As a new discipline, the cardiac surgery has a great development in the modern age, but still faces many problems and disputes. The emergence of the evidence-based medicine (EBM), which emphasizes the best evidence, and combines the doctor’s clinical experience to make the best judgment, gives the development of the cardiac surgery a new thinking. Four systematic reviews published in The Cochrane Library (Issue 3, 2004) have interprated the importance of EBM on how to resolve the actual problems in different field of the cardiac surgery.
ObjectiveTo understand the cognition and mediation tendencies of health care workers in terms of third-party mediation for medical disputes, analyze the factors influencing the trust of both doctors and patients on third-party mediation, and propose suggestions on building third-party mediation mechanisms for medical disputes. MethodsBetween August and December 2012, we made the cognition questionnaire on third-party mediation for medical disputes based on the past medical literature, and the knowledge of doctor-patient relationship as well as third-party mediation agency's organizational structure (including locations and management authorities), staffing, mediation basis, validity sources and fund ensuring. We performed the random cluster sampling survey on all health care workers in five hospitals of different levels. The original data were put into the computer for statistical analysis by SPSS 18.0. ResultsThe knowledge of health care workers on third-party mediation was high. They believed that the best place for solving medical disputes should be the court or judicial administrative department, and the management authorities should be health administrative departments. In case of mediation failure, the majority of health care staff chose to continue to solve the dispute through legal channels. For the effectiveness of mediation conclusion, most health care workers tended to believe in the form of arbitration. They thought that mediators should have professional background of medicine and law; the majority of those surveyed doctors tended to accept forensic conclusions as a basis for mediation. For determining the compensation, doctors were in favor of Applicable Regulations for Medical Malpractice. Over 40% of medical staff believed that third-party mediation should be financed by government financial allocation, and more than half of the medical staff believed that it should be paid by the insurance company. ConclusionThird-party mediation should be set in and managed by the court or judicial and administrative departments. Mediator group should be formed by professionals of law and medical sciences. In the mediation process, it is recommended that the focus of controversy should be identified by forensic identification in order to form a clear division of responsibilities and high mediation efficiency. We recommend that the government introduce in financial allocations at all levels on the basis of medical liability insurance system, and force medical institutions to purchase medical liability insurance through the regulations of law, in order to provide funding support for the operation of third-party mediation organizations. Meanwhile, medical liability insurance companies should be operated under strict supervision to avoid their interference on the mediation work.
目的：探讨《医疗事故处理条例》颁布后医疗纠纷法医学鉴定的相关特点，启示医务人员在防范医疗纠纷时应注意的相关问题。方法：对四川华西法医学鉴定中心2002年～2006年受理的356例医疗纠纷法医学鉴定资料进行回顾性研究。结果：(1)《医疗事故处理条例》实施以来，医疗纠纷案例逐年增多，个体诊所和三级医院医疗纠纷比例和过错率降低，二级医院和一级医院医疗纠纷率和医疗过错率增加；(2)误诊误治等医疗技术方面的过失是导致医疗事故的主要原因；骨科、妇产科和普外科等手术科室的医疗风险最大；(3)医疗纠纷死亡的患者尸检主要集中在儿童和中青年。各年龄段常见死因不同。三级医院在医院临床死因诊断与法医尸检诊断上符合率最高；(4)侵犯患者知情同意权的现象比较多见；(5)疾病自然转归是被鉴定为非医疗事故的最常见原因；结论：《医疗事故处理条例》颁布后，医疗纠纷法医学鉴定案例逐年增多；目前医疗纠纷的特点和产生原因有了新的变化，其中尤以侵犯患者知情同意权和医患沟通障碍突出。
目的:了解我院输血申请单规范填写的情况,分析其中存在的问题,以便采取积极有效的预防措施,规范输血申请单填写,提高临床输血安全性,防范因输血导致的医疗纠纷。方法:对2008年10月至2009年3月临床输血申请单(包括手术备血输血申请单)进行调查,以项目填写完整、字迹清楚工整、有经治医生和审核医生签字者为合格。结果:共调查7863份输血申请单,其中规范填写共6391份,占81.3%,未规范填写1 472份,占18.7%。结论:通过对临床输血申请单超填写的调查,分析其中存在的问题,以提高医务人员对规范填写输血申请单及临床输血相关的法律法规的认识,提高临床输血安全性,防范因输血导致的医疗纠纷。