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目的 分析政府补偿与监管机制改革对公立医疗卫生机构教学、科研以及学科建设的影响。方法 通过对上海市闵行区的机构调查,收集并分析2008—2012年3所公立综合性医院和12家社区卫生服务中心的医学教育、科研项目、论文发表及重点学科建设状况的相关数据。结果 闵行区公立综合性医院和社区卫生服务中心的医学教育和科研能力有所提升,重点学科建设也有所加强;但仍然存在教学能力薄弱,科研水平层次偏低,缺乏高质量的重点学科等问题。结论 政府补偿与监管机制改革在一定程度上强化了公立医疗机构的医学教育、科研能力和学科建设,但未来需进一步加大对科教和学科建设的鼓励和支持力度。 相似文献
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目的 了解政府、大型综合医院、上级医疗机构与基层医疗机构在分级诊疗体系下的利益诉求,以推进分级诊疗体系的建立。方法 采用博弈论分析这些利益主体间的矛盾,利用激励相容理论提出建议。结果 政府投入不足,上级医疗机构不愿下沉医疗资源,基层医疗机构能力不足等问题阻碍了分级诊疗体系的推行。结论 发挥政府引领作用,加大政府投入;加强医疗机构的分工协作,合理配置医疗资源;提高基层医疗机构服务能力。 相似文献
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BACKGROUND: Perusing the literature on nuclear 'genome size' shows that the term is not stabilized, but applied with different meanings. It is used for the DNA content of the complete chromosome complement (with chromosome number n), for which others use 'C-value', but also for the DNA content of the monoploid chromosome set only (with chromosome number x). Reconsideration of the terminology is required. AIM: Our purpose is to discuss the currently unstable usage of the terms 'genome size' and 'C-value', and to propose a new unified terminology which can describe nuclear DNA contents with ease and without ambiguity. PROPOSALS: We argue that there is a need to maintain the term genome size in a broad sense as a covering term, because it is widely understood, short and phonetically pleasing. Proposals are made for a unified and consensual terminology. In this, 'genome size' should mean the DNA content based on chromosome number x and n, and should be used mainly in a general sense. The necessary distinction of the kinds of genome sizes is made by the adjectives 'monoploid' and the neology 'holoploid'. 'Holoploid genome size' is a shortcut for the DNA content of the whole chromosome complement characteristic for the individual (and by generalization for the population, species, etc.) irrespective of the degree of generative polyploidy, aneuploidies, etc. This term was lacking in the terminology and is for reasons of linguistic consistency indispensable. The abbreviated terms for monoploid and holoploid genome size are, respectively, Cx-value and C-value. Quantitative data on genome size should always indicate the C-level by a numerical prefix, such as 1C, 1Cx, 2C, etc. The proposed conventions cover general fundamental aspects relating to genome size in plants and animals, but do not treat in detail cytogenetic particularities (e.g. haploids, hybrids, etc.) which will need minor extensions of the present scheme in a future paper. 相似文献
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Nir Ben‐Moshe 《Bioethics》2019,33(7):835-841
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. 相似文献
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目的 针对医疗机构的合理用药水平进行评价研究。方法 根据医疗机构合理用药的具体要求,构建医疗机构合理用药评价指标体系,采用基于模糊群决策的方法和多指标评价分析法构建医疗机构合理用药评价模型。结果 构建了基于模糊群决策的医疗机构合理用药评价模型,并通过实例分析证明了评价模型的可行性。结论 建立的基于模糊群决策的医疗机构合理用药评价模型能够对医疗机构的合理用药水平进行科学评价,为提高医疗机构合理用药水平奠定基础。 相似文献
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《Chronobiology international》2013,30(6):1019-1027
Certain sleep-wake schedule disorders (SWSDs) cannot be successfully managed clinically using conventional methods of sleep therapy. We describe two cases of SWSD, the first following head trauma and the second originating during childhood, that had been misdiagnosed by physicians for many years. After conventional treatment for SWSD with light therapy and melatonin failed to bring about substantial improvement, it was determined that they were suffering from an incurable disability. Hence, we propose new medical terminology for such cases—SWSD disability. SWSD disability is an untreatable pathology of the circadian time structure. Patients suffering from SWSD disability should be encouraged to accept the fact that they suffer from a permanent disability, and that their quality of life can only be improved if they are willing to undergo rehabilitation. It is imperative that physicians recognize the medical condition of SWSD disability in their patients and bring it to the notice of the public institutions responsible for vocational and social rehabilitation. (Chronobiology International, 18(6), 1019–1027, 2001) 相似文献
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ROBERT H. REED 《Plant, cell & environment》1984,7(3):165-170
Abstract The terminology currently employed in studies concerned with the osmotic responses of plant cells is reviewed with specific reference to (1) the suitability of expressions in general use and (2) the application of such terms to experimental studies. The widely used term osmoregulation is shown to be an inappropriate and misleading expression when used to describe the adjustments in cellular solute concentration which frequently accompany changes in external salt concentration. Such usage of osmoregulation should be discouraged; more suitable expressions (e.g. osmoacclimation, osmotic adjustment, turgor/volume regulation or turgor maintenance, osmoadaptation) should be employed, depending upon the context. 相似文献
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‘Homework’ and transnational adoption screening in Spain: the co‐production of home and family
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Jessaca B. Leinaweaver Diana Marre Susan E. Frekko 《The journal of the Royal Anthropological Institute》2017,23(3):562-579
We use the transnational adoption screening process as a lens for examining the co‐production of the home and the family in Spain. We propose the term ‘homework’ to describe the efforts of adoption applicants to perform an appropriate home and thus receive approval to adopt. The transnational adoption screening process is a key site of state‐individual interaction for communicating a set of classed, gendered norms. Through that process, participants ratify the authority of professionals to distinguish between adequate and inadequate ways to live. As such, our analysis demonstrates how moral authority is ascribed to material objects, as we document the strong link between ‘appropriate’ housing and growing families as an explanatory factor for the demographic effects of economic crises. 相似文献
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The Resource Allocation Working Party (RAWP) recognised the need to consider both health authority and primary care services in achieving its objective. RAWP and the subsequent Advisory Group on Resource Allocation (AGRA) found (but did not publish) considerable variation in resources used by both services but could not find a clear relation between them. Statistics provided by the DHSS were used to compare spending by 80 area health authorities in 1980-1 with expenditure per head on general medical services by their corresponding family practitioner committees. There was considerable variation in the provision of resources for both services and no clear relation between the variations in spending on each service. Only 40 of the 80 areas had both health authority and family practitioner committee spending levels within 10% of "target." Subregional inequalities in resources tend to be related to variations in admission rates, which in turn are related to general practitioners'' referral behaviour. These results emphasise the importance of finding out more about inequalities in the provision of general medical services and their relation to the use of hospital services. They also suggest that RAWP''s aim of equality of opportunity of access to health care resources may be achieved only if general medical services are brought into the equation as well. 相似文献
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“WE CAME TO TALK WITH THE PEOPLE BEHIND THE DISEASE:” COMMUNICATION AND CONTROL IN MEDICAL EDUCATION 总被引:1,自引:0,他引:1
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. 相似文献
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D C Dale 《The Western journal of medicine》1989,150(5):602-603
The 16 medical schools in the 13 western states are distinctive from their counterparts nationally in several ways: they are relatively young, enroll a small number of medical students, and tend to be strongly research oriented. The rise of these institutions since Abraham Flexner''s visit to all of the western schools in 1909 reflects a truly remarkable development. 相似文献
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运用知识管理的理念和方法,探讨切合实际应用的临床决策支持知识库概念模型,使医院能够通过知识管理提升其核心竞争力。方法 收集国内外相关资料,系统化研究及分析具有人工智能的临床决策支持知识库的框架。结果 实施医院知识管理的关键就是必须建立一个动态的,并具有自我学习能力的临床决策支持知识库,该知识库不仅需要通过医院信息系统收集传统的医学知识,而且需要建立用于临床指南等的标准医学知识收集的引擎和隐性知识转化模型,并嵌入智能化工具,通过知识库的自我学习功能,保证其动态更新和智能化的临床决策支持能力。结论 医院知识库创建过程实质也是医院价值的创造过程,智能化的临床决策支持知识库开发不仅涉及知识的收集和处理, 还包括知识的表达,人工智能技术的嵌入和各种规则、条件及分类方法等的应用,有待进一步研究。 相似文献
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通过对上海市非医保患者就医现状调查,研究兼顾好不同医疗费用支付形式患者和发挥优质医疗资源共享效能的对策,为建立和优化就医需求引导机制提供政策依据。方法 利用SPSS20.0描述性统计对数据进行分析。结果 非医保患者在沪就医原因列前五位的分别是沪医疗机构技术水平高,疾病需要,设备先进,在沪居住,药品种类齐全;相当比例患者为复诊或随访;平均门诊费用及住院费用高于医保患者。结论 通过有效方法影响就医者行为,引导医疗需求,合理分流和优化在市级综合医院非医保患者的医疗需求,提高优质医疗资源有效利用率。 相似文献
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The current terminology for the colobine monkeys of Java is incorrect. The appropriate term for the West Javan surili is Presbytis comataDesmarest,1822, and that for the Javan and Bali/Lombok lutung is Trachypithecus auratusE. Geoffroy St. Hilaire, 1812. 相似文献
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目的 分析高血压患者在农村医疗服务网络接受协调性和连续性服务的提供状况,为改进患者的整合服务利用提供决策参考。方法 根据国内外文献,以自行编制服务协调性和连续性提供的问卷为工具,调查数据采用描述性统计分析。结果 49.6%的患者伴有1种及以上疾病,约73.0%在乡镇卫生院有就医经历,到过2家及以上机构就医的占51.3%;在乡村两级治疗效果不佳的患者,能够获取村医和乡镇医生推荐转诊机构的比重最大,分别为28.4%和68.7%;上级医生能够根据下级机构相关诊疗信息连续诊疗的不到43.0%,下级医生能够根据前期诊疗信息继续诊疗的比例刚超4成;“上转容易、下转难”现象同样存在。 结论 农村慢性病患者的患病特点增加了在农村纵向医疗机构就诊的几率,但该网络提供连续性和协调性服务的程度却不高,应加强农村三级医疗机构间的全面整合。 相似文献
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Stefan Richter Rudi Loesel Günter Purschke Andreas Schmidt-Rhaesa Gerhard Scholtz Thomas Stach Lars Vogt Andreas Wanninger Georg Brenneis Carmen Döring Simone Faller Martin Fritsch Peter Grobe Carsten M Heuer Sabrina Kaul Ole S Møller Carsten HG Müller Verena Rieger Birgen H Rothe Martin EJ Stegner Steffen Harzsch 《Frontiers in zoology》2010,7(1):1-49
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剖析闵行区公立医疗机构政府补偿机制的要素与特点,为深化公立医疗机构改革提供决策参考。方法 收集和梳理政策文件,分析改革前后,政府补偿范围、补偿方式和补偿水平的变化,总结补偿机制特点。结果 改革后医疗服务和公共卫生服务经费按绩效考核结果进行补偿,基本建设和设备购置经费、政府指令性任务、学科发展、人员培养和科研教育经费的补偿标准和办法得到了明确。结论 闵行区公立医疗机构政府补偿机制以公益性为目标,以绩效考核为依据,运用了信息化工具,考虑了机构类型的差异,有利于引导医疗机构持续改进绩效,实现公益性目标。 相似文献