Att effektivt ta hand om akut smärta, den vanligaste orsaken till besök på akutmottagningen, är en viktig uppgift. Lindring av smärta kan medföra befrielse från lidande och förbättra patientens mående. Obehandlad eller underbehandlad smärta leder till negativa konsekvenser för patienten. Inför förbättringsarbetet genomfördes en kartläggning med journalgranskning och patientenkät vilken jämfördes med sjuksköterskornas egen uppfattning om följsamhet. På så sätt kunde ett kunskapsgap identifieras gällande smärtskattning, smärtbehandling och utvärdering av dess effekt på berörd akutmottagning. Syftet med förbättringsarbetet var att effektivare lindra smärta genom att öka sjuksköterskornas frekvens av smärtskattning. Smärtskattningen skulle ske före och efter given farmaceutisk behandling och farmaceutisk behandling skulle erbjudas i större utsträckning. Journalgranskningen begränsades till att omfatta patienter med buksmärta som är en av de vanligaste sökorsakerna vid besök på akutmottagningar. Nolans förbättringsmodell användes som metod i förbättringsarbetet. Förbättringsarbetets resultat visar på förbättringar inom samtliga mätområden där ökningen av erbjuden farmaceutisk behandling ansågs som mest betydelsefull. Resultatet tyder på att förändringen var gångbar och ledde till förbättring men visade också på vilka stora utmaningar som fanns i en komplex verksamhet. Studiens syfte var att beskriva sjuksköterskors erfarenhet av personcentrering vid smärtskattning där kvalitativ metod i form av fokusgruppsintervjuer med tillhörande innehållsanalys genomfördes. Resultatet visade på att patientens delaktighet var den främsta faktorn för framgångsrik smärtskattning. Fokus på smärta ökade medvetenheten och motivationen hos sjuksköterskorna till att efterfråga patientens berättelse och upplevelse i samband med det akuta besöket vilket är en viktig del i ett personcentrerat förhållningssätt. Slutsatsen är att förändrings- och förbättringsarbetet ökade sjuksköterskornas motivation att efterfråga patientens berättelse med ökad förekomst av smärtskattning (från 14% till 40%), erbjudande av farmaceutisk behandling (från 51% till 73%) och utvärdering av dess effekt (från 13% till 44%) som följd. / Effectively managing acute pain is one of the most important tasks of the emergency department and can improve the patient's well-being. Untreated or undertreated pain leads to negative consequences for the patient. Journal review, patient questionnaires and nurses' perception of adherence to established guidelines showed shortcomings regarding pain assessment, pain treatment and evaluation of its effect in the emergency department concerned. The aim of the improvement work was to relieve pain more effectively through increased pain assessment. The pain assessment would take place before and after given pharmaceutical treatment and would be offered to a greater extent. The journal review was limited to include patients with abdominal pain, which is one of the most common reasons for visits to emergency departments. Nolan's improvement model was used as a method in the improvement work where the results show improvements in all measurement areas. The increase in offered pharmaceutical treatment was considered most significant. The result indicates that the change led to improvement. The aim of the study was to describe nurses' experience of person-centeredness in pain assessment through a qualitative method in the form of focus group interviews with content analysis. The results showed that the patient's participation was the main factor for successful pain assessment. The focus on pain increased the awareness of the nurses to request the patient's story and experience in the emergency visit, which is an important part of a person-centered approach. The conclusion is that the improvement work increased the nurses' motivation to request the patient's story with increased occurrence of pain assessment (from 14% to 40%), offer of pharmaceutical treatment (from 51% to 73%) and evaluation of its effect (from 13% to 44%) as a result.

This Diploma thesis is focused on the issue of nursing care of acute abdominal pain in children under six years old. The abdominal pain of children can be the first symptom of an acute abdominal pain which can directly endanger a child´s life. Neglecting these troubles can lead to great health problems of a complicated character. Four research goals were set within the research. The first objective was to find specifics of acute abdominal pains of children up to six years old. The second objective was to find possible results of acute abdominal pains in children under six years old in the post-operative period. The third goal was to monitor the issue of acute abdominal pains in childhood from the point of view of a nurse and the fourth should have found the knowledge of parents about acute abdomeninal pains in childhood. The Diploma thesis strived to penetrate into the issue of this large chapter of acute medicine, highlight its specifics related to acute abdominal pains in childhood and find out how parents are informed about the existence of this type of illness. To complete the objectives of this Diploma thesis, we used a qualitative research model. This research was done by the technique of a semi-structured interview. The first research group consisted of eight nurses working in a standard paediatric ward or in a paediatric ward of the Intensive Care Unit (ICU). The second group consisted of parents, specifically mothers who responded based on their knowledge and general awareness gained. A technique of open coding a method of pencil and paper was used for processing the results of these interviews. Seven research questions were set: 1. What are the specifics of nursing care in acute abdominal pain in childhood? 2. What medical complications appear during acute abdominal pain in childhood? 3. What are the specifics of pre-operative and post-operative care in acute abdominal pain in childhood? 4. What is the post-operative period in children with acute abdominal pain? 5. What results can appear in acute abdominal pain in childhood? 6. How do nurses see the issue of sudden acute abdominal pain in childhood? 7. What is the parents´ knowledge about acute abdominal pains in childhood? Within the process of this Diploma thesis, a booklet was created. This should serve as information material for parents, which will help them to explain various terms and potential situations within this extensive diagnosis. This booklet will be at disposal in day nurseries and the outpatient department of the paediatric ward in České Budějovice.

Enligt forskning har kvinnor en högre rädsla för brott än män. En förklaring är att kvinnors rädsla för sexuella brott ökar rädslan för alla typer av brott. Andra faktorer som har visat sig påverka rädsla för brott är fysisk och psykisk ohälsa. Dessa faktorer och teorin om att kvinnors rädsla för brott påverkas av rädsla för sexuella brott kan innebära att smärtsjukdomar som vulvodyni och vaginism som innebär svår smärta vid penetration och / eller beröring av slidan gör att kvinnor som lider av det kan uppleva en högre rädsla av brottslighet än andra kvinnor. Studiens syfte var att undersöka om vulvodyni har en inverkan på kvinnors rädsla för brott. Deltagarna bestod av 243 kvinnor (medelålder= 24,58, SD= 5,15) med (n=129) och utan (n=114) vulvodyni. Resultaten av studien indikerar att vulvodyni påverkar rädsla för brott och gör kvinnor som lider av den mer rädda för brott än de utan vulvodyni. Kvinnor med vulvodyni har också en högre rädsla för sexualbrott som våldtäkt och sexuella trakasserier. Vulvodyni visar på en unik association till rädsla för brott vid kontroll över andra variabler som tidigare forskning visat samband med rädsla för brott. Rädsla för sexualbrott visar också associationer med rädsla för andra brott hos kvinnor med och utan vulvodyni. Mer forskning om ämnet behövs för att se hur kvinnor med vulvodyni resonerar om sin rädsla för brott. / According to research, women have a higher fear of crime than men. one explanation is that women's fear of sexual offenses increases the fear of all types of crime. Other factors that have been shown to affect fear of crime are physical and mental health. The factors and the theory that women's fear of crime is affected by fear of sexual offenses could mean that pain diseases such as vulvodynia and vaginism that involve severe pain when penetrating and/or touching the vagina make women who suffer from it to have a higher fear of crime than other women. The purpose of the study was to investigate if vulvodynia has an impact on women's fear of crime. The study sample consisted of 243 women (mean age=24,58, SD= 5,15) with (n= 129) and without (n=114) vulvodynia. The results of the study indicate that vulvodynia affects fear of crime and makes women who suffer from it more afraid of crime than those without. Women with vulvodynia also have a higher fear of sexual offenses such as rape and sexual harassment. Vulvodynia also demonstrates having a unique compound to fear of crime proud control for other variables. Fear of sexual crime also shows associates of fear to other types of crimes for women with and without vulvodynia. More research on the subject is needed to see how women with vulvodynia reason about their fear of crime.

Bakgrund: Akut buksmärta är en av de vanligaste sökorsakerna på en akutmottagning. Trots det är smärtlindringen till denna patientkategori omdiskuterad då smärtlindring innan läkarbedömning anses äventyra patientens hälsa och riskerar att maskera potentiellt livshotande tillstånd trots att forskning de senare årtiondena visat på motsatsen. Syfte:  Syftet med litteraturstudien var att undersöka fördelar och risker med smärtlindring administrerad av sjuksköterska innan läkarbedömning vid akut buksmärta. Metod: Systematisk litteraturstudie som granskat kvantitativa artiklar i ämnet med företrädesvis randomiserade kontrollerade studier beskrivna. De granskade artiklarna har sökts upp i medicinska databaser med hjälp av den strukturerade sökmetoden PICO. Artiklarnas resultat har granskats med innehållsanalys. Resultat: Totalt 12 vetenskapliga artiklar inkluderades och utgjorde resultatet i litteraturstudien. I resultatet framkom tre kategorier och en underkategori som belyste smärtskattning och smärtlindring, biverkningar och komplikationer, påverkan på diagnosbeslut och patientbelåtenhet. Slutsats: Tidig smärtlindring med opioider och paracetamol smärtlindrar patienten adekvat och försenar inte klinisk bedömning och efterföljande diagnosbeslut av läkare vid akut buksmärta.

<p>UVOD. Bilijarna kalkuloza je najče&scaron;će oboljenje hepatobilijarnog sistema, a holecistektomija predstavlja jedan od najče&scaron;će izvođenih operativnih zahvata. Laparoskopska holecistektomija je danas zlatni standard lečenja holelitijaze. Laparoskopska holecistektomija je pokazala pobolj&scaron;anje u klinički značajnim ishodima kao &scaron;to su skraćenje operativnog vremena, kraća hospitalizacija, smanjenje jačine i trajanja postoperativnog bola i brži povratak dnevnim i radnim aktivnostima. Postoperativna bol i vreme potpunog oporavka ostaju dva glavna problema posle nekomplikovane laparoskopske holecistektomije koje bi trebalo pobolj&scaron;ati. Bol koji je povezan sa laparoskopskom holecistektomijom je kompleksan i multifaktorijalan. On nastaje o&scaron;tećenjem tkiva, disekcijom i uklanjanjem žučne kesice iz svoje lože, stimulacijom periportalnih nerava, iritacijom dijafragme, mehaničkim i hemijskim interakcijama gasa i pneumoperitoneuma, incizijama portova. Istraživanja su označila parijetalni i visceralni bol kao dva glavna mehanizma nastanka bola kod laparoskopske holecistektomije. Bol se ne može meriti nego proceniti jer je subjektivni osećaj. Pokazalo se potrebnim da se na čvr&scaron;ćim naučnim osnovama da odgovor na pitanje da li je moguće blokirati parijetalni i visceralni bol posle laparoskopske holecistektomije u akutnoj fazi. CILJEVI. Cilj studije je da uporedi standardnu analgeziju (ne-opioidnu) (grupa O) sa davanjem parijetalne blokade (grupa P), ili davanjem visceralne blokade (grupa V), ili sa obe date blokade (grupa P+V). Primarni ishodi studije su bolesnikov procenjeni bol pre operacije i posle operacije na 1, 2, 4, 6, 12, 24, 48 sati i 7. dana. Sekundarni ishodi studije su bolesnikova procenjena mučnina na 1,2,4,6,12 sati i bolesnikova procenjena mobilnost 1. 2. i 7. dan. HIPOTEZA. Blokada postoperativnog visceralnog bola i blokada postoperativnog parijetalnog bola posle laparoskopske holecistektomije putem intraperitonealne lokalne infiltracije anestetikom i putem lokalne infiltracije anestetikom pristupnih laparoskopskih portova može značajno smanjiti rani postoperativni bol. MATERIJAL I METODE. Ova prospektivna, randomizirana jednostruko slepa studija je započela septembra 2014. godine i trajala je do januara 2016. godine. Istraživanje je sprovedeno na Klinici za abdominalnu, endokrinu i transplantacionu hirurgiju i Urgentnom centru Kliničkog centra Vojvodine u Novom Sadu kod bolesnika operisanih metodom laparoskopske holecistektomije. Rad je podeljen u nekoliko celina. 1. Procena veličine uzorka; 2. Procena podobnosti za studiju; 3. Anketiranje i uključivanje u studiju; 4. Razvrstavanje u grupe i operativni rad; 5. Period postoperativnog praćenja; 6. Statistička obrada i pisanje rada.<br />1. Procena veličine uzorka. Studija je realizovana podelom bolesnika u 4 grupe. Neophodni broj bolesnika je izračunat uzimajući podatke iz pilot istraživanja slične studije iz 2012. godine. Veličina uzorka je računata za primarni ishod studije&nbsp; (bolesnikov procenjen bol sa NAS) na pretpostavci da treba biti 20% smanjenja bola u prvom postoperativnom satu, uz verovatnoću Tip 1 gre&scaron;ke &alpha;=0.05 i Tipa 2 gre&scaron;ke &beta;=0.10 da postigne adekvatnu statističku snagu oko 80% i da otkrije 20% razlike u srednjoj vrednosti procenjenog bola jedan sat nakon laparoskopske&nbsp; holecistektomije. Procenjeni broj ispitanika po grupama prema zadatim kriterijumima je bio (P+V=65; P=68; V=68; O=65). Studija je započela uključivanjem prvog bolesnika u studiju a zavr&scaron;ena ispunjenim periodom praćenja sve dok poslednji bolesnik nije doneo upitnike o bolu, mučnini i kretanju. 2. Procena podobnosti za studiju. U periodu studije ukupan broj holecistektomiranih bolesnika je bio 1024 (440 klasično i 584 laparoskopski). Samo pogodni bolesnici su anketirani (584) i pročitali su informacioni list o istraživanju. Uključivanje ili procena podobnosti bolesnika za studiju sprovedena je na osnovu uključnih i isključnih kriterijuma. U studiju nije uključeno ukupno 226 bolesnika. Od tog broja 82 bolesnika je odbilo učestvovati u studiji a 144 bolesnika nije ispunilo uključne postavljene kriterijume. Svojim potpisom potvrdilo je uče&scaron;će u studiji 358 bolesnika. 3. Anketiranje i uključivanje u studiju. Nakon prijema bolesnika u bolnicu ispitivači su uzimali anamnezu i bolesnicima je ponuđen informacioni list i informisani pristanak. Nakon čitanja informacije, potpisivanja informisanog pristanka i zadovoljavanja&nbsp; uključnih i isključnih kriterijuma 358 bolesnika je uključeno u studiju. Obavljena je preoperativna priprema i ispitivači su popunili deo podataka u individualnom listu. 4. Razvrstavanje u grupe i operativni rad. Neposredno preoperativno od strane nezavisne osobe neuključene u studiju napravljena je randomizacija izabranih (n=358) u studijske grupe tablicama slučajnog izbora, tako da bolesnici nisu znali kojoj grupi pripadaju, dok su operater i osoblje to znali na početku operacije (jednostruko slepa studija). Nakon randomizacije i operacije bolesnici pripadaju jednoj od sledeće 4 grupe: Kontrolna grupa O=89, u kojoj su bolesnici sa urađenom laparoskopskom&nbsp; holecistektomijom bez visceralne blokade anestetikom i bez parijetalne blokade anestetikom. Eksperimentalna grupa P=88, u kojoj su bolesnici sa urađenom laparoskopskom holecistektomijom bez visceralne blokade anestetikom i sa parijetalnom blokadom anestetikom. Eksperimentalna grupa V=92, u kojoj su bolesnici sa urađenom laparoskopskom holecistektomijom sa visceralnom blokadom anestetikom i bez parijetalne blokade anestetikom. Eksperimentalna grupa P+V=89, u kojoj će biti bolesnici sa urađenom laparoskopskom holecistektomijom sa visceralnom blokadom anestetikom i sa parijetalnom blokadom anestetikom. Primenjivan je uobičajni, standardni protokol anestezije za laparoskopske operacije kod svih ispitanika. Svim bolesnicima plasirana je orogastrična sonda koja se nakon operacije odstranjivala. Kod&nbsp; bolesnika kod kojih je primenjivan lokalni anestetik neposredno pre početka operacije pravio se rastvor lokalnog anestetika (Marcaine&reg; 0,25%). Bolesnici su otpu&scaron;teni sa bolničkog lečenja prvog postoperativnog dana, pod uslovom da nisu imali komplikacija. 5. Postoperativno praćenje i ispunjavanje upitnika. Po dolasku na odeljenje&nbsp; bolesnicima je odmah uključivana ista analgezija. Tokom ispunjavanja informisanog pristanka, bolesnici su dobili upitnik na kojoj će sami procenjivati nivo bola, mučnine i kretanja tokom ležanja u bolnici i vremena praćenja od 7 dana kući. Bolesnici su dolazili na unapred zakazane postoperativne kontrole 7 do 10 dana posle operacije i donosili ispunjene upitnike. Otpu&scaron;teno je i za praćenje ostalo n=302 laparoskopski operisanih bolesnika a isključeno iz studije n=20 bolesnika. 6. Statistička obrada i pisanje rada. Ukupno je analizirano 274 listića operisanih bolesnika: u Grupi P+V =67; u Grupi P =70; u Grupi V =70 i u Grupi O =67. Od osnovnih deskriptivnih statističkih parametara za kvalitativnu i kvantitativnu procenu dobijenih rezultata su kori&scaron;ćeni apsolutni brojevi, relativni brojevi, mediana, mod, aritmetička sredina i standardna devijacija (SD). Obrada podataka se vr&scaron;ila&nbsp; osnovnim i naprednim statističkim metodama i programima. Rezultati su prikazani tabelarno i grafički. REZULTATI. Demografski podaci. Ukupno je bilo 188 žena i 86 mu&scaron;karaca, u odnosu 2,2 : 1. Prosečna starost cele grupe je bila 52,1 &plusmn; 15,72 godine. Ukupno je bilo 179 zaposlenih i 95 nezaposlenih. Ukupno je bilo 45 ispitanika sa osnovnim obrazovanjem, 153 ispitanika sa srednjim obrazovanjem i 76 ispitanika sa visokim obrazovanjem. Ukupno je bilo 186 nepu&scaron;ača i 88 pu&scaron;ača. Prosečna vrednost BMI cele grupe je bila 27,24 &plusmn; 4,21 kg/m2. Prosečna vrednost ASA u celoj grupi je bila 2,03 (mediana=2, mod=2). Ne postoji statistički značajna razlika između posmatranih grupa u odnosu na posmatrane parametre. Laboratorijski podaci. Postoji statistički značajna razlika u vrednosti leukocita između posmatranih grupa (p=0,039), u vrednosti uree između posmatranih grupa (p=0,040). Ne postoji statistički značajna razlika u vrednosti eritrocita, trombocita, hemoglobina, &Scaron;UK-a, kreatinina i bilirubina posmatranih grupa. Operativni i postoperativni podaci. Ne postoji statistički značajna razlika u količini upotrebljenog Fentanila između posmatranih grupa. Postoji statistički značajna razlika u dužini trajanja operacije između posmatranih grupa (p=0,003), u trajanju postavljenog abdominalnog drena između posmatranih grupa (p=0,024), u trajanju hospitalizacije između posmatranih grupa (p=0,027), u broju dana do povratka uobičajenim aktivnostima između posmatranih grupa (p=0,000), u broju uzetih tableta između posmatranih grupa (p=0,000). Prosečna ocena zadovoljstva bolesnika posle operacije u celoj grupi je bila 8,80 (mediana=9; mod=10). Najbolju ocenu zadovoljstva bolesnika posle operacije je imala grupa P+V. Procena bola, mučnine i kretanja. Postoji statistički značajna razlika između posmatranih grupa u proceni jačine bola pre operacije (p=0,003). Postoji statistički značajna razlika između posmatranih grupa u proceni jačine bola 1h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 2h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 4h posle operacije (najbolju procenu bola je imala grupa P); u proceni jačine bola 6h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 12h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 24h posle operacije (najbolju procenu bola je imala grupa P+V); u proceni jačine bola 48h posle operacije (najbolju procenu bola je imala grupa P) i u proceni jačine bola 7 dana posle operacije (najbolju procenu bola je imala grupa P). Procenjena bol se pojačava otprilike 2,5 sata posle operacije sa vrhom 3 sata posle operacije, a smanjuje se na istu vrednost kao 2. sata posle operacije, otprilike 5. sata posle operacije. U vremenskim intervalima 1, 2. i 7. postoperativni dan postoji značajno pobolj&scaron;anje u postoperativnoj mobilnosti bolesnika. U vremenskim intervalima 1, 2, 4, 6 i 12 sati postoji značajno pobolj&scaron;anje u procenjenoj vrednosti mučnine bolesnika. Korelacije. Statistički značajna pozitivna korelacija ocene bola posle 1. sata, posle 2. sata, posle 6. sata, posle 12. sata je utvrđena sa brojem uzetih tableta (p=0,000), kao i procene mučnine (p=0,000). Statistički značajna pozitivna korelacija procene bola posle 4. sata je utvrđena sa brojem uzetih tableta (p=0,006), kao i aktivnosti (p=0,014). Statistički značajna korelacija procene bola posle 24. sata je utvrđena sa brojem uzetih tableta (p=0,000; pozitivna) i trajanjem operacije (p=0,028; negativna). Statistički značajna pozitivna korelacija procene bola posle 48. sata i posle 7 dana je utvrđena sa brojem uzetih tableta (p=0,000). ZAKLJUČCI: Primena lokalnog anestetika datog na bilo koji način značajno smanjuje bol posle laparoskopske holecistektomije. Primena lokalnog anestetika datog i&nbsp; portalno i visceralno (P+V) značajno smanjuje bol u odnosu na samo portalnu (P) ili visceralnu (V) primenu u vremenskim intervalima 2, 6, 12 sat posle laparoskopske holecistektomije. Portalna (P) primena sa ili bez visceralne (V) primene lokalnog anestetika značajno smanjuje bol u vremenskim intervalima 1, 4, 24, 48 sati i 7 dana posle laparoskopske holecistektomije. Najbolje kretanje je bilo u grupi P+V posle laparoskopske holecistektomije. Najbolje smanjenje procenjene mučnine je bilo u grupi P posle laparoskopske holecistektomije. Najraniji povratak uobičajenim aktivnostima zabeležen je u grupi P+V. Najbolja ocena zadovoljstva bolesnika hirur&scaron;kim lečenjem bila je u grupi P+V. Postoperativna bol ima najznačajniju pozitivnu korelaciju sa procenjenom mučninom i brojem tableta uzetih od momenta otpusta do prve kontrole bolesnika.</p> / <p>INTRODUCTION: Biliary calculosis is the most frequent disease of the hepatobiliary system, and cholecystectomy is one of the most frequently performed surgical procedures. Today laparoscopic cholecystectomy represents the golden standard in treating cholelithiasis. Laparoscopic cholecystectomy showed improvement in the clinically significant outcomes, such as: reducing the duration of the surgery, shorter hospital stay, reducing the intensity and duration of postoperative pain and faster return to normal daily and working activities. Postoperative pain and the time of full recovery remain the two major problems after a non-complicated laparoscopic cholecystectomy and they should be improved. The pain related to laparoscopic cholecystectomy is complex and multi-factorial in origin. The pain occurs due to damaged tissues, dissection and removal of gallbladder from its cavity, stimulation of periportal nerves, irritation of the diaphragm, mechanical and chemical interaction of gases and pneumoperitoneum and port incisions. Researches have denoted parietal and visceral pains as two major mechanisms in occurrence of pain in laparoscopic cholecystectomy. Pain cannot be measured, but estimated, as it is a subjective feeling. It was considered necessary to find the answer, based on solid scientific evidence, if it was possible to block parietal and visceral pain after laparoscopic cholecystectomy in its acute phase. OBJECTIVES: The aim of this study is to compare standard, non-opioid, analgesia (group O) with applying parietal blockade (group P), or visceral blockade (group V), or compare with both applied blockades (group P+V). The primary outcomes of the study are the patient&acute;s estimated pain before surgery and 1, 2, 4, 6, 12, 24, 48 hours and 7th day after the surgery. The secondary outcomes of this study are the patient&acute;s estimated nausea level during 1, 2, 4, 6, 12 hours, along with the patient&acute;s estimated mobility 1st, 2nd and 7th day, postoperatively. HYPOTHESIS. Blockade of postoperative visceral pain and blockade of postoperative parietal pain following laparoscopic cholecystectomy, applying intraperitoneal local infiltration with anesthetic and also by local infiltration with anesthetic through accessible laparoscopic ports, can significantly reduce early postoperative pain. MATERIAL AND METHODS: This prospectively randomized single-blinded study started in September 2014 and lasted up to January 2016. The research was carried out at the Clinic for Abdominal, Endocrine and Transplantation Surgery and Emergency Center, Clinical Center of Vojvodina in Novi Sad and it involved patients who underwent laparoscopic cholecystectomy. This study has been divided into several units. 1. Assessment of sample size; 2. Assessment of eligibility for the study; 3. Survey and inclusion in the study; 4. Group formation and operational work; 5. Period of postoperative follow-up; 6. Statistical processing and writing the paper.1. Assessment of sample size. The study was realized by dividing the patients into 4 groups. The number of patients necessary was determined based on the data taken as pilot study from a similar study from 2012. Sample size was calculated for the primary outcome of the study (patient&acute;s estimated pain with NAS) based on the assumption that a pain reduction of 20% should occur during the first postoperative hour, with the probability of Type 1 error &alpha;=0.05 and Type 2 error &beta;=0.10 to reach the adequate statistical power of about 80%, and to reveal 20% difference in the average value of the estimated pain one hour after the laparoscopic cholecystectomy. The assessed number of respondents in groups according to the set criteria was (P+V =65;P =68;V =68; O =65). The study started when the first patient was included and it ended with the complete follow-up period when the last patient handed in the survey about pain, nausea and mobility. 2. Assessment of eligibility for the study. During the study the number of patients undergoing surgery applying the method of cholecystectomy was 1024 (440 classical and 584 laparoscopic). Only the suitable patients were surveyed (584) and given to read the information leaflet about the study. Inclusion and assessment of patients&acute; eligibility was performed on the basis of inclusion and exclusion criteria. A total of 226 patients was not included in the study. Out of that number 82 patients refused to participate in the study and 144 did not fulfill the inclusive criteria set. By signing 358 patients confirmed their participation in the study. 3. Survey and inclusion in the study. After admitting the patients to hospital the surveyors took their anamnesis and the patients were offered an information leaflet and informed consent. Following the reading of the information leaflet, signing the informed consent and satisfying the criteria for inclusion and exclusion, 358 patients were included in the study. Preoperative preparations were performed and the surveyors filled in some of the data on the individual list. 4. Group formation and operational work. Prior to the surgery an independent person not included in the study carried out the randomisation of the patients chosen (n=358) into study groups by random selection tables. The patients did not know which group they belonged to, while it became known to the surgeon and the operation stuff at the beginning of the surgery (singleblinded study). After randomization and surgery the patients belonged to one of the following groups: Control group O=89 of patients with performed laparoscopic cholecystectomy without visceral blockade by anesthetic and without parietal blockade by anesthetic. Experimental group P=88 of patients with performed laparoscopic cholecystectomy without visceral blockade by anesthetic but with parietal blockade by anesthetic. Experimental group V=92 of patients with performed laparoscopic cholecystectomy with visceral blockade by anesthetic but without parietal blockade by anesthetic. Experimental group P+V=89 of patients with performed laparoscopic cholecystectomy with visceral blockade by anesthetic and with parietal blockade by anesthetic. The standard protocol of anesthesia for laparoscopic cholecystectomy was applied to all patients. An orogastric tube used during the surgery, was removed after it. In patients with applied local anesthetic immediately before surgery a solution of local anesthetic was made (Marcaine&reg; 0,25%). The patients were discharged from hospital the first postoperative day, provided that no complications occurred. 5. Postoperative follow-up and completing the questionnaire. When admitted to the ward the patients were given the same kind of analgesia. While completing the informed consent the patients were given a questionnaire for estimating their pain level, nausea and mobility during their stay in hospital and during the 7-day follow-up period at home. The patients were required to come for 7 and 10-day postoperative check-ups by appointment and then they handed in the questionnaires. n=302 patients with performed laparoscopic cholecystectomy were released and designated for follow-up, and n=20 patients were excluded from the study. 6. Statistical processing and writing the paper. In total 274 operated patients&acute; slips were analysed, by groups as follows: in Group P+V =67; in Group P =70; in Group V =70 and in Group O =67. From the basic descriptive statistical parametres for qualitative and quantitative assessment of results obtained, absolute numbers, relative numbers, the median, mode, arithmetic mean and standard deviation (SD) were used. Data processing was carried out using basic and advanced statistical methods and programmes. The results are presented in tabular and graphical manner. RESULTS. Demographic data. In total there were 188 women and 86 men, in proportion 2,2 : 1. The average age of the whole group was 52,1 &plusmn; 15,72 years. In total there were 179 employed and 95 unemployed persons. In total there were 45 surveyed patients with primary education, 153 surveyed patients with secondary education and 76 surveyed patients with higher education. In total there were 186 nonsmokers and 88 smokers. The mean BMI value of the whole group was 27,24 &plusmn; 4,21 kg/m2. The mean value of ASA of the whole group was 2,03 (the median=2, mode=2). There is no significant difference among the groups observed considering the observed parametres. Laboratory data. There is a statistically significant difference in the value of leukocytes among the observed groups (p=0,039), and in the value of urea among the observed groups (p=0,040). There is no statistically significant difference in the value of the erythrocyte, platelets, hemoglobin, blood glucose, creatinine and bilirubin of the&nbsp; observed groups. Operative and postoperative data. There is no statistically significant difference in the amount of Fentanyl&reg; applied among the observed groups. There is statistically significant difference in the length of the surgery among the observed groups (p=0,003), in the duration of the positioning of abdominal drainage among the observed groups (p=0,024), in the duration of hospital stay among the observed groups (p=0,027), in the number of days until getting back to regular activities among the observed groups&nbsp; (p=0,000), in the number of taken pills among the observed groups (p=0,000). The patients&acute; average satisfaction grade after surgery in the whole group was 8,80 (the median=9; mode=10). Group P+V had the best patient&lsquo;s satisfaction grade after the surgery. Assessment of pain, nausea and mobility. There is statistically significant difference in the estimation of pain intensity before surgery among the observed groups (p=0,003). There is statistically significant difference in the estimation of pain intensity 1 hour after surgery among the observed groups (P+V having the best estimated pain); in the estimation of pain intensity 2 hours after&nbsp; surgery (P+V having the best estimated pain); in the estimation of pain intensity 4 hours after surgery (P having the best estimated pain); in the estimation of pain intensity 6 hours after surgery (P+V having the best estimated pain); in the estimation of pain intensity 12 hours after surgery (P+V having the best estimated pain); in the estimation of pain intensity 24 hours after surgery (P+V having the best estimated pain); in the estimation of pain intensity 48 hours after surgery (P having the best estimated pain) also in the estimation of pain intensity 7 days after surgery (P having the best estimated pain). The estimated pain intensifies at about 2,5 hours after surgery and peaks 3 hours after surgery, and decreases to the same level as it was during 2nd hour after surgery approximately during 5th hour after surgery. There is considerable improvement in mobility of patients in the time interval 1st, 2nd and 7th postoperative days. There is considerable improvement in estimated nausea level of patients in the time interval 1, 2, 4, 6 and 12 hours. Correlations. Statistically significant positive correlation in estimated pain after 1st hour, after 2nd hour, after 6th hour and after 12th hour was determined by the number of tablets taken (p=0,000), just like the estimated nausea level (p=0,000). Statistically significant positive correlation in estimated pain after 4th hour was determined by the number of tablets taken (p=0,006), just like the activities (p=0,014). Statistically significant positive correlation in estimated pain after 24th hour was determined by the number of tablets taken (p=0,000; positive), and by the duration of the surgery (p=0,028; negative). Statistically significant positive correlation in estimated pain after 48th hour and after 7 days was determined by the number of tablets taken (p=0,000). CONCLUSIONS: The application of local anesthetic, regardless of how it was applied, considerably reduces pain after laparoscopic cholecystectomy. The application of local anesthetic by port or viscerally (P+V) considerably reduces pain compared to only by port (P) or only visceral (V) application in the time intervals of 2, 6, and 12 hours after laparoscopic cholecystectomy. The application of local anesthetic by port (P), with or without visceral (V), considerably reduces pain in the time intervals of 1, 4, 24, and 48 hours and 7 days after laparoscopic cholecystectomy. The best mobility was shown by group P+V after laparoscopic cholecystectomy. Estimated nausea was most reduced in group P after laparoscopic cholecystectomy. Group P+V presented the earliest return to regular activities. The best patients&acute; satisfaction grade with surgical treatment was shown by group P+V. Postoperative pain is most considerably positively correlated with the estimated nausea and pills taken, from the moment of patient&acute;s release from hospital to the first check-up.<br />&nbsp;</p>

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Bakgrund: Antalet datortomografiundersökningar (DT-undersökningar) har ökat kraftigt i Sverige och den kollektiva stråldosen till befolkningen blir allt högre. DT-undersökningar av buken är en av de undersökningarna som ger högst stråldos till patienten, därför är det viktigt att de endast görs när det krävs för att ställa diagnos. Därmed kan det vara relevant att undersöka huruvida antalet undersökningar också lett till ökat antal patologiska fynd hos patienter. Syfte: Undersöka hur många akuta DT-undersökningar med intravenös kontrast av buken som gjordes vid två sjukhus och hur stor andel av dessa som påvisade patologiska fynd. Metod: För att besvara syftet gjordes en kvantitativ retrospektiv studie där röntgenremisser och röntgensvar från mars 2013, mars 2018 och mars 2023 analyserades. Resultat: Antalet akuta DT-bukundersökningar med intravenös kontrast har ökat vid sjukhusen med i genomsnitt 49,5% mellan 2018–2023. Den mest markanta ökningen sågs i åldrarna 50–80 år. Vid Sjukhus 1 hade andelen fynd ökat från 57,5% i mars 2013 till 72,4% i mars 2023, samtidigt som andelen fynd vid Sjukhus 2 i stället minskat från 54% i mars 2018 till 46,3% i mars 2023. De vanligaste fynden vid de två sjukhusen var ileus/subileus, appendicit och kolecystit/gallsten/vidgade gallvägar. Könsfördelningen visade att något fler kvinnor än män genomgick akut DT buk med iv. kontrast, (Sjukhus 1: 54% kvinnor och Sjukhus 2: 55% kvinnor). Slutsatser: Det har vid båda sjukhusen skett en ökning av antalet undersökningar men utvecklingen av andelen fynd har gått i två olika riktningar. De vanligaste patologiska fynden som görs skulle kunna ställas med hjälp av andra modaliteter med låg eller ingen stråldos, såsom konventionell röntgen eller ultraljud. Ökningen av antalet akut DT-buk med iv. kontrast har medfört en ökad arbetsbelastning för röntgensjuksköterskor.