上海市医疗机构床位配置调整策略研究

目的 分析上海市医疗机构床位资源配置的现状和问题。方法 采用调查问卷对上海市所有设住院床位的医疗机构进行调查,并与美国加利福尼亚州医疗机构床位情况进行对比。结果 床位总量接近规划但配置结构不合理,综合急性病诊疗床位的平均住院时间过长,医疗服务压力主要集中在三级医疗机构,社会办医疗机构病床尚没有得到有效利用。结论 建立医疗机构床位分类管理制度,严格控制中心城区三级医疗机构床位数量,严格控制综合急性病诊疗床位,大幅增加护理床位数量,有效整合医疗床位资源。     

Effect of Supervised Students' Involvement on Diagnostic Accuracy in Hospitalized Medical Patients �� A Prospective Controlled Study

Background

During internships most medical students engage in history taking and physical examination during evaluation of hospitalized patients. However, the students'' ability for pattern recognition is not as developed as in medical experts and complete history taking is often not repeated by an expert, so important clues may be missed. On the other hand, students'' history taking is usually more extensive than experts'' history taking and medical students discuss their findings with a Supervisor. Thus the effect of student involvement on diagnostic accuracy is unclear. We therefore compared the diagnostic accuracy for patients in the medical emergency department with and without student involvement in the evaluation process.

Methodology/Principal Findings

Patients in the medical emergency department were assigned to evaluation by either a supervised medical student or an emergency department physician. We only included patients who were admitted to our hospital and subsequently cared for by another medical team on the ward. We compared the working diagnosis from the emergency department with the discharge diagnosis. A total of 310 patients included in the study were cared for by 41 medical students and 21 emergency department physicians. The working diagnosis was changed in 22% of the patients evaluated by physicians evaluation and in 10% of the patients evaluated by supervised medical students (p = .006). There was no difference in the expenditures for diagnostic procedures, length of stay in the emergency department or patient comorbidity complexity level.

Conclusion/Significance

Involvement of closely supervised medical students in the evaluation process of hospitalized medical patients leads to an improved diagnostic accuracy compared to evaluation by an emergency department physician alone.     

电子病历系统在医院信息管理系统中应用初探

电子病历系统是通过计算机等电子设备为载体,对医院患者的诊疗活动进行数字化记录的软件。电子病历中详细记录了医嘱、病程、过敏史、影像检查结果、出院记录等多项医疗数据。电子病历完整、系统、科学地记录了患者身体健康情况以及历次就诊记录,通过一个维度将患者内部不同层次的信息有机的联系在一起。与传统的纸张病历相比,电子病历可以迅速实现不同时间、不同医院医疗信息的高效整合以及信息共享,为临床诊疗提供大量科学准确的信息,大大提高医院的服务效率。本文通过电子病历系统在医院信息管理系统中的应用情况进行简要分析,以期提高电子病历系统在临床中解决实际医疗问题的能力。     

The Hospital Medical Advisory Committee—The Cabinet of the Medical Staff

Before a hospital medical staff can realistically accept responsibility for the professional practices of its members, a principle initially fostered by the American College of Surgeons and adopted by both the Canadian and American accreditation programs, it must have an effectively functioning medical staff organization. The medical advisory committee is the most important committee of the medical staff organization. A representative composition, adherence to sound administrative principles, and recognition of its prime functions of co-ordination, supervision and jurisdiction will permit this committee—and the total medical staff organization—to discharge adequately the very important responsibilities delegated to them by the governing board of the hospital. Properly structured medical staff bylaws with clearly defined terms of reference assist the smooth functioning of the “cabinet” of the medical staff and safeguard the prerogatives of the individual members of the staff.     

加强军队医院非现役编制医务人员卫生勤务保障能力的重要性

目的:调查军队医院非现役编制医务人员的军事素质和卫勤保障意识,探讨提升该群体卫勤保障能力的重要性和必要性,为军队医院卫勤管理提供参考。方法:采用问卷调查的方式对我院154名非现役编制医务人员进行调查,主要包括军事理论、卫生勤务、突发事件应急管理及战伤急救等,分析非现役编制医务人员缺乏的基本军事素质,并提出针对性的加强军队医院文职人员卫生勤务保障能力的可行性培训计划,在培训结束时对医护人员的军事素质进行测评。结果:问卷调查结果:非现役文职人员的军事素质评分为(3.70±0.46)、卫生勤务能力评分为(2.48±0.91)、突发事件应急管理评分为(2.61±0.53)、战伤急救技能评分为(2.42±1.02)。测评结果:军事理论知识评分为(4.11±1.04)、卫生勤务能力评分为(4.78±1.37)、突发事件应急意识评分为(4.56±0.56)、战伤急救技能评分为(4.68±0.91)。培训后,非现役医务人员的卫勤保障能力显著提高,差异具有统计学意义(P0.05)。结论:非现役文职作为军队医院的聘用制人员已成为医务工作的主要力量,因此军队医院应加强非现役医务人员的卫生勤务保障能力,提高我军后勤医疗保障的坚固力量。     

Might there be a medical conscience?

I defend the feasibility of a medical conscience in the following sense: a medical professional can object to the prevailing medical norms because they are incorrect as medical norms. In other words, I provide an account of conscientious objection that makes use of the idea that the conscience can issue true normative claims, but the claims in question are claims about medical norms rather than about general moral norms. I further argue that in order for this line of reasoning to succeed, there needs to be an internal morality of medicine that determines what medical professionals ought to do qua medical professionals. I utilize a constructivist approach to the internal morality of medicine and argue that medical professionals can conscientiously object to providing treatment X, if providing treatment X is not in accordance with norms that would have been constructed, in light of the end of medicine, by the appropriate agents under the appropriate conditions.     

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。     

The status of medical physics in radiotherapy in China

PurposeTo present an overview of the status of medical physics in radiotherapy in China, including facilities and devices, occupation, education, research, etc.Materials and methodsThe information about medical physics in clinics was obtained from the 9-th nationwide survey conducted by the China Society for Radiation Oncology in 2019. The data of medical physics in education and research was collected from the publications of the official and professional organizations.ResultsBy 2019, there were 1463 hospitals or institutes registered to practice radiotherapy and the number of accelerators per million population was 1.5. There were 4172 medical physicists working in clinics of radiation oncology. The ratio between the numbers of radiation oncologists and medical physicists is 3.51. Approximately, 95% of medical physicists have an undergraduate or graduate degrees in nuclear physics and biomedical engineering. 86% of medical physicists have certificates issued by the Chinese Society of Medical Physics. There has been a fast growth of publications by authors from mainland of China in the top international medical physics and radiotherapy journals since 2018.ConclusionsDemand for medical physicists in radiotherapy increased quickly in the past decade. The distribution of radiotherapy facilities in China became more balanced. High quality continuing education and training programs for medical physicists are deficient in most areas. The role of medical physicists in the clinic has not been clearly defined and their contributions have not been fully recognized by the community.     

418篇医疗纠纷文献回顾性分析

??????? 目的 通过总结医疗纠纷产生的主要原因,提出防范和处置医疗纠纷的要点,为和谐医患关系、构建平安医疗环境提供依据。方法 综合运用文献调查法和统计学方法收集、整理了2003—2012年418篇医疗纠纷相关文献资料,回顾性分析了近十年来医疗纠纷研究的主要侧重方向——原因分析、防范对策及处理机制。结果 关于医疗纠纷的研究呈现出新特点、新趋势,其研究领域不仅局限于医疗卫生层面,而且涉及到社会、伦理、心理学等方面,如何全面、有效防范和处置医疗纠纷成为当前医院管理的重点之一。结论 建立预警机制,干预可控节点,现场高效处置,能够有效防范医疗纠纷。     

对某三甲医院临床医疗告知行为现状的调查与分析

??????? 目的 基于对医生告知行为的调查,发现目前临床中存在的医疗告知行为方面的不足。方法 采用随机抽样的方式对217名医务人员进行医疗告知行为情况的调查。结果 医疗机构在医疗告知方面存在缺陷：医疗告知主体高年资医师参与度不高;医疗告知对象主要是患者的近亲属,而不是患者本人;医疗告知注重风险告知,而忽视了对患者病情及医疗方案等内容的告知。结论 目前临床工作中在医疗告知方面不足,医疗机构应该通过完善制度、培训医师及管理部门加强监管等方面来保障医疗知情告知起到其应有的作用。     

Evaluation of medical physics training in radiology residency in 67 countries

PurposeThe main aim of medical physics training in radiology residency is to have appropriate and safer imaging of patients and safety of personnel. The need to have adequate coverage of medical physics and radiation safety in curricula of radiology residency is well perceived, but it is not known how far it is implemented in practice.MethodsWe have analysed the data from 67 countries on medical physics teaching and assessment of residents in radiology programs, considering differences between countries in function of their human development index (HDI).ResultsThe results indicate that teaching of medical physics by radiologists rather than by medical physicists is very common and there is relationship with the developmental status of a country. The majority of countries with very high HDI used a written test (69%) for medical physics topics, often in combination with other subjects (63%). Further, there is lack of direct involvement of medical physicists during the examination phase of residents. Geographically, it can be seen that Latin American countries in particular lack involvement of medical physicists during both the teaching and examination phase.ConclusionThe lack of adequate involvement of medical physicists in training and in the formal examination of radiology residents in both developed and developing countries is a matter of concern with likely implications on patient and staff safety.     

军校预防医学专业本科学员临床课程教学现状及建议

随着医学模式的转变,预防医学已经成为现代医疗体系的重要组成部分,在提高公共卫生健康水平方面发挥着越来越重要的作用。为了更好地开展预防医学工作,预防医学专业学员不仅要掌握牢固的预防医学专业知识,更要具备丰富的临床医学知识。针对预防医学专业本科学员的临床课程教学,我校经过多年的探索与改革,已经积累了丰富经验,教学质量较高;但现阶段仍然存在着一些问题。本文分析我校预防医学专业本科学员临床课程的教学现状及存在的主要问题,并提出建议;从而为进一步提高预防医学专业本科学员的临床课程教学质量提供依据。     

“WE CAME TO TALK WITH THE PEOPLE BEHIND THE DISEASE:” COMMUNICATION AND CONTROL IN MEDICAL EDUCATION

To explore the ways in which biomedical culture responds to the new curricular addition of communication skills training, we observed activities related to the communication skills training of a class of 70 first-year medical students in an Israeli medical school during 2002–3. In addition, focus groups were conducted with medical students (n = 210) during 1998–2001. A gap was found between the rhetoric of “patient-centered communication” and “empathy” and the traditional concerns of medical authority, efficiency, and scientism. Communication skills and empathy training were appropriated into medical socialization by being reconstructed as clinical competence. Findings are further discussed in the context of medical professionalism, Israeli culture, service acting and service roles, and organizational learning.     

A Physician's Perspective on the Incorporation of Pictograms as a Supplement to Medical Instructions in Chile: A Pilot Study

Introduction and objectivesCurrent models of health care are progressively migrating to more participatory models, where for treatment to achieve results that last over time, there must be effective communication between the patient, his or her caregivers, and health professionals. Although the use of pictograms in the context of medical instructions has been widely studied, in our country, there are no studies about their usefulness, or which set of symbols should be used by the systems. This work aims to present the first step towards the development of platforms that automatically suggest pictograms to supplement medical instructions for primary care settings in Chile.Materials and methodsIn this pilot study, we collected and analyzed the physicians' opinions on the selection of medical instructions that later will automatically be supplemented by the software that is under construction. We designed an expert validation survey using a set of 66 medical instructions with pictograms. This survey provided three rating options for each medical instruction: Not necessary (supplementing the instruction with a pictogram does not carry any value), Useful (supplementing the instruction with a pictogram may help patients to understand and remember the instruction), and Essential (supplementing the instruction with a pictogram is essential). Seventy-one physicians responded to the survey.Results22 out of 66 medical instructions were considered “essential” by >=51% of the experts, and 12 of the 66 were considered to be “useful but not essential” by >=51% of the experts.ConclusionResults of our survey validate the potential use of pictograms as a complement to better comprehension of medical instructions in our country.     

Cognition of and Demand for Education and Teaching in Medical Statistics in China: A Systematic Review and Meta-Analysis

BackgroundAlthough a substantial number of studies focus on the teaching and application of medical statistics in China, few studies comprehensively evaluate the recognition of and demand for medical statistics. In addition, the results of these various studies differ and are insufficiently comprehensive and systematic.ObjectivesThis investigation aimed to evaluate the general cognition of and demand for medical statistics by undergraduates, graduates, and medical staff in China.MethodsWe performed a comprehensive database search related to the cognition of and demand for medical statistics from January 2007 to July 2014 and conducted a meta-analysis of non-controlled studies with sub-group analysis for undergraduates, graduates, and medical staff.ResultsThere are substantial differences with respect to the cognition of theory in medical statistics among undergraduates (73.5%), graduates (60.7%), and medical staff (39.6%). The demand for theory in medical statistics is high among graduates (94.6%), undergraduates (86.1%), and medical staff (88.3%). Regarding specific statistical methods, the cognition of basic statistical methods is higher than of advanced statistical methods. The demand for certain advanced statistical methods, including (but not limited to) multiple analysis of variance (ANOVA), multiple linear regression, and logistic regression, is higher than that for basic statistical methods. The use rates of the Statistical Package for the Social Sciences (SPSS) software and statistical analysis software (SAS) are only 55% and 15%, respectively.ConclusionThe overall statistical competence of undergraduates, graduates, and medical staff is insufficient, and their ability to practically apply their statistical knowledge is limited, which constitutes an unsatisfactory state of affairs for medical statistics education. Because the demand for skills in this area is increasing, the need to reform medical statistics education in China has become urgent.     

Defensive Medicine among Obstetricians and Gynecologists in Tertiary Hospitals

Objective

To describe the daily work practice under the threat of defensive medicine among obstetricians and gynecologists.

Study Design

A prospective cross-sectional survey of obstetricians and gynecologists working at tertiary medical centers in Israel.

Results

Among the 117 obstetricians and gynecologists who participated in the survey, representing 10% of the obstetricians and gynecologists registered by the Israel Medical Association, 113 (97%) felt that their daily work practice is influenced by concern about being sued for medical negligence and not only by genuine medical considerations. As a result, 102 (87%) physicians are more likely to offer the cesarean section option, even in the absence of a clear medical indication, 70 (60%) follow court rulings concerning medical practices, and 85 (73%) physicians mentioned that discussions about medical negligence court rulings are included in their departments'' meetings.

Conclusions

Defensive medicine is a well-embedded phenomenon affecting the medical decision process of obstetricians and gynecologists.     

A Research Program in Medical Education in Canada

The current interest in medical education and the proposed expansion of medical education facilities have stimulated the development of a research program by the secretariat of the Association of Canadian Medical Colleges. The projects planned and now in progress include: (1) studies of the cost of medical education in Canadian teaching hospitals and medical schools; (2) a study of the basic medical science departments in Canada with special reference to the occupational careers of scientists who have received M.Sc. and Ph.D. degrees in those departments; (3) establishment of a student registry to facilitate prospective studies of Canadian medical students; (4) a survey of the residents in training in Canadian hospitals to obtain their evaluation of their training experience.     

Bullying of Medical Students in Pakistan: A Cross-Sectional Questionnaire Survey

Background

Several studies from other countries have shown that bullying, harassment, abuse or belittlement are a regular phenomenon faced not only by medical students, but also junior doctors, doctors undertaking research and other healthcare professionals. While research has been carried out on bullying experienced by psychiatrists and psychiatry trainees in Pakistan no such research has been conducted on medical students in this country.

Methodology/Principal Findings

We conducted a cross-sectional questionnaire survey on final year medical students in six medical colleges of Pakistan. The response rate was 63%. Fifty-two percent of respondents reported that they had faced bullying or harassment during their medical education, about 28% of them experiencing it once a month or even more frequently. The overwhelming form of bullying had been verbal abuse (57%), while consultants were the most frequent (46%) perpetrators. Students who were slightly older, males, those who reported that their medical college did not have a policy on bullying or harassment, and those who felt that adequate support was not in place at their medical college for bullied individuals, were significantly more likely to have experienced bullying.

Conclusion

Bullying or harassment is faced by quite a large proportion of medical students in Pakistan. The most frequent perpetrators of this bullying are consultants. Adoption of a policy against bullying and harassment by medical colleges, and providing avenues of support for students who have been bullied may help reduce this phenomenon, as the presence of these two was associated with decreased likelihood of students reporting having being bullied.     

医学生科研创新能力培养“3+X”模式的探索与实践

针对长期以来培养医学生的科研创新能力主要依靠零散的课外科研活动、受众面窄、没有系统性课程教学及其相关制度保障、致使对医学生科研创新能力培养明显乏力低效这一共性瓶颈教学问题,自2002年起,汕头大学医学院生物化学与分子生物学教学团队,在“科教相辅相佐”、“以学生为中心”、“以问题为导向”等先进教育理念指导下,倚重汕头大学医学院“医者之心”系列课程与书院育人文化之特色,发挥汕头大学的生物学、基础医学和临床医学一级学科均拥有本/硕/博/博后完整人才培养体系之优势,联合其他相关专业教学团队,在建立充分体现医学生科研创新能力培养内涵,覆盖医学本科5年全过程的核心课程体系的基础之上,历经20载的不懈努力,补充修善,成功构建了“3+X”模式,着力培养医学生的科研创新能力。所谓“3”意指对医学生的“全人培养”、“全程培养”和“全方位培养”。所谓“X”意指针对“3+X”模式运行效能的若干个验证性维度,主要包括组织医学生参加各种形式的全国大学生创新实验研究大赛、国际大学生学术研讨会,由医学本科生作为第一作者撰写发表学术论文等。培养医学生科研创新能力的成效十分显著,为有效解决上述共性瓶颈教学问题提供了一个有重要借鉴价值的范例。