A short history of portal hypertension and of its management

The aim of our study was to review the changing trends in the treatment of complications from portal hypertension. A short history of portal hypertension and of the treatment of its complications is reported, underlying the most important achievements and changes.     

复用器械使用后保存方式与时间对清洗效果的影响

目的探讨复用医疗器械使用后安全有效的保存和清洗方法,保证复用医疗器械清洗灭菌质量,降低由这一途径引起的医院感染。方法采用人工污染方法,将新鲜血液污染后的复用医疗器械随机分为A1、A2、B1、B2、C1、C2、D1、D2、E1、E2共10组,每组污染器械又分为6个小组,分别放置1h、2 h、3 h、4 h、12 h、16 h后再采用不同清洗方法对污染的医疗器械进行清洗,对清洗后的医疗器械进行潜血阳性检查,以检验清洗效果.该实验重复3次,合计4500件实验器械。结果对不同保存方法,不同的放置时间段,不同的清洗方法清洗后的复用医疗器械,潜血阳性率差异有统计学意义（P〈0.01）,其中放置16 h,不加任何处理开放保存的器械采用多酶机清洗[1]潜血阳性率最高,为66.67%。5种保存方法在1 h内2种清洗方法清洗,潜血阳性率差异无统计学意义（P〉0.01）。浸清水或多酶洗液浸泡组的器械在16 h内2种清洗方法清洗,其潜血阳性率在各自组内比较,差异无统计学意义（P〉O.01）。开放保存组、干密闭组和喷酶保存组2种清洗方法清洗,潜血阳性率在各自组内比较,差异有极显著的统计学意义（P〈0.01）。结论污染的医疗器因存放方式、存放时间及清洗方法的不同,清洗效果有明显差异。     

Observing pain management practice on a medical unit following changes arising from an action research study

Aim. To describe pain assessment practice within a medical unit, to identify factors that may affect the assessment of pain and evaluate changes in practice. Background. Pain is a problem for patients in all areas of a hospital, but its assessment and management on medical units had not been investigated. An initial assessment of practice found that pain was not consistently assessed and managed on the unit. A variety of activities have been employed during an action research study to change pain management practice. Method. Naturalistic unstructured participant observation of nurses and structured patient interviews were conducted. Results. The need to communicate with many people led to interruptions, multi‐tasking and practical problems were observed which appeared to affect the provision of nursing care, in particular, the administration of medications. These factors also prevented a comprehensive assessment of pain, although the assessment of pain intensity appeared to have increased. Discussion. The constant activity and interruptions observed may make it difficult for patients to discuss their experience of pain in detail. These accepted, every day and taken‐for‐granted aspects of nursing observed appeared to reduce opportunities for comprehensive pain assessment. Conclusion. Pain assessment is one of a number of nursing activities, obtaining a pain score appears to have become routine practice. Nursing takes place in a complex environment, which may disrupt the provision of nursing care and impede communication. Relevance to practice. To increase nurses awareness of the complexity of every day practice, the numerous tasks required, interruptions to the provision of care and the resultant effect on pain assessment and management. They need to then identify and reflect on these factors prior to attempting to change their practice.     

心血管内科医护人员焦虑状况调查分析

目的探讨心血管内科医护人员的焦虑状况。方法采用焦虑自评量表(self-rating anxiety scale,SAS)对98名心血管内科医护人员进行问卷调查,并与国内常模比较。了解心血管内科医护人员焦虑状况。结果非焦虑者35名,占35.7%,焦虑者63名,占64.3%;心血管内科医护人员焦虑水平明显高于国内常模(P<0.05);心血管内科护士焦虑水平明显高于医生(P<0.05)。结论心血管医务人员心理健康状况与医疗职业特点密切相关,医护人员焦虑水平明显高于国内常模,护士焦虑水平明显高于医生,应切实提高其心理应对能力。     

Postoperative Heart Block in Children with Common Forms of Congenital Heart Disease: Results from the KID Database

Postoperative Heart Block in Congenital Heart Disease. Introduction: Cardiac conduction system injury is a cause of postoperative cardiac morbidity following repair of congenital heart disease (CHD). The national occurrence of postoperative complete heart block (CHB) following surgical repair of CHD is unknown. We sought to describe the occurrence of and costs related to postoperative CHB following surgical repair of common forms of CHD using a large national database. Methods and Results: Retrospective, observational analysis performed over a 10‐year period (2000–2009) using the Kids’ Inpatient Database (KID). Visits for patients ≤24 months of age were identified who underwent surgical repair of ventricular septal defects (VSD), atrioventricular canal defects (AVC), and tetralogy of Fallot (TOF). Patients were identified who were diagnosed with postoperative CHB, further identifying those requiring a new pacemaker placement during the same hospitalization. Costs associated with visits were calculated. There were 16,105 surgical visits: 7,146 VSD, 3,480 AVC, and 5,480 TOF. There was a decrease in postoperative mortality (P = 0.0001) with no significant change in postoperative CHB. Hospital stay and cost were higher with CHB and placement of a permanent pacemaker. Repair of AVC (OR 1.77; [1.32–2.38]) was associated with a higher rate of postoperative CHB. Length of hospital stay and total cost were significantly increased with the development of postoperative CHB and increased further with placement of a permanent pacemaker. Conclusion: There has been little change over time in the frequency of postoperative CHB in patients undergoing repair of VSD, AVC, and TOF. Postoperative CHB results in major added cost to the healthcare system. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1349‐1354, December 2012)