紫斑症新藥納健保 給藥條件嚴 自由時報2011-08-11「慢性免疫性血小板缺乏紫斑病」口服新藥「血小板增生劑」,今年8月起,以嚴格門檻納入健保給付。健保局估計,每年2000名病患中,約160人符合給付條件,但醫師指出,健保給付條件過嚴,且限用半年,真正符合資格者更少,應適度放寬。台北榮民總醫院輸血醫學科主任邱宗傑表示,國內的血小板缺乏紫斑症盛行率約萬分之一,病因是人體血小板因不明原因遭免疫系統攻擊、破壞,以致數量不足,損及凝血功能。患者易有皮膚瘀青、牙齦出血、經血不止、腸胃道出血、血尿等症狀,嚴重時,可能導致腦、肺出血,甚至危及生命。53歲的張琴雯自幼被診斷出紫斑症,21歲時,二度發病,但男友莊中毅不離不棄,堅持與她完婚。後來她冒生命危險生下兩子,剖腹產前,先輸血小板,以防血崩。此後30年沒有再用藥,且病情穩定。直到近2、3年才又發病,丈夫不過是扶她過馬路,就在手臂上扶出瘀青的黑手印。經檢驗,血小板數量掉到4000單位,正常人則有10萬到15萬單位,服藥後,才又恢復正常。邱宗傑表示,傳統治療最常使用類固醇,但卻容易有月亮臉、水牛肩、腸胃道出血等副作用;外科手術切除脾臟雖有效,但多數病患寧可吃藥,忍受副作用,也不願開刀。健保本月雖開放給付低副作用的口服新藥「血小板增生劑」,但給付條件過嚴,即便符合條件也只限用6週,且須經事前審查核准,往往緩不濟急,加上自費用藥每月高達8萬元,須長期用藥,一般人難以負擔,只能回頭使用副作用較大的類固醇藥物。
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Wednesday, August 10, 2011
放眼全球或兩岸 怎樣才稱”強”!!
《社論》台大獨強的迷思 人間福報 2011/8/10 大學考試分發入學放榜,考生選填志願依舊對台大情有獨鍾,台大戲劇系的分數超過政大新聞系,地理系也超過清大動機系,傳統理工類組前十名中有七個是台大科系。儘管三、四十年前考生選填志願時就以台大為第一志願,但較不熱門的科系當時並不這麼搶手。考生寧可選擇政大、師大等其他學校比較喜愛的科系就讀。今年的情況不同,在趨勢上相對的台大成為學子的最愛。這一現象是延續過去「選校不選系」的傳統,先進名校再說,進去之後再轉到自己喜愛的科系,且台大轉系成功率高達五成,學生自然把台大當做第一優先選擇,因此台大的戲劇系、地理系的分數都比政大、清大高也就不令人意外了。但這似乎違背了大學教育的宗旨,高等教育的目標是培養一些專才,大家都擠到台大去,其他學校如何吸引有特殊專才的學生呢?其他學校又如何脫穎而出發展出自己的特色呢?難怪很多學校要抗議高教資源分配不均,五年五百億計畫,台大一年拿了三十億,政大才拿二億,惡性循環下,學生更是選擇往台大擠。五年五百億計畫的目的是希望各校能夠發展出自己的特色,不僅是在吸引學生,而是培養不同的專才,如此才可望在國際間有競爭力。但所有的預算都湧向台大,其他學校想要發展特色,也只能徒嘆巧婦難為無米炊。政大教授周祝瑛指出,當一個國家只有一所大學獨強時,學術階層化的現象將更加惡化,非國家之福。台大副校長陳泰然說,現在大學部已非精英教育而是通才教育,學生得以接受到全人教育,「考生能選擇台大是聰明的決定」。如果台大真的以通才教育、以全人教育為榮,台大為什麼會出現眾多欠缺人文素養的政客,對音樂、美術、文學、哲學等人文素養毫無興趣。一所最高學府的校友卻以自己所學的專業為犯罪工具,貪汙並為自己辯護;台大醫學院教授柯文哲批評某些畢業生的敗德行為說:「台大醫院在世俗的權勢之前,矮了身子,失了志氣。我們對不起社會對台大醫院的期望與仰慕,我們要反省、認錯、道歉!」但是台大從來不曾為眾多的畢業生對社會的虧欠和惡行向社會說過一句反省的話。台大的獨強是社會的期許,也是學生選擇的結果,不是台大刻意運作造成的;但是台大有盡到最高學府應盡的責任嗎?有注重學生的品德教育嗎?有培養學生基本的人文素養嗎?行政院長吳敦義就讀台大歷史系二年級時寫過一篇深受政壇矚目的文章:「台大人的十字架」,台大人背負著社會重大的期許,但是台大若不正視「陳水扁現象」,教出一批不重視道德、沒有人文素養的學生,這樣的大學就算是擠進世界前五大,又怎樣?五年五百億不過虛耗了納稅人的血汗錢而已!
台灣25萬黃斑部病變高危險群 阿姆斯勒方格表 (Amsler Grid)自我檢查!
老年性黃斑部病變應儘速治療 以免造成失明 經濟日報 2011/08/10 【台北訊】如果家裡的老人家出現視覺有不規則黑影,小心!這並不是撞見「阿飄」,而是眼睛出現老年性黃斑部病變的前兆。建議儘速尋求眼科醫師診治,以免造成失明的危機。台北市立聯合醫院中興院區眼科主任蔡景耀表示,老年性黃斑部病變好發於50歲以上族群,視覺出現不規則黑影、模糊、扭曲都是主要症狀,不但影響最重要的中心視覺,2年內不治療還可能造成失明危機。推估國內約有5萬人受到老年性黃斑部病變的威脅,更有多達25萬的高危險群。彰化基督教醫院視網膜科主任林純如指出,黃斑部病變的形成是由於老化的視網膜色素上皮細胞及其彈性纖維層病變,並長出不正常血管。新生血管較脆弱,常常會滲水或出血,造成黃斑部水腫,使黃斑部的中心視覺產生模糊扭曲或是黑影。若出現以上病徵,建議還是透過螢光血管攝影或眼底斷層掃瞄詳細檢查,以確定診斷。蔡景耀建議50歲以上民眾每天要「睜一隻眼、閉一隻眼」使用阿姆斯勒方格表,或透過家中磁磚、柱子排列的格線,測量是否有扭曲黑影產生,及早發現病徵。林純如指出,目前最新的治療方法是以「新生血管抑制劑」讓抗血管新生因子直接作用在不正常增生的血管中,可有效改善或穩定視力。健保局在年初通過用於老年性黃斑部病變,每年每眼可施打3針,一般在施打完3針後會再進行一次詳細的檢查評估,並觀察視力恢復狀況,第一年平均約需施打5.6針,建議患者更應積極持續治療。
嘉南科大開發羊胎盤化妝保養品!
“黑青”是紫斑症嗎??!!
身體一碰就黑青 紫斑症惹禍 人間福報 2011/8/11【記者張雅雯台北報導】手臂輕輕拉一下就有黑青,是紫斑症病友張琴雯發病的寫照,由於免疫系統產生抗體攻擊血小板,導致血液中血小板數含量明顯不足,影響凝血功能,四十多年來發作過三次,但她選擇樂觀面對,配合療程用藥、定期追蹤,因此依然能像一般人保有工作、還生了兩個兒子。張琴雯三歲多時,被媽媽發現臉上有不明原因黑青,診斷是血小板缺乏的紫斑症而住院治療,痊癒出院後也不再發生,直到二十多歲一趟中橫健行之旅後,擔任護士的她某天上班時,一個跪姿起身,膝蓋竟然出現一大片黑青,住院使用類固醇一個多月,直到血小板維持到一個穩定的單位數才停藥。雖然類固醇的確替張琴雯控制了紫斑症,但會產生水牛肩、月亮臉等副作用,身高僅一百五十多公分的她,一度因用藥胖到七十多公斤。兩年前她再度發病,血小板低到只剩下四千單位,這次使用口服的血小板增生劑,血小板回到五、六萬單位,雖仍比正常數值低,但已經達到讓她不會出血的狀態,而且沒有類固醇的副作用。台北榮總輸血醫學科主任邱宗傑表示,血小板缺乏紫斑症分為急性與慢性,急性多發生在小孩或年輕人,半年內可自行恢復正常;慢性多發生在成人,需要藥物治療來改善,治療時間與使用劑量,依患者情形不盡相同。張琴雯表示,以前大家對這個疾病認識不深,因此擔任飛官的先生,還曾被長官要求另娶他人,以免因太太的病情而影響專注度,但先生沒有放棄她,她也冒著大出血的風險,剖腹生了兩個兒子。現在她除了盡量睡眠充足、避免過勞誘發免疫系統下降,也隨時注意身上是否有不明原因的黑青,及時就醫治療。健保局八月一日起有條件通過給付口服血小板增生劑,對紫斑患者生活品質大有改善,但在嚴格的給付門檻下,估計每年二千名病患中,只有一百六十人符合給藥條件。
小檔案 紫斑症 血小板缺乏紫斑症是一種自體免疫疾病,將體內的血小板當作外來物,免疫系統產生抗體來攻擊,加速破壞血小板,又抑制血小板的生成,若血小板數量低於五萬單位,就會導致血液不凝結;一萬以下可能引發腦部及腸道內出血的風險。罹病率約萬分之一,統計資料顯示十八歲以下以及七十歲以上患者,多為男性,不過二十至六十歲,好發的則是女性。
好貴的特殊“黑青”新藥 Revolade (eltrombopag_1344元)
紫斑症昂貴新藥 本月起納健保 2011年08月10日16:32 蘋果即時 治療「慢性免疫性血小板缺乏紫斑病」的昂貴新藥-Eltrombopag口服血小板增生劑,每粒需1344元台幣,每人每粒最高劑量為2粒,病情較嚴重的患者,每月醫藥費約8萬元,經濟負擔重。健保局本月1日「有條件」通過,將該新藥納入健保給付,但限於第一線治療藥物無效時作為第二線藥物,預估第1年160人受益。
台灣醫師過勞?!!! 衛生署滅火!
衛署調查,國內住院醫師工時與美相當 【2011/08/10 聯合報】近來醫師過勞猝死案例頻傳,衛生署今天公布全國87家教學醫院住院醫師工時調查結果,第一年與第二年住院醫師每周工時平均約74.6小時,值班次數平均約2次,與美國醫師相當。衛生署醫事處長石崇良指出,由於醫師不適用勞基法,住院醫師並未訂出工時標準,即使是鄰近的日本、韓國、香港、新加坡等,都沒有相關規定。目前僅能參照美國畢業後醫學教育評鑑委員會規定,訓練中的醫師每周80到84小時工時。石崇良表示,調查發現,外科系住院醫師每周工時較高,大約80小時,其他科系則較少。衛生署預計在年底前依據此次調查結果,邀醫界共同修訂教學醫院評鑑標準,讓住院醫師工時及值班規定更合理,確保病患安全。
Rehab robots lend stroke patients a hand
Los Angeles, CA (August 10th, 2011) – Robot-assisted therapy has measurable benefits for patients with a weaker arm following a stroke. This is according to new research featured in the journal Clinical Rehabilitation, published by SAGE, which is the first to use accelerometers to track patients' improvement and compare real world results. The study authors, Keh-chung Lin, Yu-wei Hsieh, Wan-wen Liao - National Taiwan University, Ching-yi Wu - Chang Gung University, and Wan-ying Chang, Department of Physical Medicine and Rehabilitation, Taipei Hospital aimed to investigate how robot-assisted therapy helps arm function to improve after a stroke. They enrolled 20 patients in a study comparing robot-assisted therapy combined with functional training against an active control treatment group. Stroke patients usually have difficulties transferring motor skills learned in therapy to their daily living environment because of cognitive deficits. The authors included real-world arm activity in the study by having patients wear accelerometers on both arms daily as they went about their normal tasks. One of the key findings of the study was that robot-assisted therapy, when combined with functional task training, helps functional arm use and improves bimanual arm activity in daily life. Patients following a stroke often have weakness on one side of the upper body (hemiparesis), which can make daily life more difficult. Robotic rehabilitation is increasingly available, and holds promise for enhancing traditional post-stroke interventions. Because robots never tire, they can provide massive and intensive training in a consistent manner without fatigue, with programming precisely tailored to each patient's needs. The rehab robots give sensorimotor feedback via visual and auditory feedback during training sessions, to facilitate patients' motor learning. However, although stroke patients' arm motor function and muscle strength have shown to improve during robot-assisted therapy in rehabilitation, previous studies suggested that these improvements did not carry through to the patients' daily lives. Some reasons for this might include a need for better measurement scales for patients' real life daily functions, as well as the fact many people compensate by using their non-impaired arm instead. By measuring both arms and following patients with the accelerometers at home, this study addressed these issues. Two further important findings of the study were that accelerometers are suitable tools to measure real-world arm activity in stroke patients; and that when combined with traditional clinical measurements these can enhance holistic understanding of a patients' life performance. Accelerometers provide objective information about physical activity by measuring the acceleration of body movements. Stroke patients can easily wear the portable accelerometers like a wristwatch on each arm. This means researchers now have the accurate information they need to verify the intensity and amount of physical activity the patients actually do in real-life situations. During the study, both groups received intensive training for 90 to 105 minutes per session, five days per week for four weeks. The training programs were administered by certified occupational therapists during regularly scheduled training sessions, and all other routine interdisciplinary stroke rehabilitation was continued as usual. Therapy in the control group was designed to match the robot-assisted therapy in amount of therapy hours, and these participants served as a dose-matched comparison group. Occupational therapists designed activities for the control group based on neurodevelopmental techniques and contemporary rehabilitative models such as task-oriented training and motor learning theory. The mean ratio change of the robot-assisted therapy group was 0.047± 0.047, which beat the 0.007 ± 0.026 in the control group. The robot-assisted therapy group also handled more daily tasks with their impaired arm than the control group. "In this study of rehabilitation approaches for patients with mild-to-moderate upper limb impairment six months after a stroke, we found significantly greater benefits of robot-assisted therapy compared with the active control group on the amount and quality of functional arm activity for the hemiplegic hand in the living environment," said Keh-chung Lin. "Moreover, robot-assisted therapy had superior benefits on improving bimanual arm activity," he added. Larger studies along with follow up research to look at whether these improvements are lasting will be the next steps towards making the most of robots for stroke patients' rehabilitation in future.