<p>The aim was to identify diagnostic difficulties for acute abdominal pain at the emergency department and during hospital stay. A total of 3349 patients admitted to Mora Hospital with acute abdominal pain of up to seven days duration, were registered prospectively for history and clinical signs according to a structured schedule. The preliminary diagnosis from the attending physician at the emergency department, any investigations or surgery and final diagnosis were registered at a follow-up after at least one year. </p><p>There were no differences in diagnostic performance between physicians with 0.5 to 5 years of medical experience. The information collected and a careful examination of the patient was more important than formal competence. The main differential diagnostic problem was non-specific abdominal pain; this was the same for diagnoses requiring surgery. Patients originally diagnosed as not needing surgery had a median delay before operation of 22 hours (mean 40 hours, with 95% confidence interval of 30-50 hours), compared to 8 hours (mean 15 hours, 95% confidence interval of 12-28 hours) for patients with the same final follow-up diagnosis as the preliminary diagnosis. Constipation was a diagnostic pitfall, as 9% of the patients considered constipated required surgery for potentially life threatening reasons and 8% were later found to have an abdominal malignancy. Both the preliminary diagnosis and the discharge diagnosis were less reliable for elderly patients than for younger patients. Elderly patients often had specific organ disease and arrived at the emergency department after a longer history of abdominal pain. </p><p>This study confirms that assessment of suspected appendicitis can still be based on clinical judgements combined with laboratory tests. Classical clinical findings indicating localised inflammation, such as isolated pain in the right iliac fossa, rebound tenderness, right-sided rectal tenderness, pain migration to the right iliac fossa, local guarding and aggravation of pain when moving, were reliable for predicting acute appendicitis. A CT scan can be saved for the more equivocal cases of acute abdominal pain. A generous strategy regarding CT scan among elderly patients with acute abdominal pain, even in the absence of pronounced signs of an inflammatory intra-abdominal process, is recommended.</p>

Skausmo malšinimas yra nenauja ir iki šiol aktuali problema visame pa¬saulyje, o oligoanalgezijos reiškinys, deja, yra taip pat dažnas. Mokslininkai atliko ne viena studiją ir pasiūlė būdus, kaip galima būtų išgyvendinti šį reiškinį, tačiau skausmo gydymo rekomendacijų diegimas neduoda reikiamo efekto. Tikėtina, kad nusi¬stovėjusios vietos tradicijos ar žmonių požiūris gali lemti, tai, kad įrodymais grįstos rekomendacijos yra nepilnai pritaikomos praktikoje. Todėl šiame tyrime ieškoma svarbių ūminio nediferencijuoto pilvo skausmo, klinikinių skausmo charakteristikų ir veiksnių, lemiančių ūminio pilvo skausmo efektyvų gydymą universitetinės ligo¬ninės skubios pagalbos skyriuje. Tyrimo uždaviniai: 1. Ištirti pacientų, patiriančių ūminį nediferencijuotą pilvo skausmą, klinikines skausmo charakteristikas atvykstant ir išvykstant iš universitetinės ligoninės skubios pagalbos skyriaus. 2. Įvertinti ūminio pilvo skausmo malšinimo tendencijas universite¬tinės ligoninės skubios pagalbos skyriuje ir palyginti jas su šalyje galiojančiomis rekomendacijoms. 3. Nustatyti skirtumus tarp paciento subjektyvaus pilvo skausmo stip¬ru¬mo vertinimo ir slaugytojų bei gydytojų paciento patiriamo skaus¬mo stiprumo vertinimo. 4. Ištirti stipriųjų analgetikų (morfino) poveikį neaiškios kilmės ūminio pilvo skausmo malšinimui skubios pagalbos skyriuje ir paly¬ginti jo efektyvumą su nesteroidinių vaistų nuo uždegimo (diklo¬fenako) ar placebo. / The problem of pain is not new, it remains an important global issue, and a phenomenon of oligoanalgesia, unfortunately, is also common. Different researchers conducted studies and suggested different ways to eradi¬cate this phenomenon. However, the question why patients with acute abdominal pain are treated inadequately, even with clear evidence that the treatment will not cause any adverse effects so far remains unanswered. Researchers of this study have hypothesis that the well-established local tradition or people's attitudes can lead to the fact that evidence-based guidelines are not fully applied in practice. This study investigates clinical characteristics of pain in patients with acute undifferentiated abdominal pain and to identify the factors influencing effective management of acute abdominal pain in the ED at university hospital. Objectives of the study 1. To investigate clinical characteristics of pain in patients with acute undifferentiated abdominal pain upon arrival and departure from the ED at university hospital. 2. To evaluate the trends of acute abdominal pain relief in the ED at university hospital and to compare them with current guidelines. 3. To identify differences in subjective pain intensity rating between patients with abdominal pain and assessment of nurses and doctors. 4. To investigate effect of strong analgesic drugs (morphine) for acute abdominal pain management in the ED and compare their efficacy versus NSAIDs (diclofenac) or placebo.

The aim was to identify diagnostic difficulties for acute abdominal pain at the emergency department and during hospital stay. A total of 3349 patients admitted to Mora Hospital with acute abdominal pain of up to seven days duration, were registered prospectively for history and clinical signs according to a structured schedule. The preliminary diagnosis from the attending physician at the emergency department, any investigations or surgery and final diagnosis were registered at a follow-up after at least one year. There were no differences in diagnostic performance between physicians with 0.5 to 5 years of medical experience. The information collected and a careful examination of the patient was more important than formal competence. The main differential diagnostic problem was non-specific abdominal pain; this was the same for diagnoses requiring surgery. Patients originally diagnosed as not needing surgery had a median delay before operation of 22 hours (mean 40 hours, with 95% confidence interval of 30-50 hours), compared to 8 hours (mean 15 hours, 95% confidence interval of 12-28 hours) for patients with the same final follow-up diagnosis as the preliminary diagnosis. Constipation was a diagnostic pitfall, as 9% of the patients considered constipated required surgery for potentially life threatening reasons and 8% were later found to have an abdominal malignancy. Both the preliminary diagnosis and the discharge diagnosis were less reliable for elderly patients than for younger patients. Elderly patients often had specific organ disease and arrived at the emergency department after a longer history of abdominal pain. This study confirms that assessment of suspected appendicitis can still be based on clinical judgements combined with laboratory tests. Classical clinical findings indicating localised inflammation, such as isolated pain in the right iliac fossa, rebound tenderness, right-sided rectal tenderness, pain migration to the right iliac fossa, local guarding and aggravation of pain when moving, were reliable for predicting acute appendicitis. A CT scan can be saved for the more equivocal cases of acute abdominal pain. A generous strategy regarding CT scan among elderly patients with acute abdominal pain, even in the absence of pronounced signs of an inflammatory intra-abdominal process, is recommended.

Background: Managers and health professionals, so-called stakeholders, at the system and clinical level in the acute care chain, are responsible for providing safe and high-quality care encompassing both nursing and medical aspects. In patients with acute abdominal pain (AAP), high-quality nursing care has been described as not always being delivered across the entire acute care chain. This patient group frequently seeks care across the acute care chain and the care procedures and quality may differ widely. The quality of nursing care provided to patients can be understood through the framework Fundamentals of Care. The framework is divided into three dimensions: establishing a relationship with the patient, integration of the patient’s fundamental care needs, and context of care. Stakeholders are one important part of the context of care and a prerequisite for delivery of high-quality care.  Aim: The overall aim was to explore managers’ and health professionals’ understanding of managing and conducting care of patients with AAP across the acute care chain.  Method: Individual interviews with open-ended questions were used in two studies and data were analysed with a conventional qualitative content analysis method. Participants represented ambulance services, emergency departments, and surgical departments. Managers at head nurse level (n=11) and operational level (n=6) at four hospitals were included in Study I. Registered nurses (n=11) and physicians (n=8) at five hospitals were included in Study II. Results: In Study I, managers described the adult patient group as challenging and heterogenous. The managers reflected on themselves as role models. Guidelines were used to organise care, but they often had a medical focus and the managers referred to others as being responsible for the guidelines. Managers who were registered nurses focused on the medical care of patients with AAP, while managers who were physicians underlined the value of nursing care to improve patient outcome. In Study II, health professionals described dedication to applying evidence-based practices. However, they used personal experience over guidelines in care provision. They described organisational barriers to delivering high-quality care, such as varying competence among colleagues, lack of available patient beds, and lack of collaboration across the acute care chain.  Conclusion: The stakeholders’ perspectives complemented each other, but their descriptions of managing and conducting care of patients with AAP did not always fit together, which revealed a gap in the everyday clinical practices as well as structural issues at the system level. These empirical descriptions of differing understanding may reveal some of the reasons why patients with AAP do not always experience high-quality care. To optimise patient care across the acute care chain, stakeholders need a shared understanding to meet patients’ fundamental care needs and enable provision of high-quality nursing and medical care.

Bakgrund: Genusbias, det vill säga felaktigheter i vården till följd av föreställningar om kön och stereotypa könsroller, eller brist på kunskap om relevanta biologiska skillnader, är vanligt förekommande i Sverige. Buksmärta är en vanlig sökorsak för tonåringar med många könsspecifika differentialdiagnoser, och risk för genusbias finns således även där. Syfte: Syftet med studien var att ur ett genusperspektiv beskriva handläggning av tonåringar med akut buksmärta. Metod: En kvalitativ, deskriptiv studie baserad på tre fokusgruppsintervjuer med sammanlagt 16 deltagare i form av sjuksköterskor, specialistsjuksköterskor och läkare med erfarenhet av att handlägga tonåringar med akut buksmärta. Intervjuerna har analyserats med kvalitativ innehållsanalys. Resultat: Ett övergripande tema framkom i studien: Komplexitet som påverkas av kunskap, rutiner och attityder. Det övergripande temat grundas på de tre huvudkategorierna: att beakta olika orsaker till buksmärta hos tonåringar; att handlägga akut buksmärta hos tonåringar kräver lyhördhet, tydliga rutiner och kunskap och att identifiera genusbias vid handläggning av akut buksmärta hos tonåringar. Slutsats: Handläggningen av tonåringar med akut buksmärta har brister och genusbias förekommer. Könsspecifika rutiner för tonåringar med buksmärta kan vara gynnsamt både för personal och patienter, och framförallt för flickor. Genusperspektivet bör belysas mer och ytterligare utbildning och forskning i området medicinsk genusbias är nödvändig. / Background: Gender bias; inaccuracies in the healthcare system related to gender and stereotype gender roles, or a lack of knowledge and awareness of relevant biological differences among the sexes, are common in Sweden. Abdominal pain is a common reason to why teenagers up seek healthcare, and there is a lot of gender specific differential diagnosis, which comes with is a risk for gender bias to occur. Aim: The aim of this study was to describe the caring-process of teenagers with acute abdominal pain from a gender perspective. Method: A qualitative, descriptive study based on three focus groups with a total amount of 16 participants whom where registered nurses, specialist nurses and doctors with experience of administrating teenagers with acute abdominal pain. The interviews where analyzed with qualitative content analysis. Result: An overall theme appeared in the study: Complexity affected by knowledge, routines and attitudes. The theme where based on three main categories: To consider different reasons of abdominal pain in teenagers; to administrate acute abdominal pain in teenagers demands sensitivity, clear routines and knowledge; to identify gender bias in the caring-process in teenagers with acute abdominal pain. Conclusion: The caring-process of teenagers with acute abdominal pain has inadequacies and gender biases exists. Gender specific routines for teenagers with abdominal pain could be favorable both for healthcare professionals and patient, and teenage girls. The gender perspective needs to be more illuminated and further education and research in the area medical gender bias is needed.

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.

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.