Discussion on the Practicality of Strengthening Clinical Medical Ethics Education / 中国医学伦理学

To realize the education and training program of excellent doctors in China and meet the ethical requirements of clinical practice, it is crucial to carry out clinical medical ethics education for medical staff. Clinical medical ethics education is an important component of medical education and a necessary and important way for doctors to practice medical professional ethics. Starting from the concept of clinical medical ethics, this paper discussed the meaning, objectives, and content of clinical medical ethics education, and then distinguished its substantive differences from existing medical ethics education, which were manifested in clinical practice ability, situational embodiment, and action standardization. Furthermore, by summarizing and analyzing the current situation of clinical medical ethics education, it was found that it has shown its shortcomings in insufficient practicality. Finally, based on sorting out the previous countermeasures, this paper proposed strategies to strengthen the practicality of clinical medical ethics education, including adopting the integration approach of "time-space-teacher" and establishing a three-level responsibility system of "government-institution-teacher".

Study on Vulnerability of Children in Talent Genetic Testing / 中国医学伦理学

Vulnerability is an inherent and ineradicable reality, and different contexts can exacerbate or induce different manifestations of vulnerability. By sorting out the meaning of vulnerability and identifying particular manifestations and attributions of children’ vulnerability in talent genetic testing situations, including the inherent vulnerability of children themselves, the situational vulnerability derived from talent genetic testing and educational environment, as well as the pathogenic vulnerability from the protection of minors. It was proposed that talent genetic testing of children should be guided by the principles of responsibility, no harm, and permission, so as to protect children from additional harm during testing and avoid exacerbating their vulnerability.

Study on the Theory and Practical Problem of "Patient Participation" in Clinical Decision Making / 中国医学伦理学

As patient autonomy is increasingly valued and respected in clinic,"patient participation" in clinical decision making has been gradually concerned, while it has been also questioned. Through reviewing the history of the concept of "patient participation", this paper expounded the meaning of "patient participation" in clinical decision making and its theoretical and practical significance from the perspective of deontology and utility theory. On this basis, this paper discussed the main practical ethical issues of"patient participation" faced in our country, including the ability and role of patient participation in clinical decision making, the challenge of"families involvement" in clinical decision making to "patient participation", to solve people' s doubts about the practical application of "patient participation" in clinical decision making.

Moderating Effect of Clinical Ethics Consultation on Doctor-patient Relationship / 中国医学伦理学

The differences of feelings and views of disease and logical thinking between doctor and patient lead to differences in values which might result in doctor-patient conflicts,and clinical ethics consultation ease the differences in values or moral conflict between doctors and patients using ethical adjustment function.Compared with the present mediation mechanism of doctor-patient relationship in China,clinical ethics consultation has the characteristics of preventing the doctor-patient conflict or dispute,multi-disciplinary experts' consultation and coping with the doctor-patient contradiction of value-laden.Although clinical ethics consultation has theoretical significance and practical value,it still faces the theoretical challenge of moral relativism,and the practical prob-lems such as competence of ethical committee,consultation effect and support system.

Considerations on Ethical Issues of Clinical Research Based on Case Study / 中国医学伦理学

In recent years , with dramatic increase of the number of clinical studies , researchers and ethical committees face with the new challenge of ethical issues about protection of subjects .Based on the experience of previous ethical review , this article summed up a few typical cases of clinical research , involving the practical ethi-cal issues, such as the goal of research , informed consent, and compensation for damage caused by research .And then it analyzed the ethical issues in these cases , and proposed some suggestions for the reference of clinical re-searchers , ethical committees and policy makers .

Physician-patient trust as seen in medical ethics / 中华医院管理杂志

As a heteronomy,the code of medical ethics plays an important role in sustaining the trust between physicians and patients.Based on a comparative analysis of the domestic and foreign codes of medical ethics,and field survey on such trust at tertiary hospitals in Beijing,as well as medical providers’moral characteristics,this article analyzed the causes that “goodwill”is insufficient in the trust in terms of internal and external factors;and then,in respect of heteronomy as a basis,it put forward suggestions to improve code of medical ethics in order to rebuild such trust.

Ethical Considerations about the Cases of Commercial Genetic Testing in Obstetric Practice / 中国医学伦理学

Two cases, prenatal genetic testing for deafness and newborn genetic testing for diseases and talent, were firstly introduced. And then, the author analyzed the ethical issues in these cases, such as question about ge-netic testing technologies, freedom of genetic testing in clinical obstetrics, role of obstetricians in genetic testing, problems about informed consent, and harms to doctor-patient relationship, and so forth. Finally, it put forward some suggestions on commercial genetic testing in obstetric practice.

Considerations on Ethical Issues of Clinical Decision Based on Case Study / 中国医学伦理学

This article selected several typical clinical cases, analyzed many factors affect the doctor-patient relationship of ethical issues and new technology of differentiating the ethical dilemma for clinical application, and put forward some suggestions for the reference of medical staff , hospital ethics committees and health policy makers.

Analysis of the impact of cognitive difference on doctor-patient relationship / 中华医院管理杂志

In order to study the the impact of cognitive difference between doctors and patients on doctor-patient relationship, five tertiary hospitals in city B were investigated with questionnaire and quantitative interviews, and the outcomes were analyzed with SPSS16. 0 software. Cognitive differences were found in the nature of the relationship, the main part of responsibility for the relationship, and principles for communication between the parties. By analyzing the causes of the difference and their impact on the relationship, it draw the conclusion that this cognitive difference found between the two parties functions as a key to the conflicts between doctors and patients. Return of health care back to non-profit nature, encouragement of patient-doctor communication and mutual understanding will be conducive to minimizing such a cognitive difference, and building a harmonious doctor-patient relationship.

Expressions of matrix metalloproteinase-9,IV collagen and CD34 in epithelial ovarian tumor and its significance / 中国医师进修杂志

Objective To explore the expression and significance of matrix metalloproteinase (MMP)-9, IV collagen and CD34 in epithelial ovarian tumor. Methods Eighty-two patients with epithelial ovarian tumor, among them,there were 48 malignant epithelial ovarian carcinomas, 23 borderline epithelial ovarian tumors and 11 benign epithelial ovarian tumors. The expression of MMP-9, IV collagen and CD34 were detected by immunohistochemistry. Results The expression of MMP-9 was strongly linked to the degree of malignant ovarian carcinomas (F= 39.306,P< 0.01). The expression of CD34 was also strongly linked to the degree of malignant ovarian carcinomas [benign epithelial ovarian tumors was (17.18±5.64)%,borderline epithelial ovarian tumors was (29.76±7.18)%,well-differentiated malignant epithelial ovarian carcinomas was (57.20±8.55)%,moderately-differentiated malignant epithelial ovarian carcinomas was (71.20±8.48)%, poorly-differentiated malignant epithelial ovarian carcinomas was(90.38±20.03)%](F= 100.072, P < 0.01). The expression of IV collagen in malignant epithelial ovarian carcinomas was different from that in borderline epithelial ovarian tumors and benign epithelial ovarian tumors (F = 11.554,P<0.0l). The expression of MMP-9 was positive correlation with the loss expression of IV collagen and the expression of CD34 (r=0.796,0.802,P< 0.01).Conclusions The positive expression of MMP-9,CD34 and the negative expression of IV collagen are obviously relevant to degree of malignant ovarian carcinomas.The combined testing on expression of MMP-9,CD34, IV collagen on ovarian carcinomas is significant to decide degree of malignant ovarian carcinomas and evaluate future development.

Study on the management factors and countermeasures for doctor-patient Relationship / 中华医院管理杂志

y of care,in an effort to build a better doctor-patient relationship.

Endometrial Carcinoma(EC) Accompanied with Multiple Primary Malignancy / 中山大学学报(医学科学版)

【Objective】 To study the incidence, possible etiology, diagnosis and prognosis of endometrial carcinoma with multiple primary carcinom a. 【Method】 45 cases of EC with other primary tumors were eligible for the ret rospective study. 【Results】 Of 1389 cases with EC, the rate of EC accompanied wit h other primary carcinoma was 3.2% (45/1389); the interval between two tumors d iagnosed was ranged from 8 months to 19 years. The percentage of interval more t han 5 years accounted for 62% (16/26). Among these 45 patients, the percentage o f EC complicated by other reproductive tract tumor was 53%(24/45), of them, 19 were synchronous carcinoma. The rate of EC with breast cancer and colo-rectal carcinoma were 169%(7/45), and 11%(5/45) respectively. Clinical staging for pati ents with EC plus multiple primary malignancy were 30 with stage Ⅰ, 9 stage Ⅱ, 3 stage Ⅲ and 2 stage Ⅳ. All patients with first primary tumors were treated by radical treatment. While 8 cases were also treated by radiation and 6 cases t reated by chemotherapy. In this group, all multiple primary tumors were treated by radical therapy. The overall 5-year survival rate was 63%. 【Conclusions】 ①The possibility of second primary tumor, such as female reproductive tract tu mor , breast cancer, and colo-rectal carcinoma should be considered in the patients with EC. ②The etiology of EC with multiple primary tumor may be relevant to th e same embryonic histogenesis, estrogen receptor, radiotherapy and chemotherapy.

Detection of hMSH2 gene mutations in gynecologic tumor population by multiple PCR-SSCP / 中国癌症杂志

Purpose:To set up a new method to screen hMSH2 gene mutations, to detect hMSH2 gene mutations in gynecologic tumor population and to find molecular biomarkers of tumor. Methods:The basic data and blood samples from 42 gynecologic tumor patients werre collected. The genetic mutations of the sixth exon and seventh exon of hMSH2 gene were investigated by multiple polymerase chain reaction single strand conformation polymorphism (PCR SSCP),followed by DNA sequencing. Results:The successes in setting up the multiple PCR SSCP method made it possible to detect hMSH2 gene mutations more quickly and more economically. Two samples of the seventh exon mutation was detected in the tumor population. The mutation is Leu→Phe missense mutation. No mutation of the sixth exon was detected by SSCP.Conclusions:The multiple PCR SSCP method is effective in detecting genetic mutations. There is a mutation site in the seventh exon of hMSH2 gene. It is probably a biomarker of gynecologic tumor. This discovery might offer the basis for further investigation of mutations in large amount population and studies of the function of the mutation.

Media Factors Affecting Current Physician-Patient Relationship and Countermeasure Research / 中国医学伦理学

Various reasons are responsible for the current tension and conflicts in physician-patient relationship,in which media factors contribute a lot.It is of great significance for promoting the construction of a harmonious society and soothing physician-patient conflicts to conduct research on media factors affecting current physician-patient relationship and seek for relevant countermeasures.

Physician-Patient Relationship from the Viewpoints of Medical Staff and Patients / 中国医学伦理学

Objective:In investigate the status quo of current physician-patient relationship.Method:A self-designed questionnaire is conducted among the medical staff and patients in 40 hospitals(20 grade 3 hospitals and 20 grade 2 hospitals) located in 10 cities of China.Result:9.3% of the total patient responders consider the current physician-patient relationship dissatisfying,with a counterpart ratio of 31.2% in responders of medical staff.Conclusion:Currently in China,main-stream of physician-patient relationship is harmonious,but it can not be denied that medical staff are suffering tremendous stress from the ever tenser physician-patient contradictions.

Research on Factors and Countermeasure of Doctor-Patient Relationship in View of Hospital and Staff / 中国医学伦理学

It is shown by the typical investigation on the status of doctor-patient relationship in ten cities of China that doctor-patient relationship is generally harmony and relative better,and it is affected by many important factors including governmental policy,hospital and staff,and patient aspects,so it is injustice for hospital and staff to be excessively criticized.This article mainly analyzes the factors of hospital and staff and advances the corresponding countermeasure.

Ethical Discussion on Trust between Doctors and Patients on the Basis of Investigation of Doctor-Patient Relationship / 中国医学伦理学

On the basis of the investigation of the status of doctor-patient relationship in ten cities of China,this article ethically analyzes and studies the situation of trust between doctors and patients,clarifies the lack of trust inevitable and the environmental factors of trust,and puts forward the corresponding proposal.