CT增强知情同意书缺陷分析

目的了解CT增强知情同意书存在的不足与缺陷,为完善知情同意书提供参考。方法对21家医院的CT增强知情同意书告知内容进行调查。结果 21家医院的CT增强同意书不同程度存在告知内容不全等缺陷。结论 CT增强知情同意书告知内容的充分、完善是保障患者知情同意权的重要前提。     

社区家长对预防接种知情同意书的认知程度调查

目的了解社区家长对预防接种知情同意书的认知程度情况及其影响因素,为在儿童预防接种中规范开展知情同意提供参考。方法通过自行设计统一的调查问卷,对社区家长进行问卷调查,问卷内容包括:1家长基本信息。2家长对知情同意书的态度。3知情同意书内容调查。结果 63.00%的家长认为有必要签署预防接种知情同意书;预防接种知情同意书内容的回答合格率为68.50%,家长对预防接种知情同意书的认知程度受年龄、学历、居住状态、有无参加妈妈课堂等因素影响。结论家长对预防接种知情同意书的作用不太了解,建议扩大知情同意书用处的宣传,以规范执行知情同意,减少医疗纠纷,提高接种率。     

伦理审查视角下临床研究知情同意书质量分析

目的从伦理审查的视角调查医院临床研究中知情同意书质量,分析申办者和研究者发起的临床研究中知情同意书存在的主要问题,对其要点进行评价归纳并提出建议。方法收集整理上海市某三级甲等医院伦理委员会2013年1月—2020年12月接受伦理审查的临床研究项目知情同意书共计678项,根据《药物临床试验质量管理规范》要求对知情同意书的内容和语言等要素进行统计分析。结果完全符合规范的知情同意书311份(占45.9%),存在要素和/或语言问题的知情同意书367份(占54.1%),问题主要体现在研究过程(占23.7%)、可能的风险(占15.5%)、受损害后的赔偿补偿(占15.0%)和研究相关费用的告知(占14.2%)等方面;申办者发起的临床研究的知情同意书合格率高于研究者发起的临床研究。结论合格的知情同意书文本应保证内容完整和语言规范,以达到信息完整、理解无误、自愿同意的效果,确保受试者做出符合其真实意愿的选择。对于知情同意书质量的保障,需要包括申办者、研究者和伦理委员会在内的临床研究各相关方的共同努力。     

临床医学科研中的知情同意之我见

结合临床医学科研伦理管理中的经验,对知情同意的要素、知情同意的方式、知情同意的主体、知情告知的主要内容、知情告知的过程、知情同意书的签署、知情同意书的保存等方面进行了探讨,提出了一些见解、体会和经验,供广大医学科学研究工作者和医学科研管理人员参考.     

太原3000家医疗机构启用通用病历

近日,卫生部公布新版《医疗知情同意书》范本,根据病情不同,包括了麻醉知情同意书、腹腔镜手术知情同意书等数百个知情同意书样板。据了解,此次卫生部向全国医院推出的新版本是北京大学人民医院刚刚整理修订的。重点强调医患沟通,对常见疾     

1080份知情同意书填写缺陷分析

目的探讨病案中知情同意书填写存在的问题,并采取有效的改进措施,提高病案质量。方法分析我院2011年1～11月出院病案,对1 080份知情同意书填写情况进行统计分析。结果 1 080份知情同意书中,缺陷最多的是一般项目填写不全350例,占32.4%;其次是多次操作或治疗只签一次知情同意书150例,占13.9%。结论正确填写好每份知情同意书,提高医务人员对知情同意书的重要认识,是减少医疗纠纷的重要途径。     

医院科学研究应高度重视知情同意书的应用

知情同意书 (informedconsentform)是每位受试者表示自愿参加某一研究的文件证明。在医院科学研究中 ,知情同意书是受试者和研究者科学伦理关系的基本保障。     

口腔专科门急诊电子知情同意书系统设计与应用

目的 开展无纸化病案归档建设,对传统门急诊纸质知情同意书进行电子化设计与应用。方法 分析口腔专科特色的知情同意书应用需求,遵循移动性、一致性、可靠性原则,升级改造电子病历系统,引入第三方电子认证服务对电子知情同意书进行数字认证。结果 实现了口腔专科门急诊电子知情同意书的移动、可信签署,试运行期间系统整体运行稳定。结论 电子知情同意书的应用进一步保障了病案数据的完整可靠,业务流程和管理模式的转变需不断地磨合和优化,以进一步推动病案管理的信息化发展。     

解读新版医疗知情同意书

2010年3月10日,卫生部公布了新版<医疗知情同意书>范本.与旧版知情同意书相比,新版加入了疾病介绍和治疗建议,拒绝或放弃医学治疗告知书等内容,注重了措词的口语化,力图缓和目前日益紧张的医患关系,促进医患互信,构建和谐的医疗环境.     

刍议知情同意书质量管理在医疗争议中的作用

目的探讨知情同意书质量管理在医疗争议中的重要作用。方法抽查我院三年11份医疗争议案例,结合相关出院病案及外院类似个案,参照国务院颁布的《医疗事故处理条例》,分析探讨医疗争议的成因,加强知情同意书质量管理。结果医疗争议的原因中以知情权被侵犯为主要原因,通过加强知情同意书质量管理,我院知情同意书进一步得到完善,近年来医疗争议的发生率明显减少。结论加强知情同意书的质量管理,是维护医患双方权益,减少医患纠纷发生的新举措,在医疗争议中起了重要作用。     

Nurses' knowledge, attitudes, and beliefs regarding organ and tissue donation and transplantation

The acute shortage of human organs and tissues for transplantation has been attributed in part to health professionals, including nurses, for their reluctance to recognize and refer suitable candidates for donation. In 1988, nurses' knowledge, attitudes, and beliefs regarding organ and tissue donation and transplantation were assessed using a 70-item questionnaire. Respondents included 1,683 nurses employed in 62 rural and urban hospitals in the Midwest. Only 365 respondents (21.7 percent) reported having requested tissue donations and 243 (14.4 percent) reported having requested organ donations. However, of those who requested tissue or organ donations, 270 (74 percent) obtained consents for tissues and 150 (61.7 percent) obtained consent for organ donations. Respondents were knowledgeable about organ and tissue donation (mean score of 7.5 on a 0 to 10 knowledge scale with 10 as highest) and reported attitudes and beliefs were moderately positive. Factors that were significantly correlated with the number of requests made for organs and tissues and the number of consents obtained included nurses' knowledge, attitudes, and beliefs about donation; nurses' perception of their own confidence in their ability to request tissues and organs; being a supervisor; and working in an emergency department.     

上海市部分公立医院涉及人体医学研究项目知情同意过程分析

建议进一步加强医院伦理委员会的作用,规范知情同意的操作,加强公众宣传、改善医患关系,以改善公立医院涉及人体研究项目的知情同意工作。     

Ethical and legal problems of informed consent

INTRODUCTION: The previously accepted paternalistic relationship between patients and doctors has changed in last century. The expectation for patients to be involved in medical decisions is growing, but this involvement cannot be imagined without informed consent, hence it became one of the most important elements of a physician's responsibilities. Although informed consent is broadly regulated legally in Hungary, experiences show that practical realization is insufficient. This is also represented in the large number of lawsuits in connection with the inadequate or wrong use of informed consent. The aim of this study was to survey for the first time in Hungary the state of informed consent by the analysis of written consents to anaesthesia. METHODS: The authors collected and studied written consents to anesthesia from 36 hospitals and clinics in Budapest. They studied among others the presence of the following formal elements: individual consent forms for anesthesia, signatures on forms etc. They also examined whether the consents contained all of the conventional elements of informed consent. RESULTS: 61% of hospitals had individual forms for consent to anesthesia. Every consent form required a signature by the patient and almost every form (except two) by the doctor as well. 39% of forms describe the medical treatment in detail and only 25% mention its advantages and disadvantages. 28% of them specify definite risks, but only 19% mention their probability. 67% of the documents refer to the possible need to extend intervention. Patients have to declare whether they permit urgent blood transfusion in 25 institutions (69%). In only two hospitals are patients informed of their rights to revoke consent or to resign from being informed of medical treatment. CONCLUSION: Although all institutions have written consent forms that adhere to legal regulations, in terms of their format and matter they leave much to be desired. It is especially conspicuous that possible risks are named in less than a fourth of all forms, thus they have to be mentioned verbally and this obviously is a source of later arguments. The authors believe that all invasive medical procedures require templates for consent forms put together by professional panels. These forms could then be adapted to all specific medical procedures of the hospital in question.     

浅谈护理工作中患者的知情同意权

目的:了解就诊惠者对护理工作中的知情同意需求,重视并履行告知义务.方法:探讨从护理工作中的五个方面满足患者的知情同意.结果:患者及家属对医疗护理工作中的知情同意有迫切要求,护理人员对此认识不足.结论:重视、满足患者的知情同意权是尊重患者的基本权力,有利于患者疾病的康复,减少医患矛盾.     

COVID-19 highlights the policy barriers and complexities of postpartum sterilization

Multiple barriers exist to sterilization in the postpartum period. One such barrier, the Medicaid Title XIX sterilization policy, requires publicly insured patients to complete a sterilization consent form at least 30 days prior to their scheduled procedure. While this policy was set in place in the 1970s to address the practice of coerced sterilization among marginalized women, it has served as a significant barrier to obtaining the procedure in the contemporary period. The COVID-19 pandemic has highlighted specific complexities surrounding postpartum sterilization and created additional barriers for women desiring this contraceptive method. Despite the time constraints to perform postpartum sterilization, some hospital administrators, elective officials, and state Medicaid offices deemed sterilization as “elective.” Additionally, as the Center for Medicare and Medicaid Services (CMS) has revised telemedicine reimbursement and encouraged its increased use, it has provided no guidance for the sterilization consent form, use of oral consents, and change to the sterilization consent form expiration date. This leaves individual states to create policies and recommended procedures that may not be accepted or recognized by CMS. These barriers put significant strain on patients attempting to obtain postpartum sterilization, specifically for patients with lower incomes and women of color. CMS can support reproductive health for vulnerable populations by providing clear guidance to state Medicaid offices, extending the 180-day expiration of a sterilization consent form signed prior to the pandemic, and allowing for telemedicine oral consents with witnesses or electronic signatures.     

橡皮障在根管预备过程中降低根管内微生物污染的效果

目的探讨在根管预备过程中使用橡皮障技术降低根管内厌氧菌数量的效果。方法选取医院牙体牙髓科需要对双侧下颌第一磨牙进行根管预备的患者40例,在知情同意的基础上,将治疗中同一患者使用橡皮障的患牙(n=40)作为实验组,将未使用橡皮障的对侧患牙(n=40)作为对照组,根管预备前后进行根管内菌落采样计数,并进行统计学分析。结果所有的牙齿经根管治疗后患牙内厌氧菌数目明显减少(p<0.001)。实验组术后菌落计数大大低于对照组,具有统计学意义(p<0.001)。结论在根管预备过程中使用橡皮障能有效降低根管内微生物污染效果,对口腔感染控制起到非常重要的作用。     

提高医疗安全意识注重老年患者围手术期质量管理

目的提高医疗安全意识,保障老年患者围手术期医疗质量。方法复习2008年度住院的老年手术患者病历1430份,从年龄、住院科室分布、基础疾病、术前检查、知情告知等方面进行分析。结果老年手术患者占全部手术病例的32．77％,60～75岁的老年患者占全部病例的70％,以入住普外科、泌尿外科、骨外科为主。患有基础疾病的老年患者占90．84％。手术、麻醉、特殊治疗同意书签署率达到100％,特殊检查同意书签署率却只有88．04％,而谈话记录仅占全部病例的39．72％。结论重建术前准备流程,加强对老年手术患者的围手术期管理,进一步提高医疗质量,保证医疗安全。     

A participant observation study using actors at 30 publicly funded HIV counseling and testing sites in Pennsylvania

OBJECTIVES: This study was designed to augment an evaluation of Pennsylvania publicly funded HIV counseling and testing sites, particularly of the staff-client interaction. METHODS: Actors were trained as research assistants and sent to 30 randomly chosen sites to be tested and counseled for HIV disease. Instruments based on Centers for Disease Control and Prevention (CDC) guidelines were designed and used to evaluate them. RESULTS: Data were generated that identified the range of compliance with CDC guidelines and state policy. Among the findings were that 10 of 30 sites required signed consents despite a state policy allowing anonymous testing. Only 17% of providers developed a written risk reduction plan, even though 69% of all sites surveyed by mail asserted that such plans were developed. Only 2 of 5 HIV-positive actors were offered partner notification services, even though 100% of sites visited by an interviewer claimed to offer such services. CONCLUSIONS: The findings suggest that although evaluation methods such as mail surveys and site visits are useful for evaluating the existence of appropriate policies and protocols and gathering baseline data, they might not be sufficient for assessing actual staff-client interaction.     

多排螺旋CT低剂量模式在新生儿肾上腺出血中的应用评价

目的 评价多排螺旋CT（MSCT）低剂量模式扫描在新生儿肾上腺出血（NAH）中的应用价值.方法 收集2009年5月至2013年3月在广东省妇幼保健院确诊的32例NAH患儿的临床病历资料为研究对象.其中,急性期为3例,亚急性期为20例,慢性期为6例,血肿机化期为3例.采用SIEMENZ 128排及TOSHIBA 64排MSCT低剂量模式（80 kV,100 mA,0.75 s）,评价MSCT低剂量模式对NAH的应用价值（本研究遵循的程序符合广东省妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象监护人的知情同意）.结果 NAH的普通CT检查表现为肾上腺区低密度或混杂密度肿块,右侧多见,有包壳或囊壁形成,增强CT结果示病灶中央区无强化.结论 MSCT低剂量模式成像清晰,对NAH的定性和分期具有很好参考价值.     

The provision of treatment and disposal facilities for clinical waste in Scotland

This article reviews the present and future provision for clinical waste treatment and disposal in Scotland. Data was obtained using open structured interviews and a simple questionnaire. To ensure a high response rate the questionnaire was distributed only after an initial telephone call confirmed the most appropriate contact and that he/she was prepared to complete and return the survey sheet. The results of the study indicate that the transition from central to local organisation has been carried through largely without mishap. A single exception to this affects consortia who have yet to secure long-term facilities for the treatment of their waste. External influences, particularly the acquisition of planning consents for new plant remain problematic for would-be developers. The commissioning and regulation of new technologies would also appear to be ad hoc . Finally, if the proposed facilities are constructed and commissioned then the current situation of over capacity will be considerably exacerbated.