Analysis and improving countermeasures of medical disputes from the perspective of legal changes

Under the background of medical disputes growing in number,scale and intensity,tracing back legal changes in medical field as a breakthrough point,this paper took a legal perspective to illustrate changes in medical dispute settlements from legislative orientation to legal system improvement.In view of the fact that early legislation in medical field was biased towards identification and punishment of doctors’responsibility,and later intensive legislation in balancing increasing"medical trouble"phenomenon with limited effects and difficulties to abide by the law,this paper proposed to improve doctor-patient dispute settlements system in China referencing from foreign law experience,to reduce investigation of doctors at the judicial level,and to establish a settlement mechanism on doctors’apology at the legislative level,so as to promote a healthy development of doctor-patient relationship.

The effect of high-fidelity simulation in medical nursing based on the healthcare simulation standards of best practice

Background:High-fidelity simulation has been demonstrated to make great progress in learning.However,there is still ongoing exploration on how to fully harness the advantages of this teaching method and enhance its effectiveness.This study conducted high-fidelity simulation in medical nursing based on the Healthcare Simulation Standards of Best Practice and evaluated its effect.Methods:The study was conducted from September 2019 to June 2020.A total of 82 undergraduate nursing students from a university in Shanghai participated in the high-fidelity simulation in medical nursing.The simulation design scale,educational practices in simulation scale,and students’satisfaction and self-confidence were used to evaluate the effect.Results:The mean score of simulation design scale was 4.06±0.63 with the mean scores of all dimensions being over 3.0.The mean score of educational practices in simulation scale was 4.14±0.56 with the mean scores of all dimensions being over 4.0.The mean scores of students’satisfaction and self-confidence were 4.07±0.72 and 3.89±0.58,respectively.Conclusion:Students reported high levels of simulation design and educational practices in simulation.They were also satisfied with learning and reported high levels of self-confidence.Some key points need to be considered so that the learning effects might be optimized.

Government Responsibility in New Rural Cooperative Medical Care System from the Perspective of Equity and Efficiency

Equity and efficiency,as two essential parts of social security,always influence construction of China's new rural cooperative medical care system.The new rural cooperative medical care system is a rural social security system particularly intended to make it more affordable for the rural poor.It is a multi-channel fundraising system with fund of comprehensive arrangement for serious disease composed by the government,collectives and individuals.Since its implementation,it has made considerable achievements,but there are still many apparent and hidden problems.Through analyzing existing problems in the implementation of new rural cooperative medical care system,from the perspective of equity and efficiency,it reached the conclusion that government should take corresponding responsibilities.At the same time of constantly increasing efficiency,it is recommended to attach importance to the equity,so as to realize the objective of improving the security level of new rural cooperative medical care system.

The thinking about Shanghai Development “medical pension combined” type of long-term care insurance system

The aging development in Shanghai shows speed, high degree of aging, the number of elderly people living alone increased and other trends, the contradiction between degree of aging and care become more prominent. However, the prevalence of current pension model has a pension without medical care, health care and pension separate and other issues, so the development of ＂medical support combined with pension＂ long-term care insurance system is imperative. Based on the study to explore parts of the country which operate basic pension model of＂medical pension combination＂, we analyze the necessity and feasibility of the implementation of Shanghai ＂medical support combined with pension ＂ long-term care insurance system, by summing up experiences and lessons, put forward some of the recommendations for the development in Shanghai ＂medical support combined with pension＂ type of long-term care system.

Anomaly Detection Using Data Rate of Change on Medical Data

The identification and mitigation of anomaly data,characterized by deviations from normal patterns or singularities,stand as critical endeavors in modern technological landscapes,spanning domains such as Non-Fungible Tokens(NFTs),cyber-security,and the burgeoning metaverse.This paper presents a novel proposal aimed at refining anomaly detection methodologies,with a particular focus on continuous data streams.The essence of the proposed approach lies in analyzing the rate of change within such data streams,leveraging this dynamic aspect to discern anomalies with heightened precision and efficacy.Through empirical evaluation,our method demonstrates a marked improvement over existing techniques,showcasing more nuanced and sophisticated result values.Moreover,we envision a trajectory of continuous research and development,wherein iterative refinement and supplementation will tailor our approach to various anomaly detection scenarios,ensuring adaptability and robustness in real-world applications.

Point of care ultrasonography as the new“Laennec Sthetoscope”

Point of care ultrasonography(POCUS)has evolved to become the fifth pillar of the conventional physical examination,and use of POCUS protocols have significantly decreased procedure complications and time to diagnose.However,lack of experience in POCUS by preceptors in medical schools and nephrology residency programs are significant barriers to implement a broader use.In rural and low-income areas POCUS may have a transformative effect on health care management.

Revolutionizing Healthcare—The Integration of Virtual Worlds, AR, and Metaverse Technology

This paper explores the transformative impact of virtual worlds, augmented reality (AR), and the metaverse in the healthcare sector. It delves into the ways these technologies are reshaping patient care, medical education, and research, while also addressing the challenges and opportunities they present. The paper highlights the potential benefits of these technologies and emphasizes the need for comprehensive regulatory frameworks and ethical guidelines to ensure responsible integration. Finally it outlines their transformative impact and discusses the challenges and opportunities they present for the future of healthcare provision.

Analysis of the Application and Effect of Homemade Medical Scrotal Support Shorts

Objective:To design and manufacture medical scrotal support shorts for patients with enlarged scrotum and observe its application and effect.Methods:40 patients with enlarged scrotum admitted to the basic surgery department from February 2021 to March 2023 were selected and divided into a test group and a control group according to their time of admission,with the test group using scrotal support shorts and the control group using ordinary shorts without scrotal support pockets or diapers.Results:The complication rate of skin injury in the scrotum and the surrounding inguinal area of the patients in the test group was significantly lower than that of the control group(P<0.01).The medical cost covered by patients in the test group was significantly lower than that of the control group(P<0.01)and the hospitalization satisfaction of the patients in the test group was significantly higher than that of the control group(P<0.01).The difference in the therapeutic effect of the test groups was statistically significant when compared with the control group(P<0.05).Conclusion:Homemade medical scrotal support shorts reduced the local enlargement of the scrotum and bleeding,but also protected the scrotum and the surrounding skin to prevent secondary injuries.The process of patient care was simple and promoted their recovery.The length of hospitalization was also decreased,the burden of health care costs was reduced,and the overall comfort and satisfaction of the patient was improved.

Effect of medical care linkage-continuous management mode in patients with posterior circulation cerebral infarction undergoing endovascular interventional therapy

BACKGROUND Acute cerebral infarction is a severe type of ischemic stroke that can be divided into anterior circulation cerebral infarction and posterior circulation cerebral infarction(PCCI).PCCI affects the structure of the posterior circulation brain,because posterior part of the brain,which has more complex anatomical structures and more prone to posterior circulation vascular variation.Therefore,improving the prognosis of PCCI patients is necessary.AIM To explore the effect of medical care linkage-continuous management mode(MCLMM)on endovascular interventional therapy(EIT)for PCCI.METHODS Sixty-nine patients with PCCI who received EIT and conventional nursing intervention were selected as the control group,and 78 patients with PCCI who received EIT and MCLMM intervention were selected as the observation group.The incidence of postoperative complications,compliance and disease selfmanagement behavior after six months of intervention,modified Rankin scale(mRS)and Barthel index(BI)scores in the acute phase and after one year of intervention,and recurrence within one year were compared between the two groups.RESULTS The total incidence rate of postoperative complications in the observation group(7.69%)was lower than that in the control group(18.84%)(P<0.05).The scores for medical compliance behavior(regular medication,appropriate diet,and rehabilitation cooperation rates)and disease self-management behavior(self-will,disease knowledge,and self-care ability)in the observation group were higher than those in the control group(P<0.05).After one year of intervention,in the observation group,the mRS score was significantly lower,and the BI score was significantly higher than those in the control group(P<0.05).The recurrence rate within one year in the observation group(3.85%)was significantly lower than that in the control group(13.04%)(P<0.05).CONCLUSION MCLMM can reduce the incidence of complications after EIT for PCCI,improve patient compliance behavior and disease self-management ability,and promote the recovery of neurological function.

Implement the Palliative Care in Medical Practice of a Tertiary Comprehensive Hospital in China

The locations and modalities of palliative care services to patients with severe/end-stage illness can be diverse,ranging from general hospitals to home-based care.The concept of palliative care hasn't been fully applied to medical practice by care providers in China's Mainland,where the seriously ill or terminal patients mainly receive medical care in hospitals.The implementation of palliative care in medical practice has developed greatly in Peking Union Medical College hospital in terms of clinical patient care,education,and research.This article gives an overview of it,and the experiences in team building,promotion,support seaking and fund raising were also discussed in this article.We hope to explore an effective dilivering model of palliative care for end-stage patients that is adaptive to Chinese culture and social environment.

A Study on the Public Awareness of Hierarchical Medical System in Taiwan

The purpose of hierarchical medical system is to lead in terms of improving efficiency, differentiating healthcare services and promoting labor division by changing the healthcare seeking behavior. The purpose of this research aims to discuss the public awareness of hierarchical medical system in Taiwan for the reference of health policy makers. We obtained our research data using a questionnaire survey;the total number of qualified patients was 1340. This research finds that more subjects agreed to the hierarchical medical system and medical referral system, but many people still disagreed with changes to their healthcare seeking choices due to policy promotion. Subtle changes, therefore, are observed that imply a crisis in terms of the trust in healthcare. The healthcare seeking behavior will not change if there is a difference between the medical awareness of patients and policy implementation, and the government needs to be concerned with this result when making policies.

How can collective leadership influence the implementation of change in health care?

Aim: This study focuses on how a collective leadership style could influence the implementation of change in health care.Methods: Kotter's 8-step process and leadership can guide the implementation of change. Collective leadership can highlight all levels of staff engagement, establish an organizational culture of learning and trust, and create continuous improvement. At the same time, it can formulate a well-designed plan;develop efficient strategies; communicate and empower the staff; assess the performance; and integrate the improvement.Results: Collective leadership can establish vision and trust, highlight all levels of staff engagement,establish an organizational culture of learning and trust, create continuous improvement, communicate and empower the staff and integrate the improvement.Conclusions: Collective leadership can be a powerful way to overcome the barrier and create an effective environment of adaptation of changes by analyzing Kotter's eight stage process.

Integration of Medical Care and Endowment: A New Exploration of Endowment Mode in the Context of Population Aging

China's aging pressure is increasingly serious. The elderly people are difficult to seek medical advice,the elderly dependency ratio is soaring,finance fails to bear such heavy load,and social endowment service pressure is also constantly increasing. Traditional endowment mode is already incapable of satisfying current endowment demands. On the basis of the population aging,this paper came up with the new endowment mode " hospital + nursing home" and analyzed its feasibility. Finally,it reached the conclusion that this endowment mode is helpful for solving problems of endowment and medical care,and alleviating the problem of population aging.

Study of the Conditions Surrounding Fatigue That Are Common to Medical Professionals Working in Emergency and Critical Care Centers in Japan

This study aimed to clarify the conditions surrounding fatigue that are common to medical professionals working in emergency and critical care centers in Japan. Semi-structured interviews were conducted with eight professionals ranging from doctors, nurses and pharmacists to clinical engineering technologists and radiation technologists. Their narratives were analyzed using the qualitative descriptive approach to determine fatigue common to all professionals and the reasons behind it. The five categories that emerged as the reasons for fatigue common to the subjects were [playing one’s role in treatment and procedures for emergency and critical patients], [accommodating the patient’s background and coming to terms with the outcome], [difficulties in liaising with other professionals], [feeling pressure as a responsible professional in emergency care] and [loss of sense of time caused by variable working hours]. The results revealed that fatigue common to all of the subjects was related to dealing with patients, coordinating with other professionals, having professional responsibilities and the working environment. This study suggests that arrangements to improve the working environment, ensure adequate staffing, and provide mental health support for the well-being of medical professionals working in emergency and critical care centers are necessary.

Use of systems change and health information technology to integrate comprehensive tobacco cessation services in a statewide system for delivery of healthcare

Despite the availability of effective treatments and recommendations for systems change, full application of the USPublic Health Service clinical practice guideline for the treatment of tobacco use is seldom achieved. The present report describes a comprehensive, structured approach used to implement the guideline and to integrate evidence-based cessation services into a system for delivery of health care. The PRECEDE-PROCEDE model and systems strategies were employed to design and implement the Tobacco Control Initiative (TCI), which provides evidence-based cessation services for the patients of a statewide public hospital system. For the TCI, multi-level assessments, pilot programs, electronic data collection, and performance feedback were needed to produce system-wide changes in workflow and in the quality of care for tobacco users. Although there are advances in health information technology (HIT), systems approaches are required for responding effectively to the Health Information Technology for Economic and Clinical Health (HI-TECH) Act and to standards governing use of electronic data related to treatment of tobacco use and dependence.

A Systematic Review of Cultural Preferences for Receiving Medical “Bad News” in the United States

According to the dominant models of medical ethics in the United States and many Western countries, physician disclosure of information such as diagnosis, treatment options, and prognosis is considered an essential precondition for patient informed consent. While being consistent with the principle of patient autonomy stressed in many Western healthcare systems, full disclosure—particularly of life-threatening diagnoses and poor prognoses—is inconsistent with the cultural values of many ethnic communities within the United States. A systematic review of research examining cultural preferences for disclosure of medical “bad news” was conducted. Results suggested that cultural preferences are more heterogeneous than has often been portrayed. Particularly when communicating with patients and families from culturally and ethnically diverse backgrounds, health care professionals should ask about preferences for receiving medical information and making treatment decisions.

The Brazilian public healthcare system and its participation in medical training

Introduction: In Brazil, in a joint initiative of the Ministries of Health and of Education and Culture, the Program for the Promotion of Changes in Medical School Curricula (PROMED) was created, in order to give financial support to medical schools for the development and implementation of curricular changes to the medicine courses. Objective: To ascertain the influence of PROMED on the interaction between the Brazilian public healthcare system (SUS) and the universities. Method: Using the qualitative method by way of content analysis of the Bardin, interviews with 19 coordinators of the medicine courses which received financial support from PROMED were carried out and analyzed. Results: Subcategories which express the current relation between SUS and the universities were found: the need to train SUS professionals and the teaching staff involved, the lines of research directed toward SUS and partnership relations as part of the student learning process, the strengthening of SUS and the internal problems. Conclusions: Observing the needs of the relationship between SUS and the curricular changes it was noted that the public health services are of extreme importance as part of the training process of the medical student. Besides favoring practice, it establishes student activities within the health services, the evaluation of the policies, planning and management of the health services in activities of training and social communication in healthcare, linked to community organizations or diverse social entities. Thus, problems associated with the healthcare service can be identified, as well as the health conditions and life style of the population.

The Acquisition and Utility of the Family Medical History in Primary Care: A Cross-Sectional Study

Background: Acquisition of family medical history (FMH) is emphasized as a part of obtaining a complete medical history, but whether FMH is consistently documented and utilized in primary care, as well as how it can affect patient care in this context, remains unclear. Thus, the objectives of this study were to determine: 1) if FMH is regularly acquired in a representative primary care practice (the Queen’s Family Health Team, QFHT);2) what is included in the FMH obtained;3) what the utility of FMH is with regards to patient management in primary care;and 4) to utilize healthcare practitioners’ perspectives in order to elucidate any findings regarding the acquisition and utility of FMH at the QFHT. Methods: Patients were interviewed in order to obtain their FMH. For each patient, the FMH obtained was compared to the FMH documented in the patient’s record to determine the record’s completeness. Each patient’s FMH was analyzed for significant history of coronary artery disease (CAD), diabetes mellitus type II (DMII), substance abuse (SA) and colorectal cancer (CRC). Participants were patients scheduled for appointments at the QFHT between May and July 2011. Any patient of the QFHT older than 25 years was eligible to participate. Clinical staff of the QFHT completed an online questionnaire to determine healthcare practitioners’ perspectives regarding the acquisition and utility of FMH. Results: 83 patients participated in the study. Participants ranged in age from 25 - 86 years (median: 63 years);69% were female. FMH present in patients’ records was often either incomplete (42% of charts reviewed) or not documented at all (51% of charts reviewed). Knowledge of FMH can affect patient management in primary care for the diseases assessed (CAD, DMII, SA and CRC). HCP do consider FMH to be important in clinical practice and 86% of respondents stated that they regularly inquired about patients’ FMH. Interpretation: Despite the belief by HCP that FMH is important, there is a disparity between this belief and their practices regarding its documentation and utilization. Finally, analysis of the FMH of the representative population studied shows that information commonly missing in patients’ FMH can affect patient management at a primary care level.

Current Attitudes of Anesthesiologists towards Medically Futile Care

Purpose: To explore anesthesiologists’ perceptions of the reasons underlying why physicians continue to provide care that they consider futile. Methods: A qualitative study was conducted utilizing a grounded theory approach. Four separate focus groups (2 resident physician groups and 2 attending physician groups) were conducted over a three week span. An interview guide was used consisting of a proposed definition of futility and five open-ended questions. Responses to the five open-ended questions were used to guide follow up questions. Transcribed audio recordings were then analyzed. Results: With data reduction, we were able to separate responses into definitions of futility, stories of cases where futile care was provided, and opinions as to the underlying causes of continuing to provide futile care. A variety of opinions was obtained, suggesting the possibility that different groups (surgeons, anesthesiologists, family members) view questions of futility differently. Conclusions: Complete agreement on a definition of futility does not exist. Even when some agreement exists, there is great difficulty in predicting outcomes in individual cases. Future quantitative studies may provide more evidence of trends in underlying reasons for providing futile care. Focused education efforts may then lead to more agreement between all involved.

The Medical Care of Multiple Disciplinary Team Reduces the Risks of Complications in Patients after Arteriovenous Fistula Operation

Introduction: Arteriovenous fistula (AVF) operation is recognized a gold standard of hemodialysis for end-stage renal disease. Because various complications may occur during perioperative period, medical care plays an important role in improving the possibility of AVF operation. The objective of the study was to explore the effect of the mode of multiple disciplinary team (MDT) medical care on the patients with end-stage renal disease treated by arteriovenous fistula (AVF) operation. Method: 98 patients with end-stage renal disease under the AVF operation were divided into observation group and control group. The control group was performed with regular medical care and for the observation group was treated under the mode of MDT medical care. Complications after operation, hospitalized time and medical satisfaction were comprehensively compared between the both groups. Results: The overall complications including swelling, bleeding, infection and thrombosis in observation group accounted for 5%, however, 19% of patients suffered different complications in the control group. The total complications significantly decreased in the observation group compared with control group (P < 0.001). The hospitalization time was shortened to 9.8 ± 5.6 days in the observation group, and the average hospitalization in control group was 17.8 ± 8.9 days. The medical satisfaction was increased by 20.83 percent in the observation group compared with the control group (P < 0.001). 75% patients in control group were satisfied with medical care, and 98.53% patients were satisfied for observation group. Conclusion: The mode of MDT medical care was beneficial for patients with end-stage renal disease after AVF operation, which could significantly reduce complications, hospitalized time and improve patients’ degree of satisfaction. Thus, it should be recommended in the clinical work.