Class of 2012 Abstract / Specific Aims: The primary purpose of this study was to evaluate the time of vancomycin pre-operative surgical site infection prophylaxis administration relative to other scheduled antibiotic therapy at a tertiary care, academic medical center. The secondary purpose was to characterize the incidence of adverse events post-surgery that were associated with vancomycin therapy in patients who received both pre-operative scheduled vancomycin therapy and vancomycin for surgical site infection prophylaxis Methods: This descriptive study was a retrospective medical chart review of all patients over the age of 28 days who received vancomycin for surgical site infection prophylaxis between February 2011 and May 2011 at a tertiary care, academic medical center. This study was approved be the Institutional Review Board. The subject population included patients admitted to the hospital for at least 72 hours who received at least 48 hours of scheduled vancomycin (IV), daptomycin or linezolid therapy before index surgery and subsequently received surgical site infection prophylaxis with vancomycin. Main Results: Of the 20 subjects who meet the study inclusion criteria, 18 (90%) subjects received scheduled vancomycin doses within 48 hours prior to surgery, 5 (25%) subjects within 4 hours, and 4 (20%) subjects within 2 hours. No surgical site infections were reported. Conclusions: This was a pilot study to evaluate the timing of vancomycin surgical site infection prophylaxis doses with scheduled vancomycin, linezolid, and daptomycin. No adverse effects associated with surgical site infection prophylaxis were reported but the sample size is small and likely inadequate to detect this potential issue.

No description available.

Yes / For patients to be treated, decisions about their care must be made before treatment begins. In case of pre-operative anxiety, it is currently unknown how clinicians and patients discuss information about the issue, and it is also not known whether clinicians consider (or are ready to consider) their patients’ preferences of non-pharmaceutical pre-operative anxiety reduction interventions. At present no study has been conducted to find information on surgical patients’ preferences of, and their involvement in decisions about non-pharmaceutical interventions for reducing their pre-operative anxiety. This paper investigates elective surgical patients’ involvement in treatment decisions with the aim of finding out their preferred non-pharmaceutical pre-operative anxiety reduction interventions before they undergo elective surgery. Method: A survey method was used to collect data on patients’ preference of non-pharmaceutical preoperative anxiety reduction interventions at a tertiary health facility in Nigeria. Participants: A sample of 30 participants-17 male and 13 female, schedule to undergo surgical operations was selected using a convenient sampling method. Their ages range between 17 to 70 years (mean age = 41.03 and standard deviation = 16.09). Study design/procedure: To elicit preference of interventions, the study participants were presented with cards that contain picture of surgical patient receiving one of the non-pharmaceutical interventions used in reducing pre-operative anxiety. The pictures were presented one at a time for 30-40 seconds. The researcher then gives the participants a sheet of paper with the different interventions boldly written for the participants to rank order them according to the degree of their preferences. Through this process, data was collected from all the 30 participants. Results: The results obtained were entered into SPSS for analysis. Descriptive statistics, at 95 % confidence was calculated to estimate the percentage, mean, standard deviation and confidence intervals based on the participants’ preference of the interventions. Discussions: The findings were discussed alongside the existing literature and recommendations were offered for clinical practice and further research.

Hypertension is not consistently associated with postoperative cardiovascular morbidity and therefore not considered a major peri-operative risk factor. However, hypertension may predispose to peri-operative haemodynamic changes known to be associated with perioperative morbidity and mortality, such as intra-operative hypotension and tachycardia. The objective of this study was to determine whether pre-operative hypertension was independently associated with haemodynamic changes known to be associated with adverse peri-operative outcomes. We performed a five-day multicentre, prospective, observational cohort study which included all adult inpatients undergoing elective, noncardiac, non-obstetric surgery. We recruited 343 patients of whom 164 (47.8%) were hypertensive. An intra-operative mean arterial pressure of 100 beats per minute) occurred in 126 (38.9%) patients, of which 61 (48.4%) were hypertensive. Multivariable logistic regression did not show an independent association between the stage of hypertension and either clinically significant hypotension or tachycardia, when controlled for ASA physical status, functional status, major surgery, the duration of surgery or blood transfusion. There was no association between pre-operative hypertension and peri-operative haemodynamic changes known to be associated with major morbidity and mortality. These data therefore support the recommendation of the Joint Guidelines of the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the British Hypertension Society to proceed with elective surgery if a patient’s blood pressure is < 180/110 mmHg.

The thesis is focused on the role of nurse in patient education prior anaesthesia in surgical procedures in orthopaedic. Description of this role is based on the experience at the orthopaedic clinic and problems related to it are seen in the results of survey. The aim was to assess the level and effectiveness of patient education done by nurse before anaesthesia, measure the level of satisfaction and patient awareness before surgery, assess the quality and content of education provided by nurse and identify the current competencies of nurses in patient education before anaesthesia. Data for the research survey were obtained through two questionnaires designed for nurses working at the orthopaedic clinic and for patients who have undergone scheduled intervention in this clinic. The most important finding of the research results was crossing the competencies of nurses in the preoperative patient education because the lack of visits by anaesthesiologist. Based on what I studied in the available literature and the research results, in the discussion I am presenting proposals for solutions of this situation and I suggest active offering of the information material to patient during admission, the creation of improved education material for preoperative preparation, using of different teaching methods...

Objective: Research on the role of acute post-surgical pain in children is extremely important in order to have a positive influence on pre-surgical preparation and post-surgical care and to prevent pain from becoming chronic, which can extend decades into adulthood. This project aims to identify predictors of acute post-surgical pain in adolescents with idiopathic scoliosis undergoing spinal fusion by utilizing sensory thresholds obtained through quantitative sensory testing (QST). Methods: Eligible candidates were Adolescent Idiopathic Scoliosis (AIS) patients ages 10-17 who have been recommended to receive elected spinal fusion surgery at Boston Children's Hospital (BCH). 9 successfully recruited and enrolled participants underwent a full series of QST tests on their palmar thenar eminence (non-surgical site), and their lower back (surgical site). Patients' Light Touch Detection Threshold (LTDT) and Pain Detection Threshold (PDT) scores were determined using Von Frey Hairs. Patients' Pressure-Pain Sensation Threshold (PPST) scores were determined using a pressure algometer. Patients' Warm/Cool and Hot/Cold Pain Detection Thresholds were detected using a calibrated thermode strapped to the skin. Following the full-series of QST tests, and after the patient was discharged from the hospital, a retrospective chart review was conducted to determine the patients': Age at Surgery, Gender, Number of Vertebrae Fused (Fusion Length), Length of Surgery, Pre-Operative Self-Identified Pain Level (NRS 0-10), Average Post-Operative Acute-Phase Self-Identified Pain Level (NRS 0-10), and daily Pain Medication Doses (Opiate Vs. Non-Opiate Vs. Total). Correlation calculations were done between each variable, including those determined through QST as well as retrospective chart review. For every QST test, each patient's individual score was compared to the cohort's median score, which helped determine whether the patient was either hyper- or hyposensitive for that particular test. For each QST test, these hyper- and hyposensitive groups were then compared to see if there were any significant differences in post-operative pain experienced. Results: Due to the low number of participants (N = 9), the results should be considered preliminary. Correlation studies demonstrate that pre-operative pain was significantly positively correlated with post-operative pain (r = 0.81, p <0.05), indicating that patients who are pre-operatively already in pain, will consequently experience the most pain post-operatively. Additionally, fusion length had a strong positive correlation to acute post-operative opiate pain medication administration (r = 0.71, P < 0.05), indicating that patients who had more vertebrae fused were given more opiates. Through the use of QST, we discovered that patients hypersensitive in the LTDT-Spine QST test experienced significantly less pain post-operatively (3.22 NRS 0-10) than that experienced by hyposensitive patients (5.52 NRS 0-10) from the same test. Identical results were discovered in patients determined hyper- and hyposensitive using the PPST-Spine test, respectively. Retrospective chart review data show that these hyposensitive patients were experiencing greater pain pre-operatively (0.75 NRS 0-10) than that experienced by the hypersensitive patients (0 NRS 0-10), which may have contributed to the hyposensitive cohort's greater post-operative pain. Although insignificant, patients hypersensitive in the Hot Pain - Spine QST test experienced greater post-operative pain (4.72 NRS 0-10) than that experienced by hyposensitive patients in the same test (4.06 NRS 0-10). Conclusions: The goal of this study was to determine a substantiated hypothesis to test in the future, using larger pediatric cohorts. Even though it initially appears that the hyposensitive patients, as determined by the LTDT-Spine and PPST-Spine QST tests, experienced greater post-operative pain, one must consider the fact that this hyposensitive group experienced a significantly greater amount of pre-operative pain. Not only has pre-operative pain been proven to have a strong correlation to post-operative pain in this study, it has also been proven in other larger studies as well. Other studies have identified a test similar to the Hot Pain - Spine QST test as a potential predictor of post-operative pain. The present study's results, although insignificant, share the same conclusion that hypersensitive patients determined through Hot Pain - Spine QST test experience greater post-operative pain. Therefore, the hypothesis to test in the future in pediatric cohorts should read: AIS patients with no pre-operative pain who demonstrate increased sensitivity to hot pain on their surgical site via thermal stimulation (QST) will experience greater post-operative pain in the acute-recovery phase.

<p><span lang="EN-GB" style="font-size:12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-fareast-font-family:&quot / Times New Roman&quot / mso-ansi-language:EN-GB / mso-fareast-language: EN-ZA">Literature shows that cataracts are the leading cause of blindness globally and nationally. Retinal detachment has also been a substantial problem both globally and nationally. Both of these conditions are prevalent in patients of 50 years and older. The treatment for both conditions is for surgery to be performed. In the Western Cape the three leading hospitals do not have ophthalmic pre-operative and post-operative protocols<span style="mso-bidi-font-weight:bold">.</span>Review question:What are the best practices to manage pre-operative and post-operative nursing care in patients waiting for cataract and retinal detachment surgery? bjectives:1. To determine the best practice in pre-operative and post-operative care in patients who have undergone cataract and/or retinal detachment surgery regarding: health education offered by nurses, counselling to prevent psychological effects, and positioning to prevent physical complications. 2. To develop a framework based on systematic reviews for pre-operative and post-operative ophthalmic nursing care in South Africa. Methodology: </span><span lang="EN-GB" style="font-size: 12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-ansi-language:EN-GB">A systematic review using the guide by the Centre for Reviews and Dissemination was done, and <span style="mso-bidi-font-weight:bold">studies were </span>identified by searching various electronic databases and visually scanning reference lists from the relevant studies. Studies that were included were evidence-based. All study types were considered and the studies were selected based on the title and, where available, the abstract. These were then assessed against the inclusion criteria. A narrative synthesis was used. Finally the evidence was summarised and a framework was drawn up, focusing on pre-operative and post-operative nursing care for cataract and retinal detachment surgery</span></p> <p>&nbsp / </p>

<p><span lang="EN-GB" style="font-size:12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-fareast-font-family:&quot / Times New Roman&quot / mso-ansi-language:EN-GB / mso-fareast-language: EN-ZA">Literature shows that cataracts are the leading cause of blindness globally and nationally. Retinal detachment has also been a substantial problem both globally and nationally. Both of these conditions are prevalent in patients of 50 years and older. The treatment for both conditions is for surgery to be performed. In the Western Cape the three leading hospitals do not have ophthalmic pre-operative and post-operative protocols<span style="mso-bidi-font-weight:bold">.</span>Review question:What are the best practices to manage pre-operative and post-operative nursing care in patients waiting for cataract and retinal detachment surgery? bjectives:1. To determine the best practice in pre-operative and post-operative care in patients who have undergone cataract and/or retinal detachment surgery regarding: health education offered by nurses, counselling to prevent psychological effects, and positioning to prevent physical complications. 2. To develop a framework based on systematic reviews for pre-operative and post-operative ophthalmic nursing care in South Africa. Methodology: </span><span lang="EN-GB" style="font-size: 12.0pt / font-family:&quot / Times New Roman&quot / ,&quot / serif&quot / mso-ansi-language:EN-GB">A systematic review using the guide by the Centre for Reviews and Dissemination was done, and <span style="mso-bidi-font-weight:bold">studies were </span>identified by searching various electronic databases and visually scanning reference lists from the relevant studies. Studies that were included were evidence-based. All study types were considered and the studies were selected based on the title and, where available, the abstract. These were then assessed against the inclusion criteria. A narrative synthesis was used. Finally the evidence was summarised and a framework was drawn up, focusing on pre-operative and post-operative nursing care for cataract and retinal detachment surgery</span></p> <p>&nbsp / </p>

Bakgrund: Pre-operativ ångest är en subjektiv upplevelse och vanligt förekommande. För patienten leder det här bland annat till ökad smärta, behov av mer narkosmedel, längre tid för återhämtning och ytterligare vårdtid. Det finns ett antal bedömningsinstrument för att mäta pre-operativ ångest, såväl som interventioner för att lindra den. Syfte: Att med en litteraturstudie beskriva vilken effekt omvårdnadsåtgärder har vid pre-operativ ångest. Metod: Uppsatsen baserades på en litteraturöversikt av studier som belyst effekten av interventioner för att lindra pre-operativ ångest. Tio artiklar valdes ut efter kvalitetsgranskning och noggrann bearbetning för att besvara syftet. Resultat: Resultatet av de tio artiklarna skapade tre övergripande rubriker som visar på effekten av de studerade interventionerna på pre-operativ ångest. Interventionerna delades sedan in efter likheter vad gällde interventionstyp. Det som i denna litteraturstudie visade sig ha bäst effekt på pre-operativ ångest var musik och beröring i olika former. Slutsats: Det finns flera omvårdnadsåtgärder som visat god effekt för att lindra pre-operativ ångest. Sjuksköterskan har en central roll i detta genom att skapa en tillitsfull relation och identifiera ångesten i ett tidigt skede. Klinisk betydelse: Om pre-operativ ångest mäts på rutin, i ett tidigt skede, med hjälp av något bedömningsinstrument har sjuksköterskan möjlighet att bemöta individens problematik. Det är därför av stor vikt att beprövade och fungerade alternativa omvårdnadsåtgärder finns att tillgå på sjukhusen, som ett komplement till farmakologisk behandling. / Background: Pre-operative anxiety is a subjective and common experience. For the patient, it leads to increased pain, the need for more anesthetic, longer recovery time and extended hospitalization. There are multiple assessment instruments to measure pre-operative anxiety, as well as interventions to alleviate it. Purpose: Review the current literature to describe the effect of nursing interventions on pre-operative anxiety. Method: This essay was based on a literature review, studies highlighted the effect of interventions to alleviate pre-operative anxiety. Ten articles were selected after quality inspection and careful processing to fulfill the purpose. Result: From the results of the ten studies, three broad headings were created that show the effect of the studied interventions on pre-operative anxiety. The interventions were then divided by commonalties related to the type of intervention. The interventions shown to have the best effect on pre-operative anxiety where music and touch in various forms. Conclusion: There are several assessment instruments and nursing interventions that have shown good efficacy in alleviating pre-operative anxiety. The nurse has a central role in this by creating a trusting relationship and identifying anxiety at an early stage to help support these individuals. Clinical significance: If pre-operative anxiety is measured on a routine basis, at an early stage, using any assessment instruments the nurse have the opportunity to respond to individual problems. Due to that, it is of utmost importance that tested and reliable interventions are available in hospitals, as a compliment to medical treatment.

Bakgrund: Barn i sjukvården som ska genomgå anestesi och kirurg känner betydande oro och ångest vilket medför ett lidande hos barnet. Detta kan resultera i postoperativa komplikationer och förlängda vårdtider. I sjuksköterskans ansvarsroll ingår det att hjälpa barnet lindra sin oro och ångest. Syfte: Att beskriva och utvärdera de preoperativa metoder sjuksköterskan kan använda sig av för att minska barns oro och ångest inför anestesi och kirurgi. Metod: Design: Litteraturstudie. Artikelsökning genomfördes i databaserna Pubmed och Cinahl. Efter analys och kvalitetsgranskning valdes 20 artiklar ut till resultatet. Inklusionskriterier: Kvantitativa studier genomförda på barn, 0-18 år.  Studierna ska ha publicerats 2005 eller senare samt ha etiskt godkännande alternativt resonemang. Exklusionskriterier: Då interventionen var riktad mot föräldrar eller om barnen inte skulle genomgå anestesi. Resultat: Resultatet visade fyra olika teman med metoder som kan användas för att minska barns preoperativa oro och ångest. Dessa var clowninteraktion, sjukhusmiljö, distraktion och preoperativ information. Clowninteraktion och distraktion visar tydligast evidens för minskad oro och ångest hos barn. Att låta barnet bekanta sig med sjukhusmiljö samt medicinsk utrustning har även en positiv inverkan. Slutsats: I sjuksköterskans profession ingår ansvaret att arbeta mot minskad oro och ångest hos barn. Oro och ångest hos barn ger inte enbart ett ökat lidande utan även förlängda vårdtider med ekonomiska konsekvenser. Sjuksköterskan har olika metoder att använda sig av där distraktionsteknik samt clowninteraktion är de som idag har störst evidensstyrka. / Background: Children within healthcare who are undergoing anesthesia and surgery experience severe anxiety which results in suffering and can also lead to post-operative complications and extended hospitalization. As a registered nurse you are responsible to help the child reduce their anxiety. Aim: To describe and evaluate the pre-operative methods a registered nurse can use to reduce children’s anxiety related to anesthesia and surgery. Method: Literature review. Design: An article search was conducted in Pubmed and Cinahl, 20 articles were chosen for the result. Inclusion criteria: Quantitative studies conducted on children 0-18 years. Exclusion criteria: The aims of the study were directed against the parents or children not undergoing anesthesia. Results: The results showed four different themes that can be used in the reduction of children´s pre-operative anxiety. These were interaction with clowns, hospital environment, distraction, and pre-operative information. Interaction with clowns and distraction are the two methods that show the highest evidence of reducing anxiety. Allowing children to get familiar with the hospital environment and the medical equipment had a positive effect but more studies are needed in this area for greater evidence. Conclusion: The registered nurse is responsible for reducing anxiety in children who are undergoing anesthesia and surgery. A child with anxiety not only suffers more but is also at risk for prolonged hospitalization with economic consequences.  Although the registered nurse has several methods to choose from, distraction techniques and clown interaction produce the greatest results in decreasing anxiety.