一位原本使用perm-cath的洗腎患者，常常管路不通，使用urokinase多次也無效，換了新的perm-cath也是一樣。患者腦中風多年，手腳不靈活，血管也細小，自體瘻管也無法建立。經由顏旭霆醫師的建議，選擇用Flixene graft，置入後，24-72小時即可使用，非常方便，提供腎臟病患急需透析(洗腎)通路另一個選擇。
2020年10月2日 星期五
2020年9月22日 星期二
PTA 洗腎 通血管
護理長上針時，發現瘻管聲音改變，變小聲，雖然還可以透析，但是為了更好的透析品質，建議患者前往通血管(PTA)，果然有明顯的狹窄段，經過心臟科鍾昇穎醫師的妙手處理，回來後即改善了。(p月美t)
2020年9月14日 星期一
蜂蜜比一般療法更能治療上呼吸道感染
Honey Outperforms Usual Care for Upper Respiratory Tract Infections
https://ebm.bmj.com/content/early/2020/07/28/bmjebm-2020-111336
蜂蜜比起一般療法而言，在以下症狀上更有改善效果：咳嗽的嚴重度、頻率和合併症。
蜂蜜和單一藥物相比而言，療效可達到Medicon (dextromethorphan)的效果。
蜂蜜比起一般療法而言，在以下症狀上更有改善效果：咳嗽的嚴重度、頻率和合併症。
蜂蜜和單一藥物相比而言，療效可達到Medicon (dextromethorphan)的效果。
作者結論：若要開藥給上呼吸道感染患者，也許可以考慮使用蜂蜜而不使用抗生素，這樣也可以減少抗藥性產生。
2020年8月4日 星期二
血液透析患者合併骨質疏鬆因故延期副甲狀腺切除手術
腎臟與透析 31 卷 4 期，200-202 頁 (2019 年 12 月 )
Kidney and Dialysis Vol.31, No.4, pp. 200-202 (December, 2019)
© Taiwan Society of Nephrology & Ainosco Press
病例報告
DOI:10.6340/KD.201912_31(4).0009
血液透析患者合併骨質疏鬆因故延期副甲狀腺切除手術
張智鴻 1
、陳靖博 2,*
│摘要│
透析患者若合併副甲狀腺功能亢進，長期下來就會有骨質疏鬆的問題，除了傳統的藥物治療外，denosumab
（Prolia）也逐漸被使用在透析患者。注射此藥物後的低血鈣、低血磷是常見副作用，大多在數週後恢復。本文
報告一個血液透析病患因為注射 denosumab 後發生嚴重低血鈣和低血磷，讓本來嚴重需急切開刀的副甲狀腺功
能亢進，因為麻醉風險過高而被延後。本文探討 denosumab 對透析患者的影響，以及相關論述。
關鍵詞：血液透析、副甲狀腺、保骼麗
Unexpected Postpone for Parathyroidectomy in a Hemodialysis Patient With
Osteoporosis
Chih-Hung Chang1
, Jin-Bor Chen2,*
Abstract
The dialyzed patient with hyperparathyroidism is prone to osteoporosis. Recently, denosumab (Prolia) is being
administered more frequently in dialyzed patients for osteoporosis treatment. Hypocalcemia and hypophosphatemia
are common adverse effects after denosumab injection. The effects generally are recovered in a few weeks later. We
presented a hemodialysis patient with severe hypocalcemia and hypophosphatemia after denosumab injection and led
to an unexpected postpone for parathyroidectomy considering high risk for anesthesia and surgery. We also discuss the
impact and relevant information of denosumab injection in dialyzed patients.
Keywords: hemodialysis, parathyroid, denosumab
2020年7月8日 星期三
好消息！退休後每天喝一點酒，腦筋比較不會退化
Association of Low to Moderate Alcohol Drinking With Cognitive Functions From Middle to Older Age Among US Adults
June 29, 2020
JAMA Netw Open. 2020;3(6):e207922. doi:10.1001/jamanetworkopen.2020.7922
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767693
退休後每天喝一點酒，腦筋比較不會退化。
June 29, 2020
JAMA Netw Open. 2020;3(6):e207922. doi:10.1001/jamanetworkopen.2020.7922
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767693
退休後每天喝一點酒，腦筋比較不會退化。
- 19 887 participants from the Health and Retirement Study, with a mean follow-up of 9.1 years
- Low to moderate drinking (less than 8 drinks per week for women and less than 15 drinks per week for men) was significantly associated with a consistently high cognitive function trajectory and a lower rate of cognitive decline
2020年7月1日 星期三
2020年6月27日 星期六
小兒科醫師顧加護病房16或是24小時班所犯錯誤比較 (ROSTERS Study Group)
Effect on Patient Safety of a Resident Physician Schedule without 24-Hour Shifts
List of authors. (ROSTERS Study Group)
https://www.nejm.org/doi/full/10.1056/NEJMoa1900669?query=pfw&jwd=000012994502&jspc=NEP
令人驚訝的是：16小時一班(intervention group)比24小時一班(control group)所犯錯誤還多！
Resident physicians made more serious errors during the intervention schedules than during the control schedules (97.1 vs. 79.0 per 1000 patient-days; relative risk, 1.53; 95% confidence interval [CI], 1.37 to 1.72; P<0 .001="" p="">
但是要注意是不是intervention group這一組照顧病人數多一點所導致的偏差：
patients per resident physician, was higher during the intervention schedules than during the control schedules (8.8±2.8 vs. 6.7±2.2)
In a secondary analysis that was adjusted for the number of patients per resident physician as a potential confounder, intervention schedules were no longer associated with an increase in errors.
List of authors. (ROSTERS Study Group)
https://www.nejm.org/doi/full/10.1056/NEJMoa1900669?query=pfw&jwd=000012994502&jspc=NEP
令人驚訝的是：16小時一班(intervention group)比24小時一班(control group)所犯錯誤還多！
Resident physicians made more serious errors during the intervention schedules than during the control schedules (97.1 vs. 79.0 per 1000 patient-days; relative risk, 1.53; 95% confidence interval [CI], 1.37 to 1.72; P<0 .001="" p="">
但是要注意是不是intervention group這一組照顧病人數多一點所導致的偏差：
patients per resident physician, was higher during the intervention schedules than during the control schedules (8.8±2.8 vs. 6.7±2.2)
In a secondary analysis that was adjusted for the number of patients per resident physician as a potential confounder, intervention schedules were no longer associated with an increase in errors.
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