published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Young children who experience high levels preoperative anxiety often exhibit distress behaviors, experience more surgical complications, and are at a higher risk for developing a variety of negative postoperative consequences. A significant factor in pediatric preoperative anxiety is the level of anxiety present in their caregivers. Music therapy interventions addressing a variety of procedural outcomes have been met with success. The purpose of this study was to investigate the comparative effectiveness of two music therapy interventions on reducing preoperative anxiety in young pediatric surgical patients and their caregivers. A total of 40 pediatric patient and caregiver dyads were included in this study on various days that they were present for ambulatory surgery. Pediatric preoperative anxiety was measured pre- and post-intervention using the modified Yale Pediatric Anxiety Scale, while caregiver anxiety was measured through self-report using the short form Strait-Trait Anxiety Inventory-Y6. Participants received a randomized active or passive preoperative music therapy session. Results indicate a significant reduction in preoperative anxiety for both patients and their caregivers. Neither active, nor passive music therapy interventions were significantly more effective than the other. Future studies should increase sample size and control for various factors such as sedative premedication use.

Background: Patients’ recovery from surgery differs when they are in a hospital setting or at home. However, an often forgotten aspect of post-operative ambulatory care is the patients' recovery at home following ambulatory surgery.Aim: To explore and describe the patients’ experiences of recovery at home following the ambulatory surgery procedure.Method: A systematic review of 7 qualitative studies in English with pre-specified criteria was conducted. An overview of qualitative evidence derived from the 17 identified main themes across the 7 primary studies was analyzed.Result: Seven thematic analysis themes were identified as being core to the patients’ experience during recovery process at home: physical symptoms, a period of regaining pre-operative functions, psychological effects, the surgical wound, delayed recovery process, social support, and the sick-role condition.. These seven themes were described patient's experiences at home following ambulatory surgery from early stage of recovery to the time of getting back to normal life.Conclusion: Recovery at home following ambulatory surgery seemed to be challenging, a quality self-care at home was lacking in the form having full control and knowledge about symptoms; adequate information, education and medication during self-care management; sufficient support by carer and nurses; and enough time-off for recovery.

This creative project will be a compilation of surgical proceedures performed by the author on patients before a video tape. There was a superimposed narration describing the procedure as it was being performed.Since these tapes were open ended, anytime a patient presented with a problem and a willingness to be taped, a new dimension in resident education is always forthcoming. This project has also forced one author into becoming proficient in the art of surgical techniques and in the art of taping video lectures.Since much of the educational material is in tape of television form now, this will be a readily accepted media in educating future doctors of less frequently mentioned procedures.Three training video tapes, each approximately 10 minutes long were produced dealing with removal of moles from the skin, circumcision, and removal of a toenail.Production was carried out in the surgical suite of the Family Practice Center, Ball Memorial Hospital, Muncie, Indiana during the 1976-77 academic year.

Thesis (M.P.H.)--University of Michigan, 1974.

Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.P.H.)--University of Michigan, 1974.

Day care surgical services have been marketed as a cost saving alternative for inpatient care. There is evidence that the cost per episode of day care surgery is 50-70 percent less than a comparable episode in an inpatient ward. In addition, avoiding hospitalization has particular relevance for paediatrics, because of the undesirable effects of hospital stay on children. However, both cost savings and the quality-based need to decrease hospitalizations of children will be fullfilled only if each patient cared for in a day care surgery unit would otherwise have been an inpatient and the bed vacated by day care surgery use would not be filled in by other patients. In a previous B.C. study based on the total population a significant component of day care surgery was found to augment total utilization, suggesting generation of surgical activity rather than substitution. The present study was designed to examine the substitution/generation issue in the paediatric (0-14 years) population, both because experts questioned the generalizability of the findings to the paediatric population, and because of the dramatic reduction in paediatric utilization in Canada during the period since the mid-1960s. The contention was that the introduction of day care surgery may have been an important factor in this downtrend. The relationship between paediatric day care surgery use and hospital inpatient utilization was analyzed in B.C. in each of the years 1968-1976 and 1981/82-1982/83 and using a time series/cross-section study design. The data frame consisted of all B.C. school districts, in each of the study years, yielding 825 data points. Using a multivariate regression analysis, it was possible to estimate what hospital utilization patterns would have been in the absence of day care surgery capacity, and hence isolate estimates of the net impact of day care surgery on paediatric inpatient use. Findings on the relationship between day care surgery use and paediatric medical/surgical and surgical inpatient utilization strongly support the view that paediatric day care surgery has been largely an add-on to the total hospital care system. Statistically significant substitution effect was revealed only for the most narrowly defined inpatient surgery category which more closely resembled day care surgery-type cases, after controlling for potential confounding effects of age and sex, paediatric bed capacity, different socioeconomic characteristics and time- and district-specific factors. Even here, less than 10 percent of day care surgery represented substitution for inpatient surgery and over 90 percent appeared to be generation of new activity to the hospital system as a whole. Furthermore, paediatric beds which were "saved" by day care surgery use were filled with increased utilization by non-day care surgery eligible surgical patients and by medical cases. The main driving force behind hospital utilization in the 0-14 year age group was paediatric bed availability even after standardization for age, sex, physician stock, measures of socioeconomic status, and other district- and year-specific effects. According to this study paediatric day care surgery has not been a cost saving alternative for inpatient care in B.C. in 1968-1982/83. Neither has it reduced overall hospitalizations in the paediatric population. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Purpose: The purpose of this study was to compare the adverse events that occur with general anesthesia for dental rehabilitation between a hospital setting and dental clinic setting. Methods: A retrospective chart review was performed examining patients who had received dental rehabilitation with general anesthesia at the Virginia Commonwealth University Department of Pediatric Dentistry. Subjects were either treated in the Pediatric Dental Clinic or the Hospital Ambulatory Surgery Center (ASC) from July 2005 to December 2006. Anesthesia records of induction, intubation, maintenance, emergence and recovery were compared between the two settings.Results: There were a total of 422 charts reviewed with n=193 cases in the dental clinic and n=229 cases in the ASC. Patients in the dental clinic setting were slightly older (t = 2.63, df = 420, p-value = 0.0089), and healthier (chi-square = 45.9, df = 2, p-value Conclusion: Overall, the prevalence of adverse events occurring with dental rehabilitation under general anesthesia in the dental clinic setting was lower compared to adverse events in the hospital-based ambulatory surgical setting.