临床管理信息化阶段医疗收费管理流程现状分析与展望

医院信息化是医院管理水平的重要标志,而临床管理信息化阶段是整个医院信息化管理中非常重要的环节,分析临床管理信息化阶段医疗收费信息化管理流程现状,对其所存在的问题进行剖析和改进设想,以探索更加适合于临床管理信息化阶段的医疗收费管理流程。     

医学模拟教学结合以问题为导向的教学模式在重症医学教学中的应用研究

目的:探讨医学模拟教学结合以问题为导向(PBL)的教学模式在重症医学教学中的应用价值。方法:选取2015年1月~2017年1月在我院重症医学科轮转实习的五年制医学生64人作为研究对象。按随机数字表法将64名医学生分为PBL组(n=32)和结合教学组(n=32)。PBL组采用PBL教学,结合教学组采用医学模拟结合PBL教学。分别在入科时和轮转实习结束时对两组学员进行理论考试和技能操作考核,记录成绩并比较。理论考试和技能操作考核后采取发放问卷进行调查的形式获得学员对教学效果的主观评价。结果:轮转实习结束时,两组理论考试分数差异无统计学意义(P0.05);而结合教学组技能操作考核成分数显著高于PBL组,差异具有统计学意义(P0.05)。两组学员在教学方法接受度高、学习兴趣提升、自学能力提升和临床诊疗水平提高所占比例差异无统计学意义(P0.05);结合教学组学员在团队协作能力提高、沟通能力与人文关怀提高和技能操作水平提高所占比例高于PBL组,差异有统计学意义(P0.05)。结论:与单独PBL教学相比较,医学模拟教学结合PBL的教学模式应用于重症医学教学对学员技能操作的掌握有更好的效果,同时能提高学员团队协作能力、沟通能力以及对患者的人文关怀,且受到学员的认同与喜爱,应在重症医学的教学实践中逐步完善并进一步推广应用。     

Reasonability and Conscientious Objection in Medicine: A Reply to Marsh and an Elaboration of the Reason‐Giving Requirement

In this paper I defend the Reasonability View: the position that medical professionals seeking a conscientious exemption must state reasons in support of their objection and allow those reasons to be subject to evaluation. Recently, this view has been criticized by Jason Marsh as proposing a standard that is either too difficult to meet or too easy to satisfy. First, I defend the Reasonability View from this proposed dilemma. Then, I develop this view by presenting and explaining some of the central criteria it uses to assess whether a conscientious objection is proper grounds for extending an exemption to a medical practitioner.     

The dilemma posed by minority medical traditions in pluralistic societies: The case of China and Canada

Pluralistic societies such as China and Canada frequently find themselves pursuing potentially contradictory goals. China's contradiction results from a desire to preserve cultural diversity while eliminating ‘backward tendencies’ which work against the economic and social development of the country as a whole. Canada's contradiction results from a desire to preserve cultural diversity while maintaining an emphasis upon equality of rights and responsibilities for all Canadians. Behind these differences in ideology, however, is a more basic structural contradiction ‐ namely, that cultural pluralism, while considered an asset as long as it is restricted to preserving unique cultural traditions, is nevertheless a threat to a strong central government if interpreted to imply the power to set policy at the local level. To explore this issue, this article compares China and Canada in terms of three related topics. First, it briefly examines the multicultural policy of China and Canada. This is followed by a discussion of medical pluralism in China and Canada, with an emphasis upon the health of minority groups and the status of minority healing traditions. Finally, common perceptions of shamanic healing traditions in both China and Canada are considered. It is in relation to shamanism that the dilemma posed by cultural pluralism is most clearly delimited.     

How an ant decides to prey on or to attend aphids

The following results on the behavior decision making of the antLasius niger toward two species of myrmecophilous aphidsLachnus tropicalis andMyzocallis kuricola on chestnut trees have been found. (1) An individual worker consistently attended only one aphid species, even if her nestmates attended other aphid species on the same tree. (2) The ants preyed less on the aphid species which they attended than on other myrmecophilous aphid species. (3) The ants preyed less on the aphids which had been attended by their nestmates, even if both aphids were the same species. (4) The ants preyed less on aphids which had provided honeydew to their nestmates. (5) The increased aphid density per ant led to an increase in the rate of predation on the introduced aphids by the ants. These results suggest that each worker ofL. niger chooses aphid species to attend from her experience. In addition, the workers can recognize whether an aphid has been attended by their nestmates and whether an aphid has given their nestmates honeydew. Through these processes, each worker decides to attend or to prey on the aphid. As a result, they may realize efficient collective foraging dependent on aphid density per worker.     

我国台湾地区医疗服务审查制度研究

医疗保险在成为医疗服务的最主要付费者后,为避免医务工作者因道德风险产生过度医疗,确保医疗服务的必要性与合理性,建立了医疗服务审查制度,以达到费用控制和质量保障两大作用。但成本降低和质量提高是一对矛盾体,加上审查标准不一致、相关规范不全面、审核过程不够透明等问题使得台湾医疗服务审查制度饱受医疗机构的不满和诟病,尽管如此台湾在此方面还是积累了比较丰富的经验。了解台湾地区医疗服务审查制的历史、现状及存在问题对于大陆相应制度的制订有一定的启示和借鉴意义。     

某省级医院执行《江苏省医保药品目录》

目的 分析某省级三甲医院对《江苏省基本医疗保险药品目录》的执行效果。方法 选取江苏省某省级三级医院为研究对象,比较分析城镇职工医保患者和自费患者的药品使用情况。结果 新版《医保药品目录》能基本满足该院临床治疗需求;对门诊医保患者费用控制具有显著作用,但对住院医保患者的药品费用控制效果不明显,对不同疾病药品费用控制效果不一。结论 建立和完善严格的用药考核制度,需加强中高档药物使用的监管,并增加相应的适应症限制,应考虑将临床治疗可供选择、药价适应的药品纳入目录。     

国际主要医疗质量评价体系选择的临床指标及其共性

医疗质量指标是评估医疗机构的基础,很多国际机构和组织都制定了临床指标体系。通过分析国际5个主要的医疗质量评价体系（世界卫生组织、经济合作与发展组织、美国卫生服务与质量研究所、美国绩效科学研究中心、澳大利亚卫生服务标准委员会）所选择的临床指标,发现其共性在于：在选择临床指标时均高度重视临床服务的结果;高度重视临床指标的科学性和临床指标的可行性,其选择的临床指标中均包括住院死亡类指标,非计划重返类指标和患者安全类指标。     

A bioreactor system for interfacial culture and physiological perfusion of vascularized tissue equivalents

A pivotal requirement for the generation of vascularized tissue equivalents is the development of culture systems that provide a physiological perfusion of the vasculature and tissue-specific culture conditions. Here, we present a bioreactor system that is suitable to culture vascularized tissue equivalents covered with culture media and at the air–medium interface, which is a vital stimulus for skin tissue. For the perfusion of the vascular system a new method was integrated into the bioreactor system that creates a physiological pulsatile medium flow between 80 and 120 mmHg to the arterial inflow of the equivalent's vascular system. Human dermal microvascular endothelial cells (hDMECs) were injected into the vascular system of a biological vascularized scaffold based on a decellularized porcine jejunal segment and cultured in the bioreactor system for 14 days. Histological analysis and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) staining revealed that the hDMECs were able to recolonize the perfused vascular structures and expressed endothelial cell specific markers such as platelet endothelial cell adhesion molecule and von Willebrand factor. These results indicate that our bioreactor system can serve as a platform technology to generate advanced bioartificial tissues with a functional vasculature for future clinical applications.     

农作物花粉高温胁迫研究进展

高温现已成为农作物生产不可忽视的环境因素,而花粉是农作物对高温最敏感的器官.本文从细胞学、生理学和分子生物学等方面对近年来国内外有关农作物花粉高温胁迫的研究进行了综述,以期为保持农作物在高温胁迫下的高生产力提供思路.高温对农作物花粉的细胞学影响表现在绒毡层粗糙型内质网排列方式改变、药隔维管束鞘细胞形状异常、花粉管高尔基体小泡产生减少等方面;生理学影响表现在Ca²⁺动态平衡无法及时恢复、生长调节物质含量改变以及糖代谢减慢等方面;分子生物学影响表现在热激蛋白诱导表达不足和其他花粉功能基因表达被抑制等方面.