The number one myth of asset protection: why you can lose assets in a medical malpractice lawsuit

The thinking of many physicians around the country, and unfortunately their advisers as well, is that there is little risk of a physician losing personal assets in a malpractice claim, especially with typical dollars 1-3 million malpractice insurance coverage. This article dispels that myth and shows that the benefit in engaging in asset protection planning far outweighs the cost.     

北京市某三级甲等综合性教学医院医疗质量评价——住院死亡率

目的探讨使用住院死亡类指标评价北京市某三级甲等综合性教学医院医疗质量。方法基准比较,包括以年度为基准的医院自身纵向比较和以领先者为基准的医院间横向比较。结果该医院住院患者总死亡率,特别是手术患者住院死亡率呈逐年下降趋势;围手术期死亡率与重返手术室患者住院死亡率呈波动状态。在5所同地区、同类、同级别医院中,该医院2006年手术患者住院死亡率和重返手术室患者住院死亡率处于第二位;住院患者总死亡率处于第三位,围手术期死亡率处于第四位。结论该医院医疗质量相对稳定并有所改善,但在5所同地区、同类、同级别的医院中尚未达到领先水平。     

Bedside rationing by health practitioners: a case study in a Ugandan hospital.

PURPOSE: The purpose of this study was to describe bedside rationing by health practitioners in a teaching hospital in Uganda. METHODS: This was a case study involving in-depth interviews. A modified thematic approach was used in data analysis. Types of decisions, the decision-making process, key players, and hospital-, medical-, and patient-related considerations in the process were identified. Klein's 6 forms of rationing were used to identify the forms of rationing used. The setting was a tertiary hospital in Uganda. Theoretical sampling was used to identify 40 doctors and 16 nurses from the Departments of Medicine, Surgery, Paediatrics, and Obstetric and Gynaecology. RESULTS: Four types of bedside rationing decisions were identified: 1) which patients are seen first, 2) which treatment the patients receive, 3) which patients are admitted, and 4) which patients are taken to the operating theatre first. Hospital-related considerations regarding bedside rationing included the hospital budget and number of beds; medical-related considerations included the patient's diagnosis and effectiveness of treatment; and patient-related considerations included poverty, social status, and age. All forms of rationing (denial, dilution, deflection, deterrence, delay, and termination) were practiced. CONCLUSION: Although bedside rationing decisions in the study hospital seem somewhat similar to that in developed countries, the rationing of 1st-line drugs by health practitioners in Uganda is complex, difficult, and different from what has been described in industrialized countries. The complexity and severity of the consequences of the bedside decisions necessitate the development of resource-sensitive clinical guidelines and transparent decision-making processes to foster patients' understanding of the reasons and the procedures and to ensure fair decision-making processes.     

Community health care and hospital attendance: a case study in rural Ghana

This study assesses the influence of coverage with a network of PHC clinics as well as private clinics in Dormaa District, Ghana on, hospital attendance. This influence is measured by analysing hospital attendance among inhabitants during 6 months in 1984 and 1986. Several conditioning factors are analysed: the type of modern health care present in the community and the experience of the community health worker (CHW); the distance between community and hospital; the time factor (1984 and 1986); the sex and age of the attendants; the diagnosis made at the hospital. It appears that fewer people attend the hospital if a community participates in the PHC programme and if the CHW is experienced. When people from these communities attend the hospital they do so less unnecessarily than those from other communities. Simple analysis of routine hospital data may contribute to any PHC assessment programme set up around the hospital.     

Integrating qualitative research into occupational health: a case study among hospital workers

OBJECTIVE: We sought to better use qualitative approaches in occupational health research and integrate them with quantitative methods. METHODS: We systematically reviewed, selected, and adapted qualitative research methods as part of a multisite study of the predictors and outcomes of work-related musculoskeletal disorders among hospital workers in two large urban tertiary hospitals. RESULTS: The methods selected included participant observation; informal, open-ended, and semistructured interviews with individuals or small groups; and archival study. The nature of the work and social life of the hospitals and the foci of the study all favored using more participant observation methods in the case study than initially anticipated. CONCLUSIONS: Exploiting the full methodological spectrum of qualitative methods in occupational health is increasingly relevant. Although labor-intensive, these approaches may increase the yield of established quantitative approaches otherwise used in isolation.     

美国州公共卫生法律示范项目对我国立法启示

  目的  评价京沪两地法律体系对妇女保健的保障程度及其与孕产妇死亡率的关系,验证适宜的法律保障程度的定位及其于京沪的意义。  方法  系统收集两地所有妇女保健相关的规范性法律文件,综合法律体系完备程度、法律地位保障程度、刚性约束程度以及主动完善相关法律的程度,量化计算法律体系的保障程度,并使用Spearman秩相关和线性回归模型分析法律体系的保障程度与孕产妇死亡率的关系。  结果  京沪两地妇女保健的法律体系保障程度均呈现逐步上升的趋势,北京由1990年的30.2 %上升至2017年的69.8 %,上海由1990年的43.5 %上升至2017年的70.6 %。两地的妇保法律体系保障程度与孕产妇死亡率均呈负相关（相关系数均大于0.75）。拟合回归方程显示,京沪法律体系保障程度对孕产妇死亡率变化的解释程度分别为57.5 %和82.8 %。  结论  完备的法律体系对引领、规范妇女保健体系的运行与发展的作用不可替代。两地已逐步形成较为完善的法律体系,但在法律的刚性约束程度方面均需要进一步加强。     

北京某教学医院医学生健康素养认知情况研究

目的 了解北京某教学医院医学研究生对自身和患者健康素养认知情况.方法 采用便利取样的方法,选取2015年9月在北京市某高校教学医院在读的临床医学专业研究生80名进行问卷调查.结果 共收到有效问卷71份,有效回收率为88.75％.医学学习时长为(4.68±2.55)年,调查对象研究素养平均得分为(72.14±13.86)...     

Managerial procedures and hospital practices: a case study of the development of a new medical discipline

In anesthésie-réanimation, a discipline that brings together anaesthesiology and emergency as well as intensive care, the managerial methods of evaluation and control of needs in personnel, were not adequate for describing medical practices. Around four managerial standards that were used by the Paris public hospital administration, new situations have crystalized. The historical analysis of how these standards have been put into use, used and put in question throws light upon the way organizations function. The present day situation in this speciality seems to be mainly determined by the strategies of specialists for obtaining professional recognition of their discipline and for advancing their careers.