论医疗产品损害责任

医疗机构在医疗过程中使用有缺陷的药品、消毒药剂、医疗器械以及血液及血液制品等医疗产品,因此造成患者人身损害,医疗机构或者医疗产品生产者、销售者应当承担的医疗损害赔偿责任属医疗产品损害责任。这种医疗产品损害责任适用无过失责任原则,适用《产品质量法》规定的产品侵权责任的一般规则,其基本责任形态是不真正连带责任,在特殊情形下构成连带责任。     

Medical Terminology Coding Systems and Medicolegal Death Investigation Data: Searching for a Standardized Method of Electronic Coding at a Statewide Medical Examiner’s Office*

Abstract: Medical examiner and coroner reports are a rich source of data for epidemiologic research. To maximize the utility of this information, medicolegal death investigation data need to be electronically coded. In order to determine the best option for coding, we evaluated four different options (Current Procedural Terminology [CPT], International Classification of Disease [ICD] coding, Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT], and an in‐house system), then conducted internal and external needs assessments to determine which system best met the needs of a centralized, statewide medical examiner’s office. Although all four systems offer distinct advantages and disadvantages, SNOMED CT is the most accurate for coding pathologic diagnoses, with ICD‐10 the best option for classifying the cause of death. For New Mexico’s Office of the Medical Investigator, the most feasible coding option is an upgrade of an in‐house coding system, followed by linkage to ICD codes for cause of death from the New Mexico Bureau of Vital Records and Health Statistics, and ideally, SNOMED classification of pathologic diagnoses.     

试论竞合性事实错误——以行为性质错误为契合点

与单一的事实错误不同,竞合性事实错误系两个不同的错误重叠交叉所致。以行为性质错误为契合点,与其重叠的竞合性事实错误常见的有行为性质错误与打击错误的竞合、行为性质错误与对象错误的竞合以及行为性质错误与手段错误的竞合。在竞合性事实错误的处理上,应分别就不同的错误进行规范评价,进而从整体上对双重错误问题作出适中的定性分析。     

羊水栓塞死亡医疗纠纷案件的法医学分析

目的分析引发医疗纠纷的羊水栓塞死亡病例的相关因素,以帮助提高对羊水栓塞诊治能力,减少医疗纠纷。方法对我中心2006～2009年间鉴定的8例医疗纠纷相关羊水栓塞死亡病例的临床资料及过失认定进行回顾性分析。结果（1）医疗因素分析：7例具有使用催产素史;3例发生于产前破膜后,5例发生于产后;具有典型临床症状5例,不典型临床症状3例;早期诊断7例;3例实施子宫次全切除术;发生在二级医院以下6例。（2）法医学鉴定分析：催产素使用不当及观察记录缺陷占87.5%（7/8）;7例早期诊断羊水栓塞,但在供氧、解痉和子宫切除方面存在治疗缺陷。结论提高对产前、产后羊水栓塞症状特点的认识和处置能力,强化病历记录规范、完整及充分告知说明,是减少医疗纠纷案件的关键,也是法医学鉴定判断的重要依据。     

中草药复合添加剂对虹鳟鱼增重及肝功能和结构的影响

为观察中草药复合添加剂富康163对虹鳟鱼生长性能、肝功能和结构的影响,选择18月龄的虹鳟鱼400尾,随机将其分为4组,Ⅰ组为对照组,Ⅱ、Ⅲ、Ⅳ分别在基础日粮中添加30、50和70g/kg富康163,试验期60d。结果显示:饲料中添加不同水平的富康163能提高增重率,并可不同程度地降低饲料系数;与对照组相比,试验组血清腺苷脱氨酶(ADA)活性、γ-谷氨酰转肽酶(γ-GT)活性、胆碱酯酶(CHE)活性、总胆红素(TBiL)浓度和肝指数无明显变化(P>0.05);Ⅰ、Ⅱ、Ⅲ组肝细胞界限清楚,核圆而大,核膜清晰,胞质丰富,而Ⅳ组有的肝细胞间分界不明显、胞内空泡化。结果表明,虹鳟鱼饲料中添加富康163能促进鱼体生长,提高营养物质利用率,对鱼肝的功能和结构无显著影响,建议虹鳟鱼饲料中富康163的添加剂量以50g/kg为宜。     

‘An error is feedback’: the experience of communication error management in crisis negotiations

A range of studies have examined what should be said and done in crisis negotiations. Yet, no study to date has considered what happens when an error is made, how to respond to an error, and what the consequences of errors and responses might be on the negotiation process itself. To develop our understanding of errors, we conducted 11 semi-structured interviews with police crisis negotiators in the Netherlands. Negotiators reported making errors of three types: factual, judgment, or contextual. They also reported making use of four types of response strategy: accept, apologize, attribute, and contradict. Critically, the negotiators did not perceive errors as solely detrimental, but as an opportunity for feedback. They advocated for an error management approach, which focused on what could be learned from another person’s errors when looking back at them. Suggestions for improvement of the communication error management experience in crisis negotiations are discussed.     

Analysis of Forensic Autopsy in 120 Cases of Medical Disputes Among Different Levels of Institutional Settings

Despite advances in medical science, the causes of death can sometimes only be determined by pathologists after a complete autopsy. Few studies have investigated the importance of forensic autopsy in medically disputed cases among different levels of institutional settings. Our study aimed to analyze forensic autopsy in 120 cases of medical disputes among five levels of institutional settings between 2001 and 2012 in Wenzhou, China. The results showed an overall concordance rate of 55%. Of the 39% of clinically missed diagnosis, cardiovascular pathology comprises 55.32%, while respiratory pathology accounts for the remaining 44. 68%. Factors that increase the likelihood of missed diagnoses were private clinics, community settings, and county hospitals. These results support that autopsy remains an important tool in establishing causes of death in medically disputed case, which may directly determine or exclude the fault of medical care and therefore in helping in resolving these cases.     

Cuba's Response to COVID-19: What Underlies its Apparent Success?

Over the last few months extremely positive accounts have been circulating of Cuba's role and approach in the COVID-19 response, both nationally and internationally. A universal healthcare system with family doctors and nurses providing door-to-door services, as well as the swift introduction of measures to control movement have been some of the factors underlying this relative success. However, this success hides the disadvantageous social reality facing the majority of Cubans, including differential access to services, a health system that is struggling and limited choice and freedoms.     

A test of the stability of punishment hypothesis: The Dutch case

This paper tests the hypothesis of the stability of punishment as developed by Blumstein and his associates against Dutch prison data. After summarizing the existing empirical evidence, Dutch prison data are presented pertaining to the average daily population in penal institutions, on the one hand, and the number of admissions in these institutions, on the other hand. In three ways it is tested whether these data do support the hypothesis: regression analysis, Box-Jenkins analysis, and the analysis of a few dynamic models as presented by Berket al. (1981). The paper ends with discussing Blumstein's hypothesis and considers the way research into the extent of the prison population should be continued.     

Winning at the polls and in the polls: the incumbency advantage in surveys of U.S. house voters

The success of House incumbents at the polls is well known and has been studied extensively. This paper focuses on the incumbents' success in the polls: the support bestowed upon incumbents by survey respondents is substantially higher than that received from the voters. The incumbency advantage at the polls, estimated at about 10% in the most recent elections, is almost doubled when measured in the polls. The data, drawn from the 1982–1996 National Election Studies, show that respondents do not reward all winners; candidates elected to open seats have not benefitted from the kind of bounce consistently enjoyed by winning incumbents. In addition, the pattern of respondents' misreports appears to be inconsistent with earlier explanations based on instrument effects. Respondent bias should be accounted for in order to reach correct estimates of the incumbency advantage in individual-level data.