日本医疗诉讼改革及对鉴定结论的评价

自2002年以来,日本针对医疗诉讼中鉴定人选任困难、鉴定结论提出期间长、证据价值不高、法院对鉴定结论等医学证据难以作出评价等长期存在的问题,对医疗诉讼体制作出了重大改革。鉴于我国医疗诉讼中也存在类似问题,本文对日本法的改革措施以及效果展开详细考察,以供我国参考借鉴。     

Medical malpractice as reflected by the forensic evaluation of 4450 autopsies

A multicentre retrospective analysis of 4450 autopsies carried out due to suspicion of medical malpractice in 17 German institutes of forensic medicine from 1990 to 2000 was performed for the German Federal Ministry of Health. During the time period analysed an increase of cases could be mentioned. The main results of the study are: in the cooperating institutes the total number of autopsies due to suspected medical malpractice ranged from 1.4 to 20%. In more than 40% of the cases preliminary proceedings were started because the manner of death was certified as non-natural or not clarified. Hospital doctors were more affected by medical malpractice claims than doctors in private practice. However, the number of confirmed cases of medical malpractice was higher for doctors in private practice than for hospital doctors. Although surgery is still at the top of the disciplines involved in medical malpractice claims the number of confirmed surgical cases was below the average. Mistakes in care were confirmed to be above the average. Medico-legal autopsies are still a very sufficient method to evaluate cases of medical malpractice: 2863 cases could already be clarified by autopsy. Up to now there is no systematic registration of medical malpractice charges in Germany. A systematic registration should be initiated to build up and/or improve error reporting systems and, thus, to improve patient safety. Compared to other sources of medical malpractice claims (arbitration committees of the medical chambers, reference material of health and insurance companies, files of civil courts) the data of the present multicentre study are in so far unique as only lethal cases were evaluated and a complete autopsy report was available as basis of an expert opinion in alleged medical malpractice cases.     

An exploratory study of women prisoners’ attitudes towards their self-harm and the use of medical skin camouflage

Self-harm is a growing problem in UK prisons with women self-harming more than men. Self-harm can leave permanent scarring. Research on scarring suggests that living with scars can lead to psychological difficulties; however, there is little research on the specific effects of self-harm scars. Medical skin camouflage (MSC) can be used to cover numerous skin conditions. The use of MSC for women in prison with self-harm scars has not been examined previously. A focus group involving 10 women prisoners aimed to (1) explore feelings about self-harm scars, (2) examine effects that scars have on life in prison and (3) examine thoughts on using MSC in prison. This group formed part of a larger project designed to test the feasibility and acceptability of MSC for women who self-harm in prison. A topic guide was created with two service user researchers with experience of self-harm in prison. The results have been divided into three themes: (1) feelings about self-harm scars, (2) covering self-harm scars and (3) attitudes towards MSC. Our findings indicate that women in prison tend to feel embarrassed and self-conscious about their scars, and the presence of scars affects their relationships within prison. The women were enthusiastic about MSC, suggesting that it has the potential to affect women’s well-being and ability to engage with others.     

Extraction and isolation of cannabinoids from marijuana seizures and characterization by 1H NMR allied to chemometric tools

Marijuana, a drug derived from the Cannabis sativa L. plant, is the world's most consumed illicit drug. In this paper, a total of 156 marijuana samples seized in the state of Espírito Santo (ES), Brazil were studied and analysed by proton nuclear magnetic resonance (¹H NMR) spectroscopy to identify the major cannabinoids present. A crude extract of all samples was purified using high performance liquid chromatography so that these compounds could serve as reference substances. Nine fractions were obtained and analysed by ¹H NMR and gas chromatography–mass spectrometry (GC–MS), with five presented cannabinoids. ?⁹-THC (Δ⁹-trans-tetrahydrocannabinol), ?⁹-THCA (?⁹-tetrahydrocannabinolic acid), ?⁸-THC (?⁸-tetrahydrocannabinol), 11-hydroxycannabinol, CBV (cannabivarin), and CBN (cannabinol) were found, and their chemical structures were confirmed by GC–MS. The latter compound was obtained with high purity (≈100%), while the others were obtained as less complex mixtures with purity higher than 75% (except for Δ⁸-THC). Principal component analysis (PCA) was used on the ¹H NMR spectra of the 156 samples, and it was found that the samples were grouped according to the months, differentiating into two groups (from July 2014 to January 2015 and from February 2015 to July 2015), where non-grouping was observed from four macro-regions of the ES state (North, Central, Metropolitan, and South). The chemical profile of the seized samples was correlated to the ¹H NMR spectrum of an isolated CBN sub-fraction, in which the group formed by samples seized in the year 2015 presented lower CBN content in the chemical composition. From the PCA score plot, two groups of samples were confirmed using the partial least squares discriminant analysis and orthogonal projections to latent structures classification methods.     

A Need Not Being Met: Providing Paid Family and Medical Leave for All Americans

Many parents in the United States face the quandary of whether to take time off from work to care for themselves, their children, or other family member, understanding that their jobs may not be there upon return and they will receive no income during their leave. The Family and Medical Leave Act has not lifted this burden; it only provides for unpaid leave. Four states and several cities have implemented paid family and medical leave statutes with both employees and employers benefiting. This Note proposes a uniform paid family and medical leave statute based on other countries’ statutes; proposed federal legislation; and statutes in New York, California, and San Francisco.     

Access to the health records of deceased patients: Why the law is in need of review

A glance at the cases that came before the UK Information Commissioner's Office (ICO) in the period between 2005 and 2008 immediately shows that a consistently high number relate to access to the health records of deceased patients. What accounts for this interesting state of affairs? This paper aims to demonstrate that the law regulating this increasingly important area is a patchwork of case law, statutes and professional guidelines that do not always lend themselves to a congruous and seamless amalgamation. This has in turn resulted in the need for creative interpretation and at times legal gymnastics on the part of the ICO and medical professionals. We argue that in an age where allegations of medical negligence are proliferating (and access to the health records of the deceased could help confirm or dispel suspicions of wrongdoings leading to the death) and where genetic information about a deceased relative could offer valuable support to a living patient's preventative care, diagnosis and treatment plans, the law regulating access to the health records of deceased patients in the UK can no longer afford to be unclear and confusing. There is, therefore, an urgent need for review.     

医学生中医体质与睡眠质量的相关性分析

目的 探讨医学生睡眠质量与中医体质的分布特点及二者之间的关联性。方法 采用横断面研究,对安徽2所高校1 137例医学生的睡眠质量及中医体质分布情况进行横断面调查。采用典型相关分析探讨二者之间的相关性。结果 ①医学生睡眠障碍检出率为26.30%,男女学生在睡眠障碍得分上的差异具有统计学意义（P＜0.05）,各年级医学生在睡眠质量各因子得分上的差异具有统计学意义（P＜0.05）。②医学生平和质占18.47%,偏颇体质占81.53%。偏颇体质中排名前3位的依次是气虚质（占17.77%）、阴虚质（占15.22%）和阳虚质（占14.16%）。③不同体质类型的学生睡眠质量差异具有统计学意义（P＜0.05）。典型相关分析显示医学生中医体质与睡眠质量存在显著的相关性（P＜0.05）。V1所代表的湿热质与W1所代表的匹兹堡睡眠质量指数(Pittsburgh sleep quality index, PSQI)正相关,湿热体质者PSQI得分高,睡眠质量差。结论 医学生睡眠质量不佳,发生偏颇体质的可能性较高,气虚质、阴虚质、气郁质、湿热质者睡眠质量较差。     

乡村振兴背景下欠发达地区健康治理效能提升研究——以山西促进社会办医参与健康治理为视角

以促进社会办医参与推进健康治理,对我国欠发达地区实现乡村振兴具有重要的实践意义,其逻辑需求蕴含于新时代健康目标、健康返贫风险性及现实新机遇中.基于健康治理分析框架和对山西相关调研,可以发现在促进社会办医参与健康治理中,目前存在影响制约健康治理效能的多重因素,包括经营管理目标理念失当、参与机会空间难以拓展、人才短缺限制自...     

医疗事故中的因果关系初探

医疗事故中的因果关系初探刘新社，刘明俊，唐承汉，张秦初Ａｆｅｗｗｏｒｄｓａｂｏｕｔｔｈｅｃａｕｓａｔｉｏｎｏｆｍａｌｐｒａｃｔｉｃｅ￥ＬｉｕＸｉｎｇｓｈｅ（ＦｕｃｕｌｔｙｏｆＦｏｒｅｎｓｉｃＭｅｄｉｃｉｎｅ，ＸｉａｎＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ...     

论强制性医疗损害赔偿保险制度的建立

通过对我国医疗损害赔偿给付现状的分析,对国外医疗责任保险及给付的比较,认为:只有通过立法来建立一种强制医疗损害赔偿保险制度才能较合理地解决医疗损害受害人损害赔偿的兑现问题,同时,又不使医疗法人的正常医疗行为因此受到影响;并进一步指出了建立该种保险制度所存在的问题和对策。