2008年2月28日 星期四

宵夜大吃大喝 熱量多 當然會發胖 煙害~~密招 !

這篇紐約時報的問答是常識 宵夜大吃大喝 熱量多 當然會發胖
Q & A

Midnight Meals


Published: February 26, 2008

Q. Is there any truth to the idea that if you eat heavily late in the evening, you will gain weight?

Skip to next paragraph
Victoria Roberts

A. The research is not conclusive on a clinical effect of late meals, but there are suggestions that there might be one.

“If the calories are exactly the same, it shouldn’t make a difference, but my clinical impression is that people who eat late at night eat more,” said Dr. Louis J. Aronne, director of the comprehensive weight control program at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. They may be eating “an extra meal, if you will, ‘the fourth meal,’ as one ad put it,” Dr. Aronne said. Studies of college students who eat late at night have found that they are more likely to put on weight.

“Eating a big meal just before going to bed has been found in studies to elevate triglyceride levels in the blood for a period of time,” Dr. Aronne said. A higher triglyceride level “has been associated with metabolic syndrome and insulin resistance,” both related to weight gain, he said.

Dr. Aronne suggested a theoretical framework for why late meals may stay with you. “If you ate 500 calories during the day but walked around afterward, your muscles would be competing with your fat cells for the calories and could burn them up as energy for physical activity,” he said. “But if you consume it at bedtime, with no physical activity, the body has no choice but to store the calories away as fat.”

我收到林公孚先生轉來的 覺得它可能是偽造的咖啡宣傳 躊躇是否轉登

今晚與日本友人在咖啡館吸煙室活受罪--不好意思溜溜之大吉--這位台灣電影史專家還舉最近過世的大導演大煙槍 市川活到九十幾....

所以決定轉登 一笑
"
萬芳醫師的~~密招 !


下次感冒初起,不妨試試 ! 無害...

可以很快使感冒或頭痛不再繼續惡化!

如果你感覺到已經開始流鼻水、連續打噴嚏、有點頭痛,就快要感冒了!

趕緊先喝兩、三杯熱開水(不可以喝冰的) 等三、五分鐘,

再沖一杯咖啡,任何咖啡都可以,三合一的最方便了,

如果沒有,鐵罐子的咖啡也可以,ㄧ定要熱的喝才有效(不可冰)。

二、三十分鐘以後,咖啡和先前喝的開水會讓你要尿尿,

而且,很神 奇的,流鼻水、打噴嚏、頭痛都慢慢不見了!

想知道為什麼這麼好用?

一、咖啡可以讓你加速排尿,加上先喝的開水,

可以把已經侵入繁殖的病毒,從身體裡「洗」掉大部分。

二、咖啡有提神、興奮的作用,會讓你低迷不振的免疫功能提振起來,

病毒從尿尿排掉了一部分,免疫功能又加強了,感冒繼續惡化的可
能當然降低不少。"




2008年2月25日 星期一

日本新聞

2

2008.02.18
黑龍江中醫藥大學將在大阪設立中醫學校

  講授東方醫學的黑龍江中醫藥大學日本分校(東京新宿)4月將開設大阪校。目前日本對中藥和針灸等東方醫學的關注程度高漲,想學習中藥的藥劑師等也越來越多。由於以大阪為中心從關西到關東上課的學生也不少,因此決定開設大阪校,來滿足學習的需求。

  大阪校準備開設中藥、藥膳、整體、針灸等課程,從4月開始在大阪市授課,每週2次。目前有5位講師,今後還將根據生源人數增加講師。4月開課時估計會有20人入學上課。

  目前該大學日本分校在新宿區共有約120名學生。其中1/5來自關東地區之外。1994年設立學校以來,共有約1500人畢業。畢業生可獲得中國國立大學黑龍江中醫藥大學(黑龍江省哈爾濱市)的學士學位。(2月15日 《日經產業新聞》)

008.02.22
日本藥品批發商麥迪西帕塔在北京成立合資公司開展醫院醫藥品管理業務

  日本最大的醫藥品批發商麥迪西帕塔控股(Mediceo Paltac Holdings)將與三菱商事合作進軍中國市場。計劃在今年夏季之前與中國當地企業成立合資公司,從事大型醫院的醫藥品管理業務。大型廠商東邦藥品也將 於年內與中國大型藥品批發商合資,開始從事藥品銷售及物流支援業務。麥迪西帕塔將利用在日本累積起來的藥品物流等經驗,在比日本市場發展空間更大的中國市 場上立足。

  麥迪西帕塔于2005年與三菱商事在醫療相關領域簽訂了全面合作協議。該公司對在中國開展業務進行探討後,最終決定涉足醫院的醫藥品管理業務。目前,該公司已選定中國當地大型醫藥品批發商作為雙方的合資對象。

  新公司的第一項業務是在北京市內綜合醫院從事醫藥品管理業務。將提供通過與日本國內醫院(批發商)的關係累積起來的醫藥品管理經驗,來滿足醫 院希望防止出現醫療事故、提高醫療服務水準的需求。該公司今後將面向中國各地的大醫院拓展業務。(2月21日 《日本經濟新聞》晨報)


2008.02.25
日本光電將在中國設立醫療器械銷售子公司

  日本光電將於4月在中國全額出資設立銷售子公司。將銷售可監測患者病情的生物資訊監護儀等醫療器械。該公司此前主要委託貿易公司在中國銷售,今後將轉 為本公司自行銷售。該公司還將擴大維修服務的範圍,計劃在2012年將在中國市場的銷售額提高至50億日元,達到07年的2.5倍。

  將要設立的“尼虹光電貿易(上海)有限公司”的資本金為900萬元,員工約60名。新公司將在中國各地區銷售治療心臟病的除顫器(Defibrillator)和心電圖儀等醫療器械。

  日本光電在上海擁有生產子公司。此前一直通過生產子公司和貿易公司這兩個通路來銷售產品,但沒有實現預期的銷售額。今後將把銷售功能統一到新公司以提高銷售能力,而生產子公司將專門致力於生產。(2月22日 《日經產業新聞》)


日本厚勞省將促進人口稀少地區醫院醫生實施到府醫療服務

  日本厚生勞動省將在苦於醫生缺乏的人口稀少地區推動醫院醫生到患者家中出診。將在日本各地指定“自宅療養支援醫院”,從4月份起實行向出診醫生每人每月支付4萬2000日元診療報酬的新制度。此舉目的在於減少患者長期住院,完善可在家中接受醫療服務的體制。  

  厚勞省06年就已開始實施促進診療所(床位在19張以下的醫療機構)到府醫療的制度。但是在醫生缺乏的人口稀少地,居民老齡化使患者增加,而診療所卻數量不足,因此決定針對醫院制定同樣的制度。(2月22日 《日本經濟新聞》晨報)


2008.02.26
河合樂器製作所將擴充健康促進業務,利用音樂預防代謝綜合症

  日本政府規定,從08年4月起企業的健康保險協會等必須對員工進行旨在預防代謝綜合症的指定體檢以及保健指導。河合樂器製作所決定以此為契機擴充健康促進業務。該公司利用兒童體育教室業務累積的經驗,開發了將音樂和運動結合起來的業務項目。將於4月以後正式推出。  

  河合樂器開發的是伴隨鋼琴演奏聲鍛鍊身體的項目。與普通運動相比可大幅度地活動肢體,除可輕鬆堅持外,還有望減少內臟脂肪。(2月23日 《日本經濟新聞》晨報)






2008年2月19日 星期二

Gentlemen, 5 Easy Steps to Living Long and Well

Gentlemen, 5 Easy Steps to Living Long and Well

Mike Mergen for The New York Times

FRISBEE, ANYONE? Exercise is linked to living longer.


Published: February 19, 2008

Living past 90, and living well, may be more than a matter of good genes and good luck. Five behaviors in elderly men are associated not only with living into extreme old age, a new study has found, but also with good health and independent functioning.

The behaviors are abstaining from smoking, weight management, blood pressure control, regular exercise and avoiding diabetes. The study reports that all are significantly correlated with healthy survival after 90.

While it is hardly astonishing that choices like not smoking are associated with longer life, it is significant that these behaviors in the early elderly years — all of them modifiable — so strongly predict survival into extreme old age.

“The take-home message,” said Dr. Laurel B. Yates, a geriatric specialist at Brigham and Women’s Hospital in Boston who was the lead author of the study, “is that an individual does have some control over his destiny in terms of what he can do to improve the probability that not only might he live a long time, but also have good health and good function in those older years.”

The study followed more than 2,300 healthy men for as long as a quarter-century. When it began, in 1981, the subjects’ average age was 72. The men responded to yearly questionnaires about changes in health and lifestyle, and researchers tested their mental and physical functioning. At the end of the study, which was published Feb. 11 in The Archives of Internal Medicine, 970 men had survived into their 90s.

There was no less chronic illness among survivors than among those who died before 90. But after controlling for other variables, smokers had double the risk of death before 90 compared with nonsmokers, those with diabetes increased their risk of death by 86 percent, obese men by 44 percent, and those with high blood pressure by 28 percent. Compared with men who never exercised, those who did reduced their risk of death by 20 percent to 30 percent, depending on how often and how vigorously they worked out.

Even though each of these five behaviors was independently significant after controlling for age and other variables, studies have shown that many other factors may affect longevity, including level of education and degree of social isolation. They were not measured in this study.

Although some previous studies have found that high cholesterol is associated with earlier death, and moderate alcohol consumption with longer survival, this study confirmed neither of those findings.

A second study in the same issue of the journal suggests that some of the oldest of the old survive not because they avoid illness, but because they live well despite disease.

The study of 523 women and 216 men ranging in age from 97 to 119 showed that a large proportion of people who lived that long and lived with minimal or no assistance did so despite long-term chronic illness. In other words, instead of delaying disease, they delay disability.

Dr. Dellara F. Terry, the lead author and an assistant professor of medicine at Boston University, said the study showed that old age and chronic illness were no reason to stop providing thorough treatment. “We should look at the individual in making treatment decisions,” Dr. Terry said, “and not base our decisions solely on chronological age.”

過度使用手機可能致唾液腺癌

bbc
過度使用手機可能致癌

正在用手機通話的女士
大多數研究都認為手機不會增加致癌風險
最新研究表明,過度使用手機會增加人體患唾液腺癌症的幾率。

以色列研究人員對500名患有唾液腺腫瘤的以色列病人進行了研究,並將他們使用手機的頻繁程度和1,000名較少使用手機的人作了比較。

這項刊登在《美國流行病學雜誌》上的研究發現,那些在一天內用同一隻耳接聽電話長達數小時的人,患唾液腺癌的幾率比常人高出50%。

此前,有關手機致癌的研究不計其數,且大都研究認為使用手機不會致癌。

但以色列特拉維夫大學科研人員指出,以往的研究偏重於手機使用與腦癌的聯繫,而且這些研究沒有側重於過度使用手機的人群。

負責這項研究的薩德斯奇博士說,在以色列一些人使用手機的頻繁程度遠遠超過世界其它地方,而這項研究會讓人知道長期過度使用手機可能造成的危害。

她說,"與其它研究相比,我們在研究中發現的射頻輻射要更強。我認為,我們應該讓人們瞭解其危害,以便最大程度的避免輻射、保護健康。"

唾液腺癌症是一種罕見的疾病。在英國每年被確證為癌症的患者約230,000人,但只有550人被診斷為唾液腺癌。

2008年2月17日 星期日

醫療,健康與品質報 第32期

醫療,健康與品質報 32

2008/2/18 鍾漢清

幾天以前我再讀數月之前在CSQ”坐談的發言:

六、七個月前,我詳細地研究一家苗栗的牙醫診所,自己當時也是那裡的病人,我發現到診所裡的護士很容易出錯,當醫師進行植牙時需要護士協助,可能是因為她們平常練習的太少,所以頻頻出錯,我還要教護士怎樣消毒!而且我以為他們的醫師、護士好像對(衛生)洗手還有器具清潔不太注意,我們工廠說的5S都沒有,這些基本的其實也很重要。

我的母親到臺大醫院開刀,開完刀後我去看她,順道也研究了臺大醫院的醫療系統,它裡面有品管中心,記得當時還有個不倒翁運動:預防病人跌倒。但是,我母親開刀回來,她對臺大醫院手術房非常不滿意!為什麼呢?因為那時候她開的刀是只需要局部麻醉,所以手術的時候,什麼都聽得到,醫師、護士講什麼話、唱什麼歌都知道,還打情罵俏什麼的,她都聽的一清二楚。

最嚴重的是兩個護士小姐推著我母親的病床,後來醫院的廣播系統突然廣播:某某護士小姐,電話。那個護士小姐就衝出去接電話!那病床就突然間傾倒。

我母親親口跟我說這回事,我只好跟她說:沒事就好。

不過這是非常重要的事情,尤其醫療是高接觸,是人跟人之間的互動,好比剛才講到製程,這是非常特別的製程,又跟工廠不太一樣,所以我們要要用心去了解它、做好它,這是我個人的認為。

我決定加一補記:(後來我才知道我們還沒有專業的牙醫護士制。這是台灣牙醫界自私自利之恥。近聞某家鞋業大廠商開牙科,我相信他們CAD方面的知識可能對該行業有些幫助。經過此一座談,本人在部落格發行31期的『醫療,健康與品質報』,請讀者參閱。)

金黃色葡萄球菌 超級病菌亂竄!乾淨醫院在哪裡? 【文/林芝安;攝影/陳德信】

医療の質用語事典 (2005)

医療の質用語事典

医療の質用語事典編集委員会 編著

飯田修平・飯塚悦功・棟近雅彦 監修

2005-09-08発売

B6判・360

ISBN 4-542-20310-7

定価 3,150円(本体 3,000円)

 

医療の質向上を目指す医療従事者必携の実用的な事典!

【概要】

--------------------------------------------------------------------------------

医療への効率的・効果的な質マネジメントの導入や円滑な医工連携の阻害要因“言葉の壁”と“文化の壁”の払拭に大いに役立つ一冊!

医療の質保証に関心のある医療従事者に必要な用語を,単に定義だけでなく,質保証の視点から見た用語のもつ意義や医療従業者になじみの薄い用語については“医療での適用のポイント”などの説明も充実!

医療と質マネジメントの基本的な用語や概念などを体系立てて理解しやすく構成しているので、組織内の教育・研修時のテキストとしても最適!

見出し項目122語について,医療と質管理の両分野の立場から,正確,かつ,分かりやすく解説!

 

【主要目次】

--------------------------------------------------------------------------------

1章 基本概念質”,“医療の質”,“医療経営の質”,“質マネジメント”,“質保証”,“医療”,“診療”,“看護”,“薬剤関連業務”,“根拠に基づいた医療”,“後工程はお客様”,“指標”,“満足度”,“アウトプット・アウトカム”ほか,52

2章 質マネジメント質マネジメントシステム”,“TQM”,“医療連携”,“チーム医療”,“日常管理”,“方針管理”,“経営要素管理”,“診療計画”,“インフォームドコンセント”,“症例検討会”,“医療における標準化”,“クリニカルパス”ほか,45

3章 医療安全医療事故分析”,“医療安全推進”,“医療事故”,“リスクマネジメント(危機管理)”,“ヒューマンファクター・ヒューマンエラー”ほか,5

4章 運用・推進技術医療における教育・研修”,“5S”,“QCサークル”,“人材開発”,“臨床研修”,“第三者評価”ほか,12

5章 手法・技法QC手法”,“QCストーリー”,“QC七つ道具”,“新QC七つ道具”,“FMEA・FTA”,“品質機能展開”ほか,8

参考文献/引用・参考規格/関連組織のウェブサイト

索  引

超級病菌亂竄!乾淨醫院在哪裡?

【文/林芝安;攝影/陳德信】

你應該有過這樣的經驗:到醫院看病或探病時,走進洗手間,地上濕滑、便器髒污、垃圾快滿出桶子;躺在急診室抬頭往上看,天花板一團水漬或黴菌斑點,真擔心會掉落臉上。

你可能也去過國際連鎖咖啡館或五星級飯店,大廳乾淨明亮是基本要求,廁所內的潔淨清爽就好像自己是當天第一個使用的人,牆壁上的清潔確認單顯示,清潔人員被要求每隔半小時清掃一次。

琉璃工坊在上海的主題餐廳,每個月兩次全員大掃除,從半夜清掃到天亮,用幾乎拆掉天花板的精神將餐廳各區間、角落、管線、抽屜幾乎翻了一圈,不放過任何細節,務求一塵不染,因為他們相信餐廳的衛生與消費者健康息息相關。

相較於餐廳、大飯店,醫院對民眾的健康衝擊應該更高度相關吧,但乾淨這件事對醫院來說,似乎不甚重視。

誰說乾淨跟院內感染無關?

國內某醫學中心高階主管說,目前沒有科學研究顯示乾淨跟院內感染直接相關,更何況每天進出的病人這麼多,以廁所來說,「目前只能排一天三班打掃。」

翻開國內醫院評鑑,林林總總幾十個項目令人眼花撩亂,獨漏清潔指標,難怪醫院這麼髒,因為評鑑沒要求。這情形不只台灣,連「美國醫院評鑑(JC)或美國疾 病控制與預防中心(CDC)也沒將清潔指標列入,」美國降低感染死亡委員會(RID)主席貝希麥考基(Betsy McCaughey)提出抨擊。

貝希麥考基曾擔任前紐約市副州長,提出非常多健康政策,她四處演講、寫文章,要求醫院行政管理階層正視乾淨問題,因為這跟院內感染有關。

相關的研究在2007年4月美國健康照護流行病學會年會紛紛登台。波士頓大學研究者檢查49個開刀房發現,半數以上應該消毒完全的器械竟然 被忽略了。另項研究針對康乃狄克州、麻塞諸塞州與華盛頓特區20家醫院的住院病房,迎接新病人時竟然有超過半數以上的病房沒有打掃消毒完全,留下髒污。馬 里蘭大學研究指出,65%的醫師與醫事人員坦言,即使知道白袍髒了該洗了,也沒有力行至少一個星期送洗一次的基本清潔。

今年1月,勞委會公布「醫療院所生物性危害調查」,結果令人憂心,台灣醫生不愛洗白袍,44.3%穿了超過兩星期白袍仍不送洗,連續穿一個月都沒洗的則有13.5%。白袍可能成為潛在「帶菌體」。

也難怪,英國衛生部下令2008年開始禁止醫生穿白袍,理由是,白袍長袖袖口部份容易附著細菌,連手錶、珠寶與領帶也一併禁止戴。雖然各醫師團體強力抨擊新措施,但英國衛生部仍執意施行,不願悲劇重演。

在2004~2006年間,英國梅特斯通醫院爆發嚴重的院內感染,震驚全國。高達90位住院病患相繼感染「梭狀芽孢桿菌」而死亡,憤怒的病患家屬指責醫院淋浴間發霉、水槽甚至醫療器材生鏽,如此不注重衛生環境,使得原本應協助恢復病人健康的醫院變成了奪命醫院。

魔鬼總是藏在細節裡,除了看得到的髒污,還有更多細菌躲在暗處伺機而動,像是聽診器、血壓計套袖、心電圖的線上面都可能沾染。

英國一項研究發現,三分之一的血壓計套袖口上出現梭狀芽孢桿菌,捲起袖口裸露手臂量血壓時,病菌很可能隨著手腕、手指、指尖一路旅行到嘴巴,進入體內。一旦感染,易引發腹瀉、腹痛、發燒、白血球上升、結腸炎、脫水甚至敗血症、休克死亡。

院內感染,世紀之毒

各種病菌隨病人、醫護人員與各種醫療設備、建築互相交流,隱身定居在醫院各角落,院內感染可能隨時一觸即發。

「廣義來說,只要在醫院內得到的感染就算院內感染,」台大醫院感染科主任張上淳表示。但唯恐民眾將院內感染與醫療疏失直接畫上等號,最新修 訂的院內感染定義是,病患入院後72小時發病才算院內感染。因為感染有潛伏期,如果病患一入院就發病,應算社區感染(感染源來自社區)。

院內感染的殺傷力不容小覷,如果大家不健忘,幾年前全台灣籠罩在SARS病毒威脅下,和平醫院淪陷,醫生、護理人員感染死亡,連百年老店台大醫院也創紀錄關閉急診室,人人隔著口罩互動。

2003年SARS狠狠教訓了全台灣之後,各醫院開始曉得要重視院內感控(因為感染科不賺錢,以前不受重視),組織院內感染委員會、撥預 算。但成果還不顯著,2004年全台灣院內感染病例數79342,但2006年全台灣的院內感染病例數為78886,進步才466例,非常有限。

而且衛生署也沒做因院內感染而死亡的統計。

被稱為「世紀之毒」的院內感染,堪稱目前全球醫界最重視的熱門議題,也是當前病人安全重點工作。「減少健康照護相關的感染風險」已經被列入2008年美國病人安全年度目標之一。

造成院內感染的原因非常複雜,進行侵入性醫療行為是其一,例如有些住院病人接受靜脈注射,原本皮膚好端端的,因為插靜脈導管讓皮膚表皮產生 破洞,細菌透過洞口進入體內;或者像是氣管插管,空氣經過管子進入肺部,如果再加上抽痰,管子需往很深的地方抽痰,等於將細菌帶入原本不易到達的身體深 處;導尿管也如此,細菌可堂而皇之深入膀胱內,「這些管子破壞了我們正常的抵抗力,身體既有的防衛機轉沒了,」張上淳解釋,這些都是住院病人容易感染的原 因。

外科手術過程中也可能慘遭感染,美國麻醉醫師學會(ASA)將手術麻醉風險分五級,國外有項大規模研究顯示,1~2級手術(如單純性闌尾 炎)的感染率為1.9%,3~5級(例如本身有高血壓、糖尿病或心臟衰竭的患者腹部血管瘤破裂)則高達4.3%。整體來說,監控手術部位(SSI)的感染 率平均為10%,林口長庚一般外科主任趙子傑說。

甚至還曾發生麻醉師將麻醉劑放入自己口袋,因為沒用完,順手將剩餘的留給下個病人,結果原本單純做隆乳手術的女性嚴重感染,緊急轉送醫學中 心加護病房救治一個多月才逐漸康復。當時負責救治的唐高駿醫師指出,那位麻醉師使用的麻醉劑(propofol)運用廣泛,但因為製作過程沒有防腐劑,開 封後沒用完須丟棄,顯然那位闖禍的麻醉師沒有依標準作業流程,孳生出革蘭氏陰性菌,注入病人體內。

病人本身抵抗力差,如果治療過程又需要特殊處置或工作人員大意,的確容易引發院內感染,也因此許多感染科專家共同指出,院內感染不可能完全 被控制。根據國外研究,有些院內感染來自病人本身體內的病菌,有些是因必要的治療方式無可避免會感染,有些菌很自然就會出現在生理食鹽水、溫度計、導尿 管,「就算很努力做感控,也只能減少三分之一的病人發生,」張上淳表示。

不過,從可以預防的部份來看,確實還有許多地方需加把勁,目前最迫切需要提高醫護人員的洗手遵從率。「我們很清楚病人之所以會發生院內感染,80~90%是工作人員帶菌傳遞發生的,」張上淳直言,醫護人員扮演重要媒介。


醫生,請問你洗手了嗎?

也因此,世界衛生組織在2004年成立病人安全聯盟,提出的第一個宣言就是「乾淨的照護就是安全的照護」,手部衛生是當務之急。

目前國內外醫護人員洗手遵從率僅40~50%(世界衛生組織的目標是90%),還有很大的改善空間。台灣尤其困難,門診量大、病患多,如果依照規定,照顧每個病人前後都要洗手,恐怕手都要洗破了。

一向謹守洗手規定的萬芳醫院外科部主任謝茂志屈指一算,他光是一個上午的門診洗手就超過50次,用掉一包半擦手紙。在病床與病床之間送藥、換藥、更換針 頭……的護理人員更可觀了,如果依照標準,每執行一項工作就必須洗手,台北市立聯合醫院和平院區內科加護病房護理長黃露萩算了一下,她一天洗手超過百次。

雖然不忍,卻仍得持續要求,消基會曾經調查過,進出醫院後的雙手最多可驗出八萬多個細菌,比馬桶髒600倍,相當嚇人。為了便利醫護人員及民眾洗手,各醫 院應該廣設洗手乳或酒精乾洗液、擦手紙,像北部某家醫學中心別說門診區、一般病房沒設,連急診室內的廁所也看不見洗手液蹤跡,這麼基本的要求,如果能列為 醫院評鑑項目直接督促各醫院認真執行,才是全民之福。

提高洗手率的確能讓院內感染明顯下降。根據台大醫院2004年大力推動頗具成效的「手護神運動」,醫護人員洗手遵從率從43%飆至81%,院內感染率隨即從5.3降至4.3%。

有此具體成效,衛生署疾病管制局委託醫策會舉辦全國各醫院品管圈競賽,希望各醫院更重視洗手運動,且將宣導對象從醫護人員延伸到病患家屬與社區。

根據疾管局的「台灣院內監視系統」,目前國內醫學中心與區域醫院的全院院內感染密度約千分之4.2(國外可容忍的標準是千分之3~4),加 護病房每月平均院內感染密度千分之11.6~16。疾管局副局長林頂指出,這套監視系統採「鼓勵通報」,鼓勵各醫院主動透過電腦上傳,提供疾管局整合、分 析全國的院感狀況。

因為採取鼓勵通報,監視系統蒐集到的院感資料顯得破碎、不完整,不利於監控全台醫院,建議應該改為「強制通報」,美國目前已有20個州強制要求州內各醫院上傳院感資料,州政府能掌握更完整的資訊,嚴密監控院感變化。

加強偵測加護病房

從數字顯示,加護病房是院內感染的高風險區,國立陽明大學生物醫學資訊研究所所長李友專引述國內外的臨床經驗數據:如果住進加護病房一星 期,運氣好,沒死,有50%的機會得到院內感染;如果兩個星期還沒死,得到的機率為80%;如果三個星期還沒死,則有100%的機率得到院內感染。

更且,加護病房的病菌相當頑強,抗藥性較高,如果採用後線或最後一線的抗生素,即使擊退病菌,也可能損壞肝腎功能。尤其很多老年人住進加護 病房,最後往往感染肺炎而死,「可能是院內感染所致,」李友專不諱言,這是全球醫界共同的問題,只能勸民眾別以為加護病房可得到更好的照顧而要求住進去, 真正有必要才住進加護病房。

孫小姐的父親住進南部某地區醫院加護病房,未料,醫院竟然沒有認真執行感染管控,護士在加護病房與普通病房之間奔走(極易造成交叉感染), 更荒唐的是,醫師沒有穿隔離衣就進入加護病房,「完全不符合加護病房該有的標準流程,」從事醫療相關工作的孫小姐難過地說,父親後來因肺炎過世,她高度懷 疑與院內感染有關,因為父親曾被檢測出身上有鮑氏不動桿菌(俗稱AB菌,有「院內感染頭號殺手」之稱)。

偵測加護病房刻不容緩,李友專跟新加坡合作,將像鈕扣般大小的無線射頻辨識系統(RFID)引入加護病房,戴在病人與醫護人員身上,可將醫護人員的各種醫療處置行為、病床移動、曾接觸過哪些人、停留多久等等全記錄,有效追蹤感染源。

運用科技全面偵測院內感染是當前趨勢,至少不亂槍打鳥,過去,感控醫師耗費很多資源,結果「偵測五個病人中只有一個是院內感染,在這過程中 還會miss(錯失)其他已感染的病人,引發交互感染,」李友專認為,醫療資源有限,應該運用科技監控,提高打擊率(快速揪出受感染者)。

更重要的是,透過科技管制並分析病人使用的藥物種類、用藥數量、天數,將發生院內感染的高危險群先標示出來,監控抗生素使用。

「抗藥性菌株的控制是目前感控工作非常頭痛的問題,多到幾乎快要棄守了,」以傳染病防治研究發展為特色的台北市立聯合醫院和平院區院長璩大成憂心。濫用抗生素將使得抗藥性菌株愈多,病菌對人類的威脅也增強,增添治療困難。即使美、英、澳洲等國也難敵這微小生物的衝擊。

【康健雜誌111期 解悶救健康】

金黃色葡萄球菌(MRSA)

金黃色葡萄球菌 社區感染攀升至7成

〔記者魏怡嘉/台北報導〕台大醫院小兒感染科主治醫師李秉穎表示,十多年前,金黃色葡萄球菌的抗藥性問題,以發生在醫院的院內感染比較嚴重,比率高達七至八成,但至二○○○年左右,金黃色葡萄球菌的抗藥性問題在社區,也開始向上攀升至五至七成,令人十分憂心。

李秉穎進一步指出,金黃色葡萄球菌存在於周遭環境,在社區是常見的皮膚感染細菌,在醫院的院內感染,金黃色葡萄球菌常引起病患出現敗血症及肺炎。

李秉穎表示,由於菌株不同,目前在社區感染金黃色葡萄球菌,若出現抗藥性,還有兩種第一線口服抗生素可用;但如果是在醫院院內感染金黃色葡萄球菌,一旦出現抗藥性,多只能用後線的抗生素,例如萬古黴素。

李秉穎說:「過去多由黴菌的分泌物去製成抗生素,這次中研院經由降膽固醇藥物找到對抗金黃色葡萄球菌的抗藥性問題,是比較不一樣的地方。」




中研院與美國研究團隊歷經兩年研究發現,一種原用於降膽固醇的藥物,可能可以對抗目前全球都束手無策的「超級金黃色葡萄 球菌」(MRSA)。該研究論文已於台灣時間昨天(十五日)凌晨刊登在知名國際期刊《科學》(Science),惟用於臨床治療至少仍須三到 五年。



這項整合了化學、微生物學及結構生物學等跨領域的跨國性研究,國內是由中研院生物化學研究所特聘研究員兼副院長王惠鈞領軍;他帶領中研院生化所及台灣大學 生化科學研究研究團隊,成功應用X-光繞射方法,解開金黃色葡萄球菌形成色素的第一步關鍵酵素的蛋白質結構,終於將金黃色葡萄球菌一舉擊潰。

參與研究的台大生化科學研究所博士生劉佳宜表示,任何細菌進入人體後,人體內的白血球會立即分泌活性氧化物,進而殺死入侵的細菌。然而,金黃色葡萄球菌會利用葡萄金黃色素把自已粉飾成金黃色,藉此逃脫人體白血球免疫系統的獵殺行動。

劉佳宜笑說,此舉雖讓金黃色葡萄球菌抵抗力大增,卻也曝露出唯一的罩門,也就是人類要找到可抑制葡萄金黃色素的藥物,就能解除其武裝,並將它殺死。

在研究過程中,美國伊利諾大學香檳校區發現,一種名為「BPH652」的降膽固醇藥物可以和葡萄金黃色素合成黴酉每結合,導致金黃色葡萄球菌無法形成葡萄金黃色素,顏色也沒辦法從白色變為金黃色,進而難以抵抗白血球分泌活性氧化物攻擊。

劉佳宜表示,在以老鼠為對象的動物實驗中,BPH652針對金黃色葡萄球菌的清除率高達98%。接下來,研究團隊將找來體內已出現MRSA抗藥性的患者,進行人體試驗,針對金黃色葡萄球菌施以全新的治療方式,期能協助人類遠離金黃色葡萄球菌乃至MRSA的威脅。




2008年2月10日 星期日

FDA:肉毒桿菌除皺 可能致命

FDA:肉毒桿菌除皺 可能致命

美 國食品暨藥物管理局(FDA)八日警告,保妥適(Botox)以及和它一起競爭市場的Myobloc兩種以肉毒桿菌素為主要成分的除皺藥物,在有些使用者 身上,可能出現危險的肉毒桿菌中毒症狀,有些情況可能致命,例如有幾名兒童在使用這兩種藥物治療肌肉痙孿後死亡,而成人也有人出現嚴重反應與住院病例。

普遍被當作美容聖品的保妥適與Myobloc,均利用肉毒桿菌素引導神經鬆弛達到除皺效果。

食藥局說,在美容使用上,他們並未接獲任何死亡案例。有一人以保妥適治療兩眼之間縐眉紋後住院,但不確定是保妥適造成。食藥局說,他們目前調查的全部死亡案例都是兒童,多數是進行腿部痙攣治療的腦性麻痺患童。

食藥局指出,面部皺紋處注射肉毒桿菌之後,有時會擴散到身體其他部位,導致呼吸和吞嚥肌肉萎縮甚至麻痺,形成致命副作用。

消費者維權組織Public Citizen兩周前呼籲食藥局,對使用保妥適和Myobloc的消費者多加告誡,稱全國有一百八十名病患肺部充水,呼吸困難或是患上肺炎,其中十六人死亡。

食藥局警告,任何注射肉毒桿菌毒素的人,無論是美容或治療目的,若出現肉毒桿菌症狀如吞嚥或呼吸困難、吐字不清、肌肉無力或抬頭困難等,均應立即就診。

兩種抗皺紋藥的標簽都有警告,肉毒桿菌毒素有可能擴散甚至偶然致死,但這種副作用只出現在神經肌肉的病患身上。

製造保妥適的公司Allergan股價八日因食藥局的警告而重挫近百分之六;公司強調,治療腿部痙攣使用的劑量較一般美容使用高出許多。

某些醫療管理學術雜誌 隨筆

The rule is simple: be careful what you measure
這是英國專欄作者 他經常提到Deming博士這一主題在去年的一次研習會中 署立醫院的最高主管表示過類似的意見



譬如說
澄清醫院管理雜誌
榮總護理 vgh
等等

2008年2月9日 星期六

美國研究攝護腺癌的八種療法無法區別其療效

February 5, 2008, 11:07 am
No Answers for Men With Prostate Cancer
Last year, 218,000 men were diagnosed with prostate cancer, but nobody can tell them what type of treatment is most likely to save their life.

Those are the findings of a troubling new report from the Agency for Healthcare Research and Quality, which analyzed hundreds of studies in an effort to advise men about the best treatments for prostate cancer. The report compared the effectiveness and risks of eight prostate cancer treatments, ranging from prostate removal to radioactive implants to no treatment at all. None of the studies provided definitive answers. Surprisingly, no single treatment emerged as superior to doing nothing at all.

“When it comes to prostate cancer, we have much to learn about which treatments work best,'’ said agency director Carolyn M. Clancy. “Patients should be informed about the benefits and harms of treatment options.”

But the study, published online in the Annals of Internal Medicine, gives men very little guidance. Prostate cancer is typically a slow-growing cancer, and many men can live with it for years, often dying of another cause. But some men have aggressive prostate cancers, and last year 27,050 men died from the disease. The lifetime risk of being diagnosed with prostate cancer has nearly doubled to 20 percent since the late 1980s, due mostly to expanded use of the prostate-specific antigen, or P.S.A., blood test. But the risk of dying of prostate cancer remains about 3 percent. “Considerable overdetection and overtreatment may exist,'’ an agency press release stated.

The agency review is based on analysis of 592 published articles of various treatment strategies. The studies looked at treatments that use rapid freezing and thawing (cryotherapy); minimally invasive surgery (laparoscopic or robotic-assisted radical prostatectomy); testicle removal or hormone therapy (androgen deprivation therapy); and high-intensity ultrasound or radiation therapy. The study also evaluated research on “watchful waiting,'’ which means monitoring the cancer and initiating treatment only if it appears the disease is progressing.

No one treatment emerged as the best option for prolonging life. And it was impossible to determine whether one treatment had fewer or less severe side effects.

Many of the treatments now in widespread use have never been evaluated in randomized controlled trials. In the research that is available, the characteristics of the men studied varied widely. And investigators used different definitions and methods, making reliable comparisons across studies impossible.
“Investigators’ definitions of adverse events and criteria to define event severity varied widely,'’ the report notes. “We could not derive precise estimates of specific adverse events for each treatment.'’
The report findings highlighted by the agency include:

All active treatments cause health problems, primarily urinary incontinence, bowel problems and erectile dysfunction. The chances of bowel problems or sexual dysfunction are similar for surgery and external radiation. Leaking of urine is at least six times more likely among surgery patients than those treated by external radiation.

Urinary leakage that occurs daily or more often was more common in men undergoing radical prostatectomy (35 percent) than external-beam radiation therapy (12 percent) or androgen deprivation (11 percent). Those were the findings of the 2003 Prostate Cancer Outcomes Study, a large, nationally representative survey of men with early prostate cancer.

External-beam radiation therapy and androgen deprivation were each associated with a higher frequency of bowel urgency (3 percent) compared with radical prostatectomy (1 percent), according to the 2003 report.

Inability to attain an erection was higher in men undergoing active intervention, especially androgen deprivation (86 percent) or radical prostatectomy (58 percent) than in men receiving watchful waiting (33 percent), according to the 2003 report.

One study showed that men who choose surgery over watchful waiting are less likely to die or have their cancer spread, but another study found no difference in survival between surgery and watchful waiting. The benefit, if any, appears to be limited to men under 65. However, few patients in the study had cancer detected through P.S.A. tests. As a result, it’s not clear if the results are applicable to the majority of men diagnosed with the disease.

Adding hormone therapy prior to prostate removal does not improve survival or decrease recurrence rates, but it does increase the chance of adverse events.

Combining radiation with hormone therapy may decrease mortality. But compared with radiation treatment alone, the combination increases the chances of impotence and abnormal breast development.

The most obvious trend identified in the complicated report is how little quality research exists for prostate cancer, despite the fact that it is the most diagnosed cancer in the country.
Studies comparing brachytherapy, radical prostatectomy, external-beam radiation therapy or cryotherapy were discontinued because of poor recruitment. Two ongoing trials, one in the United States and one in Britain, are evaluating surgery and radiation treatments compared with watchful waiting in men with early cancer. Other studies in progress or development include cryotherapy versus external-beam radiation and a trial evaluating radical prostatectomy versus watchful waiting.

“Successful completion of these studies is needed to provide accurate assessment of the comparative effectiveness and harms of therapies for localized prostate cancers,” the study authors said.

美國發現其飲食中的"健怡"蘇打水可能增進新陳代謝症候群風險

無糖汽水天天喝 代謝易出問題

紐約時報報導,研究人員發現,一天喝一罐低糖或無糖汽水(diet soda),罹患新陳代謝症候群的機率比不喝的人提高百分之卅四。

明尼蘇達大學流行病學副教授史泰芬說:「研究結果令人深感興趣,為什麼會如此?是無糖蘇打飲料內的某種化學物,或是喝的人的某種行為造成,目前仍不得而知。 」

醫界將體重高、血糖高、血脂高、血壓高四大致命組合,稱為新陳代謝症候群。

一項西方飲食習慣的研究指出,嗜吃精緻的穀類製品、油炸食物、紅肉,導致西方人罹患新陳代謝症候群的機率整體而言提高百分之十八,但如果在飲食上多用心,例如多以水果、蔬菜、魚、雞鴨為主,罹患機率不會升高也不會降低。

此外,偏好油炸食物的人,罹患新陳代謝症候群的機會較少吃油炸的人升高百分之廿五。這項實驗的研究對象超過九千五百人,男女均有,年齡四十五到六十四歲不等,研究進行九年。





Symptoms: Metabolic Syndrome Is Tied to Diet Soda

By NICHOLAS BAKALAR
Published: February 5, 2008

Researchers have found a correlation between drinking diet soda and metabolic syndrome — the collection of risk factors for cardiovascular disease and diabetes that include abdominal obesity, high cholesterol and blood glucose levels, and elevated blood pressure.

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Related
More Vital Signs Columns »
Web Link
Dietary Intake and the Development of the Metabolic Syndrome. The Atherosclerosis Risk in Communities Study (Circulation)

The scientists gathered dietary information on more than 9,500 men and women ages 45 to 64 and tracked their health for nine years.

Over all, a Western dietary pattern — high intakes of refined grains, fried foods and red meat — was associated with an 18 percent increased risk for metabolic syndrome, while a “prudent” diet dominated by fruits, vegetables, fish and poultry correlated with neither an increased nor a decreased risk.

But the one-third who ate the most fried food increased their risk by 25 percent compared with the one-third who ate the least, and surprisingly, the risk of developing metabolic syndrome was 34 percent higher among those who drank one can of diet soda a day compared with those who drank none.

“This is interesting,” said Lyn M. Steffen, an associate professor of epidemiology at the University of Minnesota and a co-author of the paper, which was posted online in the journal Circulation on Jan. 22. “Why is it happening? Is it some kind of chemical in the diet soda, or something about the behavior of diet soda drinkers?”

2008年2月7日 星期四

Diabetes Study Partially Halted After Deaths

這是一份重要的報告 應該有組織將此全文翻譯


自由時報摘要

糖尿病降血糖更危險?
降低血糖 反而提高死亡機率
〔編譯羅彥傑/紐約時報七日報導〕數十年來,科學家相信,如果糖尿病患者將血糖降至一般水準,就不再會是心臟病猝死的高危險群。但美國聯邦政府所屬的國家心、肺暨血液研究院針對逾一萬名中年以上、患有第二型糖尿病的民眾所做的一項大型研究,卻發現降低血糖事實上反而提高死亡機率。研究人員因此宣佈,決定緊急暫停部份的研究,因為此一令人震驚的結果挑戰了糖尿病的治療方式。

這項結果不代表降血糖毫無意義。降血糖能避免罹患腎臟病、失明與截肢,但新的研究發現卻使得過去認定血糖愈低愈好及降血糖至正常水準能提高存活機率等金科玉律受到質疑。醫學專家都大感震驚。進行這項研究的研究人員強調,糖尿病患者仍應先向自己的醫師諮商,然後才考慮改變其用藥方式。

研究結果 顛覆傳統治療方式
主張低血糖的學理根深柢固,大多數人都認定血糖愈低愈好,但從來沒人嚴格驗證此一說法。所以這項研究要問的是,如果第二型糖尿病患(占全部病患的九十五%)的血糖量很低,是否能免於得心臟病與增加活命機會。

參與這項研究的患者,是以隨機方式指定降低血壓至接近正常水準,結果密集降血糖組與未嚴格控制血糖水準的對照組相比,多出五十四件死亡案例。研究人員立刻中止密集降血糖的療法,改以較溫和的治療方式。這些患者加入研究的時間,迄今平均為四年。
執行這項計畫的賽門斯莫頓博士說,他們本來懷疑是否是任何藥物或合併用藥造成患者死亡率提高,但後來發現不是;就連被懷疑會增加糖尿病患心臟病死亡機率的藥物Avandia,在研究中也沒有造成這種效果。

醫師主張 仍應努力控制血糖
威斯康辛大學糖尿病專家赫許博士說,這項結果很難說服那些花了好幾年且透過飲食與服藥來降血糖的患者,「他們不會想就此鬆懈」,「要這些患者提高血糖將難如登天」。
〔記者田瑞華/台北報導〕耕莘醫院新陳代謝科主治醫師裴馰表示,國內的糖尿病患普遍血糖控制仍不夠良好,很難達到正常血糖值,因此不可以看到這項研究發現就鬆懈控制血糖。而且,在這項研究結果獲得進一步討論和更多研究證實之前,糖尿病患仍應該遵照醫師指示,努力控制血糖比較好。



udn

【聯合報╱編譯王麗娟/報導】
2008.02.08 08:02 am

數十年來,研究人員始終認為,糖尿病患降低血糖,同時可降低死於心臟病的機率。但美國官方衛生機構一項大規模研究發現,嚴格控制血糖反而提高死亡率。由於結果出人意外,這項以上萬名中老年第二型糖尿病患為對象的研究,已緊急喊停。

儘管如此,研究人員建議,任何病患想換藥使用,均需徵求醫生的意見。目前,研究人員仍不清楚嚴格控制血糖反而提高死亡率的原因。

紐約時報報導,這項六日公布的研究發現,將血糖降到正常濃度的一組,死亡人數較血糖控制較不嚴格的一組多出五十四人。這些接受實驗的病患平均參與四年。

上述結果並不代表控制血糖毫無意義。降血糖可減少糖尿病患發生腎臟病、眼盲和截肢等併發症,但新發現顯示,傳統認為把血糖降得越低越好,或血糖應盡量降到正常值的信條,不見得是定律。

醫學專家對上述結果頗感驚訝。「美國心臟病學院」院長杜夫說:「新發現令人不安與困擾。五十年來,我們一直強調降血糖。」華盛頓大學的糖尿病研究人員赫許表示很難向病患解釋上述研究結果,許多病患嚴格執行飲食控制與用藥多年,很難說服他們放寬對自己的要求。
預期「美國糖尿病協會」也會陷入兩難之境,該組織的指導原則至今仍是患者血糖越接近正常越好。

糖尿病分為先天性的第一型糖尿病和成年後罹患的第二型糖尿病,後者占所有糖尿病的九成五。由於降低血糖理論根深柢固,因此一九九○年美國國家衛生研究院「國家心肺及血液研究中心」與「國家糖尿病、消化、腎臟疾病研究中心」建議作這項糖尿病研究時,完全沒料到會出現這樣的結果。

參加研究的對象平均六十二歲,糖尿病史十年,除了高血糖,這些病患可能還有心臟病、高血壓、高膽固醇等毛病。

研究共分成血糖、膽固醇、高血壓三組。血糖的實驗已停止,其他兩組仍繼續進行。血糖組分成兩個對照組,嚴格執行血糖控制的一組,一天可能施打四到五次胰島素,或一天檢查血糖七到八次,有時還配合藥物使用,將血糖降到儘可能正常,沒想到死亡率還高於血糖控制較不嚴格的對照組。

研究人員原本懷疑某種藥物或藥物間的交互作用造成這種現象,但經仔細研究分析,已排除這種可能。兩組患者的死亡病例也大多是因為心臟病,而非其他不尋常的死因。這項顛覆性的發現究竟原因為何,有待進一步研究。


Diabetes Study Partially Halted After Deaths

By GINA KOLATA
Published: February 7, 2008

For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels, they would no longer be at high risk of dying from heart disease. But a major federal study of more than 10,000 middle-aged and older people with Type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday.

Related
Times Health Guide: Diabetes »

The researchers announced that they were abruptly halting that part of the study, whose surprising results call into question how the disease, which affects 21 million Americans, should be managed.

The study’s investigators emphasized that patients should still consult with their doctors before considering changing their medications.

Among the study participants who were randomly assigned to get their blood sugar levels to nearly normal, there were 54 more deaths than in the group whose levels were less rigidly controlled. The patients were in the study for an average of four years when investigators called a halt to the intensive blood sugar lowering and put all of them on the less intense regimen.

The results do not mean blood sugar is meaningless. Lowered blood sugar can protect against kidney disease, blindness and amputations, but the findings inject an element of uncertainty into what has been dogma — that the lower the blood sugar the better and that lowering blood sugar levels to normal saves lives.

Medical experts were stunned.

“It’s confusing and disturbing that this happened,” said Dr. James Dove, president of the American College of Cardiology. “For 50 years, we’ve talked about getting blood sugar very low. Everything in the literature would suggest this is the right thing to do,” he added.

Dr. Irl Hirsch, a diabetes researcher at the University of Washington, said the study’s results would be hard to explain to some patients who have spent years and made an enormous effort, through diet and medication, getting and keeping their blood sugar down. They will not want to relax their vigilance, he said.

“It will be similar to what many women felt when they heard the news about estrogen,” Dr. Hirsch said. “Telling these patients to get their blood sugar up will be very difficult.”
Dr. Hirsch added that organizations like the American Diabetes Association would be in a quandary. Its guidelines call for blood sugar targets as close to normal as possible.
And some insurance companies pay doctors extra if their diabetic patients get their levels very low.

The low-blood sugar hypothesis was so entrenched that when the National Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases proposed the study in the 1990s, they explained that it would be ethical. Even though most people assumed that lower blood sugar was better, no one had rigorously tested the idea. So the study would ask if very low blood sugar levels in people with Type 2 diabetes — the form that affects 95 percent of people with the disease — would protect against heart disease and save lives.

Some said that the study, even if ethical, would be impossible. They doubted that participants — whose average age was 62, who had had diabetes for about 10 years, who had higher than average blood sugar levels, and who also had heart disease or had other conditions, like high blood pressure and high cholesterol, that placed them at additional risk of heart disease — would ever achieve such low blood sugar levels.

Study patients were randomly assigned to one of three types of treatments: one comparing intensity of blood sugar control; another comparing intensity of cholesterol control; and the third comparing intensity of blood pressure control. The cholesterol and blood pressure parts of the study are continuing.

Dr. John Buse, the vice-chairman of the study’s steering committee and the president of medicine and science at the American Diabetes Association, described what was required to get blood sugar levels low, as measured by a protein, hemoglobin A1C, which was supposed to be at 6 percent or less.

“Many were taking four or five shots of insulin a day,” he said. “Some were using insulin pumps. Some were monitoring their blood sugar seven or eight times a day.”

They also took pills to lower their blood sugar, in addition to the pills they took for other medical conditions and to lower their blood pressure and cholesterol. They also came to a medical clinic every two months and had frequent telephone conversations with clinic staff.

Those assigned to the less stringent blood sugar control, an A1C level of 7.0 to 7.9 percent, had an easier time of it. They measured their blood sugar once or twice a day, went to the clinic every four months and took fewer drugs or lower doses.

So it was quite a surprise when the patients who had worked so hard to get their blood sugar low had a significantly higher death rate, the study investigators said.

The researchers asked whether there were any drugs or drug combinations that might have been to blame. They found none, said Dr. Denise G. Simons-Morton, a project officer for the study at the National Heart, Lung and Blood Institute. Even the drug Avandia, suspected of increasing the risk of heart attacks in diabetes, did not appear to contribute to the increased death rate.

Nor was there an unusual cause of death in the intensively treated group, Dr. Simons-Morton said. Most of the deaths in both groups were from heart attacks, she added.
For now, the reasons for the higher death rate are up for speculation. Clearly, people without diabetes are different from people who have diabetes and get their blood sugar low.

It might be that patients suffered unintended consequences from taking so many drugs, which might interact in unexpected ways, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic.

Or it may be that participants reduced their blood sugar too fast, Dr. Hirsch said. Years ago, researchers discovered that lowering blood sugar very quickly in diabetes could actually worsen blood vessel disease in the eyes, he said. But reducing levels more slowly protected those blood vessels.

And there are troubling questions about what the study means for people who are younger and who do not have cardiovascular disease. Should they forgo the low blood sugar targets?
No one knows.

Other medical experts say that they will be discussing and debating the results for some time.

“It is a great study and very well run,” Dr. Dove said. “And it certainly had the right principles behind it.”

But maybe, he said, “there may be some scientific principles that don’t hold water in a diabetic population.”

2008年2月5日 星期二

德國人照X光

科学 2008.02.04
德国人爱照X光,全球排名第二

Großansicht des Bildes mit der Bildunterschrift: 1895年夏,德国物理学家W.C.Roentgen在实验室里发现了X光射线

体内伤害往往不能从外表看出。X光照相在多数情况下成了透视身体的唯一可能。然而,人们不应低估射线的危害。
一系上沉重的铅围裙,很多人都会有一种不祥的预感:肉眼看不到的X光就在里面。它们会伤害精子或者卵子,提高畸形胎儿的形成率。假如有人经常接触射线,他可能会罹患癌症——尽管几率不大,而且是在多年以后,但这已是科学界不容争议的事实。

波鸿大学附属医院放射科大夫Christoph Heyer表示:“每一次拍片都意味着会有放射发生,而且也没有杜绝危害的最低放射量。”因此,我们的格言是:除非万不得已,否则越少越好。每次拍片之前都应权衡利弊一番。

然而,X光让人看到外表无法看到的内部伤害:骨折、癌细胞病灶或者变窄的心脏冠状动脉。如果没有X光,人们也无法正确判断被击伤的头部受损情况。X光照相救了无数人的命。

价格高出一倍的MRT

无放射之忧的X光照相或者计算机体层摄影(CT)的替代品是磁共振断层扫描(MRT),不过,做一次MRT的价格可是CT的两倍。因此,医疗保险公司不主张广泛采用。

总体说来,德国人照X光太多。德国射线保护联邦局局长Wolfram Koenig提醒道。德国人对X光的青睐程度仅次于日本人,全球排名第二。 在谈到原因时,科隆放射科医生Markus Wingen认为:“医生们害怕受到索赔。”尽管明知没有太大的妨碍,为了避免遭到“玩忽职守”的起诉,还是做透视的好。

闻所未闻的X光护照

此外,医学工作者往往对先前的X光照射情况一无所知。一张X光护照可以避免重复拍照的危险:护照里注明所有诊所、医院的会诊结果,为一位医生提供丰富的信息。依据放射法规,这样的X光护照“应该随时提供给患者”。但在实践当中,人们对这一规定并不在意。很多患者对护照之说闻所未闻。

莱茵本斯堡的放射科助理医师Birgit Flemming深知X光护照的重要性,这本护照一下就能让人看到以前的透视情况,而且还能形成新旧对照。而放射科主治医师Wingen却认为,“护照的用处并不太大,因为它里面既不含照片,又无鉴定结果。”在医院里,尤其是在施行手术之前,主治医生亟需这些资料。

预诊癌症的乳腺X线摄影

特别令人担忧的是CT摄影的广泛应用。据射线保护联邦局统计, 从1996年到2004年,这种具有超强放射性的诊断手法的使用次数增加了65%。一次计算机体层摄影产生的放射量是X光照相的100倍。专业人士因此拒绝将预检阶段的病人“推向透视室”。然而,CT依然经常是“健康检查”的一项内容。

为了提前发现肿瘤,每做一次乳腺X线摄影(Mammografie)都使女性的乳房四次暴露在致癌射线的光照之下。今天,需要定期做乳房检查的妇女被界定在50岁以上,这也是癌症预检的法定内容之一。荷兰的一项研究表明,如果将透视频率降为每两年一次,50至70岁的妇女罹患乳腺癌的几率显然降低。

然而,统计是统计,乳腺X线摄影也可能会救一位三、四十岁妇女的命。尤其是那些已有家族病史的女性。德国射线保护联邦局局长Wolfram Koenig建议说,患者在接受X光检查之前,应该详细聆听医生的意见,孕妇和小孩尤其要慎防放射。

Ulrike Roll / 福音新教新闻社

2008年2月3日 星期日

一些醫學"英文" 字根-rrhea/-rrhoea

-rrhea/-rrhoea

-rrhea (-rrhoea 英國拼法)

Main Entry:
-rrhea
Function:
noun combining form
Etymology:
Middle English -ria, from Late Latin -rrhoea, from Greek -rrhoia, from rhoia, from rhein to flow — more at stream
: flow : discharge 都表非自願流出/射出


例如

<leukorrhea 白帶 >

Main Entry:
leu·kor·rhea Listen to the pronunciation of leukorrhea
Pronunciation:
\ˌlü-kə-ˈrē-ə\
Function:
noun
Etymology:
New Latin
Date:
circa 1797
: a whitish viscid discharge from the vagina resulting from inflammation or congestion of the mucous membrane



gonorrhea 淋病
Main Entry:
gon·or·rhea Listen to the pronunciation of gonorrhea
Pronunciation:
\ˌgä-nə-ˈrē-ə\
Function:
noun
Etymology:
New Latin, from Late Latin, morbid loss of semen, from Greek gonorrhoia, from gon- + -rrhoia -rrhea
Date:
circa 1526
: a contagious inflammation of the genital mucous membrane caused by the gonococcus —called also clap
gon·or·rhe·al Listen to the pronunciation of gonorrheal \-ˈrē-əl\ adjective


diarrhea
Main Entry:
di·ar·rhea Listen to the pronunciation of diarrhea
Pronunciation:
\ˌdī-ə-ˈrē-ə\
Function:
noun 腹瀉
Etymology:
Middle English diaria, from Late Latin diarrhoea, from Greek diarrhoia, from diarrhein to flow through, from dia- + rhein to flow — more at stream
Date:
14th century
1 : abnormally frequent intestinal evacuations with more or less fluid stools 2 : excessive flow diarrhe>>
di·ar·rhe·al Listen to the pronunciation of diarrheal \-ˈrē-əl\ adjective




logorrhea 多語症
: excessive and often incoherent talkativeness or wordiness

spermatorrhea 遺精

2008年2月2日 星期六

請特別注意安全 Staying a Step Ahead of Aging

新年大掃除等請特別注意安全



Personal Best

Staying a Step Ahead of Aging

Filip Kwiatkowski for The New York Times

Published: January 31, 2008

YOU know what is supposed to happen when you grow old. You will slow down, you will grow weak, your steps will become short and mincing, and you will lose your sense of balance. That’s what aging researchers consistently find, and it’s no surprise to most of us.

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But it is worth remembering that the people in those studies were sedentary, said Dr. Vonda Wright, a professor of orthopedics at the University of Pittsburgh.

Dr. Wright, a 40-year-old runner, decided to study people who kept training as they got older or began competing in middle age. She wanted to know what happens to them and at what age does performance start to decline.

Their results are surprising, even to many of the researchers themselves. The investigators find that while you will slow down as you age, you may be able to stave off more of the deterioration than you thought. Researchers also report that people can start later in life — one man took up running at 62 and ran his first marathon, a year later, in 3 hours 25 minutes.

It’s a testament to how adaptable the human body is, researchers said, that people can start serious training at an older age and become highly competitive. It also is testament to their findings that some physiological factors needed for a good performance are not much affected by age.

Researchers say that you should be able to maintain your muscles as you age, including the muscle enzymes needed for good athletic performance, and you should be able to maintain your ability to exercise for long periods near your so-called lactic threshold, meaning you are near maximum effort.

But you have to know how to train, doing the right sort of exercise, and you must keep it up.

“Train hard and train often,” said Hirofumi Tanaka, a 41-year-old soccer player and exercise physiologist at the University of Texas.

Dr. Tanaka said he means doing things like regular interval training, repeatedly going all out, easing up, then going all out again. These workouts train your body to increase its oxygen consumption by allowing you to maintain an intense effort.

“One of the major determinants of endurance performance is oxygen consumption,” Dr. Tanaka said. “You have to make training as intense as you can.”

When you have to choose between hard and often, choose hard, said Steven Hawkins, an exercise physiologist at the University of Southern California.

“High performance is really determined more by intensity than volume,” he added. “Sometimes, when you’re older, something has to give. You can’t have both so you have to cut back on the volume. You need more rest days.”

Dr. Hawkins, who says he no longer runs competitively, adds that he tries to put his findings into practice. “I run a couple of times a week and I try to make it as fast as I can,” he said. “I’m not plodding along.”

He also has been amazed by some people who seem to defy the rules of aging, people he describes as “those rare birds who get faster.” Some subjects in Dr. Hawkins’s research study, which followed runners for nearly two decades, actually had better times when they were 60 than when they were 50.

“We really don’t know why,” Dr. Hawkins confessed. “Maybe they were training harder.”

Then there are people like the 62-year-old man who suddenly took up running and began running fast marathons. That man’s inspiration to become a runner, said James Hagberg, an exercise physiologist at the University of Maryland, was watching a lakefront marathon in Milwaukee. “He got all fired up,” Dr. Hagberg recalled.

And there are people like Imme Dyson, a 71-year-old runner who lives in Princeton, N.J. She took up running when she was 48 and loved it, she says, from the moment she put on a pair of running shoes. Her daughter, who had been a college triathlete, told her how to train.

“She said, ‘Mom, if your workout didn’t hurt, you didn’t work hard enough,’ ” Ms. Dyson said.

“Working consistently really is the recipe,” she said. And it has made a difference for her, allowing her to run races, from 5K to marathons, so fast that she is consistently among the best in the nation in her age group. She has run a 15K cross-country race in 1:19:08, a pace of 8:29 a mile. And she ran a 10K race in 51 minutes 50 seconds, a pace of 8:20 a mile.

Not every aging athlete does so well. But Dr. Hagberg found that studies of aging athletes sometimes were distorted because they included people who had cut back on or stopped training. That’s understandable; there is no reason, researchers say, to exhort everyone to maintain an intense effort decade after decade.

Athletes would tell Dr. Hagberg that they had just lost their motivation. “Some of them would say: ‘Competition just doesn’t motivate me as much at 75. I’ve been doing it for 50 years,’ ” he said. “Others would say, ‘I just can’t keep it up any more.’ ”

But for those who still have the drive, the news that muscle mass and lactic threshold can be maintained is encouraging.

The reason people become slower, though, is that oxygen consumption declines with age.

In large part that is because, as has long been known, the maximum heart rate steadily falls by about seven to eight beats per minute per decade. It happens with or without training, in sedentary and in active people, Dr. Tanaka said, and no one knows why. But as a result, the heart cannot pump as much blood at maximum effort.

Dr. Michael Joyner, a 49-year-old exercise researcher at the Mayo Clinic who also is a competitive swimmer and a runner, added another factor: the lungs of older athletes cannot take in quite as much air.

With a slower heart rate and less oxygen in the lungs, less oxygen-rich blood gets to the muscles. In one study, Dr. Joyner found that highly trained athletes age 55 to 68 had 10 to 20 percent less blood flow to their legs than athletes in their 20s.

The older athletes in his group, though, were edging toward an age that often is a transition time in athletic performances, researchers are finding. For example, Dr. Wright and her colleague Dr. Brett Perricelli found that the performances of track athletes declined almost imperceptibly from year to year until their mid-60s, when the rate of decline picked up. At age 75, though, the athletes’ times fell, on average, by 7 percent.

The study, the results of which will appear in the March issue of the American Journal of Sports Medicine, involved track and field athletes age 50 to 85 who were participants in the 2001 Senior Olympics and also examined the times for American record holders in track events.

But older athletes still can have spectacular performances, Dr. Tanaka notes.

For example, the world best marathon time for men 70 or older (2:54:05) was set by a 74-year-old. That is more than four minutes faster than the winning marathon time at the first modern Olympics, the 1896 Games in Athens.

Of course, such statistics are of little comfort to athletes who do not want to slow down at all. Dr. Hawkins said he and Robert A. Wiswell, the senior author on his nearly 20-year study of athletes, used to joke that they needed a sports psychologist rather than a sports physiologist on their study. The athletes, he explained, could not bear to think that they would stop setting personal records.

That’s an issue for Don Truex, a 70-year-old dentist in Santa Barbara, Calif, who can’t understand why he has slowed down in the last year. He just ran a 5K race in 23:45. It was an average pace of 7:38 a mile, 90 seconds slower than he wanted to run.

“I’ve consulted with my doctor and we think I may be overtraining,” Dr. Truex said. He’s going to continue running five days a week but cut back on his five days a week of cycling.

Slower times are even more of a concern for Dr. Truex’s friend Barry Erbsen, a 67-year-old dentist in Los Angeles.

Dr. Erbsen started running seriously around 40. His best time in a 10K race was 38 minutes, a pace of 6 minutes a mile. Next he started running marathons, going faster each time until he had completed several, including the Boston Marathon, in 3:07:00.

Then, Dr. Erbsen started to slow down. He ran a marathon a few years ago in 3:45:00. He completed his next one in 3:58:00.

That nearly four-hour marathon was his last, he said. Instead, Dr. Erbsen took up mountain biking. So far so good, he said. He’s having a lot of fun. And, he added, “I’m not getting too much slower.”