Objective: Evaluation of surgical quality ensures consistency of care and facilitates improvements in the quality of care delivered. Methods: An overview of surgical quality measurement is presented. A system for monitoring thoracic morbidity and mortality (TM&M) at the Ottawa Hospital is introduced and evaluated. Results of a needs assessment survey on the involvement in thoracic surgical research and quality improvement initiatives are presented. Results: Structure, process, and outcomes reflect different viewpoints on how to evaluate surgical quality. The feasibility of the TM&M system is evaluated using descriptive and univariate statistics, while its inter-rater reliability is assessed amongst the Canadian Association of Thoracic Surgeons. Conclusions: Outcomes have been fundamental in the evaluation of surgical quality. TM&M classification system advocates for a practice of continuous quality improvement and provides standardized and reliable feedback on surgical outcomes. Results of the needs assessment have built a strong foundation of knowledge on prospective ways to enhance the monitoring of surgical quality.

Surgery precipitates a hypercoagulable state and has been shown to increase the development of cancer metastases in animal models, however mechanism(s) responsible for this are largely unknown. We hypothesize that the prometastatic effect of surgery may be secondary to postoperative hypercoagulable state. Surgical stress was induced in mice by partial hepatectomy or nephrectomy, preceded by intravenous injection of CT26-LacZ or B16F10-LacZ cells to establish pulmonary metastases with or without perioperative anticoagulation and their lung tumor cell emboli (TCE) were quantified. Fibrinogen and platelets were fluorescently labeled prior to surgical stress to evaluate TCE-associated fibrin and platelet clots. Surgery significantly increased metastases while anticoagulation with five different agents attenuated this effect. Fibrin and platelet clots were associated with TCE significantly more frequently in surgically stressed mice. Surgery promotes the formation of fibrin and platelet clots around TCE and this appears to be the mechanism for the increase in metastases seen following surgery.

Syfte: Att beskriva dagkirurgiska patienters upplevelse av att bli utskrivna hem samma dag efter operation utförd i generell anestesi. Metod: Kvalitativ intervjustudie med induktiv ansats. Elva patienter som har opererats via en handkirurgisk mottagning i mellersta Sverige har intervjuats utifrån en semistrukturerad intervjuguide. Sju kvinnor och fyra män i åldrarna mellan 28-71 år har deltagit i studien. Innehållsanalys användes för analys av materialet. Resultat: Patienterna upplevde hemgången som väldigt positiv. De faktorer som bidrog till en lyckad hemgång var framförallt; Patientens goda grundhälsa, en trygg hemmiljö att återvända till och återhämta sig i, samt att patienterna får sina frågor och funderingar besvarade inför hemgången, och stöd från anhöriga. Vårdpersonalens bemötande och professionella förhållningssätt bidrog till att patienterna upplevde en känsla av trygghet som skapade en förutsättning för delaktighet.  Resultatet visar även att patienter önskar mer information om det postoperativa förloppet. Slutsats: Att skrivas ut och komma hem efter ett dagkirurgiskt ingrepp är en positiv upplevelse för patienterna, dock behöver informationen inför hemgången samt möjligheten till stöd från den dagkirurgiska enheten efter hemgången förbättras. / Aim: To describe the day-surgery patients´ experience to be discharge the same day after surgery in general anesthesia. Methods: Qualitative interview study with inductive approach. Eleven patients, operated by a hand surgical receptions in central Sweden were interviewed, using a semi- structured interview guide. Seven women and four men between 28-71 years participated in the study. Content analysis was used for analysis of the material. Result: Patients experienced the discharge as very positive. The factors which contributed to a successful discharge was above all, patient good basic health, a safe home to return to and recover in, and that the patients have their questions and concerns answered before discharge, and the support from relatives. Health professionals' reception and professional approach helped the patients to feel a sense of security that created a condition for participation. The results also show that patients want more information about the postoperative recovery. Conclusions: To be discharged, and come home, after day surgery procedures is a positive experience for patients, however, the information at discharge and the possibility of support from the day surgery unit after discharge needs to improve.

Flertalet studier har påvisat ett samband mellan koncentrationen av partiklar ≤ 10µm i luftföroreningar och cardiovaskulär- och pulmonell morbiditet och mortalitet. Vid resektion, koagulering/bränning med diatermipenna under operationer alstras rök. Denna rök innehåller bland annat mutagena och carcinogena partiklar i inhalerbar storlek (partiklar ≤ 10µm). Ett första syfte med denna studie var att kvantifiera den mängd ultra-fina partiklar (UFP) och partiklar ≤ 10µm som operationspersonal exponeras för i operationsrummet, vid användande av diatermi med mobilt rökutsug. Ett andra syfte var också att ta reda på om operations-personal exponeras olika mycket beroende på var i rummet de befinner sig, samt undersöka om partikelnivåerna skiljer sig på olika operationssalar. Partikelmätningar utfördes under 14 ortopediska operationer där diatermi med rökutsug använts. Medelvärdena av UFP visar på relativt låga partikelkoncentrationer på höftprotes- och ryggoperationer, med mycket korta stunder av höga värden upp till ett maxvärde på 88 396pt/ml vid operationsområdet. Även partiklar i storleken 1-10µm låg inom låga nivåer och under gränsvärdena vid jämförelse med organisk damm. Resultaten i studien indikerar att personal som står vid operationssåret exponeras av högre partikelkoncentrationer av ultra-fina partiklar och partiklar 1-10µm än övrig personal, även vid användande av mobilt rökutsug. Vid jämförelse av partikelnivåer av ultra-fina partiklar på två olika operationssalar framkom det att på den sal med lägst antal luftväxlingar i operationsrummet, var partikelkoncentrationen signifikant högre.

No description available.

Thesis--University of Kentucky (M.S.), 2003. / Title from document title page. Document formatted into pages; contains viii, 86 p. : ill. Includes abstract and vita. Includes bibliographical references (p. 82-85).

<p>Breast cancer is the most common type of cancer among women in the United States. Despite more women undergoing treatment and increased survival rates, many women continue to suffer from emotional distress and physical symptoms associated with treatments for breast cancer (e.g., surgery). To date, there has been limited research investigating the efficacy of psychosocial interventions for breast cancer patients during the surgical time frame. This randomized controlled pilot study examined the effect of a lovingkindness meditation intervention on key psychological and physical outcomes surrounding breast surgery. Sixty women undergoing surgery were randomly assigned to one of three treatment conditions at breast biopsy: 1) lovingkindness meditation, 2) music, 3) standard care. Assessments of emotional distress, physical symptoms, and positive psychosocial resources occurred prior to patients' biopsy, following their biopsy, one week after receipt of their biopsy results, and one week following breast surgery. Multilevel model analyses demonstrated that lovingkindness meditation significantly improved anxiety, pain, self-compassion, emotional suppression, mindfulness, social isolation, and heart rate levels over time compared to control conditions. These results support the efficacy of a brief lovingkindness meditation intervention for breast cancer patients during the surgical time frame. The implications of these findings on future research, theory, and policy are discussed.</p> / Dissertation

No description available.

The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.

- / We extend the theory for a novel approach for solving Elliptic Partial Differential Equations.