综合医院医疗不良事件报告的障碍因素以及改进策略分析

????? 医疗不良事件的分析总结对保证医疗质量起着促进作用,而医疗不良事件的报告存在着许多障碍因素。通过调查湖北省、江苏省、浙江省12家医院的医疗不良事件的报告情况,分析阻碍医疗不良事件报告的原因,并提出相应建议。

     

医患不信任问题对医方医疗行为的影响及对策分析

目的 客观真实的描述医患间的信任现状及其对医方医疗行为的影响,并提出相关对策建议。方法 对北京市5家三甲医院医务人员和患者共1 010人进行问卷调查,对25位医务人员进行定性访谈,通过统计分析描述并分析医患不信任问题现状及其对医方医疗行为的影响。结果 医方对于医患关系的评价低于患方,存在感觉患者不信任医方的担忧;继而产生了其言行过分谨慎、规避风险、消极自保的行为,甚至偏离医学科学原则的现象。结论 医患不信任情况的确存在,已经对于医方的医疗行为造成了不良影响,必须从政府、医院以及媒体3方面采取应对措施,以缓解医患间的不和谐关系,重建医患间不可或缺的信任。     

抓住电子病历应用共享核心 推进数字化医院建设

国家卫生部对电子病历应用水平验收主要是对医院、区域电子病历共享进行验收,意在促进区域协同医疗和全民健康管理。长安医院紧紧抓住全国电子病历试点医院这一契机,努力建设数字化医院,获得国家卫生部“电子病历系统应用水平”考核全国第一,医院建设获得全面推进。     

中国临终关怀服务现状与伦理探讨

随着社会经济的发展、人口老龄化和疾病谱的改变,临终关怀已成为我国社会所关注的重要民生问题,也成为医学伦理的热点。该文结合中国生命关怀协会对我国城市临终关怀服务利用与需要状况的调研,反映当前我国城市临终关怀服务的基本特征,对临终关怀中涉及医学伦理的部分概念,以及临终关怀服务中的相关权益进行阐述,并建议应当在逐步完善全民医疗保健制度的基础上,健全服务体系,包括临终关怀伦理道德法规体系,才能更好地为临终患者服务,提高患者的生命质量。     

实习护生接触抗肿瘤药物的职业防护现状调查

目的:了解实习护生接触抗肿瘤药物的职业防护现状。方法:选取2010-2011年在我院实习的护生l65名,采用自行设计的调查问卷进行调查。结果:实习护生接触抗肿瘤药物的相关知识的认知及职业防护行为较差。结论:管理部门应加强实习护生的职业安全防护教育与管理,提高实习护生对抗肿瘤药物的职业防护的认知,规范职业防护行为,减少职业危害。     

Incidence of adult brain cancers is higher in countries where the protozoan parasite Toxoplasma gondii is common

We explored associations between the common protozoan parasite Toxoplasma gondii and brain cancers in human populations. We predicted that T. gondii could increase the risk of brain cancer because it is a long-lived parasite that encysts in the brain, where it provokes inflammation and inhibits apoptosis. We used a medical geography approach based on the national incidence of brain cancers and seroprevalence of T. gondii. We corrected reports of incidence for national gross domestic product because wealth probably increases the ability to detect cancer. We also included gender, cell phone use and latitude as variables in our initial models. Prevalence of T. gondii explained 19 per cent of the residual variance in brain cancer incidence after controlling for the positive effects of gross domestic product and latitude among nations. Infection with T. gondii was associated with a 1.8-fold increase in the risk of brain cancers across the range of T. gondii prevalence in our dataset (4-67%). These results, though correlational, suggest that T. gondii should be investigated further as a possible oncogenic pathogen of humans.     

Parental refusal of life-saving treatments for adolescents: Chinese familism in medical decision-making re-visited

This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the 'AP-physician-family-relationship' and the dominant role Chinese families play in medical decision-making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers from Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives 'weak' family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re-interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its 'parens patriae' power to defend the defenseless in society and the integrity of the medical profession.     

JPEG2000压缩算法及其在医学图像DICOM格式中的实现

本文描述了在医学图像DICOM格式中实现JPEG2000压缩算法的编程思路和方法。提供了部分VC＋＋代码,对关键函数进行了较详细的注解,并对两种图像压缩格式进行了比较,给出了一个详细的实验结果。     

初中学生人格类型对心理旋转能力性别差异的影响

目的:考察初中学生心理旋转能力性别差异、典型A型和B型人格被试心理旋转能力状况,及人格类型与心理旋转能力性别差异的关系。方法:采用标准心理旋转能力测验和A型人格问卷调查了260名初中一年级至三年级被试,并对人格类型对心理旋转性别差异的影响进行方差分析。结果:心理旋转能力性别差异具有跨年级(初一至初三)的一致性(初一:男4.618±0.504,女3.400±0.536;初二:男7.389±0.400,女5.30±0.416;初三:男6.207±0.546,女4.286±0.534;F=12.586,P=0.000);(2)A型人格被试心理旋转能力高于B型人格被试(6.09±0.42/4.71±0.425;F=5.320,P=0.023);(3)A型人格被试性别差异显著(男7.259±0.583,女4.920±0.606;F=7.77,P=0.006),而B型人格被试性别差异不显著(男5.269±0.553,女4.255±0.646;F=2.26;P=0.136),人格类型是影响心理旋转能力性别差异因素之一。结论:尽管心理旋转能力存在显著的性别差异,但这种差异受众多因素影响。     

Analysis of longitudinal data in the presence of informative observational times and a dependent terminal event, with application to medical cost data

Summary .   In longitudinal observational studies, repeated measures are often taken at informative observation times. Also, there may exist a dependent terminal event such as death that stops the follow-up. For example, patients in poorer health are more likely to seek medical treatment and their medical cost for each visit tends to be higher. They are also subject to a higher mortality rate. In this article, we propose a random effects model of repeated measures in the presence of both informative observation times and a dependent terminal event. Three submodels are used, respectively, for (1) the intensity of recurrent observation times, (2) the amount of repeated measure at each observation time, and (3) the hazard of death. Correlated random effects are incorporated to join the three submodels. The estimation can be conveniently accomplished by Gaussian quadrature techniques, e.g., SAS Proc NLMIXED . An analysis of the cost-accrual process of chronic heart failure patients from the clinical data repository at the University of Virginia Health System is presented to illustrate the proposed method.