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首页> 外文期刊>Journal of Perinatal Medicine >Choice of cesarean section and perception of legal pressure.
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Choice of cesarean section and perception of legal pressure.

机译：剖宫产的选择和法律压力的感知。

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OBJECTIVE: To evaluate the perception of "Defensive Medicine" by hospital based obstetricians and the influence of this attitude on the choice of cesarean delivery. SUBJECTS AND METHODS: Questionnaire sent by mail to a sample (76) of obstetricians of general district, teaching and university hospitals in a region of southern Italy (Puglia). Doctors were selected as the head, the most senior and the most junior specialist of each department. Independent variables of the study were considered as demographic data of the subjects, years of service, interest in private practice, size of the hospital, background cesarean section rate, personal and site of work exposure to legal claims. Outcome measures were experience and confidence in training for operative vaginal and breech delivery, use of the partogram in labor, opinion about a trial of labor after a previous cesarean section and about cesarean section on request, personal perception of defensive medicine. Univariate and multivariate analysis of data were performed. RESULTS: The response rate was 83%. According to our data, seniority in service meant confidence in and request of more teaching of obstetrics manoeuvres, size of hospitals was positively related to a more rationale approach of the diagnosis of dystocia, heads of units were keener to accept the patient's wish for a cesarean section. Doctors with large private practices were less likely to be sued and the perception of legal pressure was directly related to the rate of cesarean section in each unit. DISCUSSION: Defensive Medicine is a reality that encompasses all categories of doctors in this survey. The only differences were in the rate of perception of legal pressure. We believe that residential programs should be modified in order to improve specialists' understanding of malpractice problems and that the patient-doctor relationship should be ameliorated in public hospitals.
机译：目的：评估医院产科医生对“防御医学”的看法以及这种态度对剖腹产选择的影响。研究对象和方法：通过问卷将问卷发送给意大利南部（普利亚）地区的普通医院，教学医院和大学医院的产科医生（76名）。医生被选为每个部门的负责人，最高级和最初级的专家。该研究的独立变量被认为是受试者的人口统计学数据，服务年限，对私人执业的兴趣，医院的规模，剖宫产背景率，个人和合法诉求的工作地点。结果措施包括：经验和对手术阴道和臀位分娩训练的信心，在产程中使用分部图，对上次剖宫产后进行分娩试验的看法以及应要求进行的剖宫产的看法，对防御性医学的个人看法。进行了数据的单变量和多变量分析。结果：有效率83％。根据我们的数据，服务年资意味着对产科手术的信心和要求，并且医院的规模与难产诊断的更合理方法正相关，单位负责人更愿意接受剖腹产的愿望。部分。具有大型私人执业的医生被起诉的可能性较小，法律压力的感知与每个单位剖宫产的发生率直接相关。讨论：防御医学是一个现实，涵盖了本次调查中的所有类别的医生。唯一的区别在于法律压力的感知率。我们认为，应该修改住院计划，以增进专家对医疗事故问题的理解，并应改善公立医院的医患关系。

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