Bakgrund: En av de vanligaste orsakerna till att människor söker sig till sjukvården är smärta. Det är ett symptom vid många sjukdomar vilket påverkar patienternas livskvalitet. Upplevelsen av smärta är subjektiv och ska behandlas då otillräcklig smärtbehandling orsakar lidande hos patienten med potentiella skadliga fysiologiska och psykologiska konsekvenser. Sjuksköterskan har en viktig roll i hanteringen av patienternas smärtbehandling och deras främsta uppgift är att tillgodose patientens omvårdnadsbehov. Bedömning av smärta är väsentligt för att uppnå en god och effektiv smärtbehandling. Syfte: Syftet med denna studie var att utforska sjuksköterskors kunskap och attityd relaterat till akut smärta. Metod: Litteraturöversikt. Resultat: Sjuksköterskans kunskaper angående smärtbehandling är bristfällig. Det fanns rädslor och felaktiga uppfattningar kring opioider som begränsade användandet. Sjuksköterskan verkade i regel underskatta sanningshalten i patientens uppgivna smärta och tyckte att deras bedömning kring patientens smärta var mer riktig än patientens subjektiva upplevelse. Slutsats: Sjuksköterskornas kunskap om smärtbehandling var bristfällig. Sjuksköterskor gjorde en egen uppskattning av patientens smärta istället för att lyssna till patientens subjektiva upplevelse. Klinisk betydelse: Studien kan väcka tankar och funderingar hos sjuksköterskan eller sjuksköterskestudenten som får denne att reflektera över sin egen attityd och värderingar gentemot smärtbehandling. Det är viktigt att sjuksköterskan är medveten om hur förhållningssätt påverkar bedömningen i omvårdnaden. / Background: One of the most common reasons why people seek health care is related to pain. Pain is a symptom of many diseases and it effects the quality of life for the patients. Experiencing pain is subjective and should be treated, insufficient treatment causes the patient suffering and that can lead to physiological and psychological consequences. The nurse has an important role in the management of the patients‟ pain treatment since it is their main assignment to nurse the patient. Assessment of pain is key to achieve good and effective pain treatment. Aim: The purpose of this study was to explore nurses´ knowledge and attitude related to acute pain. Method: Literature overview. Result: The nurses´ knowledge regarding pain management were inadequate The limited use of opiods was related to fear and faulty views. The nurses underestimated the truthfulness in the patients assessment. The attitude reflected that the nurses´ view of assessment was more accurate than the patients own subjective perception of pain. Conclusion: The overall picture of the results indicated that nurses' knowledge about pain relief was insufficient. There were fears and erroneous beliefs about opioids that limit their use. Perception of pain differed between the ideal picture from research and the applied clinical setting. Nurses seemed to be afraid of the side effects of opioids, and they were afraid that patients would develop an addiction. In general, the nurses´ attitude seemed to be that, in a clinical setting, the nurses´ professional assessment of a patient's perception was more reliable than the patient's expression of their perception of pain. Relevance to clinical practice: The study can enlighten the nurse or the nurse student and get them to reflect about their own attitude and values regarding pain treatment. It is important that nurses are aware that their approach effects their assessment in their nursing.

Skausmo malšinimas yra nenauja ir iki šiol aktuali problema visame pa¬saulyje, o oligoanalgezijos reiškinys, deja, yra taip pat dažnas. Mokslininkai atliko ne viena studiją ir pasiūlė būdus, kaip galima būtų išgyvendinti šį reiškinį, tačiau skausmo gydymo rekomendacijų diegimas neduoda reikiamo efekto. Tikėtina, kad nusi¬stovėjusios vietos tradicijos ar žmonių požiūris gali lemti, tai, kad įrodymais grįstos rekomendacijos yra nepilnai pritaikomos praktikoje. Todėl šiame tyrime ieškoma svarbių ūminio nediferencijuoto pilvo skausmo, klinikinių skausmo charakteristikų ir veiksnių, lemiančių ūminio pilvo skausmo efektyvų gydymą universitetinės ligo¬ninės skubios pagalbos skyriuje. Tyrimo uždaviniai: 1. Ištirti pacientų, patiriančių ūminį nediferencijuotą pilvo skausmą, klinikines skausmo charakteristikas atvykstant ir išvykstant iš universitetinės ligoninės skubios pagalbos skyriaus. 2. Įvertinti ūminio pilvo skausmo malšinimo tendencijas universite¬tinės ligoninės skubios pagalbos skyriuje ir palyginti jas su šalyje galiojančiomis rekomendacijoms. 3. Nustatyti skirtumus tarp paciento subjektyvaus pilvo skausmo stip¬ru¬mo vertinimo ir slaugytojų bei gydytojų paciento patiriamo skaus¬mo stiprumo vertinimo. 4. Ištirti stipriųjų analgetikų (morfino) poveikį neaiškios kilmės ūminio pilvo skausmo malšinimui skubios pagalbos skyriuje ir paly¬ginti jo efektyvumą su nesteroidinių vaistų nuo uždegimo (diklo¬fenako) ar placebo. / The problem of pain is not new, it remains an important global issue, and a phenomenon of oligoanalgesia, unfortunately, is also common. Different researchers conducted studies and suggested different ways to eradi¬cate this phenomenon. However, the question why patients with acute abdominal pain are treated inadequately, even with clear evidence that the treatment will not cause any adverse effects so far remains unanswered. Researchers of this study have hypothesis that the well-established local tradition or people's attitudes can lead to the fact that evidence-based guidelines are not fully applied in practice. This study investigates clinical characteristics of pain in patients with acute undifferentiated abdominal pain and to identify the factors influencing effective management of acute abdominal pain in the ED at university hospital. Objectives of the study 1. To investigate clinical characteristics of pain in patients with acute undifferentiated abdominal pain upon arrival and departure from the ED at university hospital. 2. To evaluate the trends of acute abdominal pain relief in the ED at university hospital and to compare them with current guidelines. 3. To identify differences in subjective pain intensity rating between patients with abdominal pain and assessment of nurses and doctors. 4. To investigate effect of strong analgesic drugs (morphine) for acute abdominal pain management in the ED and compare their efficacy versus NSAIDs (diclofenac) or placebo.

Diploma thesis is focused on the choose of methods and optimalisation analysis procedure of selected pharmaceuticals (salicylic acid, ibuprofene, naproxene, ketoprofene and diclofenac) in surface and waste water by using gas chromatography with mass spectrometer (GC-MS). Solid-phase extraction (SPE) with Oasis HLB cartridges was used as an extraction method in this analysis. Extraction is followed by derivatization and their optimalization of selected pharmaceuticals. Derivatization and its optimalization were performed by two silylation reagens N-methyl-N-(trimethylsilyl)trifluoroacetamide (MSTFA) and N,O-bis(trimethylsilyl)trifluoroacetamide (BSTFA). Different volumes of derivatization reagents, different temperatures and different times were used during the procedure. The best combination is then used for analysis of real samples. Real samples of waste water were collected in sewage treatment plants in Brno – Modřice and real samples of surface water were collected from several rivers and one pond in region Moravia. This thesis also presents and tests SPE methods for extraction and concentration selected sulfonamide residues (sulfamethazine, sulfamethoxazole, sulfapyridine and sulfathiazole) from the aquatic environment.

From viewpoint of environmental analysis in the whole world became popular in the latest years the question of drugs’ breakthrough to the component of environment. These contami-nants belong to the biological active compounds, with different physical-chemical and biolog-ical properties and evince great tendency to bioaccumulation. They penetrate to the environ-ment because of their increasing of usage and wrong techniques of liquidation. The most often use drugs are preparations against pain – analgetics, and from this category there are non-steroidal anti-inflammatory drugs. The frequent usage of this compounds relate to their easy accessibility. From this large group of compounds was chosen for monitoring: diclofenac, ibuprofen, ketoprofen, salicylic acid, naproxen and acetaminophen; because they include in favorite preparations. The monitoring matrix was the wastewater from two waste water treat-ment plants (WWTP). The sampling was performed in inflow and outflow because the com-paring of concentration of selected contaminants and discovering of efficiency of removing the polutants reliance on treatment technology. For extraction of selected contaminants was used solid phase extraction (SPE) and for determination was used capillary zone electrophore-sis (CZE) with diode array detection (DAD). There was identified and quantified all of se-lected analgetics in inflow and so in outflow of WWTP. That means, this polutants infuse into surface water and then into other components of environment.

This diploma thesis is based on the current issue of the presence of pharmaceuticals in various components of the environment. Concerning the contamination by residues of pharmaceuticals the most affected environment is the aquatic environment where these substances leaks especially from wastewater treatment plants, which eliminate them during the cleaning process only partially. This work is focused on the selected group of pharmaceuticals, non-steroidal anti-inflammatory drugs (salicylic acid, ibuprofen, caffeine, naproxen, ketoprofen, diclofenac) in waste water. For analysis purposes two types of sampling were used and compared: the conventional spot sampling of wastewater and the sampling using passive samplers POCIS. The sampling took place at the inflow and outflow of the wastewater treatment plant in Brno Modřice. The solid phase extraction (SPE) using Oasis HLB columns was used as the extraction method. Extracted sample was derivatized then. Derivatization agents were: MSTFA (N-methyl-N-(trimethylsilyl)trifluoroacetamid) and BSTFA (N, O-bis(trimethylsilyl) trifluoroacetamid). The final analysis was performed using gas chromatography with mass spectrometric detection Time-of-Flight (GC/TOF-MS).

To determine the ecotoxicity of analgetics, first the individual ecotoxicity values of individual analgetics are determined and then a mixture of two analgetics is tested. To determine the toxicity, both standard and alternative toxicity tests are used (daphnia magna, sinapsis alba, scenedesmus subspicatum, vibrio fischeri, thamnotoxkit FTM a daphnotoxkit FTM magna). The analgetics being whish tested are the commonly used medicines ibuprofen, ASA, diclofenac and paracetamol, which are the most frequently used medicines in the Czech Republic and whole Europe. To determine the ecotoxicity of the polymers, I‘m using an indirect method of examination, in which I determine the antagonistic or synergistic effects of the mixture of monomers from which the polymer is prepared and into which it slowly decomposes in nature. For the determination both standard and alternative toxicity tests are used. The polymers the toxicity of which is being determined are the habitually used polymer PET and the formaldehyde resine known as bakelite in Eastern Europe.