骨科医师面临的医疗风险(二)

希波克拉底誓言要求医生全心全意为患者提供最佳的帮助，一个训练有素的医生如果自始至终遵从这一准则，就会将目前的医疗风险降到最低，而良好的医患关系也有助于消除医疗纠纷。导致医疗纠纷的最主要原因是医生未能正确认识到医疗本身是一门艺术而并非是医生学科水平的不足。急诊室是医疗纠纷高发之地，而纠纷的发生率与患者的受伤程度并不成正比，实际上．往往是较轻程度的损伤更易导致医患矛盾。     

Mandatory reporting of sexual abuse in Ontario

You are taking a history from a new patient. The patient, a young woman, tells you she wishes to change practiotioners because she feels uncomfortable with her previous practitioner. Her previous practitioner took a detailed sexual history which seemed irrelevant to you. During the taking of the history he commented that, given the number of her sexual partners, she would not need any sexual counselling. The prior practitioner also displayed a “swimsuit edition” calendar in his office and drew her attention to Miss May as an example of poor lifting technique. Miss May was lifting a beach ball without bending her knees. The patient requests that your keep this informatino strictly confidential, but that she wanted you to understand why she was switching practitioners.     

骨科医师的医疗风险(三)

随着骨科器械的发展，特别是内置物的成功设计，骨科医生们变得越来越专业化。但这些内置物本身存在着失效的风险。骨科医生们应该对在应用这些产品的过程中潜在的危险保持警惕。医务工作作为工业化时代的一项大规模服务体系，正面临着飞速的发展，它已不仅仅是一种职业。这种变化不仅使患者的期望值越来越高，而且使医生的社会角色发生着深刻的改变。     

骨科医师面临的医疗风险(一)

骨科学自1960年来获得了长足的进步，这种进步一方面提高了人们的生活质量，另一方面，由于技术上的革新，特别是骨科器械的创新改变了患者的社会目标，骨科医师的从业风险也因这种进步而大大的增加。除非整个社会能够达成共识，将医生不仅仅看成疾病的治疗者而且是患者社会目标的实现人，否则这种日益加大的风险短期内无法消除。对于骨科医师来说，其所作所为与这种风险系数密切相关，与患者进行良好的沟通并能做到关爱患者可以将这种风险降到最低；而一旦骨科医生面临医疗纠纷，如何作出正确的应对是非常重要的，医生必须熟悉这一过程中的法律程序，并与律师一起做好充分的准备以应对可能出现的法律诉讼。     

Management of erectile dysfunction： barriers faced by general practitioners

Aim: To explore the barriers faced by general practitioners (GPs) in the management of patients with erectile dysfunction (ED). Methods: This was a qualitative analysis of focus group discussions and in-depth interviews involving 28 Malaysian GPs. Results: GPs‘ perception of ED being not a serious condition was a major determinant of their prescribing practice. Doctor‘s age (younger), gender (female), short consultation time and lack of experience were cited as barriers. The GPs‘ prescribing habits were heavily influenced by the feedback from the first few patients under treatment, the uncertainty of etiology of ED without proper assessment and the profit margin with bulk purchase. Other barriers include Patients‘ coexisting medical conditions, older age, lower socio-economic status, unrealistic expectations and inappropriate use of the anti-impoteneet drugs. Cardiovascular side effects and cost were two most important drug barriers. Conclusion: The factors influencing the management of ED among the general practitioners were multiple and complex. An adequate understanding of how these factors (doctors, patientsand drugs) interact can assist in the formulation and implementation of strategies that encourage GPs to identify and manage ED patients.     

Allocation of medical resources: problems faced by the practicing neurosurgeon

The allocation of medical resources by the neurosurgeon begins with the patient-physician relationship and is increasingly affected by managers of third-party payers, the desire for patient autonomy, quality assurance regulation, state regulatory requirements, and the present recriminatory legal system. In addition, fiscal constraints within institutions impact on decisions regarding the allocation of medical resources by the physician. Beyond these micro-allocation problems lie the macro-allocation difficulties at the levels of state and federal government, where concepts of equality and justice--as they relate to allocation of resources--are altered by political forces; aging populations; new, devastating diseases; availability of rapidly improving technical, diagnostic, and treatment modalities; and the attendant costs and related tax burdens on the populace.     

The National Bowel Cancer Audit: the risks and benefits of moving to open reporting of clinical outcomes

Background The government’s proposals to openly report clinical outcomes poses challenges to the National Bowel Cancer Audit now funded by the UK department of health. Aim To identify the benefits and risks of open reporting and to propose ways the risks might be minimized. Methods A review of the literature on clinical audit and the consequences of open reporting. Results There are significant potential benefits of a national audit of bowel cancer including protecting patients from sub‐standard care, providing clinicians with externally validated evidence of their performance, outcome data for clinical governance and evidence that increases in government expenditure are achieving improvements in survival from bowel cancer. These benefits will only be achieved if the audit captures most of the cases of bowel cancer in the UK, the data collected is complete and accurate, the results are risk adjusted and these are presented to the public in a way that is fair, clear and understandable. Involvement of clinicians who have confidence in the results of the audit and who actively compare their own results against a national standard is essential. It is suggested that a staged move to open reporting should minimise the risk of falsely identifying an outlying unit. Conclusion The fundamental aim of the National Bowel Cancer Audit is the pursuit of excellence by identification and adoption of best practice. This could achieve a continuous improvement in the care of all patients with bowel cancer in the UK. The ACPGBI suggests a safer way of transition to open reporting to avoid at least some of its pitfalls.     

血液透析面临的问题与挑战

虽然血液透析应用于临床治疗已经90余年,成为急、慢性肾衰竭的最主要治疗手段,但仍然存在许多问题与挑战。在我国,伴随血液透析患者的快速增加,将给我国医疗保障体系带来严重挑战,亟待加快社会资金参入和培养合格的血液透析医护人员。从血液透析的基本技术层面看,血液透析开始的最佳时机？血管通路是否一定要优先选择血管内瘘？血液透析患者的适宜透析液钙浓度？目前尚存争议。从血液透析并发症防治层面看,透析患者血压控制靶目标？甲状旁腺激素控制的靶目标？目前也无定论。本文将结合现有文献证据进行评述,为临床医生的临床实践提供借鉴。     

In search of evidence-based plastic surgery: the problems faced by the specialty.

Recently, there has been significant interest both from government and medical practitioners in the discipline of evidence-based medicine. In this article we discuss the problems faced by the plastic surgeon when trying to ensure that practice is evidence-based and highlight some of the reasons behind these difficulties. With the rapid growth of the Internet we also outline its use to access high quality information for the plastic surgeon.     

Patients seeking alternatives to the long waiting list: a reality faced by transplant physicians

The need for deceased donor organs for kidney transplantation in the United States continues to increase. The increasing demand has fueled desperate attempts by patients to circumvent the long waiting list of the United Network for Organ Sharing. We report 4 patients with end-stage kidney disease who sought and obtained a live donor kidney transplant outside the United States. In each case, a nephrologist was following up with the patient regularly. Each patient experienced significant unexpected adverse events after the transplant surgery. Desperate attempts to obtain an organ are common and are likely to continue. Although patients with end-stage renal disease who obtain an organ transplant at an unregulated transplant center can have successful outcomes, transplant physicians should be aware of the common practice and should advise their patients of potential complications associated with acquisition of organs through means that circumvent standard oversight by the United Network for Organ Sharing and by institutions.