电子病案与医疗保险

目的 为了早日实现电子病案的普及与全民医疗保险网上自动审核与赔付. 方法 从目前电子病案与医疗保险报销制度存在的问题,以及有效的解决途径等方面进行了探讨. 结果 加强电子病案生成质量的管理与网络安全管理的法制化,是实现电子病案与医疗保险网上赔付,降低患者的医疗成本,为社会各界提供方便、安全、快捷信息服务的保障. 结论 实现电子病案与医疗保险数字化、信息化数据交换平台,是促进、推广电子病案与医疗保险网上赔付的纽带,是医院人性化、社会化、信息化管理发展的必然趋势.     

医疗保健与医疗保险特征及其相互关系研究

分析医疗保健和医疗保险的特征，并对两个领域及其相互联系进行探究，为如何发挥公共机制和市场机制在医疗保障中的作用提供理论依据。     

医疗缺陷与医疗纠纷的剖析

如何加强医疗缺陷的控制，正确处理医疗纠纷是医院管理者面临的新难题。据１５年统计，医疗差错是造成医疗纠纷的主要原因，在市场经济新形势下，重大医疗纠纷的处理时间日趋延长。因此，物院针对医疗纠纷直接责任者主要是口腔外科医生的特点，狠抓重点科室及关键环节的防范，减少纠纷发生。     

医疗设备档案与医疗设备管理

文章结合实际工作经验。从四个方面详细阐述了做好医疗设备档案管理的重要意义。     

医疗安全与医疗纠纷管理

1　医疗安全概述1.1　医疗安全的概念医疗安全是指医疗机构在实施医疗活动过程中 ,病人不发生法律和规定规章制度允许范围以外的心里、机体或功能上的损害、障碍、缺陷或死亡等情况。医疗安全是医院安全工作的着眼点 ,医疗安全管理是医院质量管理的核心 ,医疗质量管理又是医院管理的生命 ,医疗安全管理不到位 ,医疗质量就无法保证 ,医院管理水平也难得到提高。1.2　医疗安全常常体现在以下 4个方面1.2 .1　医疗安全将产生高质量的医疗效果　医疗不安全将会导致与医疗效果向反方向发展 ,如 :开错处方、打错针、发错药、发错误报告、医疗器械…     

The principles of medical ethics and medical research

In this paper I discuss the application of the principles of medical ethics and of medical research to the case of children and others whose consent to treatment and to research is problematic. Public health depends substantially on the possibility of ongoing research into all conditions which affect the health of the people. Constraints on this research are therefore a public health issue. Moreover and more importantly the possibility of predictive testing and indeed of screening for health-relevant conditions is an important public health tool, and limitations on the use of this tool are of great significance to public health medicine. Having considered the particular problems created by research and predictive testing on children for late-onset conditions I go on to discuss research on those whose consent is problematic more generally. I conclude with radical recommendations for the reform of The Declaration of Helsinki and of the International Ethics Guidelines for Biomedical Research Involving Human Subjects, prepared by the Council for International Organizations of Medical Sciences (CIOMS).     

优化就医流程创新医疗服务

《关于公立医院改革试点的指导意见》指出,医院要加强内部管理、优化服务流程。不少医院通过“一卡通”、“预存卡”等方式优化医疗服务流程,合理配置医疗资源,减少患者看病就医排队等候时间,取得了比较满意的社会效果。但是在实践中仍存在着一些问题,影响到这种服务模式的推广。本刊刊发以下四篇文章,对进一步推动“先诊疗、后结算”工作提出了建设性意见,供医院管理者借鉴。同时,热忱欢迎大家把医院管理工作中的经验、体会形成文字投给本刊,供广大读者借鉴、参考,为提高我国公立医院内部管理水平献计献策。     

The underrepresented in graduate medical education and medical research

There is a perception that the career options open to medical school graduates who are members of minority groups are restricted. This perception relates especially to those postgraduate medical training programs that have not traditionally encouraged or had significant minority participation. Data were therefore sought to determine whether this perception was well founded. Recent reports show the strikingly low numbers of minorities on medical school faculties and in administrative positions in spite of efforts to fill such positions. Information on the specialties of practicing minority physicians is limited, but accurate figures are available on the participation of minorities in various specialty postgraduate training programs. For instance, during recent years, 50 to 60 percent of all black residents have been trained in internal medicine, pediatrics, general surgery, and obstetrics and gynecology. Further studies are needed to document or disprove the conception that minority physicians have less access than other physicians to certain careers in the delivery of health care and education. In the interim, efforts should be continued to encourage minority physicians not only to seek preparation for community primary care practice, but also for professional participation in academic careers of other specialties (and subspecialties), in biomedical and clinical research, and in health care administration. The ability to enter these diverse careers is most often determined by the opportunities available at the time of completion of medical school education. Therefore, those involved in graduate medical education should address the challenge of providing opportunities for the proportionate representation of minorities in all aspects of medical care and medical education.     

Inner city deprivation and medical education: a survey of medical students by medical students

A total of 330 preclinical and clinical medical students and house officers at St Mary's Hospital were surveyed by questionnaire to assess their knowledge and experience of inner city deprivation and health, and their opinions on the role of the doctor in responding to these problems. The response rate was 87%. Over 75% of the respondents had had no experience of inner city living conditions before coming to medical school, and they gained little experience during the medical course until well into the clinical years. Most preclinical students wanted more contact with the community early in the course; less than one-third of the clinical students wanted this. The differences in knowledge and attitudes between the year groups are discussed and possible reorientation in medical education is considered.     

加强病案管理 提高病案书写质量

目的加强病案管理，提高病历书写质量。方法笔者将在病案室工作多年来对病案资料、病案管理及病案书写方面的重要性加以总结、分析。结果各方面须进一步加强对病案资料、病案管理及病案书写方面等诸多方面重要性的认识。结论病案不但能反映出一个医务人员所掌握的专业知识、技术水平、逻辑思维能力、文字功底等综合素质，而且还是一个医院管理水平的体现。     

“反恐”应急医疗救援体系及对卫生装备的需求

在分析“反恐”卫勤保障能力总体需求的基础上,探讨了“反恐”应急医疗救援体系的建立及其对卫生装备的需求,指出我国应重点发展急救装备、治送结合的伤病员后送装备、移动式野外医疗单元和环境生存装备等四类“反恐”卫生装备。     

Perceptions of and attitudes towards medical errors among medical trainees

OBJECTIVES: The purpose of this study was to develop a better understanding of how medical trainees define medical errors and what factors influence medical trainees' perceptions of medical errors. METHODS: We surveyed 423 medical students and house staff at an urban academic medical centre to learn about how they defined medical errors, their experiences with medical errors, their beliefs about when a patient should be informed of an error, and their attitudes towards medical errors with differing severity of outcomes. RESULTS: Trainees stated that an event could be considered an error regardless of outcome, negligence, intention or consent. Definitions did not vary according to gender or level of training. Trainees had increasing feelings of guilt and fear as the outcomes related to errors worsened. Respondents were more likely to feel guilty and angry at themselves, and be afraid of accusations of malpractice, losing their licence, damaging their reputation, or losing confidence when errors were made while working individually versus in a team setting. Female trainees were more likely than male trainees to feel guilty and angry at themselves, and were afraid of losing confidence if they made an error. CONCLUSIONS: Trainees' perceptions and attitudes towards errors vary depending on whether they are in their clinical years, the severity of outcome, and whether the error is attributable to an individual or a team. These factors will have to be explored in greater depth if we are adequately to prepare young doctors for the errors they will inevitably make.