32起医疗纠纷的原因分析与防范对策

目的为探讨医疗纠纷发生的原因及影响因素,以便制定相应的防范对策。方法对某院近3年32起完整的医疗纠纷进行影响因素分析和评估。结果该院医疗纠纷发生不断增加,外科、急诊科和妇产科位居前三位;主要原因为知情告知不充分、服务态度不满意、医疗技术不满意、违反规章制度及风险意识淡薄,其中以知情告知不充分、服务态度不满意、医疗技术不满意位居前三位。结论医疗纠纷的防范涉及医疗单位、医务工作者、患者及社会等各方因素,其中采取各种途径来尊重患者、提高医疗服务技术和提升服务态度是营造和谐医患关系、减少医疗纠纷的发生主要途径。     

急危重症病例救治中医疗纠纷的根源及防范

临床急危重症病例救治过程是医疗纠纷的高发点。本研究通过分析急危重症病例救治的特点、急危重症病例救治中医疗纠纷的触发点进行分析,探讨急危重症病例救治中医疗纠纷根源及防范措施,强调医疗安全是医疗工作的前提、建立健全各项规章制度和操作规程、不断加强医务人员业务素质、积极转换服务理念,端正服务态度掌握正确的医患交流技巧等。     

某军队中心医院医疗纠纷成因与对策

目的分析医疗纠纷发生的特点和规律,并提出防范对策和建议。方法采用回顾性分析方法 ,对某军队中心医院2011年—2015年发生的医疗纠纷进行分析。结果医疗纠纷主要责任人以中级职称人员为主;内科纠纷发生率最高,其次是外科;医疗纠纷发生的主要原因为违反规章制度,医疗技术责任,医患沟通不到位,患方缺乏医学知识;医患协商仍是医疗纠纷解决的主要途径。结论医疗纠纷的产生,既有医方因素,也有患方因素,但医方因素仍是主要原因。医院应加强医疗管理,健全和落实规章制度,提高医疗技术水平,规范和完善医疗纠纷的处理办法,以预防医疗纠纷,促进医院健康发展。     

门诊医疗纠纷的原因探讨及分析

目的防范门诊医疗纠纷的发生,提高患者的满意度,从而提高门诊两个效益。方法对我院门诊2006—2007年发生的92例医患纠纷的原因进行回顾性分析,找出发生纠纷的原因,作出相应的防范措施和处理对策。结果发生医疗纠纷的原因主要集中在服务态度（68例）、医疗质量（11例）、收费方面（8例）、其他（5例）等方面。结论医务人员应改变服务意识,以患者为中心,以医疗质量为核心,依法行医,规范医疗行为,加强与患者的有效沟通,切实履行告知义务,能避免绝大多数的医疗纠纷发生。     

医疗纠纷的成因与防范探讨

医疗纠纷是指发生在医患之间的因患方对医务人员或医疗机构的医疗服务不满意,与医方发生的争执。医疗纠纷既可由医疗事故引起,也可由医疗差错引起,还有相当部分则非医疗过失由患方引起。 医疗纠纷古已有之,它伴随着医疗活动的出现而产生。对医疗纠纷的认识,不仅涉及到医学本身的发展,而且与政治、文化、     

抗菌药不良反应发生的患者相关危险因素分析

目的:调查我院一年内抗菌药所致药品不良反应(adverse drug reaction,ADR)病例,分析ADR发生的患者相关危险因素。方法:回顾性调查2012年4月~2013年3月我院所有使用抗菌药的病例资料,分析抗菌药ADR发生的可能危险因素,并对其进行单因素分析与Logistic多因素回归分析。结果:8 629例住院患者中发生抗菌药ADR共171例,发生率为1.98%。单因素分析结果显示,患者的年龄、用药品种数、住院日、疾病严重程度、过敏史、基础疾病、肝功能、肾功能等因素与抗菌药ADR有相关性(P<0.01);而患者的性别对抗菌药ADR的发生无显著影响(P>0.05)。Logistic多因素回归分析发现,住院日、疾病严重程度、基础疾病、过敏史是抗菌药ADR发生的独立危险因素。结论:抗菌药ADR的发生是多种因素共同作用的结果,临床上选用抗菌药应综合考虑患者个体因素,减少ADR发生,保障用药安全。     

结缔组织病损切除术切口感染危险因素及对医疗费用影响的研究

摘 要 目的：探讨结缔组织病损切除术术后切口感染的独立危险因素和切口感染对医疗费用的影响,为有效预防和控制切口感染的发生提供参考依据。方法：抽取某院2014～2016年行结缔组织病损切除术的患者病例共253例,统计分析其临床资料。以患者术后切口是否发生感染作为因变量,以性别和年龄等相关因素为自变量,采用Logistic回归模型分析术后切口感染的独立危险因素。结果：253例行结缔组织病损切除术的患者中位于前三的病种分别为躯干血管瘤（12.25%）、肢体血管瘤（11.46%）和坐骨滑膜囊瘤（9.09%）。共有14例患者发生切口感染,切口感染率为5.53%。单因素分析显示,患者全麻、输血、合并糖尿病基础疾病等3项因素与切口感染的发生具有相关性（P＜0.05）;多因素非条件Logistic回归分析显示,全麻、输血、合并糖尿病基础疾病是结缔组织病损切除术切口感染的独立危险因素（P＜0.01）。感染组的药品费用和医疗总费用明显高于非感染组（P＜0.01）,两组手术治疗费用的差异无统计学意义（P＞0.05）。结论：术前控制患者的基础疾病状态,完善和落实输血制度的管理,提高麻醉医务人员的无菌操作观念,可能有利于控制结缔组织病损切除术发生切口感染的风险和降低相关医疗费用。     

郑州市某三甲医院医务人员高血压相关危险因素的调查研究

目的:调查分析郑州市某三甲医院医务人员高血压患病情况,为医务人员高血压防治提供科学依据。方法:对郑州市某三甲医院1 369名医务人员进行体检,并收集相关体检资料,对医务人员患高血压及相关体检结果进行统计分析,统计高血压患者年龄、职业分布等。结果:1 369名医务人员中共有251人发现高血压,高血压患病率为18.33%;随着年龄的增加,高血压患病率逐步上升。男性医务工作者高血压患病率、三酰甘油偏高率均高于女性;女性医务工作者总胆固醇偏高率、低密度脂蛋白胆固醇偏高率均高于男性;医生高血压患病率最高,医院管理人员高血压患病率最低。结论:郑州市某三甲医院医务工作者由于工作压力大,高血压患病率较高,应进行有针对性的降压、降脂治疗。     

供方视角药物重整发生率与诱发因素分析

目的： 调查药物重整供方相关医务人员药物重整发生率,分析可能诱发药物重整供方相关医务人员行为的因素。方法： 于2019年4月至2019年9月,在湖北省武汉市内选取18家不同类别医疗机构,采用横断面调查,通过线上分发调查问卷,向有关医务人员了解药物重整发生的基本情况,并使用二元Logistic回归模型分析药物重整行为发生的影响因素。结果： 研究最终纳入214例医务人员,药物重整发生率为73.83%;单因素分析结果显示,医务人员所在医疗机构类别（P=0.001）、执业资格（P=0.001）、是否了解药物重整（P=0.002）、是否通过同行交流了解药物重整（P=0.002）、是否主动关注患者全面用药情况（P=0.001）与其药物重整行为的发生具有相关性,且差异具有统计学意义（P<0.05）。Logistic回归结果显示,执业资格、是否了解药物重整、是否通过同行交流了解药物重整和是否主动关注患者全面用药情况是诱发药物重整供方行为的独立影响因素。结论： 虽然样本医务人员药物重整发生率较高,但他们对药物重整的认知程度不足。药物重整行为的发生是医务人员不同执业资格、是否了解药物重整、会否通过同行交流获取药物重整知识和会否主动关注患者全面用药情况多个因素影响的结果。     

上海某三甲医院医务人员职业倦怠现状调查研究

目的 :以上海某三甲医院医务人员为研究对象,调查该院医务人员职业倦怠现状,分析影响职业倦怠的因素、探讨缓解职业倦怠的措施.方法 :通过问卷方式进行调查,采取非参数检验、相关分析、logistic回归分析等方法进行统计分析.结果 :该医院医务人员的职业倦怠集中于中度倦怠水平.人口变量中,年龄、工龄、职称、性别、户籍对职业倦怠各维度有着不同的影响;压力源因素中,组织管理、职业兴趣、医患关系、人际关系对职业倦怠各维度有着不同的影响.结论 :根据相关影响因素,本文提出加强社会支持、降低工作负荷、优化管理体系、调节医患关系、完善职业发展规划等相关措施,以缓解医务人员职业倦怠,提高医疗服务质量.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.