Non-pharmacologic treatment of atrial fibrillation

The authors provide an update on non-pharmacological treatment of atrial fibrillation (AF). They emphasize that although antiarrhythmic drugs continue to be first-line therapy for the arrhythmia considered to be a cardiovascular epidemic, clinical research to develop non-pharmacological means of treatment has been unprecedentally intensified during the last decade. Electrical cardioversion is the most successful non-pharmacological method to restore sinus rhythm, also the efficacy and safety of AV node ablation for palliative ventricular rate-controll is established. "Hybrid" therapeutic procedures, involving combinations of pharmacological and non-pharmacological interventions have gained widespread use. Curative transcatheter ablation for arrhythmia prevention is to be considered in case of clinical suggestions that AF is initiated by a primary regular arrhythmia that is amenable to routine catheter ablation (secondary AF). Despite encouraging results, at this point in time, curative catheter ablation for primary AF may offer significant improvement or even cure only for a small subset of patients, mostly young individuals with normal heart, and paroxysmal AF with frequent, symptomatic episodes refractory to multiple antiarrhythmic drugs. These interventions are to be performed in the settings of a clinical research project in some institutions. Regarding pacemaker therapy in case of bradycardia indication, physiologic pacing (AAI or DDD) is associated with significantly lower incidence of atrial fibrillation than ventricular pacing. Large-scale randomized controlled trials are needed to assess the clinical value of specially designed implantable devices to prevent atrial fibrillation in patients with no conventional bradycardia indication. Also, technical optimization and proper clinical evaluation is needed for implantable atrioverters and implantable cardioverter defibrillators capable of atrial cardioversion therapy.     

Non-pharmacologic treatment of atrial fibrillation]

Curative non pharmacological treatment of AF includes MAZA anti arrhythmic surgery and ist different variants which are reserved to AF associated with mitral valve disease. Radiofrequency (RF) ablation of AF creating lesions mimicking the MAZE procedure is another curative treatment but its numerous complications lead to put it in stand-by. Focal AF radiofrequency ablation is the only curative method that has encouraging results. The development of the internal cardioversion led to the development of the implantable atrial defibrillator. In spite of the low energy used, the internal shocks are often painful and not well tolerated conducting to stop the use of these devices. Prophylactic atrial pacing among patients with interatrial conduction delay is well established by dual site pacing pioneers. After several attempts to restore sinus rhythm and the fail of drug therapy to reduce heart rate, the latest solution to prevent tachycardiomyopathy is the atrio-ventricular (AV) node modulation or ablation using RF energy.     

Care for the oncologic patient with chronic pain from the point of view of the nurse

This study aims to understand how nurses interpret the care given to cancer patients with chronic pain. The informers were eight nurses from a public hospital. Data were collected on the basis of semi-structured interviews and the analysis identified three analytical categories: the evaluation of patients' pain, the importance of multidisciplinary care and nurses' difficulties to care for these patients. The results show that nurses have difficulties to care for such patients and need to update their specific knowledge related to cancer, chronic pain and its treatment as well as their skills to deal with emotions in order to promote adequate psychological support.     

The role of nursing in percutaneous cervical cordotomy in the control of oncologic pain

Oncological pain is usually progressive and enabling. One third of the patients under treatment and two thirds of the patients with advanced cancer refer to pain. Generally treatment starts with non-opioids analgesic medicines and other drugs, passing to opioids with a progressive increase of the doses and neurosurgical procedures when recommended. Percutaneous cervical cordotomy is a neurosurgery procedure to treat unilateral cancer pain, especially in extremities, which gives immediate relief and low morbidity. The nursing professional plays an indispensable role in the effectiveness of this treatment. For this reason the author decide to report on this experience.     

A systematic review of measures for reducing injection pain during adult immunization

Objective

To evaluate the effectiveness of different pain-relieving interventions to reduce pain from immunization in adults.

Data sources

MEDLINE (1950 to October Week 3 2008) PsycINFO (1967 to December Week 1 2008), CINAHL (1982 to October Week 4 2008), EMBASE (1980 to 2008 Week 43) and the Cochrane Central Register of Controlled Trials (3rd Quarter 2008).

Review methods

Databases were searched for trials of pharmacological, behavioural, physical or operator-dependant techniques to reduce pain from immunization in adults. The primary outcome was pain as assessed by visual analogue scale or other numeric rating scale.

Results

Six studies representing 853 participants were identified. One study evaluating pharmacological interventions (lidocaine–prilocaine) found them to be effective in reducing pain from immunization. Similarly, two studies evaluating physical pain relieving techniques, either skin cooling interventions (Fluori-Methane^®) or tactile stimulation (manual pressure at the site of injection) found them to reduce pain. One study of jet injectors found them to be more painful than conventional needle and syringe. Neither freezing needles nor warming vaccines was found to be effective in reducing pain. No studies investigated psychological interventions or oral analgesics (acetaminophen and ibuprofen).

Conclusion

There was limited evidence to support the use of lidocaine–prilocaine, Fluori-Methane^® and manual pressure for reducing immunization pain in adults. There was limited evidence of more pain with jet injectors compared to needle and syringe. Due to limited data, we recommend further investigation of methods to reduce immunization pain in adults, primarily psychological and physical techniques.     

药品使用和费用问题及国内外控制措施

目前,无论是城市还是农村,无论是国内还是国外,无论是发达国家还是发展中国家,较高的药品费用是医疗卫生事业中出现的较为严重的问题。它直接阻碍了人群对于医院卫生服务的合理利用,致使因病致贫,因病返贫的人口增大。面对挑战,国内外专家提出了各种方案,以控制药品费用的过度增长。本文简要介绍了10种国内外控制药品费用的较为有效的方法。但是,这些方法只能提供一些参考,只有根据当地具体情况有选择吸收,科学地“扬弃”才可能取得较好的效果。     

SPS措施与我国农产品农药残留控制对策

近年来WTO成员在农产品和食品的市场准入方面越来越多地采用SPS措施。WTO/SPS措施通报量呈逐年增加趋势,虽然SPS措施可以很好地避免疾病、有害生物的传播,从根本上提高人们的福利,但是,由于采用的检疫方法在不同国家的差异,抑或其他技术的原因,SPS措施已经成为发展中国家农产品     

四种镇痛术用于手术流产的效果观察

目的　探讨镇痛术对手术流产的效果 ,预防人工流产综合征发生 ,镇痛术对子宫收缩及术中出血的影响。　方法　采用回顾性分析 2 0 0 0年 1月～ 2 0 0 3年 10月 ,5 0 0例孕龄 4 2～ 76 d自愿行手术流产 ,无并发症的妇女 ,分为 5组 :A组宫颈注射 2 %盐酸利多卡因加硫酸阿托品 ;B组氧化亚氮吸入麻醉 ;C组丙泊酚静脉注入麻醉 ;D组盐酸氯胺酮加硫酸阿托品、地西泮静脉注入麻醉 ;E组为对照组 ,5组均行负压吸引术流产。观察各组镇痛效果 ,宫颈扩张 ,人工流产综合征发生率 ,术中出血量 ,子宫腔收缩幅度 ,术后离院时间。　结果　 B、C、D组镇痛效果满意率为 10 0 .0 % ,C、D组宫颈扩张满意率为 96 .0 %、 93.0 % ,与对照组比较 ,差异有显著性 (P<0 .0 5 ) ,4组均无人工流产综合征发生 ;术中出血量和术后子宫收缩幅度 ,用药组与对照组比较 ,差异无显著性 (P>0 .0 5 ) ;C组术后离院时间较长 ,为 (35 .1± 8.2 ) min,与对照组比较 ,差异有显著性 (q=5 .0 9,P<0 .0 1)　结论　丙泊酚、盐酸氯胺酮静脉注入麻醉及氧化亚氮吸入麻醉镇痛效果优良 ,宫颈扩张满意 ,不增加术中出血量 ,不影响术后子宫收缩。 4种镇痛方法均可预防人工流产综合征发生     

慢性疼痛的评估及缓解对策

慢性疼痛是21世纪全球的主要健康问题,不但严重影响了患者的日常生活,更加重了公共医疗的经济负担。本文阐述了慢性疼痛的概念和分类,常用的评估方法 ,以及慢性疼痛的缓解对策。指出:缓解慢性疼痛的有效对策,就是打破疼痛的恶性循环:第一步,降低疼痛级别;第二步,建立一个长期的治疗方案,包括主流治疗法和身心治疗法。     

电容器行业铅职业危害综合治理效果评价

目的对电容器行业铅职业危害的综合治理效果进行评价,为探索有效的职业病防控方法提供依据。方法对电容器行业进行现场职业卫生调查,针对行业特点从生产工艺、卫生防护工程、职业健康教育和职业卫生管理等方面进行综合治理,治理前后检测作业场所空气铅浓度,铅作业工人作职业健康检查。结果喷金、撕纸和赋能作业场所的铅污染最严重,经治理3个工序的铅浓度大幅降低,检测点合格率分别由2.9%、3.6%、5.6%提高到45.5%、40.9%、52.4%(P<0.05),作业工人职业性铅中毒的检出率由8.7%降至0.3%(P<0.05)。结论采取的综合治理措施效果显著,适合在该行业推广。     

口腔内科门诊控制医院感染的措施和方法

探讨口腔内科控制医院感染的措施和方法,通过结合某院工作实际进行总结分析,提出健全感染制度和设施等措施,以保证口腔诊疗器械的清理质量和灭菌效果.     

The impact of patient-reported outcome measures in clinical practice for pain: a systematic review

Purpose

Patient-reported outcome measures (PROMs) have increasingly been incorporated into clinical practice. Research suggests that PROMs could be viewed as active components of complex interventions and may affect the process and outcome of care. This systematic review examines PROMs in the context of treatment for non-malignant pain.

Methods

An electronic search on: MEDLINE, EMBASE, PsycINFO, PsycARTICLES, Cochrane Library and Web of Science identified relevant papers (February 2015). The inclusion criteria were: focused on implementing PROMs into clinical practice, adults, and primary data studies. Critical interpretive synthesis was used to synthesise qualitative and quantitative findings into a theoretical argument.

Results

Thirteen eligible studies were identified. Synthesis suggested that PROMs may be included in the initial consultation to assess patients and for shared decision-making regarding patient care. During the course of treatment, PROMs can be used to track progress, evaluate treatment, and change the course of care; using PROMs may also influence the therapeutic relationship. Post-treatment, using PROMs might directly influence other outcomes such as pain and patient satisfaction. However, although studies have investigated these areas, evidence is weak and inconclusive.

Conclusion

Due to the poor quality, lack of generalisability and heterogeneity of these studies, it is not possible to provide a comprehensive understanding of how PROMs may impact clinical treatment of non-malignant pain. The literature suggests that PROMs enable pain assessment, decision-making, the therapeutic relationship, evaluation of treatment and may influence outcomes. Further research is needed to provide better evidence as to whether PROMs do indeed have any effects on these domains.

     

肿瘤专科医师培训构想

根据我国专科医师培训制度的设计,结合我国肿瘤防治特点,提出肿瘤专科医师培训的设想:肿瘤专科医师培训应采取分阶段培训方式,以肿瘤专科医院作为培训基地,将肿瘤的规范化治疗、综合治疗为亚专科培训的重点内容,以"专病专治"医师作为肿瘤专科医师培训的目标.     

重庆市天然气净化厂职业病危害工程防护措施分析

目的根据天然气净化厂的生产工艺特点,针对产生的主要职业病危害因素种类,提出相应的工程控制措施,从源头上降低职业病危害风险水平。方法对重庆市已建成并投产的大、中、小生产规模的5个天然气净化厂进行职业卫生学调查和检测。结果天然气净化厂存在的主要职业病危害因素种类有噪声、高温、粉尘和毒物,职业病危害因素检测结果基本符合国家标准要求,职业病危害工程控制措施主要包括自动控制、防毒、防噪、防尘和保温隔热措施等,从而使装置运行具有较高的可靠性和安全性。结论职业病危害工程控制措施效果较好,但部分设施仍需提高改进。