根据医疗事故鉴定进行报道何来侵权——记湖北省医院诉湖北法制报的一场“新闻官司”

《湖北法制报》报道医疗事故引起争议 1990年4月27日,患有风湿性心脏病二尖瓣狭窄的女病人杨群英,住进了湖北省医学院附属第一医院暨湖北省人民医院(以下称省人民医院)心内科。4月29日,在该院放射科,杨群英接受了被称为PBMV的心脏手术。但是,在4月29日这天较长时间的手术之后,患者杨群英于5月3日11时死亡。 1990年11月16日,湖北省医疗事故技术鉴定委员会作出的鉴定结论,将杨群英之死鉴定为一级技术性医疗事故。

94起医疗纠纷原因分析及防范对策

<医疗事故处理条例>自2002年9月1日实施以来,对正确处理医疗事故,保护患者和医疗机构及其医务人员的合法权益,维护医疗秩序,保障医疗安全,促进医学科学的发展起到了积极作用.因此,如何作好医疗安全工作,目前已成为卫生行政部门和医院领导十分关注的问题,本文试图通过对94起在施行<医疗事故处理方法>期间的医疗纠纷进行分析,找出发生原因,从而提出防范对策,以供医院管理者参考.

不懂眼科治眼睛 患者感染致失明 医生隔行乱治 误诊岂能无事

据《健康时报》方歆报道:北京市昌平区兴寿镇西营村农民张井合的左眼因误诊而失明已2年零5个月了,但他直到现在也想不通,误诊医生不是眼科医生,为啥就可以不负任何责任呢? 张井合有一辆运输车,1998年3月31日,他在修车时,感到左眼中有异物飞入,于是当即由妻子陪同来到本村刘上旺医生开的卫生室就诊。刘询问了张的病史,用电筒照了照左眼,又用棉棒蘸了一下后,开了维生素B2、螺旋霉素、牛黄清火三种药物,就让他回去了。

浅议胎儿利益的法律保护

目前我国在胎儿利益保护方面的立法尚有缺陷,笔者试图结合我国司法实践和国外立法例,提出在现实社会中对胎儿利益的保护。

资讯点击

6月7日上午,80岁的中国工程院院士、北京市神经外科研究所所长王忠诚,获得了北京市人才奖励的最高奖项——首都杰出人才奖。从医60年,如今已是世界著名神经外科专家的王忠诚院士,现在最看重的新职务,是出任北京神经外科学院的院长:用最短的时间,系统地培养年轻的神经外科医生,使他们达到国际先进水平。上个世纪五六十年代,他出版了我国第一部《脑血管造影术》,

PHC动态

霍山县县委政府采取5条有力措施,全面实施初级卫生保健工作,确保年底通过验收。 一、调整了县初级卫生保健委员会,成立了办公室,并抽查3人具体办公。全县24个乡镇也充实调整了初级卫生保健领导组,为初保普及提供了组织保证。 二、县委、县政府已将实施初级卫生保健纳入重要的议事日程。

深圳立法严管“医闹”

前不久,历经两年四审的《深圳经济特区医疗条例》（以下简称《条例》）终于经深圳市人大常委会表决通过,于2017年1月1日起实施。作为我国首部地方性医疗基本法规,深圳在全国率先把医改纳入到法治化轨道,针对“医闹”滋事的社会痛点,进行了医疗秩序与纠纷处理的详细规定。

Internal biliary fistula due to cholelithiasis:A single-centre experience

AIM： To discuss about the perioperative problems encountered in patients with internal biliary fistula （IBF） caused by cholelithiasis.METHODS： In our hospital, 4 130 cholecystectomies were carried out for symptomatic cholelithiasis from January 2000 to March 2004 and only 12 patients were diagnosed with IBF. The perioperative data of these 12 IBF patients were analyzed retrospectively.RESULTS： The incidence of IBF due to cholelithiasis was nearly 0.3%. The mean age was 57 years. Most of the patients presented with non-specific complaints. Only two patients were considered to have IBF when gallstone ileus was observed during the investigations. Nine patients underwent emergency laparotomy with a pre-operative diagnosis of acute abdomen. In the remaining three patients, elective laparoscopic cholecystectomy was converted to open surgery after identification of IBF. Ten patients had cholecystoduodenal fistula and two patients had cholecystocholedochal fistula. The mean hospital stay was 23 d. Two wound infections, three bile leakages and three mortalities were observed.CONCLUSION： Cholecystectomy has to be performed in early stage in the patients who were diagnosed as cholelithiasis to prevent the complications like IBF which is seen rarely. Suspicion of IBF should be kept in mind, especially in the case of difficult dissection during cholecystectomy and attention should be paid in order to prevent iatrogenic injuries.

Medical malpractice litigation related to gastrointestinal endoscopy in Japan:A two-decade review of civil court cases

AIM: To examine the allegations in malpractice litigations related to gastrointestinal endoscopy in Japan. METHODS: A retrospective review of cases tried in the civil court system during the 21-year period from 1985 to 2005, identified in a computerized legal database, was undertaken. RESULTS: Eighteen malpractice litigations and a total of 30 allegations were identified. Of the 18 (44%) malpractice litigations, 8 (44%) were related to eso- phagogastroduodenoscopy, 4 (22%) to colonoscopy, 4 (22%) to endoscopic sphincterotomy, and 2 (11%) to endoscopic retrograde cholangiopancreatography. Seventeen (94%) cases pertained to complications, and the remaining (6%) case pertained to misdiagnosis. In 10 cases, the patient died of the complications. Allegations were categorized as: (1) performance error during the endoscopic procedure (n = 12, 40%); (2) lack of informed consent (n = 9, 30%); (3) performance error during the treatment after the endoscopic procedure (n = 4, 13%); (4) premedication error (n = 3, 10%); (5) diagnostic error (n = 1, 3%); and (6) indication error for the endoscopic procedure (n = 1, 3%). CONCLUSION: These data may aid in the design of risk prevention strategies to be used by gastrointestinal endoscopists.

Application of Healthy-Side Needling to Treatment of Apoplectic Hemiplegia

Acupuncture is effective for the treatment of apoplectic hemiplegia, and the acupoint on the paralytic side is often selected for acupuncture. However, some doctor prefers healthy-side needling with quite satisfactory results. We study and review the treatment of apoplexy by healthy-side needling to further improve its therapeutic effects.

An epidemic of violence on medical personnel:are we prepared

The incidence of violence against doctors has been increasing, both in China and worldwide. Very often we hear doctors being molested, thrashed and abused by lay public for a trivial medical malpractice or even no fault of theirs. The once glittering halo of medical workers is being shredded thanks to the stressed health system and a lack of evaluation for risk of violence of the patients. Modem China sees a wide disparity between industry standards in rural and urban areas. People seeking health care service are often scared, can＇t get timely service and turn their anger towards those around them. To change a whole system in this giant nation is too hard a rock. Therefore, our focus is on the prompt awareness and preparation of a possible patient violence. The simplest approaches seem to be the most effective. Medical staffs should re-leam empathy on patients and be better trained on recognizing and reducing conflicts

Research on City Rapid Medical Decision System based on GIS

In order to guarantee the validity of the city emergency rescue, it will need to feedback goods demand and injuries to guide accident emergency rescue center in a timely, and also we need to fully grasp with emergency supplies and emergency hospital. Considering the effectiveness of city emergency rescue and timeliness, the paper analyzes and design Rescue Decision Support System for city distribution of emergency supplies and search of wounded man based on GIS. Emergency medical aid model established in this paper, taking ArcGIS＋VS2005 as the development platform, C# as development language, design and development the preliminary city emergency medical rescue simulation system based on GIS.

Clinical Application of the Point Yongquan

Yongquan (KI 1) is a jing (well) point of the Kidney Meridian of Foot-Shaoyin. As this point is widely used for treatment of acute or chronic diseases, it has drawn attentions from physicians both in the ancient and in the present times. If this point is taken accurately and the differentiation of disease is made properly, both the needling and the external drug application can achieve satisfactory therapeutic results.

论医疗暴力的预防和处理对策

医疗暴力是一种违法行为,已得到了越来越多的人关注。目前医疗暴力事件的频繁发生,不断降低医患相互的信任感,而且引发了恶性的医患暴力冲突事件,影响医疗行业正常发展,成为影响社会稳定的问题之一。本文从整体的角度出发,分析我国目前医疗暴力现状、诱因及对策。深度剖析医患矛盾的缘由,在社会大环境下,就如何缓解医患矛盾的问题也提出了几点建设性的对策。

Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury

Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years （mean 32 years）. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents （3 cases）, fall from height （5 cases） and hit by heavy object （2 cases）. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days （average 6.6 days）. Postoperatively, the foot function was assessed using Visual Analogue Scales （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） Scales. Healing time and complications were observed. Results： All patients were followed up for 18-24 months （average 20 months）. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score （Z89 ± 0.34） and score at postoperative 8 weeks （0.67 ± 0.13）. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion： Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients＇ quality of life.

Spinal cord injuries from road traffic crashes in southeastern Iran

Objective ： To analyze the data of patients with spinal cord injury （SCI） induced by road traffic crashes in southeastern Iran for better understanding the pattern of these injuries and therefore for better designing health system planning. Methods ： In this historical cohort study, the patients who had been transferred to Level I trauma center in southeastern Iran due to road traffic accidents with radiographic documented SCI were evaluated. Results： Among 64 patients with SCI, 38 patients （59.4 %, 36 males and 2 females, aged 27.42 years ± 9.44 years on average） were injured by road traffic accidents. Car and motorcycle accidents were responsible for 26 cases （68.4%） and 12 cases （31.6%）, respectively. And 31patients （81. 6%） had complete SCI. Conus medularis （T12-L2 ） was the most affected level. Conclusions： Results are discussed in terms of preventive measures, specifically those concerning the use of restraint and helmet and driving behavior. This study should be extended nationally to gain a larger case series so that the SCI risk of particular vehicle configurations, considering other crash factors, can be more precisely quantified and the characteristics for low occurrence of SCI can be more precisely identified.

Treatment of limb arterial injuries caused by traffic accidents

Objective: To analyze the features, diagnosis and treatment of limb arterial injuries caused by traffic accidents. Methods: A total of 43 patients with limb arterial injury admitted in our department over the past 30 years (about 50% of them happened during the last 10 years) were analyzed retrospectively in this article. The popliteal, femoral and brachial arteries were mainly involved, accounting for 43.2 %, 20.5 % and 20.5 % respectively of all the involvements. There were 35 cases of open injury and 9 of close injury. The involved vessels were transected in 43.2 % of the cases and contused in 40.9 %. All the patients had various complications, such as fractures, dislocations and severe soft tissue injuries. The injured vessels were repaired by means of end to end anastomosis in 10 cases, autogenous vein graft in 23 cases and intraluminal hydraulic dilatation in 4 cases. Results: Successful limb salvage was achieved in 34 cases initially, whereas 10 amputations were carried out due to injuries to popliteal arteries in 7, femoral arteries in 2 and humeral artery in 1 and severe soft tissue damages in 9 cases. Twenty nine patients were followed up for 1 156 months, with the average of 48.8 months. There was good circulation in 22 cases and certain ischemia in 5 cases. Two amputations were carried out in the late stage because of popliteal artery thrombosis after repair in 2 cases. There was no death in this series. Conclusions: The limb arterial injuries caused by traffic accidents are severe and complicated. It is proposed that particular attentions should be paid to the features in diagnosis and treatment for this type of injury and special efforts should be made for both life saving and limb salvage.

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

Objective： To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods： We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing （n=23）, followed by fall from height （n=20）, road traffic accidents （n-5） and fall from standing height （n=2）. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn＇s criteria. Results： Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn＇s criteria, 90.4% patients showed satisfactory results. Conclusion： Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.

Hoffa fracture associated with ipsilateral femoral shaft fracture： clinical feature and treatment

Hoffa fracture associated with ipsilateral femoral shaft fracture is very rare. Three cases of this rare type of injury were retrospectively reviewed. The sites of femoral shaft fractures and Hoffa fractures were documented. All femoral shall fractures were managed with internal tixation. The rate ofmisdiagnosis for the Hoffa fractures was documented. Functions of the affected knees were evaluated according to the modified Hospital for Special Surgery （HSS） scores at two years follow-up. Femoral fractures were either transverse or composite in all three cases. Ipsilateral Hoffa fractures occurred at medial condyle in two cases, and lateral condyle in one case. Only one Hoffa fracture was identified preoperatively. All the femoral shaft fiattures healed uneventfully. In the patient whose Hoffa fracture was correctly diagnosed, the modified HSS score was 94. In another patient, whose Hoffa fracture was treated by a second operation, the modified HSS score was 93. And in the third case, who refused additional operation for the Hoffa fracture, the modified HSS score was only 70. Conclusively femoral shall fracture can be associated with ipsilateral Hoffa fracture, especially in motorcycle accident. This type of iniury is very rare and misdiagnosis is common.

Motorcycle accidents in China

Objective： To analyze the characteristics and causes of motorcycle accidents in China from 2000 to 2005. Methods： We collected data on possession of motor- cycles and automobiles, number of traffic crashes, casualty and economic loss from 2000-2005 Statistic Annual Report of Traffic Management Bureau, Ministry of Public Security of China. The data was processed statistically by SPSS 11.0 software package. Results： During 6 years, the number of motorcycle accidents were up to 122 300 in 2003, which was the highest, and then gradually decreased. However, the casualty had the tendency of consistent increase, for example, the motorcycle accidents resulted in 26 200 deaths and 157 500 injuries in 2005. The mortality per 10 000 motorcycles and the ratio of deaths to injuries were lower than those of automobiles, but the mortality per 100 motorcycle accidents was significantly higher than that of automobiles （P〈0.01）. Conclusions： China has attached great importance to the management of traffic safety, which is beneficial to con- trol and reduce traffic accidents in recent years. However, the casualty keeps increasing annually. Therefore, it is urgent to strengthen the management of motorcycles, promote the education of motorcyclists, take effective traffic measures and improve the first-aid system of traffic injuries.