Meta-analysis of the causes of medical disputes in China
[Abstract] Objective To analyze the causes of medical disputes and the departments with many disputes, and to provide guidance for medical institutions to further implement the specific measures of medical system reform. Methods Meta-analysis method in statistics was used to process the collected documents that met the inclusion criteria, and the proportion of medical disputes was compared with that of medical disputes in various departments. Results The top three causes of disputes were poor professional diagnosis and nursing skills (22.95%), poor service attitude (2 1.24%) and communication barriers between doctors and patients (12.665,438+0%). In the distribution of medical disputes, surgery accounts for the highest proportion (34.80%), and surgery is the primary department where medical disputes occur. Conclusion Medical institutions should further deepen the reform of medical system. Medical staff should enhance their professional level, improve their service awareness, and attach importance to and enhance the communication between doctors and patients; Strengthen the management of departments with more medical disputes, ensure the quality of medical care, and reduce and avoid medical disputes.
[Keywords:] medical disputes; Cause analysis; Meta-analysis
[China Library Classification Number] R 197.32 [Document ID] B [Document Number]1673-7210 (2012) 02 (c)-0160-.
Meta-analysis of the causes of medical disputes in China
Gao Xiaofei 1, 2 Zhou Weiyan 1, 2 Sun Zhonghe 1▲
1. Nanjing First Hospital Affiliated to Nanjing Medical University, Jiangsu Province, Nanjing 210006; 2. School of Clinical Medicine, Nanjing Medical University, Jiangsu Province, Nanjing 2 10029
[Abstract] Objective By analyzing the causes of medical disputes and the distribution of departments, to provide guidance for medical institutions to implement specific measures of medical system reform. Methods By using the statistical method of meta-analysis, all the documents that meet the inclusion criteria were analyzed, and the composition of the causes of medical disputes and the proportion of medical disputes in some departments were obtained. Results The top three causes of disputes were dissatisfaction with professional medical technology level (22.95%), poor service attitude (2 1.24%) and communication obstacle between doctors and patients (12.61%). Surgery, accounting for 34.80%, is the main department where medical disputes occur. Conclusion In order to deepen the reform of medical system, medical institutions should further strengthen their professional level, enhance their service awareness, attach importance to and improve the communication between doctors and patients, and strengthen the management of departments with frequent medical disputes, so as to ensure the quality of medical care and reduce and avoid medical disputes.
[Keywords:] medical disputes; Cause analysis; Meta-analysis
Individual differences, complexity of diseases, limitations of diagnosis and treatment methods and many other factors are mixed together, which determines the high difficulty and high risk of the medical industry. In the process of changing the medical model from a simple biomedical model to a biopsychosocial model, the relationship between doctors and patients has become more complicated and tense, and even doctors in China often become victims of violent medical disputes [1]. It is urgent to understand and analyze the causes of disputes between doctors and patients in China and the distribution ratio of departments where disputes occur, and put forward countermeasures to reduce and avoid disputes. This paper comprehensively analyzes and discusses the causes of medical disputes and the distribution ratio of departments through meta-analysis, in order to provide guidance for medical institutions to better deepen the implementation of specific measures for medical system reform.
1 materials and methods
1. 1 retrieval strategy
By using the methods of computer literature direct retrieval and literature traceability, this paper searches the literatures on the causes of medical disputes before May 20 1 1 year in PubMed, CNKI, Wanfang and other databases. What are the search keywords? Doctor-patient contradiction? 、? Doctor-patient disputes, Medical disputes? And then what? Why? 、? Why? .
1.2 inclusion and exclusion criteria
Inclusion criteria: Chinese and English literature on the analysis of medical disputes that can be retrieved from PubMed, CNKI and other databases. (2) Check the full text of the literature.
Rejection criteria: ① Articles without original data; (2) Documents with unclear classification or general concepts (e.g., the reason for the dispute is poor medical quality); (3) According to the number of cases, count the documents that cause disputes; (4) Literature with sample size less than 50; ⑤ Literature that separately analyzes the causes of death disputes; 6. Documents with overlapping time and the same source of disputed cases; ⑦ Repeated published literature.
1.3 causes of medical disputes and classification of departments
In the process of medical activities, disputes caused by imperfection or negligence in technology, service and doctor-patient communication are important reasons for medical disputes in hospitals. In this paper, the causes of medical disputes are divided into: ① poor service attitude: lack of responsibility and medical ethics problems; ② Poor professional diagnosis and nursing skills: all kinds of missed diagnosis and misdiagnosis, great dependence on medical equipment, improper choice of treatment scheme, incomplete mastery of surgical indications, medication errors, operational errors, and various iatrogenic complications during operation; ③ Medical expenses: Some hospitals do charge opaque fees, prescribe expensive drugs, conduct major inspections, collect fees at random, or patients have doubts about the expenses; (4) The implementation of various management systems in the hospital is not in place (mainly the core medical system and technical operating procedures), including the bad phenomena such as poor cooperation between departments and mutual shirking; (5) Obstacles in communication between doctors and patients: doctors are the leading factor, and they fail to communicate through all kinds of characteristic and all-round information, which makes it impossible for both sides to reach an understanding and establish a trust and cooperation relationship; ⑥ Patients' reasons: patients' medical knowledge level is insufficient, they don't know unilaterally, their expectations are too high, they make trouble without reason and seek economic compensation; ⑦ Others: including patients slipping, money stolen, suicide, instruments, medical materials, drug quality problems, adverse drug reactions, interns operating without teachers' supervision, long waiting time, poor medical environment, dissatisfaction with hospital hardware and equipment and other accidents. In this paper, the departments in dispute are divided into: internal medicine (including dermatology), surgery, obstetrics and gynecology, pediatrics, ENT (including ophthalmology, stomatology, otolaryngology), emergency department (including ICU), medical technology department (including various auxiliary examination departments) and other departments (including neurology, etc. ).
1.4 quality control
Data were collected according to literature selection criteria, and the sample size was small (
1.5 statistical method
Establish a database for the selected literature, and check the consistency of the data before analysis. Due to the huge heterogeneity in this study (I2 >；; 50%), so choose the random effect model. Data processing was completed by Stata 1 1 statistical software, and heterogeneity test method was adopted, P
Two results
2. 1 literature retrieval
Through PubMed, CNKI and other databases, 458 articles about the causes of medical disputes were obtained, and 30 articles were retained according to the inclusion and exclusion criteria, totaling 6 970 medical disputes. The main sources of medical disputes are medical departments of medical institutions at all levels, medical accident appraisal associations and hospital departments. It can be clear from the literature that the controversy comes from *** 19 articles in tertiary hospitals (tertiary hospitals 17 articles, 2 articles in tertiary hospitals), and the remaining 9 articles have no clear explanation on the level of medical institutions.
2.2 Causes of medical disputes
The results show that among all the causes of medical disputes, the service attitude and the level of diagnosis and treatment are the highest, accounting for 265,438+0.24% (95% CI: 65,438+04.70% ~ 28.62%) and 22.95% (95% CI: 65 65,438+06.66%) respectively. The proportion of doctor-patient communication is the second, which is12.61%(95% ci: 8.07% ~17.99%). The reasons are small, such as inadequate implementation of hospital system (9.98%), medical expenses (3. 19%), patients' reasons (6.7 1%) and other reasons (5.72%). There were significant statistical differences among various reasons (Z = 20.82, P
Table 1 Cause Analysis of Medical Disputes (%)
Note: REM is a random effect model.
2.3 Distribution ratio of medical dispute departments
* * * There are 10 documents related to the analysis of the distribution ratio of medical dispute departments. According to statistics, surgery accounts for the highest proportion (34.80%), internal medicine (18.92%), obstetrics and gynecology (1 1.53%) and pediatrics (5.53%). The difference between departments was highly statistically significant (Z = 14.32, P
Table 2 Distribution Analysis of Departments of Doctor-patient Disputes (%)
Note: REM is a random effect model.
3 discussion
This meta-analysis of the causes of medical disputes shows that the three major causes of meta are poor professional diagnosis and nursing skills (22.95%), poor service attitude (2 1.24%) and communication barriers between doctors and patients (12.5438+0%), which are significantly higher than those caused by patients' unilateral factors (6.76438+).
3. 1 What are the three main causes of disputes? Soft competitiveness?
3. 1. 1 The medical situation in China is worrying. Due to the defects of the medical system, the average investment of governments at all levels in hospitals is only about 7% of hospital expenditure [2]. ? Survival? It has become the top priority of public hospitals, and some hospitals can only rely on medical services to generate income. The proportion of medical staff in medical institutions is too small, there are many patients, few doctors and nurses, and the pressure of medical work is great. Even so, the treatment of medical staff in China is generally not as good as that in foreign countries. In addition, the cultivation of medical talents needs more time, money and effort than other majors. The high pressure and high risk after employment are in sharp contrast with the unsatisfactory treatment. Physical and mental fatigue and low work enthusiasm of medical staff may lead to poor service attitude and insufficient sense of responsibility. Driven by economic interests, medical ethics problems are not easy to correct.
3. 1.2 More attention should be paid to the influence of patients' psychological and social environment on health and diseases, and both doctors and patients should pay attention to communication. Doctors can't only pay attention to the disease itself, but ignore that patients are people in a complete society. The process of providing medical services should not be mechanized, and the doctor-patient relationship is not orders and obedience. Seeing a doctor does not mean analyzing various laboratory tests and checklists. Doctors should learn to listen to patients and communicate with them effectively. Medical treatment is a process of doctor-patient interaction, and both sides should take the initiative. With the continuous improvement of patients' awareness of rights protection, it is necessary to consult patients on the determination of medical plans and explain and explain patients' drug use. Doctors need to take some intervention measures for patients, such as training patients to learn to communicate with medical staff through written guidelines, video courses, face-to-face lectures, etc., so as to improve patients' participation and form a negotiated doctor-patient relationship [3].
3.2 Strengthen surgical medical technology
The proportion of medical dispute departments in surgery was 34.8%, which was close to the statistical analysis result of Wang Xi et al. [4] (36.7%), and the difference was highly statistically significant (P
3.3 Establish an effective medical dispute prevention management system.
Establishing an effective medical dispute prevention and management system mainly includes the following measures: ① improving service methods, enhancing service awareness and embodying humanistic care; ② Standardize medical behaviors and strictly implement various medical rules and regulations; ③ Pay attention to the study of medical theory and improve the level of medical technology [5]; (4) Reasonable charging and increasing the transparency of charging; ⑤ Strengthen the communication between doctors and patients, and medical staff should strengthen the theoretical study and practice of social disciplines such as psychology, sociology and interpersonal communication; ⑥ Carry out medical social work, follow the value concept of helping others and helping themselves, and use the professional knowledge and methods of social work to provide patients with all kinds of help; ⑦ Strengthen the management of medical document writing; ⑧ Introduce the third-party mediation mechanism [6-8] to correctly handle disputes between doctors and patients and improve the autopsy rate of death disputes.
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Meta-analysis of epilepsy treated by traditional Chinese medicine
Objective To evaluate the overall curative effect of traditional Chinese medicine on epilepsy by meta-analysis and compare it with simple western medicine. Methods The literatures of randomized controlled trials of traditional Chinese medicine in the treatment of epilepsy were searched through the electronic service system of domestic multi-database platform, and the statistical analysis was made with the special software RevMan 4.2 of Cochrane collaboration network. Results A total of 13 randomized controlled trial papers on the treatment of various types of epilepsy with traditional Chinese medicine were retrieved, which met the inclusion criteria of RCTs. Among them, there are 6 papers about epilepsy in children. The results of meta-analysis show that Chinese medicine can improve the control rate and remission rate of epilepsy and reduce the recurrence rate. Conclusion Chinese medicine can not only stabilize the curative effect, but also reduce the recurrence. Traditional Chinese medicine treatment can also play a role in reducing toxicity and increasing efficiency.
Epilepsy; Chinese medicine; Meta-analysis; System evaluation
[Abstract] Objective To evaluate the efficacy of traditional Chinese medicine and western medicine in treating epilepsy. Methods Using the multi-database platform of domestic electronic service system, the literatures with epilepsy integrated with traditional Chinese and western medicine as the key words were searched. Then use Rev Man 4.2 of cooperative network for statistical analysis. Results The standard of randomized controlled trial was 65438 03, and that of children was 6. The analysis shows that Chinese medicine treatment can improve the total remission rate and reduce the recurrence rate. It can obviously improve the therapeutic effect of traditional Chinese medicine on EP. Conclusion Chinese medicine is an effective method to treat EP. However, the exact effect needs to be further confirmed by multi-center, large sample and randomized controlled trials.
[Keywords] Epilepsy (EP); Chinese medicine; Meta-analysis; Systematic review
Epilepsy is a group of diseases and syndromes characterized by intermittent central nervous system dysfunction caused by repeated sudden abnormal over-discharge of brain neurons. At present, western medicine treatment can inhibit most types of epilepsy, but long-term use of western medicine is prone to a variety of toxic and side effects, and long-term use will also produce drug dependence or drug resistance. These urge us to open up new ways and methods to prevent and treat epilepsy. In recent years, with the research and clinical application of traditional Chinese medicine, it can make up for the adverse reactions caused by western medicine treatment to a certain extent, and at the same time, it can enhance the curative effect and reduce the recurrence. Most studies show that traditional Chinese medicine has a stable curative effect on epilepsy and few clinical adverse reactions.
1 data and methods
1. 1 contains standards.
1. 1. 1 research type: published and unpublished RCT of traditional Chinese medicine in China in the past 10 years.
1. 1.2 intervention measures Chinese medicine treatment as the treatment group; The control group was treated with routine antiepileptic western medicine.
1. 1.3 data type: clear and similar counting data.
1. 1.4 adult efficacy evaluation criteria, refer to the efficacy evaluation criteria in the Guiding Principles of Clinical Research on the Treatment of Epilepsy with New Chinese Medicine of the Ministry of Health: marked effect: compared with the interval before treatment, the number of seizures decreased by more than 75%, or prolonged by more than 1 year, and the EEG changes were obviously improved; Effective: the number of seizures is reduced by 50% ~ 75%, or the symptoms of seizures are obviously alleviated, the duration is shortened by more than 50%, and the EEG changes are improved; Invalid: the frequency, degree, symptoms and EEG of the attack have not improved or worsened. The observation time is 3 ~ 6 months. The evaluation standard of children's curative effect refers to the four-level evaluation standard of curative effect formulated by the first National Epilepsy Society of Chinese Medical Association [1]: control: no seizure; The effect is remarkable: the attack frequency is reduced? 75% or more; Effective: Decreased seizure frequency? 50% or more; Invalid: the attack frequency is reduced.
1.2 exclude the standard cases of non-epileptic diseases; Special epilepsy syndrome; Paroxysmal sensory abnormality in 3 cases; A case of paroxysmal mental state change.
1.3 literature retrieval
1.3. 1 The deadline for document retrieval is April 2008 1.
1.3.2 electronic retrieval database China Biomedical Literature Database (CBM CD-ROM), China Journal Full-text Database (CNKI, 1994 ~ 2007), China Excellent Master's Degree Thesis Full-text Database (CNKI, 1999 ~ 2007), China Doctoral Degree Thesis Full-text Database (CNKI)
1.3.3 Search keywords are epilepsy and traditional Chinese medicine for epilepsy, which are combined into different search methods, and the search scope includes screening from references.
1.3.4 data extraction extracts relevant data from qualified documents for further analysis and evaluation. The data involved the characteristics and design of the study, the characteristics of subjects, treatment methods and clinical results.
1.3.5 The data comprehensive statistical software adopts RevMan 4.2, a special software for Cochrane cooperation network. The heterogeneity test of literature, such as P & gt0.05, has good homogeneity, and the fixed effect model is selected for analysis; The counting data were analyzed by ratio ratio (OR), and the analysis results were all expressed by 95% confidence interval (95%CI).
Two results
2. 1 research overview
2. 1. 1 Literature retrieval and analysis According to the inclusion criteria, a total of * * 13 domestic literatures on the treatment of epilepsy with traditional Chinese medicine were retrieved, and the statistical time of research cases was from 2000 to 2007. Among the 13 articles, there are 6 articles about the treatment of epilepsy in children.
2. 1.2 evaluation results of Jadad scale included in the study 13 articles were randomly divided into two groups by double-blind method, and the number of people who dropped out or lost their visits and the reasons were not reported. Jadad scores of all the literatures are 1 ~ 2, which are low-quality literatures [2 ~ 14] (table 1). Table 1 Treatment of Epilepsy with Traditional Chinese Medicine 13 Basic Information Notes: Antiepileptic drugs (AEDS): carbamazepine (CBZ); Phenobarbital (PHT); Sodium valproate (VPA); Phenobarbital (Pb); Topiramate
2. 1.3 Subjects included in the study: 20-200 cases were observed 13 cases, * * included in the observation: 1.769 cases, Chinese medicine group * * 1.067 cases, and western medicine control group * * 702 cases. Course of disease: the shortest 6 months, the longest 25 years.
2. 1.4 intervention measures All types of epilepsy were treated with antiepileptic western medicine alone or in combination with routine therapy as the control group, status epilepticus plus diazepam intravenous drip as the control group, and epilepsy was treated with traditional Chinese medicine as the treatment group.
2. 1.5 The case balance between the biased treatment group and the control group is good, and there is no significant difference in gender, age and course of disease. The selective bias included in the study is small, no other treatment is accepted before and after treatment, and the bias in the implementation of the study is also small.
2.2 Model selection of heterogeneity analysis and curative effect analysis Literature heterogeneity is expressed by test statistics Q, and? =K- 1？ 2 distribution, the analysis results of this study show that all P & gt0.05 think that the homogeneity of the study is good, and the fixed effect model is used for analysis, as shown in figure 1 ~ 2.
2.2. 1 See Figure 1 for the comparative analysis of the effective rate of treating epilepsy between Chinese medicine group and western medicine group. A total of 65,438+03 studies were selected, including 65,438+0,067 cases in the Chinese medicine treatment group and 702 cases in the western medicine control group. The comprehensive results show that the homogeneity is good (heterogeneity test P & gt0.05), and the statistical results show that OR=4.68, 95% CI (3.52 ~ 6.23) > 0, P & lt0.0 1. The diamond is completely located on the right side of the vertical line, so it can be concluded that the traditional Chinese medicine group is effective in treating epilepsy.
2.2.2 See Figure 2 for the comparative analysis of the effective rates of Chinese medicine group and western medicine group in treating children's epilepsy.
Figure 1 comparison of curative effect of traditional Chinese medicine group and western medicine group on epilepsy Figure 2 Comparative analysis of the effective rate of traditional Chinese medicine group and western medicine group on epilepsy in children. A total of 6 studies were selected, with 430 cases in the traditional Chinese medicine group and 26 cases in the control group. The comprehensive results show good homogeneity (heterogeneity test P & gt0.05), and the statistical results show that OR=4.36, 95% CI (2.75 ~ 6.92) > 0, P & lt0.0 1. The diamond is completely located on the right side of the vertical line, so it can be concluded that the traditional Chinese medicine group is effective in treating epilepsy.
In recent years, especially in the last five years, the discussion on the treatment of epilepsy with traditional Chinese medicine has developed rapidly. Most of the documents selected by our party were published in the last five years, involving Arisaema cum bile, Pheretima, Pinellia ternata, Pericarpium Citri Tangerinae, Acorus gramineus, Gastrodia elata, Bombyx Batryticatus, Salvia Miltiorrhiza, Leech and other traditional Chinese medicines. The prescriptions introduced include Tongqiao Huoxue Decoction and Dingxian Pill. And there are self-made prescriptions. The basic principles of treatment are clearing liver-fire, resolving phlegm, relieving spasm, calming wind and resolving phlegm, calming the heart and inducing resuscitation, invigorating spleen and benefiting qi, nourishing blood and softening the liver, and treating according to the condition. But so far, there is still no unified treatment plan for epilepsy treated by traditional Chinese medicine and integrated traditional Chinese and western medicine. Meta-analysis was used to calculate the complete remission rate of Chinese medicine group and western medicine control group. The complete remission rate of primary epilepsy in two groups of children or; The complete remission rate of traumatic epilepsy in the two groups was 100% or100% respectively. And their respective 95%CI, it is considered that the remission rate of epilepsy treated by traditional Chinese medicine, including primary epilepsy in children and secondary epilepsy caused by trauma and cerebral infarction is obvious, and the recurrence rate can be reduced. Based on the literature findings, clinical trials in China have the following characteristics: (1) the quality is poor, and the quality scores of 13 articles are all 1, which is a low-quality study; (2) The course of treatment is not uniform or detailed; (3) The follow-up time varies greatly, and most of them have no follow-up; (4) There is no specific random allocation method; (5) Missing or leaving without explanation; (6) The sample size varies, and most of them are small samples. In addition, meta-analysis is only an observational study, not an experimental study, and its quality control standards are not completely unified, so there may be publication bias in the process of its research. The results of this meta-analysis show that Chinese medicine can improve the clinical remission rate of epilepsy and reduce the recurrence of epilepsy. However, due to the low quality and too few documents included in this study, the reliability of the conclusion needs to be further confirmed by large-scale and multi-center RCT.
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