Analysis of 100 Cases of Nurse-patient Communication from the Perspective of Ethic, Psychology and Law / 中国医学伦理学

With the implementation of the Healthy China Strategy, the value of care has become increasingly prominent. It has become an important nursing topic to strengthen the theoretical and practical research of nurse-patient communication, especially to understand the current state, and explore the essential characteristics, the influencing factors and the differences in interdisciplinary perspectives of nurse-patient communication. Through systematic analysis of 100 real clinical nurse-patient communication cases, this paper found that the problem of poor nurse-patient communication still existed widely, which is prominently manifested as the inhibition of communication willingness, the dislocation of communication topics and the lack of communication consensus. The causes of poor nurse-patient communication were nurses’ poor communication skills, negative emotional distress, the lack of humanistic literacy and insufficient energy investment in communication, as well as the patient’s fragile state, the limitation of knowledge and cultural level, and insufficient trust in nurses. The interdisciplinary perspective analysis of ethics, psychology and law is conducive to enriching and developing the theoretical basis and research methods of nurse-patient communication, and can also provide useful suggestions for improving nurse-patient communication in clinical.

Case analysis of a patient with isavuconazonium-caused pancytopenia / 中国药房

OBJECTIVE To correctly identify and deal with the adverse drug reaction as pancytopenia caused by isavuconazonium and to provide reference for the safe use of isavuconazonium. METHODS Clinical pharmacists analyzed a case of severe infection and renal insufficiency who experienced pancytopenia after using isavuconazonium. Clinical pharmacists screened the drugs used during hospitalization and evaluated the relationship between this adverse drug reaction and isavuconazonium， as well as the possible mechanisms， based on the half-life of the drugs and relevant literature. RESULTS & CONCLUSIONS The relationship between pancytopenia and isavuconazonium was assessed as “possibly related”. When using isavuconazonium， attention should be paid to avoiding the combination of drugs with the same mechanism or potential interaction. For patients who have a course of treatment for more than 2 weeks， have hematological abnormalities or complicated with liver and renal insufficiency， or should use it combined with other drug with same mechanism， it may be considered to increase the frequency of blood routine monitoring.

Literature Case Analysis of 44 Patients with Thrombocytopenia Induced by Clopidogrel / 医药导报

Objective To investigate the characteristics of clopidogrel-associated thrombocytopenia to provide references for clinically safe drug use.Methods The case reports of thrombocytopenia induced by clopidogrel published in PubMed,Embase,CNKI,Wanfang and VIP were searched from the establishment of each database to November 2022,and their occurrence was collated and analysed.Results A total of 44 cases from 43 articles were identified and included in the analysis.There were 30 males(68.2％)and 14 females(31.8％).Ages ranged from 37 to 88(65.0±11.4)years,of which 30(68.2％)were ≥60 years old.Thrombocytopenia was found from 8 h to 9 months after medication,of which 29 cases(65.9％)appeared within two weeks.There were 31 cases(70.5％)with severe thrombocytopenia and 38 cases(86.4％)with complications,of which 24 cases(63.2％)with bleeding and 19 cases(50.0％)with thrombotic thrombocytopenic purpura(TTP).The platelet countof41 cases(93.2％)returned to normal after drug withdrawal and symptomatic treatment,and 3 cases(6.8％)died finally.Conclusion Clopidogrel related thrombocytopenia is mainly severe thrombocytopenia,and often accompanied by bleeding or thrombotic thrombocytopenic purpura(TTP),but the overall outcome is good.Platelet count should be regularly monitored within the first two weeks after medication.Clopidogrel should be stopped and symptomatic treatment should be given in case of any abnormality.

A case report of SARS-CoV-2 encephalitis / 上海预防医学

A patient with SARS-CoV-2 infection was adimitted to Shanghai Shibei hospital of Jing'an District in early 2023. According to the patient's complaits， clinical manifestations， physical symptoms， laboratory examination， radiological image results， plus lumbar puncture， the patient was diagnosed with novel coronavirus encephalitis. The patient was discharged from the hospital after a combined treatment of Chinese and western medicine.

Analysis of a case of pancytopenia complicated with delayed drug fever induced by vancomycin infusion in a child / 中国药房

OBJECTIVE To accurately identify the rare adverse drug reactions （ADR） of vancomycin-pancytopenia in order to promote its safe use. METHODS Through a case report of a child with suppurative hip arthritis who developed pancytopenia combined with delayed drug fever caused by intravenous infusion of vancomycin，Naranjo score method and related literature were used to summarize the association between the ADR and vancomycin and its possible mechanism， and suggestions for rational use of vancomycin in pediatric patients were put forward. RESULTS & CONCLUSIONS The association of pancytopenia combined with delayed drug fever and vancomycin in this child is “very likely”. In clinical practice， it is difficult to distinguish between pancytopenia combined with delayed drug fever from fever and hematopenia caused by aggravation of infection. Medical staff should increase their awareness of vancomycin rare ADR such as pancytopenia， and pharmacists should assist medical staff in timely screening for ADR. The initial dose of vancomycin infusion for children should start from 60 mg/（kg·d），and the blood concentration should be monitored 48 h after the first infusion and the dose should be adjusted in time to maintain the valley concentration of vancomycin at 5-15 mg/L to prevent the occurrence of ADR caused by excessive blood concentration. For children who have been using vancomycin for more than one week，the blood routine should be rechecked regularly. Once pancytopenia occurs，the drug should be stopped immediately，and symptomatic treatment should be given according to the situation.

Forensic Analysis of Eighteen Tubal Pregnancy-Related Medical Damage / 法医学杂志

OBJECTIVES@#To analyze the cases of medical damage after misdiagnosis of tubal pregnancy, to explore the causes of medical damage, the causal relationship between medical malpractice and the damage consequences, as well as the causative potency, in order to provide evaluation ideas for forensic identification of such cases.@*METHODS@#Eighteen cases of forensic identification of tubal pregnancy related medical damage were collected and retrospectively analyzed from the aspects of age, maternity history, fertility requirements, risk factors, diagnosis and treatment, medical malpractice, damage consequences, and causative potency.@*RESULTS@#All 18 cases were tubal pregnancy, of which 17 cases had medical malpractice, resulting in 14 cases of affected tubal resection, 2 cases of hemorrhagic shock death, 1 case of intrauterine fetal death and affected tubal resection. The other case had the consequence of affected tubal resection, but there was no malpractice in the treatment.@*CONCLUSIONS@#Correct diagnosis is helpful to make appropriate treatment plan, prevent disease progression and reduce serious adverse consequences and the occurrence of medical disputes. Scientific and reasonable analysis of the causal relationship between medical malpractice and damage consequences and the causative potency is of great significance to the successful settlement of medical disputes.

Exploration and practice of research-based audit in the management of multi-campus infrastructure projects in public hospitals / 中华医院管理杂志

Internal auditing for infrastructure projects carried at multi-campuses of a hospital to support hospital strategic growth, is a crucial means in raising the business performance and capacity. A public hospital made a research-based audit to examine infrastructure projects across multi-campuses since 2021. At the pre-trial stage, the audit plan was created in a " two-coordination" manner to define the scope of authority and responsibility of audit objectives; at the in-trial stage, audit priorities were focused on in advance through intelligent early warning, and full-course audit guidance and quality control was made through online real-time audit operation system; at the post-trial stage, efforts were focused on resolving problems, summarizing audit findings. The authors introduced the practice of the hospital and further explained the specific application methods and achievements through case analysis, providing reference for internal audit of infrastructure projects in multi-campus hospitals, for reference in likewise internal auditing.

Literature case analysis of hyperammonemic encephalopathy caused by sodium valproate / 药物流行病学杂志

Objective To investigate the occurrence and clinical characteristics of the adverse reactions of hyperammonemic encephalopathy caused by sodium valproate and provide reference for the safe clinical use of the drug.Methods CNKI,WanFang Data,VIP,PubMed and Web of Science databases were electronically searched to collect case reports on valproate-induced hyperammonemic encephalopathy from the inception to March 2023.The extracted data was conducted for statistical analysis.Results A total of 37 documents with 41 patients were finally included.Among them,28 patients(68.3%)were males and 13 patients(31.7%)were females,aged 5 to 78 years,the median age was 41 years;most of the patients had no underlying diseases but the blood ammonia concentrations of them were abnormally high in laboratory tests,and the main clinical manifestations were neurological impairment such as cognitive impairment,drowsiness,coma and other disorders of consciousness.After drug discontinuation,drug switch and symptomatic treatment,they gradually recovered consciousness and the blood ammonia concentrations returned to normal.Conclusion It is not easy to recognize and detect the high blood ammonia encephalopathy caused by the application of sodium valproate in clinical practice,so the clinical performance and blood concentration of this drug should be closely monitored,and once the abnormalities are detected,patients should be treated symptomatically in time to ensure the safety of the drug use.

Application of mixed BOPPPS combined with case analysis teaching in nursing practice teaching in the department of endocrinology / 中华医学教育探索杂志

Objective:To explore the application of mixed BOPPPS (bridge-in, objective, pre-assessment, participatory-learning, post-assessment, summary) combined with case analysis teaching in nursing practice teaching in the department of endocrinology.Methods:Forty-five nurses of Batch 2017 who practiced in the Department of Endocrinology were selected as the control group, using traditional teaching; 45 practical nursing students of Batch 2018 were selected as the research group, using mixed BOPPPS combined with case analysis teaching. After the teaching, the teaching effect was evaluated by the theoretical and practical skill operation assessments, and the satisfaction with the teaching was investigated through the questionnaire. SPSS 22.0 was used for t test and chi-square test. Results:The scores of basic theory [(28.31±2.07) vs. (24.66±2.15)] and professional theory [(67.01±3.05) vs. (55.62±3.20)] in the theoretical assessment of practical nurses in the research group were higher than those in the control group, with significant differences ( P<0.05); the scores of each sub-item of the practical skills operation assessment were better than those in the control group, with significant differences ( P<0.05); in terms of teaching satisfaction, the research group was better than the control group in such 10 aspects as whether to improve the level of theoretical and practical skills operation, whether to improve the awareness of humanistic care and whether to improve the nurse-patient communication ability, etc., with significant differences ( P<0.05). Conclusion:The BOPPPS combined with case analysis teaching significantly improves the theoretical and practical skills and comprehensive literacy of the endocrinology practical nursing students, and the teaching satisfaction is significantly better than that of the traditional teaching, which is of promotion value.

Application of symptom-guided mind mapping method combined with case analysis mode in emergency nursing teaching of practice nursing students in the department of cardiology / 中华医学教育探索杂志

Objective:To explore the application effect of symptom-guided mind mapping combined with case analysis in the emergency nursing teaching of practice nursing students in the department of cardiology.Methods:A total of 60 nurses who had internship in the Department of Cardiology in The First Affiliated Hospital of Xinjiang Medical University from August 2019 to April 2020 were included in the study, and they were averagely divided into control group and study group based on the admission sequence. The control group used traditional teaching, and the study group used symptom-guided mind mapping combined with case analysis. After 3 months of internship, the teaching effect of the two groups of intern nurses was evaluated through the cardiology emergency nursing assessment. A questionnaire survey was used to compare the evaluation of the two groups of intern nurses on their own professional ability. SPSS 22.0 was used for t test and chi-square test. Results:The practice nurses in the study group had higher scores of cardiology emergency nursing skills, comprehensive emergency response capabilities, disease assessment and observation capabilities, and total scores than those of the control group, with statistically significant differences ( P<0.05). The recognition rate of self-professional ability such as ability to combine theory with practice (96.67% vs. 70.00%), ability to discover and deal with problems (86.67% vs. 56.67%), comprehensive emergency response ability (83.33% vs. 46.67%), teamwork ability (93.33% vs. 73.33%) and condition assessment and observation ability (90.00% vs. 53.33%) of the study group was significantly higher than that of the control group ( P<0.05). Conclusion:The symptom-guided mind mapping combined with case analysis has a significant effect on the emergency nursing teaching of cardiology practice nursing students, and can effectively improve the teaching effect and self-professional recognition rate of the practice nurses.

The value of case analysis combined with role revelation method in cultivating thinking ability of surgical nursing training / 中华医学教育探索杂志

Objective:To explore the value of case analysis combined with role revelation in cultivating thinking ability of surgical nursing training.Methods:A total of 87 newly recruited nurses who needed to rotate in the surgical system of Fenyang Hospital, Shanxi Medical University from January 2019 to October 2020 were selected as the study subjects. They were divided into control group ( n=43) and study group ( n=44). The control group used traditional teaching, and the study group used case analysis combined with role revelation. The clinical thinking ability of nurses was evaluated by written examination of clinical thinking ability and clinical thinking ability score table. SPSS 22.0 was used for t-test. Results:The scores of written examination of clinical thinking ability (history collection, preliminary clinical diagnosis, preliminary nursing measures, auxiliary examination interpretation, comprehensive analysis of diagnosis and treatment process, nursing and discharge diagnosis, and health education) of nurses in the study group were significantly higher than those in the control group ( P<0.05). The scores of clinical thinking ability (critical thinking ability, system thinking ability and evidence-based thinking ability) of nurses in the study group were higher than those in the control group, and the difference was statistically significant ( P<0.05). Conclusion:Case analysis combined with role revelation in the surgical nursing training of new nurses is helpful to improve the trainees' clinical thinking ability.

Analysis of 100 Cases of Nurse-patient Communication from the Perspective of Ethic, Psychology and Law / 中国医学伦理学

With the implementation of the Healthy China Strategy, the value of care has become increasingly prominent. It has become an important nursing topic to strengthen the theoretical and practical research of nurse-patient communication, especially to understand the current state, and explore the essential characteristics, the influencing factors and the differences in interdisciplinary perspectives of nurse-patient communication. Through systematic analysis of 100 real clinical nurse-patient communication cases, this paper found that the problem of poor nurse-patient communication still existed widely, which is prominently manifested as the inhibition of communication willingness, the dislocation of communication topics and the lack of communication consensus. The causes of poor nurse-patient communication were nurses’ poor communication skills, negative emotional distress, the lack of humanistic literacy and insufficient energy investment in communication, as well as the patient’s fragile state, the limitation of knowledge and cultural level, and insufficient trust in nurses. The interdisciplinary perspective analysis of ethics, psychology and law is conducive to enriching and developing the theoretical basis and research methods of nurse-patient communication, and can also provide useful suggestions for improving nurse-patient communication in clinical.

Forensic Examination of Six Homicide Injection Cases / 法医学杂志

OBJECTIVES@#To retrospectively analyze homicide cases of death after injection and provide reference for forensic identification.@*METHODS@#Six homicide cases of death after injection which were investigated by the Criminal Investigation Team of Shanghai Public Security Bureau were collected and analyzed, including case situation, scene investigation, autopsy and other materials.@*RESULTS@#The 6 cases were premeditated crimes, 5 cases took place in private spaces, and 5 cases involved the victims approached by suspects' decoy. There were no obvious abnormalities at the scene of the 6 cases. In 6 cases, the victim's body surface injury was mild or no, lividity color was abnormal, and the needlestick injury showed different manifestations from conventional medical measures.@*CONCLUSIONS@#Death after injection is a highly concealed crime and easy to be ignored. For the suspected injection injury found in autopsy, it is necessary to carefully examine, identify and analyze, be alert to the situation of injecting poison (drug) and do a good job in evidence fixation and material extraction.

Analysis of 4 Cases of Fungal Infections in Children and Literature Review / 中国药房

OBJECTIVE：To prov ide a reference for the diagnosis and treatment of invasive fungal infection in children. METHODS：Four male children with invasive fungal infection in critical condition ，aged from 3 months to 17 years，were treated in our hospital. The types of diseases included pneumonia ，endocarditis，meningitis and pulmonary infection. The pathogens involved Trichosporon asahii ，Candida portugal ，Malassezia globosa ，Pichia guilliermondii ，Alternaria alternate and Candida krusei. Clinical pharmacists comprehensively followed up the treatment and reviewed the literature to assist doctors in formulating treatment plans. They provided Fluconazole sodium chloride injection （6 mg/kg，ivgtt，qd），Caspofungin acetate for injection （loading dose 32 mg，maintenance dose 25 mg，ivgtt，qd），Fluconazole capsules （400 mg，p.o.，qd）and Voriconazole for injection（200 mg，i.v.，q12 h）+Capofungin acetate for injection （loading dose 70 mg，maintenance dose 50 mg，i.v.，qd）and other symptomatic treatment ，and closely monitored the changes of relevant indicators and the occurrence of ADR during the treatment of children. RESULTS ：The doctor adopted the clinical pharmacist ’s suggestion ，three cases were relieved and one was not cured. No serious ADR was found. CONCLUSIONS ：Once similar infections are found in clinic ，timely targeted treatment should be given in combination with the types of pathogens and drug resistance characteristics ，so as to effectively control the disease. The real cases provided in this article can provide evidence for the treatment of children with fungal infection.

Case Analysis and Literature Review of a Case of Acarbose-induced Skin ADR by Clinical Pharmacists / 中国药房

OBJECTIVE：To summarize and analyze t he clinical characteristics of acarbose-induced skin ADR ，and to provide reference for its therapy. METHODS ：Clinical pharmacists participated in the treatment of a patient with acarbose-induced skin ADR. The patient developed erythema multiforme several days after oral administration of Acarbose tablets （100 mg/d）. After consultation by dermatology and clinical pharmacy ，considering that the adverse reaction was related to acarbose ，clinical pharmacists suggested to stop the drug. Based on the above cases ，clinical pharmacists searched Wanfang database ，CNKI， PubMed，Embase and other databases to collect case reports of skin ADR caused by acarbose ，summarize its general situation （gender，age，usage and dosage ，etc.），latency，ADR（diagnosis and manifestation ），intervention and outcome ，etc. RESULTS ： The doctor adopted the pharmacist s’advice，stopped the use of acarbose ，and gave symptomatic treatment as Methylprednisolone sodium succinate for injection 40 mg（intravenous injection ，qd）+Medloratadine tablets 8.8 mg（oral administration ，qd）+Calamine lotion（for external use ）. The patient improved and was discharged after 10 days. A total of 12 literatures involving 12 patients were retrieved. Among the 13 patients included in the analysis （including the above clinical case and 12 literature cases ），there were 8 males and 5 females，and 8 patients of them aged 50 and over；the dosage of acarb ose in most patients was within the requirements of the drug instructions. The primary diseases of 12 patients were diabetes mellitus. The latency of skin ADR in 11 patients was within 6 days of administration. Among the 13 patients，the ADR were diagnosed as rash in 4 cases，pustulosis in 3 cases， erythema multiforme in 2 cases， urticaria in 2 cases， maculopapular rash in 1 case and lip swelling in 1 case. The ADR of 1 patient improved after drug withdrawal ，and 12 patients also improved after drug withdrawal and symptomatic treatment such as glucocorticoid or antihistamine. Acarbose was re-used in 2 patients after the improvement of first skin ADR ，and skin ADR occurred again ，and the ADR were improved after drug withdrawal and symptomatic treatment. CONCLUSIONS ：Skin ADR are acarbose-induced rare ADR ，mostly within 6 days of medication ，and are more likely to occur in middle-aged and older men. When the patients suffer from ADR ，the drug should be stopped in time and given glucocorticoids or antihistamines for symptomatic treatment. Clinical pharmacists should do a good job in drug publicity and education ，remind patients to closely monitor relevant indicators and ensure drug safety.

Clinical efficacy of first-line immunotherapy plus anti-angiogenesis targeted therapy in the treatment of advanced hepatocellular carcinoma / 中华消化外科杂志

Hepatocellular carcinoma has a high morbidity and mortality, which has seriously harmed human health. Several targeted therapies have been approved for the first- and second-line treatment of advanced hepatocellular carcinoma. The emergence of immunotherapy has brought the treatment of hepatocellular carcinoma into a new era. Targeted and immunotherapeutic agents have synergistic effects in mechanism, also the combination of these two therapies has been clinically beneficial to patients with advanced hepatocellular carcinoma. At the same time, in addition to the systemic therapy of targeted combined immunological, applying appropriate local therapy can provide a longer survival period or even a chance of cure for that some patients. The authors introduce the diagnosis and treatment of a case of advanced hepatocellular carcinoma who achieved pathological complete remission by first-line immunotherapy combined with anti-angiogenesis targeted therapy.

Study on the Matching of Financing and Fund Demand in Each Stage of New Drug R&D in China / 中国药房

OBJECTIVE：To pro vide reference f or resolving structural imbalance of “supply and demand dislocation ”in each stage of new drug R&D funds in China. METHODS ：Through analyzing the fund demand in each stage of new drug R&D and the problem of “supply and demand dislocation ”in detail ，a financing scheme matching the fund demand of each stage was designed ， and analyzed with the financing process of “Wanke”. RESULTS & CONCLUSIONS ：In the basic stage of new drug R&D ，there was a large demand for funds ，but there were great technical risks ，transformation risks and investment risks ，little attention and support from investors ，resulting in the lack of R&D funds in this stage. It is suggested to increase the investment of R&D enterprises themselves. In the stage of new drug discovery ，the risks of R&D and investment were still high ，more funds were needed and funds were in short supply. It is suggested to attract more venture capital into this stage. From preclinical stage to clinical stage Ⅱ，there was a greater demand for funds. It is suggested that this stage should mainly rely on venture capital and pledge financing with patents. From the clinical stage Ⅲ to pre-marketing ，R&D had entered the mature stage with less investment risk. Therefore ，more venture capital could be obtained in this stage ，and there was a situation of excess capital. At this time ，in addition to venture capital ，R&D enterprises can also choose listing financing. In the post-marketing stage ，the sales right of a certain region in the product sales link could be transferred to provide new reserve funds for the next round of new drug R&D ，so as to achieve a virtuous circle of R&D activities. One of the reasons for the success of “Wanke”R&D financing lied in the combination of various financing methods in the financing process. It is suggested that China should improve the financial financing system and patent value evaluation system at the national level ，so as to promote the drug patent pledge financing in China as soon as possible. Finally ，new drug R&D institute must establish the concept of independent innovation ，speed up the output of technological innovation results ，so as to achieve the improvement of China ’s independent R&D capability.

Analysis of 4 Typical Cases of Clinical Pharmacists Participating in Consultation from Different Approaches / 中国药房

OBJECTIVE：To accumulate relevant experience of clinical pharmacists consultation ，and to promote clinical safe and rational drug use. METHODS ：From different approaches ，the clinical pharmacists analyzed and evaluated of drug use in 4 consultation cases ，i.e. a patient of pulmonary infection after liver transplantation was treated with antifungal therapy by voriconazole，which resulted in excessive blood concentration of voriconazole ；a hemoptysis patient with pulmonary infection was found fibrinogen decreased ，after treatmented with anti-infective and hemostatic drugs ；a patient with pulmonary infection after lung transplantation ，followed by the increase of urea and creatinine after anti-infective therapy ；a patient with grand mal epilepsy after kidney transplantation was treated with phenobarbital and diazepam ，the blood concentration of tacrolimus decreased significantly. The pharmaceutical consultation opinion was put forward and the treatment plan was optimized by clinical pharmacists. RESULTS ：Clinical pharmacists put forward pharmaceutical consultation suggestions for four consultation cases ， which were adopted by doctors. Case 1 was stopped voriconazole and omeprazole，and changed to pantoprazole for gastric protection. The steady-state valley concentration of voriconazole decreased from 12.38 μg/mL to 6.86 μg/mL，and the liver function of transaminase and total bilirubin were improved. Case 2 was stopped cefoperazone-sulbactam and hemocoagulase ，given vitamin K1，fibrinogen，cryoprecipitation，plasma for symptomatic treatment. The fibrinogen was gradually increased from 0.74 g/L to 2.88 g/L，and then remained within the normal range. Case 3 was adjusted the dosages of nephrotoxicity-related drugs （meropenem， levofloxacin，ganciclovir and Compound sulfamethoxazole were adjusted to 1 g q 12 h，250 mg qd ，94 mg qd and 2 tablets qd respectively）. The renal function indicators of urea decreased from 37.6 mmol/L to 7.8 mmol/L；creatinine decreased from 173 μmol/L to 68 μmol/L；the renal function returned to normal ，and the infectious indicators also improved. Case 4 adjusted the oral dose of tacrolimus increasing to 2 mg q 12 h，and oral dose of Pentaester soft capsule was increasing to 1 g bid. The blood concentration of tacrolimus increased from 0.8 ng/mL to 5.9 ng/mL，which reached the expected value ，and there was no further fluctuation during hospitalization. CONCLUSIONS ：Clinical pharmacists consultation mainly focuses on the following 66295644。 aspects， such as individual treatment p lan adjustment ， judgment and treatment of ADR ，adjustment of medicationplan for special population ，optimization of treatment plan for drug interactions ，so as to guarantee the safe use of drugs in clinic.

Medicolegal Identification of Medical Malpractices in Orthopaedic Surgery / 法医学杂志

OBJECTIVES@#To analyze the characteristics of medical malpractices in orthopaedic surgeries, to explore principles and methods in medical legal identification, and to provide basic data for uniform medicolegal standard for the future medical identification.@*METHODS@#A retrospective analysis was conducted on 100 cases of medical malpractices in orthopaedic surgery, among the 364 cases archived in Medicolegal Expertise Center of Xi'an Jiaotong University during 2002-2015.@*RESULTS@#In the 100 cases of orthopedic medical malpractices, with 104 hospitals involved in, 95 cases were judged with medical errors and the other 9 cases with no error. The top 3 reasons for errors were （1） inadequate observation or estimation of diseases （27.9%）, （2） intraoperative improper operation （17.3%）, and （3） delayed or missed diagnosis and treatment （12.5%）. The consequences of medical malpractices were mostly disability （61%）, followed by prolonged diseases （31%） and death （8%）. With regard to the causal relationship between medical errors and consequences, 95 cases （91.4%） were with causality and the other 9 cases （8.6%） with no causality. Specifically, 56 cases （53.9%） were with medical errors as the secondary causes accounting for 25% causative potency, and 20 cases （19.2%） were with medical errors as the major causes accounting for 75% causative potency.@*CONCLUSIONS@#It is pivotally important for determining the causative potency of medical errors to analyse the causes of damages in orthopaedic surgery and to distinguish subjective factors from objective ones of medical errors.

Retrospective Analysis of Forensic Appraisal of Post-traumatic Epilepsy in 30 Cases / 法医学杂志

Objective To summarize the general characteristics and identification considerations of appraisal of post-traumatic epilepsy （PTE） in forensic clinical expertise. Methods Descriptive statistics were made on the general situations （age and sex）, injury sites, PTE grading, clinical manifestations and blood drug concentrations of 30 cases of PTE. Chi-square test was performed on the differences of sex composition, age group incidences, injury sites, clinical manifestations and PTE grading. Fisher's exact probability method was used to test the differences in clinical manifestations and PTE grading of each site and the differences in PTE grading of different clinical manifestations. Results PTE occurred more frequently among 21 to 40 year olds, more in males than in females, and more frequently in the temporal lobe and frontal lobe. The clinical manifestations were mostly partial seizures and the PTE grading was mostly mild PTE. There were no statistical significance in the differences in distribution of clinical manifestations and PTE grading of injury sites （P>0.05）. The difference in the PTE grading of different clinical manifestations had no statistical significance （P>0.05）. The blood drug concentration of the three identified people did not reach the effective concentration, which affected the final identification opinion. Conclusion In the identification of PTE, in addition to strictly grasping the necessary factors of identification, such as the history of craniocerebral trauma, and epileptic seizures, it is also suggested that attention should be paid to the detection of blood drug concentration. Overall analysis and comprehensive evaluation should be made.