FROM MEDICAL RATIONING TO RATIONALIZING THE USE OF HUMAN RESOURCES FOR AIDS CARE AND TREATMENT IN AFRICA: A CASE FOR TASK SHIFTING

With a global commitment to scaling up AIDS care and treatment in resource‐poor settings for some of the most HIV‐affected countries in Africa, availability of antiretroviral treatment is no longer the principal obstacle to expanding access to treatment. A shortage of trained healthcare personnel to initiate treatment and manage patients represents a more challenging barrier to offering life‐saving treatment to all patients in need. Physician‐centered treatment policies accentuate this challenge. Despite evidence that task shifting for nurse‐centered AIDS patient care is effective and can alleviate severe physician shortages that currently obstruct treatment scale‐up, political commitment and policy action to support task shifting models of care has been slow to absent. In this paper we review the evidence in support of task shifting for AIDS treatment in Africa and argue that continued policy inaction amounts to unwarranted healthcare rationing and as such is ethically untenable.     

医疗投诉预警指数的建立及应用

应用环境质量指数的方法和原理,对国内5 385起医疗投诉进行分析。发现医疗投诉事件发生的主要原因为：医疗服务不到位（X₁）、医护人员态度不佳（X₂）、医院行政管理不善（X₃）、社会导向等因素不良而致的病人心理取向及药品质量等原因（X₄）。进一步推导出医疗投诉的预警指数：Ai=0.40X₁+0.32X₂+0.16X₃+0.12X₄ ,并提出了使用该指数的方法。应用此指数对某医院的医疗投诉进行评价,表明该院医疗投诉预警指数为1.25,属警报水平（Ⅲ级）,同时也指出了该院医疗投诉的重点检查对象和治理的重点。应用此指数不仅可以对医疗投诉事件进行前瞻性的预测,确定重点的管理对象,而且可以找出主要的隐患和管理重点,为宏观管理确定依据。     

中国情境下医院社会责任的概念及内涵解析

《病历书写基本规范》在原试行版经过为期7年多的实践的基础上得到了进一步的完善,并于2010年3月1日起正式施行。与试行版相比,新的《病历书写基本规范》彰显出七大特点,但在对文书记录者身份的要求、实习医务人员及试用期医务人员书写病历内容范围、前后用词的统一性等方面仍值得商榷。对此提出建议：明确每一种文书记录者的身份或资格;用词规范并前后统一;高度重视医嘱管理。     

构建医患和谐：大型医院图书馆的医学信息服务的“三个面向”

针对临床医疗引发的医患矛盾,从医学信息服务角度提出了以面向医院管理层、临床医务人员和患者的医学信息服务来化解矛盾,阐述了大型医院图书馆以医学信息服务为纽带,构建医患和谐的工作要点。     

医师资格考试存在的问题分析及对策探讨

医师资格考试对于提高医师的素质,保证医疗质量至关重要。通过专家访谈,了解目前医师资格考试存在的问题,并提出相应的管理对策,以促进医师资格考试制度不断完善。     

论新医改形势下大型公立医院可持续发展战略

新医改形势下大型公立医院要在保持公益性的前提下,实现自身的发展壮大,面临前所未有的压力和挑战。从科学发展观的视角,围绕机制创新、技术创新、管理创新、服务创新进行思考,提出实现机制、技术、学科、管理、服务五力合一的医院战略管理路径,以促进公立医院长期的、差异性的、可持续的发展。     

关于我国医疗质量监管体系的探讨

通过文献研究和典型现场调查,对国内外医疗质量监管体系进行比较研究,进而提出我国医疗质量监管体系的框架：以政府为主导,政府授权的专业监管机构、医疗保险机构和社会监督力量共同参与的多元化的监管体系。     

从证据法学角度看《病历书写基本规范》对入院记录要求的瑕疵及对策

从证据法学角度看,《病历书写基本规范》对入院记录的要求存在病历作为证据形式上不完整的瑕疵。实行患方确认病史签名,可以有效弥补这一瑕疵,维护医院、患者及其他第三方的正当权益。但由此引起的法律相关问题,需要进一步研究。     

公立综合性医院在突发灾难事件医疗救援中的伦理实践

突发灾难中的医疗救援不同于常规的医疗救治,其具有显著的特殊性。而这种特殊性不仅体现在救援组织、医疗技术上,还体现在公立医院医疗救援应遵守的伦理原则上。突发灾难事件下公立综合性医院应突破因情况特殊性而带来的医疗救援伦理局限性,使其得到充分合理转化和运用。     

MISCONDUCT IN MEDICAL STUDENTS

Medical students, subject to unique challenges and stressors, frequently engage in misconduct. In this observational study, carried out in a medical school in Colombia, we developed a survey to explore the association between misconduct and stress, potential stressors and other possible contributing factors, such as sex, age and academic year. Of the 433 students that responded to our survey, 97.9% did not fully disagree with at least one of the mentioned misconducts and 99.8% admitted to at least one transgression. Based on a scale we developed, 61.4% of the students consistently agreed with misconduct and 44.9% frequently engaged in misconduct. A logistic regression model suggests that being male (OR 1.90, CI 95% 1.27–2.84) and stress (OR 1.04, CI 95% 1.01–1.06) may increase the likelihood of misconduct. In a subgroup of students, excluding those in their last year of studies, higher academic semester (OR 1.25, CI 95%: 1.10–1.42) may also be a risk factor for misconduct. Most of the observed variation in the data, however, is not explained by these factors. Other modifiers, such as student personality and sub‐culture, may play a greater role in determining misconduct. The proportion of medical students that engage in misconduct is very high and warrants the attention of the medical education community.