创伤急救医疗纠纷的原因分析与自我保护策略

近年来，医疗纠纷已成为社会最关注的焦点问题之一，寻找医疗过程中存在的问题已成为部分病人、家属、责任方等在患者、伤者得不到自认为满意的治疗结果后索赔的方式之一。也充分暴露了在社会转型期，医患之间的关系被充分扭曲的一面。特别对创伤急救医护人员来讲，面对医疗纠纷高发人群（急、危、重伤病员），怎样在医疗及急救过程中充分做好自我保护，减少纠纷发生，已成为各大医院探讨的焦点问题之一。     

医疗责任保险的可行性分析

近年来随着医疗纠纷数量的不断增加,以及2002-09-01《医疗事故处理条例》的实施,医院对医疗纠纷的赔偿数额在大幅度飙升,2004-05-01最高人民法院实施的《关于人身损害赔偿适用法律问题的司法解释》更是引发了新一轮的诉讼高潮,各医院对医疗纠纷的赔偿额已不堪重负,均在寻求赔偿责任新的方式,商业保险则成为各医院首先考虑的对象。医疗责任保险是在保险期限或追溯期及承保区域范围内,被保险人在从事与其相符的诊疗护理工作中,因过失发生医疗事故或医疗差错造成依法应由被保险人承担的经济赔偿责任,并由被保险人在保险有效期限内首次提出索赔…     

医疗纠纷四级预防管理实践与体会

随着医疗市场的发展和全民法律意识的增强,患者就医过程中维权行为日益增多,医疗纠纷案件逐年上升,呈现出“数量多、索赔高、处理难”的特点。医疗纠纷是一个非常复杂的社会问题,不仅有患者和社会环境因素,也有医院内部的管理问题。从医疗纠纷发生、发展的规律来看,医院医疗纠纷预防管理中存在的薄弱环节,也是引起医疗纠纷居高不下的原因之一。因此,研究建立医疗纠纷预防的科学机制,加强医疗纠纷预防与管理,已成为医院迫切需要解决的课题。我院在预防医疗纠纷的工作中,探索和建立了四级预防管理机制,即针对产生纠纷的源头因素、环节因素、成形因素、转化因素实行针对性的防范,有效地扼制了医疗纠纷的发生。     

医疗纠纷医方因素及防范对策

医疗纠纷是在医疗服务中不可回避的、具有普遍性的问题。主要表现为患者方通过行政的甚至法律的手段对医疗服务提出不满 ,并要求给予经济补偿。近年来 ,随着医学知识和法律观念的普及 ,医疗纠纷呈逐年上升趋势 ,逐渐成为社会关注的热点。医疗纠纷不仅给医院带来经济上的损失 ,也影响医院正常的工作秩序。控制和解决医疗缺陷 ,防范医疗纠纷是医院管理者不可忽视的问题。本文从医院方的角度对医疗纠纷产生的原因及防范对策作了初步探讨。1　医疗纠纷产生的主要原因1 1　医疗行政人员管理不到位　现阶段医院管理队伍的特点之一是由医疗技术骨…     

医院医保医疗纠纷原因分析与对策探讨

在医疗市场异常繁荣的当下,医疗纠纷屡见不鲜。导致医疗纠纷的原因有很多。医院医保办是协调医保基金与患者需求的关键职能部门,是基本医疗保险制度改革成败的执行者。医院是医、保、患三方关系的交汇点,由于其岗位与工作职能的特殊性,医院医保办成为最容易发生纠纷的部门。1医疗纠纷的现状及原因分析1.1医疗纠纷的现状医患关系在医疗市场中的关注度相对较高。近年来随着医技水平的不断提高,人们的健康水平得到了明显改善,但医患关系也出现了     

加强医院管理 防范医疗纠纷

近年来 ,随着人们法律意识的增强 ,医疗行为的法律责任越来越受到社会重视 ,各类医疗纠纷有陡增之势 ,且已成为困扰医院正常医疗工作的一个难题。处理和解决这些医疗纠纷耗费医院管理工作者及医务人员大量的时间和精力。对于医疗纠纷 ,若处理不当 ,就不能维护患者的合法权益 ,而且直接影响医务人员的工作情绪和开拓精神。要防止和减少医疗纠纷的发生 ,就必须加强对医务人员职业道德的教育 ,规范医疗行为 ,文明行医 ,急病人之所急 ,想病人之所想 ,并且据本地区和医院的实际情况进行法规、法纪教育 ,努力提高自身防范意识 ,把医疗纠纷降到最低…     

浅谈新形势下医疗纠纷发生的原因及防范对策

医疗纠纷是指医患双方对患者在医疗过程中出现死亡、残疾、器官组织损伤导致功能障碍或其他不良后果的归责问题,或补偿问题不能达成一致而发生的纠纷。随着《医疗事故处理条例》的出台,以及医疗诉讼举证责任倒置的实行,患者维权意识不断增强,医疗纠纷呈明显增多的趋势。据中华医院管理学会对全国326所医院的调查显示：326所医院中,一年内有98．47％的医院发生过医疗纠纷,赔偿金额6000多万元。高发的医疗纠纷不仅影响医院的正常工作秩序。     

举证责任倒置中的问题与对策

医疗纠纷的处理是当前医院最头痛、最棘手的一个热点问题。特别是我国从2002年4月1日起实施的医疗侵权诉讼过程中的举证责任倒置,使作为原告方的患者或患者家属,将不再承担医疗行为与损害结果之间的因果关系和医疗机构存在的医疗过错方举证责任,明确改为由医疗机构承担提供相反证据的责任之后,势必要给医疗纠纷的处理过程中增加更大的麻烦和难度。为此,进行认真的研究探讨医疗机构中存在的医疗棘手问题与对策非常必要。     

从患者就医的权利谈医院司法"举证责任倒置"

国务院第 315号令颁布的《医疗事故处理条例》自 2 0 0 2 - 0 9- 0 1起执行。《最高人民法院关于民事诉讼证据的若干规定》也于 2 0 0 2 - 0 4 - 0 1起实施。最高人民法院在《规定》中已明确“因医疗行为引起的侵权诉讼 ,由医疗机构就医疗行为与损害结果之间不存在因果关系及不存在医疗过错承担举证责任”。医院承担司法“举证责任倒置”是医院处理医疗纠纷民事诉讼所面临的新问题 ,有必要进行深入的探讨。对此 ,笔者结合实际工作的体会 ,谈几点看法。1　患者就医的权利与义务　　患者到医院看病就医是一种特殊的消费 ,按照《消费者权益保护…     

因医疗纠纷父母将子女遗留医院的责任问题探析

医疗纠纷的处理一直是医院常抓不懈的大事,虽然国务院颁布的《医疗事故处理条例》为处理医疗纠纷提供了法律依据,但在处理一些问题上,医院往往是束手无策。如父母以医疗纠纷为由,将未成年子女遗留在医院,所欠医疗费用少则几千元,多则上万元,医院即使起诉患方,也难于挽回经济损失。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.