Objectives: To evaluate and compare an experimental surgical navigation system (ESNS) in implant placement accuracy to static planning and transfer systems. Material and Methods: Partially edentulous, surgical typodonts were used to simulate prosthetically-driven osteotomies in preclinical setting. After cbCT acquisition the DICOM files were used to reverse plan and fabricate surgical guides. Manual placement, three static guiding systems and ESNS were compared. Eight osteotomies per jaw were transferred to 10 typodonts in five series, resulting in 400 osteotomies by 3 operators, each modality. Lateral, vertical, total and angular deviations were measured and compared. Results: Computer-assisted systems were comparable and provided superior precision laterally and in angulation, but not vertically; implants placed in free-end positions were less accurate. Conclusions: All computer-aided methods showed less than 2 mm or 5 degrees error on average, which needs to be considered in clinical practice.

Objectives: To evaluate and compare an experimental surgical navigation system (ESNS) in implant placement accuracy to static planning and transfer systems. Material and Methods: Partially edentulous, surgical typodonts were used to simulate prosthetically-driven osteotomies in preclinical setting. After cbCT acquisition the DICOM files were used to reverse plan and fabricate surgical guides. Manual placement, three static guiding systems and ESNS were compared. Eight osteotomies per jaw were transferred to 10 typodonts in five series, resulting in 400 osteotomies by 3 operators, each modality. Lateral, vertical, total and angular deviations were measured and compared. Results: Computer-assisted systems were comparable and provided superior precision laterally and in angulation, but not vertically; implants placed in free-end positions were less accurate. Conclusions: All computer-aided methods showed less than 2 mm or 5 degrees error on average, which needs to be considered in clinical practice.

Bakgrund: Flera studier beskriver vikten av att minimera dörröppningsfrekvensen på operationssalarna. Högre frekvens av dörröppningar leder till försämrad ventilation på operationssalen, vilket i sin tur kan leda till vårdrelaterade infektioner. Syfte: Syftet med denna studie var att på en operationsavdelning observera frekvensen av dörröppningar under pågående operation, varför och av vem de öppnades. Metod: Metoden var en kvantitativ deskriptiv observationsstudie med tvärsnittsdesign. Personalen på en operationsavdelning i Mellansverige observerades under pågående operationer. Observationerna utfördes sex vardagar i januari 2013 och valdes från operationsprogrammet. Resultat och slutsats: 22 observationstillfällen observerades, 11 från vardera konventionell respektive infektionskänslig kirurgi. Studien visade att dörröppningsfrekvensen var högre vid konventionell kirurgi jämfört med infektionskänslig. Dörröppningsfrekvensen varierade från en gång per minut till var 10:e minut vid konventionell kirurgi. Vid infektionskänslig kirurgi varierade dörröppningsfrekvensen från var 3:e minut till var 19:e minut. Den yrkesgrupp som utförde de flesta dörröppningarna var den cirkulerande personalen. Den största anledningen till dörröppningarna var hämtning av utrustning/material/instrument. Klinisk betydelse: Studien visar att dörröppningsfrekvensen vid konventionell kirurgi är högre än vid infektionskänslig kirurgi. För infektionskänslig kirurgi finns lokala riktlinjer. Däremot finns det inte vid konventionell kirurgi, där de kunde ha betydelse för att sänka dörröppningsfrekvensen. / Background: Several studies describe the importance of minimizing the frequency of door openings to the operating room. Higher frequency of door openings leads to impaired ventilation in the operating room, which in turn can lead to surgical site infections. Aim: The aim of this study was that in a surgical department observing the frequency of door openings during surgery, why and by whom they were opened. Method: The method was a quantitative descriptive observational study with cross-sectional design. The personnel in a surgical department in central Sweden were observed during operations. The observations were performed six weekdays in January 2013 and were selected from the surgical program. Results and conclusion: 22 observations were observed, 11 each from conventional and implant surgery. The study indicated that door openings were more frequent when comparing conventional surgery with implant surgery. The frequency of door openings varied from once per minute to every 10 minutes for conventional surgery. In implant surgery the frequency of door openings varied from every 3 minutes to every 19 minutes. The profession who carried out most door openings was the circulating staff. The main reason for the door openings was retrieval of equipment / materials / instruments. Clinical relevance: This study shows that the frequency of door openings was higher at conventional surgery than at implant surgery. For implant surgery there are local guidelines. However, there are none for conventional surgery, where they could play a role in lowering the frequencies of door openings.

Ambulatory surgery is common and develops alongside surgery and anesthetic methods. Time admitted is short and aftercare takes place in the home environment. Objective: The aim of the study was to investigate which symptoms patients experience after ambulatory surgery related to anesthesia. Furthermore how strongly symptoms affect the patient. Symptoms appear as a result of anesthesia and surgery and can therefore be interpreted as nursing induced suffering. Method: Participants were recruited at ambulatory clinics at a Swedish university hospital spring, 2015.  Prior to the study permission was granted from the clinic managers. The study is a quantitative descriptive longitudinal study.  Data collection forms were administered and data collection was performed by phone. Incisional pain, headache, neck pain, hoarseness, postoperative sore throat, nausea, drowsiness, post-discharge urine retention and numbness were requested parameters. Answers were evaluated as; none-existing, mild, moderate and severe. Data was measured at 48 hours and postoperative day seven. Result: The study included 67 participants. The various symptoms were all apparent to some extent by some of the participants at 48 hours. Concerning headache, neck pain, hoarseness, sore throat, nausea, urine retention and numbness most were symptom free. Incisional pain and drowsiness however affected the participants noticeably. Seven days after surgery there was an overall improvement throughout the parameters. Although incisional pain and drowsiness also lessened some participants still evaluated their experience moderate to severe. Conclusion: The majority of the day surgery patients were content with their care, in our study 97% were satisfied. There was an improvement within the experienced symptoms after seven days compared to after 48 hours. There is room for improvement concerning pain management and time for recovery in the home environment as drowsiness was still an evident issue. / Dagkirurgi är vanligt och drivs framåt av utvecklingen inom kirurgi och anestesi. Vårdtiden är kort och mycket av eftervården sker i hemmet. Syfte: Syftet var att undersöka vilka symptom patienter upplever efter genomgången dagkirurgi relaterat till anestesi. Vidare undersöks hur starkt olika symptom påverkar patienten. Symptom efter anestesi och kirurgi uppkommer till följd av omvårdnaden och kan därför tolkas som ett vårdlidande. Metod: Deltagare har rekryterats från dagkirurgiska avdelningar vid ett mellansvenskt universitetssjukhus våren 2015. Tillstånd inhämtades före studien från verksamhetschefer. Studien är en beskrivande kvantitativ longitudinell studie och data har samlats in med frågeformulär där svaren delgivits via telefon. Parametrarna smärta i operationsområde, huvudvärk, smärta i nacke, heshet, smärta i svalg, illamående, trötthet, urinretention samt känselbortfall har efterfrågats. Svaren har delgivits på en skala som graderats i nivåer från; inte alls, mild, måttlig och svår.  Mättillfällen var efter 48 timmar samt sju dagar postoperativt. Resultat: Studien har 67 deltagare. Efter 48 timmar upplevdes de olika symptomen alltid av någon deltagare, men vid huvudvärk, smärta i nacke, heshet, smärta i svalg, illamående, urinretention samt känselbortfall var de flesta symptomfria. Smärta i operationsområdet och trötthet påverkade dock patienterna påtagligt. Efter sju dagar upplevdes förbättring i alla parametrar. Smärta i operationsområdet samt trötthet minskade, men upplevdes fortfarande av vissa som måttlig och svår. Slutsats: De flesta dagkirurgiska patienterna är nöjda med sin vård, 97% i vår studie. En förbättring i upplevda symptom finns efter sju dagar jämfört med efter 48 timmar. Förbättringspotential finns inom smärtlindring och vidare bör utrymme för återhämtning finnas då trötthet visat sig vara förekommande

<p>Background: Bariatric surgery produces marked weight loss and improvement in comorbid health conditions among individuals with Class II or Class III obesity (Class I = 30.0 &le; BMI &le; 34.9kg/m2; Class II = 35.0 &le; BMI &ge; 39.9kg/m2; Class III = BMI &ge; 40 kg/m2). However, suboptimal weight outcomes occur in a significant minority of patients. Evidence suggests that psychological and behavioral factors might affect weight loss, but most of the literature has focused on preoperative factors, with mixed results. The current study tested the hypothesis that postoperative depressive symptoms, eating behaviors, and lower levels of physical activity would be associated with poorer weight loss outcomes. Method: Preoperative data were obtained from an extant clinical database, and postoperative data were collected via a mail or online questionnaire in a sample of 141 female Roux-en-y gastric bypass (RYGB) patients at an average of 16.80 (SD=2.20) months post-surgery. Self-report measures assessed cognitive-affective and somatic symptoms of depression; binge eating, grazing, night eating, distress about overeating or loss of control over eating; and physical activity. Results: Weight outcome measures were defined as percentage of excess BMI loss (%EBMIL) and successful weight loss (&ge; 50% EBMIL). Higher distress was associated with poorer %EBMIL, and higher level of physical activity was associated with greater %EBMIL. Decreased cognitive-affective symptoms and increased somatic symptoms of depression were associated with a higher probability of successful weight loss. Increased somatic complaints predicted greater %EBMIL unless those symptoms were associated with higher sedentary behavior. Conclusions: Consistent with hypotheses, preoperative depressive symptoms and binge eating disorder did not predict weight loss. Aspects of all three postoperative domains were associated with weight outcomes. Future research should explore the relations among these psychological and behavioral factors and weight loss over a longer follow-up period.</p> / Dissertation

Over the next few years, major investments in healthcare buildings is to be performed. Most surgical theaters are in need of technological upgrades as the technology is outdated. In most cases not only a refurbishment is performed but also an expansion. The basis for expansion, is due to a large increased number of patients, but also to the complexity of the refitment. Partly it's because evacuations are difficult to implement and the disturbance that occurs in conjunction with the refitment. Löwenströmska hospital undergoing a technical upgrad. The hospital has a relatively small operation department, and during the summer the business may be closed. Rebuilding in stages is done to rehabilitate the department technically. Work is underway for four summers and covers a total refurbishment of the premises. Although shutdown is possible, the project is still complex. The purpose of this study is to examine whether other construction methods than rebuilding had been of value to the surgical department at Löwenströmska hospital. The goal is to overlook the efficiency of production, reduce the complexity added through the conversion, and compare the methods economically. Methods that have been examined are a new construction of a department, new construction with partial conversion and modules. The work is also carried out to facilitate the choice of method for future projects. The basis of the work lies in discussions and interviews with persons involved in the project. And review of blueprints and technical specifications . The conclusion of this study is that depending on the chosen construction method various advantages is gained. Depending on the circumstances and opportunities provided , all results provide beneficial solutions. Therefore, all investigated methods individually reviewed for similar projects.

Tyrimo uždaviniai: 1. Išnagrinėti medicinos komandos sampratą. 2. Apibūdinti operacinės komandos veiklos tikslus. 3. Ištirti operacinės komandos narių pasitenkinimą darbu. 4. Išanalizuoti darbo santykius tarp operacinės komandos narių. 5. Ištirti operacinės slaugytojo komandinį vaidmenį ir kompetenciją. Tyrimo populiacija: 102 Všį VUL Santariškių klinikų slaugytojos, dirbančios abdominalinės chirurgijos, ginekologijos, urologijos, kraujagyslių, akių operacinėse bei Všį VUL Santariškių klinikų gydytojai chirurgai, ginekologai, urologai, akių gydytojai, kraujagyslių chirurgai ir gydytojo asistentai dirbantys VUL Santariškių klinikų operacinėse. Tyrimo metodai: 1. Teorinė mokslinės literatūros, leidinių, publikacijų apžvalga. 2. Operacinės slaugytojų, gydytojų chirurgų, gydytojo asistentų anketinė apklausa. Kaip metodas buvo panaudotas pilotinis tyrimas. 3. Gautų rezultatų aptarimas ir jų analizė. Darbo išvados: 1. Remiantis mokslinės literatūros apžvalga bei atlikto tyrimo rezultatais nustatyta: darbo komandai būdingi bendravimas, tarpusavio pagalba ir bendro tikslo siekimas. Apklaustieji medikai apibrėžė komandą kaip grupę žmonių, kurioje žmonės pirmiausia sąveikauja tarpusavyje, kad keistūsi informacija ir priimtų sprendimus, kurių tikslas – padėti vienas kitam, vykdyti savo srities užduotis. 2. Komandinio darbo operacinėje tikslas - suteikti kvalifikuotą medicininę pagalbą, o svarbiausias operacinės komandos uždavinys - užduoties atlikimas. Slaugytojų ir gydytojų požiūris į... [toliau žr. visą tekstą] / The goals of the research: 1. Analyse the concept of the medical team. 2. Define the objectives of the surgery team. 3. Determine the level of satisfaction of the members of the surgery team with their job. 4. Look into professional relations among the members of the surgery team. 5. Consider the role and competence of the surgical nurse in the team. Survey population: 102 nurses of Public Institution Vilnius University Hospital Santariškių klinikos working in the operating rooms of abdominal surgery, gynaecology, urology, vascular and eye diseases, and surgeons, gynaecologists, urologists, eye doctors, vascular doctors and assistant doctors of Public Institution Vilnius University Hospital Santariškių klinikos working in operating rooms of Vilnius University Hospital Santariškių klinikos. Research methods: 1. Theoretical review of scientific references and publications. 2. Questionnaire survey of surgical nurses, surgeons and assistant doctors. A pilot survey was employed as the method. 3. Discussion and analysis of the results. Conclusions: 1. Based on the review of scientific references and the results of the survey, it was established that communication, mutual support and focus on the common goal are the attributes characterising a team. The surveyed medical workers described a team as a group of persons, wherein members primarily interact with one another to exchange information and make decisions, and their aim is to support each other and perform own tasks. 2. The... [to full text]

Background: Primary urethral carcinoma is a very rare condition, and no large-scale experience with such cases has been published. Treatment will therefore have to follow rules established for the treatment of similar conditions. Patients: Six cases of primary urethral carcinoma (5 male, 1 female) who had been treated at our institution between 1995 and 1999 were retrospectively analyzed. In 3 male cases, a primary urothelial carcinoma of the distal urethra was treated by distal urethrectomy only. In 3 other cases with locally advanced tumors and/or lymph node metastases surgical treatment was followed by adjuvant cisplatinum-containing chemotherapy. Results: In the 3 cases with distal urethral carcinoma, partial urethrectomy with preservation of the penis resulted in cure, with a follow-up of 12–71 months. In the cases with advanced disease, adjuvant chemotherapy after surgery has resulted in complete remissions in all 3 cases, with a follow-up of 4–47 months at present. Conclusions: In localized, noninvasive carcinoma of the distal male urethra, partial urethrectomy seems adequate and the avoidance of penile amputation justified. In advanced cases, after local excision and lymphadenectomy adjuvant chemotherapy which by necessity must follow the guidelines established for the treatment of other urothelial or squamous cell malignancies seems to be beneficial. / Hintergrund: Das primäre Harnröhrenkarzinom ist eine sehr seltene Erkrankung, und in der Literatur gibt es keine prospektiven Serien mit größeren Fallzahlen. Die Behandlung wird sich daher an Erfahrungen orientieren müssen, die bei der Behandlung ähnlicher Krankheitsbilder gewonnen wurden. Patienten: Sechs Fälle von primärem Urethralkarzinom (5 Männer, 1 Frau), die zwischen 1995 und 1999 in unserer Klinik behandelt wurden, wurden retrospektiv analysiert. Bei 3 der männlichen Patienten lag ein primäres Urothelkarzinom der distalen Harnröhre vor, und es wurde eine Urethrateilresektion ohne adjuvante Therapie durchgeführt. In den 3 anderen Fällen mit lokal fortgeschrittenen Tumoren und/oder Lymphknotenbefall wurde nach operativer Behandlung eine adjuvante Cisplatin-haltige Chemotherapie durchgeführt. Ergebnisse: In allen 3 Fällen nach Urethrateilresektion wurde eine komplette Heilung bei einer Nachbeobachtung von 12–71 Monaten erzielt. Bei den fortgeschrittenen Fällen mit lymphogener Metastasierung wurde nach adjuvanter Chemotherapie in allen 3 Fällen eine komplette Remission bei einer Nachbeobachtung von bislang 4–47 Monaten erzielt. Schlußfolgerungen: Beim lokalisierten, nichtinvasiven distalen Urethralkarzinom des Mannes ist eine organerhaltende Strategie gerechtfertigt. In lokal fortgeschrittenen und/oder lymphogen metastasierten Fällen ist nach lokaler Exzision und Lymphadenektomie eine adjuvante Chemotherapie, die sich an den Erfahrungen der Behandlung von anderen Plattenepithel- und Urothelkarzinomen orientieren muß, sinnvoll und erfolgversprechend. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The purpose of this study was to investigate the effects of three different glycemic control conditions (tight, conventional, and standard) in the intraoperative period on: 1) postoperative surgical site infections, and 2) postoperative procalcitonin, and C-reactive protein levels in patients undergoing open-heart surgery. Secondary aims of the study were to investigate the effects of the three glycemic treatment conditions on: 1) intraoperative blood glucose; 2) intraoperative glycemic stability; and 3) intensive care unit length of stay, in patients undergoing open-heart surgery. An experimental design with a multilevel, single factor, within-subjects design was utilized. Patients were nested within anesthesia provider teams. The design was counterbalanced by means of a Latin square, where each of three anesthesia provider teams dispensed each of three glycemic control conditions once. Thirty-seven participants were randomized to either tight glycemic control (n =15), which maintained blood glucose 110-149 mg/dl via continuous intravenous insulin infusion, conventional glycemic control (n = 11), which maintained blood glucose 150-180 mg/dl via continuous intravenous insulin infusion, or standard glycemic control (n =11) which maintain blood glucose 150-180 mg/dl via intravenous bolus injections of insulin. The main findings of this study were that there were no significant differences between the three glycemic interventional treatment groups in 1) thirty-day surgical site infections, 2) postoperative C-reactive protein or procalcitonin concentrations 3) intensive care unit length of stay, 4) intraoperative blood glucose levels, or 5) glycemic stability. An association between intraoperative peak blood glucose and surgical site infection was established. Participants that experienced higher peak blood glucose levels intraoperatively exhibited increased surgical site infections. Procalcitonin levels were significantly elevated in participants that experienced a surgical site infection, but C-reactive protein showed no significant difference between participants with or without a surgical site infection. Coronary artery bypass graft surgery concomitant with valve replacement surgery was associated with a higher rate of surgical site infections compared coronary artery bypass graft surgery or valve surgery independently. In conclusion, an association was found between higher peak intraoperative blood glucose levels and increased surgical site infections, therefore maintaining intraoperative blood glucose levels below 180 mg/dl via a continuous intravenous infusion of insulin, may reduce postoperative surgical site infections in the open-heart patient. The use of tight glycemic control during the intraoperative period can be achieved safely, with the use of judicious protocols, but its benefits remain unproven. Inflammatory biomarker procalcitonin was predictive of infection, where C-reactive protein was not. The addition of procalcitonin to routine postoperative blood work, in open-heart patients, may benefit providers in the diagnosis and early treatment of surgical site infections. This study was underpowered. Further studies with appropriate sample size, may be able to determine if tight glycemic control, compared to moderate glycemic control, in the intraoperative period is of benefit to patients undergoing open-heart surgery.

Bakgrund: : Vårdrelaterade infektioner är kostsamma för vården och orsakar lidande förpatienten. Operationspersonal har en viktig uppgift att förebygga smittspridning och följahygienrutiner. Dessa är bland andra att använda rätt arbetskläder, arbeta aseptiskt och enligtbasala hygienrutiner samt att bibehålla steriliteten. Syfte: Syftet med studien var att observeraföljsamheten till aseptik och basala hygienrutiner på operationssal vid allmänkirurgiskt ingreppvid två sjukhus i Mellansverige. Metod: Studien var en observationsstudie med kvantitativansats. Observationerna genomfördes utifrån ett observationsprotokoll. Ingreppen somobserverades var av allmänkirurgisk karaktär och totalt tio observationer utfördes.Yrkeskategorier som ingår i operationsteamet observerades i olika arbetsmoment, såsomarbetskläder, insättning av PVK, preoperativ huddesinfektion och steril drapering. Följsamhetentill de olika momenten beräknades i procent. Resultat: Totalt tio observationer genomfördes. Dearbetsmoment som hade bäst följsamhet var arbetskläder, insättning av PVK, preoperativhuddesinfektion och steril drapering. I alla arbetsmoment som observerades var handdesinfektionden underkategori som hade sämst följsamhet. Slutsats: I samtliga av de sex arbetsmoment somobserverades i studien fanns brister gällande följsamhet till aseptik och basala hygienrutiner trotsatt vissa moment, såsom preoperativ huddesinfektion och steril drapering av operationsområdet,hade hög följsamhet. / Background: Hospital acquired infections are costly for health care and causes distress for thepatient. Operational staff have an important role in preventing the spread of infection and followhygiene procedures. These include using the proper work clothes, work aseptically and accordingto basic hygiene and to maintain sterility. Aim: The aim of the study was to observe adherence toaseptic technique and basic hygiene procedures in the operating theater for general surgery attwo hospitals in central Sweden. Method: The study was an observational study withquantitative approach. The observations were carried out on the basis of an observation protocol.The surgical intervention that were observed was of a general surgical nature and a total of tenobservations were performed. Professional categories included in the operating team wereobserved in different tasks, such as work clothes, insertion of PVK, preoperative skindisinfection and sterile draping. Adherence to the various elements was calculated in percent.Result: A total of ten observations were made. The observed tasks that had the best adherencewere working clothes, insertion of PVK, preoperative skin disinfection and sterile draping. Handdisinfection was the subcategory that had the lowest adherence of all observed tasks.Conclusion: In each of the six tasks that were observed in the study there were deficienciesregarding adherence to aseptic technique and basic hygiene despite some tasks, such aspreoperative skin disinfection and sterile draping of the surgical field, which had high adherence.