Orientador: Antonieta Keiko Kakuda Shimo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T15:09:34Z (GMT). No. of bitstreams: 1 Frison_FernandaSucasas_M.pdf: 3727941 bytes, checksum: 18af460be04d75cbac6796673fdb2a80 (MD5) Previous issue date: 2011 / Resumo: Introdução: A mulher com câncer de mama vivencia o sofrimento da doença de maneira peculiar, pois o local onde está acometida a enfermidade é símbolo de feminilidade, sexualidade e estética, sendo alvo de contemplação. Com a mastectomia, vários sentimentos e sofrimentos são desencadeados, alterando a qualidade de vida. Há necessidade de aceitação do novo corpo e adequação das atividades diárias após a cirurgia. Diante das severas repercussões do procedimento de mutilação e sensibilizando-se com a situação dessas mulheres, propõe-se nesse trabalho um programa de intervenção, que utilizou a dança circular como instrumento para uma possível modificação no estado bio-psico-emocional. Objetivo: Avaliar a qualidade de vida das mulheres mastectomizadas do grupo de estudo e do grupo controle antes e após três meses de intervenção. Método: Trata-se de um estudo de intervenção com desenho quase-experimental, de abordagem quantitativa (envolvendo mensuração de variáveis). Os critérios de inclusão foram: ter sido submetida à mastectomia total ou parcial, com mutilação da mama; ter dezoito anos ou mais; estar ou não em tratamento quimioterápico e/ou radioterapia; ter mais de três meses de pós-operatório; ter período igual ou menor que um ano da cirurgia; não ter metástases diagnosticada; não apresentar alguma dificuldade de compreensão para responder ao instrumento. Optou-se pela amostragem de conveniência, e a formação de dois grupos (controle e de estudo). Um questionário validado e traduzido no Brasil sobre qualidade de vida (WHOQOL-bref), foi aplicado as participantes, antes e após as atividades de dança, que teve duração de três meses (doze encontros). O grupo controle também respondeu ao questionário antes e após três meses. Os resultados obtidos passaram pela análise estatística descritiva e comparativa intragrupos e entre grupos, segundo teste t de Student pareado e não pareado, respectivamente. Para avaliar o efeito da intervenção foram utilizadas as análises de Modelos Lineares Generalizados, com estimativa através das Equações de Estimação Generalizada (EEG) e Análises de Contrastes. Resultados: A amostra constituiu-se de 35 participantes, com 11 no grupo de dança e 24 no grupo controle. Na comparação dos domínios do instrumento WHOQOLbref, entre e intragrupos (antes e depois da intervenção) observou-se na análise intragrupo uma diferença significativa (p<0,05) nos domínios psicológico (p=0,0018), físico (p=0,0006) e meio ambiente (p=0,0297) do grupo de estudo, demonstrando que a intervenção (dança circular) provocou um efeito nesses domínios. As análises de contrastes revelaram ainda diferenças significativas no grupo de dança apenas para o domínio psicológico (p=0,0001). Não houve diferenças em nenhum dos domínios no grupo controle. Conclusões: Os resultados apontam que na análise entre os grupos (controle e de estudo) não se verificou diferenças significativas entre eles. Mas, ao analisar somente o grupo de intervenção, houve diferenças, com destaque para o domínio psicológico. Linha de pesquisa: O processo de cuidar em enfermagem, saúde da mulher / Abstract: Introduction: The woman with breast cancer lives deeply the suffering of the illness in a peculiar way, therefore the place where it is attacked the disease is a symbol of femininity, sexuality and aesthetic, being targeted of contemplation. With the mastectomy, many feelings and sufferings are unchained, modifying the quality of life. After surgery there is need for acceptance of the new body and adequacy in daily activities. Ahead of the severe consequences of the procedure of mutilation and sensitizing itself with the situation of these women, is proposed in this work an intervention program, who used the circular dance as a instrument for a possible modification in the bio-psycho-emotional state. Objective: To evaluate the quality of life of the mastectomies women of the group of study and of the group controlled before and after three months of intervention. Subjects and Methods: One is about a study of intervention with almost-experimental drawing, quantitative boarding (measure of the variable). The inclusion criteria had been: women submitted to the total or partial mastectomy, with mutilation of the breast; to have eighteen years or more; undergoing or not in chemotherapy and/or radiotherapy; to have three months of post operative or more; to have equal or lesser period that one year of the surgery; not to have metastases; not to present some incapacity to answer to the questionnaires. It was opted to the sampling of convenience, and the formation of two groups (control and of study). A questionnaire validated and translated in Brazil about quality of life (WHOQOL-brief) was applied the participants, before and after to the activities of dance, that it had duration of three months (twelve meeting). The group control also answered to the questionnaire before and after three months. The gotten results had passed for the analysis statistics of descriptive and comparative form intra group and between group, second test t (t of Student paired) and t of Student respectively. To evaluate the effect of the intervention were used the analysis of Generalized Linear Models with estimated through the Generalized Estimating Equations (GEE) and Analyses of Contrasts. Results: The sample consisted of 35 participants, with 11 in the dance group and 24 in the control group. In the comparison of the domains of the instrument WHOQOL-bref, between and within groups, before and after the intervention, observed in the intragroup analysis a significant difference (p<0,05), in the domains psychological (p=0,0018), physical (p=0,0006) and environmental (p=0,0297) of the group of study, showing that the intervention (dance move) caused an effect in these areas. Analysis of contrasts also revealed significant differences (p <0.05) in the group of dance just for the psychological domain (p=0,0001). It did not have differences in none of the domains in the control group. Conclusions: The results show that in the analysis between the groups (control and study) there was no significant differences between them. But in analyzing only the intervention group, there were differences, with emphasis on the psychological domain / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Made available in DSpace on 2016-01-26T18:55:28Z (GMT). No. of bitstreams: 1 DISSERTACAO_DR_HUGO_25_02_2010.pdf: 313408 bytes, checksum: ec79a26aefea94b77a4cc0743f1835ff (MD5) Previous issue date: 2009-08-26 / Electroacupuncture has been shown to be effective in experimental and clinical acute pain settings. The present study aims to evaluate the postoperative cardiopulmonary, sedative and analgesic effects of electroacupuncture, morphine or sham acupuncture in bitches undergoing mastectomy. The 30 dogs were sedated with acepromazine (0.05 mg kg-1, im), followed by induction of anesthesia with propofol (4 mg kg-1) and anesthesia maintenance with isoflurane. The dogs were equally distributed into three treatments that underwent: Gmorf, morphine intramuscular administration; GEA, application of electrical stimuli to acupuncture points; Gsham: similar to the treatment described for GEA, except that the needles were introduced into false points. Heart and respiratory rates, non-invasive systolic arterial pressure, rectal temperature and arterial blood gases, were evaluated during pre and trans-surgery periods. The analgesic and sedation score, as well as the need of rescue analgesia were measured during the first 12 hours after surgery. Statistical analysis was performed using anova for repeated measures to investigate the time in each group and between treatments. Tukey s method was used to contrast group means. Statistics were considered significant at p<0.05. Respecting the cardiorespiratory variables, the systolic arterial pressure was reduced in all groups, during anesthesia. The sedation score was lower in Gsham than in Gmorf, during the first post-surgery hour. The pain score did not differ among the groups, but in the GEA, the animals received less rescue analgesia than the others groups. In conclusion, electroacupuncture reduced the morphine need and promotes satisfactory analgesia in bitches subjected to mastectomy. / A eletroacupuntura (EA) tem se mostrado eficaz no tratamento da dor aguda experimental e clínica. Objetivou-se avaliar os efeitos cardiorrespiratório, sedativo e analgésico pós-operatórios, mediados pela aplicação de morfina, eletroacupuntura ou pontos falsos de acupuntura, em cadelas submetidas à mastectomia. Foram avaliadas 30 cadelas, submetidas à sedação com acepromazina (0,05 mg kg-1,im), seguindo-se a indução e manutenção anestésica com propofol (4 mg kg-1,iv) e isofluorano, respectivamente. Essas pacientes foram distribuídas em três grupos de dez animais cada: Gmorf: administração preemptiva de morfina (0,5 mg kg-1, im), GEA: aplicação de estímulo elétrico em pontos de acupuntura; Gsham: agulhamento em pontos falsos de acupuntura. Foram avaliadas: frequência cardíaca e respiratória, pressão arterial sistólica não invasiva, temperatura retal e variáveis hemogasométricas, durante o período pré e transcirúrgico. O grau de analgesia e sedação, bem como a necessidade de analgesia resgate foram mensurados durante as primeiras 12 horas após a cirurgia. Foi utilizada análise de medidas repetidas e teste de Tukey (p<0,05). Em relação às variáveis cardiorrespiratórias, houve redução da pressão arterial sistólica em todos os grupos, durante a anestesia. O grau de sedação foi inferior no Gsham em relação ao Gmorf, na primeira hora pós-cirúrgica. O escore de dor não variou entre os grupos; porém a analgesia resgate foi menos frequente no GEA, em relação aos demais grupos. Conclui-se que a eletroacupuntura reduziu o requerimento analgésico pós-operatório, de modo a conferir analgesia superior em cadelas submetidas à mastectomia, em relação ao estímulo de pontos falsos e à administração de morfina.

Made available in DSpace on 2016-01-26T18:55:37Z (GMT). No. of bitstreams: 1 Sergio Vilhegas.pdf: 700648 bytes, checksum: 61199638be80e4484e7e0b1e44be0387 (MD5) Previous issue date: 2013-09-23 / The aim of this study was to evaluate the analgesic effects of botulinum toxin as an adjunct in the control of postoperative pain in dogs. In a blinded study, sixteen dogs undergoing mastectomy were randomly assigned to two groups of 08 animals each and received 7U kg-1 of botulinum toxin diluted in 10mL of saline and administered 1mL in each breast, subcutaneously (TXB) or 1mL of saline administered in each breast (Control), subcutaneously. After twenty four hours, pre-anesthetic medication was intramuscular (IM) acepromazine (0.03mg kg-1) in combination with morphine (0.3mg kg-1). Anesthesia was induced with intravenously (IV) propofol (4 to 5mg kg-1) and maintained with isoflurane. The analgesic intra-operative support was provided by IV continuous rate morphine (0.1mg kg-1h-1). Heart rate, respiratory rate, systolic arterial blood pressure, oxicapnografy and end-tidal concentration of isoflurane were evaluated during the surgery. Postoperative analgesia was assessed during the first 72 hours after the tracheal extubation using a Visual Analog Scale (VAS) and Glasgow Modified Scale (GMS). Rescue analgesia with morphine (0.5mg kg-1 IM) was performed if the evaluation score exceeded 50% of VAS and/or 30% of GMS during the postoperative period. The pain scores were lower in TXB group than in Control group from 8 to 60 hours and from 12 to 60 hours post-extubation, according to VAS and GMS scales, respectively. Postoperative rescue analgesia was lower in the TXB group (2 of 8 dogs), when compared with Control group (7 of 8 dogs). Cardiopulmonary established was detected in both treatment groups. Preemptive botulinum toxin administration is a satisfactory alternative to post-operative management in dogs undergoing mastectomy. / Este estudo teve como objetivo avaliar a administração da toxina botulínica como adjuvante do controle da dor pós-operatória de cães. Em delineamento cego, dezesseis cadelas, encaminhadas para mastectomia radical foram distribuídas aleatoriamente em dois tratamentos: TXB (n=8) administração de 7U kg-1 de toxina botulínica, diluída em 10 mL de solução salina, sendo administrado 1mL em cada mama, por via subcutânea (SC); Controle (n=8) administração de 10 mL de solução salina (1mL em cada mama, SC). Vinte e quatro horas após, os animais foram encaminhados para cirurgia, sendo tranquilizados com acepromazina (0,03mg kg-1) associada à morfina (0,3mg kg-1), por via intramuscular (IM). Transcorridos vinte minutos, iniciou-se a infusão contínua intravenosa (IV) de morfina (0,1mg kg-1 h-1) que foi mantida durante toda a cirurgia. A indução anestésica foi realizada com propofol (4-5mg kg-1, IV), seguindo-se a manutenção da anestesia com isofluorano. Parâmetros avaliados: frequência cardíaca e respiratória, pressão arterial sistólica, oxicapnografia e concentração final expirada de isofluorano. No pós-operatório o grau de analgesia foi mensurado durante 72 horas após a extubação traqueal, utilizando-se a Escala Analógica Visual (EAV) e Escala de Glasgow Modificada (EGM). Analgesia de resgate foi feita com morfina (0,5mg kg-1 IM) em casos do escore de dor ser superior a 50% da EAV e/ou 33% da EGM. Os escores de dor foram inferiores no tratamento TXB de 8 a 60 horas na EAV e de 12 a 60 horas na EGM. A necessidade de suplementação analgésica foi inferior no gruo TXB (2 de 8 animais) em relação ao grupo Controle (7 de 8 animais). Estabilidade cardiorrespiratória foi observada em ambos os tratamentos. A administração preemptiva de toxina botulínica representa uma alternativa viável para o controle da dor pós-mastectomia em cadelas.

Made available in DSpace on 2016-07-18T17:53:06Z (GMT). No. of bitstreams: 1 DISSERTACAO_DR_HUGO_25_02_2010.pdf: 313408 bytes, checksum: ec79a26aefea94b77a4cc0743f1835ff (MD5) Previous issue date: 2009-08-26 / Electroacupuncture has been shown to be effective in experimental and clinical acute pain settings. The present study aims to evaluate the postoperative cardiopulmonary, sedative and analgesic effects of electroacupuncture, morphine or sham acupuncture in bitches undergoing mastectomy. The 30 dogs were sedated with acepromazine (0.05 mg kg-1, im), followed by induction of anesthesia with propofol (4 mg kg-1) and anesthesia maintenance with isoflurane. The dogs were equally distributed into three treatments that underwent: Gmorf, morphine intramuscular administration; GEA, application of electrical stimuli to acupuncture points; Gsham: similar to the treatment described for GEA, except that the needles were introduced into false points. Heart and respiratory rates, non-invasive systolic arterial pressure, rectal temperature and arterial blood gases, were evaluated during pre and trans-surgery periods. The analgesic and sedation score, as well as the need of rescue analgesia were measured during the first 12 hours after surgery. Statistical analysis was performed using anova for repeated measures to investigate the time in each group and between treatments. Tukey s method was used to contrast group means. Statistics were considered significant at p<0.05. Respecting the cardiorespiratory variables, the systolic arterial pressure was reduced in all groups, during anesthesia. The sedation score was lower in Gsham than in Gmorf, during the first post-surgery hour. The pain score did not differ among the groups, but in the GEA, the animals received less rescue analgesia than the others groups. In conclusion, electroacupuncture reduced the morphine need and promotes satisfactory analgesia in bitches subjected to mastectomy. / A eletroacupuntura (EA) tem se mostrado eficaz no tratamento da dor aguda experimental e clínica. Objetivou-se avaliar os efeitos cardiorrespiratório, sedativo e analgésico pós-operatórios, mediados pela aplicação de morfina, eletroacupuntura ou pontos falsos de acupuntura, em cadelas submetidas à mastectomia. Foram avaliadas 30 cadelas, submetidas à sedação com acepromazina (0,05 mg kg-1,im), seguindo-se a indução e manutenção anestésica com propofol (4 mg kg-1,iv) e isofluorano, respectivamente. Essas pacientes foram distribuídas em três grupos de dez animais cada: Gmorf: administração preemptiva de morfina (0,5 mg kg-1, im), GEA: aplicação de estímulo elétrico em pontos de acupuntura; Gsham: agulhamento em pontos falsos de acupuntura. Foram avaliadas: frequência cardíaca e respiratória, pressão arterial sistólica não invasiva, temperatura retal e variáveis hemogasométricas, durante o período pré e transcirúrgico. O grau de analgesia e sedação, bem como a necessidade de analgesia resgate foram mensurados durante as primeiras 12 horas após a cirurgia. Foi utilizada análise de medidas repetidas e teste de Tukey (p<0,05). Em relação às variáveis cardiorrespiratórias, houve redução da pressão arterial sistólica em todos os grupos, durante a anestesia. O grau de sedação foi inferior no Gsham em relação ao Gmorf, na primeira hora pós-cirúrgica. O escore de dor não variou entre os grupos; porém a analgesia resgate foi menos frequente no GEA, em relação aos demais grupos. Conclui-se que a eletroacupuntura reduziu o requerimento analgésico pós-operatório, de modo a conferir analgesia superior em cadelas submetidas à mastectomia, em relação ao estímulo de pontos falsos e à administração de morfina.

Made available in DSpace on 2016-07-18T17:53:12Z (GMT). No. of bitstreams: 1 Sergio Vilhegas.pdf: 700648 bytes, checksum: 61199638be80e4484e7e0b1e44be0387 (MD5) Previous issue date: 2013-09-23 / The aim of this study was to evaluate the analgesic effects of botulinum toxin as an adjunct in the control of postoperative pain in dogs. In a blinded study, sixteen dogs undergoing mastectomy were randomly assigned to two groups of 08 animals each and received 7U kg-1 of botulinum toxin diluted in 10mL of saline and administered 1mL in each breast, subcutaneously (TXB) or 1mL of saline administered in each breast (Control), subcutaneously. After twenty four hours, pre-anesthetic medication was intramuscular (IM) acepromazine (0.03mg kg-1) in combination with morphine (0.3mg kg-1). Anesthesia was induced with intravenously (IV) propofol (4 to 5mg kg-1) and maintained with isoflurane. The analgesic intra-operative support was provided by IV continuous rate morphine (0.1mg kg-1h-1). Heart rate, respiratory rate, systolic arterial blood pressure, oxicapnografy and end-tidal concentration of isoflurane were evaluated during the surgery. Postoperative analgesia was assessed during the first 72 hours after the tracheal extubation using a Visual Analog Scale (VAS) and Glasgow Modified Scale (GMS). Rescue analgesia with morphine (0.5mg kg-1 IM) was performed if the evaluation score exceeded 50% of VAS and/or 30% of GMS during the postoperative period. The pain scores were lower in TXB group than in Control group from 8 to 60 hours and from 12 to 60 hours post-extubation, according to VAS and GMS scales, respectively. Postoperative rescue analgesia was lower in the TXB group (2 of 8 dogs), when compared with Control group (7 of 8 dogs). Cardiopulmonary established was detected in both treatment groups. Preemptive botulinum toxin administration is a satisfactory alternative to post-operative management in dogs undergoing mastectomy. / Este estudo teve como objetivo avaliar a administração da toxina botulínica como adjuvante do controle da dor pós-operatória de cães. Em delineamento cego, dezesseis cadelas, encaminhadas para mastectomia radical foram distribuídas aleatoriamente em dois tratamentos: TXB (n=8) administração de 7U kg-1 de toxina botulínica, diluída em 10 mL de solução salina, sendo administrado 1mL em cada mama, por via subcutânea (SC); Controle (n=8) administração de 10 mL de solução salina (1mL em cada mama, SC). Vinte e quatro horas após, os animais foram encaminhados para cirurgia, sendo tranquilizados com acepromazina (0,03mg kg-1) associada à morfina (0,3mg kg-1), por via intramuscular (IM). Transcorridos vinte minutos, iniciou-se a infusão contínua intravenosa (IV) de morfina (0,1mg kg-1 h-1) que foi mantida durante toda a cirurgia. A indução anestésica foi realizada com propofol (4-5mg kg-1, IV), seguindo-se a manutenção da anestesia com isofluorano. Parâmetros avaliados: frequência cardíaca e respiratória, pressão arterial sistólica, oxicapnografia e concentração final expirada de isofluorano. No pós-operatório o grau de analgesia foi mensurado durante 72 horas após a extubação traqueal, utilizando-se a Escala Analógica Visual (EAV) e Escala de Glasgow Modificada (EGM). Analgesia de resgate foi feita com morfina (0,5mg kg-1 IM) em casos do escore de dor ser superior a 50% da EAV e/ou 33% da EGM. Os escores de dor foram inferiores no tratamento TXB de 8 a 60 horas na EAV e de 12 a 60 horas na EGM. A necessidade de suplementação analgésica foi inferior no gruo TXB (2 de 8 animais) em relação ao grupo Controle (7 de 8 animais). Estabilidade cardiorrespiratória foi observada em ambos os tratamentos. A administração preemptiva de toxina botulínica representa uma alternativa viável para o controle da dor pós-mastectomia em cadelas.

Bakgrund: Bröstcancer är globalt den vanligaste cancerdiagnosen för kvinnor. En av de kirurgiska behandlingarna är mastektomi, där kvinnans ena eller båda bröst avlägsnas. Tidigare forskning har visat att kvinnor som genomgått en mastektomi har en sämre kroppsuppfattning än vid andra kirurgiska behandlingar mot bröstcancer. Syfte: Syftet med litteraturstudien var att belysa bröstcancerdrabbade kvinnors erfarenheter av mastektomi, med fokus på kroppsuppfattning.  Metod: En litteraturstudie med kvalitativ ansats genomfördes. Efter databassökningar identifierades nio artiklar till resultatet. Dessa artiklar granskades och analyserades genom en tematisk innehållsanalys. Resultat: Analysen identifierade tre kategorier: Att hantera en förändrad identitet, Bröstets betydelse för kvinnan samt Sexualitet och relationer. Även nio underkategorier identifierades som belyser hur kvinnans identitet, femininitet och sexualitet påverkas av den förändrade kroppsuppfattningen. Konklusion: En mastektomerad kvinnas förändrade kroppsuppfattning påverkar hennes identitet, sexualitet och femininitet. Dessa förändringar är komplexa och individuella och påverkas av normer samt relationer till andra. Inom sjuksköterskeprofessionen behövs en ökad medvetenhet om dessa förändringar och hur individuella de är, detta för att ge bättre stöd och bemötande till dessa kvinnor. / Background: Breast cancer is the most common cancer diagnosis among women. Mastectomy is surgical treatment in which one or both breasts are removed. Previous research has shown that women who have had a mastectomy have a more negative body image than women who have had other surgical treatments. Aim: The aim of this literature study was to shed light on women with breast cancer´s experiences of mastectomy, with focus on body image.  Methods: A literature study with a qualitative approach was conducted. Nine articles were identified through database searches and were analyzed and reviewed through thematic content analysis. Results: Three categories where identified: Dealing with a changed identity, The importance of the breast for women and Sexuality and relationships. Nine subcategories were identified which shed lights to how the changed body image affects the identity, femininity and sexuality.  Conclusion: The changes in women´s body image are also affected by and linked to external norms and relationships. There is a need for increased awareness among the nursing profession about these changed perceptions and their individual and complex character. This is needed to approach and support these women in the best possible way.

Bakgrund: Bröstcancer är idag den vanligaste typen av cancer i världen hos kvinnor. Att drabbas av bröstcancer är en stor omställning i livet. Bra kontakt med omvårdnadspersonalen är viktigt för behandlingen och återhämtningen. Kvinnors upplevelser finns beskrivet i forskning och behöver sammanställas för att ge en överblick på kunskapsläget. Syfte: Syftet med denna litteraturstudie var att beskriva kvinnors upplevelse av att drabbas av bröstcancer, synen på omvårdnad och genomgå kirurgisk behandling.  Metod: Studien baserades på åtta studier som har genomförts med kvalitativ metod. Artiklarna kvalitetsgranskades med stöd av Olsson och Sörensens (2011) granskningstabell för att därefter analyseras med hjälp av Hsieh och Shannons (2005) analysmodell. Resultat: Resultatet kategoriserades i tre huvudteman: nyuppkomna känslor, kommunikation från omvårdnadspersonal och relationen med omvårdnadspersonalen med sammanlagt sex subteman. Kvinnorna som gjort kirurgisk behandling vid bröstcancer önskade stöd från omvårdnadspersonalen, förbättrad kommunikation och individanpassad information om operationen och vad som kommer hända sen. Konklusion: För att kunna ge kvinnorna bästa möjliga omvårdnad behöver omvårdnadspersonalen ha ett mer personcentrerat tankesätt med fokus på stöd och kommunikation samt ge individanpassad information. / Background: Breast cancer is the most common cancer among women all over the world. To be diagnosed with breast cancer is a big challenge. Good contact with healthcare professionals is important for treatment and recovery. The experience of women is described in research and need to be compiled to provide an overview of the state of knowledge  Aim: The purpose of this literature study was to examine women's experiences of suffering from breast cancer, their view of nursing care and undergoing surgical treatment. Methods: A qualitative method was used based on eight scientific articles reviewed with Olsson and Sörensen’s (2011) review table. The analysis process was inspired of Hsieh and Shannon’s (2005) analysis form. Results: The results were categorized into three main themes: new emotions, communication with nursing staff, and the relationship with nursing staff, altogether with six sub-themes. Women who have gone through surgical treatment due to breast cancer wanted support from the nursing staff, improved communication, personalized information about the surgery and what will happen post surgery. Conclusion: To be able to provide women with the best possible care, the nursing staff need to have a more person-centered mindset with a focus on support and communication and provide individualized information.

Bakgrund: Samhället har skapat en idealbild av hur en kvinna bör se ut. Bröstcancer är den vanligaste cancersjukdomen bland den kvinnliga populationen där bröstet är en kvinnlig markör och kan behövas opereras bort. Detta ingrepp benämns som mastektomi. Trots stora förbättringar av vården inom bröstcancer har sjuksköterskan ett ansvar över att främja delaktighet och upprätthålla integritet. Inte minst viktigt att sjuksköterskor inom hela sjukvården kontinuerligt utvärderar mastektomerade kvinnors hälsotillstånd och främjar hälsa utifrån helhetssyn på kvinnornas behov. Syfte: Syftet var att beskriva kvinnors upplevelser efter mastektomi vid bröstcancer. Metod: En litteraturöversikt som baserades på 9 kvalitativa studier och en mixad studie. Artiklarna var tagna från databaser Cinahl Complete och PubMed. Studierna kvalitetsgranskades och analyserades i fyra steg utifrån Fribergs instruktioner. Resultat: I resultatet framkommer fyra teman: En förlorad självbild, Kroppsuppfattning och Sexualitet, Sorgeprocess och Acceptans: att fortsätta framåt samt Stödjande omgivning: att gå igenom en förändring tillsammans. Sammanfattning: Mastektomi påverkar kvinnorna psykosocialt och leder till en känsla av förlorad/minskad kvinnlighet och en förlorad identitet. Förlusten av bröstet och starka samhälleliga normer kring kvinnligt utseende leder till lidande, sorg samt uteblivna sociala interaktioner. Stödjande omgivning och vårdpersonal kan underlätta kvinnors adaption samt acceptans av nya verkligheten. / Background: Today's society holds an ideal image of what a woman should be and what she should look like. When a woman suffers from one of the most common cancers among the female population, her female marker which is the breast, may need to be completely surgically removed. This procedure is called a mastectomy. Despite major improvements in breast cancer care, the nurse is responsible for promoting participation and maintaining integrity. Not least, it is important that nurses in the entire healthcare system continuously evaluate the health status of mastectomized women and promote health based on a holistic view of women's needs. Aim: The aim was to describe women's experiences after mastectomy in breast cancer. Method: A literature review based on 9 qualitative studies and one mixed study. The articles ware retrieved from the databases Cinahl Complete and PubMed. The studies were quality reviewed and analyzed in four steps based on Friberg's instructions. Results: The result shows four themes: Lost self-image, Body image and Sexuality, Grieving process and Acceptance: to continue moving forward and Supportive environment: going through a change together. Summary: Mastectomy affects women psychosocially and leads to a feeling of lost / diminished femininity and a lost identity. The loss of the breast and strong societal norms around female appearance lead to suffering, grief and default social interactions. Supportive environment and care staff can facilitate women's adaptation and acceptance of the new reality

Bakgrund: Bröstcancer är den vanligaste förekommande cancerdiagnosen hos kvinnor världen över. Den vanligaste behandlingsformen är kirurgi vilket består av mastektomi där komplikationer kan medföra bland annat förändrad kroppsuppfattning ur ett livsvärldsperspektiv. Kroppsuppfattning är starkt sammankopplat med sexualitet och sexuell hälsa. Syfte: Att beskriva kvinnors upplevelser av sexuell hälsa relaterat till mastektomi vid bröstcancer. Metod: Kvalitativ litteraturöversikt. 10 artiklar inkluderades i resultatet. Resultat: Tre kategorier identifierades: Att leva med förändrad kropp (Förändrad kroppsuppfattning &amp; förlust av identitet och Emotionell påverkan), Förändrad sexuell hälsa (Betydelse av bröst, Sexuell dysfunktion och Betydelsen av samliv &amp; relationer), Normalitet och dess betydelse (Att inte passa in och Att acceptera &amp; anpassa sig). Resultatet påvisade att kroppsuppfattningen hade inverkan på sexuell hälsa och sexualitet. Negativ kroppsuppfattning ledde till upplevelser av att vara oattraktiv och känslan av identitetsförlust. Det uppkom strävan efter normalitet. Olika hanteringsstrategier tillämpades för att kunna acceptera och anpassa sig till de förändringar mastektomin medförde. Slutsatser: Mastektomi hade i stor utsträckning negativ påverkan på sexuell hälsa. Dock är det viktigt att uppmärksamma att alla kvinnor inte delade upplevelsen och att vissa hade lättare att anpassa sig till den förändrade kroppen efter mastektomin. Varje upplevelse är individuell och unik. / Background: Breast cancer is the most common cancer diagnosis in women globally. The most common treatment is surgery in the form of mastectomy. An altered body-image is in a life-world perspective a common complication. Body-image and sexuality are strongly correlated to sexual health. Aim: To describe women’s experiences of sexual health related to mastectomy due to breast cancer. Method: A literature review with qualitative method. 10 articles were included in the result. Results: Three categories were identified: To live with a changed body (Altered body image &amp; loss of identity and Emotional impact), Altered sexual health (Signification of breast, Sexual dysfunction and The significance of cohabitation &amp; relationships), Normality and its meaning (To not fit in and Acceptance and adaptation). The result showed that perceived body image had an impact on sexual health and sexuality. Negative body image greatly impacted feelings of attractiveness and identity loss. A strive for normality emerged. Different coping strategies were used to accept and adapt to the changes the mastectomy brought. Conclusion: Mastectomy has a negative effect on perceived sexuality in women. However, it is important to note that not all women shared the experience and that some women found it easier to adapt to the mastectomy and the altered body. Each experience is individual and unique.

Existing research on health disparities in breast cancer is heavily focused on outcomes for poor or low-income women. Little is known about the experience of privately insured Black breast cancer patients that have moderate to high SES. As a result, the present study was conducted to learn more about their experiences. It examines differences in physician prescribing of two breast cancer pain treatments, peripheral nerve block (PNB) and opioids, for Black and White women with like levels of health insurance coverage and socioeconomic status (SES). Three specific questions are addressed: 1. What, if any, race-based disparities exist in usage of PNBs at time of total mastectomy? 2. What, if any, race based disparities exist in the prescription of opioids for postoperative pain following total mastectomy? 3. What, if any, changes have occurred in the frequency of orders placed for PNBs and prescription opioids over time, to treat postoperative pain resulting from mastectomy? A cross-sectional designed was used relying on an existing national dataset, Optum Clinformatics Data Mart. The study period was January 1, 2012, through December 31, 2019. Study results revealed that while moderate to higher SES Black women have equitable access to PNB and opioids - a kind of shield from long established physician bias against Black women – this protection is quite porous. They still do not have open and ready access to PNB as a more advanced pain treatment. Nor do they have assurance that they are protected from the overprescribing of opioids, a class of drugs with serious and well-known safety risks. Therefore, on the surface, it appears that equity and racial inclusion are hallmarks of physician prescribing of postoperative breast cancer pain treatment. However, further interrogation reveals that ‘separate and somewhat equal’ is a more accurate characterization of their prescribing practices, based both on race and SES.