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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
31

Lust, hopp och saknad : Kvinnors upplevelser av sexualitet efter hysterektomi / Lust, hope and loss : Women's experiences of sexuality after hysterectomy

Dahlstrand, Anna, Söderblom, Sofie January 2014 (has links)
Kunskapen om kvinnors upplevelser avsexualitet efter hysterektomi ärbristfällig bland sjukvårdspersonal.Eftersom att sexualitet är ett komplextfenomen krävs vidare forskning för attbelysa kvinnors upplevelser och därmedforma vårdpersonalens bemötande ochvårdens tillvägagångssätt. Syftet medstudien var att utforska kvinnorsupplevelser av sexualitet efterhysterektomi. Studien utfördes som ensystematisk litteraturstudie därresultatet baseras på elva vetenskapligaartiklar. Resultatet redovisades genomtre teman: förändring av det sexuellagensvaret efter hysterektomi,sterilitetens inverkan på sexualitet efterhysterektomi samt känslor av kvinnlighet och självbild efter hysterektomi. Detframkom att sexualiteten är ettsubjektivt fenomen som av kvinnorupplevs vara en del av den kvinnligaidentiteten. Många kvinnor somgenomgått hysterektomi upplevde enbevarad eller förbättrad sexuell funktionpostoperativt. Några få kvinnorupplevde en kraftigt försämrad sexuellfunktion postoperativt, vilket verkadebero på fler faktorer än ingreppet.Många kvinnor ansåg att denreproduktiva förmågan var starktbunden till sexualiteten. I mötet medkvinnor som genomgått hysterektomibör sjuksköterskan ha ett holistisktsynsätt. Mer kunskaper om fenomenetsexualitet bör involveras i utbildningenav sjuksköterskor för att förbättraförmågan till kommunikation omintimitet. Vidare forskning av kvalitativkaraktär kring kvinnlig sexualitet behövsför att forma omvårdnaden efterkvinnors behov. / Knowledge about women’s experiencesof sexuality after hysterectomy isdeficient among healthcareprofessionals. Since sexuality is acomplex phenomenon further researchis required to illustrate women’sexperiences and consequently alter thebehaviour of the healthcareprofessionals and the approach ofnursing. The aim of the study was toexplore women’s experiences ofsexuality after hysterectomy. The studywas conducted as a systematic literaturereview in which the results were basedon eleven research articles. The resultsshowed that sexuality is a subjectivephenomenon that by women isexperienced to be a part of the femaleidentity. Women who have undergonehysterectomy were likely to experience amaintained or improved sexual function postoperatively. A few womenexperienced a severely impaired sexualfunction postoperatively, which seemedto depend on several factors other thansurgery. Many women considered thereproductive ability to have a strongcorrelation with sexuality. In themeeting with women who haveundergone hysterectomy, the nurseshould have a holistic approach. Moreknowledge about the phenomenonsexuality should be involved in theeducation of nurses to improve theability of communication about intimacy.Further research of qualitative characterabout the female sexuality is needed inorder to alter the nursing to women’sneeds.
32

Discharge information and the self-reported health of women following a hysterectomy

Warden, Sandra Elizabeth January 2004 (has links)
Aim: The aim of this study was to develop a targeted health information package for women to use specifically as a reference during their return to health following a hysterectomy and to subsequently test its usefulness. Method: A quasi-experimental design measured the effectiveness of this package in improving the health and satisfaction outcomes of women compared to those who received the standard information. Women undergoing a hysterectomy for benign reasons who were between the ages of 20 and 60 years were included. There were 55 participants recruited into the control group and 44 into the intervention group. Participants completed a self-administered questionnaire both prior to and 14-16 weeks post-surgery. Results: The study found that there were no statistically significant differences between the two groups for their self-reported health, the time taken to return to usual activities and the number of symptoms experienced after surgery. Clinical improvements, however, were noted in the intervention group. A statistically significant difference was found between the groups for the amount written information that they would have preferred for their recovery (X2 8.26 df2 p=0.011). Ninety percent (90%) of the women who received the intervention wanted the same amount of written information to take home whilst 40% of the control group would have preferred more written information. This indicated a positive effect from the intervention. An unexpected finding in this study was that almost 40% of both groups wanted more verbal information and discussion prior to discharge. Conclusion: A valuable aspect of this study was its usefulness in identifying the clinical importance of discussion as part of the discharge process. These findings will be important for health professionals to utilise in their clinical practice for women undergoing a hysterectomy.
33

Sexual dysfunction and other distressful symptoms in cervical cancer survivors /

Bergmark, Karin, January 2002 (has links)
Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.
34

Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal / Perioperative duloxetine to improve operative recovery after abdominal hysterectomy: a prospective, handomized, double-blinded placebo-controlled study

Castro-Alves, Lucas Jorge Santana de [UNESP] 19 February 2016 (has links)
Submitted by LUCAS JORGE SANTANA DE CASTRO ALVES null (lucasjca@yahoo.com.br) on 2016-03-31T14:43:33Z No. of bitstreams: 1 Lucas Castro Alves (Dissertação) pós defesa.pdf: 4559025 bytes, checksum: 56a8401144b4bdca801924351e4d5764 (MD5) / Approved for entry into archive by Sandra Manzano de Almeida (smanzano@marilia.unesp.br) on 2016-03-31T19:22:22Z (GMT) No. of bitstreams: 1 castroalves_ljs_me_bot.pdf: 4559025 bytes, checksum: 56a8401144b4bdca801924351e4d5764 (MD5) / Made available in DSpace on 2016-03-31T19:22:22Z (GMT). No. of bitstreams: 1 castroalves_ljs_me_bot.pdf: 4559025 bytes, checksum: 56a8401144b4bdca801924351e4d5764 (MD5) Previous issue date: 2016-02-19 / RESUMO Introdução. A qualidade de recuperação pós-operatória é pior em pacientes do sexo feminino quando comparado ao sexo masculino. A duloxetina vem sendo usada com sucesso no tratamento da dor crônica, mas para dor aguda existe apenas um estudo. Ainda mais importante é avaliar se a duloxetina é capaz de melhorar a qualidade global de recuperação pós-operatória. O principal objetivo do presente estudo foi avaliar o efeito da duloxetina perioperatória na qualidade da recuperação pós-operatória em mulheres submetidas à histerectomia abdominal. Métodos. O estudo realizado foi prospectivo, randomizado, duplo-cego e placebo controlado. Pacientes do sexo feminino submetidas à histerectomia abdominal foram randomizadas para receber duloxetina (60 mg por via oral 2 horas antes da cirurgia e 24 horas após a cirurgia) ou uma pílula idêntica de placebo. O desfecho primário foi a pontuação do QoR-40 (Quality of Recovery- 40) em 24 horas. Dor e o consumo de opioides foram os desfechos secundários. Um valor de P <0,05 foi utilizado para anular o erro de tipo I. Resultados. Setenta pacientes foram recrutadas, e 63 completaram o estudo. A diferença média (intervalo de confiaça-95%) na recuperação global QoR-40 (Quality of Recovery-40), entre a a duloxetina e o grupo do placebo em 24 horas era de 9 (4–20) (P < 0.001). O consumo total de opioides foi reduzida em 24 horas no grupo de duloxetina em comparação com o grupo placebo, mediana (intervalo interquartil) de 1 (0-5) mg de morfina EV em comparação com 5,5 (0,5-9) mg de morfina EV (P = 0,004). Náuseas, vômitos e tempo de alta da unidade de cuidados pós-anestésica não foram significativamente reduzidos no grupo duloxetina em comparação com placebo. Conclusões. A duloxetina melhora a qualidade de recuperação pós-operatória em histerectomia abdominal. Além disso, duloxetina reduz o consumo de opioide no pós-operatório mesmo com uma analgesia pós-operatória vi multimodal. A duloxetina parece ser uma estratégia farmacológica viável para melhorar a qualidade de recuperação pós-operatória em pacientes submetidas a histerectomia abdominal. / Background. Postsurgical quality of recovery is worse in female than that in male patients. Duloxetine has been used successfully for the treatment of chronic pain conditions, but its use for preventing acute postoperative pain has been limited to a single previous study. More importantly, the effect of preoperative duloxetine on global postoperative quality of recovery has yet to be evaluated. The main objective of the current investigation was to evaluate the effect of perioperative duloxetine on postoperative quality of recovery in women undergoing abdominal hysterectomy. Methods. The study was a prospective, randomized, placebo-controlled, double-blinded trial. Female patients undergoing abdominal hysterectomy were randomized to receive duloxetine (60mg orally 2 hours before surgery and 24 hours after surgery) or an identical placebo pill. The primary outcome was the quality of recovery-40 score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. A P value <0.05 was used to reject type I error. Results. Seventy patients were recruited, and 63 completed the study. The median difference (95% confidence interval) in global recovery scores (quality of recovery-40) at 24 hours after surgery between the duloxetine and the placebo group was 9 (4–20) (P < 0.001). Total opioid consumption was reduced at 24 hours in the duloxetine group compared with the placebo group, median (interquartile range) of 1 (0–5) mg IV morphine compared with 5.5 (0.5–9) mg IV morphine (P = 0.004). Nausea, vomiting, and time to postanesthesia care unit discharge were not significantly reduced in the duloxetine group compared with placebo. Conclusions. Duloxetine improves postoperative quality of recovery after abdominal hysterectomy. In addition, duloxetine reduces postoperative opioid consumption, even in the presence of a robust multimodal analgesic strategy. Duloxetine seems to be a viable pharmacologic strategy to improve postoperative quality of recovery in female patients undergoing abdominal hysterectomy.
35

Duloxetina para melhoria na qualidade de recuperação anestésica em histerectomia abdominal

Castro-Alves, Lucas Jorge Santana de January 2016 (has links)
Orientador: Norma Sueli Pinheiro Módolo / Resumo: RESUMOIntrodução. A qualidade de recuperação pós-operatória é pior em pacientes dosexo feminino quando comparado ao sexo masculino. A duloxetina vem sendousada com sucesso no tratamento da dor crônica, mas para dor aguda existeapenas um estudo. Ainda mais importante é avaliar se a duloxetina é capaz demelhorar a qualidade global de recuperação pós-operatória. O principal objetivodo presente estudo foi avaliar o efeito da duloxetina perioperatória na qualidadeda recuperação pós-operatória em mulheres submetidas à histerectomiaabdominal.Métodos. O estudo realizado foi prospectivo, randomizado, duplo-cego eplacebo controlado. Pacientes do sexo feminino submetidas à histerectomiaabdominal foram randomizadas para receber duloxetina (60 mg por via oral 2horas antes da cirurgia e 24 horas após a cirurgia) ou uma pílula idêntica deplacebo. O desfecho primário foi a pontuação do QoR-40 (Quality of Recovery-40) em 24 horas. Dor e o consumo de opioides foram os desfechossecundários. Um valor de P <0,05 foi utilizado para anular o erro de tipo I.Resultados. Setenta pacientes foram recrutadas, e 63 completaram o estudo.A diferença média (intervalo de confiaça-95%) na recuperação global QoR-40(Quality of Recovery-40), entre a a duloxetina e o grupo do placebo em 24horas era de 9 (4–20) (P < 0.001). O consumo total de opioides foi reduzida em24 horas no grupo de duloxetina em comparação com o grupo placebo,mediana (intervalo interquartil) de 1 (0-5)... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background. Postsurgical quality of recovery is worse in female than that in male patients. Duloxetine has been used successfully for the treatment of chronic pain conditions, but its use for preventing acute postoperative pain has been limited to a single previous study. More importantly, the effect of preoperative duloxetine on global postoperative quality of recovery has yet to be evaluated. The main objective of the current investigation was to evaluate the effect of perioperative duloxetine on postoperative quality of recovery in women undergoing abdominal hysterectomy. Methods. The study was a prospective, randomized, placebo-controlled, double-blinded trial. Female patients undergoing abdominal hysterectomy were randomized to receive duloxetine (60mg orally 2 hours before surgery and 24 hours after surgery) or an identical placebo pill. The primary outcome was the quality of recovery-40 score at 24 hours. Secondary outcomes included opioid consumption and postoperative pain scores. A P value <0.05 was used to reject type I error. Results. Seventy patients were recruited, and 63 completed the study. The median difference (95% confidence interval) in global recovery scores (quality of recovery-40) at 24 hours after surgery between the duloxetine and the placebo group was 9 (4–20) (P < 0.001). Total opioid consumption was reduced at 24 hours in the duloxetine group compared with the placebo group, median (interquartile range) of 1 (0–5) mg IV morphine compared with 5.5 (0... (Complete abstract click electronic access below) / Mestre
36

Autopercepção corporea e sexual de mulheres submetidas a histerectomia / Seff-perception corporal and sexual of women submitted to hysterectomy

Sbroggio, Adriana Magrin Rivera 07 April 2008 (has links)
Orientador: Paulo Cesar Giraldo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T12:50:20Z (GMT). No. of bitstreams: 1 Sbroggio_AdrianaMagrinRivera_D.pdf: 1067710 bytes, checksum: ee257ad4d227b8c5795865af0aac269d (MD5) Previous issue date: 2008 / Resumo: A cada ano o número de histerectomias vem aumentando gradativamente em todo o mundo. Para muitas mulheres a perda do útero poderá causar impacto emocional, despertando sentimentos de perda, inutilidade e destituição da condição feminina. Objetivo: Avaliar a autopercepção das mulheres submetidas à histerectomia relativa às modificações corpóreas, afetivas e sexuais. Pacientes e métodos: Cento e sessenta e quatro mulheres histerectomizadas há mais de três meses e até cinco anos - de diferentes níveis socioeconômicos - foram entrevistadas através de um questionário semi-estruturado. O trabalho abordou questões relativas à autopercepção das alterações corpóreas, afetivas e sexuais acerca da retirada do útero com a finalidade de verificar se o ato cirúrgico poderia associar-se a essas alterações. A análise de associação entre as variáveis foi realizada através dos testes de X2 e Exato de Fisher. O trabalho foi avaliado e aprovado pela Comissão de Ética e Pesquisa. Resultados: A média de idade das mulheres foi de 47,6 (±6,9) anos; 49,4% eram da religião católica; 59,1% foram submetidas à histerectomia por mioma e 17,7% das mulheres tinham menos de dois filhos. Menos de 10% das mulheres submetidas à histerectomia relataram insatisfação quanto ao procedimento, associada a possíveis transtornos sexuais e corporais. Não houve diferença significativa da autopercepção quanto a modificações afetivas e sexuais nas mulheres de diferentes níveis socioeconômicos. Apesar disso, constatou-se que a autopercepção corpórea de ¿rejuvenescimento¿ foi estatisticamente significativa. Conclusão: A satisfação de ser histerectomizada parece suplantar os medos e receios da ausência do útero e o fator socioeconômico parece não interferir quanto à percepção das mudanças corporais, sexuais e afetivas após a histerectomia. Palavras-chave: histerectomia, mulher, sexualidade / Abstract: Every year the number of hysterectomies gradually increases all over the world. For many women the uterus loss may cause emotional impact, awakening loss feelings, feelings of uselessness and of the feminine condition deprivation. Objective: To evaluate the self-perception of women submitted to hysterectomy in relation to corporal, affective and sexual modifications. Patients and methods: One hundred and sixty-four women who have undergone hysterectomies more than three months ago up to five years, among different socioeconomic levels, were interviewed using a semi-structured questionnaire. The research approached matters of self-perception in relation to corporal, affective and sexual alterations, concerning the uterus removal, aiming to examine if the surgical act may had been associated with these alterations. The association analysis among variables was accomplished through X2 and Fisher¿s exact tests. The research was evaluated and approved by the Ethics and Research Commission. Results: The women¿s average age was 47.6 (±6.9) years; 49.4% were Catholics; 59.1% were submitted to hysterectomy due to myoma and 17.7% had less than two children. Less than 10% of these women submitted to hysterectomy showed dissatisfaction towards the procedure associated to eventual sexual and corporal disorders. There weren¿t significant differences of self-perception related to affective and sexual modifications on women of different socioeconomic levels. In spite of this, it was observed that the corporal self-perception of ¿rejuvenation¿ was statistically significant. Conclusion: The satisfaction in undergoing hysterectomy seems to overcome the fears and concerns regarding the uterus absence and the socioeconomic factor seems to not interfere in the perception of corporal, sexual and affective changes after hysterectomy. Key-words: hysterectomy, woman, sexuality / Doutorado / Ciencias Biomedicas / Doutor em Tocoginecologia
37

Diferentes aspectos clínicos do uso do sistema intrauterino liberador de levonorgestrel / Different clinical aspects of the use of the levonorgestrel releasing intrauterine system.

Makuch, Maria Valeria Bahamondes, 1976- 04 April 2012 (has links)
Orientador: Ilza Maria Urbano Monteiro / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-19T23:33:10Z (GMT). No. of bitstreams: 1 Makuch_MariaValeriaBahamondes_D.pdf: 16535785 bytes, checksum: be3709b6137735be64ac9a6dfffdc1a5 (MD5) Previous issue date: 2012 / Resumo: Introdução: O sistema intrauterino liberador de levonorgestrel (SIU-LNG) é um contraceptivo altamente efetivo com benefícios não contraceptivos, entre eles o tratamento da menorragia. Restam dúvidas sobre o uso do SIU-LNG em mulheres nuligestas, especialmente no tocante à taxa de expulsão e o custo-beneficio para o tratamento da menorragia quando se compara com tratamentos cirúrgicos. Os objetivos deste estudo foram avaliar a facilidade de inserção e o desempenho clínico do SIU-LNG em mulheres nuligestas durante um ano de seguimento; verificar a correlação entre o comprimento da cavidade uterina e as taxas de expulsão em usuárias de dispositivo intrauterino com cobre (DIU TCu380A) e de SIU-LNG, e avaliar os recursos e procedimentos envolvidos na inserção do SIU-LNG quando comparado à realização da histerectomia em mulheres com menorragia atendidas em um hospital público do Brasil. Métodos: Foi feito o seguimento de duas coortes de mulheres que inseriram o SIU-LNG no mesmo dia, 159 nuligestas e 477 mulheres com filhos, pareadas na razão1:3. A inserção foi classificada em fácil ou difícil, e quando foi difícil avaliou-se o uso de velas de Hegar ou misoprostol, e as falhas de inserção foram registradas separadamente. O segundo estudo admitiu 235 mulheres nuligestas e mulheres com filhos que inseriram o DIU TCu380A ou o SIU-LNG, com o seguimento de um ano. O comprimento da cavidade uterina foi medido por histerometria e por ultrassom, e a taxa de expulsão foi correlacionada com o tamanho uterino. O terceiro estudo teve duas coortes de mulheres com menorragia, mulheres que inseriram o SIU-LNG (n=124) pareadas com mulheres que realizaram uma histerectomia (n=122). Avaliamos o número de procedimentos realizados em cada grupo antes de escolherem o tratamento, os que foram realizados para a inserção do SIU-LNG e/ou histerectomia, e os procedimentos decorrentes das complicações registradas após um ano de seguimento. Resultados: Em quase 80% dos casos não foi encontrada dificuldade na inserção do SIU-LNG e o uso de dilatadores e misoprostol não foi frequente; entretanto, o uso de dilatadores foi três vezes maior no grupo das nuligestas. Houve uma falha da inserção no grupo de nuligestas e duas no grupo de mulheres com filhos. Não houve uma única gravidez, a taxa de expulsão foi de aproximadamente 4/100 mulheres/ano e a taxa de continuação do método foi superior a 90%, em ambos os grupos, após um ano de seguimento. A medida do comprimento da cavidade uterina foi menor que 3,2cm em 2 usuárias e de pelo menos 3,2cm de comprimento em 87 usuárias de SIU-LNG, com taxas de expulsão de 0 (0,0%) e 2 (2,3%), respectivamente (p>0,999). A média de comprimento da cavidade uterina foi de 3,9cm ± 0,3cm por ultrassom entre as 10 mulheres que expulsaram o dispositivo, comparada com a média de comprimento de 3,9 ± 0,0cm naquelas que não expulsaram o dispositivo (p=0,799). No terceiro estudo, a idade e duração da menorragia foram significativamente menores no grupo de usuárias de SIU-LNG do que no grupo de mulheres que realizaram histerectomia. Os números de consultas ginecológicas e de coleta de citologia oncológica foram levemente maiores no grupo do SIU-LNG, mas as mulheres que realizaram histerectomia realizaram testes mais complexos, como exames de laboratório, ultrassom, radiografia de tórax e eletrocardiograma. No grupo da histerectomia as principais complicações foram: hemorragia (6), perfuração de bexiga/intestino (4), complicações anestésicas (1), reimplantação ureteral (1) e dor abdominal (2). Aos 12 meses de seguimento, a menorragia foi controlada em 83,1% das mulheres no grupo do SIU-LNG e 106 mulheres continuaram usando o dispositivo. Conclusões: O SIU-LNG mostrou-se um método seguro para uso em mulheres nuligestas. A inserção é um procedimento simples e o desempenho clínico foi bom em mulheres com e sem filhos. O comprimento da cavidade uterina não foi associado a maior risco de expulsão do SIU-LNG. Ambos os tratamentos, SIU-LNG e histerectomia, foram efetivos para controlar a menorragia. O grupo de usuárias de SIU-LNG usou menos recursos e teve menos complicações que o grupo da histerectomia. O SIU-LNG mostrou-se um bom método para reduzir o número de histerectomias e de recursos usados no tratamento de mulheres com menorragia / Abstract: Background: Despite the high contraceptive efficacy and the additional non-contraceptive benefits such as treatment of heavy menstrual bleeding (HMB) of the levonorgestrel-releasing intrauterine system (LNG-IUS), concerns persist with respect to its use in nulligravidas, the expulsion rate in this group and the cost-effectiveness when compare to surgical treatments in the treatment of HMB. The objectives of this study were to evaluate the ease of insertion and clinical performance of the LNG-IUS in nulligravida women up to one year after insertion; the correlation between endometrial cavity length and expulsion rate in acceptors of the TCu380A intrauterine device (IUD) or LNG-IUS; and to evaluate the resources and procedures involved in the placement of an LNG-IUS compared to performing hysterectomy in women with HMB in a public sector hospital in Brazil. Methods: Two cohorts were formed following LNG-IUS insertion, one consisting of 159 nulligravidas and the other of 477 parous women. Each nulligravida women was paired with 3 parous women who had an LNG-IUS inserted on the same day. Insertion was classified as easy or difficult and when classified as difficult, the use of Hegar dilators and/or misoprostol, and insertion failure were also recorded. The second study included 235 nulligravida and parous women who received a TCu380A IUD or LNG-IUS and who were followed up to 1 year. The length of the uterine cavity was measured by uterine sounding and ultrasonography, and the expulsion rate was correlated to uterine size. The third study had two cohorts of women: women who accepted an LNG-IUS (n=124) and a matched woman who underwent hysterectomy on the same day (n=122), due to HMB. We evaluate the number of procedures carried out in each group of women, including those performed before the decision was made to insert an LNG-IUS or to perform hysterectomy, the insertion of the device itself and the surgical procedure and the procedures and complications registered up to one year after LNG-IUS insertion or hysterectomy. Results: In almost 80% of cases, no difficulty was encountered during insertion, and dilators and misoprostol were seldom required; however, when necessary, dilator use was almost three-fold higher in nulligravida women. Insertion failed in one nulligravida women and in two parous women. The clinical performance of the device showed zero pregnancy rate, expulsion rates of ~4/100 women/year and one-year continuation rate of over 90% in both groups. When we measured the endometrial cavity, we showed that it was shorter than 3.2 cm in 2 LNG-IUS users and at least 3.2 cm long in 87 LNG-IUS users, with expulsions occurring in 0 (0.0%) and 2 (2.3%) of these women, respectively (p>0.999). The mean length of the endometrial cavity evaluated by ultrasonography among the 10 women whose devices were expelled was 3.9 ± 0.3 cm, compared with 3.9 ± 0.0 cm in those who retained their devices (P=0.799). On the third study, age and the duration of HMB were significantly lower in the LNG-IUS acceptors than women at the hysterectomy group. The number of gynecological consultations and Pap smears were similar in both groups; however, women in the hysterectomy group also underwent laboratory tests, ultrasonography, chest X-ray and electrocardiogram. In the hysterectomy group, the main complications were: hemorrhage (6), bladder/bowel perforation (4), complications with anesthesia (1), ureteral reimplantation required (1) and abdominal pain (2). At one year, HMB was controlled in 83.1% of women in the LNG-IUS group and 106 women continued with the device. Conclusions: The LNG-IUS was suitable for use by nulligravidas. It is simple to insert and its clinical performance in nulligravidas was similar to that found in parous women. The length of the endometrial cavity do not support the hypothesis of an association between uterine length and risk of LNG-IUS expulsion. Both treatments were effective in HMB control. Fewer resources and complications were observed in LNG-IUS acceptors when compared to hysterectomy. The LNG-IUS represents a good strategy for reducing the number of hysterectomies and the resources required for women with HMB / Doutorado / Fisiopatologia Ginecológica / Doutor em Ciências da Saúde
38

Enhanced Recovery After Hysterectomy

Wijk, Lena January 2017 (has links)
Objectives: To study recovery after hysterectomy under Enhanced Recovery After Surgery (ERAS) care, and in relation to different operation techniques. Materials and Methods: An observational study was conducted comparing 85 patients undergoing hysterectomy with ERAS care to 120 patients immediately before establishing ERAS. In a prospective cohort study of 121 consecutive patients undergoing hysterectomy, the outcome was compared for patients with malignant versus benign indications. The main outcome measure was length of stay (LOS). A randomised controlled trial (RCT) of 20 women scheduled for hysterectomy compared robot-assisted laparoscopic with abdominal hysterectomy in terms of the development of insulin resistance, inflammatory reactions, and clinical recovery, and examined the relation to hormonal status. All studies were conducted in 2011--2015, at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Results: Implementation of a structured ERAS protocol significantly reduced LOS compared to non-ERAS care. The effect was similar between patients with malignant and benign indications for surgery. No difference in complications was found. There was no difference in development of insulin resistance between robotic and abdominal technique, but clinical outcomes and inflammatory responses significantly favoured robot-assisted hysterectomy. Female sex hormone status was associated with the development of insulin resistance. Conclusions: Recovery after hysterectomy can be influenced. ERAS care seems to be effective and safe. Clinical outcome can also be influenced by operational technique. Hysterectomy triggers a stress reaction in both the metabolic and the inflammatory system. It remains unclear why the reduced inflammatory reaction and favourable clinical outcome in robotic surgery were not mirrored by less insulin resistance. This could not be explained by female sex hormone status.
39

Evidence to inform the development of physiotherapy guidelines for HIV-infected and HIV non-infected women following obstetric and gynaecological surgery

Reddy, Preshani January 2014 (has links)
Philosophiae Doctor - PhD / Methods to improve women’s health have become an urgent global priority. Development of clinical guidelines is viewed as a way of improving the quality of health care in South Africa. At present there are no physiotherapy guidelines for women post-caesarean section delivery (CSD) and post-hysterectomy, which are the most common procedures performed by obstetricians and gynaecologists. South African women have the highest HIV-prevalence rates in the world, but there is a global dearth of literature on common postoperative complications for this cohort of women. The aim of this study was to provide evidence supporting the development of physiotherapy clinical guidelines relevant for HIV-infected and HIV non-infected women following caesarean section delivery and hysterectomy. The overall design of the study was prospective, descriptive and explanatory, with longitudinal, comparative and cross-sectional components incorporated at the different phases of the study. An amalgamated four-phase conceptual framework with specific objectives per phase was used to achieve the study aim. Phases 1 and 2 were conducted at four public hospitals in KwaZulu-Natal. Phase 1 identified the long-term complications and quality of life for HIV-infected and non-infected women post-CSD (N=310) and hysterectomy (N=101) over a six- month period; phase 2, which was cross-sectional in nature, identified treatment strategies and complications described by physiotherapists (N=31) for this cohort of women. Purposive probability sampling and purposive convenient sampling was used to select potential participants for phases 1 and 2. A self-administrated questionnaire with close and open-ended questions was used in the first two phases of the study. During phase 3, a systematic review and Delphi method (N=12) were used to investigate current management strategies of representative physiotherapists. Purposive sampling was used to select the participants who are considered as experts in the field of women’s health, for the Delphi study. The information from phases 1 to 3 was collated in phase 4 to provide the evidence to inform the development of the clinical guidelines. Phase 1 revealed that physical health complications commonly persisted for at least six months and negatively affected the quality of life of women post-CSD or post-hysterectomy. Phase 2 showed that very few patients post-CSD and hysterectomy were being referred for physiotherapy, and of those referred, the main problem being treated was respiratory complications. A systematic review of the literature yielded only one article relevant to the outcome of management of patients post- hysterectomy, thus illustrating the dearth of literature in this area. The experts who were consulted for the Delphi study suggested treatment techniques for the postoperative complications identified in phase 1, and consensus was reached on the techniques in the second Delphi round. The results were then collated in the final phase and presented in tables containing the identified problem, treatment and best available evidence to move towards the development of the guidelines. The common postoperative morbidities that were identified in this study can be prevented or treated with physiotherapy, but information is needed in this area to guide treatment practices. The prevention of postoperative complications can result in a decrease in demand for services, thereby reducing the current strain on the health system. The current study contributed to 18 of the 23 criteria in the appraisal of guidelines for research and an evaluation tool. The conceptual framework used to generate the evidence can also be employed in other facets of health care. In order to improve the quality of health care rendered to women, health care professionals require a complete picture of their patient. This research adds to the body of knowledge in an area where there is a dearth of literature and provides a platform to develop clinical guidelines. No national research exists that compares the postoperative complications of HIV-infected and non-infected women, which is essential to enable comprehensive care of HIV-infected women. The guidelines that will be developed can improve the quality of health care rendered to women, and establish the role of physiotherapists in this area.
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Kvinnors upplevelser av att ha genomgått hysterektomi : En litteraturöversikt / Women’s experiences of having undergone hysterectomy : A literature review

Lernefalk, Linnea, Petersdotter, Anna Sofia January 2019 (has links)
Bakgrund: Var tionde kvinna i Sverige har genomgått en hysterektomi, och globalt är siffran ännu högre. Det är en stor förändring som påverkar kvinnor på flera olika sätt. En individanpassad vård med adekvat information och goda vårdrelationer kan ha betydelse för kvinnors upplevelse av att genomgå en hysterektomi. Syfte: Syftet var att beskriva kvinnors upplevelser av att ha genomgått en hysterektomi. Metod: En litteraturöversikt baserad på tio vetenskapliga artiklar analyserades utifrån Fribergs metod för att identifiera likheter, så att olika teman som rör kvinnors upplevelser kunde identifieras. Artiklarna hämtades från databaserna CINAHL Complete och PubMed. De var kvalitativa och kvantitativa och författade mellan åren 1999–2019. Resultat: Resultatet visade att kvinnor som har genomgått en hysterektomi beskriver många liknande upplevelser. Bland dessa upplevelser kunde sex olika teman identifieras: Ny kropp – nytt liv, Förändrad identitet, Sexualitet och fertilitet, Stigma och stöd, Behov av information samt Vårdrelationens betydelse. En stor del av resultatet innefattar tankar och känslor som rör förändringar i kroppsuppfattning, självbild och livskvalitet efter en hysterektomi. Diskussion: Valda fynd diskuterades med hjälp av Callista Roys omvårdnadsteori, övrig relevant forskning, annan litteratur samt författarnas egna reflektioner.

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