医疗保险总额预付试点三级医院患者就医感受调查

目的 调查上海市实行医疗保险总额预付的三级医院中患者的就医感受。方法 经培训的调查员应用结构式调查问卷对上海市10家实行医疗保险总额预付的三级医院的699名患者进行面对面访谈，数据分析主要采用描述性统计。结果 城保患者对门诊医生明显减少处方金额（或处方天数）的感受强于非城保患者，城保和非城保患者的住院就医感受差异无显著统计学意义。结论 医疗保险总额预付对上海三级医院患者就医感受的总体效应似偏弱，而且有限的影响主要集中于门诊而非住院环节。     

Neotypification of the genusTrichosporon

The currently accepted type species of the genusTrichosporon Behrend isT. beigelii. This species has formerly been regarded as identical toT. cutaneum. However, these fungi are now known to represent separate species with different ecology. The first species described inTrichosporon wasT. ovoides, an agent of human white piedra. A neotype strain is designated for this species, while a lectotype strain is indicated forT. cutaneum. The nameT. beigelii is considered as doubtful and consequently cannot be maintained.     

Planning oral health care for the elderly in Israel for the years 2000 and 2025

The methodology and conclusions of this workshop arc reported here because the problems requiring solution are not unique to Israel. They will increasingly have wide geographical and political application. The population of Israel since its establishment in 1948 has increased about sixfold. The numbers of the elderly (65+) have increased about tenfold. The current situation must be examined and estimates obtained for the next ten years. Only thus can the system be enabled to cope with the problem as it develops. The chosen method was a carefully preplanned, multisectorial workshop. Recommendations were discussed, amended and finalised. The recommendations of the workshop included: Baseline national data is urgently required. Guidelines are required for selecting specific target populations to which priority should be given. The current favourable situation of adequate oral health manpower in Israel makes it possible to encourage providers of oral health care towards treatment for the elderly. It is essential that the appropriate health authorities allocate sufficient funds for the following urgent purposes: the conduct of a national survey of the elderly population; the establishment of oral health units on a trial basis in some selected hospitals; support institutions of higher education to facilitate training in geriatric dentistry. Conclusions. The workshop was multidisciplinary because it was necessary to include all the expertise and experience available as vital elements of the policy making process. This type of workshop was found to be an effective tool for planning oral health services.     

Ethical obligation and legal requirements: On informed consent practices in Bangladesh

Informed consent to medical intervention is fundamental in both ethics and law. But in practice it is often not taken seriously in developing countries. This paper provides an appraisal of informed consent practices in Bangladesh. Following a review of the ethical and legal principles of informed consent, it assesses the degree to which doctors adhere to it in Bangladesh. Based on findings of non-compliance, it then investigates the reasons for such non-compliance through an appraisal of informed consent practices in Bangladesh and provides recommendations aimed at improving such practices. The significance of this paper lies in unveiling the interdependence between the ethical and legal traits of informed consent and their ramifications on strengthening the patient-oriented approach of duty to care.     

News from the Biological Stain Commission No. 12

Abstract

In this 12^th issue of News from the Biological Stain Commission (BSC) under the heading of Regulatory affairs, the Biological Stain Commission’s International Affairs Committee presents information from the meetings of ISO/TC 212/WG 1 Quality and competence in the medical laboratory and ISO/TC 212/WG 3 In vitro diagnostic products both held on 2 – 3 June 2010, plus information on the second plenary meeting of ISO/TC 212 Clinical laboratory testing and in vitro diagnostic test systems held on 4 June 2010. All meetings took place in Seoul, Republic of Korea. Finally, information is provided concerning the 25^th meeting of CEN/TC 140 In vitro diagnostic medical devices held on 23 June 2010 in Berlin, Germany.     

What is the best age to circumcise? A medical and ethical analysis

Circumcision is often claimed to be simpler, safer and more cost-effective when performed in the neonatal period as opposed to later in life, with a greater benefit-to-risk ratio. In the first part of this paper, we critically examine the evidence base for these claims, and find that it is not as robust as is commonly assumed. In the second part, we demonstrate that, even if one simply grants these claims for the sake of argument, it still does not follow that neonatal circumcision is ethically permissible absent urgent medical necessity. Based on a careful consideration of the relevant evidence, arguments and counterarguments, we conclude that medically unnecessary penile circumcision—like other medically unnecessary genital procedures, such as ‘cosmetic’ labiaplasty—should not be performed on individuals who are too young (or otherwise unable) to provide meaningful consent to the procedure.     

栽培条件对灵芝子实体的三萜组成及其活性的影响

以不同灵芝品种、不同栽培基质、不同管理方式、不同生长时期获得的灵芝子实体为原料,用95%乙醇超声提取,对提取物进行了含量测定、三萜组成分析和体外抗肿瘤实验。结果表明,不同子实体醇提物中三萜和甾醇类物质的含量在4.60-6.20mg/g之间;高效液相分析发现10种三萜化合物的种类和含量在样品间存在明显差异。所有灵芝子实体醇提物对肿瘤细胞L1210的增殖均有一定的抑制作用,开伞期的灵芝子实体醇提物抑制肿瘤增殖的活性优于其他生长时期。     

采自祁连山的冷杉侧耳生物学特性及栽培条件探索

以采自甘肃省祁连山国家级自然保护区菌物保育区的野生侧耳作为试验材料,通过形态学及系统发育分析方法将其鉴定为冷杉侧耳Pleurotus abieticola。对该菌株生物学特性及栽培条件进行初步研究,结果表明：菌丝体最适生长温度为25℃;最适pH为7.0;最适碳源为玉米粉;最适氮源为豆粉;在以棉籽壳、木屑和麸皮为栽培料时,可获得子实体。     

Higher patient doses through X-ray imaging procedures

Medical imaging using X-rays has been one of the most popular imaging modalities ever since the discovery of X-rays 125 years ago. With unquestionable benefits, concerns about radiation risks have frequently been raised. Computed tomography (CT) and fluoroscopic guided interventional procedures have the potential to impart higher radiation exposure to patients than radiographic examinations. Despite technological advances, there have been instances of increased doses per procedure mainly because of better diagnostic information in images. However, cumulative dose from multiple procedures is creating new concerns as effective doses >100 mSv are not uncommon. There is a need for action at all levels. Manufacturers must produce equipment that can provide a quality diagnostic image at substantially lesser dose and better implementation of optimization strategies by users. There is an urgent need for the industry to develop CT scanners with sub-mSv radiation dose, a goal that has been lingering. It appears that a new monochromatic X-ray source will lead to replacement of X-ray tubes all over the world in coming years and will lead to a drastic reduction in radiation doses. This innovation will impact all X-ray imaging and will help dose reduction. For interventional procedures, the likely employment of robotic systems in practice may drastically reduce radiation exposures to operators- but patient exposure will still remain an issue. Training needs always need to be emphasized and practiced.     

An Automatable Hydrogel Culture Platform for Evaluating Efficacy of Antibody‐Based Therapeutics in Overcoming Chemoresistance

The microenvironment plays a major role in conferring chemoresistance to cancer cells. In order to better inform clinical response to chemoresistance, preclinical models that recapitulate its hallmark features are needed to enable screening for resistance‐specific therapeutic targets. A novel platform for seeding cancer cells in 3D hydrogels is presented utilizing derivatives of chitosan and alginate that, critically, is amenable to high throughput screening: cell seeding in hydrogels, media changes, dosing of anticancer compounds, and cell viability assays are all automated using a standard and commercially available liquid handling robot. Culture in these hydrogels elicits resistance in ovarian, lung, and prostate cancer cells to treatment by doxorubicin and paclitaxel. In correlation, proteomics analysis of SKOV3 cells cultured in 3D reveals enrichment of proteins associated with extreme drug resistance including HMOX1 and ALDH2. Subsequently, therapeutic antibodies targeted to tumor‐associated antigens upregulated in 3D cultures are shown to have higher efficacy compared to 2D cultures. Collectively, this automated 3D cell culture platform provides a powerful tool with utility in identification of drugs that may overcome chemoresistance.