Orientador: Alessandro Lia Mondelli / Resumo: A infecção de sítio cirúrgico é a complicação mais frequente em pacientes cirúrgicos e sua incidência pode ser diminuída com a profilaxia antimicrobiana realizada adequadamente. Sua importância na prevenção dessa infecção tem se tornado um tema relevante e emergencial para uma assistência adequada e segura. Este estudo objetivou avaliar o uso adequado da profilaxia antimicrobiana e a ocorrência de infecção de sítio cirúrgico de acordo com protocolo da Comissão de Controle de Infecção Relacionada à Assistência à Saúde (CCIRAS). Trata-se de um estudo de coorte, prospectivo, com seguimento de trinta dias em hospital de ensino do interior de São Paulo, Brasil. Para elegibilidade da amostra foram selecionados pacientes acima de 18 anos submetidos a cirurgias de todas as especialidades cirúrgicas, sejam eletivas e de urgência/emergência, que receberam profilaxia antimicrobiana. A coleta de dados foi através de software desenvolvido para este fim que comparou a profilaxia antimicrobiana realizada com a preconização do protocolo instituicional, identificando os acertos e inadequações para cada item avaliado. A infecção de sítio cirúrgico foi avaliada pela CCIRAS do hospital, a qual realiza a vigilância dos pacientes pós-alta através de ligações telefônicas. A amostra constituiu de 415 pacientes com cirurgias principalmente eletivas. A conformidade com todos os quesitos avaliados da profilaxia antimicrobiana foi de 1,7%. Verificamos que a cada inadequação da profilaxia antimicrobiana ... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Invasive procedures are often painful and distressing for children and disturbing for their parents. The purpose of this study was to develop a substantive theory of parental perceptions of their school-aged child's responses to an outpatient minor surgical procedure with nitrous oxide. The sample included 22 parents of 21 children who underwent a nitrous procedure. Participants were recruited from the pediatric surgery department at a children's hospital. Semi-structured, audio-recorded interviews were conducted with each participant. Grounded theory method was used to simultaneously collect and analyze the data using the constant comparative method. The findings of the study revealed parental impressions involving a process of various emotions and behaviors. The identified process began at procedural scheduling, progressing through the procedure, and terminated going home. The core category derived from the data was Weathering the Storm before the Calm by Securing Connections. This core category describes the complexity of parental impressions and all categories subsumed by the core category. Six major categories and seven subcategories derived from the data represent parental impressions. Parental feelings of anxiety and fear arose during initial phases of the process. Parents attempted to deal with these stormy feelings in several ways. Parents experienced a sense of calmness after the procedure upon realizing their child was safe. The theme that weaves through the entire process is the parental-child connection and parental presence during the nitrous procedure. Parents also identified barriers and facilitators they faced during this process. The substantive theory that emerged provides nurses with an understanding of the stormy and subsequent calm phases parents endured. This information offers clinicians unique interventions to help parents get through this process. Future research needs extension to other settings such as radiology and other specialties such as plastic surgery and urology. Further research warrants investigating children's perceptions to their procedure with nitrous oxide.

This study compares the biomechanics of early cyclic valgus loading of the ulnar collateral ligament (UCL) of the elbow repaired by either the Jobe technique or the docking technique. Better understanding of the biomechanical properties of each reconstruction may help surgeons choose the optimal surgical technique, particularly in planning earlier rehabilitation programs. Sixteen fresh frozen cadaver limbs (eight pairs) were randomized to either the Jobe cohort or the docking cohort. First intact UCLs were tested, followed by the repaired constructions. A Bionix MTS apparatus applied a constant valgus load to the elbows at 70o flexion, and valgus displacement was measured and then used to calculate valgus angle displacement. The docking group had significantly less valgus angle displacement than the Jobe group at cycles 100 and 1,000 (p = 0.0189 and 0.0076, respectively). Four of the eight specimens in the Jobe group failed at the tendon-suture interface before reaching 1,000 cycles, at cycles 7, 24, 250, and 362. None of the docking specimens failed before reaching 1,000 cycles. In this cadaveric study, the docking technique resulted in less angulation of the elbow in response to cyclic valgus loading as compared to the Jobe technique. The better response to valgus loading of the docking reconstruction may translate into a better response to early rehabilitation. Further study is needed to determine if this difference translates into improved clinical outcomes.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (p. 234-239).

Bakgrund: Dagkirurgi, att opereras och gå hem samma dag, är en vårdform som har ökat markant i Sverige senaste åren. Tidigare studier har visat att många patienter som genomgår dagkirurgi upplever oro inför operation, vilket orsakar lidande för individen men också ökat behov av sömnmedel och ökad risk för postoperativ smärta och oro. För att kunna genomföra omvårdnadsåtgärder för att minska oro måste den först identifieras, vilket framförallt är anestesisjuksköterskans uppgift i mötet med patienten. Syfte: Att undersöka patienters skattning av sin oro vid ankomst till operationsavdelningen vid dagkirurgi samt hur väl anestesisjuksköterskans skattning av patientens oro överensstämmer med patientens egen skattning. Metod: En kvantitativ enkätstudie som genomfördes på två operationsavdelningar i Uppsala län under en veckas tid, totalt inkluderades 88 patienter och 60 anestesisjuksköterskebedömningar. Enkäten bestod av en skattningsskala för oro enligt NRS samt grundläggande demografisk information. Resultat: En stor andel patienter skattade ingen eller mild oro (n=52, 59 %) vid ankomst till operationsavdelningen. Hos 70 % av de parvisa jämförelserna bedömdes anestesisjuksköterskans förmåga att bedöma patientens oro som god. Slutsats: Anestesisjuksköterskorna var generellt bra på att bedöma patientens oro, men vid några fall missbedömdes patienter som skattade hög oro. Denna studie visar att det finns ett behov av mer studier för framtagande av rutiner och vetenskapligt beprövade och användbara instrument för att kunna identifiera dessa patienter. / Background: Ambulatory surgery, to receive surgery and go home the same day, is a form of care which has increased markedly in Sweden in recent years. Previous studies have showed that many patients undergoing ambulatory surgery experience anxiety before surgery, which causes suffering for the individual but also increases the need for hypnotics and increases risk of postoperative pain and anxiety. To be able to carry out nursing interventions aimed at reducing anxiety,  it must first be identified, which is mainly the  nurse anesthetist’s role in the encounter with the patient. Objective: To investigate patients' estimation of their anxiety upon arrival at the ambulatory surgery department, and how well the anesthesia nurses' estimation of the patients' anxiety are consistent with the patients' own estimation. Method: A quantitative survey conducted in two ambulatory surgery departments in Uppsala County during one week, a total of 88 patients were enrolled, and a total of 60 anesthesia nurses' assessments. The survey consisted of a scale for estimating anxiety using NRS and basic demographic information. Results: A large proportion of patients estimated no or mild anxiety (n=52, 59 %) on arrival at the surgical department. In 70 % of the pairwise comparisons the anesthesia nurses' ability to assess the patients' anxiety were good. Conclusion: Anesthesia nurses were generally good at assessing the patients’ anxiety, however it was showed that in some cases patients that reported high levels of anxiety were not identified. There is a need for more studies about routines and  useful and scientifically tested instruments for the identification of patients’ anxiety.

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

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

Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 2 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.