ObjectiveTo understand patients’ cognition of third-party mediation model for medical disputes, analyze the factors influencing the trust of patients on third-party mediation, and propose recommendations for building third-party mediation mechanisms. MethodsFrom November 2013 to April 2014, we referred past literature to design a relevant questionnaire on the cognition of third-party mediation for medical disputes. Patients who had reached the end of the treatment were surveyed by random cluster sampling. The raw data were put into the computer for statistical analysis by SPSS 18.0. ResultsAfter giving out 500 questionnaires, we acquired 486 effective questionnaires. The result showed that 61.52% of the patients knew of third-party mediation; 55.35% of the patients considered that thirdparty mediation should be set in and supervised by the court or judicial administrative department; if the mediation failed, 57.41% of the patients chose to resolve the dispute through legal channels, and 67.90% of the patients tended to confirm the force of mediation conclusion by arbitration; 70.58% of the patients considered that mediators should have professional background of medicine and law; 73.05% of the patients tended to take conclusions of forensic identification as the basis for mediation; 64.81% of the patients were biased to take Tort Liability Act as the basis for determining the compensation; 53.70% of the patients believed that financial allocations could solve the fund problems of third-party mediation, while 38.48% of the patients thought the funds should be provided by insurance companies; 91.15% of the patients thought the medical institutions should purchase medical liability insurance, and 54.32% of the patients thought insurance companies should not intervene the process of meditation. Conclusions Government should provide financial allocations to ensure the funds of third-party mediation. Besides, medical insurance should be brought in as a supplement. Medical institutions should purchase medical liability insurance to solve problems caused by medical disputes. Third-party mediation should be set in and supervised by the court or the judicial administrative department. Mediators should have professional background of medicine and law. Conclusions of forensic identification should be the basis for third-party mediation.
Objective To investigate the reading habits of authors of articles published in the Chinese Journal of Evidence-Based Medicine (CJEBM) and to compare the findings with those from other surveys. Methods A total of 512 questionnaires were sent to authors who had contributed to CJEBM over the past 7 years. Results A total of 129 questionnaires were returned (response rate 31.6%). The replies showed that the main purpose of reading literature was to keep up with the latest developments in medicine (94% of replies). The main reading material was medical journals (86%). Most respondents (57%) spent more than 3 hours a week reading journals. The biggest problem identified by authors was the lack of full text papers, but the first choice was the electronic versions of the literature. More than half of the authors (57%) said that they spent less time reading than in the past. Conclusion Effective reading of the medical literature is a basic requirement in the practice of evidence-based medicine. It is necessary and important for clinicians and healthcare providers to improve their reading skills and methods.
Objective To investigate the use of evidence-based medicine (EBM) and barriers to applying EBM in clinical practice in medical postgraduates. Methods Three hundred and sixty-five first and second-year medical postgraduates selecting the EBM courses were included. All the students were surveyed by questionnaires. Result The response rate to the survey was 100%. About half of the students read 1~5 professional articles per month before postgraduate study. Fifty-six percent of the students used professional literature and research findings when making clinical decisions. Fifty-seven point three percent used electronic databases to search for practice-relevant literature before postgraduate study. Sixty-one point four percent found it difficult to obtain relevant clinical guidelines and 68.5% never applied relevant clinical guidelines in clinical decision-making. The barriers to using EBM in clinical practice included difficulties in searching and accessing full text of potentially relevant articles, lack of EBM knowledge, influences from clinical experience and authorities, uncertainties about the quality of evidence and time-consuming. Conclusion EBM clinical practice and EBM medical education has transformed from dissemination and popularization stage to skill acquisition stage.
Objective To investigate the feedback of continuing medical education (CME) based on short message service (SMS) for village doctors in Gaolan County of Gansu Province, and to explore how to improve the efficiency of CME based on SMS. Methods A total of 75 village doctors were investigated with a questionnaire when attending the training program conducted by the Health Bureau of Gaolan County. Results A total of 75 valid questionnaires were collected back. The statistical analyses showed that 56% of the doctors received the majority of the messages sent to them, of whom, 98% could read the messages promptly, 81% saved the majority of the messages they received, 98% could read the saved massages occasionally, 25% transmitted messages to others, 93% thought that the messages might be helpful in varying degrees, 96% would like to continue receiving the messages in the future, 51% thought the biggest shortcoming of the messages was the poor relevance to their concern, and 70% wanted the most to receive short messages about clinical diagnosis and treatment. At present, 39% of the doctors thought the most convenient approaches to get the updated medical knowledge are attending the study or training program organized by higher authorities, while 37% thought those are reading short messages on the mobile, websites or papers. Conclusion The village doctors are willing to receive the short messages about the best clinical evidence. However, both the receiving rate and use rate of the short messages have yet to improve. A complete SMS transmission system and highly-relevant contents are regarded as important guarantees for improving the receiving rate and use rate.
Objective To explore the type and frequency of oral care practice in intensive care units (ICUs) in Mainland China, and to provide evidence and suggestions for improving oral care practice. Methods Three survey methods, including mailing questionnaires to ICUs of Grade 3A hospitals, consulting experts in this field and visiting accessible ICUs, were used to survey current oral care practice in Mainland China. Results A total of 184 questionnaires were given to the subjects, of which 79 effective ones were collected, and the response rate was 42.93%. All 79 respondents considered oral care very unimportant, and 98.7% of the ICUs performed oral care in different ways. Currently, the cotton ball wipe-off method was the most frequently used for oral care (62.5%), with an average (9.1± 5.1) min per time, twice or three times daily. The mouthwashes often used were saline (76.1%), solutions containing sodium bicarbonate (22.8%), furacilin (13.9%), and hydrogen dioxide (13.9%). Conclusion The oral care practice for the critically-ill patients in ICUs of China is unsatisfactory, although it is perceived as an important item in nursing care. More evidence–based training should be given and it is necessary to establish a national oral care guideline for critically-ill patients.
Objective To investigate the lung involvement in Chinese patients with systemic sclerosis ( SSc) and its functional impact. Methods 68 patients with SSc were enrolled in Scleroderma study of PUMCH ( Peking Union Medical College Hospital) . All the patients underwent high resolution computed tomography ( HRCT) , pulmonary function testing, 6-minute walk testing, and echocardiography. And 36 patients filled in the Saint George’s Respiratory Questionnaire ( SGRQ) for assessment of healthrelated quality of life. Results HRCT revealed interstitial lung disease ( ILD) in 52 ( 76. 5% ) patients, 20 out of them without respiratory symptoms. Reticular opacification, ground-glass opacity ( GGO) , traction bronchiectasis, and honeycomb were presented respectively in 80.8% , 73.1% , 59.6% , and 30.8% of patients with SSc-ILD. Fibrosis was the predominant HRCT finding, and pure GGO ( in the absence of reticulation or architectural distortion) was only present in 8 ( 15. 7% ) patients. 57 (83.8% ) patients presented with diffusion defect, with most of them having moderate to severe impairent. Reduced FVC or TLC presented in 20 ( 29.4% ) and 28 ( 41.2% ) of patients respectively. The significant correlation was observed between the DLCO and the extent of ILD on HRCT ( rs = -0.476, P =0.000) . DLCO showed significant correlations with all the four components of the SGRQ ( Plt;0.05) . Significant correlations were also observed among the SGRQ scores and SpO2 ( maximum desaturation) or Borg index. Stepwise multiple regression analysis confirmed that the DLCO, SpO2 , and Borg index contributed to the SGRQ. Conclusions Lung involvement in Chinese SSc patients is common and insidious. The HRCT features of SSc-ILD are predominant fibrosis plus GGO, indicating little reversibility. Thus HRCT should be performed routinely in newly diagnosed SSc patients for early screening of lung involvement. The lung function defect of SSc is characterized by reduced diffusing capacity, and DLCO show better correlations with HRCT abnormities or SGRQ than FVC or TLC. Thus DLCO is of great value for early detection or severity assessment of SSc-ILD. SGRQ can be used to examine the health related quality of life of SSc patients and may reflect severity of lung involvement.
Objective To investigate the decision-making situation of doctors in the township hospitals in Gaolan, Gansu province, and to discuss its scientificity and rationality. Methods Self-designed questionnaire was adopted to investigate the clinical decision-making situation of 108 doctors from 7 township hospitals in Gaolan county. The investigation contained three parts as follows: basic information of respondents, general information of clinical decision-making evidence, and comparison between respondents’ decision-making situation and current best clinical evidence. Results Among the total 108 questionnaires distributed, 89 valid were retrieved. The feedback showed that 79% of the doctors diagnosed and treated patients in accordance with medical textbooks; 53% took curative effect into consideration in the first place; 33% failed to consider patients’ willingness properly when making clinical decisions; and 52% made clinical therapy regimen for common diseases based on the evidence which was different from that in BMJ published Clinical Evidence. Conclusion While making clinical decisions, doctors in the township hospitals do not adequately refer to the best clinical evidence as their decision-making basis, and fail to take patients’ value and willingness into consideration properly. It is necessary to promote the concept of evidence-based medicine and spread the best evidence in the township health departments.
Objective?To investigate the current status of new clinical medical postgraduate students on their learning goals and expectation of employment, and to provide the evidence and suggestions for improving the management of medical postgraduates’ training. Methods?We designed the questionnaire to investigate the current status of learning goals and expectation of employment of new clinical medical postgraduate students of Lanzhou University. We issued 164 questionnaires and took back 164 ones, among which 157 were effective, with the effective rate of 95.7%. Results?(1) The proportion of the postgraduates with working experience was less than 50%, and most of these worked in the municipal and county hospitals. (2) The 78.3% of them considered that clinical and research abilities were of the same importance. (3) The 65.6% of them expected to get Medical Science Degree; (4) The 96.8% of them wanted, after graduation, to engage in clinical work or the work in which clinical affairs and research were equally important, and only 3.2% hoped to engage in research-oriented work; (5) Although clinical skills and research capabilities of the first-year medical postgraduates were very poor at their entrance to the graduate school, their expectations of employment were very high. Conclusion?(1) The improvement and innovation of medical postgraduates’ clinical and research training are urgently needed. (2) The publicity and supporting policies should be enhanced for Clinical Medicine Degrees, and the postgraduates should be guided to comply their own expectations with social needs properly.
Objective To learn about the evaluation of the practical value of resident doctors towards the Global Minimum Essential Requirements in Medical Education (GMER), so as to provide effective information for the usage of GMER in China. Methods Two hundred and five resident doctors of West China Hospital of Sichuan University were investigated by the use of questionnaires. Results The evaluation of the practical value towards the 7 domains of GMER was high, but the “population health and health systems” domain gains the lowest scores. Conclusion The society might ask doctors to use the abilities required by GMER, especially the requirements in the "population health and health systems" domain. It is suggested that the doctors’ performance evaluation system be adjusted by adding the weight to the lower score domains, and the medical students be trained to be equipped with both macro and micro thinking abilities in medical school, so as to cultivate doctors with the "core competence" of GMER.
Objective To understand the attitude of xinjiang medical workers towards national essential drugs and the requirements and suggestions about training, so as to provide necessary baseline information for spreading the application of Essential Medicine List (EML) in Xinjiang. Methods A questionnaire designed by Chinese Evidence-Based Medical Center was distributed for a face-to-face survey. The data were double-input by EpiData 3.1 with double checks, and statistically analyzed by EXCEL with constituent ratio as the statistical index. Results A total of 80 questionnaires were distributed and then retrieved with 100% recovery rate. Respondents employed in six public hospitals at or above the county level and in six community health service centers as well. a) The accuracy of 80 respondents about the basic concepts of essential drugs, serviceable range of EML, and the relationship between EML and basic medicare drug list were 72.6%, 89.5% and 17.8%, respectively; b) 33.8% (27) of the respondents always firstly considered using the essential medicine in their prescription, and 22.5% (18) of the respondents considered using essential drugs in most cases; c) EML were welcome loy 35% (28) of the respondents; d) The problems of practicing EML issued by respondents were the following in order: doctors’ awareness of essential drugs and prescribing habit of doctors, the safety and effectiveness of essential drugs, lower income, patients’ awareness of essential drugs and preference to medication, and the applicability of the essential medicine list; e) The main approaches to getting information about essential drugs were academic seminars (37 person-time, 46.2%), professional journals (27 person-time, 33.8%) and documents (25 person-time, 31.2%); f) There were 46 respondents who had participated in EML training once or twice; g) The total EML training or learning time of 34 respondents (42.5%) was less than one week; and h) Respondents suggested that, the training objects should be medical personnel, pharmacists and administrators; the training contents should be rational drug use, formularies and the use of essential drugs, drug policy, and the effectiveness of integration of the traditional Chinese medicine and western medicine; the training methods should be theoretical teaching and online learning; and the training place should be hospitals, homes or offices. Conclusion It is extremely urgent to improve doctors’ awareness of EML and strengthen the training of usage, and to conduct the research on EML applicability and effectiveness evaluation, financial subsidies, medical staff income, purchase and reimbursement problems.