Giving tape recordings or written summaries of consultations to people with cancer: a systematic review

Objective  To examine the effects of providing recordings or summaries of consultations to people with cancer and their families.
Design  Systematic review.
Data sources  MEDLINE, CINAHL, Cancerlit, EMBASE and other electronic bibliographic databases. Bibliographies of relevant papers.
Selection criteria  Randomized and non-randomized controlled trials of the provision of taped recordings or written summaries of consultations to people with cancer and/or their families.
Main results  Eight randomized controlled trials were found, all involving adult participants. No non-randomized controlled trials were found. The quality of the studies was generally poor. Between 83% and 96% of people who received recordings or summaries found them useful to remind them of what was said and/or to inform family members and friends about their illness and treatment. Of seven studies that assessed recall of information given during the consultation, four reported better recall among the groups that received recordings or summaries than among control groups. Receiving a recording or summary had no significant effect on anxiety or depression between the groups. None of the included studies assessed survival or health outcomes other than psychological outcomes.
Conclusions  Wider use of consultation tapes and summary letters could benefit many adults with cancer, without causing additional anxiety or depression, but consideration should be given to individuals' circumstances and preferences.     

流动人口基层医疗卫生机构首诊现状及影响因素分析

目的:了解流动人口基层首诊现状及其影响因素,为推进流动人口分级诊疗提供实证参考依据。方法:基于2017年全国流动人口动态监测调查数据中82734名最近1次患病(负伤)流动人口数据,利用SPSS 25.0统计软件分析其基层首诊情况及影响因素。结果:82734名最近1次患病(负伤)流动人口中首选到基层医疗卫生机构就诊15936人,基层首诊率仅为19.3%;二分类logistic回归分析结果显示:年龄≥65岁、农业户口、流动时间0~5年、患慢性病、至少参加1项医疗保险,居住地到最近医疗服务机构所需时间≤15 min的流动人口患病后更愿意选择到基层首诊。学历大专及以上、家庭月均收入>10000元、市跨县、东北地区、不愿意落户、自评健康状况为不健康的流动人口患病后更不愿意选择到基层首诊。结论:流动人口患病(负伤)后选择到基层首诊率较低,年龄、受教育程度、户口类型、家庭月均总收入、流动时间、流动范围、流入地区域、落户意愿、自评健康状况、是否患慢性病、有无参加医疗保险、居住地到最近医疗服务机构所需时间是影响流动人口患病(负伤)后选择到基层首诊的主要因素。     

网络医药咨询的应用与管理

我院在Internet医院网站创建了与广大群众交互式医药咨询服务的平台,本文主要介绍了网络医药咨询流程、主要功能、回复情况、组织与实施。网络医药咨询的应用使医院建立了一种新型的医院服务模式,开辟了一个为病人服务的新途径,成为医院吸引病人的一种新方式。     

医疗纠纷协商解决需注意之问题

总结医疗纠纷协商解决的利弊。本文认为协商解决医疗纠纷时,医患双方应致力于以遵循医患和谐为宗旨,坚持实事求是为原则,掌握争辩适度为策略,控制事态发展为前提,落实按章办事为程序,把握赔偿适度为尺度,妥善处理好医疗纠纷。     

Bakhtin's Philosophy and Medical Practice — Toward a Semiotic Theory of Doctor — patient Interaction

Doctor-patient interaction has gained increasing attention among sociologists and linguists during the last few decades. The problem with the studies performed so far, however, has been a lack of a theoretical framework which could bring together the various phenomena observed within medical consultations. Mikhail Bakhtin's philosophy of language offers us tools for studying medical practice as socio-cultural semiotic phenomenon. Applying Bakhtin's ideas of polyphonic, context-dependent and open-ended nature of human communication opens the possibilities to develop prevailing theoretical and empirical approaches to the study of medical consultations. This revised version was published online in July 2006 with corrections to the Cover Date.     

浅议医患纠纷自行协商的法律规制

本文简要分析了医患纠纷自行协商的现状和法律规制的必要性,从法律经济分析学角度及法理角度探讨了法律规制的依据,着重阐述了法律规制的可行性,从路径、内涵、保障三方面提出了法律规制的初步设想。     

城市农民工参加医疗保险及筹资意愿调查研究

目的了解当前农民工参加医疗保险及筹资意愿。方法采用问卷调查方式,对杭州市930位外来农民工进行了问卷调查,并对有关用人单位开展访谈。结果50.8%农民工愿意参加健康储蓄,大多数农民工希望保障范围扩大,他们愿意为医疗保险筹资的水平为每月10￣30元左右。结论根据农民工的参保意愿及实际筹资能力制定切实可行的医保政策。     

Verbal exchanges in medical interviews: Implications and innovations

Medical interviews (consultations) are composed of verbal exchanges, complementary categories of speech by patients and clinicians that tend to occur together. Patients and clinicians employ a joint repertoire of exchanges to accomplish their goals in the encounter. The seven principal exchanges are called Exposition, Closed Question, Checking, Direction, Inquiry, Explanation, and Instruction/ Contracts. We discuss how the verbal exchange structure contributes to understanding the confluence of patients' and clinicians' goals and expectations, clinicians' hypothetico-deductive method of reasoning during interviews, and establishing the patient-clinician relationship. We conclude by considering new exchanges that might make medical interviewing more effective and humane.     

将远程医疗纳入基本医疗保险的研究

将远程医疗纳入基本医疗保险的报销范围,促进其应用与推广,有助于提升基层、欠发达地区医疗水平,合理化就诊结构,优化转诊模式,符合基本医疗保险的原则,且操作上为亦可行.为保障基本医疗保险金不因此被滥用,政府还需制定合理的报销上限与报销比例、明确远程医疗服务中各方的责任关系、建立有效的监督机制.     

浅议城镇农民工的医疗保障

本文对农民工医疗保障问题进行了初步探讨。首先指出了农民工的医疗保障状况不佳；然后对建立农民工医疗保障体制的必要性进行论述；最后提出了建立农民工医疗保障体制的初步思路，并突出了社会组织的作用。     

浅议临床医疗工作中的远程会诊

目的:探讨远程会诊在医院临床医疗工作中的作用。方法:通过对普通会诊和远程会诊在临床上的会诊使用率及会诊人数进行数据比较。结果:目前虽然远程会诊在会诊总数中所占的比重仍较低,但已成为多数科室选择的重要会诊方式之一,得到了临床专家的普遍认可。结论:远程会诊是运用现代化信息技术的全新的会诊方式,其高效、便捷、共享化的模式能够为临床诊疗工作提供有效的技术和信息支持,提高临床治疗水平。     

加强医院会诊管理 提高医疗服务质量

本文提出医院加强会诊管理对于提高疑难杂症的临床诊疗水平、加强医学学科间的技术交流、改善医患关系以及减少医疗纠纷的重要作用;通过传统会诊模式与信息化条件下现代会诊模式的对比,突出现代会诊模式的优势作用;并结合本院的实际提出医院会诊中应关注的问题。     

远程会诊技术在野战外科管理的应用

为了适应信息化条件下卫勤保障需要,医院在卫勤训练中不断创新训练方法,利用远程会诊技术,实现了野战外科手术的实时指导,使战时伤员的抢救时机尽量控制在后送途径的最前端,在短时间内提高了前方医务人员的基本理论和技术水平,有效提高了战时卫勤保障的信息化程度。     

野战机动医疗系统中远程会诊子系统的改进设计

目的:提高野战机动医疗系统的远程通信能力和内部信息化水平。方法:全新设计远程会诊子系统的结构,提升其功能,实现远程会诊模块、数据通信模块、话务通信模块的集成。结果:该系统改进后,信息化能力和水平明显提升,主要表现在:更加机动灵活、功能更加全面、使用更加便捷、图像更加清晰、结构布局更加合理。结论:该系统达到二代医疗系统的信息化水平,可满足远程会诊和内部办公与诊疗自动化、信息化的需求。     

成都市2周患病居民首诊行为及满意度分析

目的 了解四川省成都市2周患病就诊居民对首诊机构的选择及卫生服务满意度情况,为引导居民首诊选择基层医疗机构提供参考依据。方法 采用分阶段随机抽样方法,使用自制问卷对成都市常住居民4 201人进行问卷调查。结果 成都市2周患病居民858人,2周患病就诊居民583人,2周患者就诊率为62.40%;2周患病就诊居民首诊选择社区/乡镇医疗机构最多,占36.88%,总体满意度最高,为86.05%;多因素分析结果显示,社区/乡镇与二、三级医院比较,收入较低、无住院经历为保护因素、农村、不知晓居住地附近有社区/乡镇医疗机构、就医总体情况不满意为危险因素,与门诊或药房比较,不知晓居住地附近有社区/乡镇医疗机构为危险因素。结论 成都市居民首诊选择社区/乡镇的意识有所提高,应根据影响因素采取有效措施,实现首诊进社区。