Quantity and Quality Relationships in Cardiovascular Medicine

Hospital volume and often also operator volume have documented impacts on the quality of care for aortic and aortocoronary bypass surgery, for percutaneous angioplasty and for radiofrequency ablation for arrhythmias, whereas data are less consistent for treatment of acute myocardial infarction. A review of this research is given. In the Nordic countries hospitals are small, and often the plateau of the learning curve cannot be reached. To discourage low-volume centers from embarking upon too complicated interventional or surgical procedures, the author suggests that a minimal number should be set for certain major procedures, both for hospitals and for physicians.     

Principles of Anesthesia Monitoring—Body Temperature

In this article we discuss the importance of monitoring body temperature. Some effects of hypothermia are covered, along with the benefits of careful monitoring. Also discussed are the basic use and application of the most common monitoring methods, as well as the methods we used to help maintain body temperature.     

PBL联合情境模拟教学法在术中低体温干预护理行为指导中的实践分析

目的 探究PBL联合情境模拟教学法运用于护理人员术中低体温干预护理行为指导中的实践效果。方法 于2016年3月至10月间,采用便利抽样法,按照纳入标准随机选取新疆乌鲁木齐市两所三级甲等医院手术室护理人员作为研究对象。观察组35名,采用PBL联合情境模拟教学干预方法；对照组32名,采用传统方法。结果 观察组与对照组护理人员对术中低体温干预护理的认知现状、安全文化态度与行为现状评分及术中低体温发生率差异有统计学意义(P<0.05)；观察组麻醉后与结束时鼻咽温与肛温平均值差异无统计学意义(P>0.05)；对照组麻醉后与结束时鼻咽温与肛温差异有统计学意义(P<0.05),且结束时鼻咽温与肛温低于麻醉后；观察组变化趋势较对照组者平稳。结论 PBL联合情境模拟教学法利于改善手术室护理人员对术中低体温的认知现状、安全文化态度与行为现状,能有效预防术中低体温的发生,充分保障手术患者安全。     

Hypoxic–ischaemic brain injury following cardiac arrest

Hypoxic–ischaemic brain injury (HIBI) has become an increasingly common cause of admission to intensive care units and prolonged or permanent neurological disability. It is essential to provide an accurate prognosis to guide management. Clinical assessment is often difficult and ancillary investigation is necessary. Outcome depends on the severity of the initial insult, the effectiveness of immediate resuscitation and transfer, and the post-resuscitation management on the intensive care unit. Some patients remain profoundly impaired and others may develop complications including myoclonic epilepsy, cognitive impairment, border-zone infarction and movement disorders. The management of patients with HIBI presents considerable clinical, ethical and legal difficulties.     

Medico-legal considerations in the context of neonatal encephalopathy and therapeutic hypothermia

Neonatal encephalopathy (NE) is a significant complication of the peripartum period. It can lead to lifelong neurologic disabilities, including cerebral palsy, cognitive impairments, developmental delays, and epilepsy. Induced hypothermia is the first therapy, which has shown promise in improving the outcomes for neonates with moderate to severe NE following a presumed intrapartum insult.NE is also a frequent source of medical malpractice litigation. In this paper, we will review salient features of the American Tort System as it pertains to medical malpractice. We will discuss the obstetric medico-legal implications of therapeutic hypothermia and suggest a five-step approach to analyzing neonatal cases for causation, etiology, timing of occurrence, responsibility, and liability. We will close with three illustrative clinical cases.