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At present medical disputes still happen sometimes though governments at all levels, health departments and hospitals pay more and more attention to correctly guide patient's behavior, regulate doctor's behavior in diagnosis and treatment, purify therapeutic environment, strengthen legislation and protect the legitimate rights and interests of doctors and patients. The causes of medical disputes are great many, and the fundamental reason is that the medical behavior from the beginning to the end is related to the life and health, naturally accompanying medical risk and hiding dispute, therefore what we ought to do is not to absolutely eliminate the risk, but to reduce the risks and disputes. In this report, to explore the causes of medical disputes and risks and look for ways to reduce them, the survey of questionnaires was carried out and practical cases of medical disputes were analyzed in hospitals. Seventy-seven cases of medical disputes from 2013 to 2015 had been completed by arbitration or court decisions, and the final arbitral ideas were as follows: invalid doctor-patient communication, low technology and insufficient management were the main causes of medical disputes; the survey of 483 questionnaires on doctors and nurses in the hospital showed that in addition to the above 3 reasons, there were other deep reasons, namely heavy working intensity, low quality of patients or their family members, and the insufficient management runs through all the links in the way. Therefore, to reduce medical disputes, the following aspects should be commenced: effective communication between doctors and patients; improving doctors' clinical diagnosis and treatment ability; optimizing medical management; correcting medical work attitude;timely medical consultation; attaching importance to medical records; doctor's order leaving some leeway or allowing for unpredictable circumstances; constructing healthy hospital culture; paying attention to the physical and mental health of medical staff; actively improving the medical dispute settlement mechanism and related legal system construction.
ABSTRACT
Objective To investigate the effects of Shanzha Xiaozhi capsule on body weight, metabolic index, percentage and distribution of body fat in obese patients with dampness-heat constitution. Methods A total of 60 obesity patients with dampness-heat constitution were enrolled in this study and randomly categorized into the control group ( n=30) and treatment group (n=30). Control group was given the diet and exercise regime, and treatment group was given Shanzha Xiaozhi capsule based on the same diet and exercise regime for 12 weeks. Scores of dampness-heat, body weight, waist circumference, hip circumference, blood pressure, blood glucose, serum lipid profile, urine acid (UA), fasting plasma insulin, serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, adiponectin, lipopolysaccharide (LPS), percentage and distribution of body fat were measured before and after treatment. Results (1) Data of scores of dampness-heat and diastolic blood pressure were significantly decreased after treatment in drug group. The above indexes and hip circumference were significantly decreased after the treatment in treatment group compared with those of control group ( P<0.05). (2) The triglyceride (TG), UA, insulin, HOMA-IR, LPS and IL-1βwere significantly decreased after the treatment in treatment group than those of control group, while there were no significant differences in fast blood glucose (FBG), 2 h postprandial plasma glucose (2 hPG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), TNF-α, IL-6 and adiponectin between two groups. (3) The percentage of visceral fat was significantly decreased in treatment group than that of control group. There were no significant differences in fat changes of limbs and buttocks between two groups. Conclusion Shanzha Xiaozhi capsule can decrease body weight and visceral fat content, reduce insulin resistance, and improve chronic inflammation state in obese patients with dampness- heat constitution.
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Objective To investigate the effect of Shanzha Xiaozhi Capsules (SXC) on body weight, metabolic indexes, body fat accumulation and distribution of obesity patients with phlegm-dampness constitution. Methods Fifty obesity patients with phlegm-dampness constitution were randomized into control group and medicine group, 25 cases in each group. The control group was given lifestyle instructions for diet and exercises, and the medicine group was treated with SXC orally besides the instructions for lifestyle. The treatment for both groups covered 12 weeks. Before and after treatment, we observed the outcomes including scores of phlegm-dampness, body weight, waist circumference, hip circumference, blood pressure, fasting blood glucose, serum lipid profile, urine acid, body fat accumulation and distribution, and visceral fat accumulation. Results(1) The scores of phlegm-dampness were decreased significantly in both groups after treatment (P0.05). Hip circumference was decreased significantly in both groups(P 0.05).(3) Systolic pressure and diastolic pressure were decreased significantly in both groups (P 0.05).(4) Fasting blood glucose, 2-hour blood glucose after oral glucose tolerance test, serum lipid profile and urine acid remained unchanged in both groups after treatment (P>0.05). (5) The general body fat accumulation of both groups was decreased significantly after treatment (P 0.05). Waist fat accumulation had no significant decrease in the control group (P > 0 . 05), but was decreased in the medicine group (P<0.01). Visceral fat accumulation was decreased significantly in both groups after treatment(P<0.01), and the decrease was obvious in the medicine group (P<0.01). Conclusion In addition to its contribution to body weight loss, SXC also contribute to the reduction of visceral fat accumulation in obesity patients with phlegm-dampness constitution .
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Objective To discuss the important points of rescue strategies in saving patients and related administration to minimize the medical risk of county or district hospitals. Methods The analytic method to minimize the medical risk of district and county hospitals was from clinical practice and via induction,summary and reorganization. Results and Conclusions The reasonable and effective clinical medical operative process includes,timely necessary emergency initial examinations,immediately organizing group consultation after mastering the emergency rescue procedures in various critical situations,following the newest modern treatment guidelines or professional expert consensus,treating patients with correct motivation to maximize the therapeutic effect,carrying out treatment while the diagnosis confirmed,properly communicating between doctor and patient,timely recording the medical record,improving the diagnosis and treatment capacity in cases with critical and difficult diseases step by step,correcting the errors and mistakes,immediately and effectively proceeding to crisis public relations in time.
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ObjectiveTo investigate the effects of lipopolysaccharide ( LPS ) on cell apoptosis,proliferation, and insulin secretion in a β-cell line, NIT-1. MethodsNIT-1 cells were stimulated with 1 μg/ml LPS for 0-120 h. Cell apoptosis was evaluated by Hochest33342 staining and Annexin V/PI flow cytometry. Cell proliferation was evaluated by CCK-8 and BrdU assay. Intracellular insulin content, basal insulin secretion, and glucose-stimulated insulin secretion(GSIS) were detected by RIA. The IRS-2 tyrosine phosphorylation was determined by Western blot. ResultsCell apoptosis was not significantly changed by treatment with LPS for 120 h. Cell proliferation was stimulated by LPS before 48 h, and inhibited after 96 h. Intracellular insulin content or GSIS was not altered, but basal insulin secretion was decreased significantly by LPS after 48 h ( all P＜0.01 ). LPS decreased the tyrosine phosphorylation level of IRS-2 ( 0. 45 ± 0. 08 vs 0. 22 ± 0. 06, P ＜ 0. 05 ) and stimulated IκBα phosphorylation. Pretreatment with a specific IκBα phosphorylation inhibitor, Bay1 1-7082 for 1 h, remarkably blunted the LPS-induced phosphorylation of IκBα and cell proliferation( both P＜0.01 ). ConclusionsLow-dosages of LPS regulate proliferation and basal insulin secretion of NIT-1 β-cells, in which activation of NF-κB and inhibition of IRS2 tyrosine-phosphorylation may be involved.