论医疗合同的附合化及其规制

医疗合同的附合化主要表现为患者对医疗机构意志的附合化;这种现象是经济与法律发展的必然结果;克服医疗合同附合化的关键在于立法规制,将医疗合同直接纳入《合同法》是现实可行的选择。     

Referring patients to counsellors in primary care: Qualitative investigation of general practitioners’ perceptions

Despite growing evidence of the effectiveness of counselling in primary care, questions arise concerning the role of general practitioners in the referral process. This involves both liaison with counsellors and the management of people who do not wish to see counsellors. Respondents (n=23) in this qualitative study of general practitioners’ perceptions were clear about which patients should be referred to counsellors, based on guidelines. Additionally, these doctors perceived their role and skills as negotiating with their patients about referral to a counsellor, and managing patients who are either waiting to see a counsellor or who prefer not to see a counsellor. These doctors feel inadequately trained in managing this latter group, whose outcome they perceive as unclear. Despite this, respondents accept a role in ongoing support for their patients with consequent training issues for doctors and opportunities for liaison and mentoring by counsellors.     

危重患者的院内转运

危重患者的转运分为院内转运及院间转运,院内转运由医院内的医务人员来完成。危重患者的转运存在风险有可能增加病死率与伤残率。本文对危重患者院内转运的转运前风险评估、转运前准备、转运中监护和生命支持、特殊情况转运和转运后交接方面做一综述,目的是降低危重患者的转运风险、安全转运。     

帕罗西汀配合心理干预对术后焦虑情绪的影响

研究帕罗西汀配合心理干预对术后焦虑情绪的影响。90例手术患者随机分为三组:A组术后常规治疗,B组常规治疗+帕罗西汀,C组常规治疗+帕罗西汀+心理干预。1周末B、C两组SAS和HAMA得分显著下降(P0.01),HAMA得分比较差异显著(P0.01),与A组比较差异显著(P0.01);2周末A组HAMA评分显著改善(P0.01)。帕罗西汀配合心理干预对术后焦虑情绪有显著而快速的影响。     

从《病历书写基本规范》的施行谈对患者同意权的再认识

本文通过对《病历书写基本规范》中有关患者同意权内容的研究,重点探讨了患者同意权的应用范围、发展变化以及尚需进一步解答的具体问题。为在实践中充分领会"《规范》"内容,不断深化患者权益保障,促进医院管理水平稳步提高作出了笔者力所能及的贡献。     

谷氨酰胺在危重患者中的应用

谷氨酰胺(Glutamine,Gln)是体内最为丰富的条件必须氨基酸,危重症患者体内Gln严重缺乏,研究认为适当补充Gln可起到促进肠道黏膜屏障功能恢复、调节细胞免疫等作用,从而降低危重症患者感染性并发症、缩短住院时间及减少ICU费用等,本文就这些方面做一综述。     

对哮喘患者进行教育管理的内容和方法

目前尚不能根治哮喘,然而长期管理有助于达到哮喘控制,哮喘教育是其重要组成部分。哮喘教育内容应包括哮喘的诊断、预防及治疗相关的知识、技能。应当采取个体化、循序渐进的教育方式,集体教育是个体化教育重要的补充。     

生命末期患者及家属对“善终”看法的Meta整合

研究采用Meta整合方法,对生命终末期患者及家属善终认知的质性研究结果进行整合,形成四个整合结果:不恐惧,从心理上接受死亡,做好死亡的准备;没有痛苦和不适,不延长死亡过程,以自己期望的方式离开;不是他人的负担,能感受到来自亲人和专业人员的支持;维持做人的尊严,找到生命的价值和意义,灵性需求得到满足。揭示了生命末期患者及家属的潜在需求,要求医务人员需要根据生命末期患者、家属的不同需求,评估不同的个体对善终的偏好,提供针对性的服务,最终达到善终的目的。     

Les déterminants de la charge de travail perçue dans deux services d’urgence hospitaliers en France

This article gives an account of research carried out the workload of healthcare providers in hospital emergency wards, by focusing on several factors that are both related to the patients and to their activity. Based on 121 observations conducted in two hospitals, coupled with the NASA-TLX scale and an ad hoc questionnaire, this research indicates that the elements which contribute the most to perceived workload are the agitated behavior of patients and communication difficulties linked to handicap. However, variations in the number of tasks do not seem to have an influence on the workload perceived by health care providers which tends to highlight that the relations to patients contribute more to the perception of workload than the number of tasks. In the situation observed, the regulation of workload is made possible by the management of relational factors (physical demand, frustration and effort) which determine, in part, workload perception. In order to reduce or adapt this load, this article suggests basing interventions on the way to deal with difficult patients and not on the regulation of the number of tasks.     

实施人类辅助生殖技术如何维护医患权益

根据卫生部有关法规,结合我院实施人类辅助生殖技术中维护患者知情同意权的做法、认识和体会,探讨了医患双方的基本权利和义务、特殊项目的知情同意以及在实施辅助生育过程中应处理好的几个关系.