医学影像科医疗投诉原因分析初探

目的:通过对医学影像科医疗投诉的总结,分析医疗投诉产生的原因,探讨减少医疗投诉的有效措施.方法:收集2009年至2011年发生的医疗投诉16例.结果:医疗投诉产生的原因中医方原因13例,占81%;患方原因2例,占12%;设备原因1例,占0.06%.结论:提高医疗质量,改进服务态度,加强医患沟通,增强职业素质是保障医学影像科医疗安全,减少医疗投诉的有效措施.     

急诊科医疗投诉的原因与防范对策

目的 探讨我院急诊科发生医疗投诉的原因,就如何防范医疗投诉寻找新对策.方法 回顾我院2003年5月至2010年12月所发生的60起医疗投诉,并做较了全面的分析.结果 投诉最多的是夜间专科不齐备占33.33%,其次是抗生素过敏反应占16.67%,而服务态度差仅占3.33%.结论 医疗投诉起因有医院方面的因素,如急诊科夜间专科配置不足的因素,也有患者方面的因素.因此要从急诊科的建设与管理入手,积极寻找防范医疗投诉的对策.     

某专科医院医疗投诉原因分析

目的:分析医疗纠纷发生的原因,寻求预防及减少其发生的对策。方法:采用整群抽样的方法,对乌鲁木齐市某二级甲等专科医院2003年1月1日~2005年12月31日发生的213件医疗投诉资料进行回顾性分析。结果:213件医疗投诉中医源性投诉151件(70.89%),非医源性投诉62件(28.77%)且有逐年上升趋势。151件医源性医疗投诉中儿童投诉90件(59.60%),针对医务人员的投诉占68.87%(104/151),其中以医生的责任心不强、技术水平低、服务水平差的投诉占60.58%(63/104)。不同科室医疗投诉发生率小儿内科最低,ICU和手术科室最高。结论:ICU、手术科室及门诊部是医疗投诉最多的部门。预防和减少医源性医疗投诉的最主要措施是提高医务人员的责任心和技术水平。     

军队医院医疗投诉反映的问题及对策

近两年来,受各种因素影响,军队医院医疗投诉、医疗纠纷的数量和发生率呈不断上升趋势,因医疗纠纷诉诸法院的案例逐渐增多,医疗纠纷的解决难度较以往明显增大。据对某部4所医院两年来的医疗投诉和纠纷统计,涉及医疗质量的占72.7%,涉及医疗秩序及管理的占18.2%,涉及医德医风的占27.3%,医疗质量已成为军队医院引发医疗投诉和纠纷的主要因素。研究医务人员引发医疗投诉和纠纷的各方面原因,寻求有针对性的管理措施,无疑是医院提升医疗质量、预防医疗纠纷、促进医院发展的一种好办法。笔者从管理者层面对当前军队医院医疗投诉和纠纷反映的主要问题、原因进行分析,并提出一些防范策略。     

门急诊患者医疗投诉原因分析与防范

目的对我院2014至2015年统计上报的236例次医疗投诉原因进行分析,结合投诉起因提出有效解决对策。方法回顾性分析我院2014至2015年236例次医疗投诉资料,了解投诉内容、对象、投诉处理方式与结果。结果45.8%的投诉与服务态度有关(108/236),19.9%的投诉主要基于服务流程(47/236),8.5%的投诉涉及医疗技术(20/236),1.3%的投诉主诉医德医风(3/236),医疗费用方面的投诉占7.2%(17/236)。医生被投诉占48.7%(115/236),医技人员被投诉占34.3%(81/236),护士被投诉占29.7%(70/236),收费处人员被投诉占25.0%(59/236)。239例医疗投诉中采取沟通解释处理的有147例(61.5%),采取相关科室协商解决的有92例(38.5%),两种处理方法满意或基本满意的有237例(99.2%)。结论积极分析门急诊中的医疗投诉原因并采取相应措施解决能有效降低门急投诉率,提高医院服务质量与患者满意度。     

新型冠状病毒肺炎疫情常态化防控期间某大型三甲医院门诊医疗投诉原因分析与对策

目的 我国已进入新型冠状病毒肺炎疫情常态化防控阶段,探讨疫情常态化防控以来某大型三甲医院门诊医疗投诉的具体情况,并在实践中不断完善相应的应急预案和处理措施,以满足患者在普通门诊的医疗需求。方法 收集2020年6-12月新型冠状病毒肺炎疫情常态化防控下,某大型三甲综合医院门诊部收到的患者门诊医疗投诉记录单共90件。将投诉人的基本资料（包括性别、年龄、类别）、投诉科室、投诉原因、接待人员的基本资料（包括年龄、职称和工作年限）和投诉处理结果等项目分类进行统计,并进行投诉原因相关影响因素分析。结果 所有投诉共涉及25个临床科室,其中涉及内科有8个科室,占32.00%;外科有9个科室,占36.00%;8个专科或其他科室,占32.00%。90件门诊投诉案例中,涉及内科44例,占48.89%;外科25例,占27.78%;专科及其他科室21例,占23.33%。投诉主要原因中因疫情常态化防控所引起的就诊排队过长、疫情相关制度和预约时间过长3项共计43件,占47.78%;因医护态度不佳、医疗制度规定和医疗技术问题等相关投诉也分别占17.78%、12.22%和8.89%。有88件经过门诊投诉处理小组的耐心解...     

门诊病人用药投诉分析

目的:分析门诊病人用药投诉,明确存在的问题,确定导致这些问题的原因,并提出相关的解决措施.结果:患者投诉对象主要是医生、药学人员和收费人员,其中对医生的投诉最多,药学人员次之.对医生的投诉包括5方面,以处方问题最为突出,占60%以上;对处方问题的投诉包括11个方面,其中27%以上的投诉为医生写错药名、剂量或用法;对药学人员的投诉包括15个方面,发错药品的占25%;对收费人员的投诉包括6个方面,以收费错误为最高,占37%.结论:我们需要继续鼓励和加强患者投诉的收集工作,有针对性地制定有效措施逐步解决现存的主要问题,同时加强信息系统在门诊的应用,并适时实施药物条形码技术.     

121例护理投诉的原因分析及对策

目的:通过对121例护理投诉回顾性分析总结,探讨预防措施.方法:调查分析2007年1月至2009年7月我院受理的121例投诉的原因、影响因素等.结果:护理投诉的主要原因为沟通不到位、服务态度不好及责任心不强,占发生总数的41.3%、21.49%、21.49%;被投诉科室中门诊为第一位,占发生总数的55%;护士与护师被投...     

74起医疗纠纷事件的综合分析

目的:通过对某医院采取诉讼调解的74起医疗纠纷投诉事件材料进行分析,论述医疗纠纷发生的原因和科室分布情况,从而为医院防范和处理医疗纠纷提供依据.方法:回顾性分析了某医院2002年6月至2003年6月积累的采取诉讼调解的74起医疗纠纷投诉事件材料,用一般统计描述性方法进行分析.结果:74起医疗纠纷投诉事件经过山西省医疗事故技术鉴定委员会进行鉴定构成医疗事故的有4起(5%),未构成医疗事故的70起(95%);科室分布情况为外科系统占67%,内科系统占15%,其他相关科室投诉总计为18%.结论:医院在实际工作中为防范医疗纠纷的发生和处理相关医疗纠纷时,应注意以下几点:1.加强医院医疗安全管理模式建设,对重点科室进行严把关口.2.对病人对医学常识和相关政策规定不理解或病人一方无理纠缠引起的纠纷,医院应做出相应预防措施.3.医院应加强自身业务工作建设.4.对医疗事故处理程序进行法制化、科学化、规范化.     

接待患者投诉过程中非语言性沟通技巧的应用

随着医疗服务向市场化、规范化发展,患者对医疗和护理服务的要求不断增高,而医护人员往往比较重视技术因素,忽视了沟通交流、态度情感、服务流程等非技术因素,医患纠纷时有发生.从门、急诊投诉的性质比例上分析,大部分医患矛盾是由于医患之间交流沟通不够造成的.据我院2004年1月～6月门、急诊投诉汇总统计,因沟通不够造成的医患矛盾占60%,违反规定(如处方书写、到岗时间)占27.1%,医疗差错占11.4%,其他原因占1.5%.可见,因沟通不当造成的投诉占较大比例.要化解和避免这些矛盾,需要门诊部管理人员掌握一定的非语言性沟通技巧.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.