Communication behaviors and patient autonomy in hospital care: A qualitative study

BackgroundLittle is known about how hospitalized patients share decisions with physicians.MethodsWe conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis.ResultsMost patients were white (61%) and half were female. Most physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed.ConclusionsShared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict.Practice implicationsSome hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy.     

医患纠纷的经济学分析及对策

医患纠纷是由于患者在医院就医期间发生的许多问题导致的一种不和谐人际关系的外在表现。近年来,呈现不断上升的趋势。本文用经济学原理,通过经济模型,分析医患纠纷的经济学内涵,以此为基础提出医患纠纷的解决方案,以维护医疗环境及社会的和谐稳定,为我国经济建设做出医疗行业的贡献。     

Postoperative compensation after neurotomy in Meniere's disease: Retrospective study of 15 cases

Introduction

Vestibular neurotomy is a functional surgery for Meniere's disease in the event of medical treatment failure. The aim of the study was to assess the efficacy and complications of vestibular neurotomy, and to address the question of postoperative compensation.

急诊内科患者就诊疾病特点与去留处置分析

目的探讨我院急诊科患者的就诊疾病特点,分析其去留处置规律,总结经验,为提高医院管理、人才培养方向及急诊科医务人员的诊治水平提供数据支持。方法将2017年1月1日-2017年12月31日的患者资料按照患者年龄、性别、就诊时间、疾病症状或诊断、去留进行分类,并将数据通过EXCEL软件对结果进行汇总分析。结果27961例就诊患者中男女比例为1.14:1,男性占53.36%,女性占46.64%。急诊留观患者为15904例,占全部患者56.84%;急诊住院患者为9886例,占全部患者的35.36%;离院或转院患者为2071例,占全部患者的7.41%。结论应加强对疾病的健康宣教,可减少患病率,减轻急诊科医师接诊压力。合理分配医务人员和严格执行医院各种制度,可提高患者满意度和救治能力。为医院和急诊科建设与发展提供数据支持,便于确定医院建设重点和急诊科人才培养方向,提高急诊科医务人员的诊治水平。     

Histoire et fonctions des Unités pour Malades Difficiles (1re partie). Du quartier de sûreté à l’Unité pour Malades Difficiles de Villejuif,plus d’un siècle de prise en charge

This article is the first in a series of three, dedicated to the history and functions of what is known as a UMD in France: Unités pour Malades Difficiles, or “Units for Difficult Patients”. This particular article focuses on the oldest such secure structure, UMD Henri Colin, created in 1910 in Villejuif as a quartier de sûreté, or a “secure ward”. The article aims to detail evolutions in treatment and the types of patient treated over more than one hundred years, parallel to social change. Four distinct chronological periods are examined, for their perspective on professional practice as much as for the reasons given for patients’ admission and the psychopathological profiles of “dangerous” patients. Clinical vignettes are used to illustrate this historical evolution.     

患者家属角色转变后的心理分析及应对措施

目前医患关系紧张，医疗纠纷已经成为所有医疗机构甚至整个社会不可回避的问题，多数是由于医患沟通不到位所致．而沟通不到位或沟通障碍又多因互不了解所致。本文从8个方面总结患者家属角色转变后面临的心理情况，分析患者家属角色转变后心理情况改变的原因，提出医务人员对患者家属角色转变后的两项应对措施．旨在增进医患双方的了解，提高医务人员对患者家属角色转变后面临心理情况改变的了解和理解，提高应对能力，提高处理事件的能力，从而提高医患沟通的质量，确保医患沟通到位并收到良好的效果，以期在一定程度上化解甚至避免医疗纠纷，构建和谐的医患关系。     

Rasch-based scoring offered more precision in differentiating patient groups in measuring upper limb function

ObjectiveTo compare the discriminatory ability of Rasch-based and summative scoring in the context of assessing upper limb function of patients with stroke.Study Design and SettingData were from a cohort study of 497 adults with stroke undergoing physiotherapy. Upper limb function was assessed at admission and discharge using the upper limb subscale of the Motor Assessment Scale (UL-MAS). Rasch analysis was used to transform raw UL-MAS scores into interval measures. A relative precision (RP) index was used to differentiate patients by discharge destination.ResultsThe analysis confirmed the unidimensional structure of UL-MAS at both admission and discharge and demonstrated the adequate fit of the items. The RP index favored the Rasch-based scoring over the summative scoring in differentiating between the two patient groups, with significant gains in precision at admission (15%) and discharge (11%). When examining patients in the upper or lower quartile of UL-MAS, the gains in precision were statistically significant in favor of the Rasch-based scoring, with 20% precision at admission and 19% precision at discharge.ConclusionRasch-based scoring was more precise in differentiating patient groups by discharge destination than the summative scoring used to measure upper limb function, especially at the extreme range of the scale.     

Nurse mentor perceptions in the delivery of a home-based cardiac rehabilitation program to support patients living in rural areas: An interpretive study

Home-based cardiac rehabilitation (CR) programs improve health outcomes for people diagnosed with heart disease. Mentoring of patients by nurses trained in CR has been proposed as an innovative model of cardiac care. Little is known however, about the experience of mentors facilitating such programs and adapting to this new role. The aim of this qualitative study was to explore nurse mentor perceptions of their role in the delivery of a home-based CR program for rural patients unable to attend a hospital or outpatient CR program. Seven nurses mentored patients by telephone providing patients with education, psychosocial support and lifestyle advice during their recovery. An open-ended survey was administered to mentors by email and findings revealed mentors perceived their role to be integral to the success of the program. Nurses were satisfied with the development of their new role as patient mentors. They believed their collaborative skills, knowledge and experience in coronary care, timely support and guidance of patients during their recovery and use of innovative audiovisual resources improved the health outcomes of patients not able to attend traditional programs. Cardiac nurses in this study perceived that they were able to successfully transition from their normal work practices in hospital to mentoring patients in their homes.     

基于顾客满意度指数模型的病人满意度问卷编制

目的编制病人满意度调查问卷。方法立足美国顾客满意度指数模型理论(ACSI),参考国内相关研究,分两次调查,分别对问卷进行项目分析、探索性和验证性因素分析。结果最后确定问卷由6个维度(约束条件、质量期望、质量感知、病人满意、病人抱怨、病人忠诚)共17个项目组成,信度为0.871,模型拟合指标χ2/df、GFI、NFI、CFI、TLI、RFI、RMSEA分别为1.758、0.936、0.910、0.959、0.950、0.892、0.047。结论基于ACSI模型的病人满意度调查问卷具有良好的信效度,可以有效测量病人满意度情况,作为进一步研究的调查工具。