Cesárea a solicitud materna

La cesárea es una intervención que salva vidas y que tiene indicaciones médicas. La cesárea está clínicamente indicada cuando existe un riesgo significativo de consecuencias adversas para la gestante o el feto. Sin embargo, en los últimos años se han presentado indicaciones no médicas para la cesárea, como es la cesárea por solicitud materna. Se hace una revisión no sistemática sobre la cesárea a solicitud materna. El parto por cesárea a solicitud de la madre en comparación con el parto vaginal planificado es un tema multifacético y complejo, los datos son mínimos y en su mayoría se basan en comparaciones indirectas, desconociéndose sus implicaciones para las mujeres en edad fértil, los profesionales de la salud y la sociedad. Para los médicos, practicar una cesárea por razones no médicas es una decisión profesional, cuya ética se está debatiendo sin pruebas suficientes sobre los riesgos y los beneficios.

Cesarean section is a life-saving intervention with medical indications. Cesarean section is clinically indicated when there is a significant risk of adverse consequences for the pregnant woman or the fetus. However, in recent years non-medical indications for cesarean section such as cesarean section by maternal request have emerged. This is a non-systematic review of cesarean section at maternal request. Cesarean delivery at mother's request compared to planned vaginal delivery is a multifaceted and complex issue, the data are minimal and mostly based on indirect comparisons, and its implications for women of childbearing age. health professionals and society are unknown. For physicians, performing cesarean section for non-medical reasons is a professional decision, the ethics of which is being debated without sufficient evidence on the risks and benefits.

Módulo Medios diagnósticos para el Sistema de Información Hospitalaria XAVIA HIS / Diagnostic Means Module for the XAVIA HIS Hospital Information System

El Sistema de Información Hospitalaria XAVIA HIS desarrollado por el Centro de Informática Médica (CESIM) está compuesto por módulos que aseguran la informatización de los procesos de las áreas de la institución hospitalaria. En la actualidad la gestión de los principales medios de diagnóstico se realiza de forma dispersa en diferentes módulos o sistemas. En este trabajo se presenta el módulo de Medios de Diagnóstico, desarrollo que permite la gestión de informes de solicitudes y resultados de forma configurable, así como la planificación de horarios y gestión de citas. Se analizó el proceso de negocio asociado a la gestión de información de medios de diagnóstico, se realizó un estudio de sistemas existentes con propósitos similares y se evaluaron tecnologías para su implementación. Se utilizó AUP-UCI como metodología de desarrollo, Java como lenguaje de programación y otras tecnologías libres y multiplataforma. El patrón arquitectónico implementado fue modelo-vista-controlador. El módulo de Medios de Diagnóstico del sistema XAVIA HIS, permite el soporte de los procesos de atención al paciente y la integración de la información sobre los medios de diagnóstico, además fomenta un aumento en la calidad del servicio. El módulo facilita la configuración de aspectos de solicitud e informe de las pruebas diagnósticas y la planificación de horarios y citas(AU)

Hospital Information System XAVIA HIS developed by the Medical Informatics Center (CESIM) is made up of modules that ensure the computerization of hospital institution areas processes. Currently, the management of the main diagnostic means is realized in a dispersed way in different modules or systems. This paper presents the Diagnostic Means module, development that allows the requests and results reports management in a configurable way, as well as the schedules planning and appointments management. The business process associated with the diagnostic means information management was analyzed, an existing systems study with similar purposes was carried out, and technologies for their implementation were evaluated. AUP-UCI were used as development methodology, Java as programming language and other free and multiplatform technologies. The architectural pattern implemented was model-view-controller. The XAVIA HIS system Diagnostic Means module, allows the patient care processes support and integration of information regarding diagnostic means, also encourages an increase in the service quality. The module facilitates the request and report aspects configuration of the diagnostic tests and the schedules and appointments planning(AU)

Requerimento administrativo prévio e judicialização da saúde pública: uma análise do requisito e de suas exceções / Prior administrative request and judicialization of public health: An analysis of the requirement and its exceptions / Prior administrative request and judicialization of public health: An analysis of the requirement and its exceptions

O estudo analisou em que medida o requerimento administrativo prévio deve condicionar o acesso à justiça em demandas sobre saúde pública. Inicialmente, adotou-se o método dedutivo para, a partir da concepção de princípios presente na teoria dos direitos fundamentais de Robert Alexy, investigar a possibilidade de exigência desse pressuposto processual no contexto de colisão entre os princípios do acesso à justiça e os do devido processo legal instaurada para a proteção do direito fundamental à saúde. Em seguida, por meio do método indutivo, analisaram-se os fundamentos do julgamento do Supremo Tribunal Federal que condicionara o ajuizamento de ações previdenciárias ao requerimento administrativo prévio a fim de identificar se, consideradas as semelhanças e diferenças, essas razões seriam também aplicáveis, e em que medida, às demandas em matéria de saúde pública. Após, expuseram-se contribuições da adoção do prévio requerimento administrativo como requisito ao processamento de ações judiciais sobre saúde pública para o aprimoramento qualitativo da política pública sanitária, bem como para a prestação jurisdicional e a resolução adequada de conflitos nesse campo. Ao final, investigaram-se os limites e exceções a serem observados quanto à exigência de prévio requerimento administrativo em ações sobre saúde pública, com base na fundamentalidade do direito à saúde e nos parâmetros que vêm sendo consolidados na jurisprudência dos tribunais superiores, nos enunciados das Jornadas de Direito da Saúde e na literatura especializada.

The study analyzed to what extent the prior administrative request should condition the access to justice in public health demands. Initially, the deductive method was adopted, based on the concept of principles present in Robert Alexy's theory of fundamental rights, to investigate the possibility of requiring this procedural assumption in the context of the collision between the principles of access to justice and due process of law established for the protection of the fundamental right to health. Then, through the inductive method, we analyzed the fundamentals of Supreme Court judgment that conditioned the filing of social security lawsuits to the prior administrative request in order to identify whether, considered as similarities and differences, these possible reasons would also be applicable, and to what extent, to the demands in terms of public health. Afterwards, the contributions of the adoption of the prior administrative request as a requirement for processing lawsuits on public health for the qualitative improvement of public health policy were exposed, as well as for the provision of jurisdiction and the appropriate resolution of conflicts in this field. At the end, the limits and exceptions to be observed regarding the requirement of prior administrative request in public health lawsuits were investigated, based on the fundamentals of the right to health and on the parameters that have been consolidated in the jurisprudence of the higher courts, in the statements of the Health Law Conferences and in the specialized literature.

A root cause analysis of increasing caesarean section rates in a tertiary care private hospital in North India

Background: Increase in the incidence of caesarean section is a matter of concern worldwide. Robson’s criteria which is universally accepted now as a way for calculating caesarean rates takes into account only the obstetrical consideration, however, it is noteworthy that many socioeconomic and cultural factors also have a role to play. This study takes into account both Robson’s criteria and common socio-cultural factors which lead to increased caesarean rates with an attempt to suggest ways to curtail this trend.Methods: The study was a hospital based cross-sectional study at a private tertiary care hospital in New Delhi. 1200 consecutive live births after 34 weeks of gestation were analysed over a period of one year.Results: LSCS was the most common mode of delivery 733 (61.1%). 329 (27.4%) had induced labour of which 260 (76.2%) had LSCS. 333 women had elective LSCS. Rates of CDMR were 185 (25.2%) which is very significant. As per Robson’s criteria maximum number of women (318) were in group 2, of which 226 (71.1%) underwent caesarean section.Conclusions: High caesarean rates can be attributed to a multitude of factors. Robson’s criteria are an effective way for analysis of obstetric indications. Other added factors include comorbidities, CDMR, fear of litigations, etc which were analysed.

Evaluation of laboratory request forms submitted to clinical pathology department in tertiary health care hospital

Background: Laboratory diagnostics is the fast-growing field which contributes 70% of clinical diagnosis. Laboratory information has a profound impact on patient diagnosis. Research has demonstrated most of the laboratory errors occur in the pre-analytical phase. Incorrect and incomplete filling of information on the laboratory request forms can significantly impact the quality of laboratory results, and it affects patient outcome and resources. We, therefore, evaluated the extent of incomplete laboratory forms in our center.Methods: The study was a retrospective study conducted on all request forms received over 1 month from June 15, 2018, to July 15, 2018, in the Clinical Pathology Department of ESI hospital, Coimbatore, during working hours were analyzed for the frequency of incomplete data.Results: Only the patient’s name appeared in all the forms. Consultant in charge of requesting laboratory tests (99%) was the most omitted parameter. No clinical details or location/ward details of the patient was provided in 90.7% and 7% of the cases. Age and gender did not appear in 21.9% and 22%, respectively. Date of request, doctor’s signature, and hospital number were missing on 8.4%, 27.6%, and 4.4%, respectively.Conclusions: The study has demonstrated the level completion of laboratory request forms was suboptimal. This may be responsible for many pre-analytical errors. There should be closer interaction between clinicians and laboratory physician to improve the quality of laboratory services and resource management.

Medication and test prescription by nurses: contributions to advanced practice and transformation of care / Prescrição de medicamentos e exames por enfermeiros: contribuições à prática avançada e transformação do cuidado / Prescripción de medicamentos y exámenes por enfermeros: contribuciones a la práctica avanzada y transformación del cuidado

ABSTRACT Objective: To carry out a documentary study on the rules, guidelines, policies and institutional support for the nurse to prescribe medicines and request tests with a view to the advanced practice in the scope of Primary Health Care. Methods: Documentary research using open-access institutional documents - Federal Nursing Council (COFEN), its regional representations in the respective Brazilian states (COREN) and the Brazilian Nursing Association (ABEN). Results: Most of the news/notices were issued by the Regional Nursing Councils in the different Federative Units. The argumentation regarding the prescription of medicines and request for tests by nurses is based on three categories: Autonomy and competencies for the prescription of medicines and/or request of tests; Corporate policies that undermine the full exercise of nursing; and Transformation of health and nursing care in Primary Health Care. Conclusion: The prescriptive practice by nurses integrates health care and has been defended by the institutions that represent the category. It emerges as an important element of advanced practice and in the transformation of care in the context of health teams.

RESUMO Objetivo: realizar um estudo documental sobre as normativas, diretrizes, políticas e respaldo institucional do enfermeiro para a prescrição de medicamentos e solicitação de exames com vistas à prática avançada no âmbito da Atenção Primária à Saúde. Métodos: pesquisa documental utilizando-se de documentos de autoria institucional - Conselho Federal de Enfermagem (COFEN), suas representações regionais nos respectivos estados do Brasil (COREN) e Associação Brasileira de Enfermagem (ABEN), de acesso aberto. Resultados: a maioria das notícias/notas foi veiculada pelos Conselhos Regionais de Enfermagem nas distintas Unidades Federadas. A argumentação de convencimento das entidades representativas a respeito da prescrição de medicamentos e solicitação de exames por enfermeiros sustenta-se em três categorias: A autonomia e competências para a prescrição de medicamentos e ou solicitação de exames; Políticas corporativas que prejudicam o exercício da enfermagem de forma plena; e A transformação do cuidado em saúde e da enfermagem no âmbito da Atenção Primária à Saúde. Conclusão: a prática prescritiva do enfermeiro integra o cuidado em saúde e vem sendo defendida pelas entidades representativas da categoria. A prescrição de medicamentos por enfermeiros na Atenção Primária à Saúde (APS) desponta como importante elemento da prática avançada e na transformação do cuidado no contexto das equipes de saúde.

RESUMEN Objetivo: realizar un estudio documental sobre las normativas, directrices, políticas y respaldo institucional del enfermero para la prescripción de medicamentos y solicitación de exámenes buscando la práctica avanzada en el ámbito de Atención Primaria a la Salud. Métodos: investigación documental que utiliza documentos de autoría institucional - Conselho Federal de Enfermagem (COFEN), sus representaciones regionales en los respectivos estados de Brasil (COREN) y Associação Brasileira de Enfermagem (ABEN), de accesso abierto. Resultados: la mayoría de las noticias/notas fue vehiculada por los Consejos Regionales de Enfermería en las distintas Unidades Federadas. El argumento de convencimiento de las entidades representativas con respecto a la prescripción de medicamentos y solicitación de exámenes por enfermeros se sustentan en tres categorías: La autonomía y competencias para la prescripción de medicamentos y/o solicitación de exámenes; Políticas corporativas que perjudican el ejercicio de la enfermería de forma plena y La transformación del cuidado en salud y de la enfermería en el ámbito de la Atención Primaria a la Salud. Conclusión: la práctica prescriptiva del enfermero integra el cuidado en salud y viene siendo defendida por las entidades representativas de la categoría. La prescripción de medicamentos por enfermeros en la Atención Primaria a la Salud (APS) despunta como importante elemento de la práctica avanzada y en la transformación del cuidado en el contexto de los equipos de salud.

Study for Lists of Forensic Autopsy Request: Quantitative Analysis about Documents Relating to Autopsy Request / 대한법의학회지

In the Republic of Korea, relevant documents are submitted to forensic doctors or agencies when courts grant confiscation warrants for autopsy. If the essential data on unusual death are not submitted at the time of the autopsy, it may be difficult to properly understand the situation relating to an unusual death prior to the autopsy, thus reducing the accuracy of the autopsy. As many as 6,133 out of 6,610 autopsy data (92.8%) in the Republic of Korea in 2015 were analyzed. Most autopsy appraisal requests (99.8%) were submitted. Unusual death occurrence reports (86.0%) and command recommendations of unusual death (70.3%) were submitted in many cases. However, prosecutor commands on unusual death were submitted only in 27.8% cases, and confiscation warrants were not submitted in 7.4% cases. As for postmortem inspection and death scene investigation reports, 29.3% and 34.1% cases were submitted, respectively. In addition to the above two documents, death certificates and records of statement of a relative had significant regional variations (0.3%–80.1%, 3.1%–64.7%, 27.8%–81.3%, and 40.8%–96.8%, respectively). For postmortem inspection and death scene photos, 2.7% and 3.2% were submitted in black-and-white photographs, respectively. The authors propose a list of forensic autopsy requests including autopsy appraisal requests, unusual death occurrence reports, command recommendations of unusual deaths, prosecutor commands on unusual death, and confiscation warrants unconditionally, as an essential document reflecting the progress of investigations. We suggest that postmortem inspection reports and photos, death scene investigation reports and photos, and death certificates should be included as part of postmortem investigation data.

Profile of publications about functional foods in Brazilian journals: a scientometric analysis from 2000 to 2015 and an overview of Brazilian legislation / Perfil de publicações sobre alimentos funcionais em revistas brasileiras: uma análise cienciométrica de 2000 a 2015 e uma visão geral da legislação brasileira

Functional foods have been highlighted by having, in addition to nutritional characteristics, the possibility of preventing risk and/or delaying the development of several non-communicable diseases (NCDs). In the last decade, many articles related to functional food have been published worldwide, and there is a need to understand how the theme is reflected in national journals. The present research aimed to collect information about publications covering the topic of functional foods in journals, synthesizing these data and interpreting them, evaluating the profile of the authors and a frequency of the articles involved with the subject by scientific journal and by State/region. Subsequently, they were evaluated as the most studied foods and as more used methodologies, besides a small discussion about the advances of the Brazilian legislation on the subject. Between 2000 and 2015, 118 articles were selected in 62 educational institutions from 18 Brazilian states. The South (44%) and Southeast (34%) regions were the ones that published more, having Rio Grande do Sul the largest representation (24%). The journal with the largest publication was Food and Nutrition and the authors' academic formation was diverse (29 areas in total), in particular Food Technology (21%), Nutrition (18%) and Food Engineering (13%). The Brazilian legislation is in development and has a good perspective to include new foods/ingredients with functional property.

Os alimentos funcionais destacam- se por possuírem, além de características nutricionais, a possibilidade de reduzirem o risco e/ou retardar o desenvolvimento de várias doenças não transmissíveis. Na última década, muitos artigos relacionados às propriedades funcionais de alimentos têm sido publicados mundialmente, havendo a necessidade de entender como o tema se reflete nos periódicos nacionais. O presente trabalho procurou coletar informações sobre as publicações, abrangendo o tema alimentos funcionais em periódicos nacionais, sintetizando esses dados e interpretando-os, avaliando o perfil dos autores e a frequência dos artigos envolvidos com o tema por revista científica e por Estado/região. Posteriormente, foram determinados quais os alimentos mais estudados e quais as metodologias mais empregadas, além de ter sido realizada uma pequena discussão sobre os avanços da legislação brasileira sobre o tema. Entre os anos 2000 e 2015 foram selecionados 118 artigos, em 62 instituições de ensino de 18 Estados brasileiros. As regiões sul (44%) e sudeste (34%) foram as que mais publicaram, tendo o Rio Grande do Sul a maior representação (24%). A revista com maior publicação foi a Alimentos e Nutrição e a formação dos autores era diversa (29 áreas no total), em especial Tecnologia de Alimentos (21%), Nutrição (18%) e Engenharia de Alimentos (13%).

RADIOLOGY REQUEST FORMS (RRF) INADEQUATELY COMPLETED; THE CASE OF A TERTIARY HEALTH CENTER IN NORTHWEST NIGERIA

Background: The need and importance of adequately completing radiology request forms cannot be over emphasized. Thus, this study investigated the pattern in which radiology request forms are completed by clinicians in a tertiary health center.Methods: A total of two hundred and fourteen (214) samples of request forms were randomly selected from records of the Radiology Department of the Federal Medical Center, BirninKebbi, Nigeria. The request forms comprises of requests from various departments within the hospital. All the data collected from the request forms where entered into Microsoft excel and items/fields on the form were examined.Results: From this study, it was observed that out of the total 214 forms collected, 209 (97.7%) of the forms were not adequately completed with only 5 (2.3%) fully completed. Other items on the request form that were also least completed were the referring physicians name (2.3%), patients’ full address (2.3%) and patients age (62.6%).Conclusion: We conclude that radiology request forms are inadequately completed as seen from the present study, thus the need to enlighten the referring physicians on the need to adequately and properly complete radiology request forms as this is vital in improving the accuracy of radiologists report / interpretation.

Frecuencia de solicitud y prevalencia de reactividad de la prueba no treponémica (VDRL) en pacientes con aborto en el Hospital Local del Norte de Bucaramanga, Colombia / Frequency of nontreponemal testing (VDRL) and prevalence of test reactivity in patients with miscarriage at Hospital Local del Norte in Bucaramanga, Colombia

Introducción: la adherencia a las recomendaciones para la tamización de sífilis en mujeres gestantes es fundamental en la prevención de lúes congénita. El objetivo de este estudio fue estimar la frecuencia de solicitud de prueba no treponémica y reactividad en mujeres que cursan con aborto.Materiales y métodos: estudio de corte transversal basado en el registro de pacientes que atendieron a la consulta de urgencias de obstetricia del Hospital Local del Norte de Bucaramanga entre enero 1º y diciembre 31 de 2011, y que tuvieron un diagnóstico de aborto. En estas pacientes se determinó la prevalencia de solicitud de la prueba no treponémica (VDRL), así como de resultados reactivos.Resultados: en el periodo de estudio se identificaron 233 mujeres con diagnóstico confirmado de aborto. La edad promedio fue de 24,2 ± 7,3 años, con una edad gestacional de 9,1 ± 3,3 semanas. Se documentó evidencia de solicitud de prueba no treponémica en 135 pacientes (57,9%; IC 95%: 51,6-64,3) de las cuales 5 (3,7%; IC 95%: 0,5-6,9) tuvieron resultados reactivos: 1 con títulos de 1:2; 3 con títulos de 1:4, y 1 con títulos de 1:32.Conclusión: pese a las recomendaciones vigentes, la prevalencia de solicitud de prueba no treponémica en pacientes con aborto es baja. Lo anterior evidencia la necesidad de concientizar al personal de salud acerca de la importancia de cumplir a cabalidad el protocolo de atención a la gestante.

Introduction: Adherence to the recommendations for syphilis screening in pregnant women is critical for congenital syphilis prevention. The objective of this study was to estimate the frequency of nontreponemal test orders and prevalence of test reactivity in women with miscarriage.Materials and methods: Cross-sectional study based on the registry of patients coming to the obstetrical emergency service at Hospital Local del Norte, Bucaramanga, between January 1st and December 31st, 2011, diagnosed with miscarriage. The prevalence of nontreponemal testing (VDRL) orders as well as of reactive results was assessed in these patients.Results: During the study period, 233 women were identified to have a confirmed miscarriage. The mean age was 24.2 ± 7.3 and the mean gestational age was 9.1 ± 3.3 weeks. Evidence for nontreponemal test orders was documented in 135 patients (57.9%; CI 95%: 51.6-64.3); of them, 5 (3.7%; CI 95%: 0.5-6.9) had reactive results: 1 with 1:2 titres; 3 with 1:4 titres and 1 with 1:32 titres.Conclusion: Despite existing recommendations, the prevalence of nontreponemal test orders in patients with miscarriage is low. This points to the need to create awareness among the staff about the importance of following closely the protocol for the care of pregnant patients.

A devastação: uma singularidade feminina / Devastation: a feminine singularity

Lacan empregou o termo devastação em dois momentos de seu ensino para se referir: seja à relação da filha com sua mãe - "a filha espera mais substância de sua mãe do que de seu pai" (1972/2001); seja na relação de uma mulher com um homem - "este que é para ela uma aflição pior que um sintoma, a saber, uma devastação" (1975-1976/2007). A devastação é o retorno da demanda de amor para uma mulher.

Lacan has used the word ravage in two moments of his teaching. Once to allude to the relation of the daughter to her mother - "a daughter expects more substance from her mother than from her father" (Lacan, 1972/2001) -, and again to refer to the relation of a woman to a man - "who is for her a worst affliction then a sinthome, that is, a ravage" (1975-1976/2007). The ravage is the return of a woman's request for love.

The thorough thinking about the basic request of medical university mathematics course teaching / 中华医学教育探索杂志

The meaning,the principle and concrete methods of researching and establishment of the basic request university mathematics course teaching of medicine profession is discussed. By the analysis of the present constitution of mathematics course in medical education,the author points out the establishment such basic request has certain theoretical value and practical meaning.He has also discussed some principle and the methods to realize this value and meaning.

An Audit of Medical Autopsy: Experience at the University of Uyo Teaching Hospital (UUTH), Niger Delta Region, Nigeria.

Background: Autopsy is an essential auditing tool in clinical practice. ObjectiveS: The study set out to review all autopsies that were performed over a four-year period in order to determine the rate, indications, as well as the age and sex distribution of dead bodies, which autopsies were performed on them in the Hospital. Setting and Design: This was a retrospective study that was undertaken at the department of Pathology of the University of Uyo Teaching Hospital (UUTH), Uyo, Nigeria between January 2007 and December 2010. Materials and Methods: All the cases of death that underwent pathological autopsies in the UUTH were reviewed. The autopsy records, clinical case notes, gross and histopathological specimens as well as slides were retrieved and examined. Results: A total of 1679 dead bodies were received at the mortuary of the institution studied during the 4-year period. Autopsies were performed in 78 cases giving a request rate of 4.7%. Coroner's autopsy was commonly performed, and this accounted for 60 (76.9%) cases, while the remaining 18 (23.1%) were clinical autopsies. Autopsies were commonly performed on male bodies more than females (M: F = 2.6:1.0) with the majority having died at their second decade of life. It was observed that the majority (57.7%) of the request for autopsies were from peripheral centers outside the teaching hospital, while the remaining 42.3% cases were drawn from various clinical departments in the teaching hospital. Road traffic accident was the leading indication for coroner's autopsy (51.7%), while gastroenteritis and chronic liver disease were the two most common indications for clinical autopsy, 27.8% and 22.2% respectively. The concordance rate between clinical diagnosis and autopsy diagnosis was found to be 72.2% (13/18 cases). Conclusion: The rate of request for Autopsy at the University of Uyo Teaching Hospital during the period of this study was low, similar to other previous reports.

Procurement of prescription only medicine (POM); sources, pattern and appropriateness.

The study aims at assessing the extent of the adoption of the proper medical order of procurement for use of prescription only medicines (POM) by duly implemented health care program originated by a physician or other healthcare practitioner from community pharmacy outfits in urban centers in Nigeria. Buyers at the points of purchase located at the three senatorial districts of Akwa Ibom state were intercepted and their buying status ascertained. The prescriptions presented were analyzed for the origin, type and nature of the paper, content, correctness and other required attribute of a proper prescription followed by administration of a structured questionnaire to probe into the origin of the prescription and purpose of need of the drugs. Buyers without prescriptions were interrogated to know the source of their knowledge of the requested drugs. A total of 568 prescriptions were considered. The prescriptions were defective in identification with respect to prescriber’s name, signature and addresses of prescriber in the percentage frequency 73, 31 and 27. The bearer’s names were omitted in 34% of the prescriptions. Prescriptions with ambiguity, illegibility, wrong spellings were 16%, 15% and 12% respectively. Non prescription buyers were 48.2% of total buyers. Analgesic and antiinfective were purchased in the order 37% and 23% respectively and were significantly higher in males than females (P<0.05). The indiscriminate request and order for POMs in urban centres may call for scrutiny before sales and appropriate legislation need be in place to check the disorder of inappropriate use of this class of medications.

A Study of the Causes and the Predictive Factors in Failed Vaginal Birth After Cesarean Section / 대한주산의학회잡지

OBJECTIVE:The purpose of this study was to determine the factors associated with successful vaginal birth after cesarean section (VBAC), and to analyze the causes of failed VBAC. METHODS:This study was performed based on 193 pregnant women who tried vaginal delivery after cesarean section in Chungbuk National University Hospital from January 1997 to December 2005. Maternal age, gestational age, cervical dilatation at admisson, maternal body mass index (BMI), neonatal bodyweight, history of prior vaginal delivery, and indication of prior cesarean section were retrospectively analyzed between the successful group and the failed group of women who tried labor. The causes of the failed trial were analyzed. RESULTS:Seventy nine percent (153/193) was successful in the trial of VBAC and 21% (40/193) failed. There were no difference in maternal age or gestational age between two groups. The success rate was significantly higher when cervical dilatation at admission was more extended, BMI of pregnant women before pregnancy and birth was lower, and birthweight of newborn was lower. Maternal request was the major cause of failure (47.5%), and others were failure to progress, non-reassuring fetal monitoring and failed induction. CONCLUSION:The factors that had significant differences in this study can be used as predictor of successful VBAC. And failed trial of VBAC due to maternal request can be decreased by adequate explanation regarding the complication of emergency operation, and enough pain control during labor.

The Fundamental Request for the First-class Medical University in China / 中华医学教育探索杂志

Based on the items, the standard and the basic features of the assessment of the first-class universities in the world, the assessment of the teaching level in China and the assessment for the excellent medical teaching in a seven-year system,the author points out six requirement that the first-class medical universities in our country should possess, such as emphasizing multi-subjects, research and internationalization, having strong comprehensive strength with well- built disciplines, having the reasonable structure of the faculty with high levels, having the good condition for running the university with much finance and having the characteristics of running the universities.

WTO DDA and lssues on Healthcare Services

The GATS is the first and only set of multilateral rules and commitment covering Government measures which affect trade in services. It has two parts-the framework agreement containing the rules, and the national schedules of commitments through which each Member specifies the degree of access and is prepared for foreign service suppliers. The GATS covers all services with two exceptions, i.e., services provided in the exercise of governmental authority and , in the air transport sector, air traffic rights and all services directly related to the exercise of traffic rights. Notwithstanding this very broad scope, the agreement and the negotiations taking place under it are one of the least controversial areas of the current work in the WTO. This is because of its remarkable flexibility, which allows Governments, to a very great extent, to determine the level of obligations they will assume. There are four main elements of flexibility: Member Governments choose those service sectors or subsectors on which they will make commitments guaranteeing the right of foreign suppliers to provide the service. Each Member must have a schedule of commitments, but there is no minimum requirement as to its coverage and some cover only a small part of one sector; For those services that are committed, Governments may set limitations specifying the level of market access and the degree of national treatment they are prepared to guarantee; Governments were able to limit commitments to one or more of the four re cognized "modes of supply" through which services are traded. They may also withdraw and renegotiate commitments ; In order to provide more favorable treatment to certain trading partners, Governments may take exemption, in principle limited to a 10 years’ duration, from the MFN principle, which is otherwise applicable to all services, whether scheduled or not. The agreement contains a number of general obligations applicable to all services, the most important of which is the MFN rule. But apart from these, each Member defines its own obligations through the commitments undertaken in its schedule. Because it is a basic principle of the agreement that developing countries are expected to liberalize fewer sectors and types of transactions, in line with their development situation, the commitments of developing countries are in general less extensive than those of more industrialized countries. It was this flexibility in the scheduling of commitments which put an end to the north-south controversy over services which marked the early years of th e Uruguay Round. So far, South Korea has been asked by 14 economies, including the U.S., EU, and China, to open its services market wider. According to the initial requests submitted to the World Trade Organization (WTO), these countries urged Seoul to grant greater access to the domestic medical treatment, legal services, education, finance, and distribution markets. The ministry of Foreign Affairs and Trade (MOFAT) plans to hold a related ministerial meeting today and roll out countermeasures by next March for follow-up negotiations with the nations concerned. In the initial requests, Korean newspapers reported that the U.S has demanded Seoul guarantee full access to the medical service markets and provide the same business conditions for American companies as local ones. This was, however, denied by the Korean government, while it accepted that fact that the China also called for the removal of barriers in the herbal medicine market as well as in the education. The WTO member economies have submitted initial requests for follow-up negotiations by sector to the new round of WTO talks in November last year. Thereafter, South Korea is required to come up with a response by next March to resolve the issues by the end of 2004. An agreement with the 14 countries should take effect from January 2005.

Progress of WTO Negotiation and KMA's Countermeasures

Although the issue on trade in professional services has been mentioned as one of the built-in agendas since 1995, the Ministry of Health and Welfare(MOHW) formed the committee on WTO DDA(New Development Agenda in Doha) last November and there is no countermeasure on a government level by the time. The Korean Medical Association(KMA) has been formed the WTO DDA committee composed of standing directors and experts on this last January and actively working at present. Last April, the WTO DDA Joing Committee of Associations of Healthcare Sectors has been established by six associations, such as the Korean Medical Association(KMA), the Korean Dental Association(KDA), the Association Korean Oriental Medicine(AKOM), the Korean Nurses Association(KNA), the Korean Hospital Association(KHA), the Korean Dental Hospital Association(KDHA), and they have closely collaborated. The WTO DDA Committee of KMA has submitted the request list to the government last May on the basis of results of four times meetings for special lectures and discussion, three times surveys, and the research paper. The request list of KMA includes the contents of mode 2(consumption abroad) and 4(presence of natural persons). For the mode 3(commercial presence), it is suspended because it is related with the permission of profit-making corporation on healthcare sector which is prohibited at present. The government announced 19 countries has submitted the request list to Korea as of august 1 and among them, the healthcare relevant requests are from China and Poland. Especially China is requesting as a whole, including the education sector on oriental medicine. On this point, the main subjects which the KMA should established its position urgently are the issues regarding the permission of profit-making corporation and who should give and manage the medical license. For this, the KMA will continue to collect and analyze the relevant information and will relay these information to the members.

Moral Request of Giving Treatment to Serious burn Patients / 中国医学伦理学

The treatment process of serious burn patients has the characteristics of overwork,dirt, weariness……. Patient has nocompany, can not take care oneself. In addition, patients andrelatives can not supervies treatment work. Therefore doctors and nurses should have high sense of responsibility, sympathetic heart. And also the paper advances the moral request in the course of treatment.

Madical Education and Change of Health Care / 医学教育

It is a great social demand on the medical education system to produce high quality physicians well -prepared for the coming aged society. Besides the inborn emphasis on the technical competence in medical training, the skills to improve the quality of life of patients is currently getting more and more important. In this aspect, human relationship and amenity dimensions need to be more emphasized in the medical education process.<BR>Based upon the observation that lecture-based classes still prevail in the curricula of Japanese medical schools, I dare say that there are eventually no revolutionary strategies initiated for effective learning in the medical education system in Japan. In connection to the strategy development, it is necessary to adopt third-party evaluation of the education system as well as the evaluation by educators themselves.<BR>To sum up, I strongly emphasize the importance of strategic programming of primary care education which includes experience-based training of effective communication skills and of whole-person approach to patients.