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.     

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.     

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。     

微观辨证难以实现的根本原因

自1986年提出微观辨证和辨证微观化以来,中医界对此进行了不懈探索。目的在于以现代医学客观检测指标诠释中医的证,借以把同病异证定量区别开来,进而过渡到用客观指标辨证。本文对此类研究开展了全面考察,由于开展微观辨证和辨证微观化研究的辨证标准不规范;研究设计中适应证、参比证、客观检测指标选择、检测指标的微观程度等均存在毋庸置疑的逻辑问题;加之围绕西医疾病辨证所属症状的虚拟性广泛存在,因而导致此项研究实际上已经搁浅。明确并解决这些问题,及时调整研究思路已迫在眉睫。     

妇产科护理质量缺陷原因及防范对策

目的:探讨妇产科护理质量缺陷的原因,并提出相应防范对策。方法:采用回顾性研究方法,对本院妇产科发生的59例护理质量缺陷事件进行调查,分析护理质量缺陷与护理人员学历、职称、工作年限等的关系,提出相应防范对策。结果:护理人员未严格执行查对制度和责任心不强是造成护理质量缺陷的主要原因,护理质量缺陷的发生与护理人员工作年限存在密切联系,低年资护士更易发生护理质量缺陷事件。结论:加强护理人员的业务知识学习与技能训练、提高护理人员责任心是减少护理质量缺陷的有效途径。     

91例首次住院精神疾病患者死亡原因分析

目的研究首次住院精神痰病患者的死亡原因。方法回顾性分析首次住院死亡精神痰病患者的病历资料,进行统计学分析。结果首次住院死亡91例,死亡原因有躯体疾病、猝死、治疗综合征、自杀、意外事故,分别占50．5％、22．0％、11．0％、8．8％、7．7％;住院10天内死亡45例（49．5％）。结论躯体疾病、猝死是导致首次住院精神病人死亡的主要原因,医护人员应高度重视住院10天内的精神病患者。     

康复医院残疾患者医疗欠费状况的研究

目的：分析康复医院残疾患者住院欠费的情况，为减少或杜绝医疗欠费提供资料。方法：112例脊髓损伤、脑卒中、脑瘫出院的康复患者欠费个案作为调查研究对象进行统计分析。结果：康复残疾患者拖欠医疗费用总金额为1231829．82元，人均欠费10998．48元。欠费人员多为外地国有中小企业职工、农民工，欠费方式因经济困难无力支付费用占总欠费用的78．0％，逃费占12．9％，医疗纠纷占9．1％。结论：康复医疗机构应加强医疗欠费的管理；政府部门应建立并完善医疗法制管理制度和社会救助基金制度，切实维护医患双方合法权益。