综合性(师范)大学医学教育教学改革及思考

本文阐述了医学院校并入综合性(师范)大学后,如何利用和发挥综合性大学优势,全面实施素质教育;医文渗透,医理融合;深化教育教学改革;加强师资队伍建设与学科建设探索的体会,并对今后的发展提出某些战略性思考。     

关于卫生监督医疗纠纷类图书归类探析

指出第四版《中图法》中有关卫生监督、医疗事故、医疗纠纷等类目中存在的一些问题和不足,并提出具体改进措施和分类建议。     

大型医用设备成本效益分析在HIS上的实现

介绍了大型医疗设备成本效益分析应用系统挂接HIS(“军字一号”)上的设计、功能实现及应用。该应用系统部分实现了大型医用设备的现代经济管理。     

Effects of surgical treatment in thymoma with myasthenia gravis: our experience in 103 patients.

A retrospective study of 103 thymectomies examines the effects of the integration of surgical and medical therapy in patients affected by myasthenia gravis accompanied by thymoma. An extended thymectomy via a median longitudinal sternotomy was used in 102 patients. The operative mortality was 4.85% (5/103 patients), the 10-year survival rate was 78% with a recurrence rate of 3.06% (3/98). Neoplastic infiltration and postoperative radiotherapy did not influence the survival rate. There was no correlation between a preoperative Osserman's class better than III and postoperative outcome. The improvement of medical treatment, and anaesthesiological and intensive care techniques resulted in a decrease of the operative mortality and long-term death rate during the last 10 years of our 20-year series. Extended thymectomy via sternotomy is the best intervention in patients with myasthenia gravis associated with thymoma judged by the low operative mortality and the favorable 10-year survival rates.     

医学技术的进步与传统医学伦理的矛盾

此文全面论述了先进医学技术给传统医学伦理的医患关系模式、医生义务论、生命认识论、资源分配论等诸多方面带来的巨大冲击,并由此提出先进医学技术发展应遵循的伦理规则。     

医科院校师生对考试现状看法的调查与分析

医科院校的考试主要是学科考试。调查显示，教师和学生对目前的学科考试模式评价均不高，存在的最主要弊端是考试方法单一，考试管理不够科学、严谨，考风不好；认为作弊的主要原因在于学生自己学习不努力、社会风气影响以及学校对教师和学生要求不够严格。因此，要搞好考试改革，提高考试质量，必须着重从改革考试方法、加强考试管理的改革与研究、整顿考风、制定科学的成绩评定方法、加强能力考核、实施教考分离等方面进行探索与实践。     

Requiring Consent vs. Waiving Consent for Medical Records Research: A Minnesota Law vs. the U.S. (HIPAA) Privacy Rule

The use of medical records in research can yield information that is difficult to obtain by other means. When such records are released to investigators in identifiable form, however, substantial privacy and confidentiality risks may be created. These risks become more common and more serious as medical records move to an electronic format. In 1996, the state of Minnesota enacted legislation with respect to consent requirements for the use of medical records in research. This legislation has been widely criticized because--it is claimed--it creates an unnecessary impediment to research. In this article, we show that these arguments rest upon misinterpretation and/or misrepresentation of the 1996 legislation. A consent requirement had actually been present in Minnesota since 1976 (though codified in a patient rights statute rather than a privacy statute). The 1996 law does not require specific consent, as often claimed, but rather only a general authorization. The campaign against the Minnesota legislation appears to have been motivated by concern with respect to the then impending federal privacy rule. The HIPAA rule, as enacted, is in fact less stringent with respect to consent than the Minnesota consent law. On the other hand, the Minnesota consent law has not been effectively applied or enforced. As we change the way we manage sensitive medical information, new efforts are needed to provide protection against the confidentiality risks in research. Patient consent is an important tool in this regard. New instrumentalities are needed to solicit and document consent.     

Integrating human factors into the medical curriculum

Background  The study of human factors is a scientific discipline that deals with the interactions between human beings and the elements of a system. This is important because shortcomings in these areas, if unchecked, can result in adverse outcomes. Research into human factors in industries where safety is paramount has provided the basis of countermeasures against human error. Adverse outcomes in medicine resulting from human error exact a high cost in both patient suffering and financial outlay.
CRM training  One of the approaches used to minimise the effect of human error is to train people in a set of knowledge, skills and attitudes that underpin the domain-specific competencies for that profession. These are referred to as non-technical skills (NTS). In aviation, such an approach has been shown to be both translatable from the training environment to the workplace and effective in reducing adverse outcomes.
Discussion  Medicine has incorporated this style of training, usually centred around simulator-based courses, but as yet in a piecemeal, episodic fashion which relies on participants volunteering to attend courses. Unlike other industries there is no systematic approach to linking the content of this teaching with the more conventional range of topics. As a consequence it is difficult to assess the impact of human factors training in medicine. This is partly because very little work has been done to date in identifying the key non-technical skills required in medicine, and the overall experience of workplace based assessment is limited. Lessons from other high reliability organisations may help to address the main challenges of developing the content, integrating it into the curriculum, reinforcing the concepts in the workplace through staff development and establishing its role in summative assessment.     

浅谈医疗商业贿赂的成因及预防对策

医疗商业贿赂已引起全社会的高度关注，成为2006年六大重点领域里治理的商业贿赂之一。作者通过分析医疗商业贿赂的危害和原因，提出：①加强思想教育；②坚持依法行政；③完善相关制度；④深化体制改革；⑤完善监督制度等预防对策。     

温州市农村贫困人群卫生服务需求和利用分析

通过对近2000份调查表的分析,评价温州市农村贫困人群在就诊过程中对医疗机构的选择、未就诊原因方面的特点,提出提高卫生服务利用的方法。