醫療, 健康與品質報 3號 122707

醫療, 健康與品質報

創刊 2007/12/25

3號 2007/12/27 主編：鍾漢清

感謝朋友的幫助 請加持......

台灣：

上周五(12/21)下午參加CSQ等等單位合辦的『醫療品質論壇』*，與會專家學者等等都說出許多我們系統中潛在的問題。譬如說，台北榮總內部的許多「炒火洶湧」的餐廳、咖啡店等等，都不合 "美國"等地的醫院安全規定（同樣的，主講人從美國回來，到林口長庚醫院的大廳，一看到許多病人拿/卦著點滴「趴趴走」，簡直快被嚇昏了 …….）。

與會專家還有人提出長庚醫院的績效獎金制度威力大，讓某醫生月入不到兩萬台幣。這不只讓人想到 『裸退』，更讓人想到 Deming的一句名言，值得我們思考：

Quote from W. Edwards Deming:
Forces of Destruction: grades in school, merit system, incentive pay, business plans, quotas.

台灣的系統深受健保局(衛生署)的大影響 所以或許可由學會邀"醫療品質學會"等來談.....

(* 根據王晃三博士 --{醫療保健品質論譠 "Healthcare Quality Forum" 原先翻譯為"醫療照護品質論壇 "}策劃人--給我們的叮嚀（參考 :"專家論譠備忘錄" ）

『……這次論譠鎖定以吳欣宜博士所選定的主題方向，

「用來理解、辨識、推廣的模式架構與導入實施最佳運作模式的七大影響要素。以及

１．慢性病患的系統性主動性照護模式

２．足以確保全天候照護品質的一致性之醫院工作流程再設計

３．預防老年人跌倒的多重措施

４．用藥及轉診管理的保健資訊技術之導入」

討論話題盡可能圍繞這個主題，期能在短時間內聚焦，達成論譠的目標。為方便大家事先醞釀，我建議各位設法上網瀏覽吳博士的相關論文

網址 http://www.rand.org/labor/roybalhp/staff.html . 』)

補充:我的blogs 有中共的問題，他們最近也有一本"興邦之道"參考 安邦之道--國家轉型的目標與途徑 有一章"宏觀"探討 。

醫療品質方面 {康健雜誌}在2007年7月號對於"配藥出錯防止"等也些專業之討….

我也說過， "康健七月號20007"或可參考 ：『樂活咖啡店與聰明醫院
現在你所看到的七月號《康健》封面故事與特別企劃，其實是花了四位作者多個月完成的。直到六月二十四日，林芝 安與朱芷君都還在核對19家醫學中心用藥系統的表格，謹慎仔細，不想出錯。而那之前，她們已不知打了多少電話給各醫院。至於醫院如何使用e 科技做管控以避 免開錯刀給錯藥的採訪報導，更是累積了四個月的功力所得，非常非常用功的結果。（p124- p152）』– 我明天會說 這些醫院就是Deming的 Red Bead Experiment….. 以前思考過為什麼紅珠是20% 看過該期你就知道這太保守…

人氣興旺的相關部落格：潘震澤. 老師

http://blog.chinatimes.com/jenntser/

紐約時報報導

Cancer Fight Goes Nuclear, With Heavy Price Tag

By ANDREW POLLACK 1:44 PM ET

A push by medical centers to turn nuclear particle accelerators into weapons against cancer reflects the best and worst of America's health system, experts say.

關於郭台銘先生捐鉅款給台大醫院的"可惜"之嘆 請參考{哈佛商業評論HBR 11月號(2007)}黃達夫先生之見解...........

全球

HC致瑞麟（RL）：月前看到Emma （參考杜拉克回憶錄旁觀Emma (Jane Austen )）中的 DENTIST 或DOCTOR處，特別注意。現在打算編報，所以懇賜翻譯當例子: ：

DENTIST
ch.16, vol.3, EMMA
She had no difficulty in procuring Isabella's invitation; and she was fortunate in having a sufficient reason for asking it, without resorting to invention. There was a tooth amiss. Harriet really wished, and had wished some time, to consult a dentist. Mrs. John Knightley was delighted to be of use; any thing of ill-health was a recommendation to her; and though not so fond of a dentist as of a Mr. Wingfield, she was quite eager to have Harriet under her care. When it was thus settled on her sister's side, Emma proposed it to her friend, and found her very persuadable. Harriet was to go; she was invited for at least a fortnight; she was to be conveyed in Mr. Woodhouse's carriage. It was all arranged, it was all completed, and Harriet was safe in Brunswick Square.
RL版：
艾瑪要取得伊莎蓓拉的邀請函並沒有困難；而且她的運氣很好，有許多充分的理由，並不需要憑藉任何虛構的理由。──一顆牙齒出了毛病。海麗特真的希望去看牙 醫，而且已經希望了好一陣子。約翰‧奈特利太太很樂意幫忙；舉凡健康不佳的事她都樂於推薦│ 雖然她對牙醫沒有像對溫費爾德先生那樣喜歡，但是她還是十分熱 心願意照顧海麗特。──當她姊姊這邊安排妥當以後，艾瑪便向她的朋友建議，並且發現她的朋友很快就同意了。── 海麗特決定前往；她受邀至少待兩個星期；是坐伍 郝斯先生的馬車去的。──一切都安排好了，一切都完成了，而海麗特也平安抵達了布蘭茲維廣場。
ch.17, vol.3, EMMA
Isabella sent quite as good an account of her visitor as could be expected; on her first arrival she had thought her out of spirits, which appeared perfectly natural, as there was a dentist to be consulted; but, since that business had been over, she did not appear to find Harriet different from what she had known her before. Isabella, to be sure, was no very quick observer; yet if Harriet had not been equal to playing with the children, it would not have escaped her. Emma's comforts and hopes were most agreeably carried on, by Harriet's being to stay longer; her fortnight was likely to be a month at least. Mr. and Mrs. John Knightley were to come down in August, and she was invited to remain till they could bring her back.
RL版：
伊莎蓓拉如預期的寄來她的客人的詳細情況表；認為在她初抵達的時候悶悶不樂，這種現象完全很自然，因為即將要去看牙醫了；但是，看過牙醫以後，她不覺得海 麗特跟第一天來的時候看到的有什麼不同。│當然，伊莎蓓拉不是善於觀察的人；然而如果海麗特不跟孩子們玩的話，那就無法逃過她的觀察了。海麗特打算多住一 段時間，艾瑪得以繼續保持她的舒適和希望；兩星期的時間很可能至少延長為一個月。約翰‧奈特利夫婦將在八月裡前來，他們邀她住到那個時候再帶她回來。

馬齒

馬的牙齒。由於馬的牙齒隨年齡而添換，所以看馬齒便可知道馬的年齡。穀梁傳˙僖公二年：「荀息牽馬操璧而前曰：『璧則猶是也，而馬齒加長矣。』」後為自稱年歲的謙詞。北周˙庾信˙謹贈司寇淮南公詩：「猶憐馬齒進，應念節旄稀。」

馬的牙齒隨年齡而增長，故看 馬齒即可知馬的年歲。語出穀梁傳˙僖公二年：「荀息牽馬操璧而前曰：『璧則猶是也，而馬齒加長矣。』」後比喻年歲增加。亦作「馬齒長」。

自謙年歲徒增而毫無建樹。如：「虛度六十， 馬齒徒長，事業一無所成。」亦作「馬齒徒增」。

ばし ₁ 【馬歯】

自分の年齢をへりくだっていう語。馬齢。


在狄更斯{艱難時世}第2章有一場"開宗明義"式的教育對話:

Charles Dickens
Hard Times

Chapter 2
Murdering the Innocents

'Girl number twenty,' said Mr. Gradgrind, squarely pointing with his square forefinger, 'I don't know that girl. Who is that girl?'

'Sissy Jupe, sir,' explained number twenty, blushing, standing up, and curtseying.

'Sissy is not a name,' said Mr. Gradgrind. 'Don't call yourself Sissy. Call yourself Cecilia.'

'My father as calls me Sissy. sir,' returned the young girl in a trembling voice, and with another curtsey.

'Then he has no business to do it,' said Mr. Gradgrind. 'Tell him he mustn't. Cecilia Jupe. Let me see. What is your father?'

'He belongs to the horse-riding, if you please, sir.'

Mr. Gradgrind frowned, and waved off the objectionable calling with his hand.

'We don't want to know anything about that, here. You mustn't tell us about that, here. Your father breaks horses, does he?'

'If you please, sir, when they can get any to break, they do break horses in the ring, sir.'

'You mustn't tell us about the ring, here. Very well, then Describe your father as a horsebreaker. He doctors sick horses, I dare say?'

'Oh yes, sir.'

'Very well, then. He is a veterinary surgeon, a farrier and horsebreaker. Give me your definition of a horse.'

(Sissy Jupe thrown into the greatest alarm by this demand.)

'Girl number twenty unable to define a horse!' said Mr. Gradgrind, for the general behoof of all the little pitchers. 'Girl number twenty possessed of no facts, in reference to one of the commonest of animals! Some boy's definition of a horse. Bitzer, yours.'

The square finger, moving here and there, lighted suddenly on Bitzer, perhaps because he chanced to sit in the same ray of sunlight which, darting in at one of the bare windows of the intensely whitewashed room, irradiated Sissy. For, the boys and girls sat on face of the inclined plane in two compact bodies, divided up the centre by a narrow interval; and Sissy, being at the corner of a row on the other side, came in for the beginning of a sunbeam, of which Bitzer, being at the comer of a row on the other side, a few rows in advance, caught the end. But, whereas the girl was dark-eyed and dark-haired, that she seemed to receive a deeper and more lustrous colour from the sun when it shone upon her, the boy was so light-eyed and light-haired that the self-same rays appeared to draw out of him what little colour he ever possessed. His cold eyes would hardly have been eyes, but for the short ends of lashes which, by bringing them into immediate contrast with something paler than themselves, expressed their form. His shortcropped hair might have been a mere continuation of the sandy freckles on his forehead and face. His skin was so unwholesomely deficient in the natural tinge, that he looked as though, if he were cut, he would bleed white.

'Bitzer,' said Thomas Gradgrind. 'Your definition of a horse.'

'Quadruped. Graminivorous. Forty teeth, namely twenty-four grinders, four eye-teeth, and twelve incisive. Sheds coat in the spring; in marshy countries, sheds hoofs, too. Hoofs hard, but requiring to be shod with iron. Age known by marks in mouth.' Thus (and much more) Bitzer.

'Now girl number twenty,' said Mr. Gradgrind. 'You know what a horse is.'

日本

洋蔥皮茶的開發:健康成分たっぷり　「たまねぎ皮茶」開発

---.JSQC專集 ２００６年「品質」Ｎｏ．２（Vol.36,No.2,2006 ）

特集『医療の質・安全』

週刊東洋経済 介紹日本的醫師荒和醫院經營之困境

11月5日的{獨賣新聞} 介紹週刊東洋経済 (出版社 東洋経済新報社)

巻号2007/11/3 普通号 --特集 ニッポンの医者、病院、診療所

說它以詳細的 數據資料圖表 介紹日本的醫師荒和醫院經營之困境—四成虧本……(台灣似乎還沒有專業的研究機構….)

『檢查器的transducer 沒更換而傳染C型肝炎（五病人係同一基因）』--這是我的 NHK新聞之記憶，現在可以用朝日新聞的報導詳細補充：

器具使い回し肝炎　５人感染１８人疑い　茅ケ崎市立病院

2007年12月26日06時32分

　神奈川県にある茅ケ崎市立病院の循環器内科で心臓のカテーテル検査を受けた６０～７０代の男性患者５人が、Ｃ型肝炎に感染していたことがわかった。２５ 日、病院が記者会見して明らかにした。感染は昨年１２月から今年４月にかけてで、血圧変動を監視する器具「トランスデューサー」を交換せずに使い回したこ とが原因とみられる。メーカーの取り扱い説明書には１回ごとに廃棄するよう記載してある。使い回した理由について担当の臨床工学技士は「手術が立て込んで いて忙しかったから」と説明しているという。他に感染の疑いがある患者が１８人おり、病院は検査を受けるよう要請している。

　病院側の説明によると、５人はいずれも病状に応じた治療を受けており、肝機能は改善しているという。

　感染は今年１１月、同病院の消化器内科で肝炎と診断された２人が、同じ日に心臓カテーテル検査を受けていたことから発覚。調査の結果、昨年１２月の検査 の際、すでにＣ型肝炎に感染していた患者から非感染者１人に、今年３月にも同じ感染者から別の非感染者１人に、さらに今年４月には３月に新たに感染した患 者から別の非感染者３人に感染が広がったことが確認された。

　病院側は、最初に感染源となった患者がＣ型肝炎患者だったことを把握していたという。

　感染経路について、病院側はカテーテル検査で使われたトランスデューサーの可能性が強いとみている。出血を伴う可能性があるカテーテル検 査では、患者の血圧チェックのためにトランスデューサーが使われるが、これが生理食塩水に満たされたチューブを介してカテーテルとつながっていることか ら、この使い回しによって肝炎感染者の血液が次々に非感染者と接したらしい。

　同病院が今年１～１０月に行ったカテーテル検査は計２７６件あったが、１件ごとに使われるべきトランスデューサーは１７０個しか使われていなかった。

　茅ケ崎市立病院は、病床数４０１、医師は約７０人おり、循環器内科など２３の診療科がある。

肝炎救済法案 被害者、裁判所が認定
読売新聞 - 27分前
政府・与党は２５日、薬害Ｃ型肝炎訴訟の被害者の一律救済法案の概要を固めた。補償対象となる被害者の認定作業は、裁判所が担う。法案は１月７日に国会へ提出する方針だ。福田首相は２５日夕、訴訟原告・弁護団６人と首相官邸で初めて面会し、「言葉に尽くせないような ...

創刊號

首相、薬害Ｃ型肝炎原告団に謝罪「心からお詫び」 MSN産経ニュース
首相が薬害肝炎でおわび 原告団に、一律救済伝達 東京新聞

現在有英文版本：

Fukuda offers apology to hepatitis C patients

12/26/2007 THE ASAHI SHIMBUN

Prime Minister Yasuo Fukuda met Tuesday with plaintiffs who sued the state and drug makers over their infection of hepatitis C through tainted blood products to apologize for the government's delay in helping them.

"(We) have caused you great hardship both mentally and physically for a long time," Fukuda told the group at the Prime Minister's Official Residence. "I take this opportunity to offer a heart-felt apology."

Fukuda's apology appeared to soothe the hard feelings of the plaintiffs who had sought a meeting with him to help settle the dispute.

"We finally managed to meet the prime minister after trying to do so for the past five years," said Michiko Yamaguchi, who represented the plaintiffs, after the meeting.

They said they urged Fukuda to spell out the government's responsibility in the outline of planned legislation on uniform compensation the ruling coalition plans to compile as early as this week. Fukuda fell short of taking a clear stand on the issue, but told the group he "wants to settle the matter as early as possible."

Fukuda announced Sunday that his ruling Liberal Democratic Party and junior coalition partner New Komeito would sponsor legislation on uniform compensation in an effort to break a stalemate in the court-mediated settlement talks.

The move came amid plunging approval ratings for his Cabinet.

Fukuda apparently agreed to Tuesday's meeting in hopes the main opposition Minshuto (Democratic Party of Japan) will cooperate with passage of the planned legislation.

The talks over the Osaka High Court-mediated settlement proposal had stalled because the plaintiffs demanded uniform compensation for hepatitis C patients. They argued that they and about 800 other hepatitis C patients who are not among the plaintiffs should be given blanket relief, regardless of when they were treated with contaminated blood products.

But the government had insisted on compensating only those who were given tainted blood products during a specific timeframe. This was in line with a ruling by the Tokyo District Court, which, among similar suits, most narrowly recognized the government responsibilities.

The ruling coalition on Tuesday agreed to submit the proposed legislation to the Diet on Jan. 7. The ruling parties want to pass the bill by the end of the current Diet session that winds up Jan. 15.

Senior officials of both parties have been working on the outline of the legislation since Monday. They are likely to invite Minshuto and other opposition parties to work out details of the bill to ensure swift passage.

A central point of the planned legislation will be on wording about the government's responsibility for the public health disaster.

Fukuda on Monday indicated that the bill should touch on this in one way or another, saying it should address the government's "responsibilities or moral responsibilities."

"How the LDP makes a decision on that point will be an important part of the work," he added.

But there is still a gap between the government and the plaintiffs over the extent to which the government should acknowledge its responsibilities in the legislation.

Yamaguchi, visiting senior officials of both ruling and opposition parties Tuesday, called on them to incorporate a passage acknowledging the government's responsibility in causing the damage and allowing it to expand.

Health minister Yoichi Masuzoe said Tuesday at the Upper House health, labor and welfare committee that the government is responsible for having caused a scandal stemming from tainted blood products again and must reflect on its actions.(IHT/Asahi: December 26,2007)