不同医师群体对医疗纠纷的认识、态度及对待方式

目的了解医疗机构的医学生、实习医师、临床医师封医疗纠纷的认识、态度及对待方式．方法采用自编医疗纠纷调查问卷进行两组调查．其中,一组是医学院本科四年级医学生、医院临床本科实习医师、医院临床医师;另一组是医院发生遏医疗纠纷的临床医师和未发生遏医疗纠纷的匹配医师。结果医学生、实习医师、医师封医疗纠纷的认识、态度及对待方式有明显的共性。     

医疗纠纷对医师心理应激的影响及干预

根据医疗纠纷现状及封医师心理状态影响的研究。提出医疗纠纷发生后当事医师心理应激的分期与表现。指出心理干预的方法与策略。以保障医师的心身健康。     

不同护理路径用于颅脑损伤患者护理的效果分析

目的探讨不同护理路径用于颅脑损伤患者护理的效果。方法病例为我院2014-02以来收治的75例颅脑损伤患者,按照随机抽样法将患者分为护1组和护2组。护1组按照常规护理程序开展护理工作;护2组按照临床护理路径开展护理工作。评价抢救成功率、家属满意率;抢救时间、住院时间、总医疗费用;并发症发生率、医疗纠纷发生率。结果(1)护2组抢救成功率、家属满意率显著比护1组高,差异有统计学意义(P0.05);(2)护2组抢救时间、住院时间、总医疗费用显著比护1组少,差异有统计学意义(P0.05);(3)护2组并发症发生率、医疗纠纷发生率显著比护1组低,差异有统计学意义(P0.05)。结论临床护理路径开展护理工作用于颅脑损伤患者中效果确切,可缩短抢救时间,提高抢救成功率,降低并发症发生率,减轻医疗负担,对提升家属满意度和规避医疗纠纷有益,值得推广。     

神经外科领域医疗纠纷与诉讼的成因分析

作者分析了神经外科领域发生医疗纠纷的社会原因、经济原因和医源性因素。社会原因包括苛求医疗,医疗期望值过高,社会舆论导向和卫生资源分配不公。纠纷发生的医源性因素包括神经外科医师存在自身技术缺陷,对出现的手术并发症估计不足或不够重视、服务意识差,缺乏人文关怀,科室管理不规范,制度不落实,新技术滥用等。导致诉讼增加的原因主要是民众法律意识增强,立法机构和审判机构对医方采取严格责任,系列法规降低了诉讼的门槛,倾向救济患者等。     

医疗法制大环境的改变更显医师维权工作的紧迫

当今，尽管纠纷频发，但在医疗纠纷处理的同时不仅未相应扭转医师维权的被动局面，反而随着医疗法制的逐步完善与推进，使得医师维权工作越显紧迫。     

精神病院内的医疗纠纷与住院病人安全保险的探讨

作者调查上海市精神卫生中心1985～1991年底收治的各类精神疾病患者16739人次,期间发生医疗纠纷11例,占住院病人0.68％。处理医疗纠纷常消耗时间、人力及财力,又影响医院正常工作。为使医务人员集中精力做好服务工作,又有利于病人的身心健康,本中心试行住院病人安全保险,使医疗纠纷的处理有了保证。     

产科围术期周围神经损伤120例治疗与分析

周围神经损伤为临床常见并发症，其会导致患者出现支配区功能障碍，影响正常生活，严重甚至引发患者出现残疾［1］。产科医师在临床治疗过程中，常会忽略围术期引发的周围神经损伤，导致出现医疗纠纷。本文通过对2011‐03—2014‐05在我院产科收治的120例患者随机分组，讨论产科围术期周围神经损伤的原因及治疗方法，现报告如下。     

院内卒中21例发病因素分析

院内卒中（in—hosital stroke）是指发生在患者住院期间的卒中。容易引起医疗纠纷，因此必须引起高度重视。回顾分析我院2003年1月～2007年12月住院的卒中患者2938例，发现有21例患者于人院后发病，现将其临床情况报道如下：     

优质护理在神经外科的应用

目的探讨优质护理在神经外科的应用效果。方法收集2010-01—2011-01神经外科两病区收治500例患者病例资料,其中一病区258例采用传统的护理模式,二病区242例采用优质护理模式,出院后定期复查及电话随访,对其治愈率、患者及家属满意度、医疗纠纷次数进行对比分析。结果两病区治愈率比较差异无统计学意义;患者及家属满意度方面二病区明显优于一病区,差异有统计学意义;一病区有5起医疗纠纷,二病区无医疗纠纷。结论优质护理服务模式提高了医疗质量,减少了医疗纠纷,值得推广。     

加强护患沟通在防范医疗纠纷中的应用

随着社会的进步,人们文化生活水平日益提高以及健康观念的转变,患者的自我保护意识日益增强,传统的护患关系也正悄然发生改变.加强护患沟通是增加患者满意度的重要渠道,而患者的满意度又是减少医疗纠纷的关键因素.有资料统计,在已经发生的医疗纠纷中,由于医患沟通不够,医患关系不和谐导致的纠纷约占总量的2/3.医患关系紧张,患者在受到伤害的同时,不可避免地让医方也受到了伤害[1].加强护患沟通,以优质的服务赢得患者及家属的信任与配合,建立和谐、融洽、友好的护患关系,有利于防范医疗纠纷的发生.     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

药物治疗与合并认知行为治疗对强迫症疗效的比较

目的探讨认知行为心理治疗(CBT)在强迫症(OCD)患者各亚型治疗中的有效性和规律性。方法本研究为临床对照研究。符合入组标准的强迫症患者按患者自愿原则分为两组,治疗观察3、6、12个月。疗效评定分别运用Yale-Brown强迫量表,自拟的自评好转程度量表和临床疗效评定。结果认知行为心理治疗合并药物治疗组31例,临床有效率70.9%,其中治愈率1.8%。单纯药物治疗组24例,临床有效率33.3%。Yale-Brown强迫量表和自评量表得分在6个月和12个月两组有显著差异(P<0.05)。其中强迫症亚型(怕脏型、反复检查型和反复担心型)的疗效比较,怕脏型在治疗3个月末两组间自评量表评分有显著性差异(P<0.05);反复担心型在治疗6个月末两组间Yale-Brown强迫量表总分有显著性差异(P<0.05);反复检查型两组间无统计学差异。结论认知行为心理治疗合并药物治疗强迫症的疗效明显优于单纯药物治疗。强迫症的亚型在治疗中的有效性次序为:反复担心型>怕脏型>反复检查型。     

Characteristics of the sympathetic innervation of the nictitating membrane and of the vasculature of the nose and tongue of the cat

Summary Vasomotor responses from the nasal mucosa and tongue, and contractions of the nictitating membrane, were recorded on stimulation of the cervical sympathetic or internal carotid nerves.Preganglionic sympathetic nerve fibres which elicited a membrane response possessed a lower threshold than those which evoked nasal vasoconstriction, while the latter displayed a lower threshold than fibres which evoked tongue vasoconstriction. The sympathetic vasodilator fibres to the tongue, whose activity was revealed after-receptor blockade, had a similar threshold to the vasoconstrictor fibres.Membrane contraction, nasal vasoconstriction and occasionally tongue vasoconstriction could be evoked by stimulating the internal carotid nerve. The postganglionic fibres innervating the nasal mucosa had a similar threshold to those of the nictitating membrane, which may indicate that there are small myelinated fibres innervating the mucosa.The preganglionic compound nerve action potential had four major components, S₁–S₄. S₁, S₂ and usually S₃ fibres were associated with membrane contraction; S₂, S₃ and sometimes S₁ fibres were associated with nasal vasoconstriction; and S₃, usually S₂ and occasionally S₁ fibres were associated with vasoconstriction in the tongue. It is concluded that each of these three groups of nerve fibres, but not S₄ fibres, may include fibres associated functionally with the three effectors.There was a considerable difference between the relative amplitude of the responses of the three effectors elicited by stimulation of the cervical sympathetic nerve at frequencies between 0.2 and 2 Hz. Vasoconstrictor responses were relatively larger than membrane contractions suggesting differences in the mechanisms of neurotransmission at the neuroeffector junctions.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

A contribution to the study of the architecture of the autonomic nervous system of the digestive tract of the rat

Summary The distribution of aminergic and non-aminergic nerve fibres to the different constituents of the wall of the digestive tract in various regions is described. Aminergic fibres synapse with all nervous perikarya. Densely interlacing networks of nerve fibres are found in both layers of the tunica muscularis and in the lamina muscularis mucosae. A finely meshed plexus is observed in relation to the wall of the blood vessels in the wall of the gut. There are many fibres connecting the muscular and the vascular plexus. No nerve fibres have been observed in direct relation to the epithelium.The functional implications of these findings are discussed.