The pathophysiology and therapy of menopausal symptoms

Menopause is generally experienced as a biopsychosocial process involving physiological changes, and influenced by a wide range of psychological, social and cultural factors. The loss of ovarian oestrogen production may cause debilitating symptoms, including hot flushes, night sweats, sleep disturbance, vaginal dryness, dyspareunia, bladder dysfunction, loss of libido, and mood changes. Experience of the menopause transition varies widely between individuals, depending on the age of onset, personal health and wellbeing, social context, environment and culture.Hormone Replacement Therapy (HRT) remains the most effective treatment for the management of vasomotor symptoms and vaginal dryness, but has no proven role in the treatment of chronic diseases of ageing. Treatment should be individualized, and for most healthy women aged 50–59 years the risks of HRT are low. An understanding of the pathophysiology of menopausal symptoms and the risks and benefits of both hormonal and non-hormonal treatments assists in the individual management of patients.     

Atrial functional tricuspid regurgitation: An underappreciated cause of secondary tricuspid regurgitation

Secondary tricuspid regurgitation (TR) caused by right ventricular enlargement in the setting of left heart disease/pulmonary hypertension has been well described. In contrast, that associated with right atrial enlargement—atrial functional TR (AF‐TR)—remains largely underappreciated. AF‐TR most often occurs in the setting of lone atrial fibrillation, although it is also seen in its absence (idiopathic AF‐TR). Several recent studies have found that the prevalence, hemodynamic significance, and prognosis of AF‐TR are not inconsequential, suggesting increased physician awareness of this novel clinical entity is warranted. This article discusses the pathogenesis, echocardiographic findings, and treatment of this underappreciated cause of secondary TR.     

心脏瓣膜置换术后患者的出院准备度现状及其影响因素分析

目的:调查心脏瓣膜置换术后患者的出院准备度现状,并分析其影响因素。方法:于2018年9月至2019年3月用一般资料、出院准备度量表、出院指导质量量表对139例瓣膜置换术后患者进行调查。结果:心脏瓣膜置换术后患者的出院准备度总分为(89.51±8.53)分,与出院指导质量呈正相关;多元回归分析显示,主要照顾者、婚姻状况、工作状态、服药种类、出院指导质量为出院准备度影响因素。结论:心脏瓣膜置换术后患者的出院准备度有待提高,患者感知的个人状态得分不理想;护士应鼓励患者配合进行早期康复,强化出院指导,采取有效措施提供康复信息,满足患者及其家属需求,提高出院准备度。     

Is routine extubation overnight safe in cardiac surgery patients?

Objectives

Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database.

Management of Valvular Heart Disease in Adults: Implications for Nurse Practitioner Practice

Valvular heart disease affects patients of all ages, with the highest incidence in patients older than 75 years. The nurse practitioner, whether in the primary or acute care setting, plays a vital role in the detection, monitoring, and shared decisions in treatment options. Assessment skills in conjunction with appropriate testing can identify patients early in the trajectory of the disease. The purpose of this article is to provide tips for history-taking and physical exam techniques, identify appropriate diagnostic testing, and review treatment options for adults with valvular heart disease.