Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 5 uppsatser. Även tryckt utgåva.

Acute and chronic pain conditions have a significant impact on the individual who is experiencing pain and resolution of pain continues to present a challenge to nurses and other health care professionals. It is widely accepted that pain education for nurses is necessary if nurses are to deliver effective, evidenced based pain care. Although it has been shown that participation in pain education improves nurses’ pain knowledge, very little is known about the way in which nurses use their improved pain knowledge in their practice or about the conditions that promote application of that pain knowledge. The aims of this study are (a) to explore the transfer of pain knowledge from a continuing education nursing course into practice, and (b) to investigate the impact that the nurses’ participation in action research has on their ability to improve aspects of their pain practice. Participants are 14 registered nurses who successfully completed two accredited pain course units as part of their BSc / BN degree in Nursing. The nurses formed two groups of inquiry, who used both their participation in the pain course and in action research to investigate and change aspects of pain assessment and management practices within their clinical areas. The inquiry groups were located in two different Health Board locations in Scotland. Following involvement in a pain course, the strategies used by the participating nurses to enhance their pain assessment and management practices are examined. Qualitative data was obtained through individual and group interviews, and analysis of significant incidents. An action research approach contributes to an understanding of conditions that promote application of pain knowledge into practice following participation in the course, and focuses on the possibilities for action and improvement of pain care. The findings from this study demonstrate how nurses develop a more patient-centred approach to pain care and become more accountable for their pain practice. The research also identifies a range of strategies used by nurses to improve collaborative working practices with their colleagues that help to reduce some of the obstacles to delivery of effective pain care. From the outcomes of the inquiry, it is evident that these nurses’ participation in action research has increased the possibilities of their involvement in pain practice interventions. Conditions are created through pain course participation and involvement in action research, which supports nurses’ transfer of pain knowledge into practice Additionally, findings demonstrate the potential action research has for identifying problems with pain care and its potential for helping to develop relevant and workable solutions for improving aspects of care. The findings from this study are significant because they inform teaching and learning approaches which can be used with pain education that helps to prepare nurses to deliver more effective pain care within their health care settings.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 4 uppsatser.

Title from first page of PDF document. Includes bibliographical references (p. 28-32).

This diploma thesis called "The impact of individual physiotherapy on stereognosis and somatognosis in patients with chronic back pain" contains basic knowledge about stereognostic and somatognostic function, it summarizes significant information about pain and the development of its chronic form, and last but not least it states possible causes of back pain disorders and its functional factors. One special part of the thesis describes non-standardized tests used to examine 21 probands who had been diagnosed chronic back pain and particularly it compares the results of these two examinations, the first of which was carried out before the beginning of physiotherapy and the second one carried out after 14 days of physiotherapeutic treatment. The aim of this thesis was to evaluate the impact of physiotherapy on stereognosis and somatognosis of patients with chronic back pain. All types of medical examination were tested without visual check. As a part of the medical examination a short form of McGill ́s questionnaire and a visual analogue scale indicating the intensity of pain were to be filled in by the probands to explicate their subjective feelings. The results of all but two tests improved after 14 days of physiotherapy, the therapy impact on function of stereognosis and somatognosis of patients with...

Acute and chronic pain conditions cause significant patient distress, interference with daily activities, and increased health care costs. It is important to evaluate analgesic interventions to improve pain relief, function, quality of life, and also to prevent persisting pain after surgery. This thesis is a combination of studies evaluating analgesic interventions in the setting of acute surgical pain; prevention of persistent post-surgical pain; and chronic low back pain. In part 1, we report our comparison of morphine and hydromorphone in 402 ambulatory surgery patients, for their ability to achieve satisfactory analgesia with minimal emesis using a design of multicentre randomized controlled trial. We observed no differences in their analgesic potential and common side effects and note that appearance of side effects is likely to be idiosyncratic. In part 2, we report our 2×2 factorial feasibility trial to prevent persistent post-surgical pain in patients having elective video-assisted thoracic surgery lobectomies, comparing N-methyl-D-aspartate antagonists versus placebo, and intravenous steroids versus placebo. As our feasibility outcomes were not met, we suggest appropriate considerations for protocol changes before embarking on a definitive larger trial. In part 3, we report on our systematic review and meta-analysis assessing the effectiveness and safety of gabapentinoids (gabapentin and pregabalin) in adult patients with chronic low back pain. We observed that the existing evidence is small and there is minimal improvement in pain and other outcomes with potential for adverse events. We suggest that the use of gabapentinoids for chronic low back pain merits caution and there is need for large high-quality trials. / Thesis / Doctor of Philosophy (PhD) / It is important to evaluate analgesic interventions to decrease pain, improve function, and lessen health care costs. In a randomized controlled trial of day surgery patients, we demonstrate that there are no differences between morphine and hydromorphone in achieving pain relief and common side effects. To prevent persistent post-surgical pain in patients having elective video-assisted thoracic surgery lobectomies, we performed a 2×2 factorial, feasibility randomized controlled trial, to compare N-methyl-D-aspartate antagonists versus placebo, and intravenous steroids versus placebo. We observe that appropriate protocol changes must be made before embarking on a larger trial. Finally, we report our systematic review and meta-analysis on the use of gabapentinoids in adult patients with chronic low back pain and observe that the existing evidence is small and not supportive, and the use of gabapentinoids for chronic low back pain merits caution.

<p>Sve veća potreba za izvođenjem kolonoskopije u dijagnostičke ili terapijske svrhe nameće potrebu za usavr&scaron;avanjem ove endoskopske procedure. Izvođenje kolonoskopije u op&scaron;toj, intravenskoj anesteziji, moglo bi u značajnoj meri olak&scaron;ati njeno izvođenje, pobolj&scaron;ati podno&scaron;enje ove procedure od strane ispitanika i omogućiti otkrivanje većeg broja pacijenata sa potencijalno malignim bolestima debelog creva. Cilj ispitivanja je bio utvrditi da li primena op&scaron;te intravenske anestezije tokom kolonoskopije povećava broj totalnih kolonoskopija i skraćuje vreme intubacije cekuma, povećava broj viđenih patolo&scaron;kih procesa i smanjuje osećaj bola i učestalost neželjenih reakcija. Primena op&scaron;te intravenske anestezije značajno je povećala broj totalnih kolonoskopija u 94.3% ispitanika u odnosu na 78.7% totalnih kolonoskopija kontrolne grupe i skratila vreme intubacije cekuma, značajno je povećala broj viđenih patolo&scaron;kih promena u 46.7% ispitanika u odnosu na broj viđenih patolo&scaron;kih promena u 28.8% ispitanika kontrolne grupe i značajno je smanjila intenzitet bola i učestalost neželjenih reakcija. U kontrolnoj grupi ispitanika skalom bola nakon kolonoskopije ustanovljen je značajno veći intenzitet bola u poređenju sa ispitanicima ekperimentalne grupe. Na Likertovoj skali zadovoljstva ustanovljena je značajno bolja kontrola bola i lični stav lekara u ekperimentalnoj grupi, dok su poseta ustanovi i procedura, razumevanje procedure, tehnička ve&scaron;tina lekara, lični stav medicinskih sestara i drugog tehničkog osoblja značajno bolje ocenjeni u kontrolnoj grupi. Od svih ispitivanih faktora na zadovoljstvo obe grupe pacijenata značajno su uticali: način izvođenja procedure, bol, uočene patolo&scaron;ke promene i intubacija cekuma. U kontrolnoj grupi ispitanika između skale zadovoljstva i skale bola ustanovljena je značajna negativna korelacija. U kontrolnoj grupi se 80,1% pacijenata izjasnilo da bi ponovnu kolonoskopiju uradili u op&scaron;toj intravenskoj anesteziji u poređenju sa svim pacijentima eksperimentalne grupe koji ne bi menjali način izvođenja ponovne procedure. Primena op&scaron;te intravenske anestezije tokom kolonoskopije povećava broj totalnih kolonoskopija i uočenih patolo&scaron;kih promena, smanjuje učestalost i intenzitet neželjenih reakcija povećavajući zadovoljstvo pacijenata, &scaron;to bi prevashodno moglo imati značaja u skriningu karcinoma debelog creva. Potrebno je pro&scaron;iriti ispitivanje primene op&scaron;te intravenske anestezije u drugim endoskopskim procedurama kako bi bila uvedena u svakodnevnoj kliničkoj praksi.</p> / <p>An increasing need to perform colonoscopy for diagnostic or therapeutic purposes imposed the need for mastering this endoscopic procedure. Performing colonoscopy in general intravenous anesthesia could greatly ease the procedure, make it more comfortable for patients and it could enable detecting a higher number of patients with occult malignant diseases of the colon. The aim of this paper was to determine if the implementation of general intravenous anesthesia during colonoscopy increases the number of total colonoscopies and shortens the time of cecum intubation, increases the number of familiar pathological processes and decreases the sensation of pain as well as the frequency of side reactions. The implementation of general intravenous anesthesia has significantly increased the number of total colonoscopies in 94.3% of examined patients in relation to 78.7% of total colonoscopies of the control group and shortened the time of cecum intubation. It has significantly increased the number of familiar pathological changes in 46.7% of the patients in relation to the number of familiar pathological changes in 28.8% patients of the control group and significantly decreased pain intensity and the frequency of side reactions. A statistically greater pain intensity after colonoscopy was determined by the pain scale in the control group in comparison to the examinees of the experimental group. Likert satisfaction scale has shown that the experiment group assessed pain control and doctors&rsquo; opinion as significantly better, while the institution visits and the procedure, understanding the procedure, doctors&rsquo; technical skills, nurses&rsquo; and technical personnel&rsquo;s personal opinions were assessed as significantly better in the control group. Out of all the examined factors on the satisfaction of both groups, the following ones had a significant inluence: the way the procedure was done, the level of pain, detected pathological changes and cecum intubation. A significanlty negative correlation was determined between the scale of satisfaction and the scale of pain in the control group. 80.1% of the control group patients stated that they would undergo a general anesthesia colonoscopy again in comparison to all the patients of the experimental group who would not change the way the procedure was previously done. The implementation of general intravenous anesthesia in the course of colonoscopy increases the number of total colonoscopies and detected pathological changes, decreases the frequency and intensity of side-effects therefore it enhances patients&#39; sastisfaction, which could play a major role in colon cancer screening. It is necessary to extend the implementation of general intravenous anesthesia in other endoscopic procedures in order to introduce it in everyday clinical practice.</p>

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.