论医疗纠纷处理技巧与防范程序的建立

近年来,医院发生医疗纠纷的频率有上升态势,处理纠纷难度亦日益加大,是医院管理者经常面临的难题。依据多年从事医院医疗质量管理的实践经验和相关资料分析认为:医疗纠纷增多的现象不仅与医务人员的医疗技术、服务态度、管理人员素质、管理作风和医院对纠纷处理的方式有关,与公民的社会保健知识和法律意识的增强等因素亦有相关性。令人满意的医疗纠纷处理办法在于是否能从错综复杂的医疗纠纷中寻找其发生、发展和解决的规律,处理医疗纠纷重在把握好三个基本原则和运用技巧。此外,认为解决纠纷与防范纠纷具有同等的重要性,并对医疗缺陷防范程序的建立以及在现代医院管理中的意义进行了初步探讨。     

《医疗事故处理条例》对重庆市临床医师的心理影响评价

目的掌握和评价<医疗事故处理条例>(以下简称<条例>)颁布以来重庆市临床医师所面临的心理压力的现状,分析<条例>内容与这种心理压力之间的相关性.方法应用<焦虑自评量表>(SAS)和针对<条例>内容设计的<临床医师心理压力调查问卷>对样本医师群体进行调查.结果 (1)样本群体的SAS平均分高于正常人群及<条例>颁布前医护人员的平均分,差异具有统计学意义;(2)<条例>内容与心理压力之间存在一定的相关性.结论<条例>颁布后给重庆市的临床医师带来了一定的心理压力,管理者应针对这种情况研究为临床医师减压的问题.     

医院院长必须要处理好的几个关系

文章阐述了院长必须处理好的几个关系:一是必须正确处理办院方向与贯彻党的方针政策的关系;二是必须正确处理与上级的关系;三是必须正确处理两个一把手的关系;四是必须正确处理与副职的关系;五是必须正确处理与科主任的关系;六是正确处理与员工的关系。     

Handling of the MED-EL TEMPO+ ear-level speech processor by paediatric cochlear implant users and their parents

MED-EL launched the first ear-level speech processor offering a high-rate CIS+ strategy, the TEMPO+, in 1999. Studies have already demonstrated improved speech perception, sound quality and ability to enjoy music with the TEMPO+ due to the new CIS+ speech-coding strategy, when compared to the body-worn processor. In this study we evaluated responses from parents of young children about ease of handling and usage of the TEMPO+, and satisfaction with the TEMPO+ and its performance. Overall, 65 custom-designed questionnaires were analysed. The results showed that MED-EL cochlear implant users felt comfortable manipulating the dials and switches, changing the battery pack, using external sources of input and using the accessories provided. These results confirm the suitability of the TEMPO+ for infants and toddlers.     

Postnatal handling does not attenuate hypothalamic-pituitary-adrenal hyperresponsiveness after prenatal ethanol exposure

BACKGROUND: Prenatal ethanol exposure results in hypothalamic-pituitary-adrenal (HPA) hyperresponsiveness to stress in the adult animal. In contrast, an early environmental manipulation, termed "postnatal handling," has been shown to result in decreased and/or less prolonged HPA activity in response to moderate stressors throughout the lifespan of the animal. The effects of both prenatal ethanol exposure and postnatal handling on HPA activity may be mediated by altered feedback regulation of the HPA axis. The present study tested the hypothesis that postnatal handling could attenuate the impact of prenatal ethanol exposure on hormonal responses to stressors. METHODS: Male and female Sprague Dawley rats from prenatal ethanol (E), pair-fed (PF), and ad libitum-fed control (C) groups were either handled (H) or nonhandled (NH) during the preweaning period and were tested at 4 to 5 months of age. Animals were subjected to a 60 min restraint stress, 3 hr after intraperitoneal injection with either saline (SAL) or a synthetic glucocorticoid, dexamethasone-21-phosphate (DEX), in order to examine HPA responsiveness after DEX blockade of endogenous HPA activity. Blood samples were collected via jugular cannulae immediately before restraint (0 min), during restraint (10, 30, and 60 min), and 30 min after the termination of restraint (90 min). RESULTS: For both males and females, DEX administration significantly reduced plasma adrenocorticotropic hormone (ACTH) and corticosterone (CORT) concentrations compared with SAL administration. H animals showed greater suppression of HPA activity (i.e., lower ACTH and/or CORT levels) than NH animals regardless of prenatal group. In addition, E females from both the H and NH treatments showed elevated ACTH and CORT after both SAL and DEX administration, whereas H and NH E males showed elevations in ACTH and CORT only after SAL, compared with their PF and C counterparts. CONCLUSIONS: These data extend results from previous studies that demonstrated HPA hyperresponsiveness in E animals. The finding that E females but not males exhibit elevated ACTH and CORT after DEX administration suggests that prenatal ethanol exposure results in sex-specific alterations of HPA feedback. Consistent with previous data, handling in itself reduced the HPA response to restraint stress. However, handling did not attenuate either HPA hyperresponsiveness or feedback deficits in E animals.     

Neonatal experience interacts with adult social stress to alter acute and chronic Theiler’s virus infection

Previous research has shown that neonatal handling has prolonged protective effects associated with stress resilience and aging, yet little is known about its effect on stress-induced modulation of infectious disease. We have previously demonstrated that social disruption stress exacerbates the acute and chronic phases of the disease when applied prior to Theiler’s virus infection (PRE-SDR) whereas it attenuates disease severity when applied concurrently with infection (CON-SDR). Here, we asked whether neonatal handling would protect adult mice from the detrimental effects of PRE-SDR and attenuate the protective effects of CON-SDR on Theiler’s virus infection. As expected, handling alone decreased IL-6 and corticosterone levels, protected the non-stressed adult mice from motor impairment throughout infection and reduced antibodies to myelin components (PLP, MBP) during the autoimmune phase of disease. In contrast, neonatal handling X PRE/CON-SDR elevated IL-6 and reduced corticosterone as well as increased motor impairment during the acute phase of the infection. Neonatal handling X PRE/CON-SDR continued to exacerbate motor impairment during the chronic phase, whereas only neonatal handling X PRE-SDR increased in antibodies to PLP, MOG, MBP and TMEV. Together, these results imply that while handling reduced the severity of later Theiler’s virus infection in non-stressed mice, brief handling may not be protective when paired with later social stress.     

42所“双一流”高校学术不端行为处理办法比较研究

【目的】 探讨高校学术不端处理办法存在的问题,为进一步完善高校学术不端防治工作提供参考。【方法】 采用数据调研法、比较分析法、归纳法等,通过查阅相关网站、新闻和政策,以《高等学校预防与处理学术不端行为办法》(以下简称“教育部40号令”)为基础,细分6个方面32个指标,梳理42所“双一流”高校的学术不端行为处理办法,并作对比分析。【结果】 对于学术不端行为处理的相关文件,各高校表述各异;共有25所高校出台了含有“学术不端行为处理办法”字样的文件,只有18所高校在教育部40号令之后更新了各自的处理办法;文件的相关表述各异,存在诸多表达待改进的地方;从高校发布学术不端行为相关处理办法的角度指出存在的不足,并给出处理学术不端行为的建议。【结论】 各高校对教育部40号令的反应不一致,从一个侧面体现高校对于学术不端现象的认知与态度;高校学术期刊应抓住契机,深入到学术不端预防、调查、认定等相关环节中,主动作为,为高校学术不端行为的处理工作作出自己的贡献。     

Long-lasting handling affects behavioural reactivity in adult rats of both sexes prenatally exposed to diazepam

Environmental stressors can substantially affect the adaptive response of rats to novelty in a sexually dimorphic manner. Gender-related differences are also observed in neurochemical and behavioural patterns of adult rats following prenatal exposure to diazepam (DZ). In the present study the behavioural reactivity to novelty is investigated in open field (OF) and in acoustic startle reflex (ASR) tests, in non handled (NH), short-lasting handled (SLH) and long-lasting handled (LLH) adult male and female rats prenatally exposed to DZ. A single daily s.c. injection of DZ (1.5 mg/kg) over gestation days 14-20 decreases GABA/BDZ receptor function in both sexes, as shown by the decreased electrographic hippocampal response to DZ and the increased response to picrotoxin, after intra-locus coeruleus injection of the two compounds. In OF NH DZ-exposed males display a lower total distance travelled (TDT), a higher rearing frequency (RF) and a greater number of transitions in the centre of the arena (CNT) compared to NH rats prenatally exposed to vehicle. Conversely, NH DZ-exposed females show slight changes in TDT and RF and a greater reduction in CNT and in the amount of time spent in the centre of the arena (CAT). These effects are associated with an increase in the peak amplitude of the ASR in both sexes. Short-lasting handling slightly influences DZ-evoked effects in animals of both sexes. In DZ-exposed males long-lasting handling attenuates the reduction in TDT and the enhancement in RF, prevents the increase in CNT and reduces the peak amplitude of ASR. In DZ-exposed females, long-lasting handling increases TDT and RF, induces a lower avoidance of the centre of the arena, and does not modify the peak amplitude of ASR, when compared to controls. These findings indicate that prenatal exposure to DZ differently affects behavioural reactivity in adult male and female rats, and suggest that a long-lasting handling is able to attenuate some behavioural deficits induced by prenatal DZ exposure.     

The influence of handling and isolation postweaning on open field,exploratory and maternal behavior of female rats

Fifty-three black-hooded female rats, raised from the 28th to the 128th day of life under four types of environmental conditions differing in social and handling factors, had their behavioral performance evaluated in eight tests involving exploration of a complex environment (EX) in two open field (OF) tests and in three pup-retrieving tests. These tests were held before, during and after the period of lactation of their first brood. Females differed from (previously studied) males in that environmental raising conditions had a much smaller influence, especially during the lactation period. Nevertheless, females raised in isolation tended to remain for longer times inside a protected den in the exploration tests and to have greater locomotion in the open field. Previous handling allowed a greater exploration during the first contact with the novel complex environment as well as greater activity in the open field. The presence of small pups drastically reduced the exploratory motivation, but the presence of pups more than 20 days old tended to increase it. Maternal behavior evaluated in the pup retrieval test and in the test of time for the female to leave the nest side of the double box system was markedly refractory to previous environmental influences.     

Environmental and tactile stimulation modulates the neonatal handling effect on adult rat spatial memory

Handling of rat pups promotes their adult cognitive performance. However, new data suggest that individual components of the handling procedure, like exposure to novelty or tactile stimulation, have distinct lasting effects on behaviour. In this study we examined the interaction of early novelty exposure with a varying amount of tactile stimulation on spatial recognition memory and corticosterone secretion of adult male and female rats. A split litter design was used and the experimental animals were also compared to animal facility reared controls. The experiment was conducted in two phases. In the first phase, we examined the effect of novel or home environment during the 15-min of neonatal handling, following 10 back-strokes. Tactile stimulation of 10 back-strokes combined with novelty exposure, enhanced novel arm discrimination in a Y-maze task in adult rats of both sexes compared to their siblings that stayed at home, as well as to the animal facility reared controls. In the second phase, additional back-stroking (total of 20 back-strokes) reduced the Y-maze performance of males neonatally exposed to novelty, while the same treatment enhanced the performance of their siblings that stayed at home. Basal corticosterone levels, determined 1 week post-Y-maze, were significantly increased only in the novelty exposed/10 back-stroked females compared to same sex non-handled controls. In contrast, 10 back-strokes combined with the home cage environment increased corticosterone in males. Increase to 20 back-strokes reversed the impact of neonatal environment on corticosterone levels.