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【Objective:】 To understand the current status and related impacts of medical risk perception and treatment decision-making in preoperative patients with malignant tumors. 【Methods:】 The 350 malignant tumor patients who were hospitalized for surgical treatment in two tertiary hospitals in Liaoning Province were selected. The general information questionnaire, medical risk perception questionnaire, and participation in treatment decision-making questionnaire were used as survey tools. SPSS26.0 software, data statistical methods such as the Kappa test and multiple linear regression were used to analyze valid data. 【Results:】 Among the 350 subjects, the mean scores of the actual level of participation in treatment decision-making and attitude towards participation in treatment decision-making were(1.75±0.50) and(1.56±0.52), respectively, and the consistency between them was poor(Kappa=0.134, P<0.001). The total score of medical risk perception in preoperative patients with malignant tumors was(57.13±16.2). The results of multiple linear regression analysis showed that the actual degree of patient participation in treatment decision-making was influenced by the experience of surgical treatment(β=-1.744, P<0.05), economic risk in medical risk perception(β=0.478, P<0.05), and time risk (β=0.478, P<0.05). Economic risk in medical risk perception(β=0.043, P<0.05), time risk (β=0.646, P<0.05), and psychological risk(β=-0.329, P<0.05) were the influencing factors of patients’ attitude towards participating in treatment decision-making. 【Conclusion:】 Medical professionals should pay more attention to the influence of medical risk perception of malignant tumor patients on treatment decision-making. Malignant tumor patients should fully exercise their right to choose treatment plans independently, and jointly improve the actual level and attitude of the group when participating in treatment decision-making.
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INTRODUCCIÓN: La prematuridad es un grave problema de salud pública por la morbilidad, la mortalidad y los costos a ella asociados. OBJETIVO: Evaluar la relación entre las características sociodemográficas, obstétricas y psicosociales con el desenlace de parto prematuro frente a partos de término en el Hospital Guillermo Grant Benavente de Concepción, Chile, entre el segundo semestre de 2016 y el primer semestre de 2017. MÉTODO: Estudio cuantitativo, observacional, de tipo caso-control. La muestra la constituyeron 84 mujeres con parto prematuro y 85 con parto de término. Se utilizó un cuestionario de elaboración propia y la escala de Evaluación Psicosocial Abreviada (EPsA). El estudio fue aprobado por el comité ético científico. Se realizó análisis bivariado, con un nivel de significancia a = 0,05. Los datos se analizaron con el software estadístico SPSS v.25.0. RESULTADOS: No hubo diferencias en los antecedentes sociodemográficos (edad, nivel socioeconómico, estado civil y escolaridad) entre ambos grupos. Solo las mujeres con parto prematuro mantenían en mayor porcentaje que las gestantes de término un trabajo remunerado (43,4% vs. 25,9%). El estado nutricional y el antecedente de parto prematuro previo no se asociaron a un nuevo parto antes de las 37 semanas. La interrupción por cesárea fue significativamente más frecuente en las gestaciones de pretérmino que en el grupo control (p = 0,0377). CONCLUSIONES: En la población estudiada, las características sociodemográficas de las gestantes no tuvieron relación con el desenlace prematuro de la gestación. Algunos factores biomédicos se relacionan significativamente con este riesgo. Es necesario evaluar la pertinencia de aplicar escalas psicosociales en esta población y enfocar los esfuerzos para promover el control preconcepcional en mujeres con antecedentes de parto prematuro o comorbilidad.
INTRODUCTION: Prematurity is a serious public health problem due to morbidity, mortality and associated costs. OBJECTIVE: To evaluate the relationship between sociodemographic, obstetric and psychosocial characteristics with the outcome of premature birth versus term births at the Guillermo Grant Benavente Hospital in Concepción, Chile, between the second semester of 2016 and the first semester of 2017. METHOD: Quantitative, observational case-control study. The sample consisted of 85 women with premature delivery and 85 with term delivery. A self-elaborated questionnaire and Abbreviated Psychosocial Assessment scale (EPsA) were used. The study was approved by the scientific ethics committee. Bivariate and multivariate analysis was performed, with a level of significance a = 0.05. The data were analyzed with the statistical software SPSS v.25.0. RESULTS: There were no differences between the sociodemographic antecedents (age, socioeconomic level, marital status and education) between both groups. Only women with preterm birth had a higher percentage of paid work than full-term pregnant women (43.4% vs. 25.9%). Nutritional status and a history of previous preterm birth were not associated with a new delivery before 37 weeks. Interruption by cesarean section was significantly more frequent in preterm pregnancies than in the control group (p = 0.0377). CONCLUSIONS: In the studied population, the sociodemographic characteristics of the pregnant women were not related to the premature outcome of pregnancy. Biomedical factors are significantly related to this risk. It is necessary to evaluate the relevance of applying psychosocial scales in this population and to focus efforts to promote preconception control in women with a history of preterm birth and/or comorbidities.
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Humans , Female , Pregnancy , Infant, Newborn , Adult , Middle Aged , Young Adult , Obstetric Labor, Premature/psychology , Obstetric Labor, Premature/epidemiology , Socioeconomic Factors , Pregnancy Outcome , Case-Control Studies , Surveys and Questionnaires , Risk Factors , Gestational Age , Hospitals, PublicABSTRACT
Peking Union Medical College Hospital has carried out the practical exploration of a new system of medical risk prevention and control based on the integration of medical and law, broken the traditional practice of legal counsel only handling medical disputes after the event, explored the pre-management and control mode of medical risks. The hospital established a whole process medical risk management mode in which legal counsel, medical administrators and clinical medical staff cooperated and participated, further standardized the medical behavior, legal concept and legal practice awareness of medical personnel, realized standardized management and formed a long-term mechanism. It could not only effectively integrate the fragmented clinical legal service needs and extensively enhance the sense of occupational security of clinical medical staff, but also effectively improve the operation quality of medical safety indicators and promote the high-quality development of the hospital.
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Through the treatment of difficult case in a gynecology and obstetrics and doctor-patient communication,this paper analyzed how obstetricians and gynecologists should start from themselves,properly treat the patients,reduce the disputes and conflicts and harmonize the relationship between doctors and patients.It is believed that doctors should get patients' trust through improving their own medical technology,enhance communication skills,use "Platinum Law" to understand patients'needs,respect patients' right of informed consent,adopt reasonable requests and suggestions of patients,thus to reach a harmonious consensus of both doctors and patients and seek the best way of treating disease.
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The realization of patients′right of informed consent depends on the physician′s description of the disease status, medical treatment measures and risks. Performing the obligation of informing according to the laws is conducive to effective communication with patients on the diagnosis and treatment of disease, thereby preventing and reducing medical disputes. Meanwhile, the informing content constitutes its own legal constraint. Based on a case of medical dispute, this paper particularly discussed the performance of obligation of informing, medical risk sharing, as well as the ethical requirements.
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Medical team resource management is an effective way to control medical risk, ensure patient safety and enhance patient satisfaction. Based on defining the connotation, this paper illustrates the application and expe-rience of medical team resource management in Taiwan and finally proposes suggestions to apply medical team re-source management in domestic medical practice.
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Objective To develop a fair performance appraisal method for clinical departments,as a reference for grading performance pay.Methods Ridit method with consideration of medical risks is used to evaluate clinical departments'performance.Results Both quality of care and medical risk are graded and overlaid,to arrive at the comprehensive values on which the performance pay is divided into grades Ⅰ,Ⅱ,Ⅲ,and Ⅳ.In this practice,values 7 ~8 is grade Ⅰ,6 grade Ⅱ,4 ~ 5 grade Ⅲ,and 2~3 gradeⅣ.Conclusion A fair and justifiable department performance evaluation system that is based on performance proves vital for the sustainable development of the hospital. Ridit method with consideration of medical risk evaluation advocates the performance appraisal principle of encouraging better performance,high risk and high efficiency.
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This paper introduced the risk communication principles made by WHO including: establishing trust, releasing information betimes, keeping transparent , listening to the public opinions and involving them in etc.Seven steps to make a two -way and interactive communication are also put up on that basis .It covers infor-ming the medial information and comforting patients ’ anxiety.In addition, the strategies of informing the patients of high-risk medical issues or low -risk medical issues and good or bad news are also mentioned .
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An analysis of typical cases of AIDS infection incurred by blood transfusion suggests that the error-free infection in blood transfusion calls for a social relief mechanism.The authors also made a feasibility analysis of the compensation of medical risk health insurance for such infection,and explored a new way out for resolving the disputes involving medical risk of such infection.
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Objective: To provided solutions in view of the status and the main existence problems of hospital medical equipments quality control management. Methods:On the basis of meaning of quality control management and combined the present situation of our hospital, this research pointed out that the equipment procurement quality control management, clinical use quality control management, and medical engineering quality control management. Results:Through the construction of quality control management system of medical equipment, the accuracy and safety of medical equipment and instrument were ensured. Conclusion:Only by strengthening the quality control management of medical equipment, can reduce the incidence rate of medical accidents effectively, reduce medical disputes, the medical equipment can meet to maximize social and economic benefit.
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Covered in the paper are concepts and contents of medical risk and emergency response technology.Based on a description of medical risk information management experiences in Japan,Sweden and the United States and the current studies of medical risk response information management,the paper proposed measures for China in medical risk information emergency technology.Recommendations made include establishing a comprehensive emergency medical risk information management system,scientific medical risk information collection,monitoring,assessment,early warning systems,as well as building an intelligent risk emergency information decision system and establishing medical risk communication channels,thereby preventing effectively the occurrence of medical risks.
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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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Doctor-patient relationship and medical disputes became the central issues of recent society.Harmonious doctor-patient relationship is not only the fundamental of medical activity,but also the important part for establishing harmonious society.Establishing harmonious doctor-patient relationship and diminishing medical disputes will be realized by the effort of the whole society.Research on medical disputes in republic of China:reflection on harmonious doctor-patient relationship (Dalian Publishing House,2012,April) is sponsored by the Dalian Municipal Government.This book objectively analyzed underlying reasons for the occurrence of medical disputes,elaborated on factors for changes in medical disputes and provided references for handling of modern doctor-patient relationship from the aspects of medical risk,doctor-patient communication and patients' right based on historical vision.This book has special vision and novel content,creating a strong reality that calls for people illuminating.
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Comparison of the institutional setup, policies and adverse event report mechanism for medical risk control in the countries of UK, USA, Canada, and Australia by means of browsing information on their official websites. It is found that these countries maintain a national patient safety authority, coupled with a tiered management at national, local, medical institutions and NGOs level; the USA pattern features laws and regulations, that of UK and Australia features guidelines as policy guarantee for medical safety; these countries regulate adverse event reporting by either government leadership or cooperation with trade associations. Inspirations from this study suggest China to enhance institutional construction, complete regulations, and advocate the culture for medical safety, and to build the national-level reporting and study system for medical safety events, and improve medical risk management.
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An analysis of the medical risks exposure for resident doctors in their standardized training,and insights into the risk management measures proposed for this stage.These measures include:1) Pre-control of risks;2) Full-length supervisor of such training stage;3) Systematic education for medical risk exposure;4) Timely guidance on risk identification and response;5) Development of the evidence awareness.
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The article introduces the denomination,desire of precaution and content of medical risks of interventional radiology in brief.To strengthen the management of medical risk is an effective way to decrease malpractice and improve the safety of patients.The medical risk of interventional radiology possesses distinct characteristics,therefore the management should be strictly executed according to the principles.
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With the increasing medical conflicts,medical risk education in prothdontical practice is very necessary.This article explored the importance of the medical risk education,the cause of the medical risks,and how to avoid it.
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Doing a good job of guarding against medical risks can effectively improve medical safety and reduce waste of medical resources. In recent years, marked results have been attained in the US in studies on the use of FMEA, a prospective quality analysis tool, to minimize medical risks. Similar studies, though not many, have been made in some other countries, such as Italy and Australia. No reports, however, have been published at home on studies in this field. The paper gives an account of the use and theoretical studies of FMEA in medical risk management in the US, illustrates cases wherein it was used to lower risks in prescribing drugs to patients and ensure the safe use of hospital software and hardware, and puts forward issues that shouldn't be ignored in using FMEA so as to arouse the attention of domestic hospital management departments.
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The paper analyzes the potential drawbacks of the current medical liability insurance from the perspectives of hospitals, insurance companies and patients. It puts forward suggestions for the sustainable development of medical liability insurance, viz. involvement of insurance brokers in coordinately solving the issue of application for medical liability insurance, involvement of loss assessors in solving medical disputes, adoption of compulsory medical liability insurance in due time, and further expansion of the scope and categories of insurance.
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The authors conceive of dispersing and transferring medical risks by means of insurance. They suggest developing two modules of insurance business, including malpractice insurance and medical accident insurance. They also discuss such basic issues as risk financing, financial compensation and choice of insurance undertakers.