An Academic Internist Looks at Euthanasia

This paper points out that to persons unfamiliar with the context and suffering of dying patients, their loved ones, and last, but by no means least, the health care team can only discuss the very concrete question of euthanasia in an abstract way unaware of the fact that this question must, in the final analysis, be differently addressed in different specific patients and under specific circumstances. This paper poses questions which must be addressed and will rarely find a good answer but at least the best among a series of unpalatable options. It again points out the important and legitimate place that emotions play in decision-making.     

提高住院分娩率和产科质量是降低孕产妇死亡率的关键

本研究以河北省４个妇幼卫生项目县为现场，对１９９０年１月１日～１９９２年１２月３１日三年间全部死亡孕产妇与其有关的卫生服务及死因进行了调研。结果表明：调研地区孕产妇死因前两位为产科出血、产褥感染。可能与其大部分在家分娩，由未经培训过人员接生、接生质量低劣等有关。从而提出，提高住院分娩率和产科质量是降低孕产妇死亡率的关键。还提出，全社会重视妇女受教育的问题，提高妇女的社会地位，使其拥有生殖权力是提高住院分娩率的重要条件。     

患者信息错误的常见原因分析及对策

目的:统计病案中患者信息修改原因的数据,对比实施对策的成效分析,为医院管理提供参考依据。方法:将2017年、2018年两年内登记的患者信息修改数据分类统计后采用EXCEL进行对比分析。结果:患者信息修改原因主要以患者姓名同音不同字修改为主,占65.23%,姓名、年龄全部修改的较少,占3.37%。针对患者基本信息的错误,2018年实施干预对策后,患者信息修改的例数较2017年有所减少。结论:患者信息修改存在诸多隐患,医院应通过加强管理,制定患者信息修改的相关规定,不断完善相关流程,以减少患者信息错误的发生,保证患者信息的准确性。     

Migration Patterns for Revision Total Hip Arthroplasty in the United States as Reported in the American Joint Replacement Registry

BackgroundRevision total hip arthroplasty (revTHA) is associated with higher rates of complications and greater costs than primary procedures. The aim of this study is to evaluate the effect of hospital size, teaching status, and indication for revTHA, on migration patterns in patients older than 65 years old.MethodsAll THAs and revTHAs reported to the American Joint Replacement Registry from 2012 to 2018 were included and merged with the Centers for Medicare and Medicaid Services database. Migration rate was defined as a patient’s THA and revTHA procedures that were performed at separate institutions by different surgeons. Migratory patterns were recorded based on hospital size, teaching status, and indication for revTHA. Analyses were performed by statisticians.ResultsThe number of linked procedures included was 11,906. Migration rates in revTHA due to infection were higher for small hospitals than large hospitals (46.6% vs 28.6%, P < .0001). Migration rates were higher comparing non-teaching with teaching hospitals (55% vs 34%, P < .0001). This difference was significant for periprosthetic fractures (70.6% vs 37.2%, P = .005), instability (56.5% vs 35.5%, P = .04), and mechanical complications (88.9% vs 34.7%, P < .05). Most patients migrated to medium or large hospitals rather than small hospitals (89% vs 11%, P < .0001) and to teaching rather than non-teaching institutions (82% vs 18%, P < .0001).ConclusionHospital size and teaching status significantly affected migration patterns for revTHA. Migration rates were significantly higher in small non-teaching hospitals in revTHA due to infection, periprosthetic fracture, instability, and mechanical complications. Over 80% of patients migrated to larger teaching hospitals.     

根管治疗失败原因分析

目的：分析根管治疗失败原因。方法：随访１９９４－１９９８年根管治疗后就诊患者收集根管治疗术失败的病人４５例,分别从根管预备、充填以及其他方面分析失败原因。结果：根管欠填、超填、侧填不足,根管侧穿和根管遗漏是根管治疗失败的主要原因。结论：掌握治疗适应症,选择适当方法,遵守操作常规和高度责任心是提供根管治疗成功率的关键。     

重庆大学1999~2004年210例离退休职工死因调查分析

目的为了解重庆大学离退休职工死亡状况及原因,为高校老年教职工的预防保健工作提供科学依据。方法对210名死亡的教职工进行了回顾性调查分析。结果死因中心血管疾病居首位,占48·2%;恶性肿瘤其次,占32%;脑血管疾病居第三,占14·8%;糖尿病并发症居第四,占3·3%。死亡者中男性明显高于女性。结论高校对心血管疾病的预防和治疗尤为重要,进一步做好离退休职工的预防保健及健康教育工作,对避免疾病的发生、延缓生命具有重要意义。     

分析医疗纠纷拟定防范对策

目前，医疗纠纷的数量大幅度上升，处理难度加大，对医院产生了重大影响，已引起社会各界的普遍关注。本文分析了医疗纠纷的发生原因，并提出了防范对策。     

终末病案质量常见缺陷及原因分析

目的分析我院2004年与2005年病案书写质量的变化情况。方法对比分析我院2004年和2005年37432份终末病案。结果自成立医疗质量管理委员会和病案质量管理委员会以来,通过三级质控网络的监控,我院病案质量有了进一步的提高。     

1666例住院病人死亡原因分析

目的深入了解本地住院病人的主要死亡原因及其变化趋势。方法收集某区级医院1997~2004年住院病人的原始病案资料,采用《国际疾病分类》ICD-10对其进行疾病分类。结果前5位死因是损伤和中毒、循环系统疾病、围产期疾病、肿瘤、传染病。结论加强死因顺位前5位疾病的防治工作,以提高人群的健康水平和生命质量。     

服用紧急避孕药物失败原因的分析

目的：分析人工流产妇女紧急避孕失败的相关因素。方法：采用横断面研究，对301名曾服用紧急避孕药左炔诺孕削在计划生育门诊要求终止妊娠的妇女进行问卷调查。结果：32例属于方法失败，占10．6％；269例属于药物使用失败，占89．4％，为紧急避孕失败的主要原因。9例服药后引起异位妊娠。结论：调查的人群大多数高学历、高职位，但足避孕率低，错误服药率高，说明紧急避孕知识匮乏、避孕意识淡漠。药物来源以药店为主，但大部分避孕妇女没有得到正确的使用方法和必要的咨询，从而增加了紧急避孕法的失败率。