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Does High-Quality Care Protect Against Litigation? Not much: Good nursing homes were sued only slightly less often than bad ones. Legal theory holds that personal-injury litigation serves a social purpose, improving overall medical care by punishing substandard practice. However, a correlation between bad care and litigation risk has been difficult to establish, either for individual practitioners or for institutions. Researchers tallied tort claims filed against 1465 nursing homes belonging to five large U.S. chains during 1998–2006. Overall, weak but significant inverse correlations were found between risk for being sued and 5 of 10 commonly accepted measures of quality care, including compliance with federal standards, staffing ratios, and clinical indicators such as rates of pressure ulcers and falls. These correlations persisted in low-litigation environments but vanished in high-litigation environments. Further, the actual numerical differences were quite small: ...

Can We Prevent Transmission of Drug-Resistant Bacteria in Hospitals? Two large studies on active screening for drug-resistant bacteria produced strikingly different results. How to limit the spread of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) in the healthcare environment remains unclear. This issue was recently addressed in two large clinical studies. In a cluster-randomized trial involving 18 U.S. adult intensive care units (ICUs), Huskins and colleagues (with partial industry support) examined the effect of MRSA and VRE surveillance. In the 10 intervention ICUs, patients known or found to have MRSA or VRE colonization or infection were managed with contact precautions; all other patients received care with universal gloving pending the results of the screening studies. In the eight control ICUs, standard institutional protocols for managing MRSA and VRE were followed. Routinely scheduled surveillance cultures wer...

這是全聯會所提修正醫療法內容，有關醫療刑責的，給立法院的說帖… 內容蠻好…… 其實我們平時對外說明，也好有個準則 Q1：為何需要增修醫療法第82條第2項，現行法令有何不妥？ A1：醫療糾紛無法解決－ 現行法律規範，造成廣泛以刑逼民之法現實， 刑法成為索求賠償或和解之威嚇工具，卻仍無法徹底解決民眾於醫療糾紛中之損害賠償問題 。畢竟，刑法與民法填補損害之目的不同，法官於刑事判決時，須達無可置疑（Beyond a Reasonable Doubt）之心證始可為有罪判決， 透過刑事訴訟解決賠償糾紛，反而使民眾經由勝訴獲得賠償的機率不高，同時也影響醫師庭外和解的金額與意願 。 醫療環境每況越下－ 現行法律規範不分過失輕重，一律以刑法繩之，刑責又對醫師生涯影響巨大，醫師只好藉著醫療行為的改變，避免事後可能面臨的過失責任。例如在治療過程中，多作檢查以保周全、或對急診或複雜的重症，更加小心的權衡自己的能力及體力，在 稍有力所不及之疑慮時即予建議轉診 等。更嚴重的是無人願意涉足高風險的專科，內外兒婦的人力空窗，已非空談，而是每位民眾未來就醫時皆將面臨之窘境。 Q2：目前醫師因現行法令而被判刑的情況如何？ A2：依據陽明大學公共衛生研究所楊秀儀博士與劉邦揚碩士的實證研究 ，台灣自2000年1月1日起至2008年6月30日止，所有地方法院對醫師之醫療糾紛所做成之刑事判決書，計312名醫師被告。每個案件從醫療傷害發生時起到一審判決作成日止，平均需要經過3.12年 。在312名醫師被告中，有232名被告（74.4%）是無罪判決；80名被告（25.6%）被判有罪，刑期最高者為3年，最低者為拘役10天，所有有罪被告之平均刑期為6.7個月。有罪被告中有64人（80%）被宣告緩刑或可易科罰金，實際有入監服刑風險者僅有16人（20%）從被告醫師的科別來看，以外科最多，共計82人（26.3%），其次為內科64人（20.5%）、婦產科50人（16%）、急診醫學科40人（12.8%）、骨科23人（7.4%）、兒科10人（3.2%）。 有論者 從而認為，該研究雖僅搜集台灣地方法院刑事醫療糾紛判決，故案件尚未定讞，有部分案件上訴後被判無罪。然而，小小的臺灣在八年半內竟有八十位醫師被地方刑事法院判決「有罪」，每23.5天有一位醫師被判決「有罪」。臺灣醫師在地方法院刑事醫療糾紛判決之「有罪率」竟高達25.6%。這更...

此為法國study，心外手術後病人，此篇一出也許提倡早切者會稍受挫。若可apply to ARDS病人，則治療2星期仍是可接受的，不需太早promote急切 然則臨床判斷仍要緊 Early Tracheotomy vs. Prolonged Intubation and Late Tracheotomy Outcomes were similar with both approaches in patients requiring mechanical ventilation. Proponents of early tracheotomy (during days 3–6 of mechanical ventilation) say it lessens morbidity and mortality relative to prolonged intubation and late tracheotomy (at approximately 2 weeks), but evidence is unclear. In this single-center trial from France, 216 patients who underwent cardiac surgery and were expected to require prolonged mechanical ventilation were randomized to early tracheotomy or prolonged intubation and late tracheotomy (if mechanical ventilation was necessary beyond 15 days). All patients were managed with strict sedation and weaning protocols. At 60 days, no difference was noted in ventilator-free days between groups. In addition, no significant differences were observed in mortality at 60 or 90 days, fre...