2017年10月19日 星期四

Checklists are boring, but death is worse

Checklists are boring, but death is worse

In conversation with Malcolm Gladwell, surgeon-writer Atul Gawande explains how simple systems can save lives
October 16, 2017 | Editor's Pick Popular

By Alvin Powell, Harvard Staff Writer
EmailTwitterF new information that can save the lives of people who not long ago would have died. The challenge? Keeping it all straight.

Atul Gawande, a Harvard professor and surgeon and New Yorker staff writer, illuminated the problem by recalling a letter he received five years ago from a Texas man who was in a head-on collision at 70 miles an hour. The injuries were severe enough that years ago they might have killed the man, Gawande said. Instead, emergency responders were on the scene within minutes. Within a few more, the man was in a helicopter to a major hospital, where his spleen was removed, the bleeding was stopped, and his condition stabilized.

From there, Gawande said, the patient had to endure months of treatments addressing different injuries, but in time he got on with his life. That is, until he went to the beach one day and contracted an infection.

The spleen can be important in fighting certain infections, Gawande noted. That’s why patients who have it removed typically are given three post-procedure vaccinations. In this case, the man received only two. The third would have protected him from the bug he picked up at the beach. The man lost his feet, fingers, and nose. Then he lost his job and his ability to take care of his family.

‘We love rescue and the heroism of being able to save someone. The death that didn’t happen is invisible.’ — Atul Gawande

The incident was awful, but not isolated, said Gawande. He remembers one case at Brigham and Women’s Hospital in which the patient died. What’s needed, he said, are simple systems to help, such as the surgical checklist he developed at Ariadne Labs, which he founded and which is a joint center of the Brigham and the Harvard T.H. Chan School of Public Health.

Checklists, smartphone apps, or other interventions are penicillin-like in their life-saving potential, said Gawande, who spoke Friday at Faneuil Hall as part of HUBweek. His checklist takes aim at preventable surgical deaths, the estimated cause of as many as half of all surgery-related deaths. Recently published research on a checklist trial in South Carolina hospitals showed a reduction of 22 percent of all surgical deaths.

Though the systems can potentially save many lives, Gawande, in response to questions from author Malcolm Gladwell, said that they get little attention. Further, they meet resistance from a significant minority of doctors who feel they don’t need them.

It’s perhaps telling, Gawande said, that of the 25 percent of surgeons who said in a recent survey that the checklists were too long and unnecessary, 95 percent said that if they were having surgery, they’d want all the items on the checklist performed.

Gawande and Gladwell discussed whether the problem was related to heroism — or its lack. People get excited about saving someone who’s hurt, which is one reason surgeons are held in such high regard and demand such high salaries. There’s nothing dramatic about an injury that’s headed off, he noted, so even though the statistics tell of a life-saving impact, the work often goes unnoticed.

“We love rescue and the heroism of being able to save someone,” Gawande said. “The death that didn’t happen is invisible.”

空氣污染是某些疾病的重要原因 Researchers looked at the combined effects of air, water and soil pollution…

Studies have shown that pollution can be an important cause of diseases including asthma, cancer, heart disease, stroke and lung disease.


Researchers looked at the combined effects of air, water and soil pollution…

馬兜鈴酸 引發近8成肝癌 醫籲別吃來路不明中草藥

馬兜鈴酸 引發近8成肝癌
基因突變增風險 醫籲別吃來路不明中草藥








2017年10月17日 星期二


在非藥物的治療上,目前可以使用認知行為治療(Cognitive-Behavioral Therapy,CBT)。通常這種方式會比藥物的治療有效且持久。




另外,如果在日常生活裡,能夠找到適合自己的放鬆方式,那麼,對於克服失眠,也會有幫助,如「腹式呼吸」(Diaphragmatic Breathing)或「轉移注意力」都是不錯的方式。




2017年10月16日 星期一

Why a little dirt is good for us

UC Davis researchers find some antiseptics and disinfectants we use everyday may be harmful to our health.
UC Davis研究人員發現我們每天使用的防腐劑和消毒劑可能會危害我們的健康.
Disinfectants can inhibit cellular energy production and even lead to an increased risk of Parkinson's disease.

Travoys Arriving with Wounded at a Dressing-Station at Smol, Macedonia, September 1916 (1919, Art.IWM ART 2268)

dis • in • fect • ant
  1. 1(主として手術道具など無生物体用の)消毒薬,消毒剤.
  2. 2((俗)) ((おどけて)) ソース,調味料.
━━ [形容詞] 消毒に用いられる,滅菌[殺菌]効果のある.

an • ti • sep • tic
  1. 1殺菌の,滅菌の;殺菌力のある,消毒する,防腐(性)の. cf. ASEPTIC 1
    • antiseptic finish
    • 防腐加工.
  2. 2細菌のない,消毒[滅菌]された,無菌状態の.
  3. 3非常に清潔な.
  4. 4汚染のない.
  5. 5〈言葉などが〉冷淡な,人間味のない.
━━ [名詞] 消毒剤,防腐剤
    • apply an antiseptic
    • 消毒薬を塗る.

  • 《名詞》消毒剤


"Super-sized" chocolate bars are to be banished from hospital shops, canteens and vending machines, NHS England says.
Sweets and chocolate sold in hospitals should be 250 calories or under, the head of the body says.
Under the plans, most "grab bags" will be banned - with hospitals given a cash boost for facilitating the change.
The proposals would also see 75% of pre-packed sandwiches coming in at under 400 calories.
Pre-packed savoury meals and sandwiches must also contain no more than 5g of saturated fat per 100g.
And 80% of the drinks stocked must have less than 5g of added sugar per 100ml.

'Obesity epidemic'

In April, NHS England said it would ban sugary drinks if hospital outlets did not cut down on the number they sell.
Mr Stevens said the NHS was "stepping up" to combat an issue that was causing "an epidemic of obesity, preventable diabetes, tooth decay, heart disease and cancer".
"In place of calorie-laden, sugary snacks we want to make healthier food an easy option for hospital staff, patients and visitors."
NHS staff are also being targeted as part of the move to tackle unhealthy eating, including those on overnight shifts.
It is estimated that nearly 700,000 of the NHS's 1.3million staff are overweight or obese.
NHS premises have huge footfall from the communities they serve, with one million patients every 24 hours.
The Royal Voluntary Service, the biggest hospital retailer across the UK, said it had already begun introducing healthier choices and had seen fruit sales go up by a quarter.
Public Health England says hospitals have an "important role" in addressing obesity and not just dealing with the consequences.
Campaigners says more action is till needed.
Helen Dickens from Diabetes UK said: "We look forward to seeing more information on how it will work in practice.
"However this is just one piece of the puzzle when it comes to tackling obesity. We need to go much further, which is why we are also calling for the Government to toughen restrictions on junk food marketing to children, end price promotions on unhealthy foods and introduce mandatory front of pack food labelling."

2017年10月15日 星期日

Dr. Shigeaki Hinohara: if you must retire, do it well after age 65

Dr. Shigeaki Hinohara, credited with building the foundations of Japanese medicine and helping make Japan the world leader in longevity, often practised what he preached.
The physician, chairman emeritus of St. Luke's International University, and honorary president of St. Luke's International Hospital recommended several basic guidelines for living a long, healthy life in an interview with Japan Times journalist Judit Kawaguchi. Among them: Don't retire. And if you must, retire much later than age 65.
In the interview he explained that the retirement age in Japan was set at 65 years old back when the average life expectancy was 68. Now, people are living much longer — the average life expectancy in Japan as of 2015 was almost 84 years — and so they should be retiring much later in life too.

Until a few months before his death on 18 July in Tokyo, The New York Times reports, Hinohara continued to treat patients, kept an appointment book with space for five more years, and worked up to 18 hours a day. He was 105 years old.
"He believed that life is all about contribution, so he had this incredible drive to help people, to wake up early in the morning and do something wonderful for other people," Kawaguchi, who considered Hinohara her mentor, told the BBC. "This is what was driving him and what kept him living."
"He always had today's goals, tomorrow's, and the next five years'," she said.
Hinohara's other guidelines for living well included:
Worry less about eating well or getting more sleep, and have fun. 

"We all remember how as children, when we were having fun, we often forgot to eat or sleep. I believe that we can keep that attitude as adults, too. It's best not to tire the body with too many rules such as lunchtime and bedtime."
If you want to live long, don't be overweight. 

"For breakfast I drink coffee, a glass of milk, and some orange juice with a tablespoon of olive oil in it. Olive oil is great for the arteries and keeps my skin healthy. Lunch is milk and a few cookies, or nothing when I am too busy to eat. I never get hungry because I focus on my work. Dinner is veggies, a bit of fish and rice, and, twice a week, 100 grams of lean meat."
Don't blindly follow what your doctor says. 

"When a doctor recommends you take a test or have some surgery, ask whether the doctor would suggest that his or her spouse or children go through such a procedure. Contrary to popular belief, doctors can't cure everyone. So why cause unnecessary pain with surgery? I think music and animal therapy can help more than most doctors imagine."
To conquer pain, have fun. 

"Pain is mysterious, and having fun is the best way to forget it. If a child has a toothache, and you start playing a game together, he or she immediately forgets the pain. Hospitals must cater to the basic need of patients: We all want to have fun. At St. Luke's we have music and animal therapies, and art classes."
Always take the stairs and carry your own belongings. 
"I take two stairs at a time, to get my muscles moving."

2017年10月14日 星期六

浸泡在農藥化肥裡的國度中國土壤狀況調查實錄2017;中國稻米產區重金屬污染嚴重;中國鎘大米 (cadmium rice) 2014








Sim Chi Yin for The New York Times

在《「有色」米——湖南衡東縣稻米重金屬污染調查》(Cadmium Rice: Heavy metal pollution of China』s rice crops)一文中,綠色和平組織東亞分部(Greenpeace East Asia)的研究人員對湖南省一座有色金屬冶煉工業園附近的農田、閑置土壤、地表水和稻米進行了採樣。湖南是中國水稻產量最高的省份。
在這項研究中,研究人員發現,一些點位的土壤鎘含量超過國 家健康標準200倍。這是一條新的證據,表明在幾十年的快速工業化和經濟高增長後,中國部分土壤出現了嚴重退化,而此類證據正在越積越多。本項研究採集的 所有稻米樣品中,只有一份里的鎘含量沒有超出中國設定的食品安全標準。
文中稱,這些稻米的「鎘含量最值得關注,除了一個樣本之外,其他樣本的鎘含量均超過了食品安全國家標準規定的稻穀中鎘含量限值(0.2 mg/kg),最高的一個樣本超出22倍」。
在接受電話採訪時,陳能場說:「通過食物攝入鎘是一個小劑 量慢性中毒的過程。人體累積鎘的速度非常緩慢,但排泄和排出鎘的速度更慢。鎘的半衰期大約是17至38年,也就是說,要花這麼長的時間才會減少一半。一旦 進入人體,鎘基本上就會一直留在體內——就算不是一輩子,至少也會有大半輩子。」
德博拉·布盧姆(Deborah Blum)上周在《紐約時報》的Well博客中寫道,稻米是中國人最喜愛的糧食,但也極易受到污染,因為它很容易從土壤中吸收金屬。

‘Cadmium Rice’ Is China’s Latest Food Scandal
狄雨霏 2013年05月21日





這種做法讓許多人驚愕,也在新聞媒體和網絡上引發了批評狂潮。上周末,該機構鬆了口,公布了八個鎘含量嚴重超標的品牌和產品,而其查到的鎘含量超標的品牌和產品共有18種。政府方面說,這些發現來自今年第一季度 的食品安全抽檢,並沒有覆蓋市面上的所有大米。據官方媒體新華通訊社報道,不合格大米中鎘含量高達0.4毫克/千克,是中國安全限量的兩倍。



新華社和《人民日報》指出,從長遠來講,要通過治理土壤來 解決這一問題,中國很多地區的土壤都因工業廢料和採礦而受到污染。這兩家媒體還指出,治理土地需要更好的環境保護法和法律實施,以及更好的檢測系統。文章 還專門指出了鉛這種土壤污染物。製造手機、相機和電腦中的鎳鎘蓄電池需要鎘。作為主要的電池生產國,中國是鎘的主要消費國。

「大米中的鎘通常來自水稻生長的土地,而土地已被採礦和化學廢料所污染,」位於北京的中國農業大學的食品安全專家范志紅告訴官方媒體《環球時報》(Global Times)。




狄雨霏(Didi Kirsten Tatlow)是《國際先驅論壇報》(The International Herald Tribune)駐京記者。