• 期刊

從病人安全論醫院感染管制之法律責任－以醫療照護相關感染事件為例

醫療照護相關感染乃病人住院後，可能因醫院未落實感染管制作業而發生被感染，且可能引發為群聚事件。另外近年來全球出現的新興感染症(如嚴重急性呼吸道症候群，H5N1、H7N9新型流感、中東呼吸症候群冠狀病毒感染症、伊波拉病毒感染等)的出現，皆可能造成院內群聚感染事件，威脅其他員工、病人及家屬的健康。文獻報導醫療照護相關感染會增加額外的醫療花費、住院天數、死亡率等，且帶給病人各種身體、健康、精神的傷害。醫療法就醫院感染管制問題，要求醫院提供病人安全的醫療環境，因此若醫院及所屬醫療人員未盡感染管制義務，造成群聚感染，可能該當於法律應負的責任。

• 期刊

第2型糖尿病女性病人性功能障礙相關因素探討

目的：評估第2型糖尿病婦女性功能障礙之盛行率及相關因素。方法：採橫斷性相關性研究設計，以2014年1月至12月至南部某醫院就診的糖尿病婦女為對象，以自我填答問卷方式收集資料，若有固定的男性性伴侶也同時收集。另以年齡配對非糖尿病婦女，以瞭解糖尿病與非糖尿病婦女在性功能障礙上是否有差異。結果：共收集糖尿病女性186名，對照組71名；糖尿病婦女的性功能總分較對照組低(24.4 ± 5.3 vs. 25.5 ± 4.9,p=0.011)，但性功能障礙的盛行率沒有差異(62.1% vs. 52.5%, p=0.212)；影響糖尿病婦女罹患性功能障礙的危險因子分別為停經(OR= 6.18；95%CI 1.84–20.75)、高血壓(OR=2.87；95%CI 1.26–6.53)、以及憂鬱狀況(OR=1.11；95%CI 1.04–1.18)。結論：穩定控制糖尿病的女性病人，其性功能障礙的發生率與健康人無異。但停經、罹患高血壓及憂鬱為女性糖尿病人性功能障礙的危險因子。

• 期刊

台灣診斷關聯群支付制度對腹股溝疝氣手術給付影響之探討

目的：探討台灣診斷關聯群(Tw- DRGs : Taiwan - Diagnosis Related groups)實施後對腹股溝疝氣手術住院日數及醫療費用之影響。方法：以回溯性資料探討某區域醫院泌尿科腹股溝疝氣手術1030個住院病人(實施前2004-2009年434人次， 實施後2010-2015年596人次)，以t檢定及逐步迴歸分析實施前後的各項變項，並考慮該手術不同DRG碼。結果：Tw-DRGs的實施，住院日數顯著下降0.21天，耗用、申報及收益差分別顯著增加1910.36、3883.40及1973.03點，可解釋變異量為1.7、4.6、14.1與11.3%，而耗用費別之檢查費、藥費、及放射費則顯著減少。DRG碼在耗用及申報點數迴歸分析中有重要解釋力，DRG16201及DRG 16101相較於DRG 16202耗用點數(可解釋變異量為27.0%及10.0%)及申報點數(可解釋變異量為28.5%及15.6%)顯著較多。此外，t檢定中，DRG 16102及DRG 16101的收益差顯著增加3653.69及8946.82點，比DRG 16202顯著增加1581.04點較高，迴歸分析可解釋變異量為1.8%及1.4%。結論：腹股溝疝氣手術在Tw- DRGs實施後，住院日數減少且收益差增加，建議醫院加強正確編碼，並找出影響收益差之病人特性來控管費用，以因應未來Tw-DRGs擴大實施帶來的衝擊。

• 期刊

Persistently False Negative Antibody Response in a HIV-Infected Patient: A Case Report

Antibody detection by enzyme immunoassay ( EIA ) is primarily the screening test in the diagnosis of human immunodeficiency virus (HIV) infection. However, the result by EIA method could be negative during the window period, and another diagnostic tools should be applied to avoid any delay or miss in the diagnosis of HIV infection. Both viral load and p24 antigen tests could be used to shorten the window period for early HIV diagnosis. We report an unusual case of HIV infection with multiple opportunistic infections and persistently negative antibody response. Late stage of acquired immunodeficiency syndrome (AIDS) or acute HIV infection, leading to lack of adequate detectable antibody, could be the possible causes of negative HIV test. In conclusion, use of anti-HIV Combo assay or viral load in highly suspicious patients is the key for early diagnosis of HIV.

• 期刊

Antalgic Gait as the Initial Presentation of Spontaneous Septic Arthritis of Pubic Symphysis: A Case Report

Septic arthritis of the pubic symphysis is a rare form of arthritis. Children or adolescents having strenuous exercise are at risk of this form of spontaneous arthritis due to excessive repetitive movement making the site of microtrauma susceptible to seeding and colonisation by pathogens. It presents with fever and pubic pain irradiating to the groin and increasing when moving the hip, and this fact produces a antalgic gait. We report a 17 year-old male presenting with antalgic gait and fever after playing basketball game. Diagnosis of septic arthritis of the pubic symphysis is made by positive blood culture and magnetic resonance imaging showing signs of inflammation. The patient was treated with antibiotics with a good clinical response. Suspicion of septic arthritis of the pubic symphysis should be raised when a child or adolescent complains of a antalgic gait and has signs of infection after strenuous exercise.

• 期刊

Cerebral Lipiodol Embolism During Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma: Two Cases Report

Cerebral lipiodol embolism (CLE) is a rare complication of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Although the prognosis is generally fair, it still carries risk of poor outcome (12.5 - 20.8 % ). Plausible mechanisms of embolism were proposed, to prevent or predict the complication. But no effective therapy has been shown to stop or reverse the consequence. Here, we report two cases of CLE after TACE, treated with methylprednisolone and heparin, and had a good recovery.

• 期刊

Traumatic Knee Dislocation with Multi-Ligament Disruption Treated by Open One-Stage Anterior and Posterior Cruciate Ligament Reconstruction and Medial Collateral Ligament Repair: A Case Report

Traumatic knee dislocation is usually caused by severe injury, and it is traditionally reported as being concomitant with many associated injuries. We describe the case of a 77-year-old woman who sustained both post-dislocation of the right knee joint and a left tibial fracture. We performed open reduction and internal fixation of the left tibial fracture, open one-stage reconstruction of the anterior cruciate ligament and posterior cruciate ligament, and medial collateral ligament repair. At the 6-month follow-up, she was able to perform full weight-bearing walking, and her range of motion was 0 to 90°. No other major complications, such as wound infection or stiffness, were observed.

• 期刊

Esophageal Diverticulum Mimicking a Calcified Thyroid Nodule on Ultrasound: A Case Report

Small and asymptomatic hypo- pharyngeal diverticulum is likely to be misdiagnosed as a thyroid nodule due to the proximity of the upper esophagus to the thyroid gland. The principles to distinguish between esophageal diverticula and thyroid nodules should be noted clearly to avoid the unnecessary invasive procedures. In the current case, a 32-year-old man presented with a 'suspected malignant thyroid nodule' in the left thyroid gland, and underwent a neck exploration. However, no visible 'suspected thyroid tumor but a sac protruding from the left anterolateral wall of the cervical esophagus, was observed during the surgery. The esophageal mass was resected and the pathology revealed diverticula of esophagus. The patient recovered well after 3 months of surgery. Real-time ultrasonography and pharyngoesophagography are important techniques to distinguish a hypopharyngeal diverticulum from a thyroid nodule. That will help the clinicians to avoid the unnecessary interventions.