Effectiveness of continuity of care after robot-assisted laparoscopic adrenalectomy under ambulatory mode: a single-center intervention study.

To investigate the effectiveness of continuity of care after robot-assisted adrenal tumor resection under ambulatory mode. Patients who underwent robot-assisted laparoscopic adrenalectomy (RALA) in the ambulatory surgery department and urology department of our hospital from January 2022 to January 2023 were selected as study subjects. Among them, 50 patients in the Department of Urology as the control group were given routine care. The 50 patients in the ambulatory surgery department as the observation group were given continuity of care on the basis of routine care. Observation indexes include: wound healing, blood pressure, blood potassium, renal function impairment, self-care ability in daily life, medication compliance, follow-up rate, and patient satisfaction. There were no remarkable discrepancies between the two groups in terms of demographic data and basic preoperative conditions of the patients. Compared with the control group, the observation group significantly improved the patients' wound healing, postoperative blood pressure and blood potassium and kidney function (P value all < 0.05). Compared with the control group, the observation group significantly improved postoperative patients' ADL scores, follow-up rates within three months after surgery, and patient satisfaction scores (P value all < 0.05). For patients receiving ambulatory mode robot-assisted laparoscopic adrenalectomy, continuity of care can effectively reduce postoperative complications, improve patients' postoperative self-care ability in daily life, medication compliance and follow-up rate, and improve patient satisfaction, which is worthy of promotion and application by nursing workers.

Impact of smart health systems on the behavior of older adults under community healthcare.

Background: With the trend of world population aging, a good community health care system will determine whether the elderly can get good medical conditions. How to improve the community health care system can study how the behavior of the elderly affects it. Objective: This paper is based on the analysis of the current situation of population aging at home and abroad. Methods: On the premise of analyzing the demand and behavior of elderly people seeking medical treatment and the function of community health service institutions. Literature research was conducted to analyze the influencing factors of community health care needs and elderly people's medical seeking behavior at home and abroad. Then the elderly in Tianjin were investigated by issuing questionnaires, and the law of medical treatment behavior of the elderly in Tianjin was calculated. Combined with the results of relevant investigations abroad, the common phenomenon is summarized. Finally, the analysis method of intelligent medical system is proposed, and the design process of system acquisition module and user usage mode are given. Result: The smart medical system can bring great convenience to the elderly and community healthcare. Discussion: It emphasizes the powerful functions of smart health systems and their future importance for the health care of the elderly.

Current Status of Intergroup Threats Perceived by Chinese Physicians and Its Association with Organizational Psychology, Behavior, and Well-Being during the COVID-19 Pandemic: A Cross-Sectional Survey.

(1) Background: Chinese physicians have encountered serious physical and verbal attacks in recent decades due to poor patient−physician relationships, leading to a broad spectrum of negative consequences. This study aims to assess the status of intergroup threats perceived by physicians and explore its association with organizational psychology, behavior, and well-being during the COVID-19 pandemic. (2) Methods: We conducted a cross-sectional online survey with physicians from November to December 2020 in three provinces: Heilongjiang Province, Henan Province, and Zhejiang Province, in China. A total of 604 physicians were recruited to complete an anonymous questionnaire. There were 423 valid questionnaires. (3) Results: We developed a 25-item intergroup threat scale with four dimensions: interest damage, performance impairment, value derogation, and unjust sentiment. Internal consistency reliability analyses showed that the four dimensions and overall scale exhibited high internal consistency (0.756−0.947). Additionally, the average scores for physicians' perceived overall intergroup threat, interest damage, performance impairment, value derogation, and unjust sentiment were 4.35 ± 0.51, 4.24 ± 0.73, 4.33 ± 0.58, 4.22 ± 0.65, and 4.53 ± 0.55, respectively. Moreover, this study shows that the intergroup threats perceived positively by physicians were associated with psychological stress (ß = 0.270, p < 0.01), emotional exhaustion (ß = 0.351, p < 0.01), turnover intention (ß = 0.268, p < 0.01), and defensive medical behavior (ß = 0.224, p < 0.01), and were negatively associated with job satisfaction (ß = −0.194, p < 0.01) and subjective well-being (ß = −0.245, p < 0.01). (4) Conclusions: The newly developed scale in this study is a reliable tool for measuring intergroup threats perceived by Chinese physicians. Physicians in China were suffering high-level intergroup threats during the anti-COVID-19 pandemic, which has a significant impact on damage to organizational psychology, behavior, and well-being. Intergroup threats perceived by physicians not only enlarged the risk of emotional exhaustion and psychological stress but also threatened organizational well-being. Moreover, greater intergroup threats were associated with a lower job satisfaction, more frequent defensive medical behavior, and a higher turnover intention for physicians. The results of this study suggest that essential intervention and governance measures should be considered to protect physicians' well-being and benefits in China, which are urgently needed.

Correlation Among Psychological Resilience, Social Support, and Coping Style in Patients With Complicated Hepatolithiasis.

Objectives: To investigate the correlation between psychological resilience, social support, and coping styles in patients with complicated hepatolithiasis. Methods: The objective sampling method was used in this study to select a total of 156 patients with complicated hepatolithiasis in a Third-class Grade A hospital in Changsha, Hunan Province from January to December 2019. Self-designed general data questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), the Social Support Rating Scale (SSRS), and the Simplified Coping Style Questionnaire (SCSQ) were used to conduct a questionnaire investigation. Spearman correlation analysis was used to analyze the correlation between psychological resilience, social support, and coping styles in patients with complicated hepatolithiasis. Results: Both the total score of psychological resilience (45.79 ± 16.28) and social support (35.71 ± 9.92) of patients with complicated hepatolithiasis were significantly lower than those of the domestic norm. The total score of psychological resilience of patients with complicated hepatolithiasis was positively correlated with the total score of social support (r = 0.570, p < 0.01). The total score of psychological resilience and its three dimensions were positively correlated with the positive coping (r = 0.682, 0.673, 0.663, 0.535, p < 0.01)and negatively correlated with negative coping (r = -0.240, -0.207, -0.221, -0.286, p < 0.01). Conclusions: This study indicated that strengthening social support and improving the coping style of patients with complicated hepatolithiasis are helpful to improve their psychological resilience, which provided theory basis and reference for further intervention measures to improve social support system and coping styles.

Construction and empirical study of clue enrichment model of excessive medical behavior based on the rank assignment method / 中华医院管理杂志

Objective:To construct and verify a model of excessive medical behavior clues enrichment, for the technical support for the safe and rational use of medical insurance fund.Methods:A model of excessive medical behavior clues enrichment was constructed by the rank assignment method. The inpatient transaction records of medical insurance for employees and residents in 5 tumor hospitals in Beijing from 2016 to 2019 were obtained to verify the validity of the model. The patients were grouped according to age and gender, and each transaction record was converted into a standardized score V(0-100 scores), all transactions were divided into 22 groups according to V value. The Cochran-Armitage trend test was used to analyze the variation trend of enrichment rate with the increase of V value. Chi-square test was used to compare the chargeback rates of different groups. The correlation between the standardized score V and the amount of chargeback was tested by Pearson.Results:There were 872 599 and 86 356 hospitalization transactions for employee and resident medical insurance patients, with included 1 164 and 103 chargeback records respectively. The average score and median of V-value of employee and resident medical insurance transactions were scores of 49 and 50 respectively.When V>0, the enrichment rates of the employee and resident medical insurance were on the rise with the increasing of V( Z=23.86, P<0.001; Z=11.02, P<0.001), the refusal rates among different groups was significant different( χ2=1 307.16, P<0.001)and the correlation between V value and the chargeback amount was statistically significant( r=0.29, P<0.001; r=0.30, P=0.003). Conclusions:This study established a clue enrichment model of excessive medical behavior based on the rank assignment method. By analyzing a large number of medical insurance transaction records, the model can focus on the medical insurance transaction with suspected excessive medical treatment behavior, and has a certain guiding role in the management of medical insurance fund.

Reasons and countermeasures for medical disputes under the role of medical staff as "economic person" / 中华医学教育探索杂志

Traditional medicine endows medical staff with the role of "moral person";however,with the development of market economy,the role of medical staff has gradually changed to "economic person" in medical activities.Under the role of "economic person",there is an increasing number of medical disputes and injuries of medical staff,with more and more serious consequences.This article analyzes the behavior characteristics of the rights and obligations of "moral person" and "economic person" and the causes of medical disputes under the role of "economic person".Since the lack of honesty has become the product of the new role of medical staff,patients have a doubtful attitude towards medical staff,and the defects in system guidance and management system make it more difficult to settle medical disputes.This article provides a new perspective for building a harmonious doctor-patient relationship and puts forward the hypothesis of "honest economic person",so as to achieve the dialectical unity of the dual identities of "moral person" and "economic person".Under the role of "honest economic person",adherence to honesty and trustworthiness,pursuit of maximum medical benefits,emphasis on the social benefits of medical treatment,and material and spiritual incentives for medical staff can help to alleviate the conflict of interests between doctors and patients and reduce medical disputes.

Building a platform of medical qualifications authorization and control in a hospital group:practice and exploration / 中华医院管理杂志

Control of the qualifications and behaviors of medical practitioners in branches of a hospital group has become imperative to guarantee medical quality and safety.We have explored a development program of the information platform to meet the needs of unified authorization and closed-loop management of hospital groups,constructed a medical qualifications authorization management and control platform based on private clouds,established a specialized medical qualifications and authorization model,standardized the approval process,and reduced the approval time.At the same time,we work with a human resources management platform,to develop qualifications assessment tools for supervision,for the purposes of dynamic renewal and withdrawal of medical qualifications.We have set up a centralized medical behavior authority database and an authority verification interface,selected key business steps,and readapted the business system for authority verification.These measures can effectively control practitioners' medical behavior and ensure medical safety.

The effect of physicians' occupational risk cognition on defensive medical behavior in China / 中国卫生政策研究

Objective:The aim of this paper is to explore the influence of physician's occupational risk cogni-tion on defensive medical behavior. Methods:Semi-structured interview was applied for data collection from in-serv-ice doctors. A grounded theory was used to analyze and develop the relationship between physicians'occupational risk cognition and defensive medical behavior. Results:This study shows that the cognition of various occupational risks may lead to a series of psychological effects on doctors,such as mental stress,anxiety and depression,professional i-dentity decrease,fear of adventure and innovation,job enthusiasm decrease and probability of malpractice increase. Adverse defensive medical behaviors, such as ordering more tests, treatments and consultations, selective treatment of patients,shirking responsibility through informed consent, and favorable defensive medical behaviors, such as to improve service attitude,being more cautious during work and to improve professional skills,should be in response to occupational risks. Conclusions:Physicians'occupational risk cognition is the primary motivation of defensive medical behavior,and the relationship between physicians'occupational risk cognition and defensive medical behavior may al-so be mutually causal and effect.

Utilizing Electronic Medical Records to Discover Changing Trends of Medical Behaviors Over Time.

OBJECTIVES: Medical behaviors are playing significant roles in the delivery of high quality and cost-effective health services. Timely discovery of changing frequencies of medical behaviors is beneficial for the improvement of health services. The main objective of this work is to discover the changing trends of medical behaviors over time. METHODS: This study proposes a two-steps approach to detect essential changing patterns of medical behaviors from Electronic Medical Records (EMRs). In detail, a probabilistic topic model, i.e., Latent Dirichlet allocation (LDA), is firstly applied to disclose yearly treatment patterns in regard to the risk stratification of patients from a large volume of EMRs. After that, the changing trends by comparing essential/critical medical behaviors in a specific time period are detected and analyzed, including changes of significant patient features with their values, and changes of critical treatment interventions with their occurring time stamps. RESULTS: We verify the effectiveness of the proposed approach on a clinical dataset containing 12,152 patient cases with a time range of 10 years. Totally, 135 patients features and 234 treatment interventions in three treatment patterns were selected to detect their changing trends. In particular, evolving trends of yearly occurring probabilities of the selected medical behaviors were categorized into six content changing patterns (i.e, 112 growing, 123 declining, 43 up-down, 16 down-up, 35 steady, and 40 jumping), using the proposed approach. Besides, changing trends of execution time of treatment interventions were classified into three occurring time changing patterns (i.e., 175 early-implemented, 50 steady-implemented and 9 delay-implemented). CONCLUSIONS: Experimental results show that our approach has an ability to utilize EMRs to discover essential evolving trends of medical behaviors, and thus provide significant potential to be further explored for health services redesign and improvement.

Game Analysis of Constraint Mechanism on Excessive Medical Behavior of Doctors in Chinese Medical Market / 中国药房

OBJECTIVE:To investigate the constraint mechanism on excessive medical behavior of doctors in Chinese medical market. METHODS:Under certain assumptions(suppose the hospital and the doctor's demands are consistent,the government and the patient's demands are consistent,etc),mixed game method(game theory)was used to analyze Nash equilibrium between government and doctors,between patients and doctors.The qualitative analysis was performed for these constraints based on the re-ality. RESULTS&CONCLUSIONS:The strict punishing mechanism and the choice right to doctor of patients and public satisfac-tion with the government can achieve the Nash equilibrium of game and effectively inhibit excessive medical behavior. The govern-ment should create a competitive environment to enhance the right of patients to select doctor and improve the relevant legal system on the basis of promoting incentive compatibility among all parties so as to strengthen the implementation of supervision. At the same time,the government should establish credit archives of the doctor to form effective reputation incentive mechanism to doc-tors,and proactively explore the patients participation mechanism based on reducing the cost of patient participation.

Game Analysis of Constraint Mechanism on Excessive Medical Behavior of Doctors in Chinese Medical Market / 中国药房

OBJECTIVE:To investigate the constraint mechanism on excessive medical behavior of doctors in Chinese medical market. METHODS:Under certain assumptions(suppose the hospital and the doctor's demands are consistent,the government and the patient's demands are consistent,etc),mixed game method(game theory)was used to analyze Nash equilibrium between government and doctors,between patients and doctors.The qualitative analysis was performed for these constraints based on the re-ality. RESULTS&CONCLUSIONS:The strict punishing mechanism and the choice right to doctor of patients and public satisfac-tion with the government can achieve the Nash equilibrium of game and effectively inhibit excessive medical behavior. The govern-ment should create a competitive environment to enhance the right of patients to select doctor and improve the relevant legal system on the basis of promoting incentive compatibility among all parties so as to strengthen the implementation of supervision. At the same time,the government should establish credit archives of the doctor to form effective reputation incentive mechanism to doc-tors,and proactively explore the patients participation mechanism based on reducing the cost of patient participation.

The autonomy of patients in medical behavior / 国际中医中药杂志

The autonomy is one of the basic authorities of patients.It isn't only an ethical concept,but also can help enhance the efficacy and compliance to a certain extent.The autonomic behavior of the patients isn't as optimistic as we think.The patient's autonomy can be influenced by many factors.We should base on the principles,advantage,respect and communication,to encourage patients to make an appropriate and unbiased decision and change into a collaborative,patient-centered doctor-patient relationship model.

An investigation of potential demand for acupuncture and moxibustion from the medical information center for foreign residents in Japan / 全日本鍼灸学会雑誌

[Introduction]The number of foreign residents in Japan reached 1.7%of the national population at the end of 2010, and currently the number of foreign permanent residents is increasing. Althogh this “domestic globalization”has been in progress for some time, the health status and needs of foreign residents for acupuncture treatment are not known to acupuncture practitioners in Japan. The purpose of this study is to reveal the proportion of potential demand for acupuncture by examining the consultation records for medical informations from foreigners living in Japan.<BR>[Method]From all the records of telephone consultation for medical information by foreign residents from all over the country to AMDA International Medical Information Center in 2010, we extracted the consultations associated with acupuncture.<BR>[Results]Among a total of 2,172 consultations, 6calls were associated with acupuncture (0.3%). Most of the foreign residents who made these consultations were from South America. 4calls were requests for information about acupuncture clinics from foreigners suffering from orthopedic disease or symptoms (66.7%). With respect to the consultion languages, 4consulters accepted inquiries in Japanese (66.7%).<BR>[Discussion]Foreign residents who expect acupuncture treatment are not common, but it became obvious that some foreigners have difficulty finding acupuncture clinics and information in Japan. There were some cases that should have been applicable to acupuncture, but were instead directed to other diagnosis departments or hospitals. One reason for this consequence seems to be the lack of information among foreign residents about the indications and therapeutic effects of acupuncture. Considering the influx of foreigners and the aging of foreign residents, the possibility of foreigners reciving acupuncture treatment may be developed by appropriate distribution of information.

Using Medical Staff' Understanding of Medical Ethics to Guide the Medical EthicsEducation / 中国医学伦理学

Objective: To understand the medical staff' cognition of medicalethics.Method: Descriptive study and various analysis were performed. Results: Four aspects including the understanding of hospital Ethic Review Committee, the status of medical ethics education, the understanding of medical ethics in clinic and research, the requirement of medical ethics training were surveyed among the medical staff in five hospitals. Conclusion: The influence of medical ethics in clinical practice and medical research were greatly improved. The hospital Ethic Review Committee should be strengthened and a lot of works was needed for medical ethics education.

Multidimensional reflections on the current situation of the physician-patient relationship / 中华医院管理杂志

In the light of sociological and psychological theories, the authors reflect from the perspectives of social politics, economy, culture, psychology and law on the current situation of the physician-patient relationship, the causes and lessonss. They argue that the current situation of the worsening physician-patient relationship is worrisome, its causes are multifarious, and channels for improvement ought to be as wide as possible. They hold that there is still a long way to go to improve the situation, efforts ought to be made by the whole society and humane medical services are indispensable.

Medical Moral Consciousness and Medical behavior under Market economy / 中国医学伦理学

The paper discusses three questions sucw as follmings: (1)the lash of market e-conomy to medical moral consciousness;(2)reasons to develop the new medical moral consciousness and behaviors;(3)reason analysis of bad medical moral consciousness and behaviors, under market economy.

The Support of Medical Ethics for Physician-Patient Relationship under Information Asymmetry / 中国医学伦理学

The specialization of medical science determines the objective existence of asymmetric information in medical and health industry.These different understandings in the psychological and behavioral area influenced the development of physician-patient relationship.Medical personnel should look squarely at the professional attributes and dare to play a leading role.Meanwhile,the exchange of the role of patient and medical personnel,understanding patient,clearing of communication channels and enlarging patients′ means of communication will promote harmonious relations between doctors and patients.