Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

published_or_final_version / abstract / Nursing Studies / Master / Master of Philosophy

[Truncated abstract] There have been few studies into the effects of rehabilitation following lumbar microdiscectomy and consequently little evidence of its effect, if any, on outcome. Most studies cited fall into one of two categories: research involving a spinal surgery procedure without rehabilitation, or research involving spinal surgery with a nonspecific generic 'rehabilitation' or 'physical therapy'. In an era of evidence based medicine the efficacy of specific rehabilitation protocols following defined lumbar spine surgical procedures needs to be established for surgeons, therapists and patients to have confidence that the rehabilitation is appropriate and effective. The study was proposed to investigate the outcome of a specific and novel rehabilitation protocol commenced immediately after lumbar microdiscectomy. Data collected from the research cohort were compared to data collected from a contrast group who underwent standard rehabilitation at a distant site. A retrospective study (Phase One) was carried out with a cohort of post-operative microdiscectomy patients between February 2000 and December 2002. The outcome of surgery followed by the rehabilitation protocol was assessed using validated outcome instruments. A contrast or control group was not included. After reviewing the data limitations with the design and implementation of the study were identified. A prospective study (Phase Two) was proposed and changes made in the principal outcome measure used, in the demographic data to be retrieved, the addition of pain scales, and in the exclusion of compensable patients. A contrast group was included for the prospective study. ... The study group commenced exercise and posture correction the day following surgery. There were restrictions placed on activity involving bending. The contrast group followed the advice of the surgeon in Queensland and attended rehabilitation at local physiotherapy facilities. Both groups were followed for 12 months using outcome instruments. Strict comparison between WA and QLD cohorts were limited due to sample size, however trends were observed. Data of the prospective study showed that there was greater reduction in back pain with the early rehabilitation protocol (P<.0001) compared to standard rehabilitation (P=.09), while there was no difference between groups in leg pain. There was a significant improvement in the level of functional disability between time-points for the WA cohort, and overall change from pre-operative RMQ measures to 12 months in both groups were statistically significant. The WA group was less reliant on pain medication and was more satisfied with the results of their surgery. The primary hypothesis of this study that there would be a difference in outcome following lumbar microdiscectomy in patients who receive early specific rehabilitation compared to those who receive standard rehabilitation at another centre, was supported in both primary and secondary outcome data. The key finding of this study was that commencing the early exercise protocol resulted in significantly less back pain over the 12 month time period of the study. Other major findings were that the WA cohort demonstrated significant improvement in function at all time-points and between all time-points except six to 12 months, took less pain medication and were more satisfied with the outcome of their surgery than the QLD cohort.

published_or_final_version / Nursing Studies / Master / Master of Nursing

Background Nosocomial infection is a crucial problem and cause of morbidity and mortality especially in cardiac surgery settings. The risk of acquiring such infection is even higher because cardiac surgery patients require intensive care postoperatively. The phenomenon is evidenced by longer length of hospital stay and increased cost of care. Pneumonia and surgical site infections were ranked among the top three most common hospital acquired infections. The usual practice for mouth care is diluted thymol gargle solution for intubated patients after cardiac surgery in Hong Kong. No local studies examine the effect of oronasopharyngeal care on minimizing such infections. An evidence based guideline in oral and nasopharyngeal nursing care is necessary to implement in hospitals for improving patient surgical outcome. Objective To develop an evidence based practice guideline for pre- and postoperative oronasopharyngeal care of in-patients undergoing cardiac surgery with implementation planning and discussion on evaluation. Methods The most recent publications were searched till August 2011. Randomized controlled trials with oropharyngeal and/ or nasopharyngeal care with outcome measures on surgical site infection and/ or nosocomial pneumonia were reviewed. Essential data were extracted with quality assessed methodologically. Results Six randomized controlled trials comparing oropharyngeal and/ or nasopharyngeal care intervention with usual care were reviewed. The studies mostly included middle-aged male patients undergoing cardiac surgery. The results showed positively of interventions on nosocomial pneumonia and surgical site infection when compared with usual care. In view of quality assessments and statistically significant findings, the proposed change that could improve surgical outcome of patients is to use chlorhexidine gluconate on oronasopharyngeal care in the guideline. It mainly carries out in in-hospital settings both by patients with education from nurses preoperatively, and by nurses postoperatively. Conclusion Reviewed evidence shown that the oronasopharyngeal care interventions help effectively on minimizing the occurrence of nosocomial pneumonia and surgical site infections for patients undergoing heart surgery. It could be potentially adopted for nurses working in cardiac surgical ward and cardiac intensive care unit. / published_or_final_version / Nursing Studies / Master / Master of Nursing

The purpose of this research study was to evaluate pain, strength, balance, and function in subjects before and after total knee arthroplasty. Thirteen subjects were tested prior to total knee arthroplasty. Seven of the original subjects returned to the laboratory and were tested one month after knee replacement surgery. At each testing session subjects completed questionnaires including a pain visual analog scale (VAS), Falls questionnaire, global rating of knee function, Western Ontario McMaster Universities (WOMAC) osteoarthritis index, and Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS). Strength was tested via unilateral, isometric squat. Knee range of motion was measured using a standard goniometer. Functional activities including walking, sit to stand transfers, and stepping on and off a curb were assessed using the Balance Master Force Plate system (Neurocom International). Balance activities including tandem walk, modified clinical test of sensory interaction on balance (mCTSIB), limits of stability (LOS), and sensory organization tests (SOT) were also assessed using the SMART Equitest (Neurocom International). There was a trend towards decreased pain on VAS post- surgery although the results were not significantly different (p = 0.0585). Subjective rating of function was improved on the composite WOMAC Osteoarthritis Index score (p = 0.0313). No differences were found after surgery for strength in the involved limb, balance tasks, or ability to perform functional activities. From this study we conclude that total knee arthroplasty does not have a deleterious effect on function or balance in the immediate post-operative period even through the knee is still in an acutely inflamed state. Further testing is needed to evaluate the effect of TKA on more strenuous functional activities and balance tasks and at larger post-operative intervals. / School of Physical Education, Sport, and Exercise Science

It is generally recognized that a serious illness with concurrent hospitalization in an ICU will have an impact on family members. Few researchers, however, have described the ways in which spouses are affected when their mates are hospitalized in an ICU. Therefore, this study aimed to describe and explain the spouses' experiences of having a mate in an ICU following coronary artery bypass graft surgery. Kleinman's conceptual framework guided the development of the research question and provided the focus for data collection and analysis. Kleinman proposes that an understanding of the client's perspective is necessary for the provision of effective health care. A qualitative research method based on the theoretical perspective of phenomenology was used to answer the research question. The spouses' viewpoints were elicited through unstructured interviews. The sample consisted of seven spouses, four women and three men. The spouses were interviewed on two occasions, once while their mate was still in the ICU and once shortly following their mate's discharge from the ICU. A total of 13 in-depth interviews were conducted over a 3 month period. Data were analyzed simultaneously with and following data collection. Responses that were similar were grouped together into categories. After the data were examined and sorted into categories, the researcher defined the theme that dominated each category. The themes that emerged from the data were clarified, validated, and/or rejected by the participants during subsequent interviews. As relationships between the categories were identified, the important aspects of the spouses' experiences became apparent. The findings revealed that the spouses located the ICU experience within the context of their experience with their mate's coronary artery bypass graft surgery. The spouses understood and made sense of the ICU experience by attaching meaning to specific events that related to the entire surgical experience. They perceived the surgical experience as consisting of three distinct but interrelated phases: pre-surgery; waiting during surgery; and post-surgery. During each phase, the spouses described and explained how they reacted to and coped with each new situation. These two themes, "reaction to the situation" and "coping with the situation," appeared as threads throughout the entire surgical experience. By organizing the data in relation to phases and themes, the researcher was able to meaningfully understand and communicate the spouses' entire surgical experience. In view of the study findings, implications for nursing practice, education and research are delineated. / Applied Science, Faculty of / Nursing, School of / Graduate

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

There is a growing recognition that removal of an eye may cause a significant impact on a person's body image and her or his role in society; and may evoke a variety of emotional responses. The loss of an eye does not only signal disfigurement, it also means a loss of a body part and a vital sense; that of sight. Without vision, individuals have difficulty communicating. The emotional responses to this loss many a times, go unrecognized as the doctors and nurses who are in close contact with the patient at this time are not necessarily prepared to provide emotional care. This study seeks to address this gap by identifying the emotional impact of loss of an eye and sight on people's lives and the implication it has for health care workers, especially nurses. The eliciting of the different feelings and experiences of these patients can provide information for the formulation and design of protocols for holistic health care management. A non-experimental exploratory and descriptive design was used to conduct In-depth conversational interviews with seven purposively selected participants who had enucleation or evisceration between 2000 and 2005. Information-rich data yielded findings that clearly stressed the need for greater sensitization to the problem. All the participants expressed shock at the final diagnosis of enucleation or evisceration even if this was on their request. Patients wanted to know about the operation and its outcome, the prosthesis, how will it look like and its fit. Findings indicate that answers to these questions were not provided. Patients were not adequately emotionally prepared pre-operatively and were therefore not appropriately cared for post-operatively. Families were not satisfactorily involved and as such were not in a position to provide emotional support that the patients needed The recommendation was that a study to explore the health care team's knowledge in the psychological and emotional management of patients in crisis should be conducted as a benchmark for further training. / Health Studies / M.A. (Health Studies)

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: On average one in three patients following lumbar surgery (LS) for radiculopathy experience persistent pain and disability following surgery. No perioperative treatments have shown any ability to decrease this persistent pain and disability. In another challenging low back pain (LBP) population, chronic LBP, pain education focusing on the neurobiology and neurophysiology of pain, has shown an ability to reduce reported pain and disability. The purpose of this research study was to develop and test a preoperative neuroscience education program for LS and determine its effect on pain and disability following LS. Research Design and Methods: After a series of studies, a newly designed preoperative neuroscience educational tool (PNET) was developed. Eligible patients scheduled for LS for radiculopathy participated in a multi-center study where they were randomized to either receive usual care (preoperative education), or a combination of usual care plus one session covering the content of the PNET, as delivered by a physiotherapist in a one-on-one verbal session. Prior to LS, and one, three and six months after LS, 67 patients completed a series of self-report outcome measures consisting of LBP and leg pain rating (Numeric Rating Scale), function (Oswestry Disability Index), fear avoidance (Fear Avoidance Beliefs Questionnaire), pain catastrophization (Pain Catastrophization Scale), pain knowledge (Pain Neurophysiology Questionnaire), various beliefs and experiences related to LS (Likert Scale), and post-operative utilization of healthcare (Utilization of Healthcare Questionnaire). Results: At six month follow up there were no statistical difference (p <0.05) between the experimental and control groups in regards to the primary outcome measures of function (p = 0.296), LBP (p = 0.077) and leg pain (p = 0.074). The experimental group scored significantly better on various questions regarding beliefs and experiences having undergone LS, compared to the control group indicating a more positive surgical experience. Analysis of healthcare utilization showed that patients who received the preoperative neuroscience educational program had dramatically less health care utilization (medical tests and treatments) in the six months following LS (p = 0.001), resulting in a 38% savings in healthcare cost. Conclusion: The addition of a preoperative neuroscience educational program to usual care for LS for radiculopathy resulted in a profound behavioral change leading to a more positive surgical experience, decreased healthcare utilization and resultant savings, despite persistent pain and disability. / AFRIKAANSE OPSOMMING: Agtergrond: Gemiddeld een uit elke drie pasiënte ervaar volgehoue pyn en gestremdheid na lumbale chirurgie (LC) vir radikulopatie. Geen peri-operatiewe behandeling het al getoon dat dit die vermoe het om hierdie volgehoue pyn en gestremdheid te verminder nie. In nog 'n uitdagende lae rug pynbevolking, naamlik chroniese lae rugpyn, het pyn-onderrig, wat fokus op die neurobiologie en neurofisiologie van pyn, getoon dat dit kan lei tot verminderde rapportering van pyn en gestremdheid. Die doel van hierdie navorsingstudie was om 'n preoperatiewe neuro-onderrig program vir lumbale chirurgie te ontwikkel en te toets, en die uitwerking daarvan op pyn en gestremdheid na LC te bepaal. Navorsingsontwerp en Metodiek: Na 'n reeks studies is 'n nuwe preoperatiewe neuroonderrig hulpmiddel (PNET) ontwikkel. Geskikte pasiënte wat geskeduleer was vir LC weens radikulopatie, het deelgeneem aan 'n veelvuldige- sentrum studie. Deelnemers is lukraak in een van twee groepe ingedeel om of gewone sorg (preoperatiewe onderrig), of 'n kombinasie van gewone sorg met een sessie wat die inhoud van die PNET gedek het. Laasgenoemde sessie is aangebied deur 'n fisioterapeut in 'n een-tot-een verbale sessie. Voor die LC, en een, drie en ses maande na LC, het 67 pasiënte 'n reeks van selfverslaggewende uitkoms metings voltooi, wat insluit: Lae Rug- en beenpyn gradering („Numeric Pain Rating Scale‟), Funksie („Oswestry Disability Index‟), Vrees-vermyding („Fear Avoidance Beliefs Questionnaire‟), Pyn-katastrofering („Pain Catastrophization Scale‟), Pynkennis („Pain Neurophysiology Questionnaire‟), verskeie oortuigings en ervarings wat verband hou met LC („Likert Scale‟), en postoperatiewe Gesondheidsorg-benutting („Utilization of Healthcare Questionnaire‟). Resultate: Tydens die ses-maande-opvolg was daar geen statistiese verskil (p <0,05) tussen die eksperimentele- en kontrolegroepe met betrekking tot die primêre uitkoms metings van Funksie (p = 0,296), Lae rug Pyn (p = 0.077) en beenpyn (p = 0,074), nie. Die eksperimentele-groep het betekenisvol beter gevaar met verskeie vrae oor oortuiging en ervarings na afloop van LC. Ontleding van gesondheidsorg benutting, het getoon dat pasiënte wie die preoperatiewe neuro-onderrig program ontvang het, dramaties minder Gesondheidsorg (mediese toetse en behandelings) in die ses maande na LC benodig het, (p = 0,001), wat gelei het tot 'n 38% besparing in gesondheidsorgkoste. Gevolgtrekking: Die byvoeging van 'n preoperatiewe neuro-onderrig program, tot die gewone-sorg vir LC weens radikulopatie, het „n noemenswaardige gedragsverandering veroorsaak wat tot n meer positiewe chirurgiese ervaring, verminderde gesondheidsorg benutting en finansiele besparing gelei het, ten spyte van volgehoue pyn en gestremdheid.