La donación de órganos y el veto familiar. Razones bioéticas para un cambio / Organ donation and family refusal. Bioethical reasons for a change

Cases of next-of-kin veto, i.e., a family refusal to allow organs harvest contrary to donor wishes or when the law presumes consent, is a widespread practice that seriously harms thousands of people. This is a practice settled in many countries Family refusal to donate reduces an already shallow donor pool by approximately 43% in the Americas, 25% in Europe (37,3% in United Kingdom) and 54% in Asia. Some countries, such Argentina, France, Colombia and Wales, current reversed its policy on organ donations to a system that prevents next of kin to dishonoring the donor's wishes restricting the confirm donor status only with the National Donor Registry and unless evidence of their objection is produced. In part I we review the latest amended transplant legislation of those countries that are trying to change this scenario. In part II we question the most frequently cited arguments to uphold the next-of-kin veto right and the countries that successfully changed their legislation banning this practice to encourage organ donation. We conclude that it is imperative to change this practice because the harm caused by promoting the family veto is greater and more serious than the potential harm of not allowing it

Los casos de veto familiar a la donación de órganos es una práctica generalizada que perjudica seriamente a miles de personas. Esta es una práctica establecida en muchos países. La negativa de la familia a donar reduce en un 43% las donaciones bajas de los donantes en las Américas, un 25% en Europa (37,3% en el Reino Unido) y un 54% en Asia. Algunos países como Argentina, Francia, Colombia y Gales han intentado revertir su política de donación de órganos de modo de impedir que los parientes revoquen los deseos del donante. En la primera parte, revisamos las más recientes reformas legislativas de aquellos países que están tratando de cambiar este escenario. En la segunda parte cuestionamos los argumentos más citados para defender el derecho de veto de la familia. Concluimos que es imperativo cambiar esta práctica porque el daño causado por el veto familiar es mayor y más grave que el daño potencial de no permitirlo

Prospects on the Value Ethics Survey and Future Value Orientation at the Current Stage of Medical Reform in China / 中国卫生经济

Based on the theory of value and value ethics,there were 3 aspects problems as following at the present stage of the health care system reform:paying more attention on the quantity of inpatient services rather than the quality of medical services,taking hospital as the center instead of the close cooperation of various sanitary institutions and inappropriate incentive mechanism.It considered that the next step of the health care system reform of China should make efforts to achieve 3 value goals:to improve people's health level,provide high-quality medical services and service experience and affordable health care costs.To achieve these value goals,it proposed suggestions from five aspects:providing integration services,transforming the functional localization of hospitals,changing the incentive mechanism,improving the medical service quality continually and enhancing the participation of the public.

Evaluation of medical efficiency before and after Sanming healthcare reform / 中华医院管理杂志

Objective To evaluate the medical efficiency of sample hospitals in Sanming city before and after Sanming health care reform.Methods One tertiary hospital,two general county hospitals and two TCM county hospitals in Sanming were sampled for the study.Two dimensions(the intensity index of medical work and work efficiency index)were selected.In addition,six indexes were identified,namely the number of discharged patients,number of outpatients and emergency diagnostics,doctor′s daily workload per capita for inpatients,bed turnover times,bed utilization rate and average days of stay.Descriptive trend analysis and comprehensive index method were applied in turn to evaluate the longitudinal changes in medical efficiency at the sample hospitals before and after the medical reform.Results The five sample hospitals in Sanming were found with less days of stay in average,and three were found with year-by-year rise of medical efficiency index,with one of them rising from 1.57 to 2.42.Conclusions Sanming′s health care reform has effectively improved internal operational efficiency at the sample hospitals,and has well addressed the relationship of medical service efficiency and scale expansion.On the other hand,the relationship between work intensity and medical efficiency needs to be further balanced,resource allocation to be further optimized,and more priority to be put in the development of TCM hospitals.

Analysis of U.S.military health system reform / 军事医学

To curb the increase in health care costs and improve government efficiency , a series of structural and governance reforms for U.S.Military Health System(MHS) were implemented, which is the biggest structural organizational change in the MHS′s history.The reform focusing on the establishment of Defense Health Agency ( DHA) and enhancement of multi-service markets will achieve its goal by the end of 2015.This paper analyzes the major reasons for the reform and changes of the U.S.MHS before and after the reform and offer some tips for the reform of the Chinese Military Health System .

Practicality and Interdependence of Essential Drug System,Primary Health Care and Rational Drug Use System / 中国药房

OBJECTIVE: Description the practice and interdependence of essential drug system, primary heath care and rational medicine use. The authors further emphasize the necessity of carry out essential drug system and rational medicine use simutaneously, provide a reference for the country’s new medical reform. METHODS: According to the defined connoctation of essential drug system and primary health care by the government and cited with the WHO idea, combined with lessons learned from past unsuccessful health care reform,introduced current drug research and evaluation index system, analyzed the practice and interdependence of essential drug system, primary heath care and rational medicine use. RESULTS & CONCLUSION: Now, in the crucial time of launching new health care reform, we must attach important to the WHO experience of promoting essential drug system, primary health care and rational medicine use as a whole and equally emphasize them, especially to promote essential drug system and rational medicine use concurrently.

Seizing of Opportunities for Meeting Challenges ——Opinions about Clinical Medical Engineering's Development / 医疗卫生装备

Objective To explore the ways of accelerating development of clinical medical engineering at the stage. Methods According to the review and analysis of development course of domestic clinical medical engineering, its restraining factors during the development were understood, the development strategies and means which to promote our country clinical engineering were sought. Results Various policy information and medical dynamic trends can be indicated that the development conditions of Chinese clinical medical engineering were undergoing a marked improvement and opportunities for the development had come. Conclusion Both opportunities and challenges, clinical medical engineers can be established their own beliefs, discipline construction, expansion of discipline connotation, striving for the support of hospital managers and other aspects to promote the development of clinical engineering disciplines.