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1.
目的:了解承德市某医院医疗纠纷发生现状,分析医生医疗纠纷遭遇对其诊疗行为的影响.方法:采用医院常规统计数据和问卷调查相结合的方式,以该院全体临床医生为调查对象,调查医生的基本情况、是否经历过医疗纠纷及其对医生诊疗行为的影响等.结果:该医院医疗纠纷发生比较普遍.医疗纠纷经历对医生诊疗行为都有较大的影响.半数以上医生表示有过防御性医疗行为,且经历医疗纠纷的医生采取防御性医疗行为的比例要高于没有经历过的.医疗纠纷经历影响医生的治疗原则,所有医生都倾向于选择稳妥的治疗方案.讨论:调查缺失值对调查结果没有影响.医疗纠纷经历对医生诊疗行为影响巨大,医疗纠纷经历使医生更容易采用防御性医疗行为.  相似文献   

2.
目的:了解贵阳市村卫生室就诊病人诊疗行为对村医诊疗行为的影响,进一步探讨影响村卫生室病人就诊的医疗卫生服务因素,寻求有效的医疗卫生服务途径.方法:组织经过培训的具有5年以上临床经验的县级临床医师,对在村卫生室就诊的210名病人进行了问卷调查.结果:在贵阳市农村,病人以45岁以上人群为主,达47.14%;病人文化程度以小学及以下为主,达74.29%;病人的人均年收入以2 000元以下为主,达63.34%;他们对村医的诊疗技术和诊疗价格满意度分别为20.48%和22.86%;在发烧时.对输液和新药治疗期望值分别为93.33%和15.24%.结论:目前.乡村医生的诊疗行为有向不够科学化、缺乏规范化和功利化方向发展的趋势.鉴于这种情况,有关部门应对普通疾病的诊疗行为进行重点规范.同时,应开展乡村病人的诊疗健康教育和农村中老年疾病的防治,要从病人的角度来促使村医诊疗行为规范化、科学化,要发挥村民对村医生诊疗活动的民主监督.  相似文献   

3.
医院急诊流程重组应用研究   总被引:4,自引:0,他引:4  
本研究采用过程方法、持续质量改进理论、控制论等,对急诊流程现况进行充分认识.通过现况分析,明确急诊流程的关键环节、关键质控点和影响急诊医疗质量的主要原因.在此基础之上,制定急诊流程重组的基本框架和实施方案,明确急诊流程重组的总体目标为:以病人为中心,实现就诊全程时间更短、诊疗行为更规范、效率更高.此方案在解放军304医院急诊科进行了实际应用,并对应用前后的部分指标进行了对比分析,得到了较为满意的结果,急诊病人人均全程就诊时间较重组前明显缩短,人均医生就诊时间较前有所延长,人均检查等待时间较前明显缩短.  相似文献   

4.
医院门诊患者向社区卫生服务机构分流的经济效益   总被引:2,自引:1,他引:2  
通过对不同医疗机构的医生和病人的调查,了解目前病人的分布、就诊次均费用和可分流情况,测算出实现病人合理分流后病人的分布及可节省的医疗费用。结果表明:病人的最佳流向有19.50%、23.28%和57.22%的病人分别在三级医院、二级医院和社区卫生服务机构就诊,如果能使目前病人的就诊分布实现合理分流,可分别节省100.70亿元、505.53亿元的间接医疗费用和直接医疗费用,占2004年个人卫生支出的14.89%。病人的合理分流不仅能解决部分看病贵问题,而且能缓解看病难的问题,提高资源的利用效率,实现社区卫生服务机构和医院之间合理分工、密切协作的互动关系。  相似文献   

5.
在病人调查的基础上比较分析各级医疗机构病人就诊时间、反应性、满意度及其影响因素。结果表明:在社区卫生服务机构,病人的病情较轻,路途和候诊时间较短,看病时间较长,病人的时间满意度较高;而医院的情况则相反。各指标地区之间差异较大。提示:社区卫生服务机构得到了病人的一致认可,医院尚需在政策、内部管理和规范医生行为方面努力,以提高满意度。  相似文献   

6.
病人全面选择医疗的利弊分析   总被引:1,自引:0,他引:1  
病人全面选择医疗的内容包括病人选择医院、病人选择病房、病人选择医生和护士、病人选择检查、病人选择治疗方案等。实行病人选择医疗,可以促进病人早日康复、降低病人医疗费用支出、抑制社会医疗费用过快增长、改善医患关系、增进医患之间相互理解、减少医疗纠纷、规范药品市场、引导医疗资源的合理配置、促进医院提高医疗服务质量。但也可能会增加医生和护士的工作量,在短期内可能影响医院发展、影响实习教学和导致医疗技术垄断。病人全面选择医疗可以先在城市医院试行,然后推向农村。  相似文献   

7.
医院如何适应医疗保险制度改革   总被引:1,自引:0,他引:1  
1 医疗保险制度改革对医院的影响 1.1 病人流向的改变 (1)病人减少:个人账户的建立和OTC的实施,使小病或发病早期的病人、慢性病病人减少了看病的次数,出现自助医疗。 (2)病人转向:病人可多选后就会根据自身的情况对社区、专科、综合医院做出选择,根据具体疾病情况有区别地选择每次的就诊医院,使一部分医院的病人减少。 1.2 收入减少或增长幅度下降 (1)个人账户管门诊看病,买药要花自己的钱,病人的费用意识增强。 (2)投入总量减少。1998年北京市医药费用支出占工资总额的18.4%,按规定的筹资比例计算,所筹费用将低于支出水平。 (3)各种制度的实施和医保机构的审核,加强了对医院的制约。  相似文献   

8.
在调查病人和医生的基础上,比较分析病人常就诊机构的分布,病人和医生对社区首诊制的看法及潜在的可分流病人数量。结果表明:社区机构病人的常就诊机构为社区机构,医院病人常就诊机构为医院;目前尚有近50.0%的病人不同意社区首诊制,主要是医院病人;医院医生多认为社区首诊不必要和不可行,而社区医生则认为必要和可行;在二级和三级医院,有30.2%至55.8%的病人可分流至社区机构。这说明社区首诊制的实施目前尚面临多方面挑战。  相似文献   

9.
552名门诊患者的调查分析   总被引:32,自引:6,他引:26  
目的 为了了解患者的需求,更好地实现以病人为中心,提高服务满意度。方法 随机抽取门诊患者552名进行患者选择就诊医院的影响因素和门诊患者的候诊需求等问卷调查。结果 影响患者选择就诊医院的主要因素有医疗技术水平、对医生的信任度等。患者希望得到和改进的候诊服务有健康知识宣传、随时通报就诊进展、专家医师的介绍,增设看病流程提示标识等。结论 提高医疗水平和医务人员整体素质、强化服务意识、规范医疗行为等是医院搞好以病人为中心服务的重要举措。  相似文献   

10.
疾病诊断水平对肺结核病人经济负担影响研究   总被引:1,自引:0,他引:1  
目的:探讨医生的疾病诊断水平对肺结核病人经济负担的影响.方法:对山东省不同经济发展水平的6个县(区)819例肺结核病人的诊断过程及诊疗费用进行了调查和分析.结果:肺结核病人诊疗期间花费的总费用5641.42元,占家庭总支出的56.03%;就诊次数为5次以上的病人确诊前医疗费用为就诊次数为1~2次病人的2.03倍;有21.1%的病人属于诊断延迟.结论:提高医生对肺结核病的诊断水平,减少病人就诊次数,减少病人的诊断延迟.  相似文献   

11.
Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.  相似文献   

12.
This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.  相似文献   

13.
深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.  相似文献   

14.
Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO2) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO2. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO2 at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO2 gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO2 also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO2.  相似文献   

15.
Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L?1 to a maximum of 79?mg·L?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.  相似文献   

16.
The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.  相似文献   

17.
Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).  相似文献   

18.

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.  相似文献   

19.
20.
The repeatability and validity of a questionnaire for upper limb and neck complaints were assessed in a population of 105 hospital outpatients with a range of upper limb and neck disorders (including cervical spondylosis, adhesive capsulitis, lateral epicondylitis, carpal tunnel syndrome and Raynaud's phenomenon). Subjects were asked to complete a modified Nordic-style upper limb and neck discomfort questionnaire on two occasions closely spaced in time. The repeatability of their responses was assessed by calculating a kappa coefficient (kappa), and the sensitivity and specificity of component items in the questionnaire were determined for specific diagnostic categories of upper limb and neck disorder. Symptom reports for pain in the upper limb and neck, pain interfering with physical activities, neurological symptoms and blanching were all found to be highly repeatable (kappa = 0.63-0.90). A number of regional pain reports proved to be very sensitive in relation to specific upper limb disorders, but, with the exception of reported finger blanching in patients with Raynaud's phenomenon, none proved to have a good specificity (range = 0.33-0.38). We conclude that a modified Nordic-style questionnaire is repeatable and sensitive, and is likely to have a high utility in screening and surveillance. However a complementary examination schedule of adequate specificity and repeatability is essential to establish a clinical diagnosis.  相似文献   

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