Quantifying the amount of padding improves the comfort and function of a fibreglass below-elbow cast

Aim

To determine the quantity of cotton underpadding needed for a comfortable, functional, below-elbow fibreglass cast.

Methods

In this randomised, prospective, crossover, clinical trial, 45 people with minimally displaced distal radial fractures were enrolled to randomly receive, 14 days after injury, a fibreglass below-elbow cast with either two or four layers of cotton underpadding. The characteristics of the recipients were recorded. After 2 weeks of immobilisation, participants completed a numerical survey evaluating parameters of comfort and underwent clinical and radiographic assessment. They then crossed over to receive the other fibreglass cast design, the process was repeated, and they indicated their cast preference, if any.

Results

Of 37 people who completed the study, 20 preferred the two-layer model, 13 the four-layer model and 4 had no preference. No significant trend for one design over the other was shown (p = 0.1), nor any statistical association between preference and participant characteristics or the order in which cast models were received.

Conclusions

Participants did state a preference, but this was not related to recipient characteristics. Neither cast design was significantly the more comfortable; and both models were safe and functionally satisfactory.     

Incidences et causes d’insatisfaction des patients vis-à-vis de la prise en charge de la douleur postopératoire

Introduction

Patient satisfaction regarding postoperative pain management (POPM) is not always correlated with pain level relief.

Objective

To evaluate the percentage of satisfied patients while splitting satisfaction related with nurses, anaesthesiologists and surgeons during 48 h postoperative period.

Patients and methods

The study was performed in 2007 by two investigators in six different surgical suites in a university hospital. Approximatively 15 patients have been randomly selected in each surgical ward. Each patient received during the first or second postoperative day an anonymous questionnaire and was required to complete it with the investigator assistance if necessary. Questions requiring a yes-or-no reply assessed the patient's satisfaction with POPM performed by nurses, surgeons, and anaesthesiologists. In case of dissatisfaction, patients were invited to explain the reasons.

Results

Ninety-two patients were included, 5% of the patients were not satisfied with nurse POPM and nearly 15% were not satisfied with anaesthesiologist or surgeon POPM. The main reasons of dissatisfaction with nurses were the excessive delays between requesting and receiving an analgesic and because of the significant discrepancies in POPM between nurses. Patient discontent regarding surgeons was explained by the lack of interest of the latter for POPM. Patient discontent regarding anaesthesiologists was explained by the lack of anaesthesiologist visit in the postoperative period.

Conclusion

There is a relationship between patient dissatisfaction and the lack of attention for POPM by surgeons and the lack of postoperative visit by the anaesthesiologist. A postoperative visit by a team of anaesthesia nurses should improve patient satisfaction with POPM.     

医疗责任保险对化解医患纠纷的作用分析

借鉴国外先进经验,结合中国特殊国情,提出医疗责任保险介入来缓解医患纠纷的设想,并着眼于医疗责任保险对缓解医患纠纷的作用分析,同时对作用发挥过程中存在的问题及相应的解决途径进行阐述。     

对医患沟通的伦理思考

建立和谐的医患关系,是构建和谐社会的重要组成部分。而良好的沟通是和谐医患关系的重要渠道,因此医务人员应该加强自身的职业道德修养,注重医患沟通,给患者以尊重、理解和人文关怀,缓解医患关系不平衡不对称的矛盾,从而促进医患之间相互尊重,相互理解和相互信任,建立和谐的医患关系。     

Methodological quality of randomised controlled trials in burns care. A systematic review

Objective

To evaluate the methodological quality of published randomised controlled trials (RCTs) in burn care treatment and management.

Methods

Using a predetermined search strategy we searched Ovid MEDLINE (1950 to January 2008) database to identify all English RCTs related to burn care. Full text studies identified were reviewed for key demographic and methodological characteristics. Methodological trial quality was assessed using the Jadad scale.

Results

A total of 257 studies involving 14,535 patients met the inclusion criteria. The median Jadad score was 2 (out of a best possible score of 5). Information was given in the introduction and discussion sections of most RCTs, although insufficient detail was provided on randomisation, allocation concealment, and blinding. The number of RCTs increased between 1950 and 2008 (Spearman's rho = 0.6129, P < 0.001), although the reporting quality did not improve over the same time period (P = 0.1896) and was better in RCTs with larger sample sizes (median Jadad score, 4 vs. 2 points, P < 0.0001). Methodological quality did not correlate with journal impact factor (P = 0.2371).

Conclusions

The reporting standards of RCTs are highly variable and less than optimal in most cases. The advent of evidence-based medicine heralds a new approach to burns care and systematic steps are needed to improve the quality of RCTs in this field. Identifying and reviewing the existing number of RCTs not only highlights the need for burn clinicians to conduct more trials, but may also encourage burn health clinicians to consider the importance of conducting trials that follow appropriate, evidence-based standards.     

重视急诊医疗中的伦理问题

目的探讨急诊医疗中伦理问题的重要性。方法参考相关文献,并融合本院急诊的特点,探讨目前急诊医疗中所存在的伦理问题,以及重视伦理问题的必要性,并根据本院急诊医生小范围调查结果所反映的问题探讨相应对策。结果因目前急诊医疗的特殊性,产生了与其他科室所不同的伦理问题。结论要重视急诊医疗中伦理问题产生的原因,要完善急诊医疗中相应的政策法规和急诊流程问题;要重视病人权益,加强医患沟通,保障病人返家后的安全;同时也要减轻急诊医生工作压力,加强急诊医生可持续性培训和团队合作精神。     

患者隐私保护对医患关系影响的伦理学分析与对策思考

首都医科大学承担的国家社科规划办“医患关系对构建和谐公平社会的影响及对策研究”课题组,2007年对全国十个省市进行了问卷调查,通过对患者隐私的尊重和保护层面的调查,结果显示,主流是好的,但仍存在一些不足。并对如何改进做了分析与建议。     

制度建设在解决医患关系异化中的作用

医患关系紧张的背后隐含着严重的信息不对称,但这只是医患之间紧张的必要条件,而不是充分条件,经济利益至上才是问题症结所在。为此,有必要形成病人利益至上的观念。医患沟通有利于改善信息不对称的状态,但并不能保证医务人员的诚信行为。制度所具有的特性满足从“特殊化信任”向“普遍化信任”转变的要求。为了提高制度对改善信息不对称的功效,要致力于提高制度的遵从率和可行性,完善奖惩机制。     

医务人员和患者眼中的医患关系

目的了解我国的医患关系现状。方法采用问卷调查的方法,在全国十所城市随机选择20家三级医院和20家二级医院,对医务人员和患者进行调查。结果有50％的患者认为目前的医患关系还好,40．7％的患者认为一般,9．3％的患者认为不好;而有29．1％的医务人员认为目前医患关系还好,39．7％的医务人员认为一般,31．2％的医务人员认为不好。结论医患关系存在着不少问题,但和谐的医患关系是主要方面,而医务人员在工作中承受着医患关系紧张的巨大压力。