From U.S. News & World Report

重點是前50沒有台彎大學，但對岸、香港、及日本都有上榜！台灣社會似乎也不重視，仍在自我陶醉，看來台灣不只政治及經濟被邊緣化！

這件事最近上了版面，院方也發公告因應。

我個人意見是，會有這樣想法，是因台灣從來不尊重專業。家裡叫個水電工來看看，即使沒做啥，也要付錢，那為何看報告不用付錢？

報告只有數字，報告判讀必須加上判斷，醫師除須解釋外，尚須承擔誤判後果。也就是說，醫師是要負責的！

另外，當天做檢查，若要等報告，以敝院忙碌的情形，醫師不可能一整天都在等報告出來後向病人解釋。例如照X光病人等到一百多號，又有骨科病人照X光，一等就是兩個小時，不可能所有病人都能當診次就看到，何況有些報告就是要數天。如前所說，下次回診看X光報告，醫師得判讀是否正常，難道判讀正常就不應該收費？

如果真是如此，建議由掛號櫃檯直接列印報告給病人，連掛號都不必了，還可省去列印掛號單的耗材，病人也不用久候，不是很好？什麼都要醫師負責 (政客從不負責)，又不讓醫師收費！？

不過，換個角度想，如果看完報告退掛，則病歷沒有紀錄，說錯我就不負責任了！這樣似乎也不錯，呵呵！

這樣的後果會如何？可能以後醫師只念X光科的報告或印X光科的報告給病人，然後就可以退掛號，反正又沒有紀錄？沒有收入又沒有責任，何必認真看呢？如此受損的是誰的權益呢？

希望不要有這樣的結果！

The AP (6/26, Stobbe) reports, "Swine flu has infected as many as one million Americans, US health officials said Thursday, adding that six percent or more of some urban populations are infected." The estimate "was no surprise to the experts who have been closely watching the virus." Lyn Finelli, a flu surveillance official with the CDC "made the one million estimate in a presentation to the vaccine panel," using "mathematical modeling, based on surveys by health officials." At the meeting, CDC officials also "made projections about flu vaccines expected to be available to protect against both seasonal and swine flu this fall," suggesting that "more than 25 million doses of seasonal flu vaccine should be available by early September."

The Los Angeles Times (6/26, Maugh) notes that Finelli told the vaccine advisory committee in Atlanta that "standard models of viral spread indicate that many times" the reported figure of 28,000 "have been infected. Although one million seems like a high number, between 15 million and 60 million Americans are infected by the influenza virus during a normal flu season." Nationwide, "at least 3,065 of those infected in this country have been hospitalized and 127 have died. The very young are most likely to be infected, Finelli said, but older patients seem to suffer more. The average age of swine flu victims is 12, the average age of hospitalized patients is 20 and the average age of those who have died is 37, she said."

Bloomberg News (6/26, Randall) reports, "Swine flu is responsible for about 98 percent of the influenza cases tested in the US, overshadowing other strains in a population with little natural resistance to the new virus, a US study found." The CDC reported that "the new flu, H1N1, is widespread across 11 states and circulating in parts of 19 others." Bloomberg also quotes Lyn Finelli saying, "So far it doesn't look like transmission is declining at all."

Michigan says it will stop providing H1N1 information to public. The Detroit News (6/26, Stolarz) reports, "The swine flu has claimed two other Michigan residents, putting the state's death toll at seven, according to state health officials." However, "more information was not available as the state is no longer releasing information to the public." Michigan Department of Community Health spokesman James McCurtis said, "Now, as we accumulate more deaths, which is unfortunate, we're leaving it up to the local county health departments to funnel that information out." So far Michigan has 655 confirmed and probable cases of H1N1.

結論是可以不用防了，因為防不勝防，無從防起！飲食正常，保持健康最重要！

By Rob Stein Washington Post Staff Writer Wednesday, February 25, 2009; Page A01

For years, many women have been buoyed by the news about one of life's guilty pleasures: That nightly glass of wine may not only take the edge off a day but also improve their health. Now it turns out that sipping pinot noir might not be such a good idea after all. A new study involving nearly 1.3 million middle-aged British women -- the largest ever to examine alcohol and cancer in women -- found that just one glass of chardonnay, a single beer or any other type of alcoholic drink per day increases the risk of a variety of cancers. "That's the take-home message," said Naomi E. Allen of the University of Oxford, who led the study being published March 4 in the Journal of the National Cancer Institute. "If you are regularly drinking even one drink per day, that's increasing your risk for cancer." Understandably, the study may leave many women scratching their heads, given all the talk about red wine being something akin to a fountain of youth. "I thought drinking wine was good for you," said Mirella Romansini, 27, of Chevy Chase, outside Paul's liquor store in Northwest Washington. "Now they are saying it increases your risk for cancer? Yes, I would say I'm surprised." Romansini is hardly alone. At least half of U.S. women drink sometimes, and even the Dietary Guidelines for Americans, the government's official bible on what we should be putting into our mouths, says alcohol can have "beneficial" effects, allowing women as much as one drink a day (men get two, of course). Confused? It turns out the guidelines were never intended to recommend that anyone drink for his or her health. Yes, it's true that studies have indicated that moderate drinking may cut the risk of heart disease and other ailments. And researchers have identified a substance in red wine (remember resveratrol?) that could offer a host of benefits. But officials have long worried about sending the wrong message, giving people who take extraordinary risks if they drink -- young people, pregnant women, those prone to alcoholism -- permission to abuse alcohol. As a result, officials have long tried to walk a fine line between acknowledging the possible benefits of alcohol and encouraging people to start drinking or to abuse it. The guidelines were intended to set an upper limit on what might be safe, not a recommended daily dose. "It's a level of consumption that generally has been found in scientific studies to be associated with a relatively low risk of harms," said Robert D. Brewer of the federal Centers for Disease Control and Prevention. "But low risk does not mean no risk." In fact, many previous studies have found that alcohol appears to increase the risk of breast cancer, and that heavy drinking could make men and women prone to other cancers as well. The new study is a large-scale attempt to explore all cancer risks posed by more typical drinking levels and a spectrum of alcoholic beverages. Allen and her colleagues analyzed data collected by the Million Women Study, which since 1996 has been gathering detailed information from 1.28 million women ages 50 to 64. The researchers examined how much alcohol women reported consuming when they volunteered for the study and again three years later, and examined whether there was any link with the 68,775 cancers they developed over an average of the next seven years. Even among women who consumed as little as 10 grams of alcohol a day on average -- the equivalent of about one drink -- the risk for cancer of the breast, liver and rectum was elevated, the researchers found. Among women who also smoked, the risk of mouth and throat cancer also increased. Based on the findings, the researchers estimated that about 5 percent of all cancers diagnosed in women each year in the United States are the result of low to moderate alcohol consumption. Most are breast cancers, with drinking accounting for 11 percent of cases -- about 20,000 extra cases each year -- the researchers estimated. In any group of 1,000 U.S. women up to age 75 who consumed an average of one drink a day, the researchers calculated, there would be 15 extra cancers; two drinks per day would result in 30 extra cancers, and so forth. The risk appeared the same regardless of whether women drank wine, beer or any other type of alcohol. Allen noted that even less than one drink per day may increase the risk. "There doesn't seem to be a threshold at which alcohol consumption is safe," she said. The reason alcohol increases the risk for cancer is not entirely clear, but there are several possibilities, including that it enables carcinogens to do their damage, increases inflammation or, in the case of breast cancer, boosts estrogen levels. Several researchers noted that the findings were essentially consistent with previous studies, and despite its size the study does have shortcomings. The researchers could not, for example, distinguish between women who drank only one or two drinks every day and those who drank seven drinks all at once. Some researchers worried the findings would unnecessarily frighten women and deprive them of the possible health benefits of an occasional drink. "We can't use this to scare people away from alcohol," said Eric Rimm of the Harvard School of Public Health. Allen plans to analyze the study data to try to determine whether the net risks from cancer outweigh any heart benefits. But others researchers were doubtful. "Among women, the major cause of death by far during the middle age years is cancer," Michael S. Lauer and Paul Sorlie of the National Heart, Lung and Blood Institute noted in a editorial accompanying the study. "For this large group, the only reasonable recommendation we can make is there is no clear evidence that alcohol has medical benefits." As it turns out, the federal government is rewriting its dietary guidelines, including the part about alcohol consumption, and will consider the new study in that process. "No one study is ever sufficient to make a recommendation," said Linda Van Horn, a professor of preventive medicine at Northwestern University who is chairing the committee revising the guidelines. "But it will be added to the body of literature that will be reviewed." In the meantime, several experts said women should consult with their doctors about whether they should drink. "It really comes down to a personal decision based on their own history and risk factors," Rimm said. "But it shouldn't be based only on health. Some people drink for cultural reasons; some people drink for religious reasons. I personally think it enhances the flavor of meals, and some people think it enhances the company you're with."

引述

[轉貼]護理新方向 重量不重質

這篇文章是一個朋友轉寄給我的   原作者我找不到  所以沒有附reference在這  請原著讓我借貼一下在我的blog  別介意呀!

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怎麼樣的人力配置才是合理的??????????

以前在署立醫院滿床時白班小姐一個人是care 11 個病人
最近換了工作發現這醫院更猛~~
白班leader只要care10個病人
剩下的30個就另外兩個人扛~~平均一護士照顧15位病人
你問我那護理品質呢?! 沒有品質呀!!!!
寶貝~~~別傻了!!那是過去的口號
現在我們的護理是---重量不種質---啊!!
反正提早一個多小時到單位點班、備藥、備點滴
交班時順便推著治療車出門做事才能結省時間
規定要看著病人把要吃下才離開 屁啦!! 哪來的時間~~
現在只能要求基本的別給錯藥而已
15床的血壓心跳呼吸脈搏量下來在加上病人魯小小一下
哇!!回到護理站已經一堆滿滿的醫生order要處理了呢
翻開一本本的chart開始大呼小叫的聯絡檢查或跟別單位周旋
時間一到OR狂催 ER狂定床 出院病人狂問你要多少錢(o_O?)
要追大夜班送檢的報告 異常時找不到醫生處理
家屬要求解釋病情 告知應由醫師解釋病情
居然還反諷"那妳都不懂還照顧我媽媽喔?!"哇哩OOXX咧!!
點滴任何管路到期的一床一床重on
哈哈 如果來了一床難on的真是恭喜呀!!
今天大概會被外放到病人單位回不去護理站了
出院時送水果 送花籃佔滿了我們的護理站
上面全是寫著"某大醫師妙手回春" 去!
一場大亂之下11點又到了 急忙出門給飯前藥 加抗生素
吃飯?! 沒錯~~要去餵時間到家屬就自動消失的老背背吃飯
一兩點回來還會跟你說不好意思我剛剛先去吃飯了!
還有誇張的表情驚訝的口吻說"啊~~你幫我爸爸餵好了喔!!"
去~~沒錯 我還慫恿你爸爸以後遺產要過戶給我(內心OS)
我可憐的雞腿便當又要帶回家當晚餐了
這是當護士的好處吧!! 省錢兼瘦身
沒有休息的時間 已辦好出院的床要整理 要鋪床(好想躺上去暖被說)
趁三點之前改快寫一下紀錄 身體評估?! 很難~~~
按規定每班都要寫紀錄代表我今天至少有見過病人一面就好了
出發 開始每一床倒尿 導引流管 再一次檢查所有管路通暢性
鈴鈴鈴~~電話響了要十秒內接起 不然電話禮儀會被扣分
呼~~還好不是無聊的督導打來測試我們的
是要交班接新病人 接開刀後病人
如果醫生心情好大概會提早來看病人 所以異常的檢驗數據要報告
不然小姐你就死定了~~
喔喔~~太開心了 Hb掉 要輸血耶!!!要去抽血送血庫備血
然後開刀的病人喊痛所以要打止痛針
要total I/O哇~~真爽 負了兩千多耶!!要架另一個line補充
小姐要趕三點半耶!! 趕快處理事情還要寫交班單以方便小夜的人
終於四點一到 先交班再說~~
班交完了 再繼續埋頭苦幹寫病歷
寫病歷的同時還要處理病人問題 畢竟還穿著制服嘛!!
呼!!終於可以下班了~~天都黑了!!
難怪小姐總是白皙皙~~因為太陽照不到呀!!
難怪小姐瘦巴巴 因為雞腿便當都沒動過所以已經在燃燒自己呀!!
看清楚了衛生署長~~這就是妳要的護理
看清楚了民眾~~最好沒事常保健康
看清楚了愛罵小姐的家屬~~有種就讓你的小孩當護士
看清楚了護士~~愛加油呀!!^^