加强医患沟通落实知情同意

知情同意权是患者的一项基本权利.文章阐述了知情同意权的内涵,分析了知情同意与医患沟通的关系,指出了知情同意在临床实施中存在的问题并分析原因,最后从医患沟通的角度,提出落实知情同意权的意见和建议,以改善医患关系.     

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。     

建立以人为本的新型知情同意模式构建和谐医患关系

构建和谐医患关系是构建社会主义和谐社会的重要内容，而医患沟通不够、医患之间缺乏信任和理解等是影响医患关系的重要因素。知情同意是加强医患沟通、增强医患相互信任的重要方式。我们应从生物-心理-社会医学模式的要求出发，通过加强医务人员的医德修养，提高沟通技巧；建立和完善知情同意制度，深化知情同意的内涵；设置和完善心理咨询专科，加强人性化的知情沟通；探索新型知情同意模式；建立和完善医患沟通监督机制和投诉处理制度等．让患者作出更自主、更充分的知情选择，构建和谐的医患关系。     

手术知情同意的实施及改进效果分析

目的探讨综合性三甲医院手术患者知情同意改进实践的干预效果,进一步确保医疗安全,改善医患关系。方法根据上一轮PDCA循环中手术患者知情同意过程的实施缺陷,使用六步法的医疗质量"闭环"管理,采用强化医学人文知识培训和医疗质控,选取一组医生两年同期手术患者的运行病历评估和患者态度调查,将改进前与改进后进行自身比较。结果在知情同意实践过程中,医生的法制意识、医患柔性沟通、知情同意书的执行、患者的满意度及依从性都有显著改进,大多数差异有统计学意义(P<0.05或P<0.01)。结论医疗知情同意的过程,需要外科医生注重与患者的柔性沟通,同时完善落实知情同意告知内容,最后达到规范知情同意书的刚性执行。     

非侵入性产前检测技术知情同意与遗传咨询的国际经验

围绕非侵入性产前检测技术(NIPT)应用于唐氏产前筛查的知情同意与遗传咨询实施,总结分析了国际相关经验与研究,并结合我国国情提出了相关政策建议。建议加强相关人员培训,明确知情告知内容,进一步规范知情同意与遗传咨询的操作实施。     

妇科手术知情同意的特点及应注意的问题

妇科诊疗过程具有与其他科室不同的特殊性。妇科手术知情同意涉及知情同意的签署、明确知情同意的主体、医患之间良好的沟通、知情同意的证据、急诊手术的处理以及知情不同意的处理,这些都是实施妇科手术知情同意应注意的问题,也是防止发生医疗纠纷的关键。     

知情同意--临床医疗服务观念的变革

在临床治疗之前征求患者的意见是医生的职责 ,也是临床医学与有关法律条文所规定的患者权益。在临床治疗之前征求患者的意见是一种社会文化价值的反映 ,它体现了对患者权益的尊重以及个人自治权在道德上的重要性。随着社会文化价值观念的变革和伦理道德的逐步规范 ,知情同意 (Inform ed Consent,IC)在临床医疗服务过程中的作用越来越重要。文章阐述了知情同意在临床运用的发展过程及其在临床治疗过程中出现的一些具体问题 ;分析说明了加强医患关系、向患者提供明确的临床信息以及改善医患交流技巧是知情同意的基本要求。     

重视知情同意过程 防范医疗纠纷

知情同意权是病人在诊疗过程中享有的基本权利之一,尊重和保护病人的知情同意权是医务人员应尽的义务。本文从行使知情同意权的条件入手分析知情同意过程及其作用,以期达到改善医患关系,减少医疗纠纷的目的。     

泛知情同意概念在我国的引入与实践思考

近年来国外正在逐步推行泛知情同意来提升医疗数据和生物样本的利用率, 但泛知情同意可能面临着告知不完善而影响受试者权利等伦理问题。国外对于泛知情同意已有相关规定和实践。我国法律并未明确泛知情同意的概念, 目前在实践中生物样本的处理大致可分为4类, 存在泛知情同意的潜在适用空间。应明确泛知情同意的具体范围, 与捐献行为作出区分, 在保障受试者权利的基础上探索实施泛知情同意。     

论知情同意制度的不足以及术中改变术式的法律责任

知情同意制度贯穿于医疗活动的整个过程,尊重患者的知情同意权是医务人员的法定义务,国内诸多法律法规均对医疗活动中的知情同意做了原则性的规定。但是由于缺乏针对具体医疗行为如何适用知情同意制度的指引或者规范,导致医务人员常常不知如何正确的地履行知情同意程序。而且．当前的知情同意制度存在诸多不足,司法实践也对知情同意缺乏深入的研究．这为医务人员的执业活动带来了潜在的法律风险。     

北京市31家医院乳腺癌化疗住院病历质控结果分析

目的了解北京市31家医院2020年乳腺癌化疗住院病历质控现状,并提出改进建议。方法以2020年北京市化疗质控检查中31家医院的106 份乳腺癌化疗住院病历为研究对象,应用SPSS 22.0软件进行数据统计,采用一般描述性分析、两独立样本t检验、配对样本t检验等方法进行数据分析。结果化疗过程质控亟待改善项目包括药物选择、剂量、用法记录以及化疗知情同意、化疗前常规检查、肿瘤分期,药事质控亟待改善项目为化疗方案确定及药物应用剂量是否有依据说明、药物输注时间是否合理。二三级医院比较,化疗病历质控评分总分、化疗过程质控评分、药事质控评分均不具有统计学意义（P＞0.05）;肿瘤内科化疗病历质控评分总分、化疗过程质控评分与非肿瘤科比较,差异均具有统计学意义（P＜0.05）。结论北京市医院乳腺癌规范化诊疗水平还存在较大改进空间。后续需以乳腺癌单病种质控工作为基础,制定乳腺癌单病种质控指标,规范病历书写,提高非肿瘤科医师乳腺癌化疗能力。     

上海市部分公立医院涉及人体医学研究项目知情同意书的评价

随机抽取上海市8所公立医院145份涉及人体的医学科研项目知情同意书,对其内容、语言和签字状况进行了审核。研究显示,知情同意书总体符合研究伦理要求,但仍存在不足。为此,建议规范知情同意书的的内容。     

Informed consent for dentistry in public hospitals, Federal District, Brazil

Personal powers of decision and individuality must be respected, grounded on autonomy expressed through informed consent. This paper examines data on the actual use of informed consent in public hospitals in Brazil's Federal District. A questionnaire was completed by dentists in public hospitals, and its findings show that verbal informed consent is obtained at the start of treatment in most of the hospitals. Errors were noted in the use and conceptualization of informed consent. Failing to distinguish between image rights authorization and informed consent, the documents provide little information and do not explain important aspects of the treatment. Dentists practicing in the public hospital network thus need more detailed knowledge of basic bio-ethics in order to merge the long-consolidated and regulated principle of welfare with the principle of autonomy.     

Patients' perceptions of informed consent in acute myocardial infarction research: a Danish study

Seeking informed consent from patients in the acute phase of acute myocardial infarction (AMI) poses an ethical challenge due to the fact that these patients are under stress and require urgent medical attention. The very procedure of informed consent, which is supposed to protect eligible patients, may in fact cause harm due to a potential delay in the provision of therapy. Whether or not informed consent can and should be obtained under these particular circumstances is far from evident. Patients participating in various large-scale AMI trials have been enrolled with, as well as without, informed consent in recent years. Little is known, however, about how patients experience the informed consent process in the emergency situation of an AMI. This paper reports the results from qualitative interviews with 32 patients, who had to decide whether or not to participate in a large multi-centre clinical trial in Denmark. We analyse to what extent patients found the informed consent process acceptable as well as how various factors influenced their experience of the consent process. We argue that it is morally sound to involve those patients in a brief and concise informed consent process and that consent should be sought in such trials. Finally, we discuss how future AMI trials may nonetheless be improved by accommodating some of the concerns of the patients.     

The performance and perception of informed consent in a health-care section of Catalonia

BACKGROUND: Informed consent entails a process which involves more than signing a form to give one's consent. This process involves the mutual exchange of information, understanding, trust and consent between physician and patient. The purpose of this study is that of ascertaining the degree to which those consumers who have gone through the informed consent process in a health care district in Catalonia have filled out and fully understood this form. METHODS: Telephone survey conducted among 314 former surgery patients at hospitals in a given district, ages 18-75, who had undergone surgery within the three months immediately prior to the date on which the survey was conducted for the purpose of ascertaining the opinion of these consumers regarding the consent process. A review of the clinical records of 30% of these individuals was conducted for the purpose of ascertaining the degree of compliance with the consent form process. RESULTS: Sixty-one percent (61%) of the patients surveyed remembered having signed the consent form, 59.2% recalling explanations regarding risks or complications of the surgery they were to undergo. Nine percent (9%) did not understand well enough what was going to be done to them during the surgery, and 36% were of the understanding that the consent form released the health care professionals from liability. A statistically significant relationship was found to exist among the age group, educational level and admissions channel. Seventy-eight percent (78%) of the clinical records reviewed included informed consent forms. The diagnosis was stated on 14.9% of these forms, and 48.9% had been signed by the attending physician. A statistically significant relationship was found between the channels through which patients were admitted to the hospital. CONCLUSIONS: The informed consent process is not being implemented correctly at the two hospitals analyzed. Physicians are not totally involved in the process.     

Mixed methods, mixed methodology health services research in practice

Mixed methods, mixed methodology research is a little documented but increasingly accepted approach employed to investigate organizational phenomena. The author presents a synthesis of literature that informed the decision to adopt a mixed methods, mixed methodology, dominantly naturalistic study approach to health services research in which she explored the process and organizational consequences of new artifact adoption in surgery. She describes the way whereby a collective case study involving five Australian hospitals yielded quantitative and qualitative data that were analyzed using inductive and/or deductive reasoning. She goes beyond the theoretical rational for employing a mixed methods, mixed methodology approach to present a summative conceptual model of the research process and describe the structural aspects of the dissertation in which the research was reported that should benefit researchers contemplating the value of such an approach.     

知情同意原则及其对医院管理的启示

随着社会与医学进步，知情同意作为医疗实践的一个基本原则越来越为人们所接受和认可，但是从目前的实际情况来看，在我国要想真正实现的知情同意权还存在诸多困难，医院在实施知情同意的过程中还存在种种制约因素，本文拟从医院管理的角度提出相应的管理措施。     

整形美容手术中知情同意的伦理探讨

目的 明确知情同意在整形美容行业中的必要性和重要性,探讨其中隐藏的伦理学意蕴,用知情同意这一重要的伦理原则规范医务人员的行为.方法 使用文献检索法、专家咨询法、抽样调查等方法对整形美容手术中的知情同意情况进行调查,分析实施过程中的规范化情况和遇到的难点和伦理困境.结果 整形美容医师牢牢把握了知情同意这一原则,作为术前常规工作执行,但在实际操作过程中还有些难点.结论 整形美容医生应规范履行知情告知义务,尊重患者的知情权;院方须制定一系列的制度来规范知情同意这一原则.     

紧扣市场 创新民营医院宣传路径

针对医院宣传工作的必要性、存在的宣传误区进行剖析,并结合笔者医院的宣传工作总结了民营医院宣传的方法和思路以及在此过程中应该注意的问题,并阐述了作为民营医院应该善于创新宣传路径在民营医院发展中起到的关键作用。