〔藥師週刊〕加入糖尿病共同照護網，您準備好了沒?

[MK]

http://ys34485257.imgshelf.com/1833/1833-1-2.htm

[fatorange]

藥師加入DM共照網可以多申請甚麼嗎?

[李誠民]

至少有許多降血糖藥(口服或注射)都有其副作用,....作有名的是Avandia精美國兩次植灣加會議後,還是保不住---下市;;現在還有新作用機轉專利藥,陸續上市,是否有Post-Marking 副作用出現,可說是肯定的;....Drug就是種商品(對Drug Industry來說),就會競爭,仿冒(合法?or不合法?)等問題,最後就看您的國家是否有實力(G8--G20)?!
所以訴訟是不會減少的(世界先進國家,台灣?!),這是藥房潛在利益!!!
另外可以銷售許多健康保健食品(Diet Supplements),有時不見得會比醫師處方藥,來德國人信任,;就是簡單的 醫-病關係的建立,只是改為藥-病關係(?那還要讀醫學院,幹嘛 醫-病關係的建立,只是改為藥-病關係(?那還要讀醫學院,幹嘛?!)....
醫師因為利潤不足(銷量有限!),但在藥師就成為吸引力(削價競爭?!...連鎖藥局...藥廠直銷....),品質會保嗎???--請教滕女士???--公衛專家,衛教內容(醫師會指導用藥---苦口婆心! 藥師也取得專業資格,也苦口婆心!?),請問加上政府公權力介入,病人會聽醫師的 ?還是藥師的?!!!......
大腸癌防制前些時候,不是開放給藥局也能取"糞便"檢查,最近不是本網站::有人發言說國健局提高誘因(多少?!),再回頭鼓勵鎮所配合?!(真的嗎?),國民黨應下台了!!有個Bumbler就夠了!!...十月又要油(本月!!) 電雙漲,營業稅漲, 健保稅(費?)也在蠢蠢欲動....Bumbler 永遠是Bumbler,習性難改(不可能改!!因為他都是對的!!!)

[李誠民]

Chronic kidney disease controversy: how expanding definitions are unnecessarily labelling many people as diseased
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4298 (Published 30 July 2013)
Cite this as: BMJ 2013;347:f4298

前兩三年,本網站有"健康電子報"主編曾討論"慢性腎臟病防治講習班"是否須參加?討論了近一年,我知道只會混淆參予的醫師(基層醫師),我相當清楚,因為我是腎臟科醫師,對美國Kidney Fundation運作相當了解!!
最後就是我的慢性腎臟病惡化以前叫chr. renal insufficience with Acute Exacerbation?),就是有突發的腎功能短期內惡化,要積極尋找原因(不難?!腎臟科的ABC),排除後,80-90%可避免透析治療,但是短期腎功能惡化, 往往是人為的因素(IATROGENIC).......怎辦?!...就是繼續騙下去!!!.....
WHO訂四月第二個星期四(?)為腎臟日(Kidney Day)--誰在操作的????....今年的Kidney Day 定為急性腎傷害(Acute Kidney Ingury AKI)為目標,所以防治慢性腎衰竭又走回原點,Serum Cr.升高0.5-1.0(甚至0.3)mg%,就定義是一條件,;......台灣健保規定,基層醫師感根據病史(歷)做個Serum Cr.檢查,既簡單又不昂貴,確實用性很大---決定是否轉診的條件!!!......台灣再不遵重醫師的專業性,只知以點值控制健保財務膨脹,舊制有愈浪費健保醫療資源!!!!.......

Summary box
• Clinical context—Concern about the late presentation of kidney disease and missed opportunities for earlier intervention
• Diagnostic change—A novel framework defining and classifying “chronic kidney disease” (CKD) introduced in 2002 and modified in 2012, based largely on laboratory measurements of kidney function and damage
• Rationale for change—Identifying chronic kidney disease early would slow progression towards total kidney failure and provide an opportunity to prevent associated illness, particularly cardiovascular disease
• Leap of faith躍過—Identifying, monitoring, and treating the newly described chronic kidney disease will improve survival and quality of life
• Increase in disease—The new definition labels over 1 in 8 adults (around 14%) as having chronic kidney disease. Before 2002 the lack of a consistent definition made prevalence estimates unreliable, but one US study suggested a figure of 1.7% of the population.
• Evidence of overdiagnosis—The combination of the large numbers now labelled as having chronic kidney disease with low rates of total kidney failure suggest many of those diagnosed will never progress to symptomatic forms of kidney disease
• Harms from overdiagnosis—Psychological effect of a disease label and the burden and costs of repeated assessment, testing, and potentially unnecessary treatment
• Limitations—Lack of prospective data evaluating the benefits and harms of testing for, monitoring, and treating the early stages of chronic kidney disease
• Conclusions—Clinicians should be sceptical about the current definition of chronic kidney disease and cautious about labelling patients, particularly older people