假如我来代理本案

患方的知情同意权和选择权与医方的紧急处置权，哪项权利更优先，不是一个总是有共识的议题。在医患关系良好时或社会特殊时期（如非典时期），医方的紧急处置权能为社会和患方接受；但在目前，尊重患者和患方的知情同意权和选择权，则是当今社会的主流意识。     

论患方的知情同意权

诊疗是以患者自身不可替代的生命、身体为对象进行的，目诊疗行为的结果不仅通常侵袭患者身体和造成患者痛苦，而且有时使患者负担巨额的医疗费用。所以，在诊疗活动中，患方享有知情同意权是很必要且很重要，医方有义务尊重患者本人的知情同意权，本文着重论述医患关系中的患方的知情同意权的行使和保护。     

从法律角度谈医患关系的和谐构建

本文首先从医患关系的法律概念入手，分析了医患关系的现状；从医方未尽告知义务、患者知情同意权未受到尊重，医方知情权与患方隐私权之间的冲突、适用医疗纠纷的相关法律法规不健全几方面论述了影响医患关系法律方面的主要原因；指出了构建和谐医患关系的主要法律途径：建立缓解医患关系的三种保险，健全完善处理医疗纠纷的法律法规，加强医患沟通，维护患方权利。     

知情同意书的法律依据、属性及证据作用

告知作为医方的法定义务，将有助于缩小医患之间的信息不对称，保障患方知情同意权，有助于患方参与到整个诊疗过程中，营造良好和谐的医患关系。知情同意书作为医方动态告知过程的静态留存再现，其法律效力和属性在日常医疗实践和司法实践过程中常出现不同的理解与定位。正确理解知情同意书的法律属性和定位将有助于指导我们的日常医疗实践和司法实践。     

急危患者知情不同意的医疗处置研究

知情不同意是患者行使知情同意权的一种结果,医务人员应尊重患者知情不同意的权利.患方的知情不同意决定可能危及患者生命.急危情况下,患者本人尤其是其代理人的不同意决定危及患者生命时,患者的知情同意权应让位于其生命权.法律应赋予医务人员紧急救治权,患方不能以其不同意为由要求医务人员对此后果承担法律责任.     

知情同意的表现形式问题研究

近年来因患者的知情同意权受到侵犯而引起的诉讼越来越多 ,这不得不引起医方的高度重视。知情同意权不仅是患者人格独立和生命健康权的体现 ,同时 ,它也是医生进行医疗诊治行为的依据。在许多情况下 ,没有患者方的同意 ,医生的医疗处置就是侵权行为。知情同意是患者方的权利 ,反过来 ,告知患者方真实、主要的信息是医疗方的义务。我国法律关于知情同意的有关规定并不完善 ,象履行告知义务的标准、告知和同意的表现形式、知情同意的例外情形等都没有具体的规定 ,临床实践中的做法也极不规范。为了督促医生履行告知义务和防止纠纷后无证可举 ,…     

法律视角下的医患沟通

医患沟通是增进医患信任、改进医患关系中非常重要的一环。本文从法律的视角对医患沟通进行了解读：知情同意权是法律赋予患者的权利；与患者进行有效沟通，取得患者的授权和配合，是医方的法定义务。保障患者的知情同意权利，与医方履行沟通义务是对立统一的。     

某三甲医院医疗鉴定中医疗过错原因分析及对策初探

目的:从医方角度审视医疗鉴定中医疗过错产生的原因,探究避免医疗过错、防范医疗纠纷的合理建议。方法:通过EXCEL软件从医疗鉴定的数量、科室分布、鉴定结果分类等对某医院2014年至2018年的107例医疗鉴定进行描述性分析。结果:产生医疗过错的共性问题:手术科室、急诊科医疗纠纷发生率较高;忽视病历的证据效应;怠于患方知情同意权的保护;医务人员自身专业素质和责任心的欠缺。结论:建立健全医院管理制度;加强医务人员职业道德素养;正视病案资料的法律效力;尊重患方知情同意权。     

严格责任倾向--对当前医疗纠纷诉讼审判的思考

我国现有法律表明医疗侵权诉讼适用过错责任原则,但是目前审判界有对医方采取严格责任的倾向。严格责任主要通过举证责任倒置实现,强调对受害人的保护。作者列举典型案例,分析医疗事故争议案件采用严格责任的表现:①患方对医方造成的损害是否具有过错无须举证;②医方免责事由是受到限制的,医方不得以尽到合理注意为抗辩条件;③医疗行为与患方损伤结果之间的因果关系也是推定的。作者认为严格责任虽可以提高医务人员的注意义务,但是在缺乏成熟的医疗责任保险情况下审判适用严格责任原则加重了医疗机构及其工作人员的责任,并不能真正解决医患争议。审判机构应该严格按照法律规定的情形来适用严格责任,救济患方损害不能牺牲司法公正。     

精神卫生法实施后知情不同意问题的再思考

《中华人民共和国精神卫生法》中关于"强行收治""非自愿入院"等争议多年的焦点议题引发了公众极大的关注。对于有精神障碍的患者,医院精神科执业医师依条件和程序作出"需要住院治疗"判定结论,患方对此知情后作出不同意住院治疗的决定,这一决定可能危及患者的生命健康,可能侵犯他人或自己的权利。病情发作时的不同意决定让医方面临艰难选择。针对医疗机构对于知情不同意所引发的一系列问题该如何处置作出思考和研究。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

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.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.