美国医疗器械立法嬗变及其动因

1938年《联邦食品药品及化妆品法》和1976年《医疗器械法》是两个具有里程碑意义的法律。某种程度上，每一部法律的制定都是灾难性事件的杰作。而在立法进程中，立法者都在促进医疗器械安全与鼓励新医疗器械的发展上进行着一种平衡，美国联邦食品药品管理局在执行这些立法过程中更追求这种平衡。中国医疗器械安全立法及侵权法都忽视了这一点，一味追求对医疗器械生产商和医疗机构课以责任。     

违反告知义务引发医疗纠纷案例分析

告知义务是医师应尽的注意义务之一,在医疗损害赔偿诉讼中原告常以医师在医疗活动过程中未能履行告知义务造成病人损害而要求医疗机构承担赔偿责任。本文介绍了5例有关医师违反告知义务的医疗损害案件及人民法院审理结果,并对医师违反告知义务时如何判定其是否存在医疗过错以及医疗过错与损害后果之间的因果关系进行了分析和讨论,旨在为医疗损害司法鉴定提供参考。     

医疗事故技术鉴定的调查取证

医疗事故技术鉴定中,进行调查取证是至关重要的环节。调查取证对明确案情事实,保证医疗事故技术鉴定结论公正、公平,合理、科学解决医患纠纷,缓解社会矛盾起着非常重要的作用。但在某些情况下,司法机关可能对医疗事故技术鉴定的调查取证不予认可,其原因是多方面的。因此应当重视调查取证工作,注意其规范性、程序性和有效性,从而提高调查取证工作的质量,保障医疗事故技术鉴定的公信力。     

新型农村合作医疗管理体制改革探讨

本文分析了我国新型农村合作医疗卫生部门管理模式成效及存在的问题,提出新型农村合作医疗管理体制改革的思考与建议     

对医学生职业生涯规划教育的几点思考

在高校中开展大学生职业生涯规划教育已成为教育部的明确要求。而医学生因专业性较强,在开展职业生涯规划教育方面也存在着一定的独特性。分析医学生职业生涯规划教育的现状,探讨针对医学生职业生涯规划教育的特点,有助于提高医学生职业生涯规划能力。     

老年人健康权直接保障义务之让渡——从政府导向型向市场导向型转变

健康权乃基本人权之一,应得到充分尊重并保障实现。老年人为社会弱势群体,其健康权的保障更应受国家及社会的重视。一般认为,国家是保障公民基本权利实现的义务主体,但养老服务机制下由国家直接保障老年人健康权的实现有其缺陷。在公共服务社会化趋势的背景下,政府将该直接义务让渡于市场服务行业,亦即使健康权的保障由单一的政府导向型转向多元化的市场导向型,对老年人健康权的保障具有灵活、专业、高效等优势。基本医疗制度下通过竞选资质优厚的医疗卫生服务机构来保障老年人健康权,当属充分保障人权的有效举措之一。     

关于社会转型期医患冲突问题的若干思考

在社会转型的特殊历史时期,尤其是在努力实现"病有所医"的重大医改过程中,因医疗纠纷引发医患冲突甚至导致群体性事件不断增多,呈现出秩序危机、暴力危机、信任危机、赔偿危机、舆情危机"五大危机",究其根源是利益博弈的集中体现,只有做到以民生为本,才能从根源上有效减少医患冲突,而作为维护社会稳定主力军的公安机关,要立足本职,做到情法交融,既积极介入,有情操作;又适时出手,无情打击,切实促进社会和谐稳定。     

Alleged Biological Father Incest: A Forensic Approach

Paternal incest is one of the most serious forms of intrafamilial sexual abuse with clinical, social, and legal relevance. A retrospective study was performed, based on forensic reports and judicial decisions of alleged cases of biological paternal incest of victims under 18 years old (n = 215) from 2003 to 2008. Results highlight that in a relevant number of cases: victims were female; the abuse begun at an early age with reiteration; the alleged perpetrator presented a history of sexual crimes against children; sexual practices were physically poorly intrusive, which associated with a forensic medical evaluation performed more than 72 h after the abuse, explain partially the absence of physical injuries or other evidence—these last aspects are different from extrafamilial cases. In conclusion, observations about paternal incest are likely to exacerbate the psychosocial consequences of the abuse and may explain the difficulty and delay in detect and disclose these cases. Few cases were legally prosecuted and convicted.     

Retropharyngeal Hematoma Secondary to Cervical Spine Surgery: Report of One Fatal Case

A 53‐year‐old woman suffering from radicular pain due to cervical herniation underwent a spinal surgery consisting of anterior cervical discectomy and fusion with an implantable titanium cage. Five hours after the procedure, the patient developed cervical swelling and dyspnea. An emergency surgery permitted evacuation of a deep cervical hematoma and intubation of the patient, who died some minutes later. The family of the deceased lodged a complaint with the public prosecutor because of unclear circumstances of death. After analysis of the medical records by two forensic pathologists, a medicolegal autopsy was ordered. Massive retropharyngeal and mediastinal hematomas were diagnosed. Pathological study confirmed acute cervical hemorrhage, but failed to detect the source of bleeding. The forensic pathologists concluded that death was due to mechanical asphyxia secondary to pharyngeal compression by the cervical hematoma. To the best of our knowledge, death secondary to retropharyngeal hematoma in this neurosurgical context is rarely encountered.     

医疗机构大型化和医疗服务市场化对公立医院改革的启示

医疗机构的大型化和医疗服务的市场化对公立医院来说,除了带来严峻的考验也提供了改革的借鉴。医疗机构整合的发展模式为公立医院提供了一个新的改革模式参考,公立医院如何发挥"团结力量大"的优势,利用不同医院间的专业和特长采取联盟的优势,发挥规模经济效益,将改革效益回馈到医院的医疗服务和管理机制,形成公立医院治理的良好循环,值得期待。