Introdução. Apesar dos recentes e importantes avanços no tratamento das Doenças Cardiovasculares, a cirurgia cardíaca ainda pode ser a única opção de tratamento para alguns pacientes. Os pacientes que vivenciam sintomas de ansiedade e de depressão no pré-operatório podem sofrer influência destes na recuperação pós-operatória. Objetivos. Avaliar a relação dos sintomas de ansiedade e depressão pré-operatórios com as características sociodemográficas e clínicas e avaliar a relação desses sintomas com a presença de complicações no pós-operatório (PO), durante a permanência na Unidade de Terapia Intensiva (UTI), dos pacientes submetidos às cirurgias cardíacas eletivas. Método. Estudo observacional analítico, de coorte prospectiva, desenvolvido nas unidades de internação de clínica médica e clínica cirúrgica de um hospital universitário do interior paulista. A amostra do estudo foi constituída por pacientes submetidos à primeira cirurgia de revascularização do miocárdio (CRM) e à primeira cirurgia para correção de valvopatia, entre setembro de 2013 e setembro de 2015. A coleta de dados foi realizada por meio de entrevistas individuais e consulta aos prontuários. Para a avaliação dos sintomas de ansiedade e depressão, foi utilizado o instrumento Hospital Anxiety and Depression Scale (HADS), com a avaliação das respostas considerando o valor total de cada subescala (HADS-ansiedade e HADS depressão), variando de 0 - 21 (quanto maior o valor maior o transtorno emocional). Foram investigados complicações pulmonares, cardíacas, neurológicas, endócrinas, infecciosas, digestivas, sensoriais e o óbito. Para investigarmos a relação dos sintomas de ansiedade e depressão com as características sociodemográficas (sexo, idade, estado civil e situação profissional) e com a presença de complicações PO (sim/não), foi utilizado o teste de Mann Whitney. Para investigarmos a correlação dos sintomas com as características clínicas (tempos de internação pré-operatória, de cirurgia e de permanência na UTI), foi utilizado o teste de Correlação de Spearman. O nível de significância adotado foi de 0,05. Resultados. A amostra foi constituída por 145 pacientes, sendo 75 pacientes submetidos à CRM e 70 pacientes submetidos à cirurgia valvar. Entre os pacientes submetidos à CRM, a idade média encontrada foi de 61,8 anos, a maioria do sexo masculino (69,3%), e a principal complicação no PO foi a hiperglicemia (97,3%). As mulheres submetidas à CRM apresentaram maiores médias para os sintomas de ansiedade, quando comparadas com os homens. Pacientes submetidos à CRM, com maiores médias para os sintomas de ansiedade, apresentaram com maior frequência a instabilidade hemodinâmica no PO. Aqueles pacientes que apresentaram maior média para os sintomas de depressão apresentaram com maior frequência a náusea, a agitação, o déficit neurológico e permaneceram mais tempo entubados no PO. Entre os pacientes submetidos à cirurgia valvar, a idade média foi de 54,4 anos, maioria do sexo masculino (61,4%), e a principal complicação no PO foi a hiperglicemia (92,9%). As mulheres apresentaram maiores médias para os sintomas de depressão, quando comparadas com os homens. Pacientes submetidos à cirurgia valvar com maiores médias para os sintomas de depressão apresentaram com maior frequência a agitação no PO. Conclusão. Dos pacientes submetidos à CRM, encontramos relação dos sintomas de ansiedade pré-operatória com o sexo e com a presença de instabilidade hemodinâmica no PO, bem como dos sintomas de depressão com a ocorrência de náusea, agitação, presença de cânula orotraqueal (COT) por mais de 48 horas e déficit neurológico. Entre os pacientes submetidos à cirurgia valvar, encontramos relação dos sintomas de depressão com o sexo e com a agitação no PO / Introduction. Despite the recent and important advances in the treatment of Cardiovascular Diseases, cardiac surgery can still be the only treatment option for some patients. The patients who experience symptoms of anxiety and depression in the preoperative phase can be subject to the influence of these symptoms during the postoperative recovery. Objectives. Assess the relation between the preoperative anxiety and depression symptoms and the sociodemographic and clinical characteristics and the relation between these symptoms and the presence of postoperative (PO) complications while staying at the Intensive Care Unit (ICU) of patients submitted to elective cardiac surgeries. Method. Analytical and observational prospective cohort study, developed at the medical and surgical clinical inpatient units of a teaching hospital in the interior of the State of São Paulo. The study sample consisted of patients submitted to the first coronary artery bypass graft (CABG) surgery and the first valve correction surgery between September 2013 and September 2015. The data were collected through individual interviews and consultation of patient histories. To assess the anxiety and depression symptoms, the Hospital Anxiety and Depression Scale (HADS) was used. In the assessment of the answers, the total value of each subscale was used (HADS-anxiety and HADS-depression), ranging between 0 - 21 (the higher the score, the higher the emotional disorder). Pulmonary, cardiac, neurological, endocrine, infectious, digestive, sensory complications and death were investigated. To investigate the relation between the anxiety and depression symptoms and the sociodemographic characteristics (sex, age, marital status and professional situation) and the presence of postoperative complications (yes/no), the Mann-Whitney test was used. To investigate the correlation between the symptoms and the clinical characteristics (lengths of preoperative hospitalization, surgery and stay at the ICU), Spearman\'s correlation test was used. The significance level adopted was 0.05. Results. The sample consisted of 145 patients, being 75 patients submitted to CABG and 70 patients to valve surgery. Among the patients submitted to CABG, the mean age was 61.8 years; mostly male (69.3%), and the main PO complication was hyperglycemia (97.3%). The women submitted to CABG presented higher means for anxiety symptoms when compared to men. Patients submitted to CABG with higher averages for anxiety symptoms presented PO hemodynamic instability more frequently. Patients with higher mean scores for depressive symptoms most frequently presented nausea, agitation and neurological deficit and spent more time intubated during the PO. Among the patients submitted to valve surgery, the mean age was 54.4 years, mostly male (61.4%) and the main PO complication was hyperglycemia (92.9%). The women presented higher averages for depressive symptoms when compared to the men. Patients submitted to valve surgery with higher means for depressive symptoms most frequently presented PO agitation. Conclusion. Among the patients submitted to CABG, we found a relation between preoperative anxiety symptoms and sex and the presence of hemodynamic instability in the PO period, as well as between depressive symptoms and the occurrence of nausea, agitation, presence of endotracheal tube for more than 48 hours and neurological deficit. Among the patients submitted to valve surgery, we found a relation between depressive symptoms and sex and PO agitation

PROPOSIÇÃO Avaliou-se radiograficamente o grau de precisão de um guia radiográfico-cirúrgico na predição do posicionamento final de mini-implantes inseridos no septo inter-radicular e, sequencialmente, determinou-se um índice de risco para normatizar a indicação do procedimento de inserção dos mini-implantes. MATERIAL E MÉTODOS Um total de 53 mini-implantes foram inseridos no septo inter-radicular vestibular da região posterior da maxila e/ou mandíbula de 27 pacientes com idade média de 19,17 ± 9,06 anos (idade mínima de 12,72 anos e máxima de 56,37 anos). O Guia Radiográfico-Cirúrgico Graduado (GRCG) foi utilizado para inserir os mini-implantes no centro do septo de forma equidistante em relação às raízes dos dentes adjacentes. As distâncias entre o mini-implante e as raízes dos dentes adjacentes foram mensuradas nas 53 radiografias pós-cirúrgicas com intuito de avaliar a precisão do GRCG a partir do grau de centralização do mini-implante no septo. O grau de imprecisão do GRCG foi associado à largura do septo e ao diâmetro do mini-implante para compor a fórmula do índice de risco utilizada na avaliação do risco cirúrgico de inserção dos mini-implantes. RESULTADOS O grau de imprecisão do GRCG mostrou que, em média, os mini-implantes foram inseridos com um desvio de 0,13mm (±0,13) em relação ao centro do septo. O valor médio do índice de risco (IR) foi menor do que 1, significando um reduzido risco cirúrgico. CONCLUSÕES A ligação estabelecida entre os procedimentos radiográfico e cirúrgico proveu ao GRCG um reduzido grau de imprecisão de 0,13mm, e uma acurada predição do posicionamento final do mini-implante no septo inter-radicular, contribuindo para um reduzido risco cirúrgico (IR<1). / OBJECTIVE This study evaluated the radiographic-surgical guide accuracy to predict post-surgical mini-implant positioning in the interradicular septum. Additionally, a risk index to standardize surgical procedure indication for mini-implant insertion was determined. MATERIAL AND METHODS A total of fifty-three titanium mini-implants were placed in the buccal interradicular septum of the posterior maxillary and/or mandibular region of 27 patients with a mean age of 19.17 ± 9.06 years (ranging from 12.72 to 56.37 years). The Graduated Radiographic-Surgical Guide (GRSG) was used to insert mini-implants in the interradicular septum in a centralized and equidistant position regarding adjacent tooth roots. The fifty-three post-surgical radiographs were used to measure the distances between mini-implants and adjacent tooth roots to evaluate GRSG accuracy in obtaining mini-implant centralized position in the septum. The GRSG inaccuracy degree was related to the septum width and the mini-implant diameter to obtain risk index formula, which was used to predict surgical risks during mini-implants insertion. RESULTS The GRSG inaccuracy degree showed that, on average, the mini-implants were 0.13mm (±0.13) displaced regarding the centralized position initially intended. The risk index (RI) presented a mean value smaller than 1, indicating a reduced surgical risk. CONCLUSION The link established between radiographic and surgical procedures propitiated a small GRSG inaccuracy degree of 0.13mm, allowing an accurate prediction of the final mini-implant positioning in the interradicular septum, which contributed to a low surgical risk (RI<1).

PROPOSIÇÃO Avaliou-se radiograficamente o grau de precisão de um guia radiográfico-cirúrgico na predição do posicionamento final de mini-implantes inseridos no septo inter-radicular e, sequencialmente, determinou-se um índice de risco para normatizar a indicação do procedimento de inserção dos mini-implantes. MATERIAL E MÉTODOS Um total de 53 mini-implantes foram inseridos no septo inter-radicular vestibular da região posterior da maxila e/ou mandíbula de 27 pacientes com idade média de 19,17 ± 9,06 anos (idade mínima de 12,72 anos e máxima de 56,37 anos). O Guia Radiográfico-Cirúrgico Graduado (GRCG) foi utilizado para inserir os mini-implantes no centro do septo de forma equidistante em relação às raízes dos dentes adjacentes. As distâncias entre o mini-implante e as raízes dos dentes adjacentes foram mensuradas nas 53 radiografias pós-cirúrgicas com intuito de avaliar a precisão do GRCG a partir do grau de centralização do mini-implante no septo. O grau de imprecisão do GRCG foi associado à largura do septo e ao diâmetro do mini-implante para compor a fórmula do índice de risco utilizada na avaliação do risco cirúrgico de inserção dos mini-implantes. RESULTADOS O grau de imprecisão do GRCG mostrou que, em média, os mini-implantes foram inseridos com um desvio de 0,13mm (±0,13) em relação ao centro do septo. O valor médio do índice de risco (IR) foi menor do que 1, significando um reduzido risco cirúrgico. CONCLUSÕES A ligação estabelecida entre os procedimentos radiográfico e cirúrgico proveu ao GRCG um reduzido grau de imprecisão de 0,13mm, e uma acurada predição do posicionamento final do mini-implante no septo inter-radicular, contribuindo para um reduzido risco cirúrgico (IR<1). / OBJECTIVE This study evaluated the radiographic-surgical guide accuracy to predict post-surgical mini-implant positioning in the interradicular septum. Additionally, a risk index to standardize surgical procedure indication for mini-implant insertion was determined. MATERIAL AND METHODS A total of fifty-three titanium mini-implants were placed in the buccal interradicular septum of the posterior maxillary and/or mandibular region of 27 patients with a mean age of 19.17 ± 9.06 years (ranging from 12.72 to 56.37 years). The Graduated Radiographic-Surgical Guide (GRSG) was used to insert mini-implants in the interradicular septum in a centralized and equidistant position regarding adjacent tooth roots. The fifty-three post-surgical radiographs were used to measure the distances between mini-implants and adjacent tooth roots to evaluate GRSG accuracy in obtaining mini-implant centralized position in the septum. The GRSG inaccuracy degree was related to the septum width and the mini-implant diameter to obtain risk index formula, which was used to predict surgical risks during mini-implants insertion. RESULTS The GRSG inaccuracy degree showed that, on average, the mini-implants were 0.13mm (±0.13) displaced regarding the centralized position initially intended. The risk index (RI) presented a mean value smaller than 1, indicating a reduced surgical risk. CONCLUSION The link established between radiographic and surgical procedures propitiated a small GRSG inaccuracy degree of 0.13mm, allowing an accurate prediction of the final mini-implant positioning in the interradicular septum, which contributed to a low surgical risk (RI<1).

Made available in DSpace on 2014-06-11T19:22:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-15Bitstream added on 2014-06-13T19:48:21Z : No. of bitstreams: 1 ambrozin_arp_dr_botfm.pdf: 169682 bytes, checksum: e35521aad39da34ec6c55a5da6cd12ad (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Algumas variáveis propostas para predizer o risco de complicação pósoperatória (CPO) são a altura no teste da escada (TE) e a distância do teste de caminhada de seis minutos (TC6) e acreditamos que o tempo no teste da escada (tTE) também pode ser utilizado para este fim. Além disso, são utilizados a prova de função pulmonar e os índices pré-operatórios. Objetivo: Determinar se os índices de Torrington e Henderson, American Society of Anesthesiologists, Goldman, Detsky e Charlson, a variável VEF1 da espirometria e as variáveis obtidas nos testes de esforço (TC6 e TE) podem ser preditivos das complicações pós-toracotomia e qual deles seria o melhor preditor dessas complicações. Método: Foram avaliados pacientes com indicação de toracotomia para ressecção pulmonar ou não, maiores de 18 anos. As comorbidades foram obtidas e traçados os índices de Comorbidade de Charlson, de risco de Torrington e Henderson, de Goldman, de Detsky e o ASA. A espirometria foi realizada de acordo com a ATS, em espirômetro Medgraphics Pulmonary Function System 1070. O TC6 foi realizado segundo os critérios da ATS e a distância prevista calculada. O TE foi realizado numa escada à sombra, composta por seis lances, num total de 12,16m de altura. O tTE em segundos percorrido na subida da altura total foi obtido e a partir deste a Potência (P) foi calculada utilizando a fórmula clássica. Também foi estimado o VO2 a partir do tTE (VO2 t) e da P (VO2 P). No intra-operatório foram registradas as complicações e o tempo cirúrgico. E no pós-operatório foram registradas as CPOs. Para análise estatística os pacientes foram divididos em grupos sem e com CPO. Foi aplicado o teste de acurácia para obtenção dos valores preditivos para o TC6 e para o tTE, a curva ROC e dessa o ponto de corte. As variáveis foram testadas para uma possível associação com as CPO pelo teste t de... / Some varieties purposed to predict the postoperative complication (POC) risk are the height in the stair-climbing test (SCT) and the distance in the six minute walk test (6MWT), we also believe that the time on the stair-climbing test can also be used for this purpose. Besides, the pulmonary function test and the preoperative index are also used. Objectives: We aim to determine if the Charlson, Torrington and Henderson, Goldman, Detsky and American Society of Anesthesiologists indexes, the variable FEV1 obtained on the Spirometry and on the Cardiopulmonary Exercise Testing (6MWT, SCT) can be predictive of the complication after thoracic surgery and which one of them would be the best. Method: Patients with indication to thoracic surgery, for resection or not, and older than 18 years old were evaluated. The comorbidities were obtained and the Comorbidity Charlson, Torrington and Henderson risk, Goldman, the Detsky and ASA indexes were calculated. The spirometry was performed according to ATS in Medgraphics Pulmonary Function System 1070. The 6MWT was performed according to the ATS criteria and the predicted distance was calculated. The SCT was performed indoor, on six flights of stairs, which results as a 12,16m climb. The time on the SCT was obtained after finished the stair height total in seconds and the Power (P) was calculated using the class formula. The maximum oxygen uptake (VO2) was estimated from the time of SCT (VO2 t) and the P (VO2 P). In the intraoperative was registered the complication and the surgery time. And in the postoperative was registered the POC. In the statistics analysis, the patients were divided in groups with and without POC. It was applied the accuracy test for the distance 6MWT and for the time in the SCT. We have found the cutoff from the ROC curve. The correlation between the variables and POC were tested using the t test for independent population ... (Complete abstract click electronic access below)

Introdução. Apesar dos recentes e importantes avanços no tratamento das Doenças Cardiovasculares, a cirurgia cardíaca ainda pode ser a única opção de tratamento para alguns pacientes. Os pacientes que vivenciam sintomas de ansiedade e de depressão no pré-operatório podem sofrer influência destes na recuperação pós-operatória. Objetivos. Avaliar a relação dos sintomas de ansiedade e depressão pré-operatórios com as características sociodemográficas e clínicas e avaliar a relação desses sintomas com a presença de complicações no pós-operatório (PO), durante a permanência na Unidade de Terapia Intensiva (UTI), dos pacientes submetidos às cirurgias cardíacas eletivas. Método. Estudo observacional analítico, de coorte prospectiva, desenvolvido nas unidades de internação de clínica médica e clínica cirúrgica de um hospital universitário do interior paulista. A amostra do estudo foi constituída por pacientes submetidos à primeira cirurgia de revascularização do miocárdio (CRM) e à primeira cirurgia para correção de valvopatia, entre setembro de 2013 e setembro de 2015. A coleta de dados foi realizada por meio de entrevistas individuais e consulta aos prontuários. Para a avaliação dos sintomas de ansiedade e depressão, foi utilizado o instrumento Hospital Anxiety and Depression Scale (HADS), com a avaliação das respostas considerando o valor total de cada subescala (HADS-ansiedade e HADS depressão), variando de 0 - 21 (quanto maior o valor maior o transtorno emocional). Foram investigados complicações pulmonares, cardíacas, neurológicas, endócrinas, infecciosas, digestivas, sensoriais e o óbito. Para investigarmos a relação dos sintomas de ansiedade e depressão com as características sociodemográficas (sexo, idade, estado civil e situação profissional) e com a presença de complicações PO (sim/não), foi utilizado o teste de Mann Whitney. Para investigarmos a correlação dos sintomas com as características clínicas (tempos de internação pré-operatória, de cirurgia e de permanência na UTI), foi utilizado o teste de Correlação de Spearman. O nível de significância adotado foi de 0,05. Resultados. A amostra foi constituída por 145 pacientes, sendo 75 pacientes submetidos à CRM e 70 pacientes submetidos à cirurgia valvar. Entre os pacientes submetidos à CRM, a idade média encontrada foi de 61,8 anos, a maioria do sexo masculino (69,3%), e a principal complicação no PO foi a hiperglicemia (97,3%). As mulheres submetidas à CRM apresentaram maiores médias para os sintomas de ansiedade, quando comparadas com os homens. Pacientes submetidos à CRM, com maiores médias para os sintomas de ansiedade, apresentaram com maior frequência a instabilidade hemodinâmica no PO. Aqueles pacientes que apresentaram maior média para os sintomas de depressão apresentaram com maior frequência a náusea, a agitação, o déficit neurológico e permaneceram mais tempo entubados no PO. Entre os pacientes submetidos à cirurgia valvar, a idade média foi de 54,4 anos, maioria do sexo masculino (61,4%), e a principal complicação no PO foi a hiperglicemia (92,9%). As mulheres apresentaram maiores médias para os sintomas de depressão, quando comparadas com os homens. Pacientes submetidos à cirurgia valvar com maiores médias para os sintomas de depressão apresentaram com maior frequência a agitação no PO. Conclusão. Dos pacientes submetidos à CRM, encontramos relação dos sintomas de ansiedade pré-operatória com o sexo e com a presença de instabilidade hemodinâmica no PO, bem como dos sintomas de depressão com a ocorrência de náusea, agitação, presença de cânula orotraqueal (COT) por mais de 48 horas e déficit neurológico. Entre os pacientes submetidos à cirurgia valvar, encontramos relação dos sintomas de depressão com o sexo e com a agitação no PO / Introduction. Despite the recent and important advances in the treatment of Cardiovascular Diseases, cardiac surgery can still be the only treatment option for some patients. The patients who experience symptoms of anxiety and depression in the preoperative phase can be subject to the influence of these symptoms during the postoperative recovery. Objectives. Assess the relation between the preoperative anxiety and depression symptoms and the sociodemographic and clinical characteristics and the relation between these symptoms and the presence of postoperative (PO) complications while staying at the Intensive Care Unit (ICU) of patients submitted to elective cardiac surgeries. Method. Analytical and observational prospective cohort study, developed at the medical and surgical clinical inpatient units of a teaching hospital in the interior of the State of São Paulo. The study sample consisted of patients submitted to the first coronary artery bypass graft (CABG) surgery and the first valve correction surgery between September 2013 and September 2015. The data were collected through individual interviews and consultation of patient histories. To assess the anxiety and depression symptoms, the Hospital Anxiety and Depression Scale (HADS) was used. In the assessment of the answers, the total value of each subscale was used (HADS-anxiety and HADS-depression), ranging between 0 - 21 (the higher the score, the higher the emotional disorder). Pulmonary, cardiac, neurological, endocrine, infectious, digestive, sensory complications and death were investigated. To investigate the relation between the anxiety and depression symptoms and the sociodemographic characteristics (sex, age, marital status and professional situation) and the presence of postoperative complications (yes/no), the Mann-Whitney test was used. To investigate the correlation between the symptoms and the clinical characteristics (lengths of preoperative hospitalization, surgery and stay at the ICU), Spearman\'s correlation test was used. The significance level adopted was 0.05. Results. The sample consisted of 145 patients, being 75 patients submitted to CABG and 70 patients to valve surgery. Among the patients submitted to CABG, the mean age was 61.8 years; mostly male (69.3%), and the main PO complication was hyperglycemia (97.3%). The women submitted to CABG presented higher means for anxiety symptoms when compared to men. Patients submitted to CABG with higher averages for anxiety symptoms presented PO hemodynamic instability more frequently. Patients with higher mean scores for depressive symptoms most frequently presented nausea, agitation and neurological deficit and spent more time intubated during the PO. Among the patients submitted to valve surgery, the mean age was 54.4 years, mostly male (61.4%) and the main PO complication was hyperglycemia (92.9%). The women presented higher averages for depressive symptoms when compared to the men. Patients submitted to valve surgery with higher means for depressive symptoms most frequently presented PO agitation. Conclusion. Among the patients submitted to CABG, we found a relation between preoperative anxiety symptoms and sex and the presence of hemodynamic instability in the PO period, as well as between depressive symptoms and the occurrence of nausea, agitation, presence of endotracheal tube for more than 48 hours and neurological deficit. Among the patients submitted to valve surgery, we found a relation between depressive symptoms and sex and PO agitation

Despite increasingly sophisticated perioperative management, cardiovascular complications continue to be major challenges for the clinician. As a growing number of elderly patients with known coronary artery disease (CAD) or with risk factors for CAD are undergoing non-cardiac surgery, cardiovascular complications will remain a significant clinical problem in the future. The overall objective of this thesis was to study the incidence of myocardial damage and perioperative adverse cardiac events, to determine predictors of poor outcome and to assess the effect of a medical intervention in patients at risk undergoing non-cardiac surgery. The studies in this thesis were conducted on a total of 952 patients undergoing non-cardiac surgery. Studies I and IV were multicenter studies; whereas the patients included in studies II and III underwent non-cardiac surgery at Linkoping University Hospital, Sweden. The correlation between postoperative myocardial damage and short- and long-term outcome were studied in 546 patients, aged 70 years or older undergoing non-cardiac surgery of at least 30 minutes duration. This study showed a close correlation between postoperative myocardial damage and poor short- as well as long-term outcome. Elevated Troponin T was a strong independent predictor of mortality within one year of surgery. In 186 patients with ASA physical status classification III or IV undergoing non-elective surgery, the incidence of myocardial damage was 33%. In this study preoperative myocardial damage was an independent predictor of major adverse cardiac events in the postoperative period. In 69 patients with ASA physical status classification III &amp; IV undergoing acute hip surgery, we found a close correlation between elevated NT-proBNP value prior to surgery and cardiac complications in the postoperative period. To study the effect of acetylsalicylic acid on postoperative myocardial damage and cardiovascular events, 220 patients at risk were randomized to receive 75 mg of acetylsalicylic acid or placebo 7 days prior to surgery until the third postoperative day. This study showed that treatment with acetylsalicylic acid resulted in an 8% (95% CI 1-15%) absolute risk reduction of having a postoperative major adverse cardiac event. No statistically significant differences of bleeding complications were seen between the groups. In conclusion, this thesis contributes to the understanding of the clinical relevance of elevated cardiac markers (with or without clinical or ECG signs of myocardial damage) in patients undergoing elective or emergency surgery. Moreover, we have identified predictors of poor outcome in the perioperative period that could be used as tools for identifying patients at risk. Finally, we have shown that continuing acetylsalicylic acid in the perioperative period reduced the risk of major adverse cardiac events within 30 days of surgery.

Die vorliegende Arbeit beschäftigt sich mit der altersabhängigen Inzidenz und den Risikofaktoren für das Auftreten von lokalen Gefäßkomplikationen nach Herzkathetern über den femoralen Zugang. Diese sind die häufigsten Komplikationen nach Herzkatheteruntersuchungen überhaupt. Besonders berücksichtigt wurden multimorbide und sehr alte Patienten. Durch den demographischen Wandel und eine stetig wachsende Zahl an durchgeführten Herzkatheterprozeduren wird das Aufkommen solcher Patienten in der Zukunft weiter ansteigen. Der Zugang über die Leistengefäße stellt vielerorts noch immer den meistgenutzten dar. Frühere Studien konnten bereits diverse Risikofaktoren für das Auftreten von lokalen Gefäßkomplikationen nach Herzkathetern ermitteln, unter anderem hohes Alter und typische Alterskrankheiten. In den untersuchten teils sehr kleinen Kohorten wurden oft außerordentlich hohe Komplikationsraten ermittelt. Um zu verhindern, dass alten Patienten aus Sorge um mögliche Komplikationen potentiell lebensrettende invasive Maßnahmen vorenthalten werden, ist eine stetige Risikoevaluation notwendig. In dieser Studie wurden 42.628 Prozeduren bei Patienten, die am Herzzentrum Leipzig zwischen 2005 und 2009 einen diagnostischen Herzkatheter oder eine perkutane Koronarintervention (PCI) erhielten, ausgewertet. Ziel der Arbeit war es, die altersabhängigen Komplikationsraten sowie Prädiktoren für das Auftreten von Komplikationen zu ermitteln. Dazu wurden für drei Altersgruppen (Patienten unter 65, zwischen 65 und 79 sowie über 80 Jahre) jeweils prozedurale und klinische Parameter analysiert. Es wurde ein moderater Anstieg der Komplikationsraten festgestellt. Dies zeigt, dass Herzkatheter über einen Leistenzugang bis ins hohe Alter ein sicheres Verfahren sind. Die ermittelten Prädiktoren können einer klinischen Risikostratifizierung dienen.

Bakgrund: Perifer venkateter är ett vanligt förekommande ingrepp i modern sjukvård därför är det viktigt att vara medveten om vilka risker det innebär, och vad sjuksköterskan kan göra för att förhindra komplikationer. Det finns lagar och riktlinjer som sjuksköterskan ska hålla sig till för att ge en god vård. Syfte: Att beskriva effekter av sjuksköterskans handhavande av PVK hos patienterna inom slutenvården. Metod: En litteraturöversikt har genomförts där tio artiklar med kvantitativ ansats inkluderades, dessa analyserades med hjälp av Fribergs trestegs-modell. Resultat: Fem faktorer som påverkar sjuksköterskans handhavande framkom i resultatet: hygien, komplikationer, kunskap, PVKegenskaper/placering och tid. Dessa presenteras med hjälp av tabeller. Slutsats: Det visade tydligt hur viktig sjuksköterskans handhavande är då det är just sjuksköterskan som kan arbeta för att förhindra och förebygga komplikationer, bara genom att vara uppmärksam på sina patienter och vara medveten om sina egna attityder och egenskaper. Det behövs mer forskning inom området och det är högst aktuellt att fortsätta forska inom. / Background: Peripheral venous catheter [PVC] is a common occurrence in modern health care, therefore it is important to be aware of the risks it involves and what the nurse can do to prevent complications. There are laws and guidelines that the nurse should be aware of to provide a good care. Aim: The aim of this study is to show the effects of the nurse care of PVC in patients in hospital. Method: A literature review has been made where ten articles with quantitative assumptions were included, which were analyzed using the Friberg three-step model. Result: Five different factors affecting the nurse's operation were found in the results: hygiene, complications, knowledge, PVC characteristics / location and time. These are presented with the help of tables. Conclusion: It clearly showed how important the nurse’s handling is, since it is the nurse that can work to prevent and forestall complications, just by being observant with their patients and by being aware of their own attitudes and abilities. There´s not enough research in the field and it is highly relevant to continue researching within.

The goal of the work is to ensure a safe feeling for the patient in preoperative preparation so that it can cooperate more actively in the prevention of incontinence in the postoperative period. Another goal of the work is to create an educational material intended for patients with planned prostate surgery. The research was carried out by a qualitative method using questioning in the form of interviews. One group of patients was educated according to the custom of the department and the other group was edited using a brochure. When searching for the respondents, patients were approached by the patients of the Písek hospital. Data analysis was carried out by the hand-coded method, also referred to as the paper and pencil method. The results can be divided into four areas according to which research question they apply. The first part of the results provided information that if the patient is subjectively well informed, we will ensure active co-operation in the prevention of incontinence in the postoperative period. In the second question, we investigated whether the lack of information has an impact on the feeling of safety and security. This has also been confirmed. The third area gave the answer to whether the patient is satisfied if he feels time pressure during reception. The majority of men were unsatisfied with the time pressure. The fourth area assessed the suitability of education through a brochure and according to the practice of the department in the success of the preventive measure of postoperative incontinence. The men who used the brochure were aware of the possible complication and its prevention. The work provides a comprehensive view of the issue of education in prevention of incontinence after prostate surgery. The output of this work is an information brochure for patients of the urological ambulance. Results of the research are used to improve the educational process in patients coming for surgery of the prostate.

Abstract The thesis examines the role of a nurse in prevention and treatment of recurrent and chronic rhinitis and possible complications in children. Rhinitis belongs to the most frequent diseases with chronic course in the group of children and adolescents. The number of affected people, particularly among children living in towns and cities is still rising, so sufficient and suitable education of children and parents provided by nurses is very important. Four goals were set in this thesis. The first goal was to examine the role of a nurse in prevention of recurrent and chronic rhinitis. The second goal was to examine the role of a nurse in treatment of recurrent and chronic rhinitis. The third goal focused on examination of the complications nurses most frequently face. The fourth goal was to elaborate an educational standard for nurses working at paediatric wards of hospitals and in surgeries of practitioners for children and adolescents. Three hypotheses were linked to the goals. The first hypothesis assumed that nurses educated parents in prevention of recurrent and chronic rhinitis. The second hypothesis asked whether nurses educated parents and children in treatment and possible complications of recurrent and chronic rhinitis. The third hypothesis said that otitis media, sinusitis and conjunctivitis were the most frequent complications of recurrent and chronic rhinitis. Quantitative research performed by the questionnaire method was used to achieve the goals. An anonymous questionnaire was designed for nurses and parents. The questionnaire for nurses and parents contained 24 questions. 70 questionnaires were distributed among nurses from paediatric wards and 50 returned. The return was 71 %. 60 questionnaires were distributed among nurses in surgeries of practitioners for children and adolescents, 40 returned. The return was 66 %. 50 questionnaires were distributed among parents and 30 returned. The return was 60 %. The data collection was performed in March 2011. The research results showed that most of the nurses educate parents in prevention and treatment of recurrent and chronic rhinitis. The parents confirm the benefit of the education. They consider a talk with a nurse in a surgery the most suitable education form. Education by a nurse has strong influence on parents and children suffering from recurrent and chronic rhinitis. A nurse helps them learn and understand the disease, teaches them how to find a new lifestyle, informs them about prevention and provides information on treatment. We also found that no educational standard dealing with care about children suffering from recurrent and chronic rhinitis existed. We have elaborated the standard and provided it to nurses in surgeries of practitioners for children and adolescents and paediatric wards.