精神分裂症患者及其家属对住院知情同意权的态度及影响因素

目的探讨精神分裂症患者及其家属对患者住院知情同意权的态度及其影响因素。方法对符合CCMD-3的精神分裂症患者及其法定监护人各986例,进行患者知情同意和入院方式的相关调查。结果家属让患者对住院知情387例(39.2%),不让知情599例(60.8%);患者同意入院249例(25.3%),不同意入院737例(74.7%)。影响患者享有住院知情权的因素是:监护人态度和患者的性别、MOAS总分、自身攻击因子分、体力攻击因子分、有攻击行为、PANSS总分、P分、SI分、G分;影响患者自愿入院的因素是:监护人态度和患者MOAS总分、体力攻击因子分、SI分、P分、G分和攻击行为。结论目前精神分裂症患者对住院的知情同意率和自愿入院率仍很低;监护人和患者的特征都影响患者家属对患者知情同意权的态度;精神分裂症患者住院与否主要取决于监护人的态度;保证监护人的知情同意权是解决患者住院和减少医疗纠纷的关键。     

发作期躁狂症患者知情同意状况及影响因素

摘要：目的 了解发作期躁狂症患者对就诊和住院的知情同意状况，探讨影响患者享受知情同意权的相关因素，寻找既能让患者得到及时就诊和住院治疗，又能避免因患者知情同意问题引起医疗纠纷的方法。方法 采用自编知情同意调查表及外显攻击行为量表（ＭＯＡＳ）、Ｂｅｃｋ ｒａｆａｅｌｓｅｎ躁狂量表（ＢＲＭＳ）、临床疗效总评量表的严重程度分量表（ＳＩ），对１２４例患者进行 问 卷 调 查，对相关因素进行单因素和多因素Ｌｏｇｉｓｔｉｃ回 归 分 析。结 果 患者对就诊知情４８ 例（３８.７１％），同意就诊４０例（３２.２６％）；对住院知情３０例（２４.１９％），同意住院２３例（１８.５５％）。ＭＯＡＳ总分１５.１９±５.６９，其中言语攻击２.１１±１.１５，财产攻击３.５１±２.０８，自身攻击３.０９±３.２６，体力攻击６.４８±４.２４；ＢＲＭＳ总分２２.２６±３.０９，ＳＩ３.４８±０.６３；患者对就诊和住院的知情状况与性别、职业、ＢＲＭＳ总分、ＳＩ、ＭＯＡＳ总分、财产攻击、自身攻击、体力攻击密切相关（Ｐ＜０.０５，Ｐ＜０.０１）；患者对就诊和住院的同意状况与ＢＲＭＳ总分、ＳＩ、ＭＯＡＳ总分、财产攻击、自身攻击、体力攻击密切相关（Ｐ＜０.０５，Ｐ＜０.０１）。结论 患者对就诊和住院的知情率和同意率仍较低；对就诊和住院知情、同意受多种因素的影响；由家属享受知情权、选择权是可行的；既不能忽视患者的知情同意权，也不能盲目地强调患者的知情同意权，保证患者监护人对就诊和住院治疗的知情同意权是减少医疗纠纷的关键。关键词：躁狂症；　知情同意；　法定监护人；　数据收集中图分类号：Ｒ４７３．７４　　文献标识码：Ｂ　　文章编号：１００１-４１５２（２００７）０５-００５７-０３     

食管癌患者不同知情程度对照顾者生活质量的影响

目的:探讨食管癌患者的知情状况对照顾者生活质量的影响。方法:随机选取200例食管癌患者及其照顾者,嘱其填写自制的知情度问卷、生存质量问卷,然后对所得资料进行统计学分析。结果:200例患者中,68例(34%)为完全知情,92例(41%)为部分知情,40例(25%)为完全不知情。照顾者是否选择告知患者病情真相与照顾者受教育的程度有关(rs=0.89,P=0.007)。三组不同知情状况患者的照顾者,其生理机能、躯体疼痛、一般健康状况、精力和精神健康总体生活质量的差异均有统计学意义(P0.05)。结论:食管癌患者对疾病的知情程度对其照顾者有很大影响,采取适当的方式、方法,提高患者对疾病的知情度,有助于提高其照顾者的生活质量。     

知情程度对中晚期肺癌化疗患者治疗依从性及生活质量的影响

目的:探讨知情程度对中晚期肺癌化疗患者治疗依从性及生活质量的影响。方法:选取96例中晚期肺癌化疗患者(首次化疗52例,非首次44例)作为研究对象,在入院3 d内进行知情程度调查,采用量表法对患者用药依从性、合理呼吸功能锻炼配合程度及生活质量。结果:首次化疗周期完全不知情者用药依从性、合理呼吸功能锻炼配合程度及生活质量均优于完全知情者及部分知情者(P0.05);非首次化疗周期部分知情者治疗依从性、合理呼吸功能锻炼配合程度及生活质量均优于完全知情者及完全不知情者(P0.05)。结论:对于中晚期肺癌化疗患者,应酌情逐步落实患者知情权,提高其生活质量及护理依从性,从而使其有效配合医护人员完成诊疗工作。     

癌症患者实施保护性医疗后对病情的知情程度分析及对策

对46例家属要求进行保护性医疗的癌症患者,采用自行设计的评估表调查其对病情的知情程度。结果发现:实施保护性医疗后,本组患者对疾病完全知情0例,部分知情10例(占22%),不知情25例(占54%),怀疑癌症11例(占24%)。认为应与家属沟通,转变家属要求保密的观念;对部分知情及持怀疑态度的患者,满足其了解疾病的愿望,积极告知,并给予心理护理;对完全不知情的患者,进行有限告知。这对提高患者满意度及疾病宣教率非常有效。     

重性精神疾病患者出院后参加社区管理治疗的现状及影响因素分析

目的了解重性精神疾病患者出院后同意参加社区管理治疗的现状及影响因素。方法对2011年出院的1 021例重性精神疾病患者所填写的社区管理治疗知情同意书进行回顾性分析。结果同意参加社区管理治疗患者为588例(57.59%),不同意参加患者为433例(42.41%);不同意参加社区管理治疗的患者与性别(男性)、年龄(25岁)、居住地(城市)等因素相关,经比较,P0.01。结论重性精神疾病患者出院后同意参加社区管理治疗比例较低,与性别、年龄、居住地有关。     

知情与不知情对消化道肿瘤患者自身生活质量的影响

目的分析消化道肿瘤患者对自己所患病名知情与不知情对自身生活质量的影响。方法回顾性总结39例消化道肿瘤患者,分析22例对自己病名病情知情患者的生活质量和17例对自己病名病情不知情的生活质量,并进行对比分析,观察其对生活质量的影响。结果知情患者的生活质量和心理障碍程度与不知情患者的生活质量和心理障碍有明显差别(P<0.01)。结论消化道肿瘤患者对疾病知情则主动配合治疗,生活质量及生存期都明显提高和延长。     

知情与不知情对消化道肿瘤患者自身生活质量的影响

目的分析消化道肿瘤患者对自己所患病名知情与不知情对自身生活质量的影响。方法回顾性总结39例消化道肿瘤患者，分析22例对自己病名病情知情患者的生活质量和17例对自己病名病情不知情的生活质量，并进行对比分析，观察其对生活质量的影响。结果知情患者的生活质量和心理障碍程度与不知情患者的生活质量和心理障碍有明显差别(P&;lt;0．01)。结论消化道肿瘤患者对疾病知情则主动配合治疗，生活质量及生存期都明显提高和延长。     

消化道肿瘤病人的知情程度对生活质量及满意度的影响

[目的]探讨消化道肿瘤病人的知情程度对生活质量以及满意度的影响。[方法]将2014年8月—2016年10月收治的120例接受化疗的消化道肿瘤病人依据知情程度分为完全知情组、部分知情组和不知情组3组,每组40例,按照知情程度的不同给予不同的护理措施,分别对其接受化疗3个月后生活质量状况以及住院满意度进行调查。[结果]化疗3个月后,与不知情组比较,部分知情组和完全知情组病人具有较好的生活质量以及满意度,差异有统计学意义(P0.05);完全知情组和部分知情组生活质量以及满意度比较,差异有统计学意义(P0.05)。[结论]消化道肿瘤病人对病情完全知情有利于更好地对其进行护理,提高病人生活质量以及对医疗工作的满意度。     

知情同意告知书的设计与应用

为减少医疗护理纠纷,维护病人就医的知情同意权,增强医患之间的理解和信任,我科自2000年1月起,自行设计知情同意告知书,在临床实际应用中收到满意效果。     

急性期精神分裂症患者知情权问题探讨

目的探讨急性期精神分裂症患者住院过程中的知情权问题。方法将630例精神分裂症患者按人院顺序分为A组316例和B组314例；A组只让家属享受知情同意权，B组先让家属享受知情同意权，如家属同意让患者享受知情权，再让患者享受知情权，如患者拒绝住院，在家属同意的情况下强制住院。根据家属的意愿，两组之间可相互调整，调整后的A组为研究组382例，B组为对照组248例。于患者入院24h内采用攻击行为量表、阳性症状和阴性症状量表、临床总体印象量表评定两组患者的临床特征，采用自拟问卷统计患者及家属的一般资料，并进行对比分析。结果60．63％家属不同意让患者享受知情权，不同意享受知情权患者的特征是：男性多，年龄低，病程长，受教育年限短，从事体力劳动者，性格外向，家族史阳性者，有攻击行为，阳性症状和阴性症状量表总分及P分和G分，临床总体印象量表严重程度总分，攻击行为量表总分及4个因子分高。结论急性期精神分裂症患者的知情权可以转移给患者的法定监护人；既不能忽视患者的知情权，也不能盲目地强调患者的知情权，最重要的是保证患者监护人对就诊和住院治疗的知情同意权。     

知情同意在护理实践中存在的问题与对策

为减少和避免知情同意在护理实践中的矛盾，笔者分析了知情同意在护理实践过程中出现的问题：知情同意与医疗保护的矛盾；与医患双方医疗知识不平等的矛盾；与正常医疗护理行为不一致的矛盾；告知病人知情权时医与医、医与护不一致。并针对问题提出相应对策：增强法律知识学习；处理好知情权与医疗保护；与患者沟通的过程中用简洁明了、浅显易懂的语言描述问题；尊重病人的自主权；维护病人知情权中的医护一致性。     

医患双方对医疗知情同意书意见的调查

目的探讨医患双方对医疗知情同意书的意见,以期为修改医疗知情同意书提供参考依据。方法收集不同等级医院的医疗知情同意书进行分析。采用自制的调查问卷对某医院100名医生和100名患者进行医疗知情同意书意见的调查。结果医患双方在医疗知情同意书的性质、过程、签署及改进方面的差异均有统计学意义(均P<0.05)。结论临床现行医疗知情同意书仍有许多方面不能达到医生及患者的要求,且绝大部分的医生及患者均认同知情同意书应采取全国统一格式。     

从"知情同意"谈患者的权利

在近几年繁多的医疗纠纷中,围绕知情同意权的纠纷不在少数,本文主要围绕患者的知情同意权 进行分析,并介绍了患者在诊疗护理过程中享有的主要权利。保护患者的权利,不仅要加强医护人员的法律意识, 而且要加强医护人员与患者之间的沟通和交流,如在患者的知情同意权的实现中,医护人员加强语言社会化,使之 能与患者更好的沟通,使得患者对相关事宜有更好的了解,也是减少医患纠纷的措施之一。     

An Approach to Community Consultation Prior to Initiating an Emergency Research Study Incorporating a Waiver of Informed Consent

OBJECTIVES: In November 1996, the Food and Drug Administration (FDA) and the Department of Health and Human Services (DHHS) enacted rules allowing a narrow exception to the requirement for prospective informed consent when enrolling critically ill patients in clinical research studies of emergency treatments. These rules require that, prior to initiation of the study, the applicable institutional review board (IRB) assess the acceptability of the proposed research study to members of the community in which the research will be conducted. Specifically, the IRB must perform community consultation-a process during which community members learn about the proposed research and communicate their opinions regarding its acceptability to investigators or IRB representatives. The FDA and DHHS rules do not define specific acceptable methods for performing this community consultation. The objective of this study is to demonstrate the feasibility and utility of one proposed method for performing such community consultation. METHODS: Parents of children being seen for minor traumatic injuries in three pediatric EDs were asked to participate in a study regarding informed consent. After consent, an instructor described to the parent a prospective, randomized, placebo-controlled trial of phenytoin for the prophylaxis of posttraumatic seizures in children with severe closed head trauma. All parents were then asked whether they would have consented for their own child's participation, if their child had suffered such head injury. The parents were further asked to explain the reason(s) for their responses. RESULTS: Parents of 227 children (children's mean +/- SD age 8.0 +/- 4.8 years, 57% male) were interviewed. Sixty-six percent of parents (149/227) stated they would give consent for their child's participation. Of the 149 consenting parents, 85% (126/149) cited potential benefit to their child, 72% (107/149) cited potential benefit to other children, and 60% (90/149) cited furthering medical knowledge. Of the 78 nonconsenting parents (34% of total), 54% (42/78) cited fear of adverse effects, 39% (30/78) did not want their child to be a research subject in general, 27% (21/78) believed they needed to discuss participation with family members who were unavailable, and 26% (20/78) stated they were unable to decide unless they were in the actual situation. Parental ethnicity and household income were found to influence the consent decision, while the parent's gender, religion, language, and educational level were not associated with the consent decision. CONCLUSIONS: Community consultation regarding the acceptability of an emergency research protocol can be obtained via interview techniques in the ED. This methodology may allow investigators to obtain data on opinion from a targeted community for IRB consideration during the review of emergency research studies proposing a waiver of informed consent.     

A change in the Dutch Directive on Medical Research Involving Human Subjects strongly increases the number of eligible intensive care patients: an observational study

Objectives To determine the effect of a change in the “Dutch Directive on Medical Research Involving Human Subjects” (DD) on the number of eligible intensive care unit (ICU) patients for medical research. In addition, we determined how family members experience their role as acting representative for giving informed consent, and in turn whether patients feel their representatives would do well representing them.Design and setting Prospective observational study in three Dutch ICUs.Participants 714 consecutive ICU patients. Analysis was restricted to 211 patients who were incapacitated for more than 24 h after ICU admission.Measurements and results The old DD left 45.5% of patients without a legal representative; with the new DD this figure declines to 8.1%. Older age was significantly associated with the impossibility of obtaining informed consent in the old DD; after the change there was no effect of age. The median grade of confidence that representatives had in giving informed consent for incapacitated patients was 8.0 (IQR 7.0–9.0) on a scale from 0 to 10. Patients gave an equal median grade to their representatives.Conclusion When patients' adult children are not legally allowed to give informed consent, older patients are excluded from medical research, causing selection bias. The change in the DD has increased the number of surrogates allowed to give informed consent. Representatives felt very confident in their ability to represent the patients. In turn patients were equally confident that their representatives were able to represent them.This article is discussed in the editorial available at:     

耳鼻咽喉科22起医疗护理纠纷的原因分析及对策

笔通过分析耳鼻咽喉科22起医疗护理纠纷,认为发生在耳鼻咽喉科的医疗护理纠纷与专科的自身特点,社会问题．医患关系紧张．医护人员依法自我保护意识薄弱,医疗护理服务不到位,没有严格执行医疗护理的规章制度等因素有关。提出不断加强法制教育．强化医护人员的法律法规意识：提高医疗护理服务和管理水平;深入开展围手术期健康教育;增强服务意识,尊重患的隐私权和知情同意权：建立新型的医患合作关系是防范耳鼻咽喉科医疗护理纠纷的重要途径。     

新生儿科知情谈话记录单的设计与应用

目的应用知情谈话记录单，降低医患纠纷的发生率并提供法律依据。方法将患儿住院期间的病情、治疗护理方案、治疗费用、检查结果等真实情况告知患儿父母并在知情谈话记录单上签名。结果患儿父母对医护工作满意度由95．07％上升至99．13％，投诉率由2．61％下降至0．58％。结论知情谈话记录单的应用有利于提高患儿父母的满意度，减少医患纠纷。     

A preliminary study on the knowledge and attitudes of physicians at two university hospitals towards the medical insurance system of Japan

In this preliminary study, we surveyed the physicians at two academic hospitals on their knowledge of and attitudes toward the medical insurance system in Japan. Most of the physicians had not read the "Ministerial Ordinance on Insurance Medical Institutions' and Insurance Medical Doctors' Medical Treatment under Health Insurance." Of the 433 physicians who filled out the questionnaire completely, 34% had either not read or rarely read the "Medical Fee Point List." Most (89.1%) of the physicians knew that there is a stepwise reduction in the hospitalization fee as the length of a patient's hospital stay increases. However, approximately 30% did not know the stipulation of obtaining an informed consent from the patient prior to blood transfusion. As for the right of patients to see their medical care remuneration statements, which was decided by the government in 1997, 26.8% of the physicians did not know this rule. Physicians who had read the "Ministerial Ordinance on Medical Treatment," were more likely to read the "Medical Fee Point List" frequently; were more likely to know the stipulation about diminishing hospitalization fee; were more likely to know that an informed consent must be obtained prior to blood transfusion; and were more likely to know that patients had a right to see their medical care remuneration statements. The longer the clinical experience of the physician, the more likely that the physician had read the "Ministerial Ordinance on Medical Treatment" and know the other stipulations well. In these two academic hospitals, it is important to establish educational seminars for physicians on the guidelines of the medical insurance system so that physicians will become familiar with the medical insurance system quickly.