举证责任倒置引发过度医疗的伦理思考

举证责任倒置对于医患双方都具有重要的伦理意义,但举证责任倒置本身具有的缺陷容易导致医务人员为保护自关键是加强管理,提高医务提要正确认识和理解举证责任倒置,己而采取过度医疗行为.为杜绝过度医疗行为,从医方来看,前人员的职业道德素质;社会在加强监督的同时,要认识医学本身的高风险性,建立健全医生执业保险制度.     

How predictive are photosensitive epilepsy models as proof of principle trials for epilepsy?

PurposeHuman photosensitive epilepsy models have been used as proof of principle (POP) trials for epilepsy. Photosensitive patients are exposed to intermittent photic stimulation and the reduction in sensitivity to the number of standard visual stimulation frequencies is used as an endpoint. The aim of this research was to quantify the predictive capabilities of photosensitive POP trials, through a survey of current literature.MethodsA literature search was undertaken to identify articles describing photosensitive POP trials. Minimally efficacious doses (MEDs) in epilepsy were compared to doses in the POP trials that produced 50–100% response (ED_50–100). Ratios of these doses were calculated and summarised statistically.ResultsThe search identified ten articles describing a total of 17 anti-epileptic drugs. Of these, data for both MED and ED_50–100 were available for 13 anti-epileptic drugs. The average ratio of MED to ED_50–100 was 0.95 (95% CI 0.60–1.30). The difference in MED to ED_50–100 ratios between partial epilepsy (0.82) was not significantly different from that of generalised epilepsy (1.08) (p = 0.51).ConclusionPhotosensitive POP trials are a useful tool to quantitatively predict efficacy in epilepsy, and can be useful as early and informative indicators in anti-epileptic drug discovery and development.     

《辅行诀》抄本寻踪

《辅行诀五脏用药法要》原藏敦煌藏经洞,1908年为法国伯希和盗掠,守洞道士王圆篆在为伯希和装箱时暗藏之,1918年售予河北省威县张僵南,僵南传其嫡孙大昌,毁于1966年“文革”初,“文革”期间张大昌将抄写本寄赠中国中医研究院,中国中医研究院加以整理,于1975年打印35本内部交流（简称“中研本”）,继而王雪苔先生两次亲访张大昌,收集到两个抄本,经整理收录于1988年江西科学技术出版社《敦煌古医籍考释》（简称“考释本”）;二十世纪九十年代中国中医研究院中国医史文献研究所派王淑民先生陶广正先生再访张大昌,收集到3个抄本,经整理收录于1998年江苏古籍出版社的《敦煌医药文献辑校》（简称“辑校本”）。今仍有大昌弟子抄本传世。     

Can bedside needle arthroscopy of the ankle be an accurate option for intra-articular delivery of injectable agents?

BACKGROUNDBedside needle arthroscopy of the ankle under local anesthesia has been proposed for intra-articular delivery of injectable agents. Accuracy and tolerability of this approach in the clinical setting–including patients with end-stage ankle pathology and/or a history of prior surgery–is not known.AIMTo assess clinical accuracy and tolerability of bedside needle arthroscopy as a delivery system for injectable agents into the tibiotalar joint.METHODSThis was a prospective study that included adult patients who were scheduled for an injection with hyaluronic acid to the tibiotalar joint. In our center, these injections are used as a last resort prior to extensive surgery. The primary outcome was injection accuracy, which was defined as injecting through the arthroscopic cannula with intra-articular positioning confirmed by a clear arthroscopic view of the joint space. Secondary outcome measures included a patient-reported numeric rating scale (NRS, 0-10) of pain during the procedure and willingness of patients to return for the same procedure. NRS of ankle pain at rest and during walking was collected at baseline and at 2-wk follow-up. Complications were monitored from inclusion up to a 2-wk control visit.RESULTSWe performed 24 inspection-injections. Eleven (46%) participants were male, and mean age was 46.8 ± 14.5 years. Osteoarthritis was the indication for injection in 20 (83%) cases, of which 8 (33%) patients suffered from osteoarthritis Kellgren-Lawrence grade IV, and 10 (42%) patients from Kellgren-Lawrence grade III. An osteochondral defect was the indication for injection in 4 (17%) cases. A history of ankle surgery was present in 14 (58%) participants and a history of multiple ankle surgeries in 11 (46%) participants. It was possible to confirm accuracy in 21 (88%) procedures. The 3 (12%) participants where needle arthroscopy did not reach a clear view of the joint space all suffered from Kellgren-Lawrence grade IV osteoarthritis. Pain during the procedure was reported with a median of 1 [interquartile ranges (IQR): 0–2]. Willingness to return was 100%. Pain in rest decreased from a median NRS of 4 (IQR: 2–7) at baseline to a median of 3 (IQR: 1–5) at follow-up (P < 0.01). Pain during walking decreased from a median NRS of 8 (IQR: 6–9) to a median of 7 (IQR: 4–8) (P < 0.01). Infections or other complications were not encountered.CONCLUSIONClinical accuracy and tolerability of bedside needle arthroscopy of the ankle as a delivery system for injectable agents are excellent. Accuracy was 100% in patients without total ventral joint obliteration.     

论医疗侵权的归责与举证

医疗侵权归属于民法中侵权行为的范畴,医疗领域是高风险行业有特殊性。医疗侵权责任的承担应适用过错责任原则,同时制定医患双方应申请第三方鉴定机构鉴定,逐步开放病历等措施来平衡双方的举证责任分配。     

Proof of Hazard and Proof of Safety in Toxicological Studies Using Simultaneous Confidence Intervals for Differences and Ratios to Control

Simultaneous confidence interval for differences or ratios to control are described for both the proof of hazard and the proof of safety for the typical design in toxicology including several doses and a control. For most endpoints the direction of harmfulness is a priori known; therefore one-sided confidence intervals for Gaussian distributed endpoints, proportions, and poly-k-adjusted tumor rates are used. Special packages in the software R are provided to estimate these confidence intervals. Real data examples are given to demonstrate the estimation of the confidence intervals and their interpretation for selected toxicological studies.     

护士对举证责任倒置制度的紧张状况调查

目的探讨不同层次护理人员对举证责任倒置制度(下称制度)的紧张状况是否存在差异.方法采用自编量表对1 826名护士进行问卷测试,比较不同年龄、工龄、职称、学历和不同等级医院护士对制度的紧张水平、紧张反应和应对能力.结果不同年龄、工龄、职称护士对制度的紧张水平和应对能力比较,差异有显著性意义(均P＜0.01),高年资护士对制度的紧张水平和应变能力相对高于低年资护士;二级甲等医院护士对制度的紧张水平高于三级甲等医院.结论建议各医疗机构加强低年资护士的法律知识教育,提高其自我保护意识和应变能力,采取有效措施从容应对举证.     

医疗损害诉讼举证责任配置的演变

医疗损害诉讼举证责任的配置经历了三个阶段,即谁主张谁举证、举证责任倒置以及淡化举证责任倒置的阶段。举证责任配置的演变体现了立法者对医患关系本质的认识更加深刻,审视公正的视角也从个案上升到整个社会,并希望通过举证责任配置的手段来引导医疗资源的合理利用,实现更高层次的医疗领域中的公正。当然,《侵权责任法》中关于医疗损害诉讼举证责任配置的规定能否实现立法的本意和目的,尚有待实践检验。     

A -mode ultrasonography in maxillary sinusitis

Fifty cases of either sex (30 males and 20 females) of chronic hypertrophic maxillary sinusitis were studied during a period of eight months in E.N.T. Out-patients clinic of J. N. Medical College, Aligarh Muslim University, Aligarh. The cases were analysed on the basis of subjective symptoms, objective signs transillumination test. Ultrasonography conventional X-ray of maxillary antrum, routine haematological and urine examination. Diagnostic antrum puncture was invariably done in all the cases subjected to ultrasonographic evaluation. The results of ultrasonography, conventional X-ray (Occipitomental view), and proof puncture were analysed. It has been found that ultrasonography plays an important role in therapeutic decision without performing the diagnostic puncture.