Mortal exposure: on the goodness of writing medical ethics

Abstract:Narrative ethics has recently been advanced as an alternative to more "principled" and "theoretical" approaches to medical ethics. This turn prompts reflection on the distinctive activity of writing medical ethics. When writing medical ethics is recognized as a distinct activity, the forms of care it accomplishes can be distinguished from medical care. This distinction enables analysis of how caring for one's own needs as a writer of medical ethics is in productive tension with the ends of caring in medicine. One important good of writing medical ethics is that the act of writing forces one to reflect on the common mortal reality that is a condition of medical experience. Because it provides occasions for reflection on one's own mortality, medical ethics may no longer need immediate medical application in order to claim its contribution to caring.     

Functional Anatomy of Writing with the Dominant Hand

While writing performed by any body part is similar in style, indicating a common program, writing with the dominant hand is particularly skilled. We hypothesized that this skill utilizes a special motor network supplementing the motor equivalence areas. Using functional magnetic resonance imaging in 13 normal subjects, we studied nine conditions: writing, zigzagging and tapping, each with the right hand, left hand and right foot. We identified brain regions activated with the right (dominant) hand writing task, exceeding the activation common to right-hand use and the writing program, both identified without right-hand writing itself. Right-hand writing significantly differed from the other tasks. First, we observed stronger activations in the left dorsal prefrontal cortex, left intraparietal sulcus and right cerebellum. Second, the left anterior putamen was required to initiate all the tested tasks, but only showed sustained activation during the right-hand writing condition. Lastly, an exploratory analysis showed clusters in the left ventral premotor cortex and inferior and superior parietal cortices were only significantly active for right-hand writing. The increased activation with right-hand writing cannot be ascribed to increased effort, since this is a well-practiced task much easier to perform than some of the other tasks studied. Because parietal-premotor connections code for particular skills, it would seem that the parietal and premotor regions, together with basal ganglia-sustained activation likely underlie the special skill of handwriting with the dominant hand.     

北京市公立医院试点医事服务费调查

北京市在公立医院试点医药分开,取消药品加成、挂号费和诊疗费,收取医事服务费。对试点医院门诊调查发现,医院改变传统管理和经营模式,从关注创收转变为控制成本,从多开药转变为合理用药,门诊患者数量明显增多,多数患者对现行的医事服务费政策支持并感到满意。部分医院管理者认为采用医事服务费并取消药品加成没有真正切断医生和药品之间的利益关系,对医院和医护人员长期影响有待进一步观察。     

探索医疗供给侧改革之路——从“互联网+”开始

中国医疗供给侧改革之路任重而道远,在当前逐步推进革新的医疗体制下,如何利用“互联网+”开启医疗供给侧改革之路,为国家13亿多人口的医疗问题提供有效的解决办法,是一项重要的改革课题。

     

When rational men fall sick: An inquiry into some assumptions made by medical anthropologists

Medical anthropologists spend most of their time eliciting and interpreting people's statements about sickness and health. For this task, they make certain assumptions about the importance of language and reason. In this paper I argue that their assumptions are tailored to fit an hypothetical Rational Man rather than real people. The concept of explanatory models of sickness is used to illustrate this point.My critique begins by drawing attention to two non-cognitive determinants of people's statements: their degree of emotional arousal and their capacities for discoursing on medical subjects. These determinants are briefly discussed and then set aside, to make room for the paper's argument proper. This starts with the observation that medical anthropologists tend to overlook the fact that they have established a cognitive no man's land stretching between their informants' statements and the cognitive structures which are supposed to generate these statements.I survey this void, using a five-fold model of medical knowledge. People use one kind of knowledge to organize their medical experiences and perceptions. In Rational Man writing, this form of knowledge is considered equivalent to cognitive structures (e.g., causal models, classificatory schemes), but I argue that it also includes knowledge of prototypical sickness events and knowledge that is embedded in actions, social relations, and material equipment. The theoretical implications of the five-fold model are outlined.This is followed by an analysis of the reasoning processes in which people use medical knowledge to produce the statements whose meaning we wish to learn. I demonstrate the importance of being able to distinguish operational and monothetic forms of reasoning from pre-operational and polythetic ones. Rational Man writers are described as ignoring the latter pair. The concept of prototypes is reintroduced to illustrate these points.     

Neuroradio-anatomie

Development and use of new tracers in neurological exploration by nuclear medicine, both in cognitive or tumoral field, requires to specify the encephalic anatomical knowledge. This article offers a reminder of the neuro-anatomy by studying CT-scanner and MRI, to know the essential structures for the writing of the medical report. Anatomical structures are described from outside to inside, through the normal anatomy as well as the pathological one.     

Radio-anatomie de la prostate et du pelvis

Development and use of new tracers in tumoral prostatic exploration by nuclear medicine require specifying the pelvic anatomical knowledge. This article offers a reminder of the prostate–pelvic anatomy by studying CT-scanner and MRI to know the essential structures for the writing of the medical report.     

Can learning style predict student satisfaction with different instruction methods and academic achievement in medical education?

The curriculum of our medical school has a hybrid structure including both traditional training (lectures) and problem-based learning (PBL) applications. The purpose of this study was to determine the learning styles of our medical students and investigate the relation of learning styles with each of satisfaction with different instruction methods and academic achievement in them. This study was carried out with the participation of 170 first-year medical students (the participation rate was 91.4%). The researchers prepared sociodemographic and satisfaction questionnaires to determine the characteristics of the participants and their satisfaction levels with traditional training and PBL. The Kolb learning styles inventory was used to explore the learning styles of the study group. The participants completed all forms at the end of the first year of medical education. Indicators of academic achievement were scores of five theoretical block exams and five PBL exams performed throughout the academic year of 2008-2009. The majority of the participants took part in the "diverging" (n = 84, 47.7%) and "assimilating" (n = 73, 41.5%) groups. Numbers of students in the "converging" and "accommodating" groups were 11 (6.3%) and 8 (4.5%), respectively. In all learning style groups, PBL satisfaction scores were significantly higher than those of traditional training. Exam scores for "PBL and traditional training" did not differ among the four learning styles. In logistic regression analysis, learning style (assimilating) predicted student satisfaction with traditional training and success in theoretical block exams. Nothing predicted PBL satisfaction and success. This is the first study conducted among medical students evaluating the relation of learning style with student satisfaction and academic achievement. More research with larger groups is needed to generalize our results. Some learning styles may relate to satisfaction with and achievement in some instruction methods.     

异地就医即时结算现状及问题探讨

随着流动人口规模的不断扩大,异地就医即时结算问题也日益突出。通过从不同险种、不同地区、不同结算方式三个方面总结异地就医结算的现状,提出需要解决的问题和需要防范的风险,为进一步促进异地就医即时结算提供借鉴。     

结合互联网应用的医保卡与京医通融合实践与思考

首都医科大学附属北京世纪坛医院承担了“京医通二期”项目试点工作。项目主要目标是在不改变医保卡介质使用的前提下,让医保患者可以方便使用京医通支付体系,持一张医保卡即可完成在医生诊间、自助终端的便捷支付。同时,借助互联网应用建立京医通微信公众服务号,实现医保及京医通全人群患者在手机微信端进行预约挂号,就诊导诊等功能。试点项目投入使用后,使患者平均在院滞留时间减少16.7分钟,提升了患者就诊体验。以项目建设实践为基础,介绍了整个项目的系统架构设计、医疗机构对接方式、目前系统实现的功能、应用效果等内容,并结合项目建设规划总结项目建设的意义及存在的问题。

     

Language, Ideology, and the Press in Catalonia

This article, relying on Bakhtin's approach to canonization, demonstrates an empirical link between language and ideology. The authors employ content and discourse analysis to examine political discourse exemplified in editorial writing as a particular speech genre. They scrutinize editorials in four newspapers published in Catalonia, two of them in Castilian and two in Catalan. Despite political differences between the papers in each language, the authors discern a Catalan-language discourse style that differs significantly from the Caslilian-language discourse style. They conclude that the historically canonized discourse styles, different in Catalonia's Castilian and Catalan press, reflect the intimate relationship between language of use and ideology.     

读《本草图经》序，仰苏颂本草撰述思想

苏颂撰述的《本草图经》是一部独具文献价值和撰述思想的本草经典。尽管《本草图经》的撰述缘起朝廷倡议和组织,药图及其经文素材来源于全国各级地方政府和广大医药劳动人民工作,但是由苏颂“俾专撰述”的《本草图经》集中体现了他的本草撰述学术思想。研究苏颂的本草撰述学术思想,对深入发掘《本草图经》所蕴涵的宝贵文献信息、传承我国源远流长的丰富的本草医药科学和本草生活文化,具有积极的历史和现实意义。     

台湾地区全民健保下分级诊疗制度之借鉴

借鉴我国台湾地区全民健保下分级诊疗制度,落实和完善现行分级诊疗制度以保证医疗资源的合理配置。利用文献分析,对比研究两岸不同卫生体制下分级诊疗制度实施现状,结合专家访谈的形式明确台湾分级诊疗制度的特点。通过建立短期医疗网计划、成立社区医疗群、改革医保补偿机制、构筑医联体等方式优化分级诊疗制度。     

Use and abuse of performance indicators.

An audit was performed by this department after allegations by the regional health authority of low productivity. It was found that the health authority had underestimated the number of operations performed in 1983 by only 5%, but an inexact classification and grading of operations had led to errors in the performance indicators of 19.8% for the "weighted number of operations" and 34.5% for the "number of major operations per consultant." When the throughput of orthopaedic departments in districts was compared by the regional health authority it was found that such errors in performance indicators had been further compounded by the inconsistent use of population data and incorrect data on medical staffing. Medical practitioners and the health authorities are alerted to this amplification of inaccurate data. Other methods for assessing trauma and orthopaedic surgery are proposed, such as a simplification of the Office of Population Censuses and Surveys classification of surgical operations, grading operations based on time spent in the operating theatre, and provision of computer programs to code for diagnosis and operation when writing discharge summaries.     

台湾地区全民健保总额预算制度设计与运行效果评述

总额预算制作为医保对供方主要支付方式之一在国际上得到广泛应用,我国的上海、北京等地区也开始在不同程度上通过总额预算方式实现支付方式改革。总额预算作为一种控制医疗费用过快增长的方式既有优势也存在弊端。以我国台湾地区为例,介绍总额预算制度的运行机制和总额制定方式,并探讨总额预算制的实施效果,分析总额预算达到效果最优化的制度设计,为改革提供政策借鉴。     

医疗投诉管理模式的探析

规范医疗投诉管理日益成为医疗机构改善与提高医疗服务质量的目标之一。将对我国现阶段5种较为普遍的医疗投诉管理模式的基本情况、特点以及适应范围进行分析,为各医疗机构建立和完善医疗投诉管理制度提供借鉴。     

Adaptive gene expression divergence inferred from population genomics

Detailed studies of individual genes have shown that gene expression divergence often results from adaptive evolution of regulatory sequence. Genome-wide analyses, however, have yet to unite patterns of gene expression with polymorphism and divergence to infer population genetic mechanisms underlying expression evolution. Here, we combined genomic expression data—analyzed in a phylogenetic context—with whole genome light-shotgun sequence data from six Drosophila simulans lines and reference sequences from D. melanogaster and D. yakuba. These data allowed us to use molecular population genetics to test for neutral versus adaptive gene expression divergence on a genomic scale. We identified recent and recurrent adaptive evolution along the D. simulans lineage by contrasting sequence polymorphism within D. simulans to divergence from D. melanogaster and D. yakuba. Genes that evolved higher levels of expression in D. simulans have experienced adaptive evolution of the associated 3′ flanking and amino acid sequence. Concomitantly, these genes are also decelerating in their rates of protein evolution, which is in agreement with the finding that highly expressed genes evolve slowly. Interestingly, adaptive evolution in 5′ cis-regulatory regions did not correspond strongly with expression evolution. Our results provide a genomic view of the intimate link between selection acting on a phenotype and associated genic evolution.