认真履行告知义务,积极防范医疗纠纷

自2002年9月新的医疗事故处理条例实施以来,医院对维护患者知情同意权及认真履行告知义务有了更为深刻的认识,告知行为已成为医疗活动中极其重要的组成部分.但在如何实施告知方面,仍存在一些不易把握的问题,一些医院及医务人员尚不能规范、科学的实施告知义务,由此给医疗工作带来了一定的影响,甚至成为引发医疗纠纷的重要成因.文章就如何履行告知义务、维护患者知情同意权和防范医疗纠纷的发生进行了简要分析.     

重视知情同意 减少医疗纠纷

探讨了医务人员对不同患者、不同病种应告知的内容、事项、告知方式等问题。在医疗活动中,医务人员应履行告知义务,保障患者的知情同意权。只有重视知情同意,执行和落实知情同意制度,加强医患沟通,才能保证医疗安全,减少因知情同意告知不全而引发的医疗纠纷。     

浅谈患者的知情同意权

知情同意权是指患者有权知悉自己的病情并可以对医务人员采取的医疗防治措施、药物使用等决定进行取舍，主要目的在于通过赋予医疗机构及其医务人员相应的告知义务，使患者在了解自己将面临的风险、付出的代价和可能取得的收益的基础上自由做出选择，从而维护患者的利益，改变患者的弱势地位。从完整意义上来说，知情同意权包括：了解权、被告知权、拒绝权和同意权。     

知情同意类型及法律属性探讨

医疗损害赔偿案例常常涉及到医疗机构履行告知义务和患者知情同意权的争议.我们在此根据我国现行法律、法规,探讨医务人员应告知的内容事项及告知方式、患者或其家属签署的各种意见的法律属性及其证据效力等问题,旨在警示医务人员在履行告知义务中应注意的事项[1].     

尊重患者知情同意权 构建和谐医患关系

因侵害患者知情同意权引发的医疗纠纷越来越多,已影响到和谐医患关系的构建。医疗机构及其医务人员应当充分认识患者知情同意权的本质,尊重患者知情同意权;增强责任心,防止过失侵害患者知情同意权;提高医疗水平,避免对患者知情同意权的侵害;严格规范告知义务履行的程序和方式,防止医患之间因侵害知情同意权而发生纠纷,保护医患双方的合法权益,构建和谐的医患关系。     

医务人员的告知说明义务与患者的知情同意权刍议

医务人员的告知说明义务与患者的知情同意权是一个难以理清的问题。文章从如何履行医务人员的告知说明义务入手阐述了如何保证患者同意权的实现，以及不履行该项义务或履行有瑕疵时法律责任承担问题。     

医疗机构医患沟通管理体系的构建与管理实践探索

在《基本医疗卫生与健康促进法》《民法典》等法律法规实施背景下,为提升医疗安全管理水平,保障患者知情同意权,促进医患之间有效沟通,四川大学华西医院致力于构建和完善医患沟通管理体系的实践探索,开展了明确管理架构,制定规章制度;分层分类进行医患沟通能力培训;规范化使用和管理知情同意书,强化医务人员在诊疗活动过程中对疾病诊断、治疗方案、医疗风险、替代医疗方案、治疗费用等的告知义务,保障患者知情同意权;拟定各类特殊情形下的医患沟通流程;建立专用谈话室,运用信息技术予以保障;开展医患沟通问题分析,不断持续改进等一系列举措。实施以来,院内医患沟通规范化水平显著提高,有效保障了患者知情同意权,为构建医患和谐关系奠定了坚实基础。     

《侵权责任法》施行后一例法院判决引发的思考

知情同意权是患者享有的基本权利.若医护人员没有有效履行告知义务,侵犯患者的知情同意权,造成患者损害,医疗机构承担赔偿责任.《侵权责任法》施行后,医护人员在诊疗活动中须特别注意尊重患者的知情同意权,依法有效履行告知义务.     

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 ,…     

患者“被自费”引发的思考

近年来,大量的侵犯患者知情同意权纠纷的案例不断涌现。据统计,全国每年医疗纠纷案件数以万计,并且以11％的速度递增。在这些案件中,认为医方未履行告知义务,侵犯患方知情同意权的超过60％。患者选择侵犯其知情同意权之诉呈迅速增长之势向广大医务人员敲响警钟,我国医生“告知”意识亟待提高。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.