醫療,健康與品質報30號 Health Renaissance No. 30

醫療,健康與品質報30號 Health Renaissance No. 30

2008/01/18 (創刊： 2007/12/25) 主編：鍾漢清

Quote from W. Edwards Deming:
People learn in different ways: reading, listening, pictures, watching.

台灣

勞委會調查，超過兩週不洗醫師服逾四成四，行政院衛生署醫事處長薛瑞元今天表示，為降低院內感染機率、保護病人安全，醫事處自去年開始就加強宣導醫護人員勤洗手及相關配套措施，但醫護人員的醫師服、護士服要多久洗一次，並無硬性規定。 ..

肺癌印記找出 復發可預測

《2008/01/17 20:31》

　記者戴淑芳／台北報導
肺癌在全世界與台灣皆為癌症死因之首，由台大醫學院長楊泮池領導的研究團隊，利用現代生物技術與生物統計演算法，發現一個可預測肺癌復發率及存活率的癌症印記，居世界領先地位，已申請世界性專利。
楊泮池院長表示，根據衛生署最新的統計資料顯示，肺癌分別位居女性與男性癌症死因的第一位及第二位。同時， 96年全球的新增癌症病例已超過 1200 萬，並且有 760萬人死於癌症，肺癌在國內的發病率和致死率正迅速上升，有 80%的病人在手術治療後 2年內會發生癌症轉移，最終導致死亡。
以台灣為例，肺癌發生率每年近 7千人，但死亡率卻有 6千人，足見肺癌是最常見引起死亡的癌症。
由於目前醫界對肺癌治療預後的預測並不準確，楊泮池院長表示，在國科會支持下，由台灣大學、中興大學、台中榮民總醫院、中國醫藥大學和中央研究院組成的研 究團隊，利用現代生物技術與生物統計演算法，發現一組由 5個微核醣核酸（ microRNA）組成的肺癌印記，可預測肺癌復發率及存活率的癌症印記，對 於未來癌症的個人化醫療的發展，提供了重要的資訊。
楊泮池院長表示，肺癌依組織細胞型態可分為小細胞癌與非小細胞癌。其中，以非小細胞癌為東方人最常見的類型，約占肺癌的 85%以上。微核醣核酸 (microRNA)為一類新的小核醣核酸，它可以反向調節基因的功能。
透過微核醣核酸（ microRNA）組成的肺癌印記，可準確地預測癌症復發和肺癌患者的存活率，進而應用在癌症分子病理學的研究或新標靶性治療的開發， 更可進一步發展成癌症檢測試劑，以用於評估病患預後，並可有助於選擇高風險的癌症病人，在早期即進行輔佐性化療，或給予更進一步的治療。
這一研究成果已發表於本期癌症醫學領域的頂尖期刊「癌細胞 (Cancer Cell)」，目前正在申請世界性專利。
楊泮池院長表示，研究團隊去年也在新英格蘭醫學期刊發表一個 5個基因為基礎的肺癌預後預測印記，亦可準確地預測癌症復發和肺癌患者的存活率。進一步結合 兩種不同印記篩檢法研究結果發現，當病人同時被兩種印記判定為高風險病人時， 3年存活率僅 16%，反之則存活率可達 8成，致命風險達 8倍之多，將 可作為癌症病患個人化醫療的重要參考。
由於兩種印記的基因表現，都可以普通的研究設備檢驗、換算，楊泮池院長表示，這項研究成果正由多醫學中心展開大規模臨床試驗中，預計最快 5年內可以用於臨床診斷，一旦篩檢技術普及後，成本僅約台幣 1200元。

中國

廣東省氣象局發佈報告說，廣東省的空氣污染形勢嚴重。 2007年，該省27個主要縣市的出現灰霾日數達75.5日，是中華人民共和國建國59年以來陰霾日數最多的一年。

美國

Doctors are making inappropriate decisions on prescribing antidepressants because the effectiveness of some medications has been exaggerated by drug makers' selective publication of favorable results, researchers told the U.S. Food and Drug Administration.

人物Google Offers a Map for Its Philanthropy

$300 to Learn Risk of Prostate Cancer

By GINA KOLATA

Researchers have reported that a simple DNA test can help predict a man’s risk of getting prostate cancer.

日本

Ambulance sirens sound alarm on funding cuts

01/17/2008

Whenever I hear an ambulance siren, I get nervous, even though the sound means paramedics are trying to save a person's life. Is the ambulance charging through traffic to reach someone or rushing a patient to a hospital? The noise is alarming, even if it doesn't concern me personally. How must it sound to the people inside the ambulance?

At the end of last year, an 89-year-old woman in Tondabayashi, Osaka Prefecture, became ill and an ambulance was called so she could get prompt medical attention.

But she was refused admittance by 30 hospitals. The woman died. Many of the hospitals gave the excuse that they were busy treating other patients. I can only imagine the despair of the woman's family as they were given the bad news in the ambulance.

There seems to be no end to cases of hospitals slamming their doors to emergency patients. Even though ambulance calls are on the rise, with government cuts in health funding, many hospitals are not adequately staffed to treat emergency cases.

The shortage of doctors and nurses has added to problems, as working in emergency operating theaters has become excessively arduous. That in turn has discouraged doctors from seeking such jobs. It is a vicious circle.

The nation's emergency hospitals are classified in three categories. Primary hospitals, which treat relatively mild cases, secondary hospitals, which treat patients who require hospitalization or surgery, and tertiary hospitals, which handle life-threatening cases.

In the last two years, 235 secondary hospitals, or 5.6 percent of all hospitals in the category, stopped offering emergency services.

Now, in some cases, patients who should be rushed to secondary hospitals are being brought to tertiary hospitals. As a result, medical centers for critical cases are overflowing with patients.

Of course paramedics, doctors and nurses all want to save lives, but their good intentions often fail to produce positive results.

The Asahi Shimbun in its Osaka edition ran a letter from an emergency medicine specialist from Nara Prefecture, who said: "I feel the torch of advanced emergency medicine carried by devoted and passionate specialists is growing weaker with the reductions in medical funding."

The sound of an approaching siren surely is merciful. As our society ages, demand for emergency aid will rise. At this rate, people cannot feel relieved until they are admitted into a hospital. The siren outside my window sounds like an SOS call from the medical system.

--The Asahi Shimbun, Jan. 16(IHT/Asahi: January 17,2008)