Use of personal medical records for research purposes.

The established practice of doctors using medical records for research purposes is threatened by the recent proposed guidelines from the Department of Health, the BMA, and the European Commission. The European Commission has proposed that explicit consent should be obtained from each patient before his or her medical records can be used; the proposals from the Department of Health and the BMA would require all research that needs access to personal medical records to be submitted to an ethics committee. We believe that these proposals would seriously impair an entire category of research and suggest therefore that another set of guidelines, proposed by a Royal College of Physicians'' working group, should be used to modify the proposals. The guidelines of the working group encourage the use of medical records for research and ensure that such use can be made in a confidential manner without causing harm.     

Is it possible to "achieve a balance" and meet the "safety net"? Paediatric Advisory Subcommittee to the North West Thames Regional Health Authority.

The government''s document Hospital Medical Staffing--Achieving a Balance--Plan for Action introduced the concept of a "safety net"--that is, a minimum safe level of staffing--of junior doctors in the acute specialties. The North West Thames Paediatric Advisory Group has therefore reviewed the implications and consequences of implementing the safety net in respect of children''s services. The group found that if a reasonable safety net was to be provided that enabled the services to stay within the projected junior staffing levels, maintain a balance, meet training needs, and reduce junior doctors'' hours of work, then changes in the organisation of the services would be required. Examining the options available showed that to achieve a safety net within the projected numbers of junior staff at least six paediatric units in the region would have to close. It is doubtful if there is the political will to support the very radical changes that would be needed in the distribution of services if the government''s recommendations in Achieving a Balance were to be implemented. The profession, the Department of Health, and the public must be made aware that the proposed changes in medical staffing will cause a fundamental change in the traditional pattern of delivery of health care.     

ACMC: past,present and future.

In this article, the president of the Association of Canadian Medical Colleges (ACMC) and its director of research review the issues that have confronted ACMC since its inception: the founding of ACMC; development of the clinical teaching unit; creation of the Medical Research Council and expansion of the research mission; the Royal Commission on Health Services and the founding of new faculties of medicine; ACMC''s in-house research program; accreditation and ACMC''s links with medical education in the United States; and French-language medical education in Canada. The review points out the perennial nature of many of these issues, and how often perceived solutions to the problems later become problems themselves. It ends on the optimistic note that ACMC can successfully meet the challenges of the future.     

Medical Education and Research: The Foundations of Quality Health Care

In May 1964 the Royal Commission on Health Services declared that “health research is essential to health progress”. However, since that time the means of providing adequate health care have received far less attention than have methods of payment for physicians'' services. Because medical education and research is the source from which all other health benefits flow, urgent attention must be paid to the adequate support of teacher-scientists, as set forth in the Woods, Gordon (Gundy) report. It is the numbers and quality of these men and women, more than any other factor, that will determine the shape of medical science and, hence, medical practice in Canada in the future. Expensive as it is, Canadian medicine and Canadian medical scientists must have generous support if medical care in this country is to be of high quality.     

Fishing for Interpretation: The ITLOS Advisory Opinion on Flag State Responsibility for Illegal Fishing in the EEZ

On 2 April 2015, the International Tribunal for the Law of the Sea (ITLOS) rendered its first full-bench Advisory Opinion. In its reply to the request of the West African Sub-Regional Fisheries Commission the ITLOS found that Arts. 62(4), 58(3), 192 of the United Nations Convention on the Law of the Sea contain obligations for a flag state to ensure that vessels flying its flag do not engage in illegal fishing in the exclusive economic zones of coastal states. The Advisory Opinion has widely been praised for bringing clarity to the inadequate international fisheries law regime. This article undertakes to analyze the ITLOS's interpretive approach, expose interpretive deficiencies, and offer possible explanations for some of the outcomes where the ITLOS itself did not do so.     

Health,humanitarian relief,and survival in former Yugoslavia.

Since the World Health Organisation''s effort in former Yugoslavia started in July 1992 it has been concerned with the public health policies of survival. It has provided advice to the United Nations High Commission for refugees, helped the voluntary agencies coordinate their work, assessed health needs, and provided practical help in the field to all parties to the conflict. Three features of the Bosnia war have particularly deplorable effects on health: ethnic cleansing, deliberate attacks on hospitals, and systematic rape. The WHO''s response has included initiatives in nutrition, winter survival, and medical supplies. This experience shows that the WHO can have a useful role complementary to that of other agencies in situations where the basic elements for survival of the population are seriously compromised by war.     

Health Data and the Physician

California Health Data Corporation was formed to create better health data resources under the direction of hospitals and medicine. Highest priority is being given to developing information systems that will serve physicians, as well as those who are usually considered health data users. This is illustrated in CHD''s first major activity, sponsorship of a medical record information system for California hospitals. This system is designed first of all to provide better information for medical staff committees, and as a byproduct to provide data flow into a CHD data bank. For the practicing physician, the significance of CHD is that the organization will attempt to develop information systems that will help the medical profession maintain its central role in guiding the present and future patterns of health care.     

Great Expectations: Teaching Ethics to Medical Students in South Africa

Many academic philosophers and ethicists are appointed to teach ethics to medical students. We explore exactly what this task entails. In South Africa the Health Professions Council's curriculum for training medical practitioners requires not only that students be taught to apply ethical theory to issues and be made aware of the legal and regulatory requirements of their profession, it also expects moral formation and the inculcation of professional virtue in students. We explore whether such expectations are reasonable. We defend the claim that physicians ought to be persons of virtuous character, on the grounds of the social contract between society and the profession. We further argue that since the expectations of virtue of health care professionals are reasonable, it is also sound reasoning to expect ethics teachers to try to inculcate such virtues in their students, so far as this is possible. Furthermore, this requires of such teachers that they be suitable role models of ethical practice and virtue, themselves. We claim that this applies to ethics teachers who are themselves not members of the medical profession, too, even though they are not bound by the same social contract as doctors. We conclude that those who accept employment as teachers of ethics to medical students, where as part of their contractual obligation they are expected to inculcate moral values in their students, ought to be prepared to accept their responsibility to be professionally ethical, themselves.     

Prioritising health services in an era of limits: the Oregon experience.

How do we decide who should receive the benefits that medical science has to offer? One approach to this decision process, that used by the state of Oregon, is described: who and what are covered, and how health care is financed and delivered, are considered. Oregon''s priorities were set on the basis of broad consensus. The objective of health care reform, it was agreed, is to improve, maintain, or restore health--not universal coverage, access to health care, or cost containment. A Health Services Commission was created to consider clinical effectiveness and, through public involvement, to attempt to integrate social values into the priority list. Oregon''s legislature can use the list to develop an overall health policy which recognises that health can be maintained only if investments in several related areas are balanced.     

新医改背景下委属委管医院绩效评价体系研究

目的 建立国家卫生计生委委属委管医院绩效评价指标体系。方法 通过文献查询梳理医院绩效评价指标、理论研究并设计结构化访谈提纲,对专家进行结构化访谈,设计问卷进行专家咨询。结果 根据新医改要求并结合国家卫生计生委委属委管医院职能定位,初步制定了评价指标体系。结论 指标体系的建立应充分考虑研究对象、本阶段政府的引导方向以及指标的内涵。     

Medical women of the West.

The presence in the West of women physicians with degrees from regular medical schools spans a period of approximately 130 years. Women''s Medical College of Pennsylvania graduated many of these early women physicians. The first woman medical graduate of a western school was Lucy M. Field Wanzer, who finished in 1876 at the Department of Medicine, University of California in San Francisco. Soon thereafter, schools that would become Stanford University and the Oregon Health Sciences University schools of medicine, as well as the newly founded University of Southern California, were contributing to the pool of women physicians. The University of Michigan Medical School, the first coeducational state medical school, also educated some of the western women physicians, who by 1910 numbered about 155. This regional account of the progress of women physicians as they strove to become an integral part of the profession emphasizes the familiar themes of altruism, ingenuity, and perseverance that characterized their efforts.     

For the Class of '98, the real-world education is about to begin

In their 4 short years in medical school, members of the Class of ''98 have witnessed massive changes within the health care system. These are going to have a direct, and often negative, impact on the way they practise. Despite this, members of this group can''t wait to become full-fledged members of the medical profession.     

Not a slippery slope or sudden subversion: German medicine and national socialism in 1933.

The history of medicine this century is darkened by the downfall of the German medical profession, exposed during the doctors'' trial at Nuremberg in 1946. Relying largely on documents published during 1933 in German medical journals, this paper examines two widely accepted notions of those events, metaphorically termed "slippery slope" and "sudden subversion." The first connotes a gradual slide over infinitesimal steps until, suddenly, all footing is lost; the second conveys forced take over of the profession''s leadership and values. Both concepts imply that the medical profession itself became the victim of circumstances. The slippery slope concept is a prominent figure of argument in the current debate on bioethics. The evidence presented here, however, strongly suggests that the German medical community set its own course in 1933. In some respects this course even outpaced the new government, which had to rein in the profession''s eager pursuit of enforced eugenic sterilizations. In 1933 the convergence of political, scientific, and economic forces dramatically changed the relationship between the medical community and the government. That same convergence is occurring again and must be approached with great caution if medicine is to remain focused on the preservation of physical and medical integrity.     

Results from CMA's huge 1998 physician survey point to a dispirited profession

Results from the CMA''s 1998 Physician Resource Questionnaire are in, and they point to a serious decline in physician morale. The PRQ, the country''s most important poll of physician attitudes, provides an annual "state-of-the-nation" message for the medical profession.     

Medicine and the Gulag.

The nature of the medical treatment of prisoners in the Gulag has emerged from accounts published by survivors. Over a period of 70 years some doctors entrusted with the medical care of prisoners failed to discharge their ethical duties, contributing to the prisoners'' neglect and suffering. The medical profession must carefully examine what occurred and properly assign responsibility for ethical as well as unethical medical acts. Understanding the history of these ominous events will alert doctors worldwide to the importance of medical autonomy in the support of imprisoned patients.     

中英两国医疗质量评价比较研究

通过文献研究、专题小组讨论、深层访谈以及对浙江省等五省和对英国卫生部、英国医疗质量委员会（等的现场调研,进而对中英两国医疗质量评价的组织管理模式、工作机制、操作流程、标准制定等方面进行比较研究,并提出建立职责明晰的监管体系、明确评价机构的独立地位和处置权限、突出医疗质量评价等完善我国医疗质量评价体系的相关建议。     

我国省级层面分级诊疗文件比较分析

通过访问各省（区、市）卫生计生委的官方网站,获取有关分级诊疗政策的文件,在获取国家卫计委和万方、知网的相关分级诊疗文献的基础上,对各省（区、市）2016年2月28日以前的分级诊疗文件进行分析研究,通过对比各省分级诊疗文件的基本情况和实施措施等具体内容,分析不同省份在分级诊疗文件内容设定中存在的问题,从而为未来的分级诊疗决策和实践提供经验。     

MEDICINE AT MID-CENTURY

The Public Relations Committee of the California Medical Association recognizes that medical public relations is a reflection of every event in each doctor''s office, every action or inaction of each medical society and every public utterance of each doctor speaking officially or unofficially. The importance of good medical public relations has been emphasized repeatedly through the years in various actions of the Council and the House of Delegates of the California Medical Association.The goal of the medical profession is, through all its activities, including public relations, to achieve and preserve the best medical care for every individual.     

Ecosystem integrity in the Great Lakes Basin: an historical sketch of ideas and actions

The concepts of ecosystem and integrity effectively entered the binational political arena in the Great Lakes Basin in the early 1970's. They were brought together explicitly in the statement of the purpose of the 1978 Great Lakes Water Quality Agreement. The 1987 Protocol to that Agreement has helped to specify the practical meaning of ecosystem integrity of the Great Lakes Basin. The proceedings of a binational workshop in 1988, titled An Ecosystem Approach to the Integrity of the Great Lakes Basin in Turbulent Times, helped to clarify the conceptual meaning. An Ecosystem Charter for the Great Lakes-St. Lawrence River Basin was proposed in 1989 to help achieve more thorough implementation of the commitment to ecosystem integrity. The evolutionary emergence of this political concept and related practice is described in the paper.List of abbreviations used in the text CUSIS Canada-U.S. Inter-University Seminar Series - LAA Environmental Lakes Area - EPA Environmental Protection Agency - GLBC Great Lakes Basin Commission - GLC Great Lakes Commission - GLER Great Lakes Ecosystem Rehabilitation - GLFC Great Lakes Fishery Commission - GLSAB Great Lakes Science Advisory Board - GLU Great Lakes United - GLWQA Great Lakes Water Quality Agreement - HASP Heritage Area Security Plan - IBP International Biological Program - IJC International Joint Commission - IZAP Inundation Zone Adaptive Plan - LAMP Lake-wide Management Plan - LLRS Lake Levels Reference Study - MAB Man and the Biosphere program - NEPA National Environmental Policy Act - PLUARG Pollution from Land Use Activities Reference Group - RAP Remedial Action Plan - SCOL Salmonid Communities in Oligotrophic Lakes - SGLFMP Strategic Great Lakes Fishery Management Plan - SPOF Strategic Plan for Ontario Fisheries - UNESCO United Nations Educational, Scientific and Cultural Organization Aquatic Ecosystem Health and Management Society. Symposium at the University of Waterloo, July 23–25, 1990.