Tena Tamayo Carlos, Sánchez González Jorge M, Campos Castolo Esther Mahuina
Comisión Nacional de Arbitraje Médico.
Ginecol Obstet Mex. 2006 Oct;74(10):523-31.
Hemoderivative and blood transfusions without proper medical indication bring uncertain benefits, increase health risks and adverse effects. It is necessary to also consider the patient's values and preferences and the denial to receive transfusions. A deficient medical evaluation and an unnecessary transfusion can generate untoward effects regarding patients' health and safety.
A retrospective, observational, and transverse study of 767 complaints for alleged denial of medical attention presented by Jehovah's Witness patients was undertaken, coupled with their denial to receive blood transfusions and their perception of the problem.
It was established that 95.6% of cases studied involved adult patients, while 4.4% involved underage patients, with a mean of 43 years. The majority of complaints appeared at the secondary level of medical attention, 64.5% came from social security institutions and 19% from private institutions. The motive for medical consultation was surgical in 91.9% cases. 98.7% of the complaints were due to a perceived denial of medical attention, associated to religious conviction. 1.3% of complaints were filed after having received blood transfusions, without proper patient consent. The major health problems were solved in different medical units from the beginning in 500 cases (65.2%). Medical care was provided in 450 cases, in private clinics, while 50 cases were cared for in public institutions without the need for transfusion.
Several studies coincide on the high number of unnecessary or unjustified blood transfusions. To improve the quality of transfusion medicine steps should be taken to install specialized hospital committees, update the use of guidelines based on the best scientific evidence, as well as to respect patient autonomy.
在没有适当医学指征的情况下使用血液衍生物和输血带来的益处不确定,还会增加健康风险和不良反应。还必须考虑患者的价值观和偏好以及拒绝接受输血的情况。医学评估不足和不必要的输血可能会对患者的健康和安全产生不良影响。
对耶和华见证会患者提出的767起因涉嫌拒绝医疗救治的投诉进行了回顾性、观察性横断面研究,同时研究了他们拒绝接受输血的情况及其对该问题的看法。
确定所研究的病例中95.6%为成年患者,4.4%为未成年患者,平均年龄43岁。大多数投诉出现在二级医疗层面,64.5%来自社会保障机构,19%来自私立机构。91.9%的病例中医疗咨询的动机是手术。98.7%的投诉是由于感觉因宗教信仰而被拒绝医疗救治。1.3%的投诉是在未经患者适当同意接受输血后提出的。500例(65.2%)的主要健康问题从一开始就在不同医疗单位得到了解决。450例在私人诊所接受了医疗护理,50例在公共机构接受护理且无需输血。
多项研究一致认为不必要或不合理输血的情况很多。为提高输血医学质量,应采取措施设立专门的医院委员会,根据最佳科学证据更新指南的使用,并尊重患者自主权。