在現代外科實務中，我們今天認為是標準作業程序的手術，追溯到初期可能是激進創新。多年來，外科技術雖然已經有頻繁的修改，但往往是漸進式地。心臟和血管外科領域中的大多數創新並沒有導致日常實踐劇變。然而，在過去的幾年中，在我服務的醫院和全世界，我看到了治療腹主動脈瘤 (AAA) 的典範轉移，亦即主動脈腔內修復 (EVAR)。 相對於傳統開腹手術修復 （OSR），主動脈腔內修復較傳統開腹手術修復有顯著較低的手術死亡率。不過，長遠來說，總死亡率或動脈瘤相關死亡率並無差異；而主動脈腔內修復有較高的植入物相關併發症和必須再次手術的機率，且成本更高。然而，主動脈腔內修復還是成為腹主動脈瘤治療的支柱。這是為什麼？ 除了是激進的技術創新，主動脈腔內修復也是技術頓悟。傳統上，醫療服務是典型的技術輔助服務情境，其中包含兩個單獨的、然而是密切相關的溝通系統： 一個是產業與醫師之間，另一個是醫師與病人之間。醫師居於樞紐地位，不僅確保治療之執行，而且還要評估結果。由於現代資訊與通信技術的發達，病人可以方便地搜尋輔助醫療文獻資訊、線上資訊和個人社會網絡的意見。這就像是詮釋者的作用。這詮釋者的解釋對病人、外科醫生、和醫療產業界產生了實質上重大的影響，反之亦然。以前在這服務體系中互相分離的部分現在可以緊密地互相配合了，這與服務導向邏輯中價值共同創造的概念是不謀而合的。 總之，對多重利益相關者之意義提升是臨床醫療服務典範轉移的原因。在醫療行業中引入服務導向邏輯的概念的重要性，不論是在日常實務和創新策略上的意義都是不容忽視的。醫療服務中，多重利益相關者比以前更涉及共同創造價值的過程。未來的創新者除了專注在技術和科技上，更必須考慮該創新對多重利益相關者之意義提升。 / In modern surgical practice, what we consider as standard procedures today may be radical innovations dated back to the early days. Over the years, there has been frequent modification of surgical techniques, often incremental though, and most innovations in the field of cardiac and vascular surgery didn’t result in drastic changes in the daily practice. However, during the past several years, I have been witnessing a paradigm shift in the treatment of abdominal aortic aneurysm (AAA) in my hospital and worldwide towards endovascular aortic repair (EVAR). In comparison to the traditional open surgical repair (OSR), EVAR was associated with a significantly lower operative mortality than OSR. However, no differences were seen in total mortality or aneurysm-related mortality in the long term, and EVAR was associated with increased rates of graft-related complications and reinterventions and was more costly. Nevertheless, EVAR is becoming the mainstay of AAA treatment. Why is this? Except for being a radical technology innovation, EVAR is also a technology epiphany. Traditionally, medical service is a typical technology-assisted service encounter, consisting of two separate, however, closely inter-related communication systems: one between the industry and the physician, and the other one between the physician and the patient. The physician is of the pivot role that not only ensures the execution of treatment but also evaluates the results.With modern information and communication technologies, patients caneasily search information from paramedical literatures, online information, and opinions from personal social network. This serves the emerging role of an interpretor. This interpretors’interpretation has substantial influence on patients, surgeons, industry, and payers and vice versa. Previously separated parts in the service system now can be closely inter-related. This is in concordance with the concept of co-creation of value in service-dominant logic. It is concluded that newly defined meanings to multiple stakeholders are the reasons for paradigm shift in clinical medical service. The importance of introduction of the concept of service-dominant logic into the medical industry, both in daily practice and in innovation strategy can never be over-emphasized. Multiple stakeholders are being involved much more than before in the process of co-creation of value in medical service.Future innovators must concentrate on meanings to multiple stakeholders as well on techniques and technologies.

Kyoto University (京都大学) / 0048 / 新制・課程博士 / 博士(工学) / 甲第15343号 / 工博第3222号 / 新制||工||1485(附属図書館) / 27821 / 京都大学大学院工学研究科社会基盤工学専攻 / (主査)教授 宮川 豊章, 教授 朝倉 俊弘, 教授 河野 広隆 / 学位規則第4条第1項該当

京都大学 / 0048 / 新制・論文博士 / 博士(工学) / 乙第12857号 / 論工博第4104号 / 新制||工||1608(附属図書館) / 31537 / (主査)教授 宮川 豊章, 教授 河野 広隆, 准教授 山本 貴士 / 学位規則第4条第2項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(工学) / 甲第18691号 / 工博第3969号 / 新制||工||1611(附属図書館) / 31624 / 京都大学大学院工学研究科社会基盤工学専攻 / (主査)教授 宮川 豊章, 教授 河野 広隆, 准教授 山本 貴士 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DFAM

University of Macau / Faculty of Social Sciences. / Centre for Macau Studies

我國經濟犯罪之範圍，係由司法機關(司法院)與行政機關(法務部) 分別以作業性之行政規則頒訂，仍以侵害個人財產法益之金融犯罪為 規範對象。 就經濟犯罪所得，由於其性質屬於準不當得利之衡平措施，自應予以 追繳或抵償(再發還被害人或充公收歸國有)以修復正義，該行為只要 與法規範對立矛盾(即具有不法構成要件該當之違法性)即足，無庸探 究行為人之罪責要件。我國將犯罪所得規定為從刑，須待行為人(即 被告)受有罪科刑判決方能併宣告沒收，緩不濟急。 建議將犯罪所得追繳後發還被害人之個別法律，移置於刑法總則一體 適用，定性為強制處分，並將沒收、追繳、追徵或抵償自從刑之規定 刪除，另於刑事訴訟法宣示判決之條文增加發還被害人或得請求損害 賠償之人，且得由法院依職權或依檢察官之聲請權單獨宣告。 我國附帶民事訴訟受請求之被告，不限於刑事訴訟進行中之被告，尚包括「其他依民法應負賠償責任之人」，刑事庭法官遇有此種情形，因對渠等並無確定刑罰權有無及範圍之權限，在刑事訴訟程序的操作上格格不入，有仿襲德國刑事訴訟法第403條規定，被請求人應以刑事被告為限。 由於附帶民事訴訟規範之目的在避免雙重工作負擔及二次裁判，惟依 現行刑事訴訟法之規定，法官除刑事判決外，另需製作一份民事訴訟 判決，如此顯違反前揭附帶民事訴訟規範之目的；故正本清源之道， 乃無庸另製作一份附帶民事訴訟之判決，就犯罪不法利得，逕於刑事 判決主文中諭知發還被害人或給付若干金額予被害人。 被害人與加害人間共同參與之修復式司法近年來在世界各國實務及 學說均肯定其實踐層面之重要性，為具體落實憲法訴訟權應保障犯罪 被害人公平且有效的權利救濟途徑及程序主體性之地位，本文建議在 審理刑事案件之前階段即擴大強制調解及和解制度之運用，由被告及 被害人共同參與決定採取何種途徑最有利於促成實質修復正義之結 果，俾利被害人程序主體性之建立及擴大紛爭解決一次性之要求。 / Economic crime in Taiwan is defined by the administrative regulations of the Judicial Yuan and the Ministry of Justice, respectively. Such regulations are aimed at financial crimes that damage personal property. Because the proceeds of economic crimes are “quasi-kondiktionelle Ausgleichsmaßnahme”, the courts should seize the profits, and then use them to either compensate victims or confiscate them in the name of serving justice. So long as this offense is contradictory to criminal law (i.e. constituting the penal code and finding no specific legal cause for that offense), the courts need not review the problem of offender's guilt. As ill-gotten gains are stipulated as “Nebenstrafe” in the Taiwan penal code, the courts cannot confiscate those gains unless there is a simultaneous conviction, which seems too slow. The following suggestions are presented. The individual laws regulating “Verfall” and compensation to the victims should be reorganized in the penal code and characterized as “maßnahme”. The legal effect of these laws as “Nebenstrafe” should be deleted. The articles relating to the compensation of criminal proceeds to the victims should be increased as well. In addition, the courts should be allowed to announce verdicts either alone by its authority or according to the prosecutor’s request. In Taiwan, defendants accused during the adhesion process are not limited to being defendants in the process of criminal litigation, but also include other persons who should bear damages in accordance with civil law. When criminal court judges face this situation, since it is not certain whether there is a right to impose criminal punishment, or what the scope of punishment should be, there are inconsistencies in the operations of the criminal litigation procedure. There have been attempts to imitate Germany’s Criminal Litigation Law Clause 403, in which the accused should be limited to criminal defendants. The purpose of the rules on the adhesion process is to prevent a double workload and multiple judgments. However, according to existing requirements for criminal litigation, in addition to criminal judgments, judges must also make civil litigation judgments. This violates the aforementioned purpose of adhesion process rules. Thus, the way to rectify this situation is to create another adhesion process judgment based on the proceeds of crime, in order to assign restitution or to pay a certain amount to the victim, inside the main text of the criminal judgment. Restorative justice, in which the victim and offender jointly participate, has recently been affirmed in its importance, both in theory and in practice, all over the world. In order to concretely realize the principle that constitutional litigation rights should protect crime victims, as well as provide fair and effective remedial paths and procedural subjectivity, this study suggested that in the stage prior to judging criminal cases, there should be expanded use of enforced arbitration and mediation systems, in which the defendant and the victim jointly participate, in order to determine the best course for promoting restorative justice, to satisfy the demand for victim procedural subjectivity, and to expand the one-time character of dispute resolutions.