentional ingestion of cyanoacrylate

Abstract

Background. Diphenidine (1-(1,2-diphenylethyl)piperidine) and its 2-methoxylated derivative methoxphenidine (MXP, 2-MeO-diphenidine) are substances with dissociative effects that were recently introduced for “recreational” purpose through the online-based sale of new psychoactive substances (NPS). A number of analytically confirmed non-fatal intoxications associated with diphenidine or MXP have occurred in Sweden and were included in the STRIDA project. Study design. Observational case series of consecutive patients with admitted or suspected intake of NPS and requiring intensive treatment in an emergency room and hospitalization in Sweden. Patients and methods. Blood and urine samples were collected from intoxicated patients presenting at emergency departments all over the country. NPS analysis was performed by multi-component liquid chromatography–mass spectrometry methods. Data on clinical features were collected during telephone consultations with the Poisons Information Centre and retrieved from medical records. Information was also obtained from online drug discussion forums. Case series. Over a 12-month period from January to December 2014, 750 cases of suspected NPS intoxication originating from emergency departments were enrolled in the STRIDA project of which 14 (1.9%) tested positive for diphenidine and 3 (0.4%) tested positive for MXP. Co-exposure to several other NPS (e.g., 5-/6-(2-aminopropyl)benzofuran, 2-4-bromomethcathinone, butylone, 3,4-dichloromethylphenidate, 5-methoxy-N-isopropyltryptamine, methiopropamine, and α-pyrrolidinopentiothiophenone), also including other dissociative substances (3-/4-methoxyphencyclidine), and classical drugs of abuse (e.g., cannabis and ethanol) was documented in 87% of these cases. The 17 patients were aged 20–48 (median: 32) years, and 13 (76%) were men. They commonly presented with hypertension (76%), tachycardia (47%), anxiety (65%), and altered mental status (65%) including confusion, disorientation, dissociation, and/or hallucinations. Eight patients (47%) displayed severe intoxication (Poisoning Severity Score 3). The diphenidine- or MXP-positive patients required hospitalization for 1–3 (median: 2) days. In addition to standard supportive therapy, half of the cases were treated with benzodiazepines and/or propofol. Conclusion. The adverse effects noted in analytically confirmed cases of NPS intoxication involving diphenidine or MXP were similar to those reported for other dissociative substances such as ketamine and methoxetamine. However, the high proportion of polysubstance use might have played a role in the intoxication and clinical features in some cases.     

Development of a Coroner-Based Surveillance System for Drug-Related Deaths in Los Angeles County

Existing data sources do not provide comprehensive and timely information to adequately monitor drug-related mortality in Los Angeles County. To fill this gap, a surveillance system using coroner data was developed to examine patterns in drug-related deaths. The coroner provided data on all injury deaths in Los Angeles County. A list of keywords that indicate a death was caused by drug use was developed. The cause of death variables in the coroner data were searched for mentions of one of the keywords; if a keyword was detected, that death was classified as drug related. The effectiveness of the keyword list in classifying drug-related deaths was evaluated by matching records in the coroner death data to records in the state death files. Then, the drug-related deaths identified using the keywords were compared to drug-related deaths in the state mortality files identified using International Classification of Death codes. Toxicological test results were used to categorize drug-related deaths based on the type and legality of the drug(s) ingested. Mortality rates were calculated for each category of drug and legal status and for different demographic groups. Compared to the gold standard state mortality files, the coroner data had a sensitivity of 95.6% for identifying drug-related deaths. Over three quarters of all drug-related deaths tested positive for opiates and/or stimulants. Males, Whites, and 35–54-year-olds each accounted for more than half of all drug-related deaths. The surveillance of drug-related deaths using coroner data has several advantages: data are available in a timely fashion, the data include information about the specific substances each victim ingested, and the data can be broken down to compare mortality among specific subpopulations.     

60例骨科医疗纠纷分析与对策

对5个地区(县)医院骨科10年来发生的医疗纠纷作回顾性调查,结果提示日益增高的 医疗纠纷中骨科占了相当高的比例,究其产生因素非医源性高于医源性。全面提高医务人员素质,增强法律意识,做好医疗纠纷防范工作是减少医疗纠纷发生的有效措施和对策。