医疗纠纷特质的变化及其对策

只有认清医疗纠纷特质的变化,才能正确处理医疗纠纷并维持良好的医患关系.为防范医疗纠纷的发生,医疗机构必须倡导"医疗体验"理念、转变医疗行为、加强医患间的沟通并改进沟通技巧,使医务人员从单纯技术至上转向同时注重人文关怀.     

医疗机构妇产科医疗纠纷原因分析及防范策略

目的:研究医疗机构妇产科医疗纠纷与医疗过失责任特点,探讨改善医疗服务质量,防范并化解妇产科医疗纠纷的策略.方法:收集2013年—2020年黑龙江省医疗纠纷人民调解委员会处理并登记的57例妇产科卷宗进行回顾性分析.结果:妇产科医疗纠纷在医疗纠纷中占比较高,医疗机构过失原因种种,且与医疗机构级别有关.结论:增强医疗机构妇产科工作的风险意识,采取必要的防范措施,最大限度地减少医疗机构妇产科医疗纠纷的发生.     

35例医疗纠纷的司法鉴定分析

目的 研究医疗纠纷的产生原因、特点及新趋势,为医疗机构及医务人员防范医疗纠纷提供参考.方法 对2010年1～10月在重庆市法庭科学司法鉴定所进行司法鉴定的35例医疗纠纷案例进行回顾性分析.结果 发生医疗纠纷的医院以区、县医院为多见;发生医疗纠纷的主要原因:医疗技术缺陷、医院管理缺陷及医患沟通缺陷等.结论 规范医疗行为、提高医务人员综合素质、加强医患沟通能力、提高风险意识是防范医疗纠纷重要措施.     

谈新形势下医疗纠纷的应对要略

当前，在医疗纠纷愈已成为人们关注的热点问题的形势下，如何降低医源性医疗风险已成为各级医疗机构的当务之急。作为医疗机构和医务人员有效防范和正确处理医疗纠纷，将有助于改善医患关系，维护医院秩序和社会稳定，促进医学科学事业发展，实现构建和谐社会的目标。     

防范医疗纠纷的关键-加强医疗质量管理

本文指出了医疗纠纷对医院的危害,分析了医疗纠纷与医疗质量管理的关系,并论述了如何加强医疗质量管理以防范医疗纠纷的方法,得出了加强医疗质量是防范医疗纠纷的关键措施。阐明了医院只要充分认识医疗纠纷的危害,强化落实防范医疗纠纷的责任,建立科学的医疗质量管理机制,切实加强医疗质量和医疗安全管理,就能更好地防范和处理医疗纠纷。     

胆道外科医疗事故损害病例分析

本文通过列举部分胆道外科医疗活动中因胆道损伤发生医疗纠纷的医疗事故技术鉴定情况，分析此类医疗纠纷的成因及医疗机构应注意的事项，旨在加强意外防范，避免在胆道手术中发生医疗过失行为和及时处理方面引起医务人员重视，从而达到减少医源性胆道损伤的发生。     

构建和谐医患关系预防医疗纠纷

回顾性分析我院近几年医疗纠纷发生的原因,了解目前医疗纠纷不断增多的原因,探讨防范医疗纠纷的对策。提高医疗质量,学习相关法律,加强医患沟通,降低医疗纠纷的发生,有利于构建和谐医患关系。     

履行告知义务在减少医疗纠纷中的作用

医疗纠纷是指发生在医患之间，因患对医务人员或医疗机构的医疗服务不满意而发生的争执。如何加强医疗安全，减少医疗纠纷，是卫生行业亟待解决的问题，有关调查结果表明。98．47％的医院发生过医疗纠纷，而绝大部分的医疗纠纷经鉴定不属于医疗事故，多由于医方未履行告知义务而发生，医方所承担的部分或全部责任，给医院带来了很大的损失，甚至医院的正常诊疗秩序遭到破坏。我们在日常的医疗护理工作中，应尽可能地履行告知义务，严格执行规章制度和操作规程，加强对医疗纠纷的防范，告知义务是在医疗活动中，由医疗机构及其医务人员将患的病情、医疗措施、医疗风险等如实告知患，并应及时解答其疑问。近年来，由于此措施的落实，我院医疗纠纷的发生率明显下降。     

医疗纠纷成因及防范意见

随着医学模式的改变．法制社会的建全，人们生活水平的提高，医疗条件的改善．人们的健康意识和法律虑识不断增强．医疗纠纷有逐年上升的趋势。医疗纠纷导致医患关系紧张，既影响患者的就医情绪，也影响医生及护士的工作情绪．干扰医疗机构正常工作秩序。因此，及时正确地分析医疗纠纷的成因，加强医疗纠纷的防范，是医疗机构当前重要工作。     

新时期构建和谐医患关系的若干思考

回顾性分析近几年医疗纠纷发生的原因,了解目前医疗纠纷不断增多的原因,探讨防范医疗纠纷的对策.提高医疗质量,强化医德医风建设,加强医患沟通,降低医疗纠纷的发生,有利于构建和谐医患关系.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.